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October 2003, Vol. 9, No. 3 Quality of Care Improving family planning services provided at health facilities can significantly increase contraceptive use and continuation rates, according to a recent study completed by Population Council researchers and their collaborators. “This is the first rigorous analysis that establishes a link between quality of care and contraceptive use,” write the authors of the study. Why investigate quality? At the same time, it seems intuitively likely that increased contraceptive choice, enhanced training for health care providers, and improved provider–client interactions in family planning facilities would result in more women being satisfied with their care and meeting their reproductive goals. This hypothesis is supported by some evidence but merits a more rigorous exploration. To this end, Population Council researchers Saumya RamaRao, Marilou Costello, and Heidi Jones collaborated with investigators from the Ateneo de Davao University in the Philippines. The researchers looked at 80 health facilities in the provinces of Davao del Norte and Compostela Valley, the Philippines. They interviewed 1,728 family planning users who had obtained services at these facilities between April and December 1997. More than 80 percent of the respondents were interviewed within six months of receiving care. Interviews took place between September 1997 and January 1998. Known as the Davao project, the investigation is one of four field studies being undertaken by the Population Council under the Impact Studies Program. The program is designed to document the feasibility of improving quality of care and the effect of improved quality on women’s reproductive behavior. It is directed by Anrudh Jain, Population Council senior director of policy and regional programs. Rating quality of care Subsequently, the clients were interviewed between May and August 1999 to obtain information on their contraceptive and reproductive behavior since the first round of interviews. By collecting information at two points in time, the researchers were able to assess the effect of quality of services on subsequent contraceptive use. At the time of follow-up, 75 percent of women said they currently used a contraceptive method, over two-thirds of them a modern method. Results from a cross-tabulation of quality and contraceptive use at follow-up indicated that use of a modern method was greater at the highest level of care than at the lowest level. Continuation of a modern method steadily increased as the level of quality increased. This trend continued to be statistically significant even after adjusting for other variables, such as respondents' education and income. "This is a noteworthy result," the authors write, "because previous analyses have indicated that the effect of quality of care tends to diminish with the addition of socioeconomic controls," such as education, employment, and wealth. Many ways of improving quality of care—such as training providers in interview techniques that show respect for the client—cost very little to implement and can have a substantial influence on clients' subsequent choices. Research findings, for example, have shown repeatedly that fearing and experiencing side effects are the main reasons women discontinue contraceptive use. "Our results suggest that providers can allay these legitimate fears if they are trained in ways of presenting information about contraceptives and responding to clients' concerns," says RamaRao. "Clients at family planning and reproductive health clinics deserve to receive high-quality care," says Jain. "This study provides additional justification for improving services." Source Outside funding See Also
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