Client Perceptions of Quality and Choice at Static, Mobile Outreach, and Special Family Planning Day Services in 3 African Countries.

BACKGROUND: Use of long-acting reversible contraceptives (LARCs) has grown rapidly in the Democratic Republic of the Congo (DRC), Tanzania, and Uganda. Uptake of LARCs is particularly high during mobile outreach and special family planning day events. It is therefore important to examine client perceptions of and experiences with full, free, and informed choice (FFIC) in different service delivery modalities. METHODS: Between April and July 2015, we conducted a cross-sectional family planning client survey to assess FFIC and client satisfaction at static, mobile outreach, and special family planning day services in the DRC (n=9 sites), Tanzania (n=13), and Uganda (n=8). The study investigated clients' perceptions across 13 elements of FFIC, including measures of the quality of counseling and respondent satisfaction with services across the service delivery approaches. Composite FFIC scores were constructed and analyzed as the proportion of women who reported affirmatively to all elements and the mean score of positive responses. Satisfaction was assessed using a 4-point Likert scale. We used logistic regression to assess the association between the primary outcomes and mode of service delivery. RESULTS: In total, we interviewed 585 women (n=150 in Uganda, n=200 in Tanzania, and n=235 in the DRC). The large majority of clients in all countries and modalities received their method of choice. Clients of mobile outreach and special family planning days preferred LARCs and permanent methods, particularly implants, compared with clients at static services. Composite measures of FFIC were lower for mobile outreach than for static services in Tanzania among all family planning clients (odds ratio [OR]=0.5; P≤.001) and among LARC clients specifically (OR=0.5; P≤.01); no significant differences were found in the DRC or Uganda. A mean FFIC score among all family planning clients showed that clients in all modalities in all countries reported experiencing most elements of FFIC, with averages ranging from 4.8 to 6.1 of 7 elements. Among LARC clients specifically, mean scores ranged from 8.3 to 9.8 of 11 elements. Where greater proportions of clients experienced higher FFIC, greater proportions of clients also tended to report being "very satisfied" with aspects of services and counseling. CONCLUSIONS: The results underscore that special family planning days and mobile outreach services are important and viable ways to increase women's access to family planning services, notably to LARCs, but further attention to respecting and fulfilling clients' full, free, and informed choice across all service delivery modalities is required.

Quality and Cost Interventions During the Extended Perinatal Period to Increase Family Planning Use in Kinshasa, DRC: Results From an Initial Study.

BACKGROUND: Most women worldwide do not desire another pregnancy within a year after giving birth, but uptake of modern contraception during this time period is low. We independently tested 2 approaches to increasing contraceptive uptake and the 2 approaches combined using a quasi-experimental study design in Kinshasa, the Democratic Republic of the Congo. METHODS: The primary analytic data came from client exit interviews conducted post-intervention (N=563) from 4 study groups. The first arm (n=150) received free family planning, and the second arm (n=113) a quality inputs intervention involving systematic screening, referral, and immediate provision of long-acting reversible contraceptives (LARCs) after labor and delivery. The third arm (n=150) received a combination of the 2 interventions, and the fourth (n=150) no intervention. Family planning service statistics were also collected throughout the intervention period. RESULTS: Women in the quality arm (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.8 to 10.9) and free/quality arm (OR=6.7; 95% CI, 2.8 to 16.1) were more likely to be properly screened for family planning than women in the control group, but paper referral was seldom implemented in any group. Women in the free arm (OR=3.8; 95% CI, 1.6 to 9.0) and in the free/quality arm (OR=11.0; 95% CI, 4.3 to 27.9) were more likely than the control group to report being properly counseled on family planning. Clients were more likely to be modern contraceptive users (excluding condoms) in the free arm (OR=3.2; 95% CI, 1.4 to 7.2) and in the free/quality arm (OR=8.6; 95% CI, 3.9 to 19.0) than in the control group. Clients in all study arms were more likely to use a LARC compared with the control group (Quality arm: OR=2.9; 95% CI, 1.1 to 7.9. Free arm: OR=5.6; 95% CI, 2.3 to 13.7. Free/quality arm: OR=8.4; 95% CI, 3.4 to 20.6). Service statistics from the combined intervention arm showed that a significantly greater proportion of family planning adoption occurred within the immediate postpartum period (0 to 2 days) in the quality arm (P<.001) and free/quality arm (P<.001) than in the control arm. Quality inputs, free contraceptives, and the combined intervention had positive impacts on aspects of screening and contraceptive uptake. The combined intervention performed best by all measures. CONCLUSION: Providing family planning, including LARCs, in the immediate postpartum period, implementing a systematic screening and referral system, and providing free methods may improve family planning access and uptake in the extended perinatal period in this environment.