Trend and determinants of quality of family planning counseling in Ethiopia: Evidence from repeated cross-sectional surveys of PMAs, (2014-2019)
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PLoS One. 2022 May 27;17(5):e0267944. doi: 10.1371/journal.pone.0267944. eCollection 2022.
INTRODUCTION: The modern contraceptive prevalence rate (mCPR) among married women increased almost fivefold in Ethiopia, from 8.1% in 2000 to 37% in 2019. Despite this increase, the receipt of contraceptive counseling from high quality, as measured by the percentage of contraceptive users who were told about alternative methods, counseled about side effects, and counseled on what to do in case they experience side effects, has declined in recent years years. The quality of family planning counseling service measured using these three components, known as the Methodological Information Index (MII), is an index designed to measure quality and a key indicator of the initiative. FP2020. The effects of potential client- and service-provider-level factors on the receipt of high-quality counseling and its evolution over time have not been well studied in Ethiopia.
METHODS: We pooled data from seven rounds of Performance Tracking for Action (PMA) surveys, formerly PMA2020, to examine the trend and effect of potential factors on obtaining advisory services in high quality family planning in Ethiopia. Data from a total of 15,597 women aged 15-49 from seven survey cycles were used in the analysis. To account for study design and unequal probabilities of selection among target populations for sampled women, design-based analysis was used to calculate proportions. A multilevel ordinal regression model with enumeration area as the second level was used to examine potential factors associated with quality of family planning counseling service.
RESULTS: We found that the percentage of women who received high-quality family planning counseling decreased from 39% (95% CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI %: 10%, 14%) nationally. The Amhara region had the lowest percentage of women receiving high-quality counseling in the first (2014) and last (2019) surveys (17% and 6%, respectively). The results show that lack of media exposure on family planning, lack of formal education, use of short-acting methods, and obtaining pharmacy service were the main factors associated with receiving poor quality family planning counseling.
CONCLUSIONS: Given the importance of the continued provision of information on the range of family planning methods, it is imperative to use the media and especially regional media that can effectively reach rural populations in the local languages as an important carrier of family planning information. Interventions to improve the quality of family planning counseling must take into account regional disparities in the severity of the problem to ensure equity in access to services. To improve coverage of high-quality family planning counseling services, there is an urgent need to review the format of family planning counseling services.