Family planning counseling by a health provider has the potential to help women understand and meet their desired sexual and reproductive health needs, including adopting and continuing contraception. As a key component of the quality of care, family planning counseling is critical to meeting the nuanced demands of the reproductive health rights of individuals and couples. It is also critical to evaluate the effect of health provider training on quality of care.
The quality of family planning counseling can be assessed by evaluating the observation of counseling on five specific items during the provider-client consultation. These items include instructions on how to use the contraceptive method, counseling on side effects, and whether the client should return to a clinic if side effects appear or persist. Multivariable logistic regression was used to identify the determinants of receiving quality family planning counseling, including factors related to the client, health provider, and facility.
The 2017-2018 Haiti Service Provision Assessment (SPA) survey was used to examine the quality of family planning counseling in Haiti. The survey included data from 756 public and private health facilities that provided family planning services by 3,495 health providers. Within these health facilities, 1,135 clients agreed to participate in the SPA client-provider observation and exit interviews. Among female clients, 85% were observed to have been provided, prescribed/counseled, or referred for an injectable or a pill prescription.
The analysis found that only 27% of clients who were prescribed and/or provided with an injectable or a pill prescription/method received quality family planning counseling. Facility characteristics, such as the type of facility and department, were found to be associated with the quality of family planning counseling received by clients. The odds of clients receiving quality family planning counseling were 2 times higher in women who visited clinics, both with and without beds, compared to clients who received family planning counseling in hospitals.
Provider characteristics, such as the type of provider and years of completed education, were also found to be associated with the quality of family planning counseling received by clients. The majority of health providers who provided quality counseling on injectable or pill use were nurses/midwives/other providers. However, there was no statistical difference in quality family planning counseling received and whether the health provider received recent family planning training.
Client characteristics, such as age, education, and new or returning client status, were also found to be associated with the quality of family planning counseling received by clients. Women with more education had a lower odds of receiving quality counseling, and returning clients had a lower odds of receiving quality counseling compared to new clients.
The analysis suggests potential provider bias based on the client’s education, and recommends further research and understanding of family planning provider training at various levels of the health system as well as type of facility in Haiti. Evaluating what health providers are being trained to counsel clients on across different types of contraceptive methods is essential.