Provider Selection of Evidence-Based Contraception Guidelines in Service Provision

This study from the Institute for Reproductive Health publication Evaluation & the Health Profession, March 2008 edition, presents simulated client data on the quality of oral contraceptive provision collected during the impact study for the Standard Days Method in India, Peru, and Rwanda.

The study explains the simulated client methodology to evaluate family planning counseling, discusses aspects of service delivery in India, Peru, and Rwanda, reviews the literature on service delivery guidelines, and examines barriers to prioritising the information given in family planning counseling. An outcome of the preparation is an appendix with prioritised items, per guideline category for family planning counselors.

The study found that out of a list of items to cover during family planning counseling, providers idiosyncratically select different areas to focus on during counseling. In India and Peru, providers focused on use instructions, while Rwandan providers focused on contraindications. According to the results of the simulation data, not even those guidelines deemed essential by the authors were addressed by a majority of providers. The authors conclude that it is likely that providers cannot remember the full set of guidelines during counseling, nor do they usually have time to cover everything in a brief counseling session. Moreover, providers have not been provided adequate guidance for which elements to focus on; thus, they select items to address based on personal preference rather than empirical evidence of their relevance to improving method use and continuation.


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