Improving Quality of Care in Family Planning
Population Council researcher Anrudh K. Jain provided some of the first empirical evidence for the relationship between family planning method choice as an aspect of service quality and the prevalence of contraceptive use. Since then, several studies have demonstrated that improving the quality of reproductive health services increases contraceptive use.
Population Council policy analyst Judith Bruce expanded upon Jain's observations. Bruce maintained that family planning is a vital social investment and an essential aspect of development, independent of a country's demographic interests. She also contended that when the quality of family planning services is improved, more women would become committed and satisfied users, with clear demographic benefits. These outcomes would include a healthier and more empowered female population. Improving the quality of family planning services would also help a country meet its distinct but important goal of slowing population growth.
To make these good intentions a programmatic reality, Bruce developed the family planning quality of care framework, which motivated widespread reassessment of how family planning services could be improved.
The Paradigm Shift
Bruce detailed six "salient elements of family planning programs that together constitute quality":
1. Choice of methods: "Choice is not only the first, but the fundamental element of providing quality in services," wrote Bruce. Clients' needs and preferences change over time; having the ability to switch methods when women desire is a foundation for satisfied and sustained use of family planning. The spectrum of methods offered must have sufficient diversity to meet the varying needs of clients.
2. Information given to clients: "There persists poor knowledge of the proper use, risks, and benefits of contraceptives," wrote Bruce. Providers often do not inquire about clients' intentions and health and fail to offer information necessary to help users select and practice contraception effectively.
3. Technical competence: "Clients bear the consequences of poor technique in the form of unnecessary pain, infection, other serious side effects, and in some circumstances, death," Bruce wrote.
4. Interpersonal relations: It is often assumed that providers can't be taught better interpersonal relations. However, they can, Bruce maintained. And, "for many clients," Bruce wrote, "being treated badly is worse than receiving no care at all." Providers must recognize and address all of the personal dimensions of service, including sensitivity and respect.
5. Mechanisms to encourage continuity of care: The broad objective of encouraging continuity of care is to ensure that after the first contact with a family planning provider, the trail does not end. …