Indicators of Full, Free, and Informed Choice and Rationale for Inclusion
| Indicator | Rationale | Denominator |
|---|---|---|
| 1. Received an FP method | Clients receiving FP is key to FFIC; however, a client not receiving a method does not necessarily demonstrate a lack of choice. A client may come for removal, other services, or choose not to adopt a method. | All women |
| 2. Reported being asked about reproductive intentions (when or whether a client wants more children) | Provider's knowledge of a client's desire to delay, space, or limit childbearing is important for recommending appropriate methods. | |
| 3. Reported discussing 3 or more methods with provider | Clients should be aware that they have options to select the method best suited for them. | |
| 4. Client given a chance to ask questions | Clients in any clinical setting should be given an opportunity to ask questions. | |
| 5. Obtained FP method of choice | Full choice and free choice are contingent on the client receiving her desired method. The reasons for not receiving the desired method include unavailability of the method, lack of a trained provider, cost, medical contraindication, or other. | Women who adopted an FP method |
| 6. Participated in FP decision making (client chose method by herself, jointly with the provider, or jointly with a partner) | Clients should have agency in choosing their method, either by themselves or together with the provider, with a partner, or with someone else. If the client reported that someone else made the decision for her, a lack of FFIC is indicated. | |
| 7. Counseled on method received | The client being given general information on the method received is key to being informed. | |
| 8. Counseled on benefits of method received | The client being told the benefits (e.g., effectiveness, health benefits) of the method received is key to being informed. | |
| 9. Counseled on side effects of method received | The client being told and understanding the side effects of the method received is key to being informed and can also prevent early discontinuation. | |
| 10. Told where to get implant/IUD removed | A client should know the effort required to have the LARC removed before she adopts it (e.g., long distance travel). | Women who adopted a LARC |
| 11. Told when to get implant/IUD removed | A client should know when to have the LARC removed. This is key to correct use and fulfilling reproductive intentions. | |
| 12. Told could have implant/IUD removed whenever she wanted | A client should know that she is free to discontinue use when desired. This is key to free choice. | |
| 13. Could correctly state the maximum duration of implant/IUD use | This indicator verified that clients understood the maximum duration of use. | |
| FFIC composite: Percentage of FP adopters who responded positively to indicators 3 through 9 | These 7 indicators represent the minimum threshold for a client to fully exercise FFIC. All 7 indicators had to have a positive response for this indicator to be satisfied. | Women who adopted an FP method |
| FFIC score: Average number of indicators 3 through 9 for which the response was positive (maximum score of 7) | The average provides a more nuanced view of the differences among service-delivery approaches. | |
| FFIC LARC composite: Percentage of LARC adopters who responded positively to indicators 3 through 13 | These 11 indicators represent the minimum threshold for a client to fully exercise FFIC when obtaining a LARC: all regular indicators of FFIC plus 4 specific to LARC. All 11 indicators had to have a positive response for this indicator to be satisfied. | Women who adopted a LARC |
| FFIC LARC score: Average number of indicators 3 through 13 for which the response was positive (maximum score of 11) | The average score provides a more nuanced view of the differences among service delivery approaches. |
Abbreviations: FFIC, full, free, and informed choice; FP, family planning; IUD, intrauterine device; LARC, long-acting reversible contraception.