Figures & Tables
Figures
Clients of mobile outreach services in Tanzania listen to a group family planning counseling session. © 2015 Sala Lewis/EngenderHealth
A family planning provider in Tanzania counsels a client of mobile outreach services on IUDs. © 2015 Sala Lewis/EngenderHealth
Tables
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.
DRC (N=235)a Tanzania (N=200) Uganda (N=150) Static n=55 Outreach n=120 FP Day n=60 Static n=100 Outreach n=100 Static n=90 Outreach n=60 Age Age, years, mean 29.2 26.9*b 28.9*c 27.6 28.8 26.9 27.9 Age, years, range 19–49 17–45 18–44 18–49 17–46 17–47 17–41 Age groups, years, % 15–19 1.8 11.% 5.0 5.0 11.0 11.1 5.0 20–24 25.5 30.0 18.3 41.0 26.0 28.9 23.2 25–29 29.1 22.5 35.0 17.0 19.0 26.7 33.3 30–34 16.4 24.2 23.3 19.0 13.0 16.7 23.3 35–39 23.6 9.2 10.0 8.0 20.0 14.4 11.7 ≥40 3.6 2.5 8.3 10.0 11.0 2.2 3.3 Marital Status Married or in union, % 81.8 68.3 81.7 84.0 82.0 80.0 93.3* No. of Children No. of children, mean 3.8 4.1 4.1 2.8 3.4 3.3 4.1* No. of children, range 1–10 0–10 1–9 0–11 0–11 0–9 0–11 No. of children, distribution, % 0–3 49.1 44.2 38.3 76.0 62.0* 54.3 43.3 >3 50.9 55.8 61.7 24.0 38.0* 45.6 56.7 Education Received at least some secondary education, % 83.6 75.0 75.0 25.0% 15.0 31.1 25.0 Read some/all sample sentence,e % 83.3 60.8**b 63.3*d 85.0 83.0 80.0 75.0 Socioeconomic Status Owns a mobile phone, % 74.6 46.7***b 56.7*d 59.0 38.0** 63.3 58.3 Has electricity, % 87.3 82.5 63.3**c,d 26.0 24.0 30.0 25.0 Occupationf Housewife/not working, % 27.3 40.8 41.7 16.0 12.0 18.9 13.3 Farmer, % 1.8 2.5 3.3 59.0 82.0*** 55.6 65.0 Trader/business owner, % 47.3 43.3 43.3 15.0 2.0*** 20.0 15.0 Contraceptive History Ever used modern FP, % 81.8 66.7*b 65.0*d 91.0 90.0 98.9 100.0 Ever used non-condom modern FP, % 74.6 46.7***b 51.7*d 83.0 84.0 88.9 96.7 Ever used LA/PM, % 5.5 2.5 3.3 33.0 36.0 25.6 15.0 Method Preferences Had a preference for implant, % 58.2 86.7***b 85.0***d 41.0 55.0 25.6 51.7*** Had a preference for LA/PM, % 58.2 86.7***b 88.3***d 47.0 62.0* 28.9 53.3** Had a preference for short-acting method, % 29.1 2.5***b 6.7**d 37.0 20.0** 63.3 33.3*** Fertility Desires Wants no more children, % 34.6 41.7 30.0 14.0 32.0** 25.6 41.7* Wants child 2 or more years, % 49.1 40.0 50.0 67.0 55.0 44.4 38.3 Doesn't know when or if want more, % 9.1 10.0 16.7 14.0 3.0 5.6 6.7 Abbreviations: DRC, Democratic Republic of the Congo; FP, family planning; LA/PM, long-acting or permanent method.
↵a One-way analyses of statistical significance were conducted between mobile outreach and static services; special family planning days and static services; and special family planning days and mobile outreach.
↵b Difference between mobile outreach and static services was statistically significant.
↵c Difference between special family planning days and mobile outreach was statistically significant.
↵d Difference between special family planning days and static services was statistically significant.
↵e Women who were visually impaired or who did not read the language on the card (n=5) were excluded.
↵f Only the 3 most common occupations overall are listed, so categories do not add up to 100%.
↵* P≤.05;
↵** P≤.01;
↵*** P≤.001
- TABLE 3.
Primary Family Planning Method Received, by Country and Service Delivery Approach
Method DRC (N=235)a Tanzania (N=200) Uganda (N=150) Static (%) n=55 Outreach (%) n=120 FP Day (%) n=60 Static (%) n=100 Outreach (%) n=100 Static (%) n=90 Outreach (%) n=60 No method 5.5 2.5 0.0 6.0 9.0 8.9 18.3 Condom 0.0 0.0 0.0 3.0 1.0 2.2 0.0 Pill 1.8 0.0 0.0 13.0 9.0 11.1 11.7 Injectable 29.1 3.3***b 1.7***c 24.0 8.0** 51.1 23.3** Implant 63.4 94.2***b 96.7***c 46.0 64.0** 24.4 43.3* IUD 0.0 0.0 1.7 8.0 4.0 2.2 3.3 Tubal ligation 0.0 0.0 0.0 0.0 5.0* 0.0 0.0 Abbreviations: DRC, Democratic Republic of the Congo; FP, family planning; IUD, intrauterine device.
↵* P≤.05;
↵** P≤.01;
↵*** P≤.001.
↵a One-way analyses of statistical significance were conducted between mobile outreach and static services, special family planning days and static services, and family planning days and mobile outreach.
↵b Difference between mobile outreach and static services was statistically significant.
↵c Difference between special family planning days and static services was statistically significant.
- TABLE 4.
Measures of the Association of Service Delivery Approach With Elements of FFIC, by Country
Outcome DRC (N=235) Tanzania (N=200) Uganda (N=150) Static (n=55) % Outreach/Special FP Day (n=180) % OR (95% CI)a or P Valueb Static (n=100) % Outreach (n=100) % OR (95% CI)a Static (n=90) % Outreach (n=60) % OR (95% CI)aor P Valueb All women 1. Obtained a method 94.6 98.3 3.4 (0.4,27.9) 94.0 91.0 0.6 (0.1,5.9) 91.1 81.7 0.4 (0.1,2.3) 2. Reported being asked about reproductive intentions 80.0 59.4 0.4 (0.1,2.7) 94.0 75.0 0.2 (0.1,0.7)** 64.4 55.0 0.7 (0.4,1.3) 3. Reported discussing three or more methods with provider 65.5 78.3 1.9 (0.4,10.1) 90.0 81.0 0.5 (0.2,1.1) 26.7 41.7 2.0 (0.3,12.5) 4. Given a chance to ask questions 61.8 48.3 0.6 (0.1,2.4) 72.0 70.0 0.9 (0.7,1.2) 75.6 96.7 9.4 (0.8,115.2) Women who adopted an FP method n=52 n=177 n=94 n=91 n=82 n=49 5. Obtained FP method of choice 100.0 98.3 NA 92.6 96.7 2.4 (0.2,24.7) 97.6 95.9 0.6 (0.1,2.6) 6. Participated in FP decision making 96.2 74.0 0.1 (0.0,0.4)*** 97.9 87.9 0.2 (0.0,2.3) 92.7 89.8 0.7 (0.4,1.4) 7. Counseled on method received 80.8 83.6 1.2 (0.2,8.7) 93.6 87.9 0.5 (0.4,0.6)*** 39.0 42.9 1.2 (0.2,6.1) 8. Counseled on benefits of method received 69.2 75.1 1.4 (0.3,6.6) 84.0 78.0 0.7 (0.4,1.1) 76.8 85.7 1.8 (0.6,5.4) 9. Counseled on side effects of method received 69.2 62.7 0.7 (0.2,3.2) 75.5 58.2 0.5 (0.2,1.1) 63.4 65.3 1.1 (0.6,1.9) FFIC composite: Percentage of women who adopted an FP method responding positively to ALL indicators 3 through 9 48.1 19.2 0.3 (0.1,1.3) 48.9 31.9 0.5 (0.4,0.7)*** 22.0 20.4 0.9 (0.1,5.6) Women who adopted a LARC n=35 n=172 n=54 n=68 n=24 n=28 10. Told where to get implant/IUD removed 74.3 70.4 0.8 (0.2,3.8) 96.2 79.1 0.1 (0.1,0.2)*** 79.2 92.9 3.4 (1.4,10.2)* 11. Told when to get implant/IUD removed 85.7 81.4 0.7 (0.1,4.3) 98.1 89.4 0.2 (0.0,2.6) 91.7 96.4 2.5 (1.4,4.2)*** 12. Told could have implant/IUD removed whenever wanted 77.1 76.7 1.0 (0.1,6.7) 84.9 68.7 0.4 (0.1,1.3) 83.3 96.4 5.4 (0.6,51.6) 13. Could correctly state when implant or IUD would expire 85.7 80.8 0.7 (0.1,4.1) 88.9 86.8 0.8 (0.5,1.4) 91.7 92.9 1.2 (0.6,2.2) FFIC LARC composite: Percentage of women who adopted a LARC responding positively to ALL indicators 3 through 13 37.1 15.7 0.3 (0.1,1.8) 40.7 26.4 0.5 (0.3,0.8)** 20.8 17.9 0.8 (0.1,5.1) FFIC mean score FFIC mean score: Average number of indicators 3 through 9 for which response was positive (highest possible score = 7) among women who adopted an FP method 5.5 5.2 .23 6.1 5.6 .02* 4.8 5.1 .15 FFIC mean LARC score: Average number of indicators 3 through 13 for which response was positive (highest possible score = 11) among women who adopted a LARC 8.5 8.3 .70 9.8 8.7 .002** 8.3 8.6 .33 Abbreviations: CI, confidence interval; DRC, Democratic Republic of the Congo; FFIC, full, free, and informed choice; FP, family planning; IUD, intrauterine device; LARC, long-acting reversible contraception; OR, odds ratio.
↵* P≤.05;
↵** P≤.01;
↵*** P≤.001.
↵a Error estimates are adjusted for clustering by facility.
↵b P values are reported for the FFIC mean scores at the end of the table.
- TABLE 5.
Proportion of Clients Reporting Being “Very Satisfied” With Aspects of Services, by Country and Service Delivery Modality
DRC (N=235) Tanzania (N=200) Uganda (N=150) Static (n=55) % Outreach/SpecialFP Day (n=180) % OR (95% CI)a Static (n=100) % Outreach (n=100) % OR (95% CI)a Static (n=90) % Outreach (n=60) % OR (95% CI)a Amount of time waited to see a provider 69.1 32.2 0.2 (0.1, 0.8)* 94.0 84.0 0.3 (0.1, 0.8)* 27.8 66.7 5.2 (2.3, 12.0)*** Privacy of your consultation with the provider 78.2 42.2 0.2 (0.0, 1.1) 94.0 91.0 0.6 (0.0, 0.8)*** 72.2 95.0 7.3 (1.6, 33.3)* The cleanliness of the facility 65.5 25.0 0.2 (0.0, 1.2) 85.0 81.0 0.8 (0.2, 2.4) 41.1 61.7 2.3 (0.7, 8.0) The amount of FP information you were given 65.5 27.8 0.2 (0.0, 0.8)* 88.0 85.0 0.8 (0.2, 2.6) 56.7 73.3 2.1 (1.2, 3.7)** The opportunity to ask questions 45.5 16.9 0.2 (0.1, 0.7)** 87.0 80.0 0.6 (0.2, 1.7) 71.1 95.0 7.7 (1.9, 31.0)** The quality of the FP counseling you received 61.1 33.9 0.3 (0.1, 1.3) 91.0 85.0 0.6 (0.3, 1.1) 46.7 68.3 2.5 (1.4, 4.3)** The way you were treated by staff 87.3 43.3 0.1 (0.0, 0.4)*** 95.0 88.0 0.4 (0.2, 0.7)** 67.8 86.7 3.1 (1.2, 8.3)* The way you were treated by the provider 89.1 43.3 0.1 (0.0, 0.7)* 95.0 88.0 0.4 (0.1, 1.5) 87.8 98.3 8.2 (0.7, 88.9) Overall satisfaction with services 79.6 40.6 0.2 (0.0, 2.0) 96.0 89.0 0.3 (0.2, 0.6) 78.9 91.7 2.9 (0.7, 11.8)
