Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda

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FIGURE 1
Flow Diagram of Participant Enrollment and Follow-Up
Note: Women who were lost to follow-up are indicated in the flow chart at the time they were last contacted, while those who discontinued between 2 rounds are shown in the former round.
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FIGURE 2
Distribution of Method Information Index Scores, by Country
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FIGURE 3
Cumulative Probability of Modern Method Continuation Among Women in Need, by MII Score (Binary) and Country
Abbreviation: MII, Method Information Index.
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FIGURE 4
Cumulative Probability of Modern Method Continuation Among Women in Need, by MII Score (Ordinal) and Country
Abbreviation: MII, Method Information Index.
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FIGURE 5
Cumulative Probability of Modern Method Continuation Among Women in Need, by MII Score (Binary) and Method Type Used at Baseline, by Country
Abbreviations: LARC, long-acting reversible contraceptive; MII, Method Information Index; STM, short-term.
Note: Model presented for new users aged 35–49 years.

TABLE 1.

Baseline Characteristics of Study Participants, by Country

	Pakistan (n=813) No. (%)	Uganda (n=1185) No. (%)
Age group, years
15–24	125 (15.4)	475 (40.1)
25–34	443 (54.5)	531 (44.8)
35–49	245 (30.1)	179 (15.1)
No. of prior live births
None	1 (0.1)	112 (9.5)
1	97 (11.9)	255 (21.5)
2–3	317 (39.0)	448 (37.8)
4–5	235 (28.9)	239 (20.2)
6 or more	163 (20.0)	131 (11.1)
Highest completed education
None (never went to school)	468 (57.6)	29 (2.4)
Primary	145 (17.8)	401 (33.8)
Secondary	151 (18.6)	595 (50.2)
Beyond secondary	49 (6.0)	160 (13.5)
Wealth quintile
1 (lowest)	54 (6.6)	21 (1.8)
2	126 (15.5)	46 (3.9)
3	210 (25.8)	43 (3.6)
4	228 (28.0)	180 (15.2)
5 (highest)	195 (24.0)	895 (75.5)
User type
First-time adopter	294 (36.2)	314 (26.5)
Lapsed user	42 (5.2)	177 (14.9)
Switcher	477 (58.7)	694 (58.6)
Type of method adopted at baseline
Intrauterine device	350 (43.1)	276 (23.3)
Implant	0 (0.0)	431 (36.4)
Injectable	199 (24.5)	335 (28.3)
Pill	149 (18.3)	122 (10.3)
Male condom^a	115 (14.2)	21 (1.8)

↵a Also includes 1 female condom user and 1 emergency contraceptive user in Uganda.

TABLE 2.

Risk of Modern Method Discontinuation While in Need, by Country, With MII as a Binary Variable

	Pakistan (N=810)				Uganda (N=1,054)
	Unadjusted HR (95% CI)	P Value	Adjusted HR (95% CI)	P Value	Unadjusted HR (95% CI)	P Value	Adjusted HR (95% CI)	P Value
MII Score
MII<3 (ref.)	–		–		–		–
MII=3	0.45 (0.28, 0.74)	.001	0.52 (0.32, 0.85)	.009	0.62 (0.35, 1.09)	.097	0.64 (0.35, 1.19)	.16
Type of Method Used at Baseline
LARC (ref.)
Short-acting method			1.75 (1.10, 2.80)	.02			7.67 (3.76, 15.63)	<.001
Age Group, years
35–49 (ref.)
15–24			1.43 (0.74, 2.75)	.28			2.06 (0.69, 6.13)	.19
25–34			1.56 (0.91, 2.68)	.11			2.52 (1.04, 6.13)	.04
Prior Contraceptive Use
First-time adopter (ref.)
Return user			0.73 (0.25, 2.12)	.56			1.86 (0.73, 4.74)	.19
Method switcher			0.63 (0.43, 0.91)	.02			1.09 (0.50, 2.39)	.83

Abbreviations: CI, confidence interval; HR, hazard ratio; LARC, long-acting reversible contraceptive; MII, Method Information Index.

TABLE 3.

Risk of Modern Method Discontinuation While in Need, by Country, With MII as an Ordinal Variable

	Pakistan (N=810)				Uganda (N=1,054)
	Unadjusted HR (95% CI)	P Value	Adjusted HR (95% CI)	P Value	Unadjusted HR (95% CI)	P Value	Adjusted HR (95% CI)	P Value
MII Score
0 (ref.)
1	0.73 (0.29, 1.82)	.50	0.73 (0.29, 1.84)	.51	0.25 (0.09, 0.74)	.01	0.32 (0.12, 0.83)	.02
2	0.35 (0.14, 0.90)	.03	0.48 (0.16, 1.42)	.18	0.06 (0.02, 0.22)	<.001	0.10 (0.03, 0.34)	<.001
3	0.28 (0.11, 0.70)	.007	0.35 (0.13, 0.95)	.04	0.14 (0.07, 0.29)	<.001	0.19 (0.08, 0.44)	<.001
Type of Method Used at Baseline
LARC (ref.)
Short-acting method			1.53 (0.86, 2.71)	.15			6.79 (3.41, 13.52)	<.001
Age Group, years
35–49 (ref.)
15–24			1.40 (0.73, 2.70)	.32			2.36 (0.78, 7.19)	.13
25–34			1.54 (0.90, 2.64)	.12			2.71 (1.05, 6.96)	.04
Prior Contraceptive Use
First-time adopter (ref.)
Return user			0.75 (0.26, 2.21)	.61			1.73 (0.64, 4.69)	.28
Method switcher			0.65 (0.44, 0.96)	.03			1.03 (0.47, 2.21)	.95

Abbreviations: CI, confidence interval; HR, hazard ratio; LARC, long-acting reversible contraceptive; MII, Method Information Index.

TABLE 4.

Risk of Modern Method Discontinuation While in Need, by MII Aspect (Question), by Country

MII Questions	Pakistan				Uganda
MII Questions	Unadjusted HR (95% CI)	P Value	Adjusted HR^a (95% CI)	P Value	Unadjusted HR (95% CI)	P Value	Adjusted HR^a (95% CI)	P Value
Informed about other methods (ref.=no)	0.74 (0.45, 1.21)	.23	0.89 (0.44, 1.82)	.75	0.27 (0.14, 0.50)	<.001	0.27 (0.13, 0.56)	<.001
Informed about side effects (ref.=no)	0.36 (0.24, 0.54)	<.001	0.58 (0.32, 1.07)	.08	0.61 (0.33, 1.14)	.12	1.74 (0.72, 4.22)	.22
Informed of what to do if experienced side effects (ref.=no)	0.36 (0.24, 0.54)	<.001	0.73 (0.41, 1.31)	.29	0.3 (0.16, 0.55)	<.001	0.45 (0.24, 0.85)	.01

Abbreviations: CI, confidence interval; HR, hazard ratio; MII, Method Information Index.
↵a Adjusted for participants' age, prior contraceptive use, and short-acting baseline method use. All 3 MII questions are included in the adjusted model.