%0 Journal Article %A Karen T. Chang %A Nirali M. Chakraborty %A Amanda M. Kalamar %A Waqas Hameed %A Ben Bellows %A Karen A Grépin %A Agha Xaher Gul %A Sarah E.K. Bradley %A Lynn M. Atuyambe %A Dominic Montagu %T Measuring Service Quality and Assessing Its Relationship to Contraceptive Discontinuation: A Prospective Cohort Study in Pakistan and Uganda %D 2020 %R 10.9745/GHSP-D-20-00105 %J Global Health: Science and Practice %X Key FindingDespite extensive coverage across structural and process domains, social franchises found that facility-level family planning quality metrics were nonstandard and lacked consistent associations with contraceptive discontinuation.Key ImplicationsResearchers should seek to harmonize and simplify family planning quality measurement tools to enable routine facility-level monitoring in lower-resource clinics and community settings.Policy makers should consider the value of comparable and generalizable metrics for benchmarking performance of family planning programming and contributions to population well-being.Program managers should consider assessing facility-level quality of care by monitoring data that are simple to both collect and analyze and that are shown to be associated with reproductive health outcomes, including voluntary contraceptive continuation rates. Background:The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality measures based on these tools were consistently associated with contraceptive discontinuation.Methods:We linked existing, routinely collected facility audit data from social franchise clinics in Pakistan and Uganda with client data. Clients were women aged 15–49 who initiated a modern, reversible contraceptive method from a sampled clinic. Consented participants completed an exit interview and were contacted 3, 6, and 12 months later. We collapsed indicators into quality domains using theory-based categorization, created summative quality domain scores, and used Cox proportional hazards models to estimate the relationship between these quality domains and discontinuation while in need of contraception.Results:The 12-month all-modern method discontinuation rate was 12.5% among the 813 enrolled women in Pakistan and 5.1% among the 1,185 women in Uganda. We did not observe similar associations between facility-level quality measures and discontinuation across these 2 settings. In Pakistan, an increase in the structural privacy domain was associated with a 60% lower risk of discontinuation, adjusting for age and baseline method (P<.001). In Uganda, an increase in the management support domain was associated with a 33% reduction in discontinuation risk, controlling for age and baseline method (P=.005).Conclusions:We were not able to leverage existing, widely used quality measurement tools to create quality domains that were consistently associated with discontinuation in 2 study settings. Given the importance of contraceptive service quality and recent advances in indicator standardization in other areas, we recommend further effort to harmonize and simplify measurement tools to measure and improve contraceptive quality of care for all. %U https://www.ghspjournal.org/content/ghsp/early/2020/08/17/GHSP-D-20-00105.full.pdf