TY - JOUR T1 - Evaluating Counseling for Choice in Malawi: A Client-Centered Approach to Contraceptive Counseling JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-22-00319 VL - 11 IS - 2 SP - e2200319 AU - Amanda Kalamar AU - Kendal Danna AU - Alexandra Angel AU - Claire W. Rothschild AU - Innocent Meja AU - Eva Lathrop AU - Philip Mkandawire Y1 - 2023/04/28 UR - http://www.ghspjournal.org/content/11/2/e2200319.abstract N2 - Key FindingsCounseling for Choice (C4C) addresses the interpersonal relations domain of quality of care by anchoring the counseling approach in the core elements of respect, dignity, and empathy and in care that is nondiscriminatory and responsive to unique client needs.Women counseled by providers trained in the C4C approach rated their experience more positively against all 4 person-centered contraceptive counseling measures.Women counseled by C4C-trained providers rated their providers higher on several quality dimensions, including provision of information to make an informed decision, respectful care, and counseling on side effects.Key ImplicationClient-centered counseling approaches that structure information provision and interpersonal care based on clients’ priorities and that provide enhanced anticipatory side effects counseling are a promising strategy for improving the quality of counseling and supporting informed and autonomous contraceptive decision-making globally.Introduction:High-quality contraceptive counseling is critical for supporting full, free, and informed contraceptive decision-making. However, the quality of family planning counseling remains poor globally and is too often not tailored to the individual client. The Counseling for Choice (C4C) approach comprises provider tools and training to structure counseling to center clients’ self-identified priorities and to provide relevant information and anticipatory side effects counseling.Methods:Providers at 25 public and 20 private facilities in Malawi were trained in the C4C approach. Between October and December 2018, we enrolled women seeking contraceptive services in intervention facilities and in matched comparison clinics in a quasi-experimental study. We collected data immediately before and after contraceptive services were received. We used multilevel logistic regression to compare dimensions of women’s counseling experience.Results:Of 1,179 participants, women counseled by C4C-trained providers rated their providers higher on several quality dimensions, including enabling informed decision-making (11.1% of the comparison group rated their provider as excellent versus 34.4% in intervention), respectful care (35.0% comparison versus 51.3% intervention), and information given about side effects (38.1% comparison versus 72.5% intervention).Conclusion:In Malawi, C4C improved the quality of care that clients received and their client experience relative to standard counseling. Counseling approaches that center clients’ priorities and provide enhanced anticipatory side effects counseling show promise in improving contraceptive counseling experiences and the quality of care that clients receive. ER -