TABLE.

Details of Articles Included in Scoping Review of Client-Provider Interaction During Counseling and Contraceptive Discontinuation

Authors and DateKey Finding Related to Contraceptive Discontinuation
Madden et al., 2013U.S. study examined discontinuation seen in clients in the contraceptive CHOICE project; however, counseling was not a variable in the analysis. The authors did not set out to examine the effects of their contraceptive counseling approach and therefore did not look at its effects on discontinuation.
Liu et al., 2013Higher quality of counseling, particularly measures of information provision, method choice, and interpersonal relations was associated with higher rates of continuation among DMPA-SC adopters in Nigeria.
Blanc et al., 2002Analysis of DHS data from 15 countries showed a large proportion of discontinuation while in need caused by poor quality of the service environment, this discontinuation has a substantial effect on fertility outcomes. Mixed evidence on the use of discontinuation as an outcome indicator for the quality of care. More evidence is needed to understand the relationship between counseling and discontinuation.
Koenig et al., 1997High quality of care was associated with a 72% higher likelihood of contraceptive discontinuation at up to 30 months in Bangladesh.
Sanogo et al., 2003Quality of care in Senegal at the time of family planning adoption was a significant determinant of whether a client would be using contraception over 1.5 years later.
Kim et al., 1998Analysis of counseling sessions in Kenya showed that contraceptive decision making and informed choice could be improved if providers took a more active role in counseling and related information provided to a client’s circumstances and needs.
Fruhauf et al., 2018From Burkina Faso, Ethiopia, Kenya, and Uganda, there was mixed evidence on the impact of quality (measured using a newly developed composite index) on contraceptive use. Discontinuation over time was not measured.
Chakraborty et al., 2019Higher scores on the 3-question Method Information Index—measuring client-reported receipt of contraceptive information—were associated with continued use of family planning over 12 months among clients in Pakistan and Uganda.
Dehlendorf et al., 2016U.S. study on quality of interpersonal care, particularly establishing rapport and eliciting the patient perspective measured using the Interpersonal Quality of Family Planning, influenced contraceptive use and continuation.
Dehlendorf et al., 2018U.S. study on Interpersonal Quality of Family Planning showed positive associations with satisfaction with counseling and with the chosen method.
Abdel-Tawab and RamaRao, 2010Inconsistent results showed observational evidence of a strong association between the client-provider interaction and continuation. However, evidence of interventions to improve counseling and impact continuation was not as strong.
Ramarao et al., 2003Quality of care at the time of service delivery was positively associated with continuation at follow-up in the Philippines.
Abdel-Tawab and Roter, 2002Analysis of counseling sessions in Egypt showed that client-centered counseling sessions, as opposed to provider-centered, were 3 times more likely to result in client satisfaction and method continuation at 7 months.
Jain et al., 2019Quality of care among contraceptive adopters in India was predictive of method continuation in that clients who were provided counseling that scored higher on a 10-item index of quality that included information exchange and interpersonal relations were 3 times more likely to continue using their chosen method after 3 months.
Cotton et al., 1992Women in Niger and the Gambia who reported they were not adequately counseled on side effects were more likely to discontinue their chosen method.
Nawar et al., 2004After intervention to improve counseling in Egypt, including supportive supervision for providers, improving the facility’s physical environment, and provider training, no effect was observed on discontinuation even though the client-provider interaction improved.
Leon et al., 2004After an intervention to improve counseling in Peru, including provider training in the use of the Balanced Counseling Strategy, uptake among the intervention group improved but there was no observed effect on discontinuation.
Jain et al., 2012Following an intervention to improve quality of care at the time of counseling in the Philippines, when the control and intervention groups were pooled, quality of care was found to be associated with discontinuation, but this effect was not seen when comparing between the control and intervention groups.
Modesto et al., 2014Findings showed no significant differences between the intensive and routine counseling (on side effects) groups in Brazil on the discontinuation rates due to unpredictable menstrual bleeding of the 3 contraceptives. The authors concluded that routine counseling may be sufficient for many women to help reduce premature discontinuation rates and improve continuation rates and user satisfaction among new users of long-acting reversible contraceptive methods.
Lunde et al., 2017Findings in the United States highlighted a need for better, anticipatory advising at the time of counseling that better prepared clients for side effects they may experience.
Villavicencio and Allen, 2016Reviews the importance of supporting clients in the United States to understand and manage contraceptive-induced bleeding changes and highlighted the evidence supporting better anticipatory counseling as a strategy to improve rates of continuation.
Goldhammer et al., 2018Women in Australia reported a desire for consistent and accurate contraceptive information and less bias from providers, regardless of age. Discontinuation was not evaluated.
Littlejohn and Kimport, 2017Findings explored the different ways that providers in the United States discussed side effects during contraceptive counseling and highlighted the importance of counseling clients on the medical uncertainty of contraceptive side effect experience.
Canto de Cetina et al., 2001Women in Mexico in the intervention group were provided with detailed pretreatment and ongoing counseling on common side effects of injectables and encouraged to return for follow-up visits, which was shown to lead to a higher likelihood of continuation.
Lei et al., 1996Women in China in the intervention group were provided with intensive structured pretreatment and ongoing counseling on common side effects of injectables and encouraged to return for follow-up visits, which was shown to lead to a higher likelihood of continuation.
Grimes and Schulz, 2011Authors asserted that counseling on side effects that was not optimistic may create a nocebo effect, whereby clients were more likely to report side effects.
Holt et al., 2018Women in Mexico reported a desire for privacy, confidentiality, informed choice, and respectful treatment. They also wanted clear, complete, and correct information during counseling. The authors also highlighted variations in counseling preferences among groups of different ages and educational statuses. Discontinuation was not evaluated.
Teshome et al., 2017In Ethiopia, among those counseled on family planning (n=139), women were significantly more likely to be satisfied with the family planning service they received if their provider discussed their partner's attitudes about family planning, and their own concerns about family planning. Discontinuation was not measured.
Donnelly et al., 2014Findings demonstrated the different counseling priorities between clients and providers in the United States, in particular the elements of counseling that clients rank as most important—“how does the method work to prevent pregnancy,” and “is it safe”—vs. the providers’ priorities of “how is it used” and “how often does a patient need to remember to use it.” No evaluation of discontinuation.
De la Vara-Salazar et al., 2018Analysis of provider surveys in Mexico demonstrated variations in the quality of counseling between urban and rural providers, with rural providers providing better counseling overall. Cultural barriers to quality counseling are also discussed.
Brittain et al., 2018Findings demonstrated that young people’s preferences during counseling and highlights elements of counseling that are barriers to quality care. Young people value confidentiality, supportive client-provider interactions, specialized provider training, and the removal of logistical barriers to family planning.
Gomez and Wapman, 2017Findings explored young U.S. Latinx and Black women’s perceptions of their counseling experience and highlight the implicit pressure they receive and bias they perceive from their providers. Clients reported feeling pressured to choose a particular method, or family planning in general, and rapidly discontinuing these methods following these poor counseling experiences.
Johnson et al., 2010Testing of the WHO decision-making tool in 3 countries showed that provider training in this tool resulted in better quality counseling overall, particularly regarding increased client participation, more tailored counseling, and better information exchange. Discontinuation was not evaluated.
Kim et al., 2005Provider training in Mexico on the WHO decision-making tool resulted in better quality counseling overall, particularly about information exchange, more tailored counseling, and client involvement in decision making. Discontinuation was not evaluated in this study.
Chin-Quee et al., 2007While clients in Nicaragua who were counseled by providers in the intervention group, those trained in the use of the WHO decision-making tool, reported an improved counseling experience, there was no significant difference between contraceptive use or discontinuation when compared to the control group.
Kim et al., 2003Clients in Indonesia who were part of the intervention were coached on how to ask questions, express concerns, and seek clarifications. Participants in this group participated more fully in counseling sessions, asked more questions, and articulated concerns. There was a marginally significant effect on discontinuation, with participants in this group being less likely to discontinue use of their method after 8 months.
Whittaker et al., 2015Study findings from the United States validated that the motivational interviewing technique could be effective with postabortion clients seeking family planning care.
Whittaker et al., 2016Twice as many clients in the United States in the intervention group initiated a family planning method following motivation interviewing-based counseling. This group was more likely to still be using their method when followed up at 3 months.
Dehlendorf et al., 2019After interaction with the My Birth Control app, clients in the United States in the intervention group rated their counseling session higher on measures of quality, but no effect was seen on contraceptive discontinuation.
Brandi and Fuentes, 2020The authors argued that the use of tiered effectiveness as a primary aspect of counseling has the potential to undermine patient autonomy and choice.
Stanback et al., 2015The authors advocated for the use of the tiered effectiveness tool to ensure clients are well informed about the effectiveness of their method options.
Marshall et al., 2017This was an evaluation of U.S. client perceptions of the Birth Control Navigator but not a study of health outcomes or discontinuation.
Blitzer et al., 2017This was not an evaluation of the Contraceptive Counseling and Care approach and did not explore discontinuation.
Holt et al., 2017This was not an evaluation of the Quality in Contraceptive Counseling approach and did not explore discontinuation.
Dehlendorf et al., 2014Review summarized best practices in counseling but did not directly address discontinuation. This was not an evaluation of these practices, but a review of the evidence for each best practice.
Hersh et al., 2018The authors sought to validate the feasibility of using a GATHER-based counseling video instead of conversational counseling in Colombia. Discontinuation was not evaluated.
Rinehart et al., 1998This was not an evaluation of the GATHER approach and did not explore discontinuation.
Callegari et al., 2017The authors reviewed the evidence and discussed potential pitfalls of the Reproductive Life Planning approach and suggested alternatives. This was not an evaluation and did not explore discontinuation.
Nelson et al., 2016Participants in this U.S. study often did not report well-defined reproductive health goals and the contraceptive methods they chose often did not align with their goals, so this highlighted the need for improved counseling.
Tyden et al., 2016At follow-up, women in Sweden in the intervention group had better knowledge about reproduction compared to the control group, and they wished to have their last child earlier in life than at baseline. Client perspectives on the counseling they received were also overwhelmingly positive. Discontinuation was not evaluated.
Mittal et al., 2014U.S. evaluation explored knowledge of contraception but did not explore contraceptive use and did not evaluate discontinuation.
Bommaraju et al., 2015U.S. evaluation explored contraceptive use but did not evaluate discontinuation.
Rademacher et al., 2018The NORMAL tool is a promising and evidence-based innovation for counseling on contraceptive-induced bleeding changes. No evaluations have yet assessed its effectiveness or impact on discontinuation.
Wyatt et al., 2014Review identified the necessity for decision aids to be evidence-based, evaluated, and created in collaboration with intended users to guarantee relevant attributes are included (though they admit this can be challenging, as counseling priorities are different among groups of clients and over one’s lifespan. The authors did not discuss discontinuation.

  • Abbreviations: DHS, Demographic and Health Survey; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; GATHER, Greet, Ask, Tell, Help, Explain, Return;

  • NORMAL, Normal, Opportunities, Return, Methods, Absence of Menses, and Limit; U.S., United States; WHO, World Health Organization.