<p>Quality of Long-acting Reversible Contraception Provision in Lomé, Togo</p>

Abstract

Context: Provision of high-quality contraceptive counseling and services is essential to ensure family planning (FP) programs are rights-based and voluntary. Togo's modern contraceptive use has steadily increased with almost a quarter of the method mix attributed to longacting reversible contraceptives (LARC). The purpose of this study is to assess the quality of LARC provision in Togo. Methods: Data for this study were collected in 2016 as part of a larger research study conducted in Lomé, Togo to assess the effectiveness of the ongoing FP service delivery model. Quality of FP service was assessed in terms of program capacity and program performance. Program capacity was measured with five individual variables and program performance was measured with the Method Information Index (MII). Descriptive statistics and mixed effects models were used to assess likelihood of LARC uptake. Results: Of the 669 clients included in the study, 19.4% received a LARC method. Multivariable results show that LARC uptake is significantly associated with supervisory visit at the facility in the last three months (program capacity indicator) (OR 1.44; 95%CI 1.48-2.39) and is twice as likely for those with a positive MII score, even after controlling for provider and client characteristics (OR 2.1; 95%CI 1.61-2.51). Conclusion: This study identified supervisory visits and comprehensive contraceptive counseling as the key quality factors positively associated with uptake of LARC. Continued focus on quality of care and provider-client information exchange is necessary to ensure women's FP needs are met.

A qualitative exploration of how a community engagement approach influences community and health worker perceptions related to family planning service delivery in Togo

“…For example, one study found that youth post-abortion care clients were more likely to choose a contraceptive method if the provider was trained in offering youth-friendly post-abortion care ( 5 ). A lack of basic items at the facility such as trained staff, equipment and commodities were also associated with low contraceptive uptake ( 6 ) while having health workers benefit from a supervisory visit at health facilities was associated with client uptake of long-acting reversible contraceptives in Togo ( 7 ).…”

Improving provider and client communication around family planning in Togo: Results from a cross-sectional survey

“…Another increasingly used measure of quality provider-client communication is the validated three item method information index (MII) or the four item MIIplus, which assess the extent to which information about FP methods is communicated to clients [7,8]. The MII and MIIplus have been found to be positively associated with better FP continuation in Pakistan and India and the MII has also been found to be positively associated with voluntary use of long-acting reversible contraception (LARC) [7,[9][10][11][12].…”

Do users of long-acting reversible contraceptives receive the same counseling content as other modern method users? A cross-sectional, multi-country analysis of women's experiences with the Method Information Index in six sub-Saharan African countries

“…Despite its wide adoption by researchers and policy makers to evaluate the success of family planning programs, including FP2020 [23] , some scholars have questioned the validity of the measure, noting that it may overestimate the information exchanged between patients and providers during counseling [24] . Additionally, while the MII was designed to measure information given to clients during counseling, it has been routinely adopted as a proxy for the full spectrum of informed choice or for the construct of quality of care writ large [25] , [26] , [27] , [28] . This may be problematic given that the MII does not include items to capture information on correct method use, warning signs, or the range of methods presented to the client, among other elements important to informed decision-making.…”