Postpartum Family Planning Service Provision in Durban, South Africa: Client and Provider Perspectives

Abstract

Researchers in sub-Saharan Africa have found health facility factors influence client contraceptive use. We sought to understand how client provider interactions, discussion of side effects and HIV status influence women’s contraceptive use post-partum. We conducted in-depth interviews with 8 HIV negative clients and 6 HIV positive clients in Zulu and with 5 nurses in English. Interviews were translated and transcribed into English. We created a codebook and coded all transcripts. Nurses and clients reported limited time to discuss contraception, side effects and HIV. Nurses did not comply with national contraceptive policies and created unnecessary barriers to contraceptive use.

What do we know about patient-provider interactions in Sub-Saharan Africa? a scoping review

“…We included nine studies in this scoping review ( Figure 1 ). The studies included were published between 2013 and 2018 in ten sub-Saharan African countries: Rwanda [ 7 ], Mali [ 14 ], South Africa [ 8 , 20 ], Ethiopia [ 16 ], Tanzania [ 13 , 15 ], Malawi [ 11 ], and one a multiple settings study (Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, Uganda) [ 21 ] ( Table 1 ). Eight studies were conducted in government health facilities and one in both government and NGO health facilities.…”

“…Six studies were qualitative, two used a mixed-method design [ 11 , 16 ], and one was a quantitative one [ 21 ]. Five studies explored the interaction between health providers and patients in HIV care [ 11 , 13 - 16 ], three in maternal care [ 8 , 11 , 13 ] one in family planning services [ 20 ], one in child health care [ 21 ] and one in adult primary health care [ 7 ].…”

“…Regarding health providers´ explanations to patients, a cross-sectional study which assessed health providers´ communication tasks with caregivers seeking care for their children in seven African countries, it reported that 54% of caregivers said they were informed of the child´s diagnosis and only 10% received counselling on feeding or providing liquids to the child [ 14 ]. Qualitative studies in a context of general [ 7 , 20 ] as well as HIV care [ 13 , 16 ] reported that patients were denied an explanation about their physical health, paramedical examination, diagnosis and treatment. A 32-year-old female HIV patient seeking family planning in South Africa reported [ 20 ]: [The nurse] asked if I chose pills or the injection, I said the injection for 3-months and she wrote it down, and I got the injection.…”

“…Qualitative studies in a context of general [ 7 , 20 ] as well as HIV care [ 13 , 16 ] reported that patients were denied an explanation about their physical health, paramedical examination, diagnosis and treatment. A 32-year-old female HIV patient seeking family planning in South Africa reported [ 20 ]: [The nurse] asked if I chose pills or the injection, I said the injection for 3-months and she wrote it down, and I got the injection. They don´t explain a lot of things; you just say the injection that you want or the pills that you want, that´s all.” [ 20 ].…”

Models of Postnatal Care for Low-Income Countries: A Review of the Literature Abstract

“…Family planning counselling is an aspect of the public health domain where midwives should have more involvement (Biro, 2011). However, the initiation of effective postpartum contraceptives is an issue that requires greater awareness by health professionals as well as parents, and it is an area where health professionals would benefit from an enhanced knowledge and training (Kestler, Orozco, Palma, & Flores, 2011;Marlow, Maman, Moodley, & Curtis, 2013). In order to support this, the WHO handbook for building skills (2013a) has summarised the required health providers' knowledge about family planning and the information to provide to parents.…”