Provider verbal disrespect in the provision of family planning in public-sector facilities in Western Kenya

Tumlinson, Katherine; Britton, Laura E.; Williams, Caitlin R.; Wambua, Debborah Muthoki; Onyango, Dickens; Senderowicz, Leigh

doi:10.1016/j.ssmqr.2022.100178

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…Similar to previous evidence, 47 unexpected traits of healthcare professionals, such as an unwelcoming and discriminatory approach, coercing women into using contraceptives against their will, and refusing to change or remove methods, were reasons for unintended pregnancy. Likewise, counselling women while they are in labour, prescribing contraceptives without providing enough information about the method’s side effects and how to manage them, and failing to listen to women’s concerns during counselling, were the reasons given for unintended pregnancy following no or inconsistent and/or improper use of contraceptives.…”

Section: Discussionsupporting

confidence: 74%

Reasons and prevention strategies of unintended pregnancy in Addis Ababa, Ethiopia: a phenomenological qualitative study

Yalew¹,

Olayemi²,

Yalew³

2023

BMJ Open

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ObjectivesTo explore the reasons for unintended pregnancy and effective prevention measures from the perspectives of women and healthcare providers in Addis Ababa, Ethiopia.DesignPhenomenological qualitative study.Setting and participantsThis study was conducted at three public health facilities found in Addis Ababa, Ethiopia. Women with unintended pregnancies and healthcare providers currently working in maternal health services were purposively recruited for in-depth interviews. Twenty in-depth interviews were conducted until data saturation was achieved. Data were analysed using thematic analysis.ResultsSeven themes emerged from the transcribed interview data. These include: Personal characteristics (negligence; lower pregnancy expectation), family influence (fear of family), sociocultural and economic influence (stigma and discrimination), healthcare provider influence (disrespectful and abusive approach; disregard for women’s contraceptive choice), preconception thoughts and behaviours (unprotected early sexual practice; myths and misunderstanding), lack of access to quality family planning services (lack of trained contraceptive counsellor, inappropriate contraceptive use), and preventive strategies for unintended pregnancy (comprehensive sexual education; sexual and reproductive health and rights service integration)ConclusionsThis study identified multilevel reasons for unintended pregnancy from the perspective of the participants. Participants shared their views on preventive measures for unintended pregnancy, including comprehensive sexual education, service integration and male-inclusive contraceptive counselling. This study highlights the need to improve sexual and reproductive health services by shedding light on the viewpoints and experiences of women and healthcare providers.

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Section: Discussionsupporting

confidence: 74%

Reasons and prevention strategies of unintended pregnancy in Addis Ababa, Ethiopia: a phenomenological qualitative study

Yalew¹,

Olayemi²,

Yalew³

2023

BMJ Open

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“…Studies in LMICs show that women face barriers to the removal of long-acting methods, including a lack of trained providers, provider unwillingness to remove methods, or unaffordable fees for removal. 45 , 46 Thus, emphasis on informed and free choice is particularly important for women adopting long-acting, provider-dependent methods such as the IUD.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of non-preferred family planning methods among reproductive-aged women in Burkina Faso: results from a cross-sectional, population-based study

Bullington

Sawadogo

Tumlinson

et al. 2023

Sexual and Reproductive Health Matters

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Family planning researchers have traditionally focused efforts on understanding contraceptive non-use and promoting contraceptive uptake. Recently, however, more scholars have been exploring method dissatisfaction, questioning the assumption that contraceptive users necessarily have their needs met. Here, we introduce the concept of “non-preferred method use”, which we define as the use of one contraceptive method while having the desire to use a different method. Non-preferred method use reflects barriers to contraceptive autonomy and may contribute to method discontinuation. We use survey data collected from 2017 to 2018 to better understand non-preferred contraceptive method use among 1210 reproductive-aged family planning users in Burkina Faso. We operationalise non-preferred method use as both (1) use of a method that was not the user’s original preference and (2) use of a method while reporting preference for another method. Using these two approaches, we describe the prevalence of non-preferred method use, reasons for using non-preferred methods, and patterns in non-preferred method use by current and preferred methods. We find that 7% of respondents reported using a method they did not desire at the time of adoption, 33% would use a different method if they could and 37% report at least one form of non-preferred method use. Many women cite facility-level barriers, such as providers refusing to give them their preferred method, as reasons for non-preferred method use. The high prevalence of non-preferred method use reflects the obstacles that women face when attempting to fulfil their contraceptive desires. Further research on reasons for use of non-preferred methods is necessary to promote contraceptive autonomy.

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“…A total of 18 women receiving FP services were interviewed. The average age was 27 (ranged from 21 to 34) and the majority (14) were married. Education level skewed high with only 1 with primary, 4 with secondary, 8 with high school, and 5 with college education.…”

Section: Study Participantsmentioning

confidence: 99%

“…Outright disrespect and abuse are far less common but still a concern with 2% of interviewed FP clients reporting they felt pressured to use the provider's preferred method and 1.2% reporting they felt scolded because of their marital status (12). Another study in Kenya using mystery clients and third-party observations found that approximately one in ten FP clients was treated with disrespect by the provider, often in the form of verbal abuse including laughing at, shouting at, or scolding clients (13). Disrespectful treatment originates from provider judgements about clients such as their young age, being unmarried, number of children they have, reporting multiple sexual partners, or body size as well as provider impatience when clients asked questions or were slow to respond or choose a method (14).…”

Section: Introductionmentioning

confidence: 99%

“…Another study in Kenya using mystery clients and third-party observations found that approximately one in ten FP clients was treated with disrespect by the provider, often in the form of verbal abuse including laughing at, shouting at, or scolding clients (13). Disrespectful treatment originates from provider judgements about clients such as their young age, being unmarried, number of children they have, reporting multiple sexual partners, or body size as well as provider impatience when clients asked questions or were slow to respond or choose a method (14). Even as contraceptive use continues to rise, far too many women who want to avoid pregnancy are still not using contraception and too many women discontinue contraception for method related reasons (15).…”

Section: Introductionmentioning

confidence: 99%

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Development of a client exit survey tool to measure person-centered contraceptive counseling as part of a quality improvement process in Kenyan hospitals

Sitrin,

Laudeman,

Odipo

et al. 2023

Preprint

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Background Simple methods and tools that health care facilities can routinely use to measure trends in the quality of family planning (FP) counseling are necessary for applying a quality improvement process. This paper describes the development and testing of a client exit survey tool that is being used by quality improvement teams in 8 hospitals in Kenya to improve FP counseling. Methods A stakeholder consultation was held in Kenya to select questions from existing tools that measure client-reported quality of FP services and were validated or tested in low or middle-income countries. Ten questions were selected: 4 comprising the Person-Centered Contraceptive Counseling (PCCC) measure, 4 comprising the Method Information Index Plus (MII+), 1 comprising the Net Promoter Score, and 1 pulled from the Service Provision Assessment. We then conducted cognitive interviews with 18 women receiving FP services in Kenya to assess their understanding of questions, the face validity of the tool, and client preferences for survey logistics. Results There were mixed results in understanding of PCCC questions, which had not been used in Kenya previously: two were easily understood while two were frequently misunderstood. Respondents generally reported the survey was not difficult to understand and it was not hard to respond to questions. The results of asking participants to rank survey items from most to least important were that PCCC statements ranked most important followed by MII+ items. The Net Promoter Score ranked lowest. Few participants thought questions needed to be added to the tool to capture what they view as quality provider-client interactions. Most participants were unable to select questions for removal. Respondents had differing preferences for how to take the survey, with the most popular mode (8/18) being that the client reads and responds to the survey herself on paper followed by a facility staff member reading the questions aloud and the client recording her responses on paper (5/18). Conclusions A client exit survey tool incorporating the PCCC and MII+ scales seems reasonably understandable and to have good face validity in measuring dimensions of FP counseling important to clients in Kenya.

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Provider verbal disrespect in the provision of family planning in public-sector facilities in Western Kenya

Cited by 8 publications

References 43 publications

Reasons and prevention strategies of unintended pregnancy in Addis Ababa, Ethiopia: a phenomenological qualitative study

Reasons and prevention strategies of unintended pregnancy in Addis Ababa, Ethiopia: a phenomenological qualitative study

Prevalence of non-preferred family planning methods among reproductive-aged women in Burkina Faso: results from a cross-sectional, population-based study

Development of a client exit survey tool to measure person-centered contraceptive counseling as part of a quality improvement process in Kenyan hospitals

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