Using mystery clients to assess the Intra Uterine Contraceptive Device (IUCD) recommending practices and client counseling behavior of providers.
Using mystery clients to assess the Intra Uterine Contraceptive Device (IUCD) recommending practices and client counseling behavior of providers.
- c2013.
- 17p.
Research Report.
SUMMARY: The2011NDHS showsthat, despitea decline inNepal'stotal fertility rate since 1984-86,12% of the births were still mistimed and 13% unwanted in the five years preceding the survey. Furthermore, 27.5% of currently married women had an unmet need for family planning services,with 10%of which hadan unmetneed for spacing and 18%of which had an unmet needfor limiting.(NDHS, 2011) IUCDs were among the first modern methods of contraception to be introduced in Nepal. Because of their numerous advantages, several reproductive health organizations have focused on increasing their use. NDHS Data shows that use of IUCDs among currently married women has tripled in the last decade from 0.4% in 2001 to 1.3% in 2011. Since 2009, PSI/Nepal has been implementing the Women's Health Project (WHP) to improve the reproductive health of women, with several goals, including: to increase contraceptive prevalence rate,todecrease the rate of maternal mortality,andtoreduce the national fertility rate. Currently, WHP is operational in 50 of 75 districts. PSI/Nepal's WHP activities focus on identifying and supporting private service providers, increasing demand for IUCDs through interpersonal communication (IPC) and mass media, and improving access to IUCDs by increasing the number of service delivery points through the establishment of PSI network providers and increasing women's access to IUCDs through increasedIUCDservice delivery pointsthroughtheestablishmentof PSI network provider. The purpose of this study was to assess the IUCD recommending behaviors of PSI network providers, based onprovider training and provider behavior change communication, using a Mystery Client (MC) methodology.Key findings from this study include the following: Interpersonalrelationship A majority of clients were satisfied with the service that they received from providers.About96%all clients were greeted politely, and nine out of ten clients (92%) were given an opportunity to ask questions related to family planning methods. Providers met clientsin private places(71%)andmaintainedthe confidentiality of the discussion. Less than half of the providers (43%) inquired aboutthe age of the clients. About one in two providers (53%) asked whether the client wantedto have another child in near future. More than four-fifths of providers inquired about number of living children and birth spacing methodscurrentlybeingusing. On the other hand, only 22% of providers asked whether the client was pregnant, and only 36%ofproviders inquiredaboutthepastmedical history of the client. FP informationprovided/choice of methods More than two-thirds (78%) of providers asked clients about their preferred choice of FP method.In most cases (92%), providers explained about thedifferent available FP methods. The percentages of providers that informed about different methods were: 97% injectable, 94% pills, 87% implant, 78% condom, and 100% IUCD. Additionally, 88.5 % of clients received counseling on more than 3 FP methods and 11.5% were informed of less than 3 FP methods. When discussing methods other than IUCDs, aboutone-third of providersshared only information abouttheirside effects. Information aboutIUCDinformation provided/practicesrecommended A majority of providers shared basic information on IUCDs with clients: 83% spoke about possible side effects ofIUCDs, 89%explained thatIUCDsarea reversible methodthat canbe removed at any time,and97%explainedwhereIUCDsareinserted.A majority of providers recommended that clients use IUCDs(96.3%), and 87.3%ofproviders offered IUCD services to clients. Only afewproviderscounselled on whenIUCDs may not be suitable, includingduring pregnancy (30%), when the client or her partner has multiple sexual partners (16%), or if sheis infected with an STI (78.3%) A majority of providers (99%) did not charge clients a FP consultation fee. The cost of IUCD services differed by provider, ranging from NRs200 to NRs 1500.
Mystery clients.
Intra Uterine Contraceptive Device.
RES00824
Research Report.
SUMMARY: The2011NDHS showsthat, despitea decline inNepal'stotal fertility rate since 1984-86,12% of the births were still mistimed and 13% unwanted in the five years preceding the survey. Furthermore, 27.5% of currently married women had an unmet need for family planning services,with 10%of which hadan unmetneed for spacing and 18%of which had an unmet needfor limiting.(NDHS, 2011) IUCDs were among the first modern methods of contraception to be introduced in Nepal. Because of their numerous advantages, several reproductive health organizations have focused on increasing their use. NDHS Data shows that use of IUCDs among currently married women has tripled in the last decade from 0.4% in 2001 to 1.3% in 2011. Since 2009, PSI/Nepal has been implementing the Women's Health Project (WHP) to improve the reproductive health of women, with several goals, including: to increase contraceptive prevalence rate,todecrease the rate of maternal mortality,andtoreduce the national fertility rate. Currently, WHP is operational in 50 of 75 districts. PSI/Nepal's WHP activities focus on identifying and supporting private service providers, increasing demand for IUCDs through interpersonal communication (IPC) and mass media, and improving access to IUCDs by increasing the number of service delivery points through the establishment of PSI network providers and increasing women's access to IUCDs through increasedIUCDservice delivery pointsthroughtheestablishmentof PSI network provider. The purpose of this study was to assess the IUCD recommending behaviors of PSI network providers, based onprovider training and provider behavior change communication, using a Mystery Client (MC) methodology.Key findings from this study include the following: Interpersonalrelationship A majority of clients were satisfied with the service that they received from providers.About96%all clients were greeted politely, and nine out of ten clients (92%) were given an opportunity to ask questions related to family planning methods. Providers met clientsin private places(71%)andmaintainedthe confidentiality of the discussion. Less than half of the providers (43%) inquired aboutthe age of the clients. About one in two providers (53%) asked whether the client wantedto have another child in near future. More than four-fifths of providers inquired about number of living children and birth spacing methodscurrentlybeingusing. On the other hand, only 22% of providers asked whether the client was pregnant, and only 36%ofproviders inquiredaboutthepastmedical history of the client. FP informationprovided/choice of methods More than two-thirds (78%) of providers asked clients about their preferred choice of FP method.In most cases (92%), providers explained about thedifferent available FP methods. The percentages of providers that informed about different methods were: 97% injectable, 94% pills, 87% implant, 78% condom, and 100% IUCD. Additionally, 88.5 % of clients received counseling on more than 3 FP methods and 11.5% were informed of less than 3 FP methods. When discussing methods other than IUCDs, aboutone-third of providersshared only information abouttheirside effects. Information aboutIUCDinformation provided/practicesrecommended A majority of providers shared basic information on IUCDs with clients: 83% spoke about possible side effects ofIUCDs, 89%explained thatIUCDsarea reversible methodthat canbe removed at any time,and97%explainedwhereIUCDsareinserted.A majority of providers recommended that clients use IUCDs(96.3%), and 87.3%ofproviders offered IUCD services to clients. Only afewproviderscounselled on whenIUCDs may not be suitable, includingduring pregnancy (30%), when the client or her partner has multiple sexual partners (16%), or if sheis infected with an STI (78.3%) A majority of providers (99%) did not charge clients a FP consultation fee. The cost of IUCD services differed by provider, ranging from NRs200 to NRs 1500.
Mystery clients.
Intra Uterine Contraceptive Device.
RES00824