The influence of quality of care upon contraceptive use in rural Bangladesh

Abstract

Efforts to develop quantitative indicators of quality of care for family planning services, and to evaluate its role in contraceptive behavior, remain at an early stage. The present study, based upon an analysis of prospective data from a sample of 7,800 reproductive-aged rural Bangladeshi women, provides empirical evidence on the importance of quality of care for contraceptive practice. The results demonstrate that the perceptions of women regarding the quality of field-worker care were significantly related to the probability of subsequent adoption of a family planning method. Women who were not using a method and who scored high on an index of perceived quality of care were 27 percent more likely to adopt a method subsequently, compared with women with a low score. Effects were even more pronounced for contraceptive continuation; high quality of care was associated with a 72 percent greater likelihood of continued use of any method of contraception.

PIP: This report opens with an overview of the development of the concept of "quality of health care" and attempts to identify appropriate research methodologies to define and measure quality of care indicators. The present study uses longitudinal data collected after May 1989 via interviews with 7829 women in rural Bangladesh to describe the influence of quality of care on contraceptive behavior. After describing the study setting and data, results are presented in terms of 1) evidence gleaned about the standards of care offered by the government field workers from the perspective of the clients served and 2) the relationship between selected quality of care indicators and contraceptive adoption and method continuation. The analysis provided compelling evidence of the important effect of quality of care on contraceptive behavior. Clients were more likely to continue contraceptive usage if they perceived a high quality of care from field workers. Higher standards of care were also associated with a 27% increase in subsequent adoption of contraception by nonusers. It was also found that the absolute number of contraceptive methods offered to a client may not be as important as the degree of trust developed between the field worker and the client. The findings also indicate that significant improvements are needed in the quality of care provided by field workers. Only half of the ever-visited respondents received acceptable standards of care, only 25% welcomed a return visit, and only a minority had positive views of services provided through government clinics. Further research is needed to collaborate these findings in other settings, and efforts should be made to identify the ways that policies and programs realistically can be changed to improve quality of care in order to meet the needs of individuals and broad demographic goals.