Estimates of Side Effects Counseling in Family Planning Using Three Data Sources: Implications for Monitoring and Survey Design.

With growing attention to monitoring and improving quality of care, it is critical to have evidence-based recommendations to measure quality of care indicators and guidelines to interpret estimates from different data sources. This study facilitates methodological discussion regarding measurement of counseling for side effects in family planning, a critical component of quality. The study assesses and compares estimates of side effects counseling based on three data sources. Data came from nationally representative facility and household surveys, Service Provision Assessments, and Demographic and Health Surveys in four countries. The level of side effects counseling was unacceptably low and varied systematically by data source. Compared to observation data in the facility survey, exit interview data from the survey overestimated the level substantially, and its reporting had poor predictive value. Estimates from household surveys were comparable with the observation-based estimates applying the minimum definition of counseling. In monitoring quality of care, data sources should be carefully reviewed, and estimates may need to be adjusted if the sources are inconsistent.