Puri Mahesh C, Moroni Matthew, Pearson Erin, Pradhan Elina, Shah Iqbal H
Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal.
Department of Sociology, Development Studies, Lund University, Lund, Sweden.
BMC Womens Health. 2020 Feb 18;20(1):29. doi: 10.1186/s12905-020-00904-y.
Though modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women's perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision.
In-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically.
Overall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling.
There is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women's needs.
尽管尼泊尔已婚妇女现代避孕方法的使用率已从1996年的26%提高到2016年的43%，但产后妇女的使用率仍然较低。在产前护理（ANC）和分娩时纳入计划生育（FP）咨询有可能增加产后避孕方法的使用。本研究调查了在ANC就诊期间提供的FP咨询服务的质量，以及妇女对其在帮助她们做出产后计划生育（PPFP）决定方面有效性的看法。
对24名孕妇进行了深入访谈（IDI），这些孕妇曾在六家公立医院中的一家至少进行过两次ANC就诊，这些医院接受了一项干预措施，该措施旨在将FP咨询纳入孕产妇护理服务，并在产后立即引入产后宫内节育器插入术。IDI数据是作为该干预措施过程评估的一部分收集的。使用最大差异抽样法选择妇女，以代表不同的社会人口特征。IDI进行了录音，逐字转录为尼泊尔语，并翻译成英语。数据使用Bruce-Jain护理质量框架进行整理，并进行主题分析。
总体而言，基于患者的期望、与提供者互动的体验以及提供的FP方法，ANC期间FP咨询的质量并不令人满意。尽管她们有兴趣，但大多数妇女报告说她们没有得到关于FP的全面信息，其中约三分之一的人说她们没有得到任何关于PPFP的咨询服务。对咨询服务不满意的原因包括环境非常拥挤、与提供者相处时间短、提供者不在、等待时间长、ANC服务天数有限以及缺乏全面的FP相关信息、教育和咨询（IEC）材料。在设有专门FP顾问的医院就诊的妇女报告说FP咨询质量更高。
迫切需要重新审视ANC就诊期间PPFP咨询的形式、相应的IEC材料、咨询环境，并加强与提供者的接触和互动，以提高ANC就诊期间FP咨询的质量、体验和满意度。还需要改善基础设施和人力资源，以充分满足妇女的需求。
