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BackgroundMonitoring clients' experiences with contraceptive care is vital to inform quality improvement efforts and ensure fulfillment of individuals' human rights. The Quality of Contraceptive Counseling (QCC) Scale is a previously validated scale that comprehensively measures individuals' experiences receiving counseling in three subscales: Information Exchange, Interpersonal Relationship, and Disrespect and Abuse. We sought to better understand the correlation of client, provider, and visit factors with client-reported quality of contraceptive counseling in the public sector in two Mexican states using the QCC Scale.MethodsThis cross-sectional survey study used the QCC Scale total score and subscale scores as outcome variables. Explanatory variables included clients' age, LGBTTTIQ status, relationship status, number of children, education, and occupation; providers' gender and type of provider; and the reason for visit. Linear and logistic regression models assessed bivariate associations. Multivariable, multilevel mixed-effects models with clinic as a random effect were fit. All models used complete cases (n = 470).ResultsIn the multilevel mixed-effects analyses, patients aged 35+ years reported worse Information Exchange (coefficient - 0.29, p = 0.01). Clients receiving care post-partum reported worse Information Exchange (coefficient - 0.25, p = 0.02) and worse total scores (coefficient - 0.15, p = 0.04) compared to clients seeking contraceptive information or methods. Clients who had 1+ children reported better Information Exchange (coefficient 0.21, p = 0.01) than those with no children. Though Disrespect and Abuse subscale scores were overall high (indicating high quality of care), we found a significant association between age and report of such negative experiences: clients in increasing age categories had increasingly higher adjusted odds of reporting no disrespect and abuse (aORs compared to the youngest group were 2.50 for those aged 19-24 years, p = 0.04; 4.53 for those 25-34 years, p = 0.01; and 6.11 for those 35+ years, p = 0.01.) CONCLUSIONS: Our findings align with previous results that younger clients have lower adjusted odds of reporting high-quality services in Mexico. There is a need for continued work supporting youth-friendly services in Mexico, and efforts should aim to ensure zero tolerance for disrespectful or coercive provider behaviors, such as pressuring or scolding clients. Improvements are also needed to ensure quality in counseling for post-partum clients, those aged 35+ years, and those without children.

Resumen Simple Monitorear las experiencias de las usuarias con los servicios anticonceptivos es vital para visibilizar los esfuerzos orientados a mejorar la calidad de la atención y garantizar sus derechos humanos. La Escala para Medir la Calidad de la Consejería Anticonceptiva (QCC) es una encuesta que evalúa las experiencias individuales de las usuarias con los servicios anticonceptivos. Está fundamentada en perspectivas centrada en la persona y de derechos humanos, e indaga explícitamente sobre posibles experiencias negativas. Este artículo describe el análisis de los datos recabados de la implementación de la Escala QCC, explorando asociaciones estadísticas entre las puntuaciones de las características de las usuarias, personal de salud y visita. En este estudio, también se analizaron los puntajes de las tres subescalas que conforman la Escala QCC (Intercambio de Información, Relaciones Interpersonales y Maltrato y Abuso). Los resultados del análisis revelan que, aunque no es reportado comúnmente, las usuarias más jóvenes tienen más probabilidades de reportar Abuso y Maltrato. Las usuarias de 35 o más años reportaron peor Intercambio de Información; las usuarias que recibieron atención postparto reportaron peor Intercambio de Información y peores puntuaciones totales; y las usuarias que tenían uno o más hijos, reportaron tener mejor Intercambio de Información. Estos hallazgos coinciden con resultados previos que indican que las usuarias más jóvenes tienen menores razones de probabilidad ajustada de reportar valores altos de calidad de los servicios anticonceptivos en México. Es necesario seguir apoyando a los servicios amigables para adolescentes en México, y los esfuerzos deberían apuntar a eliminar conductas irrespetuosas o coercitivas del personal de salud, tales como presionar o regañar a las usuarias. También es necesario mejorar y garantizar la calidad de la orientación consejería para usuarias en postparto, aquellas que tienen 35 o más años, y aquellas que no tienen hijos.

Abstract Background Unmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. We developed a client facing mobile phone-based family planning (FP) decision aid and assessed acceptability, feasibility, and utility of the tool among health care providers and postpartum women. Methods Semi-structured in-depth interviews (IDIs) were conducted among postpartum women (n = 25) and FP providers (n = 17) at 4 Kenyan maternal and child health clinics, 2 in the Nyanza region (Kisumu and Siaya Counties) and 2 in Nairobi. Stratified purposive sampling was used to enroll postpartum women and FP providers. Data were analyzed using an inductive content analysis approach by 3 independent coders, with consensual validation. Results FP providers stated that the Interactive Mobile Application for Contraceptive Choice (iMACC) tool contained the necessary information about contraceptive methods for postpartum women and believed that it would be a useful tool to help women make informed, voluntary decisions. Most women valued the decision aid content, and described it as being useful in helping to dispel myths and misconceptions, setting realistic expectations about potential side effects and maintaining confidentiality. Both women and providers expressed concerns about literacy and lack of familiarity with smart phones or tablets and suggested inclusion of interactive multimedia such as audio or videos to optimize the effectiveness of the tool. Conclusions The iMACC decision aid was perceived to be an acceptable tool to deliver client-centered FP counseling by both women and providers. Counseling tools that can support FP providers to help postpartum women make informed and individualized FP decisions in resource-limited settings may help improve FP counseling and contraceptive use in the postpartum period.