Quality of Care and Contraceptive Use in Urban Kenya.

CONTEXT Family planning is highly beneficial to women's overall health, particularly in developing countries. Yet, in much of Sub-Saharan Africa, contraceptive prevalence remains low and unmet need for family planning remains high. It is hypothesized that the poor quality of family planning service provision in many low-income settings is a barrier to contraceptive use, but this hypothesis has not been rigorously tested. METHODS Survey data from 3,990 women were used to investigate whether family planning service quality was associated with current modern contraceptive use in five cities in Kenya in 2010. In addition, audits of selected facilities and service provider interviews were conducted in 260 facilities, and exit interviews were conducted with family planning clients at 126 high-volume clinics. Individual- and facility-level data were linked according to the source of the woman's current method or other health service. Binomial regression was used to estimate adjusted prevalence ratios, and robust standard errors were used to account for clustering of observations within facilities. RESULTS Sixty-five percent of women reported currently using a modern contraceptive method. Provider's solicitation of clients' method preferences, assistance with method selection, provision of information on side effects and good treatment of clients were positively associated with current modern contraceptive use (prevalence ratios, 1.1 each); associations were often stronger among younger and less educated women. CONCLUSION Efforts to assist with method selection and to improve the content of contraceptive counseling and treatment of clients by providers have the potential to increase contraceptive use in urban Kenya.