Service Delivery Factors Influencing Contraceptive Use Dynamics in Developing Countries: A Mixed-Methods and Cross-Disciplinary Approach
Summary
Current research calls for a better understanding of contraceptive behavior through a more detailed look at the adoption and discontinuation of specific methods and service delivery factors contributing to discontinuation. Several challenges exist to responding to this research agenda. First, little is known about the reliability and validity of the standard tool for measuring contraceptive continuation: the retrospective reproductive calendar. Secondly, a dearth of studies designed to collect time-to-event data combined with poor strategies for linking individual and facility-level data has resulted in limited ability to understand the relationship between quality of family planning service delivery and contraceptive behavior. Finally, there is increasing evidence that standard quantitative approaches to measuring quality in large-scale demographic surveys may overestimate health system performance or may fail to capture more hidden aspects of the interaction between clients and providers such as absenteeism, demands for informal fees, or abusive treatment. This research is both novel and of public health importance, with relevance for reducing maternal, infant, and child mortality in developing country settings.