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Randomized Controlled Trial
. 2019 Jul 25;14(7):e0218187.
doi: 10.1371/journal.pone.0218187. eCollection 2019.

Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines

Mari Nagai  1 , Saverio Bellizzi  2 , John Murray  3 , Jacqueline Kitong  4 , Esperanza I Cabral  5 , Howard L Sobel  6
Affiliations
Randomized Controlled Trial

Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines

Mari Nagai et al. PLoS One. .

Abstract

Background: In the Philippines, one in four pregnancies are unintended and 610 000 unsafe abortions are performed each year. This study explored the association between missed opportunities to provide family planning counseling, quality of counseling and its impact on utilization of effective contraception in the Philippines.

Methods: One-hundred-one nationally representative health facilities were randomly selected from five levels of the health system. Sexually-active women 18-49 years old, wanting to delay or limit childbearing, attending primary care clinics between April 24 and August 8, 2017 were included. Data on contraceptive use, counseling and availability were collected using interviews and facility assessments. Effective contraceptive methods were defined as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use.

Findings: 849 women were recruited of whom 51.1% currently used effective contraceptive methods, 20.6% were former effective method users and 28.3% had never used an effective method. Of 1664 cumulative clinic visits reported by women in the previous year, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility, with 83.7% having a missed counseling opportunity on the day of the interview. Most women (55.9%) reported health concerns about modern contraception, with 2.9% receiving counseling addressing their concerns. Only 0.6% of former users and 2.1% never-users said they would consider starting a modern contraceptive in the future. Short and long acting reversible contraceptive methods were available in 93% and 68% of facilities respectively.

Conclusions: Missed opportunities to provide family planning counseling are widespread in the Philippines. Delivery of effective contraceptive methods requires that wider legal, policy, social, cultural, and structural barriers are addressed, coupled with systems approaches for improving availability and quality of counseling at all primary health care contacts.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Status of contraceptive use among 849 women 18–49 years of age wanting to delay or limit childbearing, outpatient care clinics, Philippines, 2017.
Fig 2
Fig 2. Missed Opportunities to provide family planning counseling on the day of the interview, by women’s characteristic (%), outpatient care clinics, Philippines, 2017.
Fig 3
Fig 3. Cumulative number of visits and missed opportunities for family planning counseling by type of outpatient care clinic visit, Philippines, January 1 2017 –December 31, 2017.
Fig 4
Fig 4. Family planning counseling received by women with health concerns about contraception on the day of the interview at outpatient care clinics, Philippines, 2017.
See this image and copyright information in PMC

References

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