Increasing literate and illiterate women's met need for contraception via empowerment: a quasi-experiment in rural India.

Background: Virtually all the evidence on the relationship between women's empowerment and use of contraception comes from cross-sectional studies that have emphasized macrosocial factors.This analysis tested whether literate and illiterate women are empowered by an intervention designed to provide information addressing technical and gender concerns and expand contraceptive choice, and evaluated the effects of women's decision-making power on contraceptive behavior.

Methods: The data came from a three-year quasi-experiment conducted in two comparable, yet not equivalent, rural blocks in Jharkhand, India.

Predicting contraceptive use from an egalitarian model of women's overall household power vis-à-vis conventional power models and third variables.

Research on gender power in contraceptive use has focused on whether women have an active role in household decision-making (the participation model) or on the extent of their control of domestic decisions (the control model); it has also addressed the joint effects of power, age, education and work. Findings published in this journal (Woldemicael, 2009) suggest a third power model according to which wives make joint decisions with their husbands on important domestic areas and autonomous decisions on secondary matters (the egalitarian model). In analyses of Demographic and Health Survey data sets from 46 countries, the egalitarian model explained contraceptive use better than the control and participation models in 19 out of 20 countries outside sub-Saharan Africa; its superiority was less overwhelming in this sub-continent.

Assessing the effect of introducing a new method into family planning programs in India, Peru, and Rwanda.

Background: Introducing a new method into family planning programs requires careful attention to ensure it meets an actual need and has a positive effect on program goals. The Standard Days Method® is a fertility awareness-based method of family planning that is being introduced into family planning programs in countries around the world. It is different from other methods offered by programs, and may bring new couples into family planning, and increase contraceptive prevalence.

The role of need for contraception in the evaluation of interventions to improve access to family-planning methods.

A nonrandomized experiment carried out in Jharkhand, India, shows how the effects of interventions designed to improve access to family-planning methods can be erroneously regarded as trivial when contraceptive use is utilized as dependent variable, ignoring women's need for contraception. Significant effects of the intervention were observed on met need (i.e.

Provider selection of evidence-based contraception guidelines in service provision: a study in India, Peru, and Rwanda.

Providers underutilize evidence-based practice guidelines as they prescribe contraceptives. To discern biases in guideline utilization by 172 providers of three countries, this study used observations from simulated clients trained to choose oral contraceptives. Providers implemented less than one third of the guideline set, but they addressed, more frequently than other guidelines, items categorized as essential by expert opinion (p < .

Four criteria to evaluate providers' service-delivery response to new contraceptive introduction.

This article presents an evaluation framework developed to assess the first-level effects of introducing the Standard Days Method (SDM) in Peru Ministry of Health clinics. Four questions are asked: 1) To what extent do providers routinely achieve SDM service delivery standards? 2) Is the time invested in SDM delivery consistent with program norms? 3) How does SDM delivery compare with delivery of established methods? and 4) How does SDM introduction affect delivery of established methods? A study at 62 clinics demonstrated the framework's usefulness. The Standard Days Method introduction had positive overall effects on the quality of care but provider training needed adjustments.

Challenging the courtesy bias interpretation of favorable clients' perceptions of family planning delivery.

Favorable client perceptions of provider's interpersonal behavior in contraceptive delivery, documented in clinic exit questionnaires, appear to contradict results from qualitative evaluations and are attributed to clients' courtesy bias. In this study, trained simulated clients requested services from Ministry of Health providers in three countries. Providers excelled in courteousness/respect in Peru and Rwanda; in India, providers were less courteous and respectful when the simulated clients chose the pill.

Quality of delivery of the Standard Days Method as compared with contraceptive pills in Rwanda.

Background And Methodology: Replicating a Peruvian study, this research introduced the Standard Days Method (SDM) into Rwanda Ministry of Health clinics and evaluated client counselling on the new method against that given for contraceptive pills. Providers received technical reinforcement concerning established methods in addition to SDM training. To evaluate their quality of care, simulated clients implemented a service test in visits to 20 clinics.

Training x Trainee Interactions in a family planning intervention.

This study investigated the effects of introducing a family planning counseling model at clinics of Peru's Ministry of Health. Providers trained in the model presented greater quality of care and longer counseling sessions than did controls. The main effects, however, were misleading.

Providers' compliance with the balanced counseling strategy in Guatemala.

The balanced counseling strategy developed in Peru improved family planning care and clients' knowledge of their contraceptive method choice, but few providers adopted it. To expand its use, an algorithm was introduced and training, job aids, and reinforcement were supplied to Ministry of Health providers, most of whom were paraprofessionals, from two areas (40 clinics) in Guatemala. Mystery clients made pretest and post-test visits to these clinics and to providers from a nonequivalent control group (40 clinics).