Abstract

Kelvin Smith and Rebecca Philips

The quality of family planning services can have important implications for uptake and continued method use. Yet, measuring quality of care is complex, and quality itself is a multifaceted concept. In 2015, a new injectable contraceptive method, DMPA-SC (depot medroxyprogesterone acetate – subcutaneous, also known as Sayana Press®), was introduced through several private sector distribution channels in Nigeria. To examine aspects of quality for DMPA-SC service provision and contraceptive services more broadly, we compared self-reports from follow-up phone surveys with users to simulated client interactions that were designed to measure the same concepts. By using multiple methods, we sought to understand more deeply the biases associated with different data collection methods that ultimately lead to different conclusions regarding quality of contraceptive services, and to further assess to what extent these methods were suitable for detecting differences in quality across sub-groups using the case of married versus unmarried women. We found that simulated clients reported lower levels of quality across all comparable quality indicators than phone survey respondents attending the same facilities. Both methods were able to detect similar differential treatment by marital status. A mixed methods approach can provide differential insights into quality of family planning services, especially when aiming to understand both objective and subjective aspects of quality.