Predictors of quality of family planning counselling in Ethiopia: multilevel analysis of the SPA survey 2021/22

TL;DR

This study finds that family planning counselling in Ethiopia is often of low quality, with provider and facility factors being key influences.

Contribution

The study identifies specific client-, provider-, and facility-level predictors of high-quality family planning counselling in Ethiopia.

Findings

Only 32% of women received high-quality family planning counselling, with key information often missing.

Provider experience and adherence to guidelines were strongly associated with better counselling quality.

Facility-level factors accounted for about 52% of the variation in counselling quality across regions.

Abstract

High-quality family planning (FP) counselling is essential for informed contraceptive choice, reducing discontinuation, and improving reproductive health. However, many women in sub-Saharan Africa continue to face barriers. This study examined client-, provider-, and facility-level determinants of FP counselling quality in Ethiopia using nationally representative, multi-source data.

We analysed data from the 2021/22 Ethiopia Service Provision Assessment, including 2,224 women who received or were prescribed injectables, pills, or implants. Counselling quality was assessed using a 15-item checklist derived from direct observations and client exit interviews. Multilevel ordinal logistic regression was applied to identify predictors at the client-, provider-, and facility-levels.

Only 32% of clients received high-quality FP counselling, with key information on side effects, STI protection, and a follow-up frequently omitted. High-quality counselling was more likely among women who had never used FP (aOR 1.40; 95% CI: 1.01–1.95) or were past users (aOR 2.05; 95% CI: 1.44–2.92), those counselled by providers with more than five years of experience (aOR 1.91; 95% CI: 1.26–2.89), and those served by providers with high adherence to medical-eligibility screening (aOR 1.67; 95% CI: 1.22–2.29). The presence of a FP-trained provider and national FP guidelines was also positively associated. Marked regional disparities were observed, with facilities in Sidama performing better and those in emerging regions lagging behind. Facility-level factors accounted for approximately 52% of the variation in counselling quality.

The quality of FP counselling in Ethiopia remains suboptimal and is largely driven by provider and facility-level factors. Strengthening provider training, ensuring guideline availability, addressing regional disparities, and improving counselling for current users are essential for enhancing service quality, reducing discontinuation, and improving reproductive health outcomes.

Figures