Impact of accessibility and quality of family planning services on contraceptive use dynamics: Evidence from north India

Earlier efforts to demonstrate independent effects of organized family planning programs upon contraceptive behavior have produced inconsistent results. This may be attributed in part to the imperfect and incomplete specification of the programmatic efforts in the form of only geographical accessibility. Recently the focus has shifted from 'quantity' to 'quality' of the services. However efforts to quantify quality of care for family planning services and its role in contraceptive behavior remain at an early stage.;The study uses linked data from the individual women survey and health facility survey conducted as the part of PERFORM baseline survey in the state of Uttar Pradesh in North-Central India to examine the impact of accessibility and quality of family planning services on subsequent adoption of a contraceptive method and continuation of use. In addition, the study examines the effect of clients' socio-demographic characteristics on the quality of care received. Multivariate logistic regression and multinomial logistic regression models are used to test the study hypotheses. Separate analyses were done to assess the time dependence of the impact of programmatic factors on continuation of use.;The results suggest that there is a considerable scope for further improvements in coverage and quality of care provided by the Indian public sector Family Welfare Program. Presence of competent providers, availability of a greater number of methods, performance of at least one information-education and communication (IEC) activity, presence of a female medical provider all have significant positive, independent effects on subsequent adoption of a contraceptive method and client's choice of method. The number of competent providers and availability of a greater number of methods significantly reduce the likelihood of discontinuation in the initial three months of use. Aggregate number of outreach visits in the primary sampling unit (PSU) is not a significant predictor of subsequent adoption of contraception, but significantly lowers the risk of discontinuation in the first three months of use. An increase in the travel time to the nearest facility reduces the odds of subsequent adoption of a contraceptive method, but reduces the likelihood of discontinuation of use of a temporary method. Study results also suggest that clients' socio-demographic characteristics and policy factors such as method-specific target approach do influence the quality of care received by the clients.;Potential limitations of the study are discussed. Despite some limitations, many useful insights into the link between the service delivery system and contraceptive use dynamics emerged. The study provides persuasive evidence that both the quality and availability of services are important determinants of adoption of a contraceptive method and continuation of use, suggesting the need for concurrent strategies aimed at enhancing both access and quality.