The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61451

John Stanback, PhD¹, Fatimata Diabate, MD², Florence Jean-Louis, MD³, Thierno Dieng⁴, Telma Duarte, MD⁵, and Michael S. Cummings, MS¹. (1) Health Services Research, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, 919 405 1473, jstanback@fhi.org, (2) Service de Gyneologie-Obstetrique, University of Mali, Hôpital Gabriel Touré, Bamako, Mali, (3) Chef de Service, Association des Oeuvres Privées de Santé (AOPS), P.O. Box 13489 Delmas, Port-au-Prince, Haiti, (4) CEFOREP, B.P. 22340, Dakar- Ponty, Senegal, (5) APROFAM, 9na Calle 0-57, Zona, Guatemala City, Guatemala

Denial of contraception to non-menstruating women limits access to family planning in countries where pregnancy tests are unavailable or unaffordable. Fearing that contraceptives might harm an unrecognized pregnancy, and without sensitive pregnancy tests to rule out pregnancy, providers routinely deny contraceptive services to non-menstruating clients. In some countries, up to 20% of new presenters for family planning are sent home without services, some of whom may never return. To address this barrier to access, we used existing international recommendations to develop a new “best practice:” a simple checklist to help providers rule out pregnancy. The effectiveness of the checklist has been previously validated in Kenya using dipstick pregnancy tests.

This presentation describes a quasi-experiment conducted in Senegal, Mali, Guatemala, and Haiti to assess the impact of this new job aid on the proportion of new clients who denied services. In each country, we collected baseline data in 2-6 clinics for several months to determine the rate of service denial to new, non-menstruating clients. We then introduced the checklist during a one-day training by a local physician. We then measured posttest denial rates for several months. We used one-sided paired T tests to assess differences in each country. A secondary objectives was to assess whether introduction of the job aid improved provider attitudes towards serving non-menstruating clients.

Baseline rates of service denial ranged from 4% to 15% of new, non-menstruating clients. The checklist reduced service denial, in one country from 15% to 1%. Provider attitudes improved in most clinics.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Describe why menstruation requirements are a barrier to access in many parts of the world;
• Discuss a new best practice for ruling out pregnancy in the absence of laboratory tests; and
• Discuss the success of the tested job aid at improving access to family planning in developing countries.

Keywords: Family Planning, Access to Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.