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Quality of Family Planning services in Malawi: what
can we learn by observing consultations with clients?
Women and men are influenced in theirchoice of health provider by many factors,including cost and accessibility. Quality ofprovision has also been identified as animportant driver of service utilisation, andwhere deficient can represent a barrier toutilisation. Observation of consultationsallows direct assessment of service quality.
The aim of the present study was to collect
information about the interactions between
clients and providers during family planning
(central and southern regions) or Tumbuka
languages (northern region). The commonest
government run facilities from a nationally
contraceptive supplies. 4/5 of the consultationsobserved were with a female provider, and three
quarters of clients were seen by a nurse. The
majority of consultations took place between 9
am and midday. New consultations (9/42) had a
mean duration of 43 minutes (range 15-85) while
southern regions, and of service provider.
for existing clients the mean duration was 15
minutes (range 2-80). The longest consultations
were recorded when pelvic examination was
government health centres, private health
carried out without provision of Depo Provera,
centres and clinics of Banja la Mtsogolo.
reflecting longer discussion time in those notalready seeking a specific method.
With the consent of clients, consultationswere observed and notes made of the
duration and content of consultations.
For new clients, information elicited regarding age,marital status, number of children, pregnancyhistory, husband’s attitude and STI history was
Fact Sheet 12 Reproductive Health Research funded by DFID
patchy. There was little or no enquiry about
usually the same individual who had conducted
desire for more children or preferred timing
the consultation, who was usually a nurse.
Other staff involved were medical assistants and
Consultations included responding to questions,encouraging clients to ask questions, and
The client’s name was confirmed prior to the
assurance of confidentiality in more than half
injection in less that one fifth of cases.The correct
those episodes observed. Clients were asked
date of administration for the client was usually
about concerns with methods, shown respect,
checked. Verification that the client was not
afforded privacy and offered a return visit in a
pregnant occurred in only half the cases. There
high proportion of consultations (88-98%).
was almost universal application of safe sharpsdisposal practice.
Method choice and information
Among the new clients all but one received the
Hand washing was observed for just under half
method of choice.These were the pill (3), Depo
before the injection procedures, as was also the
Provera (5) and female sterilization (1). Because of
suspected infection one client was given condoms.
examination was usually conducted without
Including existing users, the method mix was
asking clients to take slow deep breaths and in
Depo Provera (71%), the pill (21%), female
the few instances of speculum examination
sterilization (2.4% ) and the condom (2.4%).
observed, the procedure was almost neverexplained to the client.
The range of potential methods was discussed indetail in one third or fewer consultations, whereas
injectables were discussed with 74% of clients.
The observations demonstrate adherence tosome aspects of good practice in communication,
For pill users, the blood pressure was checked in
especially demonstrating respect and affording
8/9 cases, 8 clients were weighed, pregnancy was
privacy to clients. There is some evidence for
excluded in all clients, breastfeeding was discussed
provider bias towards injectables.The main flaws
with 4/9 and menstrual cycle disturbance was
in relation to administration of injectables were
failing to exclude pregnancy and hand washing.
For Depo Provera users, blood pressure was
Priorities for attention are consultations that
checked in all cases, 20/25 were weighed,
explore fertility intentions and that
smoking history was obtained in 4/25, pregnancy
support wide method choice, and good
was positively excluded in 18/25, the medical
clinical practice during intimate
menstrual irregularity was discussed in 20/25consultations.
Health’s Department for Population Services
and the University of Malawi’s Demographic
administration of Depo Provera (71% of clients).
The person administering the injection was
For details about this report contact: Rosemary Lawrence, Opportunities and ChoicesProgramme, Department of Social Statistics, University of Southampton, Southampton, SO171BJ, UK.Tel: +44 (0)23 8059 5763, Fax: +44 (0)23 8059 3846, E-mail: firstname.lastname@example.org
Fact Sheet 12 Reproductive Health Research funded by DFID
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IngentaConnect Post-dexamethasone cortisol correlateswith severity of depression. during carbamazepine treatment in women Authors: Osuch, Elizabeth A.1; Cora-Locatelli, Gabriela2; Frye, Mark A.3; Huggins, Teresa2; Kimbrell, Timothy A.4; Ketter, Terence A.5; Callahan, Ann M.2; Post, Robert M.2 Source: Acta Psychiatrica Scandinavica, Volume 104, Number 5, November 2001 , p