Counseling tools alone do not improve method continuation: further evidence from the decision-making tool for family planning clients and providers in Nicaragua

BackgroundThe decision-making tool (DMT) was developed by the World Health Organization's Department of Reproductive Health and Research and the Johns Hopkins University Center for Communication Program's staff to promote clients' informed choice and participation in family planning service delivery, to enable providers to apply evidence-based best practices during client-provider interaction and to provide the technical information necessary for optimal delivery of contraceptive methods. This tool has been tested in several countries and been shown to improve the quality of counseling for family planning clients.Study DesignWe conducted intercept and follow-up home interviews with new family planning acceptors in three health departments in Nicaragua to assess the impact of the DMT on method continuation and counseling experiences. The study was a quasi-experimental design with 65 experimental and control clinic sites.ResultsAnalyses of overall and method-specific contraceptive use rates revealed no differences between experimental and control clinic clients. However, clients in the experimental group reported better counseling experiences than their counterparts in the control group.ConclusionThe authors conclude that sufficient evidence exists that counseling alone — with or without specialized job aids — does not influence contraceptive use rates. A new strategy is needed to help women maintain use of family planning methods.