Women’s Perspectives on Counseling Quality in a Tanzanian Postpartum Contraception Intervention

Leigh G. Senderowicz, University of Wisconsin at Madison
Erin Pearson, Ipas
Kristy Hackett, Harvard University
Sarah Huber-Krum, Harvard University
Joel Francis, University of the Witwatersrand
Julia Rohr, Harvard School of Public Health
Iqbal Shah, Harvard T.H. Chan School of Public Health

With the increasing focus on long-acting reversible contraceptives, some family planning (FP) interventions promote single methods as their programmatic focus. We explore women’s experiences with FP counseling in a postpartum IUD (PPIUD) intervention and the ways that this single-method focus affects access to high-quality FP. We conducted semi-structured interviews with twenty women receiving antenatal care as part of a PPIUD intervention in five hospitals in Tanzania, using open-coding and inductive content analysis. Women reported overall satisfaction with the quality of counseling, but also shared that counseling sometimes focused narrowly on PPIUD to the detriment or exclusion of other methods. Benefits of the IUD were exaggerated while disadvantages were downplayed during counseling, seemingly with the aim of maximizing method uptake. Though single-method interventions can bring attention and resources to FP programs, they may paradoxically serve to constrain access to a wide FP method mix and high-quality counseling the emphasizes client choice.