Background: Family planning and reproductive health programs have contributed to the
fertility decline in developing countries and advocates agree that the quality of family
planning and reproductive health services positively affects the contraceptive use and
behavior of the clients. However, little empirical evidence is available to show the
relationship between the quality of family planning services and the population based
prevalence of contraceptive methods, especially the methods required to be administered
at the health facility, and by the trained healthcare providers.
Methods: The analysis used data from the 2003 Egypt Interim Demographic and Health
Survey that included 8,445 married women aged 15-49, and the 2002 Egypt Service
Provision Assessment survey that included 602 facilities offering family planning
services. Geographic Information System (GIS) data of latitude and longitude coordinates
were collected in both surveys. Using GIS data, individual women were linked to a
facility located within 10 km of their community. A facility-level index was constructed
to reflect the quality of family planning services. Effects of the quality of family planning
services and other factors on the use of intrauterine devices (IUD) and other
contraceptive methods were estimated using multinomial logistic regression. Results are
resented in Relative Risk Ratio (RRR) with significant level (p—value)
Results: The results show that IUD use among women who obtained their method from
public sources is strongly positively associated with the quality of family planning
services, independent of other factors (RRR=1.36, p<0.01).
Conclusions: This study is the first of its kind that uses geographic information to link a
population based survey data with an independently sampled health facility survey to
analyze the association of the quality of family planning services with the use of IUD.
The effects of quality in family planning services on the use of IUD obtained from a
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public source demonstrates that service quality is an important determinant of the use of
clinical contraceptive methods that require administration in a health facility in Egypt.