Challenges to informed choice counselling: a qualitative study of contraceptive self-care introduction in the Copperbelt Province of Zambia.

introductionContraceptive self-care adds a new dimension to informed choice counselling as providers communicate not only information about methods but also choice in how that method is to be administered. Even as many countries are scaling subcutaneous depot medroxyprogesterone acetate (DMPA-SC) for self-injection (SI), no studies have examined the potential repercussions for informed choice counselling. This qualitative study from Zambia investigates the content and quality of information given to family planning clients to understand whether DMPA-SC and SI are introduced in ways that respect informed choice.

methodsThe study explored complex attitudes and practices through structured and in-depth interviews with 48 family planning clients and 24 providers from 24 public sector facilities in the Copperbelt Province of Zambia. Interviews were conducted in person, in a private setting, and in the preferred language of the participant. In-depth interviews were audio-recorded, translated and transcribed; the structured interview was entered electronically. Qualitative coding followed an inductive approach to identify key themes that resonate with the two groups of participants.

resultsWhile providers do not appear to prefer specific methods, some express strong views about the appropriateness of different methods for adolescents, and these views may shape the tenor and content of their counselling sessions. The study found a lack of comprehensive, method-specific side effects information, which likely contributes to method discontinuation. While two clients were pressured to self-inject, the more common scenario was failure to discuss SI entirely or in sufficient detail for clients to make an informed choice. Providers expressed concerns around the type of client for whom SI is appropriate, showing reluctance to offer self-care options to adolescents and women with less education.

conclusionFindings reveal the importance of reinforcing informed choice principles and monitoring the quality of contraceptive counselling when introducing new contraceptive methods and self-care innovations.