BACKGROUND Though modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women's perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision. METHODS In-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically. RESULTS Overall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling. CONCLUSIONS There is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women's needs.

中文翻译：

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调查计划生育咨询作为常规产前护理的一部分的质量及其对尼泊尔妇女产后避孕方法选择的影响。

背景技术尽管尼泊尔已婚妇女使用现代避孕药具的比例从1996年的26％增长到2016年的43％，但在产后妇女中仍然较低。产前保健（ANC）和分娩时计划生育咨询（FP）的整合可能会增加产后避孕药的使用。这项研究调查了非国大访问期间提供的计划生育咨询服务的质量，以及妇女对其协助产后计划生育（PPFP）决策的有效性的看法。方法对接受干预的六家公立医院之一中的至少24名孕妇进行了至少2次ANC访视的深度访谈（IDI），这些干预措施旨在将FP咨询纳入产妇护理服务并引入产后宫内节育器在产后立即。收集IDI数据作为对此干预过程进行评估的一部分。使用最大变异抽样选择女性代表不同的社会人口统计学特征。对IDI进行录音，用尼泊尔语逐字记录，然后翻译成英语。数据使用Bruce-Jain护理质量框架进行组织，并进行专题分析。结果总体而言，根据患者的期望和与提供者互动的经验以及所提供的FP方法，ANC期间FP咨询的质量不能令人满意。尽管有兴趣，大多数妇女报告说他们没有得到有关FP的详尽信息，其中约三分之一的妇女说她们没有得到关于PPFP的任何咨询服务。对咨询服务不满意的原因包括环境非常拥挤，提供者的时间短，提供者不可用，等待时间长，ANC服务的天数有限以及缺乏与FP相关的全面信息，教育和咨询（IEC）材料。在计划生育咨询顾问的陪伴下访问医院的妇女表示，计划生育咨询的质量更高。结论迫切需要重新审视ANC访问期间PPFP的咨询形式，相应的IEC材料，咨询设置，并加强可用性和与提供者的互动，以提高ANC访问期间FP咨询的质量，经验和满意度。 。还需要改善基础设施和人力资源，以充分满足妇女的需求。