RESUMO
Through linkage of a Demographic and Health Survey to a situation analysis, this article explores whether current contraceptive use in Peru is affected by the service environment in which a woman resides. The investigation focuses explicitly on the impact of the quality of family planning services and finds that, net of personal and household characteristics, a significant, albeit small, effect exists for one specification of quality in the total sample and for the other specification a nearly significant (p = .053) effect exists. The analysis reveals that contraceptive prevalence would be 16 to 23 percent greater if all women lived in a cluster with the highest quality of care compared with the lowest. Methodological problems that arise in measuring quality of care at the cluster level and in linking quality to individual contraceptive use are also addressed.
Assuntos
Comportamento Contraceptivo , Países em Desenvolvimento , Serviços de Planejamento Familiar , Garantia da Qualidade dos Cuidados de Saúde , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Peru , Controle da População , Meio SocialRESUMO
This report reviews the experience of the World Fertility Surveys and the Demographic and Health Surveys (DHS) in collecting community-level data on family planning. It assesses the validity of the community data for Peru that were collected via a service availability module, much like that which is used for the DHS, through a comparison with data from the Situation Analysis. The analysis indicates that the knowledgeable informant, the main source of information about family planning in each community for the service availability module, may not be an accurate source of data. Information about the availability of family planning services is more reliable when it is obtained by means of visits to service sites. However, given cost considerations, sampling problems, and analysis issues, routine linkage of Situation Analyses to household surveys such as the DHS is not recommended at this time.
PIP: Using data from the 1992 Demographic and Health Survey (DHS) in Peru, population researchers compared family planning data obtained by knowledgeable informants with family planning data from visits to health facilities to assess the validity of community data. The data were based on a total number of 239 clusters. 92.5% of the responses about the presence of hospitals were consistent. The situation analysis (SA) field team found three hospitals, while the knowledgeable informants said that 21 hospitals existed within a 5 km radius. 69% of responses about the presence of clinics and medical posts were consistent. The SA field team found 95 clinics or medical posts, while the knowledgeable informants said that there were 123. The consistency rate for pharmacies was 77%. The field team identified 23 pharmacies, while the informants claimed that there were 67. 60.6% of responses by the informants about the presence of any health provider were consistent with information obtained from an SA questionnaire. The consistency rate was highest for midwives (93.2%) and lowest for birth attendants (54.7%). These findings show that the knowledgeable informant in Peru is often not a reliable source of family planning data. Yet the service availability module assumes that the key informant is the main source of family planning information in each community. The findings also suggest that field visits to service delivery points generate more reliable family planning data. Nevertheless, the researchers did not recommend routine linkage of SAs to household surveys (e.g., DHS) due to relatively high costs, sampling problems, and analysis issues.