Preparing for family planning in Jamaica in the 21st century

A quantitative goal of Jamaica's National Population is the achievement of replacement level fertility by the year 2000. The total fertility was 2.8 in 1997. Despite an increasing contraceptive prevalence, the total fertility rate has remained stable around 3, since 1989. Contraceptive use and fertility vary depending on area of residence, health region and age cohort. The contraceptive methods used based on reproduction intention are inappropriate. Contraceptive discontinuation is high. The failure of fertility to decline as predicted is due to a lack of factual information on side effects of contraception, health concerns and the ambivalence to the 2-child family as a norm by women in the reproductive age group. Additionally, the technical competence of providers and the quality of counselling need strengthening. The challenges for the 21st century include operationalising family planning into reproductive health sustainability as well as identifying needs.(AU)

Assessing family planning service-delivery practices: the case of private physicians in Jamaica

This report presents a study of the family planning service-delivery practices of private physicians in Jamaica. All 367 private physicians in Jamaica who offer family planning services, counseling, or referral were included in the survey. The study revealed that a client seeking services might be given a method by one provider and not by another, and that the methods clients use are likely to be influenced by the providers' preferences. Private physicians in Jamaica are in need of access to current international guidance on contraceptive methods and service practices. (AU)

Quality of care among Jamaican private physicians offering family planning services

The National Family Planning Board is the agency of Government empowered to prepare, carry out and promote family planning programs in Jamaica. The Board has prioritized the expansion and sustainability of family planning services in large part through encouraging the participation of the private sector. To enhance the availability and effectiveness of private physician family planning services, information was collected on the service practices of 90 percent of physicians, through face to face interviews. Bruce's framework was used to evaluate the findings of the study. The study indicated that: (1) A wide variety of contraceptives are available. (2) Basic equipment and adequate supplies are in place for the provision of services. (3) Provider bias, inapproriate contraindicators and process and scheduling hurdles exist. The major recommendations relate to the: (1) Revision of norms and guidelines for all contraceptives. (2) Continuation of contraceptive technology updates for private physicians. (3) Revision of legal/regulatory barriers which restrict access to some contraceptives for certain target groups (AU)

Quality of care in family planning clinics in Jamaica: Do clients and providers agree?

This paper uses data from 199 providers and 20 simulated clients at 50 public sector and Non Government Organization (NGO) health facilities islandwide in 1995 to compare the two groups' views on quality of care of family planning services. Each of the five components of quality of care studied can be improved in Jamaica. Nearly two-thirds of the simulated clients felt able to freely choose a contraceptive method; however, more adequate and appropriate information needs to be imparted to clients through improved counselling, including promotion of dual method use (against STD/HIV/AIDS and conception). The requirement that a woman must be menstruating to receive services has inadvertently resulted in many clients going away empty-handed (without counselling or condoms) when they visit family planning clinics. While providers generally treat clients well, training and service delivery practices need to be revised to improve the technical competence of providers. All of the providers would recommend these clients to others, compared to a little over half of the simulated clients. Both the providers and simulated clients said that privacy should be strengthened, particularly in small facilities in rural areas. Many of these aspects of quality of care are being improved in Jamaica's public sector health facilities. Managers can learn more about quality of care by seeking the knowledge, opinions and experiences of both providers and clients. (AU)