Comparing simulated client experiences with phone survey self-reports for measuring the quality of family planning counseling: The case of depot medroxyprogesterone acetate – subcutaneous (DMPA-SC) in Nigeria

Background : The quality of family planning services can have important implications for uptake and continued method use. The aim of this analysis is to examine aspects of quality for a new injectable contraceptive method, DMPA-SC (depot medroxyprogesterone acetate – subcutaneous, known as Sayana Press®), service provision and contraceptive services more broadly in Nigeria. Methods : We compared self-reports from follow-up phone surveys with users to simulated client interactions that were designed to measure the same concepts. Through mixed-methods, we sought to more deeply understand the biases associated with different data collection methods that ultimately lead to different conclusions regarding quality of contraceptive services, and to further assess to what extent these methods were suitable for detecting differences in quality across sub-groups using the case of married versus unmarried women. Results : We found that simulated clients reported lower levels of quality across all comparable quality indicators than phone survey respondents attending the same facilities. Both methods were able to detect differential treatment by marital status. Conclusions : A mixed-methods approach can provide differential insights into quality of family planning services, especially when aiming to understand both objective and subjective aspects of quality.