Evaluation and Program Planning 83 (2020) 101861 Available online 15 August 2020 0149-7189/© 2020 Elsevier Ltd. All rights reserved. Lot quality assurance sampling: Information provided to female users of contraceptive methods regarding side effects Leticia Su´ arez-L´ opez a , Elvia de la Vara-Salazar a, *, F´ atima Estrada b , Lourdes Campero a a Reproductive Health Division, Center for Population Research, National Institute of Public Health. Mexico, Av. Universidad 655, Col. Santa María Ahuacatitl´ an, CP 62100, Cuernavaca, Morelos, Mexico b CONACYT – Instituto Nacional de Salud Pública, 7a. Cerrada de Fray Pedro de Gante #50, Col. Secci´ on XVI, Tlalpan, C.P. 14080, Ciudad de M´ exico, Mexico A R T I C L E INFO Keywords: Contraceptive methods Side effects Counseling Monitoring LQAS Mexico ABSTRACT Women need to receive accurate information on the proper use of contraceptive methods (CM). The objective of our analysis was to evaluate the quality of CM counseling in health institutions of the public sector using the Lot Quality Assurance Sampling (LQAS) technique. We specifcally analyzed whether health-service providers informed CM users of all the side effects they might experience, as specifed under the Mexican health-care regulations. Our results demonstrated that, among the four CM analyzed –the intrauterine device, hormonal injection, condom and subdermal implant– only the users of the subdermal implant received complete infor- mation on side effects. Our fndings thus indicate that the quality of family planning services in the institutions analyzed is defcient. We recommend that service providers be regularly trained in order to improve their performance and that LQAS methodology be adopted as an effective means of regularly monitoring the quality of health services in Mexico. 1. Introduction Family planning (FP) contributes to the well-being of families and the empowerment of women by offering the possibility of making informed decisions on the number and timing of children and of expe- riencing enjoyable sexual lives (World Health Organization [WHO, 2018]). Nearly 60 years after the establishment of a FP policy in Mexico, 72 % of women of reproductive age use modern contraception; of these, 75 % obtain their contraceptive methods (CM) from a Social Security institution or program (Hern´ andez, Murad´ as, & S´ anchez, 2015). According to several studies on the quality of FP services, particu- larly as regards CM counseling, offering users a positive experience has a strong impact on their acceptance and use of CM (Bruce, 1990; 1992; Canto De Cetina, Canto, & Ordo˜ nez Luna, 2001; RamaRao & Mohanam, 2003; RamaRao, Lacuesta, Costello, Pangolibay, & Jones, 2003; Abdel-Tawab & RamaRao, 2010; Jain, RamaRao, Kim, & Costello, 2012). Although it has been recognized that effective communication be- tween providers and users constitutes a service quality indicator and is signifcantly linked to benefts, the value of communication has yet to be fully appreciated. Various studies have demonstrated that health-care providers who take a more active role in counseling and develop a close and trusting relationship with users can help patients make informed, shared and appropriate decisions (Kruk et al., 2018; de la Vara-Salazar et al., 2018a; Jain & Hardee, 2018; Holt, Delendorf, & Langer, 2017, Organizaci´ on Mundial de la Salud, 2018), contributing markedly to the achievement of uninterrupted CM use. It has been observed that structured and detailed advice on the effectiveness and possible side effects (SE) of CM increases the rates of continuous use (Canto De Cetina et al., 2001; Am´ erico et al., 2013). It has also been noted that the possibility of making an informed decision on a specifc type of CM based on a clear understanding of its SE mini- mizes the likelihood of discontinuance (Bahamondes, Pinho, de Melo, Oliveira, & Bahamondes, 2011; Pierre & Clapis, 2010). Because certain methods can produce unpleasant sensations, it is important that FP counseling include an explanation of all potential adverse effects of CM and their approximate duration, as well as information on those that tend to disappear with consistent use (Espin´ os G´ omez, Balash Cortina, Barranco Castillo, Lertxundi Bara˜ nano, & Parrilla Paricio, 2008; The American Collage of Obstetrician & Gynecologist, 2011). A variety of methods have been used internationally to evaluate the quality of FP services (Holt, Zavala, Quintero, Hessler, & Langer, 2019); * Corresponding author at: Reproductive Health Division, Center for Population Research, National Institute of Public Health. Mexico, Av. Universidad 655, Col. Santa María Ahuacatitl´ an, CP 62100, Cuernavaca, Morelos, Mexico. E-mail address: edelavara@insp.mx (E. de la Vara-Salazar). Contents lists available at ScienceDirect Evaluation and Program Planning journal homepage: www.elsevier.com/locate/evalprogplan https://doi.org/10.1016/j.evalprogplan.2020.101861 Received 22 March 2019; Received in revised form 25 October 2019; Accepted 30 July 2020