Community perspectives on family planning service quality among users and non-users: a qualitative study from two cities in Burkina Faso

Plain Language SummaryQuality of family planning services typically is captured from women visiting a family planning facility and thus misses the perceptions of women who may perceive quality as poor and choose not to visit a facility. This qualitative study collects focus group discussion data from women recruited at the community level to understand varying women's perceptions of family planning service quality. Different groups were undertaken with younger women, older women, married women, unmarried women, current non-users of contraception, and current users of contraception. A total of twenty focus groups were undertaken. Findings show that women discuss FP service quality in a variety of locations, depending on their age and marital status group. Perspectives on service quality for younger women are often informed by others' experiences whereas for the older women, they are formed by their own and others' experiences. Women reported the importance of provider interactions as a key element of service quality. This included the provider being respectful and welcoming, the quality of counseling the provider offered, that providers did not stigmatize clients, and that providers offered services that were private and confidential. Participants also valued short wait times for services, availability of methods, low cost or free methods and services, and the ability to remove a method when they wanted. Undertaking programs that address women's perceptions of quality can lead to improved services and ideally help programs to meet the family planning needs of all. BackgroundMost studies that focus on quality of family planning (FP) services collect data from facilities. These studies miss the perspectives of quality from women who do not visit a facility and for whom perceived quality may be a barrier to service utilization.MethodsThis qualitative study from two cities in Burkina Faso examines perceived quality of FP services from women who were recruited at the community level to avoid potential biases based on recruiting women at facilities. Twenty focus group discussions were undertaken with varying groups of women of different ages (15-19; 20-24; 25+), marital statuses (unmarried; married), and current modern contraceptive use experiences (current non-users; current users). All focus group discussions were undertaken in the local language and transcribed and translated into French for coding and analysis.ResultsWomen discuss FP service quality in a variety of locations, depending on their age group. Perspectives on service quality for younger women are often informed by others' experiences whereas for the older women, they are formed by their own and others' experiences. Two important aspects of service delivery emerge from the discussions including interactions with providers and selected system-level aspects of service provision. Important components of provider interactions relate to (a) the initial reception from the provider, (b) the quality of counseling received, (c) stigma and bias from providers, and d) privacy and confidentiality. At the health system level, discussions revolved around (a) wait time; (b) stockouts of methods; (c) costs of services/methods; (d) the expectation for tests as part of service provision; and (e) difficulties with method removal.ConclusionsTo increase contraceptive use among women, it is crucial to address the components of service quality they identify as related to higher quality services. This means supporting providers to offer services in a more friendly and respectful manner. In addition, it is important to ensure that full information is provided to clients on what to expect during a visit to avoid false expectations that lead to poor perceived quality. These types of client-focused activities can improve perceptions of service quality and ideally support use of FP to meet women's needs.