Perceptions of women regarding the quality of family planning services in low income urban areas of Karachi : an exploratory study

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Quality of care for family planning services is measured primarily at three levels; policy, client and service delivery. However, the definition of quality for health care is diverse; the definition given by The International Conference on Population and Development (ICPD), Program of Action (PoA) defines quality of care (QoC) for reproductive health (RH) as, "Ensure universal access for all women to a full range of high-quality and affordable health care, including sexual and reproductive health services". However, the Judith Bruce defines quality of care for family planning (FP) as "The way individual couples/clients are treated by the health system provided services". In addition Donna M. defines and links the quality with the health care delivery particularly in relation to family planning. As "The extent to which health services for populations increased the likelihood of desired health outcomes and is consistent with current professional knowledge". The slow pace of increase in Contraceptive Prevalence Rate (CPR) and more than half of the population in reproductive age (15-49 years) in Pakistan is indicative of an increase in future population growth. On the other hand, the high rate of discontinuation of FP method (37%), contraceptive switch (12%) , (7% in five proceeding time) resulting in unwanted pregnancies (9%). It is crucial to improve quality of health care for tilling in the gaps related to FP services provision, will address the need of women at local level and will also increase the CPR. This study will identify the gaps for the quality in FP services through the perception of local women who are FP current users and FP past users. Methodology: A qualitative exploratory study design was carried out during July to September 2016, to explore and understand the perceptions of married women of reproductive age who are family planning users and past-users regarding the quality in general, quality in healthcare and quality in family planning. Willows International Foundation was purposely selected because Willows model is based on the Willows International's vision of provision and access to accurate and up-to-date information and high quality services for FP and RH, through providing information, education and referral services so that women's reproductive needs and choices are fulfilled. FGDs were conducted and in depth interviews were conducted with MWRA availing FP services. The aim of this study was to identify the gaps in quality of services from the client's perspective to enable to bring a change in improving the CPR and continuation of FP method. Data were collected using a qualitative study design whereby four Focus Group Discussions (FGDs) were conducted with the married women of reproductive age. Similarly a total of twelve in-depth interviews were conducted with the MWRAs of the study areas. All the FGDs and in-depth interviews were conducted using separate guidelines specifically developed for the purpose. During the FGD pilot testing the guidelines women were unable to understand the concept of quality, we revised our guideline under three themes; i.e. quality in general, healthcare quality, FP quality. Findings: The analysis of FGDs and IDIs with married women of reproductive age revealed three major themes "Perception of women about "Quality", "Quality in Healthcare" and "Quality of FP". The first theme included five main categories, "Physical appearance", "cost", "durability", "role offate", and "do not harm". The second theme included four main categories, "physical environment", "cost", "bad behavior", and "do not harm". The third theme included six main categories, -physical environment", "cost", "bad behavior" "side effects", "satisfied and ideal FP" and "health educator role". All the main categories further included sub categories. Conclusion: MWRA perceive Quality for all the themes as; •Respectful treatment •Personal satisfaction •Complete and true information •Should not harm Majority of the women explained "high quality of care as being treated as a human being". From this study finding it is highlighted that service provision quality is poor due to bad behavior of providers, clients have not been provided with enough choices, and clients lack complete information, inadequate time given by the providers, cost variation between public/private sectors, incompetency of staff in terms of providing QoC according to WHO quality dimensions. In this study women expressed their need to use FP birth spacing methods but were not satisfied with the existing methods due to fear of side effects, lack of information on side effects, discomfort involved with provider's attitude, methods and services which they considered as unsafe, inequitable, inefficient, ineffective. Keywords*: Women Perspectives on Quality, Family Planning, and Low Middle income Countries

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