“I Got What I Came for”: A Qualitative Exploration into Family Planning Client Satisfaction in Dosso Region, Niger

Abstract

Background Client satisfaction is recognized as an important construct for evaluating health service provision, yet the field of family planning (FP) lacks a standard approach to its measurement. Further, little is known about satisfaction with FP services in Niger, the site of this study. This study aims to understand what features of FP visits were satisfactory or dissatisfactory from a woman’s perspective and reflect on the conceptualization and measurement of satisfaction with FP services. Methods Between February and March 2020, 2720 FP clients (ages 15–49) were interviewed across 45 public health centers in Dosso region, Niger using a structured survey tool. The focus of this paper is on a random sub-sample of 100 clients who were additionally asked four open-ended questions regarding what they liked and disliked about their FP visit. Responses were audio-recorded, translated into French, transcribed, translated into English, coded, and analyzed thematically. Results FP clients described nine key visit attributes related to their satisfaction with the visit: treatment by the provider, content of the counseling, wait time, FP commodity availability, privacy, cleanliness/infrastructure, visit processes and procedures, cost, and opening hours. The reason for FP visit (start, continue, or change method) was an important driver of the dimensions which contributed to satisfaction. Pre-formed expectations about the visit played a critical role in shaping satisfaction, particularly if the client’s pre-visit expectations (or negative expectations) were met or not and if she obtained what she came for. Conclusion This study makes a significant contribution by identifying visit attributes that are important to FP clients in Dosso region, Niger, and highlights that satisfaction with FP services is shaped by more than just what occurs on the day of service. We propose a conceptual framework to understand satisfaction with FP services that can be used for future FP programming in Niger.

“You could find a good or a bad provider, I would say you just have to go and see”: A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso

“…Bobo Dioulasso, unmarried users ages [20][21][22][23][24] Many respondents sought to use the calendar method if they did not want to go to the health facility because of expectations of negative treatment as reported by their friends or family. However, the calculations needed to use such 'natural' methods effectively were sometimes perceived to be too complex for uneducated women.…”

“…Banfora, married users ages [15][16][17][18][19][20][21][22][23][24] In addition, when asked what women who did not want to visit a facility would do, a number of respondents talked of going to visit informal vendors who often sold unregulated pills and products which they claimed could prevent pregnancy.…”

“…Bobo Dioulasso, unmarried non-users ages [20][21][22][23][24] Importantly, in some cases, married women felt obliged to (re)visit the facilities or find another facility to visit despite their or their peers' negative experiences as they felt they had no choice. They acknowledged that they still needed family planning, since they are sexually active and want to delay/avoid childbearing, and thus felt obliged to accept the risk of poor treatment.…”

“…Bobo Dioiulasso, unmarried users ages [20][21][22][23][24] Others felt that as long as they got what they came for-i.e., a contraceptive method-they were prepared to deal with poor service quality and, in particular, an unfriendly welcome. It appeared that often, perceptions of service quality were so low, that women simply managed their expectations and put up with the poor treatment to obtain the FP product they desired.…”

“…Typically, the quality of FP services is defined in relation to services and commodities available at a facility as well as in relation to perceived provider competence, the existence of follow-up mechanisms (for example for LARC removal), and client-provider relations [19,20]. For young and unmarried women in Burkina Faso and elsewhere, provider interactions have been documented as being particularly key to determining client appraisals of service quality and the intention to revisit facilities [21][22][23]. The fear of stigmatization of young unmarried sexually active women by providers in cultural contexts where premarital relations are taboo, and childbearing is valued, has been widely documented as leading to the non-use of services [23,24] and confirmed by the new evidence presented here.…”