Quality of family planning services in Mexico: The perspective of demand

Abstract

IntroductionFamily planning (FP) is one of the key services provided by health care systems. Extending beyond matters of sexual and reproductive health, its area of influence impacts directly on the development of individuals and nations. After 60 years of intense FP activities in Mexico, and in light of recent restructuring of health service supply and financing, services need to be assessed from a user perspective.ObjectiveBased on a comprehensive conceptual framework, this article assesses the quality of the FP services provided by the Mexican Ministry of Health (MoH). Analysis considers not only accessibility and availability but also the users’ perceptions of the care process, particularly as regards the interpersonal relations they experience with staff and the type of information they are provided.Material and methodsThis study used a descriptive, qualitative design based on maximum variation sampling in six Mexican states. It included visits to 12 clinics in urban and rural areas. Thematic analysis was performed on 86 semi-structured interviews administered to FP service users.ResultsWhile access was described by users as “easy,” their experiences revealed normalized barriers. One of our key findings referred to inverse availability, meaning that the contraceptive methods available were generally not the ones preferred by users, with their selection therefore being shaped by shortage of supplies. Challenges included disrespect for the free choice of FP users and coercion during consultations for contraception post obstetric event. Finally, information provided to users left considerable room for improvement.ConclusionsAfter six decades of FP service supply, results indicate a series of quality issues that may lie at the heart of the unmet demand reported in the literature. Based on a comprehensive conceptual scheme, the present study analyzes the quality of services, highlighting areas for improvement that should be considered by the MoH in future efforts.

Assessing the continuum of care for maternal health in Mexico, 1994–2018

“…Sixth, we have explored some objective indicators of quality of care focused on the care process, but have not provided evidence on subjective indicators of quality; however, prior studies have shown that large populations receiving reproductive health services in Mexico perceive that interactions with health personnel are inadequate. 48 , 49 Regardless of the achievements depicted by our results, the ability to improve health care is also dependent upon the performance of health personnel. Finally, our data on postnatal care are limited.…”

Mexico’sProsperaProgram and Indigenous Women’s Reproductive Rights

“…This response may have been due to me being an outsider; nevertheless, such contradictions suggest a normalization of program pressures and an internalization of the program discourse (cf. Torres-Pereda, Heredia-Pi, Ibáñez-Cuevas, & Ávila-Burgos, 2019).…”

“…Dansereau et al (2017), in focus groups in some of Chiapas’ poorest municipalities, including five Indigenous communities, found that participants described similar outstocks of hormonal methods and held misconceptions about their side effects, with some citing health care workers as their source of information. Torres-Pereda et al (2019), in interviews with mestizo participants in six Mexican states, found evidence of an “inverse availability,” a shortage of preferred methods coupled with the availability of the least preferred methods. Participants reported that pressure to choose the IUD was particularly intense during post obstetric events and especially in urban clinics, sometimes resulting in its forceful insertion.…”

Access, Quality of Family Planning Service, and Unmet Need: A Systematic Review

“…This is because it is not uncommon for reverse availability to occur in the quality of health services, which means that the available contraceptive methods are generally not preferred by users, this is due to a lack of supply and causes unmet need. The government must also be wise in ensuring that family planning activities cover every nook and cranny (Bellows et al, 2017;Chukwuji et al, 2018;Torres et al, 2019).…”

“…The availability of contraception must be adjusted to the demands and needs of the community in order to increase the use of contraception so as to reduce the incidence of unmet need. In addition, outreach efforts must be targeted according to contraceptive requests from the public, especially those hampered by poverty levels (Bellows et al, 2017;Torres et al, 2019;Tappis et al, 2015).…”