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

Lisa M Calhoun,1– 3 Amelia Maytan-Joneydi,1 Abdoul Moumouni Nouhou,4 Lenka Benova,3 Thérèse Delvaux,3 Thomas van den Akker,2,5 Balki Ibrahim Agali,4 Ilene S Speizer1,6 1Carolina Population Center, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Athena Institute, Vrije Universiteit, Amsterdam, Netherlands; 3Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; 4GRADE Africa, Niamey, Niger; 5Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands; 6Department of Maternal and Child Health, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Lisa M Calhoun, Carolina Population Center, the University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, Chapel Hill, NC, 27516, USA, Email lisa_calhoun@unc.eduBackground: 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.Keywords: client satisfaction, family planning, contraception, Niger