“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

This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women’s motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15–19 and 20–24 and ever married women ages 15–24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women’s demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women’s (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence

"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.

This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women's motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15-19 and 20-24 and ever married women ages 15-24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women's demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women's (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence

Characteristics of female respondents aged 15 to 49 and their closest female friends age 15 to 49 in Burkina Faso^b'*'.

Characteristics of female respondents aged 15 to 49 and their closest female friends age 15 to 49 in Burkina Fasob'*'.</p

Safety of most recent reported induced abortion among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Faso^b'*'.

Safety of most recent reported induced abortion among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Fasob'*'.</p

Induced abortion incidence (per 1,000) among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Faso by background characteristics.

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One-year annual incidence of induced abortion per 1,000 women aged 15–49 for respondents and friends in Burkina Faso by background characteristics, 2020.

One-year annual incidence of induced abortion per 1,000 women aged 15–49 for respondents and friends in Burkina Faso by background characteristics, 2020.</p

Details of most recent reported induced abortion among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Faso^b'*'.

Details of most recent reported induced abortion among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Fasob'*'.</p

Percent of induced abortions that were unsafe among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Faso by background characteristics.

Percent of induced abortions that were unsafe among female respondents aged 15 to 49 and their closest female friends aged 15 to 49 in Burkina Faso by background characteristics.</p

Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data

International audienceLittle is known about postabortion care (PAC) services in Burkina Faso, despite PACu2019s importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. Methods: Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15u201349 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by womenu2019s background characteristics. Results: PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. Conclusions: Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary levelu2014the main source of care for many womenu2014which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly

Characteristics of female respondents aged 15 to 49 overall and by whether they report having at least one close female friend in Burkina Faso.

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