Factors affecting quality of care in family planning clinics: A study from Iran

Background. Despite good contraceptive coverage rates, recent studies in Iran have shown an alarmingly high incidence of unplanned pregnancy. Objective. To determine factors affecting quality of family planning services, a cross-sectional study was performed from June to August 2006 on women visiting urban Primary Health Care clinics in a provincial capital in western Iran. The primary focus of the study was on provider-client interaction. Method. We used a slightly edited version of a UNICEF checklist and a convenient sampling method to assess quality of care in 396 visits to the family planning sections at 25 delivery points. Results. Poor performance was observed notably in Counselling and Choice of method sections. In logistic regression analysis, the following factors were found to be associated with higher quality of care: provider experience OR (odds ratio) = 1.9, CI0.95 (confidence interval) = 1.2-3.0, low provider education (OR = 6.7, CI0.95 = 4.0=10.8), smaller workload at the clinic (OR = 3.7, CI0.95 = 2.0-6.7), and 'new client' status (OR = 4.2, CI0.95 = 2.6-6.7). Conclusion. This study identified the issues of counselling and information exchange as the quality domains in serious need of improvement; these areas are expected to be the focus of future training programmes for care providers. Also, priority should be given to devising effective supervision mechanisms and on-the-job training of senior nursing and midwifery graduates to make them more competent in delivering basic family planning services. © The Author 2008. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved