Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya.
BACKGROUND
Nearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied.


METHODS
We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice.


RESULTS
When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality.


CONCLUSIONS
Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA. sirina.keesara@uchospitals.edu.
Sirina R
SR
Keesara
African Population Health Research Center, Nairobi, Kenya. atienopam@yahoo.com.
Pamela A
PA
Juma
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA. Cynthia.harper@ucsf.edu.
Cynthia C
CC
Harper
D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003268:Contraception Behavior; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D010362:Patients' Rooms; D010465:Perception; D049590:Postpartum Period; D017149:Private Sector; D017150:Public Sector; D036301:Qualitative Research; D014505:Urban Population; D055815:Young Adult