Family planning clinics through women's eyes and voices: a case study from rural Bangladesh
Schuler, S.R.; Hossain, Z.
International Family Planning Perspectives 24(4): 170-175
1998
ISSN/ISBN: 0190-3187 DOI: 10.2307/2991975Document Number: 281745
It is noted that the voices and views of clients are an essential, but often neglected, aspect in initiatives to improve the quality of care provided by family planning and reproductive health programmes. In anticipation of an increased emphasis on clinic-based services in Bangladesh's national family planning programme, a small qualitative study was undertaken in six villages in late 1996 (n=34 women). In-depth interviews were conducted with 34 clients of six government and two non-government clinics, and researchers spent one day at each clinic observing how providers and clients interacted. Hierarchical modes of interaction and poor communication dominated many of the encounters, and women had to beg for services in some clinics. Providers appeared to selectively apply interpersonal skills and common courtesy; rudeness to clients was not merely a reflection of ignorance, since the paramedics appeared to know the basic principles of counseling. Limited access to medication and often arbitrary ways of determining when to dispense it created suspicion and tension between providers and clients. Most clients expressed a willingness to overlook rude treatment, long waits and unhygienic conditions, saying that because they were poor, they could not expect better care and had no service alternatives. Technical solutions, such as training in counseling, may not be enough to improve the quality of care provided in clinics in rural Bangladesh. Institutional policies, norms and incentives need to become more client-oriented if the transition from in-home delivery to clinics is to be a success.