Quantifying Satisfaction: An Analysis of Family Planning Services for Married Women (15–49) in Karachi’s Private Clinics
Quality of Care in Private Family Planning Services: A Karachi Study
Keywords:
Client satisfaction, family planning, contraceptive methods, reproductive health, cross-sectional surveyAbstract
Background:
Client satisfaction is a vital component of quality reproductive healthcare, influencing both contraceptive uptake and continued use. In Pakistan, despite growing reliance on the private health sector, limited research has explored client perspectives, especially among married women in urban settings. This study aims to assess satisfaction levels among married women of reproductive age (15–49 years) receiving family planning (FP) services at private clinics in Karachi.
Methods:
A cross-sectional client exit survey was conducted across six private FP clinics located in different urban areas of Karachi. A total of 600 married women (100 per clinic) were interviewed using a structured questionnaire that captured socio-demographic data, FP method uptake, and satisfaction levels on an 11-point Likert scale. Descriptive statistics were computed, and non-parametric tests—including the Kruskal-Wallis and Mann-Whitney U tests—were applied to compare satisfaction across clinics.
Results:
The findings revealed high overall satisfaction with FP services. Nearly 89% of respondents rated their satisfaction between 8 and 10, with DHA receiving the highest rating (100% scored 10), and Korangi displaying the most variation in satisfaction. Statistically significant differences were observed across clinics (Kruskal-Wallis H = 223.91, p < 0.001). DHA significantly differed from all other clinics (p < 0.001 in each pairwise comparison), indicating exceptional service quality. Korangi also differed significantly from most clinics, suggesting inconsistencies in service delivery. Non-significant differences were found between PECHS, Gulshan, New Karachi, and Nazimabad in some comparisons, implying a relatively uniform standard of service among these sites.
Conclusion:
While client satisfaction with private FP services in Karachi is generally high, substantial differences exist between clinics. Clinics such as DHA and New Karachi exemplify best practices, whereas facilities like Korangi require targeted improvements. These results underscore the importance of continuous quality monitoring and using client feedback to inform policy and programmatic decisions.
References
Andaleeb SS. Service quality perceptions and patient satisfaction: a study of hospitals in a developing country. Soc Sci Med. 2001;52(9):1359–1370. doi: 10.1016/S0277-9536(00)00235-5.
Baltussen R, Ye Y, Haddad S, Sauerborn R. Perceived quality of care of primary health care services in Burkina Faso. Health Policy Plan. 2002;17(1):42–48. doi: 10.1093/heapol/17.1.42.
Blanc AK, Curtis SL, Croft TN: Monitoring contraceptive continuation: links to fertility outcomes and quality of care. Stud Fam Plann 2002, 33(2):127-140.
Blanc AK, Curtis SL, Croft TN: Monitoring contraceptive continuation: links to fertility outcomes and quality of care. Stud Fam Plann 2002, 33(2):127-140.
Bruce J: Fundamental elements of the quality of care: a simple framework. Stud Fam Plann 1990, 21(2):61-91.
Cleland, J., S. Bernstein, A. Ezeh, A. Faundes, A. Glasier, and J. Innis. 2006. “Family Planning: The Unfinished Agenda.” The Lancet 368(9549):1810-1827.
Donabedian, A. 1988. “The Quality of Care: How Can It be Assessed?” JAMA 260(12):1743-1748.
Duong D, Binns CW, Lee AH, Hipgrave DB. Measuring client-perceived quality of maternity services in rural Vietnam. Int J Qual Health Care. 2004;16(6):447–452. doi: 10.1093/intqhc/mzh073.
Haddad S, Fournier P, Potvin L. Measuring lay people’s perceptions of the quality of primary health care services in developing countries. Validation of a 20-item scale. Int J Qual Health Care.1998;10(2):93–104.
Howard L. Sobel, Dale Huntington, and Marleen Temmerman. Quality at the centre of universal health coverage. Health Policy and Planning, 2015, Vol. 0, No. 0.
Hulton LA, Matthews Z, Stones RW. Applying a framework for assessing the quality of maternal health services in urban India. Soc Sci Med. 2007;64(10):2083–2095. doi: 10.1016/j.socscimed.2007.01.019.;
Jain, Anrudh K. Fertility reduction and the quality of family planning services. Stud Fam Plann. 1989; 20(1):1–16.
National Institute of Population Studies (NIPS) and ICF International, Pakistan Demographic and Health Survey 2012-13, National Institute of Population Studies (NIPS), Islamabad, Pakistan; ICF International, Calverton,Md, USA, 2013.
Petruney T, Wilson LC, Stanback J, Cates Jr W. Family planning and the post-2015 development agenda. Bull World Health Organ. 2014;92:548–548A.
Population Reference Bureau, “World Population Data Sheet,” 2013, http://www.prb.org/Publications/Datasheets/2012/worldpopulation-data-sheet.aspx.
Saumya RamaRao and Raji Mohanam, Studies in Family Planning Volume 34, Issue 4, pages 227–248, December 2003
Singh S, Darroch JE, Singh S, Darroch JE. Adding it up: Costs and benefits of contraceptive services - Estimates for 2012. New York: Guttmacher Institute and United National Population Fund (UNFPA); 2014.
Stenberg K, Axelson H, Sheehan P, Anderson I, Gülmezoglu AM, Temmerman M, Mason E, Friedman HS, Bhutta ZA, Lawn JE, et al. Advancing social and economic development by investing in women's and children's health: a new Global Investment Framework. The Lancet. 2014;383:1333–54.
Strobino, D., M. Koenig, and H. Grason. 2000. Approaches and Indicators for Measuring Quality in Region VIII Family Planning Programming. Baltimore, MD: Women’s and Children’s Health Policy Center, Johns Hopkins School of Public Health.
Tumlinson et al. Validity of Standard Measures of Family Planning Service Quality: Findings from the Simulated Client Method. Stud Fam Plann. 2014 December ; 45(4): 443–470. doi:10.1111/j.1728-4465.2014.00007.x.
UNDP, The Real Wealth of the Nations: Pathways to Human Development, 2014.
Williams T, Schutt-Aine J, Cuca Y: Measuring Family Planning Service Quality through Client Exit Interviews. International Family Planning Perspectives 2000, 26(2):9.
World Health Organization. Ensuring Human Rights in the Provision of Contraceptive Information and Services: Guidance and Recommendations [Online]. Geneva: World Health Organization; 2014.
Flack VF, Afifi AA, Lachenbruch PA, Schouten HJA: Sample size determinations for the two rater kappa statistic. Psychometrika 1988;53:321–5
Bujan MA, Baharum N: Guidelines of the minimum sample size requirements for Cohen’s Kappa. Epidemiology Biostatistics and Public Health 2017, Volume 14, Number 2
RamaRao, S., & Mohanam, R. (2003). The quality of family planning programs: Concepts, measurements, interventions, and effects. Studies in Family Planning, 34(4), 227-248.
DOI: 10.1111/j.1728-4465.2003.00227.
Biggs, M. A., Gould, H., & Foster, D. G. (2010). Understanding why women seek abortions in the US. BMC Women’s Health, 13, Article 29. DOI: 10.1186/1472-6874-13-29
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Wajahat Hussain Shamsi, Pro. Dr. Rana Saba Sultan, (Retd), Dr Ambreen Fazal (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Journal of Women and Child Health (JoWaCH) adheres to the CC BY 4.0 license, which is a Creative Commons Attribution 4.0 International License. For comprehensive information, we kindly request that you refer to the full license legal code. JoWaCH employs a non-exclusive license agreement for the purpose of open-access publication. In the context of open access publishing, the authors maintain the copyright of their work while also granting the journal the rights to publish and distribute it, while retaining the primary academic use rights. This practice facilitates the optimal use and dissemination of the work, while also guaranteeing proper attribution to the original source. The handling of manuscript content shall be conducted with confidentiality, with the exception of cases involving review processes and investigations related to potential misconduct, plagiarism, and duplicate/redundant or overlapping publications, in accordance with the guidelines provided by the Committee on Publication Ethics (COPE) COPE Guidelines.
JoWaCH is prohibited from disseminating content derived from previously published scientific work without obtaining proper authorization. Obtaining permission from the copyright holder, who may be either the author(s) or the publisher, is necessary in cases where the copyright holder is the publisher, for any work you want to use.
While it is acceptable to use a small amount of a work, obtaining permission from the copyright owners is necessary for a significant extraction.
The use of unmodified or little modified tables, graphs, and artworks (whether they are the user's own work previously published elsewhere or created by another copyright holder) necessitates obtaining permission.
Tables, graphs, charts, and artworks that have been fully redesigned and rebuilt, and include proper reference of the source, do not need obtaining permission.
JoWaCH facilitates unrestricted access to journal material for readers, necessitating the imposition of membership fees. The journal operates on a self-sustaining financial model and does not rely on support from other sources. The procedure of publishing is contingent only upon the financial resources of the publisher. The readers have unrestricted access to the information on the journal website.
