Family Planning Clinics Through Women's Eyes and Voices: A Case Study from Rural Bangladesh

Abstract

At present Bangladeshs rural family planning program relies heavily on domiciliary services provided by the family welfare assistant. However as part of a strategy to deliver a more comprehensive package of essential health services the domiciliary system will gradually be de-emphasized and family planning will be provided through static clinics periodic satellite clinics and supply depots. To help program leaders develop strategies for this transition interviews were conducted in 1996 with 34 women from six rural villages who already rely on government and nongovernmental clinics for reproductive health services and client-staff interactions at these sites were observed. The issues that emerged from the interviews and site observations related more to power relations between clients and providers accountability and broad institutional policies than to technical skills standards and protocols. In five of the eight clinics at least some clients (especially the poorest women) were treated harshly and in a hierarchical manner by staff. In two clinics women were observed pleading for services. Although only one of the 13 women who requested IUD insertion had difficulty obtaining the device six of 10 women seeking IUD removal experienced problems. Medication was another source of conflict. Clients believed that staff were withholding and illegally selling drugs while staff viewed clients as pestering them for medications to which the women were not entitled. In general rural women tended to be less critical of the quality of the care they received than the researchers. Most clients were willing to overlook rude treatment long waits and unhygienic conditions maintaining that because they were poor they could not expect better care. Measures must be taken to ensure that poor rural women understand basic reproductive health know their rights and what to expect and can make informed decisions in utilizing health services.