[Quality of care in family planning clinical services in Latin America]. / Calidad de atencion en los servicios clinicos de planificacion familiar en America Latina.

PIP: Quality of care in family planning is a difficult concept to measure because of the multitude of factors contributing to it and the subjective nature of many of them. Because family planning programs were developed largely in response to rapid demographic growth, their evaluation has concentrated on fulfillment of quantified goals such as numbers of new users, coverage, or prevalence. Such measures give no indication of the relative satisfaction or dissatisfaction of users. Family planning programs seeking high volume tend to have many new acceptors with low continuation rates, and a choice of methods limited to those considered highly effective and easy to distribute. In most Latin American programs, only oral contraceptives and surgical sterilization have high prevalence rates. In recent years, however, community pressure for greater attention to users needs and disappointment with results of programs oriented to obtaining high rates of new users have prompted greater attention top satisfaction of family planning clients and to quality of services. A recent review identified 6 crucial elements in determining the quality of family planning care: 1) free and informed selection of methods 2) information provided to clients 3) technical competence of service providers 4) interpersonal relations between clients and workers 5) mechanisms to promote continuation of use and 6) adequate provision of additional services. This work surveys the quality of family planning services in Latin America, using these 6 factors as a point of departure. The current situation, the ideal and minimal acceptable levels, and the most promising strategies for achieving improvements are assessed for each factor. Free selection of contraceptive method is restricted in most Latin American family planning programs because access is limited to a few methods, because inadequate information is provided to users, because high prices of some methods limit accessibility, or because some methods are considered inappropriate for particular clients or populations. The information provided to clients may be incomplete or biased, the personnel providing it may be inadequately trained, information provided by different types of workers may be incoherent of conflicting, or information provision may be neglected once the method has been chosen. Great regional differences have been found in the technical competence of family planning workers. Physicians working in family planning are usually technically competent for the most common techniques but often lack adequate training in other methods. Interpersonal relations often show a lack of concern for the needs of the client, a lack of warmth, and lack of respect for elementary modesty and privacy. Operational studies can be of great use in comparing results of different strategies to improve the quality of care on contraceptive acceptance and continuation rates.^ieng