This dissertation sought to learn whether clients of different racial, ethnic and language backgrounds have different family planning service experiences or different service preferences. First, a review of the US literature on family planning service quality was conducted. Second, a quantitative analysis was carried out to test for racial, ethnic and language group differences in low income women's perceptions of reproductive health service quality and service delivery preferences. The data came from a telephone survey with a nationally representative sample of 1,852 low income African-American, Latina, and White women. Logistic regression analysis was used. Third, forty in-depth interviews were conducted with women who were recent family planning clients. Women were recruited from two family planning clinics in the San Francisco Bay Area.
In the quantitative phase, racial, ethnic and language group differences in quality perceptions and service delivery preferences were identified. Spanish-speaking and English-speaking Latinas were more likely than Whites to prefer a female clinician at reproductive health visits and to prefer provider continuity across visits. English-speaking Latins and African-Americans were more likely than Whites to prefer reproductive health service delivery at a site delivering general health care.
There were no group differences in clients' perceptions of the interpersonal treatment at their most recent reproductive health visit or in clients' reports about whether they were informed about contraceptive options; however, Spanish-speaking and English-speaking Latins were less likely than Whites to rate the facility environment or the patient-centeredness at their most recent visit optimally. African-Americans were more likely than Whites to report ever being pressured by a health care provider to adopt a contraceptive method.
The qualitative study indicated that women evaluated the quality of their family planning care considering nine factors: the information provided, whether their autonomy was respected, accessibility, how personalized services were, how caring providers seemed, the attention paid to their comfort, technical quality, organizational factors, and the outcome of the visit. There were few racial, ethnic, or language group differences in the factors women considered important when receiving care.
These results can inform future research on family planning service quality and future service delivery improvement efforts.