Understanding patient perspectives on the quality of family planning care: a qualitative study

In 2024, the United States (US) Office of Population Affairs updated federal guidelines for the provision of quality family planning (QFP) services, outlining six guiding principles-person-centered, evidence-based, inclusive, accessible, sex- and body-positive, and trauma-informed care-to promote equitable, high-quality sexual and reproductive health (SRH) services. This study explores patients' SRH care preferences and the extent to which asserted preferences are aligned with the systems-level definition of quality advanced in the QFPs.

We conducted a secondary qualitative analysis of data; the original study used a qualitative methodology where data were collected in a series of semi-structured interviews between 2018 and 2021. Interview participants were recruited through a survey conducted at publicly supported sexual and reproductive health clinics in Arizona and Iowa. Eligible individuals were those who opted into qualitative follow-up after taking a baseline survey at publicly funded sexual and reproductive health clinics in Arizona and Iowa (n = 80). We completed a content analysis of participant interview responses to identify themes that pertained to several domains of sexual and reproductive health care quality and preferences.

We found substantial overlap between participants' preferences for care and the 2024 Quality Family Planning guiding principles. Participants described their preferences for and experiences of care that were person-centered (feeling respected and listened to), inclusive (identities respected and considered), accessible (clinic wait times and appointment availability), sex-positive (were not judged or stigmatized), and confidential. Evidence-based and trauma-informed care, quality counseling, and informed consent were less prevalent in our findings, though largely because they were not assessable by patients or were not explicitly covered in the interviews.

Patient preferences are largely in keeping with the recommendations for providing quality family planning services, especially around the domains of person-centered care and accessibility. These guidelines should be adopted by clinics across the country to ensure that patients receive the highest quality family planning care possible and be able to achieve their reproductive autonomy.