Abstract

PIP: This study examined quality of care (QOC) among a sample of 378 women from two low-income communities (Sefakoy and Halkali in Kucukcekmece District) in Istanbul, Turkey, in 1992. Data were obtained from questionnaires and site visits with structured checklists. Istanbul's TFR was 2.2 in 1990, but fertility varies within the city by socioeconomic factors. The growth rate is 4.5%. Sefakoy has had a home visitor project since 1991 that trains community women to serve as family planning counselors and providers. Halkali has a few government family planning service sites, but no home visit program. The sample of women had a mean age of 31.5 years. 66% had completed primary school. 90% were housewives. The Sefakoy women scored significantly higher on the SES index. Among ever users, the most recently used contraceptive method included 41.5% for the IUD, 29.9% for condoms, and 18.0% for the pill. 38.0% of current users relied on an IUD, 19.4% used condoms, and 14.6% used withdrawal. Over 85% reported joint decisions for fertility issues. Findings indicate that trained women from the community are competent to deliver high-quality family planning information and counseling. In contrast, doctors and nurses in health settings scored low on the QOC index. The highest QOC scores were found among community workers and private doctors. Multivariate analysis reveals that women with more education reported better information and counseling. Quality scores varied by type of family planning method. The best information and counseling occurred among women who accepted the pill, followed by spermicides, the IUD, and condoms. Constraints to public family planning services were limited hours of operation, inadequate training, limited method choice, supply problems, limited IEC, inadequate record keeping, and lack of proper equipment and procedures for assuring infection control.