A multilevel analysis on the predictors of client satisfaction with family planning services in Ethiopia: evidence from the Ethiopian service provision assessment (ESPA) 2021/22

BackgroundEthiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.ObjectiveThe objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.MethodA multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021-22. A total of 2071 clients (level one) and 529 facilities (level two) were included.ResultsOverall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.ConclusionsHuman resource and professional development training and health system strengthening is recommended.