To provide high-quality care, service providers must understand and respect their clients' values, attitudes, and priorities concerning family planning (101, 252, 211). Because most family planning clients are women, service providers must have an ability to see "experiences, values, issues, and information from the point of view of the women whose lives are affected" (13).

From clients' point of view, not only the technical quality of services is important but so are other aspects, including privacy and confidentiality, competent counseling, friendly personnel, and the opportunity to make an informed choice about contraception. In a study of a family planning clinic in Santiago, Chile, women defined high-quality care as being treated well. Among the elements of quality that clients identified were hygienic conditions, prompt service, useful and accurate information, adequate time for consultations and counseling, opportunities for learning and personal growth, friendly and interested staff, and being treated as an equal (200).

Women are more likely to use family planning if they respect and have a positive relationship with service providers (10). Research shows that health care providers' attitudes and treatment of clients often determine which health services women use and even determine whether women seek services at all. For example, in Nepal service providers' poor treatment was one reason that women made little use of clinical family planning services. A study found that, when lower-status women visited clinics, they received less courtesy and less information than educated, middle-class clients. Women who were treated poorly discussed their bad experiences with friends and neighbors, and thus family planning services developed a bad reputation (177).

Service providers' treatment of women as clients also may affect how women feel about contraceptive methods. When women believe that the medical quality of services is good, and when they are treated with respect and empathy, minor side effects or problems with particular methods often become more tolerable (258). Satisfied clients are more likely to recommend family planning services to other women (31, 126). "The best and most effective publicity any program can achieve is that which flows by word of mouth," Miguel Trias of Colombia's PROFAMILIA has written. "The quality of the programs has to be perceived by our clients to be good enough to recommend to relatives and friends" (188).