We sought to study how healthcare factors related to logistics, functional value and quality of interpersonal relations contributed to overall user satisfaction with family planning services (FPSs). The finding that approximately 80% of users reported being generally satisfied with the services provided by their clinics is in line with other studies [26,27,28,29].
Less is known about what clients perceive as quality care. A recent systematic review shows that clients were most likely to identify issues related to accessibility, client-centeredness and, to a lesser extent, equitability as key elements. Efficiency and effectiveness in care were less important. It is worth noting, however, that the majority of studies in the review were conducted in the USA . Our analysis indicated that issues related to efficiency (logistics) and effectiveness (functional values) were associated with overall satisfaction, while issues related to client-centeredness (interpersonal relations) were less important.
Our results are similar to those found in other Latin American countries, where patients have reported being highly dissatisfied particularly as regards the information offered by care providers on contraceptive methods, and the lack of opportunity to ask questions and clarify doubts. These results suggest that these factors are particularly important and shape the overall impression of services more strongly in Latin American populations than in developed countries .
Key results include the prominent role that reproductive history plays in contributing to higher satisfaction; notably, the highest odds ratio in our model was associated with having had more than two prior pregnancies. This lends credence to the theory that the satisfaction of users is strongly related to their expectations . Simply having utilized a contraceptive method when seeking to limit fertility represents a met expectation. Other indicators such as having the motives for visits addressed and being satisfied with the contraceptive methods provided also reinforce the hypothesis that meeting client expectations is a primary factor in their evaluation of services .
We found that the reproductive age group (20–35 years) reported significantly lower levels of satisfaction than the adolescent and > 35 groups. Socio-demographic factors that have previously been shown to influence patient satisfaction with health services include increased age and better health, although the literature is not conclusive and may not be applicable to outpatient FPSs;  one study found no association between age and reported satisfaction . We hypothesize that the decreased level of overall satisfaction with FPSs in this age group may be attributable to the higher expectations of its members due to a higher level of experience with FPSs and contraceptive methods. This result suggests that tailoring services to address specific client characteristics and needs is an important component in providing quality FPSs.
We did not find any statistically significant differences between men and women in the key independent variables analyzed. One reason could be the small number of men receiving health services in general, and reproductive health services in particular. This evidence suggests that health services have not created effective strategies for incorporating men into the system,  leaving the responsibility for fertility control with women [31, 32]. It is necessary to recognize men as enjoying reproductive rights and adapt FPSs to their needs .
While our study provides important insights, some limitations should be noted. One of them is the potential for courtesy bias, as surveys were administered within the clinics. In addition, users of public FPSs in Mexico may not have the resources that would allow them to exercise choice over the type and location of clinic they are using, particularly those associated with the Ministry of Health. Users of these clinics may have such low expectations that even if the service is poor, they evaluate it positively because it exceeds their expectations .
Although this study included both male and female users of FPSs, it is necessary to increase the sample size of men in order to obtain a more complete perspective on the differences between the sexes. Other key factors that could affect overall satisfaction, such as technical issues, are not included in this study; measuring them is essential for providing a deeper understanding of this topic.
It would be useful to conduct loosely structured interviews outside the clinic to obtain a more nuanced picture of client experiences at the clinic and more detailed opinions of quality and satisfaction. Additionally, broadening data collection to include the private sector would serve to complement the information in this study pertaining to the public sector, the principal provider of FP methods in Mexico.