Utilization, acceptability, and satisfaction regarding reproductive health services at rehabilitated community clinics in climate disaster prone chars in Bogura: A mixed-method research among women of reproductive age

Abstract

Background: Bangladesh reduced its maternal mortality ratio to 115 per 100,000 live births in 2023 but remains above SDG target. Women in char areas consistently face compound barriers to reproductive health (RH) services. Community Clinics (CCs) are the primary community-level RH service delivery, yet evidence on how rehabilitated CCs in climate-vulnerable settings particularly from women’s perspective remains limited. Objectives: This study evaluated how women of reproductive age experience RH services delivered through rehabilitated CCs under the JAMUNA Project in the char areas of Bogura District, Bangladesh. Specific objectives were to assess utilization trends, measure client satisfaction, explore acceptability of RH services and identify barriers and facilitators to service use. Methods: A convergent parallel mixed-methods design was used at two rehabilitated CCs. The quantitative part included a cross-sectional client survey (N = 101 women aged 18--49 years; simple random sampling) using 18-item Patient Satisfaction Questionnaire (PSQ-18) and a secondary trend analysis of routine RH services across 26-months period (12 months pre- and 14 months postrehabilitation). The qualitative part included ten in-depth interviews (IDIs) guided by the Theoretical Framework of Acceptability and non-participant facility observation. Quantitative data were analyzed using Stata/BE 19.5; qualitative data through Framework Analysis. Both strands were combined at interpretation. Results: The PSQ-18 overall mean satisfaction score was 3.94 (SD = 0.26, scale 1-5) with 60.4% of participants classified as satisfied (95% CI: 50.2% - 70.0%). Interpersonal Manner had the highest score (mean = 4.29) while Accessibility and Convenience had the lowest (mean = 3.71). Clinic site was the only variable significantly associated with satisfaction (χ² = 8.110, p = 0.004, Cramér's V = 0.283) while women at partially rehabilitated Tengra Kura CC reported higher satisfaction (73.6%) than those at fully rehabilitated Pakuria CC (45.8%). Age, education, and type of RH service received were not significantly associated. Utilization trends were mixed. FP volumes increased at both sites (Pakuria CC: +6.2%; Tengra Kura CC: +6.8%) while ANC volumes diverged as +11.3% at Tengra Kura CC and -12.8% at Pakuria CC. PNC showed the weakest uptake, 22.9% declined at Pakuria CC with a marginal +7.1% at Tengra Kura CC. Qualitative findings pointed provider courtesy and geographic proximity as the primary acceptability facilitators. Seasonal flooding compounded persistent infrastructure deficits, irregular provider attendance, opportunity costs and limited awareness of the full RH service package. Conclusions: Physical rehabilitation of community clinics in flood-prone char areas is meaningful as client satisfaction reached 60.4% and FP utilization grew consistently. However, PNC declined at the fully rehabilitated site and ANC trends diverged indicating structural completion alone does not reliably translate into increased utilization. The provider-client relationship, gender-responsive staffing, climate-resilient service continuity and basic diagnostic capacity were the factors most consistently associated with whether rehabilitated CCs services are acceptable and accessible. Climate-resilient CC policy should incorporate minimum quality standards with construction metrics and seasonal contingency frameworks.