Contraceptive choices in Karachi: a phenomenological analysis of women's perspectives on the quality of family planning services in low-income urban areas.

Introduction: Family planning (FP) services are essential for reproductive health and women's empowerment, yet quality gaps persist in low-income urban areas of Pakistan. This study explores women's perspectives on FP service quality in the underserved communities of Malir Town, Karachi. Methods: Using a phenomenological qualitative design, in-depth interviews and focus group discussions were conducted with current and past users of modern contraceptives from three Union Councils: Saudabad, Khokhrapar and Kala Board. Data were collected through 12 in-depth interviews and four focus group discussions (n=25 participants). Data were analysed thematically using Judith Bruce's 'Quality of Care' framework. Results: Participants reported inadequate contraceptive options, poor counselling, lack of follow-up and limited decision-making autonomy. Respectful provider interactions, clear communication and community health worker support were identified as key facilitators. Structural issues, such as fragmented service delivery and poor integration, hindered consistent contraceptive use. Conclusion: Improving FP service quality in poor urban settings requires a client-centred approach that strengthens counselling, ensures method availability, integrates services and leverages community-based support. Further research should include non-users to inform scalable, equity-focused interventions.