A qualitative study of provider perspectives on the barriers to contraceptive use in Kaliro and Iganga Districts, Eastern Central Uganda

Abstract

Background: Family planning confers unique benefits including preventing unintended pregnancies, improving maternal and child health outcomes, and increasing women's access to education and economic opportunities. However, Uganda has a low contraceptive prevalence rate of only 30%, and progress in improving maternal and child health outcomes is slow. Objective: This assessment explores community health workers' and facility-based health workers' qualitative perspectives on the use of contraceptives in the Iganga and Kaliro districts in Eastern Central Uganda. Methods: The baseline assessment used a qualitative approach with a focused sample of community-and facility-based health workers aged 20-60 years. Two focus group discussions with Community Health Workers and four key informant interviews with facility-based health workers were conducted. Thematic content analysis was done manually. Results: The main factors influencing contraceptive use in these communities were preference for large families, perceived inadequate knowledge of family planning and fear of side effects, inadequate spousal and family support, male domination and risk of violence, divorce and polygamy, inadequate human resource capacity and low motivation, and user fees. Conclusion:The study findings suggest that there is low use of contraceptives for family planning in the Kaliro and Iganga districts in Uganda. Recommendations include developing a strong focus in exploring policy options to build the capacities of trained health workers to offer long-term methods in order to increase the availability of family planning options. Family planning interventions should increase the availability of contraceptive methods using gender-sensitive strategies, including community mobilization.

Improved contraceptive use among women and men in Uganda between 1995-2016: A repeated cross-sectional population study

“…Although men’s participation in the family planning process has been recognized as being critical to its effectiveness, traditional gender norms and perceptions often dictate that pregnancy, family planning and reproductive health are a woman’s ‘domain’ or ‘business’, and thereby exclude men’s involvement in the process [15, 18, 25]. Yet, partner opposition is often a significant predictor of poor healthcare access, unmet need for contraception, the use of traditional rather than modern methods, and clandestine use of contraception [25–28]. The largely patriarchal nature of Ugandan society and gender norms around male-dominant, normative decision-making processes, as well as the lack of spousal communication on fertility preference, and the timing and spacing of pregnancies [18, 27, 29, 30] often results in men making decisions about contraception without much discussion or consultation with their partners [26, 31–33].…”

Understanding the contextual and cultural influences on women’s modern contraceptive use in East Uganda: A qualitative study

“…Many older respondents described defying their partners' wishes, and openly talked about ways in which they subverted partner opposition through covert contraceptive use, mainly through injectable contraceptives. However, the consequences that women face, if discovered by their partners, can be severe and include violence, being abandoned or 'chased out' [18,19,40]. Many respondents reiterated that attempts at discussing family planning with their partners were unproductive and a source of conflict they sought to avoid:…”

“…This priority reflects a growing body of research that recognises community beliefs and acceptance of contraceptive use can influence women's own contraceptive knowledge, choices and behaviour [16]. Misconceptions and fears of both real and perceived negative contraceptive side effects are widespread barriers to contraceptive use [17][18][19][20]. The reliance on peers and community beliefs as a source of family planning information remains a challenge in addressing myths and fears associated with contraceptive side effects [21].…”

“…Traditional gender norms and perceptions dictate that pregnancy, family planning and reproductive health are a woman's 'domain', and thereby exclude men's involvement [29,31,32]. Partner opposition is often a significant predictor of poor healthcare access, unmet need for contraception, the use of traditional rather than modern methods, and clandestine use of contraception [18,19,32,33]. The lack of spousal communication on fertility preference as well as the timing and spacing of pregnancies has often been reported in the literature [18,26,30,31]; coupled with a male-dominant, normative decisionmaking process, this often results in men making decisions around contraception with little discussion or consultation with their partners [28,[33][34][35].…”

The global church and family planning: creative collaboration

“…Barriers exist to the implementation of family planning as we published in a recent study in Uganda by Shumba, et al 2 Three submissions described studies to surmount them. One barrier was when stockouts of relevant medicines and equipment occurred.…”