Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey

Abstract

ObjectiveIn the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP.DesignLongitudinal study.SettingA community-based approach was used to investigate FP use in the North and South-Kivu regions.ParticipantsOverall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up.Primary and secondary outcomesFP use and intention to use FP.ResultsThe mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective normswere negatively and significantly associated with intention to use FP (β=−0.572; p=0.003) whileperceived controlwas positively associated with intention to use FP (β=0.578; p<0.0001). Education andperceived controlwere positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), whileIntention to use FPwas positively and marginally significantly associated with the use of FP (β=0.583; p=0.052).ConclusionTPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.

“It’s as if her husband has become the wife and she the wife has become the husband”: the Social Norms and Gender Dynamics of Men’s Engagement in Family Planning Practices in the DRC

“…Furthermore, the perceptions of family and peer groups appeared to strongly in uence decisions regarding family size, with certain members advocating for birth spacing while others encouraged couples to "multiply and ll the earth". Subjective norms, such as the belief that "children are a gift from God" and the perception that contraceptives are sinful, as demonstrated by a study in Eastern Congo, are found to have a negative and signi cant association with the intention to use family planning [21]. Further, injunctive norms highlighted in our study reveal that religious leaders and messages from religious institutions in uence decision-making and perceptions about contraceptive use and family size.…”

United States Government-Supported Family Planning and Reproductive Health Outreach in the Democratic Republic of the Congo: Lessons Learned and Recommendations

“… 8 However, misinformation and lack of information are key barriers to FP uptake in the DRC, 8 while FP education in that area has been shown to be significantly positively associated with intention to use FP. 10 …”

“…8 However, misinformation and lack of information are key barriers to FP uptake in the DRC, 8 while FP education in that area has been shown to be significantly positively associated with intention to use FP. 10 The USAID Integrated Health Program in the Democratic Republic of the Congo (USAID IHP) works closely with the Government of the DRC's Ministry of Public Health, Hygiene, and Prevention (MSPHP), along with other stakeholders, to strengthen their capacity in delivering high quality, integrated health services in several health areas, including FP. The USAID IHP is the largest USAID health project in the DRC.…”