Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi

Abstract

Background With a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members. Methods An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n = 132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes. Results The overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09–10.27 p = 0.038), those that have completed secondary school and having four or less children were significantly associated with use of family planning (aOR 1.72 (95%1.35–2.01) p = 0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. Conclusion Given that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.

ASR, Volume 26, n° 1, 2022 - Full Issue

“…Concerning FP utilization, it is evidenced that the majority of the households that report not to use any FPM are poor (23 percent) relative to their counterparts using FP (15 percent). This observation resonates well with the argument by Hakizimana and Odjidja (2021) that low utilization of FP leads to large family sizes that exert a lot of pressure on household resources in terms of educating and feeding so many children and thus leading to high poverty incidences and reduced welfare. Considering the location of the household, fewer urban households were poor (8 percent) relative to rural households (23 percent).…”

Household welfare perspective of family planning utilization in Uganda

“…Concerning FP utilization, it is evidenced that the majority of the households that report not to use any FPM are poor (23 percent) relative to their counterparts using FP (15 percent). This observation resonates well with the argument by Hakizimana and Odjidja (2021) that low utilization of FP leads to large family sizes that exert a lot of pressure on household resources in terms of educating and feeding so many children and thus leading to high poverty incidences and reduced welfare. Considering the location of the household, fewer urban households were poor (8 percent) relative to rural households (23 percent).…”

Pengaruh Budaya Patriarki terhadap Partisipasi Pasangan Usia Subur dalam Program Keluarga Berencana di Indonesia: Tinjauan Sistematis

“…Wanita usia subur di negara yang memiliki nilai patriarki yang kuat seperti Uganda juga menghadapi tantangan sosial seperti penolakan oleh keluarga dan diskriminasi dalam masyarakat jika mengikuti program KB (Muyama, 2020). Di Afrika sub-Sahara, pria yang menerima keluarga berencana tidak dapat mengakui dan membela keputusan mereka di depan umum karena dianggap sebagai tanda kelemahan dan bertentangan dengan norma-norma budaya yang sangat menjunjung tinggi peningkatan ukuran rumah tangga sebagai tanda kekayaan dan kekuasaan (Hakizimana, 2021). Hal ini menunjukkan bahwa patriarki mempengaruhi perilaku seseorang melalui lingkungannya, sejalan dengan teori Social Cognitif Theory (SCT) bahwa perilaku seseorang terpengaruh oleh dirinya sendiri dan lingkungannya (Alwisol, 2006).…”