Contraception and post abortion services: qualitative analysis of users’ perspectives and experiences following Zika epidemic in Honduras

Abstract

Background Zika virus (ZIKV) infection during pregnancy has severe consequences on the new-born. The World Health Organization declared the Zika outbreak to be a Public Health Emergency of International Concern (PHEIC) in 2016. Health facilities in the regions most affected by Zika lacked the capacity to respond to the increased demand for contraception. The objectives were to explore healthcare users’ perceptions regarding contraception, Zika prevention during pregnancy and post-abortion care (PAC) services in the context of a Zika outbreak in Tegucigalpa, Honduras, and to follow these services over time. Methods This study was part of a broader implementation research study. We used qualitative research consistent with grounded theory approach. Semi-structured interviews and focus groups were performed with women and their partners who used contraceptive services or received PAC services. Data were collected in two stages from December 2017 to July 2018. Themes explored included contraception, Zika and PAC services. Results Participants had positive attitude towards the use of contraceptive methods and demanded more information on safety, efficacy and on side effects. Health care services were inconsistent in the provision of information on Zika and contraception services. ZIKV vector transmission was known but fewer participants were aware of risk of sexual transmission of Zika. Barriers to access healthcare services included contraceptive and PAC services included distance to healthcare facilities, disorganized admission process, long waiting times and out-of-pocket expenditure to purchase medicines. Furthermore, poor quality, mistreatment and abuse of women seeking PAC was prevalent. Some positive changes were noted over time, such as improvements in infrastructure including improved privacy and cleanliness, removal of fees, requisite to bring clean water to hospital. Conclusions Our results highlight the challenges and areas for improvement in policy and practice related to contraceptive services and PAC in the context of ZIKV infection. Public policies to prevent epidemics should focus more on providing proper sanitation; removing barriers to access and use of effective contraception as human rights priority. Zika epidemic has highlighted weaknesses in health systems that obstruct access to and use of sexual and reproductive health services. The study results call for increased efforts to improve access, especially for women of low socio-economic status and intervene at different levels to eradicate discrimination and improve equity in the provision of health care. Qualitative methods can capture the community perspectives and can provide useful information to develop interventions to improve services.

Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review

“…Despite a drop in FPS utilization during the early phases of lockdown, a sharp reversal in FPS service uptake during the post-lockdown phase was reported [ 24 ]. Furthermore, distance from the health facility, restricted functioning hours of the facility, long waiting time [ 25 ], restrictions to getting inside the hospitals [ 25 ], and fear of contracting the infection were significant limiting factors for availing FPS.…”

“…Likewise, the qualitative findings of the reviewed articles reported a decline in ANC service uptake. This decline was attributed to numerous factors including inadequate information, geographical barriers, high cost of institutional care, dread of infection, a lack of diagnostic services, and shortage of healthcare workers [ 25 , 37 – 46 ]. Beneficiaries in Zika-related studies claimed that they were aware of the potentially harmful effects of the infection on the fetus and preventive measures [ 25 ].…”

“…This decline was attributed to numerous factors including inadequate information, geographical barriers, high cost of institutional care, dread of infection, a lack of diagnostic services, and shortage of healthcare workers [ 25 , 37 – 46 ]. Beneficiaries in Zika-related studies claimed that they were aware of the potentially harmful effects of the infection on the fetus and preventive measures [ 25 ]. On the other hand, during Ebola and COVID-19, beneficiaries were apprehensive about the transmission of disease and pointed out that the media was disseminating misinformation or excessive information about the pandemic [ 39 , 46 ].…”

Uso de métodos anticonceptivos de larga acción en mujeres adolescentes en hospitales de Honduras

“…19 Las barreras en el uso de MLA incluyen: costo, acceso, conocimiento sobre métodos, falta de información confiable y temor al método en sí; el uso y continuación es influenciado por preferencias personales, características del dispositivo, las redes sociales inclusive, la opinión de los pares sobre todo si comparten dudas y objetivos con respecto a un anticonceptivo y muy importante, factores relacionados al propio prestador de salud quien con sus propios conceptos sobre determinado método, puede influir en que una usuaria lo acepte. [20][21][22][23] Fomentar el acceso a MLA postaborto inmediato es esencial para prevenir la repetición dxe embarazos no deseados. 10 La forma de evacuación del aborto puede influir sobre el tipo de anticonceptivo que la mujer elija después del manejo.…”

“…A pesar de ser opciones similares, menos mujeres sometidas a un tratamiento médico iniciaron DIU en comparación con mujeres sometidas a aspiración manual endouterina (AMEU) esto relacionado a que el método puede aplicarse en forma segura el mismo día, mientras que las sometidas a tratamiento medicamentoso requieren una segunda visita de seguimiento. 23,24 El proyecto de uso de contraceptivos CHOICE, para reducir embarazos no deseados en la región de San Luis, Missouri (USA), con más de 9000 mujeres desde 14 a 45 años, mostró, que de aquellas que eligieron un método de larga acción (75%), hubo mayor continuación del método, el anticonceptivo fue 20 veces más efectivo y se documentó reducción sustancial en embarazo en adolescentes, partos y abortos (34, 19.4 y 9.7/1000 respectivamente), concluyendo que el acceso a MLA resulta en menos embarazos no deseados y abortos, además de reducción en los costos de atención en el sistema de salud. 24 Independientemente del método más utilizado por las adolescentes, un hallazgo importante en nuestro estudio fue que se entregó un método de planificación familiar al 53.1% de las pacientes que lo solicitaron, evidenciando una brecha que debe analizarse buscando reducir la demanda insatisfecha en relación con los contraceptivos; 60.9% de las pacientes manifestaron que el embarazo no había sido planeado y 84.9% de ellas no habían utilizado un método contraceptivo antes de embarazarse.…”