Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

Abstract

Background Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided. Methods We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar. Results Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Postseminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members. Conclusions Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.

Influence of Religion and Religiosity on Fertility and Contraceptive Use in Continental Sub-Saharan Africa: A Comprehensive Review

“…These perceived side effects were also reported in other studies across Sub-Saharan Africa (Audu, et al, 2008;Mosha, et al, 2013;Nalwadda, et al, 2010;Olakunde, et al, 2019;Otoide, et al, 2001;Thummalachetty, et al, 2017). In Nigeria and Tanzania, the source of this information was often from family and friends rather than from health facilities (Aristide, et al, 2020;Sinai, et al, 2019), and enforced by some political and religious campaigns against modern methods (Izugbara & Ezeh, 2010).…”

“…Eritreans, who practice Christianity, preferred to limit their family size to 3 to 5 children due to economic constraints and refugee status, and were not influenced by their religious beliefs. In Tanzania, some Christian respondents believed that using family planning was a moral responsibility (Aristide, et al, 2020) and that limiting the number of children was in line with religious texts (caring for children and living within one's means). Using contraceptives was consistent with these moral standards.…”

“…Women who regularly attend religious services were reported to be less likely to receive family planning information from health care facilities (Dynes, et al, 2018). Some Christian respondents were unsure whether their faith allowed them to control the number of children they give birth to due to vague statements and interpretations regarding fertility in the Bible, and lack of talk on the subject from religious leaders (Aristide, et al, 2020). Although some participants did not feel it was appropriate that family planning was discussed in a religious setting, others were open to it (Sundararajan, et al, 2019).…”

“…Women were also perceived to be obligated to grant a man as many children as he desires, which is seen as a sign of respect and love for the husband (Aristide, et al, 2020;Kabagenyi, et al, 2016). If a woman does meet the marital expectations, she can be chased away from her marital home.…”

“…Downs, et al, 2017;Yeatman, & Trinitapoli, 2008). Outreach to Church leaders inAristide's, et al (2020) study overcame barriers to the uptake of family planning including opposition by male partners / husbands and uncertainty of compatibility with religious faith. In a study in Mwanza in Tanzania(Nsanya, et al, 2019), postintervention showed increased self-efficacy among male and female Church leaders as well as in the population, including increased use of oral contraceptives among unmarried sexually active women.…”