Gender, inequality and Depo-Provera: Constraints on reproductive choice in Nicaragua

Abstract

This article examines the sociocultural determinants of Nicaraguan women's use of Depo-Provera as a means of contraception. The prevalence of Depo-Provera in Nicaragua is high and increasing compared to other Central American countries. Drawing on data from structured interviews with 87 women and from focus groups with 32 women, we show how women's preference for Depo is shaped by both gendered inequalities and socioeconomic constraints. We employ basic statistical tests to analyse correlations between women's marital status and socioeconomic status (SES) with contraceptive use. Our statistical findings show significant associations between use of Depo and both marital status and SES, such that women who are married or in conjugal unions and women with lower SES are more likely to use Depo. To help explain women's use of Depo-Provera in Nicaragua, we situate our findings within the context of gender, culture, and power, reviewing the contested history of Depo-Provera in the developing world and dynamics of gender inequality, which constrain women's contraceptive choices. We conclude with suggestions for reproductive health programming in Nicaragua and beyond, arguing that gender equity and addressing socioeconomic barriers to family planning remain priorities for the achievement of global reproductive health.

Values and preferences for contraception: A global systematic review

“…Contraceptive users often reported considering whether they or their partner(s) could feel the contraceptive method/device during intercourse, and how the contraceptive method affected the spontaneity, pleasure, and frequency of sex. Partner's influence towards women's contraceptive choice was also highlighted, where oftentimes “[m]en's disapproval over contraceptive use restricted preferences for women” [42] , particularly in low- and middle-income countries regarding “non-natural” or hormonal contraceptives. Even in the USA, though, young women mentioned using withdrawal because of their male partners, though it “did not align with their own contraceptive desires,” since using a condom would imply lack of trust or relationship intimacy and they were embarrassed about using withdrawal as a contraceptive method [43] .…”