Gender-Informed Family Planning Perceptions and Decision-Making in Rural Chiapas, Mexico: A Mixed-Methods Study

Abstract

Compared to other Mexican states, Chiapas possessed the lowest rate of contraception use among women 15−49 years old (44.6%) in 2018. This convergent mixed-methods study assessed family planning use, perceptions, and decision-making processes among women and men in rural communities where Compañeros En Salud (CES) works in Chiapas, Mexico. We conducted surveys of reproductive-aged women and semi-structured interviews with reproductive-aged women, men, and physicians completing their social-service year in CES communities from 2016 to 2017. Of the 625 survey respondents, 368 (58.9%) reported using contraception. The most common methods were female sterilization (27.7%), bimonthly injection (10.9%), and the implant (10.9%). Interviews were completed with 27 women, 24 men, and 5 physicians and analyzed through an inductive approach. Common reasons for contraception use were preventing pregnancy, lack of resources for additional children, and birth spacing. Adverse effects, influence of male partners, and perceived lack of need emerged as reasons for non-use. Male partners often made the final decision about contraceptive use, while women often chose what method. Physicians reported adverse effects, misconceptions about methods, and lack of women’s autonomy as barriers to contraception use. Given misconceptions about contraception methods and the dominant role of men in contraception decision-making, our study illustrates the importance of effective counseling and equitable gender dynamics for family planning programming in rural Chiapas.

<p>Determinants of Postpartum Contraception Use Among Teenage Mothers in Eastern Uganda: A Cross-Sectional Study</p>

“…Previous research findings have documented that male partners object to women using contraceptives. 25 , 26 This control is worse for the adolescent women who are more vulnerable to coercion. These findings call for renewed focus on empowering adolescent women to take charge of their fertility intentions.…”

Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics

“…Decision-making processes between husbands and wives are not straight forward and determined by continuous changes in attitudes and situations ( Downey et al., 2017 ). Male partners often make the final decision about contraceptive use ( Truong et al., 2020 ). In Nigeria, for example, wives with lower socioeconomic status are less empowered to overtly use contraceptives when their husbands oppose family planning; however, they still use it covertly ( Adanikin et al., 2019 ).…”

“…In Nigeria, for example, wives with lower socioeconomic status are less empowered to overtly use contraceptives when their husbands oppose family planning; however, they still use it covertly ( Adanikin et al., 2019 ). Recent literature reported that both the influence of male partners and lack of women's autonomy were the main reasons for not using any MFPM ( Truong et al., 2020 ).…”

“…While recent literature reported that the most common reasons for MFPM use were birth spacing, preventing pregnancy, and lack of resources to have more children, side effects and influence of male partners were the main reasons for not using any method as perceived by women ( Truong et al., 2020 ). Physicians, on the other hand, perceived that the main barriers to use MFPM include adverse effects, misconceptions about FP methods, and lack of women's autonomy ( Truong et al., 2020 ).…”

“…While recent literature reported that the most common reasons for MFPM use were birth spacing, preventing pregnancy, and lack of resources to have more children, side effects and influence of male partners were the main reasons for not using any method as perceived by women ( Truong et al., 2020 ). Physicians, on the other hand, perceived that the main barriers to use MFPM include adverse effects, misconceptions about FP methods, and lack of women's autonomy ( Truong et al., 2020 ). In particular, a 2016 study found that 42% of married Syrian refugees living in Jordan have never used modern contraception ( UNFPA: United Nations Population Fund, 2018 ), and the latest DHS population survey showed that the unmet need for contraception among Syrian refugees was 19%, compared to 14% among Jordanian women ( Department of Statistics (DOS) & ICF, 2019b ).…”