‘I am the master key that opens and locks’: Presentation and application of a conceptual framework for women's and girls' empowerment in reproductive health

Karp, Celia; Wood, Shannon N.; Galadanci, Hadiza; Kibira, Simon P. S.; Makumbi, Fredrick; Omoluabi, Elizabeth; Shiferaw, Solomon; Seme, Assefa; Tsui, Amy O.; Moreau, Caroline

doi:10.1016/j.socscimed.2020.113086

Cited by 80 publications

(107 citation statements)

References 46 publications

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“…An inductive thematic approach was used to analyze the data, including familiarizing oneself with the data, generating initial codes, sorting the data, and reviewing themes and sub-themes identified in the analysis. This analytic approach was selected in order for themes to emerge directly from the quotes of participants [29,31]. A team of investigators from JHSPH led the cross-site codebook development, which involved a rigorous review of the transcripts and frequent discussions with in-country teams in Ethiopia, Nigeria, and Uganda.…”

Section: Discussionmentioning

confidence: 99%

“You better use the safer one… leave this one”: the role of health providers in women’s pursuit of their preferred family planning methods

et al. 2020

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Background: Universal access to quality sexual and reproductive health (SRH) services is pivotal to ensuring gender equality. In high-income countries, patient-provider interactions have been shown to shape women's decisions about contraception, with poor exchanges decreasing method uptake and satisfaction. While significant progress has been made to increase women's access to SRH services, in low-and middle-income countries, little is known about the quality of family planning patient-provider interactions. The primary objective of this analysis was to explore the role of health care providers in women's family planning decision-making in Ethiopia. Methods: From July to August 2017, 10 focus group discussions (n = 80) and 30 in-depth interviews were conducted with women aged 15-49 and men aged 18+ recruited via purposive sampling from urban and rural sites in Ethiopia. Semi-structured interview guides explored women's and girls' empowerment in SRH surrounding sex, childbearing, and contraception. All interviews were conducted in Amharic, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data. Eleven codes specific to provider services for family planning were reviewed and matrixes creates for synthesis. Results: Three primary themes emerged: the role of providers in women's awareness of and demand for family planning services; selection and uptake of contraceptive methods; and discontinuation and switching of contraceptive methods. Results indicate that health extension workers were central to women's awareness of family planning, and health providers' endorsements were instrumental in decisions to adopt methods. The majority of respondents described positive interactions with providers and appreciated thorough counseling when considering using or switching methods. Some women, however, described health providers directing them toward long-acting methods by communicating inaccurate information or emphasizing disadvantages of short-acting methods. A few women described provider reluctance or resistance to switching methods, especially from implants.

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Section: Discussionmentioning

confidence: 99%

“You better use the safer one… leave this one”: the role of health providers in women’s pursuit of their preferred family planning methods

et al. 2020

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“…Consent to participate was written and assent oral in Uganda and Nigeria per Makerere University, Anambra Ministry of Health, and Bayero University Kano IRB guidelines; consent was oral and assent written in Ethiopia per Addis Ababa University IRB guidelines. In-depth qualitative study procedures are further described elsewhere [16,35].…”

Section: Methodsmentioning

confidence: 99%

“…Most of the current literature on covert use of contraception falls in two categories: qualitative studies of women's reasons for and experiences of using contraception without their partner's knowledge [9,[15][16][17][18] or quantitative assessments of covert use from Demographic and Health Surveys (DHS) inferred from discordant reports of modern method use reported by the wife, but not the husband [19,20]. Two mixed-methods studies have begun to bridge the gap between qualitative and quantitative research by investigating levels of and reasons for discreet contraceptive use in facility-based or cohort populations [13,14].…”

Section: Introductionmentioning

confidence: 99%

Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges

et al. 2020

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Background: The balance between increasing men's participation in family planning and rights-based initiatives favoring women's empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low-and middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women's decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women's choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries. Methods: Women aged 15-49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women's and girls' empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes. Results: Findings comprised three thematic areas: the practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure.

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“…Covert use, the use of a contraceptive method without the knowledge of a woman's partner, may represent her attempt to maintain reproductive autonomy in the face of reproductive coercion and potential violence by her partner [1][2][3][4][5]. Beyond autonomy, covert use may also be due to misperceptions of partners' views of contraceptive use and desired family size [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…When couples negotiate reproductive outcomes, this is done against the backdrop of normative values, and if they disagree, whether this is real or perceived, there needs to be some form of conflict resolution [6]. As a result of the outcome of couple communication, or the absence of any communication, women may decide on their own to use a family planning method, even if this means using a method covertly [2,5,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women’s degree of contraceptive empowerment

OlaOlorun

Anglewicz

2020

PLoS ONE

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Objective In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women’s contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner’s support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. Methods Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017–2018. A sample of 12,948 women 15–49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. Results Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06–6.93)] and overt users [AOR = 5.01 (95%CI: 3.24–7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96–2.73)] compared to overt users. Conclusion By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women’s realization of their reproductive goals.

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‘I am the master key that opens and locks’: Presentation and application of a conceptual framework for women's and girls' empowerment in reproductive health

Cited by 80 publications

References 46 publications

“You better use the safer one… leave this one”: the role of health providers in women’s pursuit of their preferred family planning methods

“You better use the safer one… leave this one”: the role of health providers in women’s pursuit of their preferred family planning methods

Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women’s degree of contraceptive empowerment

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