Informed consent for family planning for poor women in Chiapas, Mexico

Kirsch, John A. W.; Cedeño, Marcos Arana

doi:10.1016/s0140-6736(99)90136-8

Cited by 16 publications

(15 citation statements)

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“…Together, these studies highlight the continued need for improved family planning counseling. Given that several participants felt that they lacked information about family planning methods, patient-centered counseling is particularly crucial given the extensive history of procedures without informed consent in vulnerable populations [26]. Our findings specifically demonstrate the importance of tailoring family planning counseling to dispel myths and adequately prepare women for the potential side effects of each method [11,20].…”

Section: Resultsmentioning

confidence: 72%

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

Truong

Onis

Lindley

et al. 2020

International Journal of Reproductive Medicine

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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.

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Section: Resultsmentioning

confidence: 72%

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

Truong

Onis

Lindley

et al. 2020

International Journal of Reproductive Medicine

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“…Finally, as some misconceptions were reinforced by providers, provider training on these risks is also needed. However, any interventions targeting provider-patient interactions – especially those related to conveying long-term fertility risks – must consider the difficult history in Chiapas where providers controlled poor and indigenous women’s fertility through intrauterine devices (IUDs) or sterilization without consent [ 40 ]. There is also evidence that some respondents, particularly in rural indigenous communities, continue to distrust the government and see it as a coercive force for family planning, which may reflect historical efforts to control fertility and broader political divisions in the region.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents

et al. 2017

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BackgroundIn the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method. A qualitative study was needed to design effective and culturally appropriate interventions.MethodsWe used purposive maximum-variation sampling to select eight municipalities with a high proportion of residents in the poorest wealth quintile, including urban, rural, indigenous, and non-indigenous communities. We conducted 44 focus group discussions with 292 women, adolescent women, and men using semi-structured topic guides. We analyzed the data through recursive abstraction.ResultsThere were intergenerational and cultural gaps in the acceptability of family planning, and in some communities family planning use was greatly limited by gender roles and religious objections to contraception. Men strongly influenced family planning choices in many households, but were largely unreached by outreach and education programs due to their work hours. Respondents were aware of many modern methods but often lacked deeper knowledge and held misconceptions about long-term fertility risks posed by some hormonal methods. Acute physical side effects also dissuaded use. The implant was a new and highly acceptable method due to ease of use, low upkeep, and minimal side effects; however, it was perceived as subject to stock-outs. Adolescent women reported being refused services at health facilities and requested more reproductive health information from their parents and schools. Mass and social media are growing sources of reproductive health information.ConclusionsOur study identifies a number of barriers to family planning that have yet to be adequately addressed by existing programs in Chiapas’ poorest regions, and calls for reinvigorated efforts to provide effective, acceptable, and culturally appropriate interventions for these communities.Electronic supplementary materialThe online version of this article (10.1186/s12978-017-0392-4) contains supplementary material, which is available to authorized users.

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“…Freyermuth, who has written extensively about these issues, explained that when a woman in Chiapas wanted to have a tubal ligation, the hospital would arrange for transportation, whereas this arrangement would not be provided for women in labor with severe complications who did not want to be sterilized 13 . Others have reported that, in Chiapas, "Pressure is placed on physicians to urge poor women to accept birth control and IUDs immediately after they have given birth, irrespective of the patient's wishes or responses" 16 (p. 419), which has also been documented in Mexico City 18 . Early in 2003, a Mexican newspaper reported that health care workers employed by IMSS-Oportunidades, having to meet sterilization quotas, had to entice indigenous women to submit to sterilization and pay their transportation costs to the hospital from their own pockets, for fear of losing their jobs 19 .…”

Section: Hospital Admission Without the Ability To Paymentioning

confidence: 97%

“…She later clarified that these women feared racist humiliation, political interrogation, and forced sterilization -fears that have been documented in several publications 13,14,15,16,17,18 . Under the rubric of Misión Chiapas, an intensive birth control campaign initiated in 1995, public hospitals, were stocked with contraceptive methods, but were depleted of other essential medicines.…”

Section: Hospital Admission Without the Ability To Paymentioning

confidence: 99%

In and out: user fees and other unfortunate events during hospital admission and discharge

Castro

2008

Cad. Saúde Pública

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Informed consent for family planning for poor women in Chiapas, Mexico

Cited by 16 publications

References 0 publications

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

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

Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents

In and out: user fees and other unfortunate events during hospital admission and discharge

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