Motivations and consequences of secret contraceptive use among young married women in Malawi

Enabling and hindering factors of health surveillance assistants’ roles in the provision of contraceptive services in Mangochi, Malawi

“…This was the case for Yao, Chewa as well as other tribes. A qualitative study of Kaneka and Mturi (2015) in Ntcheu, Mangochi and Zomba districts found that reasons for secret use of contraceptives by young married women were: the fear of being abandoned by the husband (because of not looking attractive as a result of frequent child bearing), being in a hostile or unstable marriage, lack of communication between spouses, lack of resources to raise children, uncertainty over husbands' return dates from South Africa and safeguarding women's health [12]. Many of these reasons were also found in our study, where the lack of resources to raise children was most profound and, as Kaneka and Mturi (2015) indicate, could be related to Mangochi being matrilineal, where the women and her family are responsible for raising the children.…”

“…Decision-making on contraceptive use or contraceptive use itself can also be influenced by gendered differences in power. A qualitative study in Ntcheu, Mangochi and Zomba districts found that unsupportive husbands made women to use contraceptive secretly [12]. Husbands' resistance was related to their desire to exert control over the sexual and reproductive lives of their wives [13].…”

“…Figure 1 provides a conceptual framework on the factors that could influence HSAs' ability to conduct their roles and tasks in the provision of contraceptive services in Malawi. The framework is based on general frameworks on CHW performance [18][19][20], access to care [21] and the above presented evidence on communities' preferences and perceived needs in relation to sexual and reproductive health [11][12][13][14][15][16][17].…”

Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study

“…Covert use may lead to emotional distress, as it may generate feelings of distrust or fear within a relationship or conflict with the user's faith. [ 5 , 9 , 11 , 12 ]. Consequences of discovery may be severe, potentially resulting in physical violence and marital or financial abandonment upon discovery [ 3 , 9 , 13 ].…”

Perceptions of Partners’ Fertility Preferences and Women's Covert Contraceptive Use in Eight Sub‐Saharan African Countries

“…Covert users may be less likely to switch methods due to side effects than open users (Biddlecom and Fapohunda 1998; Castle et al 1999; Kibira et al 2020). Covert use may lead to emotional distress, as it may conflict with the user's religion or belief system (Adanikin, McGrath, and Padmadas 2019; Castle et al 1999; Heck et al 2018; Kaneka and Mturi 2015). Further, the impacts of discovery, whether feared or realized, may include marriage dissolution, social sanctions, financial backlash, and/or intimate partner violence (Alio et al 2009; Bawah 2002; Castle et al 1999; Heck et al 2018; Wilson‐Williams et al 2008).…”