Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators

Olakunde, Babayemi O; Sam-Agudu, Nadia A.; Patel, Tanviben; Hunt, Aaron T.; Buffington, Aurora M.; Phebus, Tara; Onwasigwe, Ebube N.; Ezeanolue, Echezona E.

doi:10.1016/j.contraception.2018.12.007

Cited by 24 publications

(14 citation statements)

References 85 publications

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“…These results also established the influential role male partners and others, such as peers, relatives, or healthcare providers, play in decision making with regard to contraceptive use and choice in Africa [12,[48][49][50][51]. Power imbalances as a result of traditional socio-cultural norms, economic differences, and age disparities allow male partners to influence reproductive health decision making in patriarchal societies that exist in many Africa countries [52,53].…”

Section: Plos Onementioning

confidence: 84%

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Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

et al. 2020

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Background Female permanent contraception is a cost-effective contraceptive method that can help clients with the desire to limit childbearing achieve their reproductive intention. However, despite its benefits, the use of FPC remains low in sub-Saharan Africa (SSA), and limited studies have examined the correlates of its uptake. In this study, we assessed the individual- and country-level factors associated with the use of FPC among married or in-union women using modern contraceptive methods to limit childbearing in SSA. Methods This study was a secondary data analysis of individual- and country-level data obtained from the Demographic and Health Surveys (DHS) Program and three open data repositories. The study included 29,777 married or in-union women aged 15–49 years using modern contraceptive methods to limit childbearing from DHS conducted in 33 sub-Sahara African countries between 2010 and 2018. We performed descriptive statistics and fitted multilevel logistic regression models to determine the predisposing, enabling, and need factors associated with the use of FPC. Results Approximately 13% of the women used FPC. About 20% of the variance in the odds of using FPC was attributable to between-country differences. In the full model, the significant individual-level factors associated with the use of FPC compared with other modern contraceptive methods were: age (odds ratio [OR] = 1.10; 95%CI = 1.08–1.12), living children (OR = 1.11, 95%CI = 1.04–1.16), high household wealth (OR = 1.39, 95%CI = 1.18–1.64), rural residence (OR = 0.83, 95% CI = 0.71–0.97), joint contraceptive decision with partner (OR = 1.68, 95% = 1.43–1.99), contraceptive decision by partner and others (OR = 2.46, 95% = 1.97–3.07), and the number of living children less than the ideal number of children (OR = 1.40, 95%CI = 1.21–1.62). The significantly associated country-level factors were births attended by skilled health providers (OR = 1.03, 95%CI = 1.00–1.05) and density of medical doctors (OR = 1.37, 95%CI = 1.01–1.85). Conclusions Our results suggest that both individual- and country-level factors affect uptake of FPC in SSA. Increasing geographic, economic, and psychosocial access to FPC may improve its uptake in SSA.

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Section: Plos Onementioning

confidence: 84%

“…While women face multilevel barriers in accessing modern contraceptive methods in SSA, how these factors affect uptake of FPC have not been comprehensively examined [12]. A number of quantitative studies that have assessed the use of FPC in SSA conflated FPC with other long-acting reversible methods.…”

Section: Introductionmentioning

confidence: 99%

Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

et al. 2020

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“…Other health system challenges beyond the price and availability of the commodities at the health facility, which were not measured in this research, also influence accessibility. These challenges include policy and regulatory issues, infrastructural issues, lack of knowledge amongst the population and healthcare workers, cultural beliefs, and lack of skilled healthcare workers [25,[58][59][60][61][62][63][64][65][66][67]. The physical availability of an ultrasound scan, for example, does not mean it is routinely used or functional; lack of healthcare workers trained in its use, lack of electricity or high user costs are also barriers [61].…”

Section: Findings and Implicationsmentioning

confidence: 99%

“…The physical availability of an ultrasound scan, for example, does not mean it is routinely used or functional; lack of healthcare workers trained in its use, lack of electricity or high user costs are also barriers [61]. Use and acceptability of male and female sterilization is also dependent on lack of knowledge and negative attitudes of clients and healthcare workers, religious beliefs, fear of surgery and side effects, lack of equipment, long travel distances, and long waiting times [62][63][64][65][66]68].…”

Section: Findings and Implicationsmentioning

confidence: 99%

Access to sexual and reproductive health commodities in East and Southern Africa: a cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia

et al. 2020

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Background: Access to sexual and reproductive health services continues to be a public health concern in Kenya, Tanzania, Uganda and Zambia: use of modern contraceptives is low, and unmet family planning needs and maternal mortality remain high. This study is an assessment of the availability, affordability and stock-outs of essential sexual and reproductive health commodities (SRHC) in these countries to inform interventions to improve access.

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“…The acceptability and uptake of long acting reversible contraception in many low and middle-income countries (LMIC) is shaped by a complex interplay of factors including organizational logistics, challenging geography, sparse human service resourcing issues and a lack of integration and understanding of the diversity of traditional knowledge and practices around reproductive health [1][2][3][4]. Qualitative research from these diverse settings also highlight the broader gendered issues which underpin key differences in men and women's attitudes towards reproductive health and impact upon uptake of the various contraceptive methods available [4][5][6][7][8][9]. While research around the use of modern contraception in LMICs is expanding [1][2][3], the existing literature on how gender, as a relational issue, impacts upon the decision-making process to accept long acting reversible contraception is in its infancy.…”

Section: Introductionmentioning

confidence: 99%

Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea

et al. 2020

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Background: Despite targeted interventions to improve contraceptive implant acceptability and uptake in rural Papua New Guinea (PNG), ongoing use of this method remains limited. Previous literature has suggested community attitudes and intrinsic factors within the decision-making process may be negatively impacting on implant uptake, however these elements have not previously been studied in detail in this context. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG. Methods: We conducted 10 focus-group (FGD) and 23 in-depth interviews (IDI) using semi-structured topic guides. Key sampling characteristics included age, exposure or non-exposure to implants, marital status, education and willingness to participate in discussion. Four FGDs were held with women, four with men and two with mixed gender. IDIs were carried out with five women (current implant users, former implant users, implant never users), five men, five religious leaders (Catholic and non-Catholic), four village leaders and four health workers. Two indepth interviews (four participants) were analysed as dyads and the remaining participant responses were analysed individually. Results: Men were supportive of their wives using family planning but there was a community-wide lack of familiarity about the contraceptive implant which influenced its low uptake. Men perceived family planning to be 'women's business' but remained strongly influential in the decision making processes around method use. Young men were more receptive to biomedical information than older men and had a greater tendency towards wanting to use implants. Older men preferred to be guided by prominent community members for decisions concerning implants whilst young men were more likely to engage with health services directly.

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Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators

Cited by 24 publications

References 85 publications

Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

Access to sexual and reproductive health commodities in East and Southern Africa: a cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia

Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea

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