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

Abstract

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.

‘I haven’t heard much about other methods’: quality of care and person-centredness in a programme to promote the postpartum intrauterine device in Tanzania

“…42 Under the banner of quality, a growing number of recent studies document the ways that family planning programmes, intent on providing LARC methods, are failing to help clients make free, full and informed contraceptive decisions. 11 43-45 A recent study by Yirgu et al 43 from Ethiopia found that 'some women felt manipulated toward using LARCs' and that some providers refused to help women discontinue LARC methods they no longer wished to use. A 2019 South African study from Towriss et al found that 'the delivery of injectable contraceptives to women in the hours following birth is a procedure that emerged during apartheid and became so common that healthcare workers referred to it as the 'fourth stage of labour', and that, even today, 'healthcare workers may not always present the procedure as optional'.…”

Norwegian women’s experiences and opinions on contraceptive counselling: A systematic textcondensation study

“…As to the aspect of choice of methods presented, as reported previously in our study, women were given little information, except on non-hormonal methods [35][36][37] . While shared decision making and informed choice is promoted and encouraged in healthcare globally, it appears not so easy to accomplish in practice 38 .…”

“It was my own decision”: the transformational shift that influences a woman's decision to use contraceptives covertly

“…But finding this balance in a context where joint decision-making on contraceptive use may be preferred can be challenging. A study examining the role of health providers in women’s decision making about contraceptive use in Ethiopia found that women were uncomfortable when asked if they had their husband’s permission prior to being issued a contraceptive method [ 33 ]. This line of questioning, even if well-intentioned, can undermine a women’s perception that she is entitled to make decisions about contraceptive use herself.…”