"Doctors are in the best position to know…": The perceived medicalization of contraceptive method choice in Ibadan and Kaduna, Nigeria

The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study

BACKGROUND

Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions.

METHODS

A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted.

RESULTS

Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice.

CONCLUSIONS

FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.

Healthcare provider interaction and other predictors of long-acting reversible contraception adoption among women in Nigeria

OBJECTIVE

To test the association between healthcare provider communication and adoption of long-acting reversible contraception (LARC) among women in Nigeria.

METHODS

The present cross-sectional observational secondary analysis included women aged 18-49 who were interviewed between June 1 and July 31, 2014, at selected family planning sites in Ibadan and Kaduna, Nigeria. A multivariate generalized estimating equation was utilized to assess the predictors of LARC adoption.

RESULTS

597 women were interviewed, and the study showed that each unit increase on the GATHER index-a self-reported measure of interaction with the provider-was significantly associated with a 16% increased likelihood (adjusted odds ratio [AOR] 1.16, 95% confidence interval [CI] 1.03-1.32) of adopting LARCs. Joint decision making with a partner (AOR 1.51, 95% CI 1.0-2.20), desire to have children in the next 2 years (AOR 0.36, 95% CI 0.18-0.74), whether or not a pregnancy in the next 6 months would be a problem (AOR 1.69, 95% CI 1.16-2.46), and LARC use in the past (AOR 4.15, 95% CI 1.19-14.50) were associated with LARC uptake.

CONCLUSION

Improved patient-provider communication involving patient preferences, information about all methods of contraception, and planned follow-up could play a central role in increasing the demand for, and uptake of, LARCs.

Inadequate birth spacing is perceived as riskier than all family planning methods, except sterilization and abortion, in a qualitative study among urban Nigerians

Background

Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians.

Methods

A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach.

Results

The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items.

Conclusion

Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants’ risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items’ perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing.

Trial registration Number:

This study is not a randomized control trial so the study has not been registered as such.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0439-2) contains supplementary material, which is available to authorized users.

Perceptıon scale of barrıers to contraceptıve use: a methodologıcal study

BACKGROUND

The objective of this study was to design and develop the Perception Scale of Barriers to Contraceptive Use (PSBCU) as a measurement tool for the qualitative assessment of the barriers and obstacles women perceived with regard to contraceptive use or low rates of contraceptive use in women using family planning services.

METHOD

The data for this methodological study were collected using the face-to-face interview technique from 320 married women between the ages of 15-49 who were attending clinics at the Hafsa Sultan Hospital, CBU. The data collection tools used in the study, which was carried out from May to September 2014, were the "Introductory Information Form" and the "Perception Scale of Barriers to Contraceptive Use". Language validity and construct validity (explanatory factor analysis) were applied in order to test the validity of the Perception Scale of Barriers to Contraceptive Use.

RESULTS

Kaiser Meier Olkin (KMO) analysis was performed to determine the availability of the scale for the size of participants. The sample adequacy calculated as the KMO value was 0.916 and the Bartlett's Test of Sphericity (X² = 6721.793 p < 0.000) sample size analysis value was found to be sufficient for factor analysis. The total Cronbach's Alpha coefficient of 34 items which included three factors explaining 54.95% of the variance after Varimax rotation was calculated to be 0.95. The largest factor was the "cognitive domain" explaining 18.89% of the variance, followed by the "emotional domain" explaining 18.05% of the variance, and finally the "social domain" explaining 18.01% of the variance. Item-total score correlation coefficients of scale items were found to be between 0.54 and 0.83.

CONCLUSIONS

The study demonstrateded that the "Perception Scale of Barriers to Contraceptive Use" was valid and reliable. We believe that the scale is suitable for use by women in a family planning education and training programs in order to evaluate their situation. It should also be assessed for validity and reliability for different groups (adolescents, men, etc.).