1
|
Achola R, Atuyambe L, Nabiwemba E, Nyashanu M, Garimoi Orach C. Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study. PLoS One 2024; 19:e0278731. [PMID: 38427612 PMCID: PMC10906906 DOI: 10.1371/journal.pone.0278731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/22/2023] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.
Collapse
Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathew Nyashanu
- Department of Health & Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
2
|
Van Damme L, Chatrou L, de la Peña E, Kibungu P, Bolya CS, Van Damme P, Vanhove W, Ceuterick M, De Meyer E. Plant use and perceptions in the context of sexual health among people of Congolese descent in Belgium. J Ethnobiol Ethnomed 2024; 20:20. [PMID: 38373968 PMCID: PMC10877895 DOI: 10.1186/s13002-024-00662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The use of medicinal plants is integral to global healthcare systems, with Sub-Saharan Africa maintaining a robust tradition of herbal medicine alongside Western-oriented healthcare. As migrant communities tend to continue traditional herbal practices after migration, documenting this use is vital to develop culturally sensitive healthcare. This study investigates plant usage and perspectives in the context of sexual and reproductive health among the Congolese community in Belgium, particularly in the Matongé quarter of Brussels. Our research questions were: (1) What is the current knowledge of medicinal plants among the Congolese community in Belgium in the context of sexual health, and what are the applications and commonly employed administration methods of these plants? (2) What role does herbal medicine play in the context of sexual health for people of Congolese descent in Belgium and how this is influenced by perceptions of sexuality? and (3) Is there a gender bias in the use of medicinal plants, and if so, can this be related to perceived gender norms? METHODS We conducted 22 semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using both snowball sampling and purposive sampling. Plant use in the context of sexual health was recorded through freelisting. Data on narratives, ideas, and perceptions of this plant use in the context of sexual health were collected. Interview transcripts were analyzed using thematic analysis. RESULTS We identified 17 plant species used for sexual health. Three overarching themes emerged from our data. Plants were used with a notable gender bias favoring male sexual potency enhancement. Men used these plants for both remedying potency issues and enhancing sexual prowess. In contrast, knowledge about plants for female sexual health was limited. Gender norms reinforced the importance of male sexual potency, while stigmatizing open discussions of female sexuality. CONCLUSIONS The use of medicinal plants for sexual health raises health, social, and conservation concerns, underscoring the need for further research in this area. This study contributes to understanding medicinal plant use within the Congolese community in Belgium and highlights the necessity for future research on herbal practices for female sexual health in this context.
Collapse
Affiliation(s)
- Laura Van Damme
- Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000, Ghent, Belgium
| | - Lars Chatrou
- Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000, Ghent, Belgium
| | - Eduardo de la Peña
- Department of Plants and Crops, Ghent University, Coupure Links 653, 9000, Ghent, Belgium
- Spanish National Research Council (CSIC), Institute for Subtropical and Mediterranean Horticultural Research (IHSM-UMA-CSIC), Malaga, Spain
| | - Pathy Kibungu
- Department of Plants and Crops, Ghent University, Coupure Links 653, 9000, Ghent, Belgium
- Natural Products & Food Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Department of Environmental Sciences, Kinshasa University (UNIKIN), BP 127, Kinshasa XI, Democratic Republic of the Congo
| | | | - Patrick Van Damme
- Faculty of Tropical AgriSciences (FTA), Czech University of Life Sciences Prague, 165 00, Prague, Czech Republic
| | - Wouter Vanhove
- Lignaverda Belgium, Duwijckstraat 17, 2500, Lier, Belgium
| | - Melissa Ceuterick
- Department of Sociology, Health & Demographic Research, Ghent University, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Emiel De Meyer
- Department of Plants and Crops, Ghent University, Coupure Links 653, 9000, Ghent, Belgium.
| |
Collapse
|
3
|
Gage AJ, Wood FE, Kittoe D, Murthy P, Gay R. Association of Male Partners' Gender-Equitable Attitudes and Behaviors with Young Mothers' Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC. Int J Environ Res Public Health 2022; 19:12182. [PMID: 36231485 PMCID: PMC9565980 DOI: 10.3390/ijerph191912182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners' gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15-24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project's 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners' willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners' gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers' health outcomes are shaped by their male partners' gender-related attitudes and behaviors.
Collapse
Affiliation(s)
- Anastasia J. Gage
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Francine E. Wood
- Center on Gender Equity and Health, University of California San Diego, La Jolla, CA 92093, USA
| | - Darling Kittoe
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Preethi Murthy
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Rianne Gay
- Tulane International LLC, Ngaliema, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
4
|
Kapadia-Kundu N, Tamene H, Ayele M, Dana F, Heliso S, Velu S, Berhanu T, Alemayehu G, Leslie L, Kaufman M. Applying a gender lens to social norms, couple communication and decision making to increase modern contraceptive use in Ethiopia, a mixed methods study. Reprod Health 2022; 19:138. [PMID: 35765014 PMCID: PMC9237964 DOI: 10.1186/s12978-022-01440-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia, sub-Saharan Africa's second most populous country has seen improvements in women's reproductive health. The study objectives are (1) using mixed methods research, to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication and contraceptive use. METHODS The study includes both quantitative and qualitative methods. Researchers interviewed a total of 2770 women of reproductive age (15-49 years) in 2016 using a structured survey covering six health areas. Eligible households were identified using a multi-stage cluster-sampling technique. Using probability proportionate to size sampling, the researchers selected 10% of the proposed target woredas (24 of 240 woredas). The qualitative study included 8 rapid assessments, 16 in-depth interviews, 24 key informant interviews, and 16 focus group discussions. Qualitative data were analyzed using NVivo version 8. RESULTS Adjusted odds ratios were estimated for current modern family planning use among married women with logistic regression. The primary influencing factors for contraceptive use are gender equitable norms, high self-efficacy, and weekly exposure to the radio. Qualitative data indicate that the timing of contraceptive use is linked to the social norm of the desired family size of 4-5 children. Gender inequity is evident in couple communication with men controlling decision making even if women initiated conversations on family planning. A key finding based on an inductive analysis of qualitative data indicates that the micro-processes of couple communication and decision making are often dictated by male advantage. The study identified six micro-processes that lead to gender inequity which need to be further examined and researched. CONCLUSIONS Barriers to contraceptive use include unequal couple communication and compromised decision making. Inequitable gender norms are also barriers to modern contraceptive use. The study recommends using a gender lens to study couple communication and decision making, with the goal of making both processes more equitable to accelerate the adoption of modern family planning methods in Ethiopia.
Collapse
Affiliation(s)
- Nandita Kapadia-Kundu
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Habtamu Tamene
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Ethiopia, Africa Avenue (Bole Road) Dembel City Center 10th Floor, P.O. Box: 26171 Code 1000, Addis Ababa, Ethiopia
| | - Minyahil Ayele
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Ethiopia, Africa Avenue (Bole Road) Dembel City Center 10th Floor, P.O. Box: 26171 Code 1000, Addis Ababa, Ethiopia
| | - Feleke Dana
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Ethiopia, Africa Avenue (Bole Road) Dembel City Center 10th Floor, P.O. Box: 26171 Code 1000, Addis Ababa, Ethiopia
| | - Simon Heliso
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Ethiopia, Africa Avenue (Bole Road) Dembel City Center 10th Floor, P.O. Box: 26171 Code 1000, Addis Ababa, Ethiopia
| | - Sanjanthi Velu
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Tsega Berhanu
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Ethiopia, Africa Avenue (Bole Road) Dembel City Center 10th Floor, P.O. Box: 26171 Code 1000, Addis Ababa, Ethiopia
| | - Guda Alemayehu
- United States Agency for International Development (USAID/Ethiopia), 3Q57+9C7, Addis Ababa, Ethiopia
| | - Lindsey Leslie
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michelle Kaufman
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| |
Collapse
|
5
|
Mulumeoderhwa M. "A Slap of Love": A Way of Showing Love and Resolving Conflict Among Young People in South Kivu, Democratic Republic of Congo. J Interpers Violence 2021; 36:10884-10911. [PMID: 31894717 DOI: 10.1177/0886260519897335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article draws on qualitative study to examine Congolese male and female high school students' attitudes toward intimate partner violence. A total of 56 boys and girls aged 16-20 years from two urban and two rural high schools in South Kivu province took part in focus groups, and 40 of these were subsequently interviewed individually. To the majority of male and female participants, when the man or boy beats his wife or girlfriend that means he loves her and he wants her to change. They believed that if a boy does not love her, he may let her go on making mistakes. Some male participants viewed women and girlfriend beating as a way to let her realize her inferiority. However, some female participants disagreed with these assumptions but they concomitantly accepted a "slap of love." There is a strong need to re-educating both males and females to address the problem, and particularly train men to treat women respectfully and non-violently.
Collapse
|
6
|
Sileo KM, Wanyenze RK, Mukasa B, Musoke W, Kiene SM. The Intersection of Inequitable Gender Norm Endorsement and HIV Stigma: Implications for HIV Care Engagement for Men in Ugandan Fishing Communities. AIDS Behav 2021; 25:2863-2874. [PMID: 33566214 DOI: 10.1007/s10461-021-03176-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Men's engagement in the HIV care continuum may be negatively affected by adherence to inequitable gender norms, which may be exacerbated by HIV stigma. This cross-sectional study with 300 male fisherfolk in Uganda examined the independent and interacting effects of inequitable gender norm endorsement and HIV stigma on men's missed HIV care appointments and missed antiretroviral (ARV) doses. Greater gender inequitable norm endorsement was associated with increased odds of missed HIV clinic visits (adjusted odds ratio [AOR)] 1.44, 95% CI 1.16-1.78) and a statistically significant interaction between internalized HIV stigma and inequitable gender norms on missed ARV doses was identified (AOR 5.32, 95% CI 2.60-10.86). Adherence to traditional gender norms reduces men's HIV appointment attendance, and among men with high internalized stigma, increases the likelihood of poor treatment adherence. These findings point to the need for HIV interventions that reconfigure harmful gender norms with a focus on stigma reduction.
Collapse
Affiliation(s)
- K M Sileo
- Department of Public Health, University of Texas At San Antonio, One UTSA Circle, MB 3.472, San Antonio, TX, 78249, USA.
- SDSU School of Public Health, San Diego State University, San Diego, CA, USA.
| | - R K Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | | | - S M Kiene
- SDSU School of Public Health, San Diego State University, San Diego, CA, USA
| |
Collapse
|
7
|
Zimmerman LA, Koenig LR, Pulerwitz J, Kayembe P, Maddeleno M, Moreau C. The Intersection of Power and Gender: Examining the Relationship of Empowerment and Gender-Unequal Norms Among Young Adolescents in Kinshasa, DRC. J Adolesc Health 2021; 69:S64-S71. [PMID: 34217462 DOI: 10.1016/j.jadohealth.2021.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine how perceptions of gender norms and expressions of empowerment are related among disadvantaged young adolescent boys and girls in Kinshasa, DRC. METHODS We included data from 2,610 adolescent boys and girls between 10 and 14 years old. We examined correlations between three dimensions of perceived gender norms (a sexual double standard, gender stereotypical roles, and gender stereotypical traits) and two domains of agency (voice and decision-making), overall and by sex. We conducted sex-stratified simple and multivariable linear regression models to assess these associations, adjusting for sociodemographic factors. We also tested for differences in the association between gender norm perceptions and agency by sex. RESULTS Correlations between gender norm perceptions and agency scores were low (under 0.15). Among boys, greater perception of a sexual double standard was related to more voice (p=0.001) and more decision-making power (p=0.008). Similar patterns were observed among girls for the relationship between sexual double standard and voice (p≤.001), but not for decision-making. Increased perceptions of gender stereotypical traits were related to more voice among girls (p≤.001), while conversely girls who perceived greater gender stereotypical roles had less decision-making power (p=0.010). CONCLUSIONS This study demonstrated that gender norm perceptions and agency are distinct but related constructs. Interventions aimed to promote gender equality must consider gender unequal norms and gender-unequal divisions of power as important but different dynamics.
Collapse
Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Leah R Koenig
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie Pulerwitz
- HIV/AIDS Program, Population Council, Washington, District of Columbia
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
| |
Collapse
|
8
|
Addo B, Berchie R. Attitude towards gender norms in Ghana: understanding the dynamics among men and women in intimate relationships. J Pop Research 2021; 38:197-220. [DOI: 10.1007/s12546-021-09258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Lugova H, Samad N, Haque M. Sexual and Gender-Based Violence Among Refugees and Internally Displaced Persons in the Democratic Republic of the Congo: Post-Conflict Scenario. Risk Manag Healthc Policy 2020; 13:2937-2948. [PMID: 33328772 PMCID: PMC7734039 DOI: 10.2147/rmhp.s283698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022] Open
Abstract
The ongoing humanitarian crisis in the Democratic Republic of the Congo has triggered sexual and gender-based violence, including rape, sexual slavery, trafficking, intimate partner violence, and sexual exploitation. Gender inequalities and abuse of power experienced by women and young girls at refugee settings further exacerbate their vulnerability to different forms of violence. This study aimed to offer an evidence-based approach to developing strategies in tackling the complex problem of sexual and gender-based violence among refugees and internally displaced persons in the Congo. We conducted a narrative review of all the relevant papers known to the authors to explore the origins of the problem, its implications on public health, and its impact on equity. The study revealed that sexual assault survivors face physical and psychological sufferings, excruciating emotions, and profound disruption of their social well-being since they are often stigmatized and ostracized by society. The analysis of current government policies revealed a lack of programs to address survivors' specific concerns and policy enforcement problems. This study suggested strategic objectives and policy implementation steps. The proposed strategies address women empowerment and gender stigma, provision of effective health services, and adequate response action.
Collapse
Affiliation(s)
- Halyna Lugova
- Unit of Community Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
10
|
Lewis S, Moucheraud C, Schechinger D, Mphande M, Banda BA, Sigauke H, Kawale P, Dovel K, Hoffman RM. "A loving man has a very huge responsibility": A mixed methods study of Malawian men's knowledge and beliefs about cervical cancer. BMC Public Health 2020; 20:1494. [PMID: 33008344 PMCID: PMC7532091 DOI: 10.1186/s12889-020-09552-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Malawi, numerous barriers may prevent women from accessing cervical cancer screening services - including social factors such as male partner involvement. We conducted surveys that included open- and closed-ended questions with married Malawian men to evaluate their knowledge and beliefs about cervical cancer. METHODS HIV-positive adult (≥18 years) men (married or in a stable relationship) were recruited from an antiretroviral therapy clinic in Lilongwe, Malawi. Men were asked a series of survey questions to assess their knowledge about cervical cancer, experience with cervical cancer, their female partner's screening history, and their beliefs about gender norms and household decision-making. Following the survey, participants responded to a set of open-ended interview questions about cervical cancer screening, and men's role in prevention. RESULTS One hundred-twenty men were enrolled with average age 44 years and 55% having completed secondary school or higher education. Despite only moderate knowledge about cervical cancer and screening (average assessment score of 62% correct), all men expressed support of cervical cancer screening, and most (86%) believed they should be involved in their female partner's decision to be screened. Over half (61%) of men said their female partner had previously been screened for cervical cancer, and this was positively correlated with the male respondent having more progressive gender norms around sexual practices. Some men expressed concerns about the screening process, namely the propriety of vaginal exams when performed by male clinicians, and whether the procedure was painful. CONCLUSIONS Male partners in Malawi want to be involved in decisions about cervical cancer screening, but have limited knowledge about screening, and hold rigid beliefs about gender norms that may affect their support for screening. Messaging campaigns addressing men's concerns may be instrumental in improving women's adoption of cervical cancer screening services in Malawi and similar settings.
Collapse
Affiliation(s)
- Samuel Lewis
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Corrina Moucheraud
- University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Devon Schechinger
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs, Los Angeles, CA, USA
| | | | | | | | - Paul Kawale
- African Institute for Development Policy, Lilongwe, Malawi
| | - Kathryn Dovel
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Risa M Hoffman
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
11
|
Abstract
Objective: To determine the gender equality attitudes of nursing students studying at a private university, the sociodemographic factors affecting gender equality, and the difference in gender attitudes between Turkish and foreign students. Methods: This cross-sectional study was carried out in the Faculty of Nursing at Near East University in March and April 2019. Three hundred six students studying in Turkish and English nursing programs in the thirdyear of study were included in the research. A sociodemographic questionnaire and the GEM scale were used as the data collection tools. Results: The mean age of the participants was 21.11 ± 3.88. 76.1% of the students were female and 33.3 students were foreign. The Gender Equality Men scores of the Turkish and foreign students were significantly different (p=0.001). Gender, the educational level of the father, a history of violence in the family, and talking about family and sexual issues affected the gender attitudes of all students. Conclusion: The results of the present study indicate that culture, gender, family education, and a history of violence in the family affected the gender equality scores of the nursing students.
Collapse
Affiliation(s)
- Serap Tekbas
- Dr. Serap Tekbas, ST., Department of Women Health, Near East University of Nursing Faculty, Lefkosa, Cyprus
| | - Ganna Pola
- Dr. Ganna Pola, AP., Department of Women Health, Near East University of Nursing Faculty, Lefkosa, Cyprus
| |
Collapse
|
12
|
Kibira SPS, Karp C, Wood SN, Desta S, Galadanci H, Makumbi FE, Omoluabi E, Shiferaw S, Seme A, Tsui A, Moreau C. Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges. BMC Public Health 2020; 20:865. [PMID: 32503485 PMCID: PMC7275340 DOI: 10.1186/s12889-020-08977-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The balance between increasing men's participation in family planning and rights-based initiatives favoring women's empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low- and middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women's decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women's choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries. METHODS Women aged 15-49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women's and girls' empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes. RESULTS Findings comprised three thematic areas: the practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure. CONCLUSIONS Results indicate that while covert use of contraception is common, continued covert use is challenging, especially when side effects manifest. Covert use may further suggest women taking independent action, symbolizing some level of empowerment. Results underscore the importance of disentangling unique reasons for covert use and the severity of repercussions of disclosure.
Collapse
Affiliation(s)
- Simon P S Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Selamawit Desta
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hadiza Galadanci
- Center for Advanced Medical Research and Training, Bayero University Kano, Kano State, Nigeria
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Elizabeth Omoluabi
- Centre for Research Evaluation Resources and Development, Ile-Ife Osun State, Nigeria
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807, Le Kremlin-Bicêtre, France
| |
Collapse
|
13
|
Costenbader E, Zissette S, Martinez A, LeMasters K, Dagadu NA, Deepan P, Shaw B. Getting to intent: Are social norms influencing intentions to use modern contraception in the DRC? PLoS One 2019; 14:e0219617. [PMID: 31310641 PMCID: PMC6634398 DOI: 10.1371/journal.pone.0219617] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/27/2019] [Indexed: 12/02/2022] Open
Abstract
Meeting the reproductive health needs of women in post-conflict settings is a global health priority. In the Democratic Republic of the Congo, social norms perpetuate gender-based violence and contribute to low contraceptive use and high fertility. The Masculinité, Famille, et Foi (MFF) intervention is working with communities in Kinshasa to create normative environments supportive of modern contraception access and use. Our analysis uses survey data collected from 900 men and women in 17 community groups prior to the MFF intervention. We aimed to measure the extent to which social norms influence intentions to use modern contraception. Using multiple items to assess social norms and reference groups related to family planning and gender equity, we identified four distinct social norms constructs through factor analysis. Through structural equation modeling, we found that social norms influence intentions to use modern contraception overall, but that normative influence varies by gender.
Collapse
Affiliation(s)
| | | | | | - Katherine LeMasters
- FHI 360, Durham, NC, United States of America
- University of North Carolina Gillings School of Public Health, Chapel Hill, NC, United States of America
| | - Nana Apenem Dagadu
- Institute of Reproductive Health at Georgetown University, Washington, DC, United States of America
| | | | - Bryan Shaw
- Institute of Reproductive Health at Georgetown University, Washington, DC, United States of America
| |
Collapse
|