Barriers and enablers to utilisation of postpartum long-acting reversible contraception in Eastern Uganda: a qualitative study.
Immediate postpartum family planning
Intrauterine devices, implant, qualitative
Long acting reversible contraception
Modern contraceptives
Uganda
Journal
Contraception and reproductive medicine
ISSN: 2055-7426
Titre abrégé: Contracept Reprod Med
Pays: England
ID NLM: 101703414
Informations de publication
Date de publication:
10 Oct 2024
10 Oct 2024
Historique:
received:
13
05
2024
accepted:
21
09
2024
medline:
11
10
2024
pubmed:
11
10
2024
entrez:
10
10
2024
Statut:
epublish
Résumé
In Uganda, although most women wish to delay or prevent future pregnancies, uptake of postpartum family planning (PPFP) is low. We explored behavioural factors influencing the utilisation of postpartum long-acting reversible contraceptives (LARCs) in Eastern Uganda. We conducted a qualitative study in two districts of Eastern Uganda. We conducted 20 in-depth interviews and three focus group discussions with postpartum women, male partners, midwives, and village health team members. We analysed transcripts using framework analysis, based on the COM-B framework. The use of immediate postpartum LARC was affected by the capabilities of women in terms of their knowledge and misconceptions. Limited capabilities of health workers to provide counselling and insert IUDs, as well as shortages of implants, reduced the physical opportunites for women to access PPFP. Social opportunities for women were limited because men wanted to be involved in the decision but rarely had time to accompany their partners to health facilities, and health workers often appeared too stressed. Men also feared that PPFP would enable their partners to be unfaithful. Motivation to take up immediate postpartum LARC included the desire to space births, preference for contraceptive implants over intra uterine devices (IUD) at the 6-week postpartum period, resumption of sex and menses, partner support, and perceived effectiveness of postpartum contraception. Participants thought that uptake of immediate postpartum LARC could be improved by health education and outreach visits, male involvement and couples' counselling in antenatal clinic appointments, and enabling switching between family planning methods (in case of side-effects) . Low uptake of PPFP was caused by inadequate knowledge and misconceptions about LARC by women and their partners, insufficient numbers of midwives trained to provide PPFP, stock-outs of PPFP methods, and few social opportunities for couples to be counselled together. These factors could be addressed by scaling up effective, low cost and innovative ways to provide health education (such as films), involving men in decision-making, as well as training more midwives to provide PPFP services, and ensuring that they have sufficient time and supplies.
Identifiants
pubmed: 39390530
doi: 10.1186/s40834-024-00308-5
pii: 10.1186/s40834-024-00308-5
doi:
Types de publication
Journal Article
Langues
eng
Pagination
49Subventions
Organisme : National Institute for Health Research
ID : NIHR 302412
Informations de copyright
© 2024. The Author(s).
Références
Pasha O, Goudar SS, Patel A, Garces A, Esamai F, Chomba E, et al. Postpartum contraceptive use and unmet need for family planning in five low-income countries. Reproductive Health. 2015;12(2):1–7.
Nakaggwa F, Kimuli D, Kasule K, Katwesige JF, Kintu D, Ssempebwa R, et al. Postpartum family planning uptake in Uganda: findings from the lot quality assurance sampling survey. Contracept Reproductive Med. 2023;8(1):44.
doi: 10.1186/s40834-023-00243-x
WHO. Report of a WHO technical consultation on birth spacing. Rep WHO Tech Consult Birth Spacing. 2005;13:1–44.
World Health Organisation. Family Planning/ contraception methods 2023 [ https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
World Health Organisation. Family Planning Handbook 2022. https://fphandbook.org/sites/default/files/WHO-JHU-FPHandbook-2022Ed-v221115a.pdf
Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(9837):149–56.
doi: 10.1016/S0140-6736(12)60609-6
pubmed: 22784533
Cheslack Postava K, Winter AS. Short and long interpregnancy intervals: correlates and variations by pregnancy timing among US women. Perspect Sex Reprod Health. 2015;47(1):19–26.
doi: 10.1363/47e2615
pubmed: 25623196
Sserwanja Q, Mukunya D, Nabachenje P, Kemigisa A, Kiondo P, Wandabwa JN, et al. Continuum of care for maternal health in Uganda: a national cross-sectional study. PLoS ONE. 2022;17(2):e0264190.
doi: 10.1371/journal.pone.0264190
pubmed: 35202413
pmcid: 8870527
UBOS. GOVERNMENT OF UGANDA Uganda Demographic and health survey. 2016–2017.
World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health. Center for Communication Programs (CCP), Knowledge for Health Project. Family Planning: A Global Handbook for providers (2018 update). Baltimore and Geneva: CCP and WHO; 2018.
Ssebatta G, Kaye DK, Mbalinda SN. Early contraceptive implants removal and its associated factors among women using implants at a National Referral Hospital, Kampala Uganda. BMC Womens Health. 2021;21(1):399.
doi: 10.1186/s12905-021-01541-9
pubmed: 34852790
pmcid: 8638549
Sileo KM, Wanyenze RK, Lule H, Kiene SM. Determinants of family planning service uptake and use of contraceptives among postpartum women in rural Uganda. Int J Public Health. 2015.
Rutaremwa G, Kabagenyi A, Wandera SO, Jhamba T, Akiror E, Nviiri HL. Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study. BMC Public Health. 2015;15:262.
doi: 10.1186/s12889-015-1611-y
pubmed: 25885372
pmcid: 4372233
Anguzu R, Tweheyo R, Sekandi JN, Zalwango V, Muhumuza C, Tusiime S, et al. Knowledge and attitudes towards use of long acting reversible contraceptives among women of reproductive age in Lubaga division, Kampala district, Uganda. BMC Res Notes. 2014;7:153.
doi: 10.1186/1756-0500-7-153
pubmed: 24636154
pmcid: 3985592
Morse JE, Rowen TS, Steinauer J, Byamugisha J, Kakaire O. A qualitative assessment of Ugandan women’s perceptions and knowledge of contraception. Int J Gynaecol Obstet. 2014;124(1):30–3.
doi: 10.1016/j.ijgo.2013.07.014
pubmed: 24156991
Nalwadda G, Mirembe F, Byamugisha J, Faxelid E. Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives. BMC Public Health. 2010;10:530.
doi: 10.1186/1471-2458-10-530
pubmed: 20813069
pmcid: 2940919
Kabagenyi A, Jennings L, Reid A, Nalwadda G, Ntozi J, Atuyambe L. Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health. 2014;11(1):21.
doi: 10.1186/1742-4755-11-21
pubmed: 24597502
pmcid: 3946591
Willcox M, King E, Fall E, Mubangizi V, Nkalubo J, Natukunda S, et al. Barriers to uptake of postpartum long-acting reversible contraception: qualitative study of the perspectives of Ugandan health workers and potential clients. Stud Fam Plann. 2019;50(2):159–78.
doi: 10.1111/sifp.12088
pubmed: 30963601
Tumusiime J. Peoples ad Cultures of Uganda Edition t, editor. Kampala Fountain P. 2011.
De Leo A, Bayes S, Bloxsome D, Butt J. Exploring the usability of the COM-B model and theoretical domains Framework (TDF) to define the helpers of and hindrances to evidence-based practice in midwifery. Implement Sci Commun. 2021;2(1):1–8.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
doi: 10.1186/1748-5908-6-42
pubmed: 21513547
pmcid: 3096582
Polit DF, Beck CT. Nursing research. Generating and assessing evidence for nursing practice. 2012;9.
Ritchie J, Spencer L. Qualitative data analysis for applied policy research. Analyzing qualitative data: Routledge; 2002. pp. 173–94.
Asmamaw DB, Belachew TB, Fetene SM, Addis B, Amare T, Kidie AA, et al. Postpartum long-acting reversible contraceptives use in sub-saharan Africa. Evidence from recent demographic and health surveys data. PLoS ONE. 2023;18(10):e0291571.
doi: 10.1371/journal.pone.0291571
pubmed: 37812616
pmcid: 10561849
Memon ZA, Mian A, Reale S, Spencer R, Bhutta Z, Soltani H. Community and Health Care Provider perspectives on barriers to and enablers of Family Planning Use in Rural Sindh, Pakistan: qualitative exploratory study. JMIR Formative Res. 2023;7(1):e43494.
doi: 10.2196/43494
Gahungu J, Vahdaninia M, Regmi PR. The unmet needs for modern family planning methods among postpartum women in Sub-saharan Africa: a systematic review of the literature. Reproductive Health. 2021;18:1–15.
doi: 10.1186/s12978-021-01089-9
Tran NT, Yameogo WME, Gaffield ME, Langwana F, Kiarie J, Kulimba DM et al. Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study. Open Access J Contracept. 2018:63–74.
Harrison MS, Goldenberg RL. Immediate postpartum use of long-acting reversible contraceptives in low-and middle-income countries. Maternal Health Neonatology Perinatol. 2017;3:1–9.
doi: 10.1186/s40748-017-0063-z
Jalinga Vuamaiku G, Epuitai J, Andru M, Aleni M. I Don’t Support It for My Children: Perceptions of Parents and Guardians regarding the Use of Modern Contraceptives by Adolescents in Arua City, Uganda. International Journal of Reproductive Medicine. 2023;2023.
Mubangizi V, Plastow J, Nakaggwa F, Nahabwe H, Natukunda S, Atim F, et al. Assessing changes in knowledge, attitudes, and intentions to use family planning after watching documentary and drama health education films: a qualitative study. Reproductive Health. 2022;19(1):65.
doi: 10.1186/s12978-022-01370-5
pubmed: 35279189
pmcid: 8917732
Mubangizi V, McGrath N, Kabakyenga JK, Muller I, Stuart BL, Raftery JP, et al. Antenatal couples’ counselling in Uganda (ACCU): study protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud. 2022;8(1):97.
doi: 10.1186/s40814-022-01049-5
pubmed: 35488317
pmcid: 9051788