Tibaijuka Leevan, Odongo Robert, Welikhe Emma, Mukisa Wilber, Kugonza Lilian, Busingye Imelda, Nabukalu Phelomena, Ngonzi Joseph, Asiimwe Stephen B, Bajunirwe Francis
Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.
BMC Womens Health. 2017 Apr 4;17(1):25. doi: 10.1186/s12905-017-0382-2.
Unplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection.
We performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews.
The prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability.
Our results suggest that interventions to improve uptake of LARC among reproductive age women in this setting should consider: incorporating desired method-characteristics into LARC methods; targeted promotion and supply of LARC; and increased counselling, sensitization, and education.
在许多资源有限的地区，意外怀孕仍然是一个常见问题，这主要是由于获得现代计划生育（FP）服务的机会有限。特别是，与短效避孕方法（如避孕套、避孕药、注射用激素和杀精剂）相比，更有效的长效可逆避孕（LARC）方法（即宫内节育器和激素植入剂）的使用率仍然较低。在乌干达参加计划生育和产前保健诊所的育龄妇女中，我们评估了她们对现代避孕方法使用的看法和做法。我们特别旨在评估影响方法选择的因素。
我们进行了一项混合方法的横断面研究，对180名客户进行了结构化访谈，并与36名客户进行了4次焦点小组讨论（FGD），与卫生服务提供者进行了8次深入的个人定性访谈。我们总结了定量数据，并对FGD和定性访谈的记录进行了潜在内容分析。
LARC方法的曾经使用率为23%。方法特征（如客户控制）似乎比结构因素（如方法可用性）或个体客户特征（如知识和看法）更常驱动方法选择。选择LARC方法的最常见原因是：保护时间更长；更好的生育间隔；以及有效性。不选择LARC方法的最常见原因包括需要客户控制的方法以及希望在不久的将来怀孕。选择短效方法的最常见原因是易于获得；成本较低；隐私性；感觉副作用较少；以及在不涉及卫生服务提供者的情况下自由停止使用某种方法。似乎很重要的客户个人特征是客户知识和子女数量。似乎很重要的结构因素是方法可用性。
我们的结果表明，在这种情况下，为提高育龄妇女对LARC的接受度而采取的干预措施应考虑：将所需的方法特征纳入LARC方法；有针对性地推广和供应LARC；以及加强咨询、宣传和教育。
