肯尼亚未满足现代避孕需求的女性中避孕方法的使用和停止使用的定性探索。
A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya.
机构信息
Jhpiego Corporation, Johns Hopkins University Affiliate, Nairobi, Kenya.
Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.
出版信息
Reprod Health. 2021 Feb 9;18(1):33. doi: 10.1186/s12978-021-01094-y.
BACKGROUND
Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives.
METHODS
Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach.
RESULTS
Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods.
CONCLUSION
This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.
背景
满足对现代避孕方法的未满足需求是所有计划生育和避孕项目的目标。有避孕需求的人停止使用避孕方法会阻碍女性实现生育愿望，从而导致意外怀孕。本文介绍了避孕方法的使用经验、停止使用的原因以及未来使用现代避孕方法的意图。
方法
2019 年，在肯尼亚的两个农村县，我们从曾经使用过现代避孕方法但仍有避孕需求的女性中收集了定性数据。还从一些接受访谈的女性的男性伴侣那里收集了额外的数据。深入访谈和焦点小组讨论探讨了之前使用避孕方法的经验、停止使用的原因以及未来使用的意图。在数据收集之后，使用主题分析方法通过归纳法对数字记录的数据进行逐字转录、翻译和编码。
结果
使用现代避孕方法来预防怀孕和计划生育规模是使用避孕方法的主要动机。使用的避孕方法主要来自公共卫生设施，尽管青少年是从私营部门获得的。停止使用的原因包括副作用、方法失败、同伴影响、因暗中使用避孕药具而遭受性别暴力、以及卫生系统的失败。对于那些不愿意在未来使用的人，提供了五个原因：担心副作用、避孕服务的费用、家庭对使用现代避孕药具的冲突、需求减少以及转向传统方法。
结论
本研究通过检查有避孕需求的女性停止使用避孕方法的原因和未来使用的意图，扩展了相关文献。研究结果强调了计划生育干预措施需要将服务提供中的护理质量纳入其中，以解决避孕方法的停止使用问题。让男性和其他社会影响者参与计划生育项目和服务，将有助于争取对避孕方法的支持，而不是仅仅关注女性。本研究的结果可以为肯尼亚及其他地区的计划生育项目实施提供信息，以确保它们解决了曾经使用过现代避孕方法的用户的关注。
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