School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom.
Royal College of General Practitioners, London, United Kingdom.
PLoS One. 2021 May 5;16(5):e0251190. doi: 10.1371/journal.pone.0251190. eCollection 2021.
Although health workers have been trained to provide post-partum family planning (PPFP), uptake remains low in Uganda. An important reason is that women want the agreement of their partner, who is often absent at the time of delivery. In order to address this, we aimed to understand the views of couples and explore barriers and facilitators to implementation of antenatal couples' counselling on PPFP in Uganda.
We conducted individual interviews with a purposive sample of 12 postpartum and 3 antenatal couples; and 34 focus groups with a total of 323 participants (68 adolescent women, 83 women aged 20-49, 79 men, 93 health workers) in four contrasting communities (urban and rural) in South-West and Central Uganda. These were recorded, transcribed, translated, and analysed thematically.
Although most participants felt that it is important for partners to discuss family planning, half of the couples were unaware of each other's views on contraception. Most had similar views on motivation to use family planning but not on preferred contraceptive methods. Most liked the idea of antenatal couples' counselling on PPFP. The main barrier was the reluctance of men to attend antenatal clinics (ANC) in health facilities. Respondents felt that Village Health Teams (VHTs) could provide initial counselling on PPFP in couples' homes (with telephone support from health workers, if needed) and encourage men to attend ANC. Suggested facilitators for men to attend ANC included health workers being more welcoming, holding ANC clinics at weekends and "outreach" clinics (in rural villages far from health facilities).
Antenatal couples' counselling has the potential to facilitate agreement PPFP, but some men are reluctant to attend antenatal clinics. Counselling at home by VHTs as well as simple changes to the organisation of antenatal clinics, could make it possible to deliver antenatal couples' counselling on PPFP.
尽管卫生工作者已经接受了提供产后计划生育（PPFP）的培训，但在乌干达，这一服务的利用率仍然很低。一个重要的原因是，妇女希望得到其伴侣的同意，而伴侣通常在分娩时不在场。为了解决这个问题，我们旨在了解夫妇的观点，并探讨在乌干达实施产前夫妇咨询以提供产后计划生育服务的障碍和促进因素。
我们对来自四个不同社区（城市和农村）的 12 对产后和 3 对产前夫妇进行了有针对性的个人访谈；并对总共 323 名参与者（68 名青春期妇女、83 名 20-49 岁妇女、79 名男性、93 名卫生工作者）进行了 34 次焦点小组讨论。这些讨论被记录、转录、翻译，并进行了主题分析。
尽管大多数参与者认为伴侣讨论计划生育很重要，但一半的夫妇并不知道对方对避孕的看法。大多数人对使用计划生育的动机有相似的看法，但对首选的避孕方法没有相同的看法。大多数人喜欢产前夫妇咨询产后计划生育服务的想法。主要障碍是男性不愿意在卫生设施的产前诊所（ANC）就诊。受访者认为，乡村卫生工作队（VHT）可以在夫妇家中提供关于产后计划生育的初步咨询（如果需要，由卫生工作者提供电话支持），并鼓励男性参加 ANC。鼓励男性参加 ANC 的建议措施包括卫生工作者更加热情、在周末开设 ANC 诊所以及“外展”诊所（在远离卫生设施的农村村庄）。
产前夫妇咨询有可能促进对产后计划生育的同意，但一些男性不愿意参加产前诊所。VHT 在家中提供咨询以及对产前诊所组织的简单改变，可以实现提供产前夫妇咨询以提供产后计划生育服务。
