Kamwesigye Assen, Amanya Daphine, Nambozo Brendah, Epuitai Joshua, Nahurira Doreck, Wani Solomon, Nafula Patience Anna, Oguttu Faith, Wadinda Joshua, Nantale Ritah, Napyo Agnes, Wandabwa Julius N, Mukunya David, Musaba Milton W, Willcox Merlin
Department of Obstetrics and Gynecology, Mbale Regional Referral and Teaching Hospital, P.O. Box 921, Mbale, Uganda.
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, P.O. Box 1460, Mbale, Uganda.
Contracept Reprod Med. 2024 Oct 10;9(1):49. doi: 10.1186/s40834-024-00308-5.
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.
在乌干达，尽管大多数女性希望推迟或避免未来怀孕，但产后计划生育（PPFP）的使用率较低。我们探讨了影响乌干达东部产后长效可逆避孕方法（LARC）使用的行为因素。
我们在乌干达东部的两个地区进行了一项定性研究。我们对产后妇女、男性伴侣、助产士和乡村卫生团队成员进行了20次深入访谈和3次焦点小组讨论。我们基于COM - B框架，使用框架分析法对访谈记录进行了分析。
产后立即使用LARC受到女性知识水平和误解方面能力的影响。卫生工作者提供咨询和插入宫内节育器的能力有限，以及植入剂短缺，减少了女性获得PPFP的实际机会。女性的社会机会有限，因为男性希望参与决策，但很少有时间陪伴侣去医疗机构，而且卫生工作者往往压力过大。男性还担心PPFP会使他们的伴侣不忠。采用产后立即使用LARC的动机包括希望生育间隔、在产后6周时比起宫内节育器（IUD）更倾向于避孕植入剂、恢复性生活和月经、伴侣支持以及对产后避孕效果的认知。参与者认为，通过健康教育和外展访问、男性参与以及在产前诊所预约时进行夫妻咨询，以及在出现副作用时允许在计划生育方法之间切换，可以提高产后立即使用LARC的比例。
PPFP使用率低是由于女性及其伴侣对LARC的知识不足和误解、接受PPFP培训的助产士数量不足、PPFP方法缺货以及夫妻共同接受咨询的社会机会少。可以通过扩大提供健康教育的有效、低成本和创新方式（如电影）、让男性参与决策、培训更多助产士提供PPFP服务以及确保他们有足够的时间和物资来解决这些因素。
