BARRIERS TO USE CONTRACEPTIVE METHODS AMONG POST ABORTION CLIENTS IN SARGODHA, PAKISTAN: A QUALITATIVE STUDY
Abstract
World Health Organization (WHO) recommends at least 6 months interpregnancy interval after an abortion. Pakistan has a low contraceptive prevalence rate and a high unmet need for contraception. Post-abortion women are the potential clients for contraception but national data reveal low uptake of the contraceptive methods by these clients. This study aimed to explore the barriers to adopting contraception among post-abortion clients in the district of Sargodha, Pakistan. A qualitative research design was used. Study participants were recruited from three private and three public sector hospitals in the district of Sargodha, Pakistan. The study was conducted from July 2018 to November 2018. Ninety-nine in-depth interviews (IDIs) of post-abortion women were conducted using an unstructured interview guide within the period of one month after abortion. Detailed field notes were made. Interviews continued until thematic saturation had reached. The content was organized into a matrix based on themes and sub-themes. A descriptive thematic analysis using both inductive and deductive coding was conducted. Reasons for not adopting contraceptive methods were explored Although many clients expressed a desire to limit fertility, some barriers were found to be hindering the uptake of contraception. Major barriers expressed by clients were the unwillingness of the husband, the resistance of other family members and real or perceived fear of side effects of contraceptive methods. Lack of adequate knowledge about fertility and contraception was another factor which contributed to the decision not to adopt contraception. Socio-cultural norms to have large family sizes were also reported by some clients. Other barriers include religious beliefs, focus on other health issues, financial unaffordability, infrequent intercourse and plan for tubal ligation. The study concluded that without addressing the barriers post-abortion contraceptive uptake is unlikely to improve. Identification of barriers is the first step to addressing the existing unmet need for contraception.
References
National Institute of Population Studies (NIPS) and ICF. PDHS 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF; 2018. Available at https://dhsprogram.com/publications/publication-fr354-dhs-final-reports.cfm
Singh LM, Prinja S, Rai P, et al. Determinants of Modern Contraceptive Use and Unmet Need for Family Planning among the Urban Poor. Open Journal of Social Sciences 2020;8(5):451-73.
Goujon A, Wazir A, Gailey N. Pakistan: A population giant falling behind in its demographic transition. Population Societies 2020(4):1-4.
Sinai I, Omoluabi E, Jimoh A, et al. Unmet need for family planning and barriers to contraceptive use in Kaduna, Nigeria: culture, myths and perceptions. Culture, health & sexuality 2020 ;22(11):1253-68.
Malel ZJ, Henry BB, Legge S, et al. Introduction of postpartum and post abortion family planning into three hospitals in South Sudan. South Sudan Medical Journal 2020;13(2):90-4.
Baynes C, Yegon E, Lusiola G, et al. Post-abortion fertility desires, contraceptive uptake and unmet need for family planning: voices of post-abortion care clients in Tanzania. JBS 2020:1-6.
Imran M, Yasmeen R. Barriers to family planning in Pakistan. J Ayub Med Coll Abbottabad 2020;32(4):584-7.
Purcell C, Cameron S, Lawton J, et al. Contraceptive care at the time of medical abortion: experiences of women and health professionals in a hospital or community sexual and reproductive health context. Contraception 2016;93(2):170-7.
Gemzell-Danielsson K, Kallner HK, Faúndes A. Contraception following abortion and the treatment of incomplete abortion. International Journal of Gynecology & Obstetrics 2014 ;126:S52-5.
Nadeem M, Malik MI, Anwar M, et al. Women Decision Making Autonomy as a Facilitating Factor for Contraceptive Use for Family Planning in Pakistan. Social Indicators Research 2021:1-9.
Eltomy EM, Saboula NE, Hussein AA. Barriers affecting utilization of family planning services among rural Egyptian women. EMHJ-Eastern Mediterranean Health Journal 2013; 19 (5): 400-408.
Che Y, Dusabe-Richards E, Wu S, et al. A qualitative exploration of perceptions and experiences of contraceptive use, abortion and post-abortion family planning services (PAFP) in three provinces in China. BMC women's health 2017;17(1):1-3.
Gold N, Viviano M, Yaron M. Contraception: what is the resistance all about?. The European Journal of Contraception & Reproductive Health Care. 2021 Jan 2;26(1):62-72.
Merki-Feld GS, Caetano C, Porz TC, Bitzer J. Are there unmet needs in contraceptive counselling and choice? Findings of the European TANCO Study. The European Journal of Contraception & Reproductive Health Care. 2018 May 4;23(3):183-93.
Rustagi N, Taneja DK, Kaur R, et al. Factors affecting contraception among women in a minority community in Delhi: a qualitative study. Health Popul Perspect Issues 2010;33(1):10-5.
Cleland J. The complex relationship between contraception and abortion. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020 Jan 1;62:90-100.
Muanda M, Gahungu Ndongo P, Taub LD, et al. Barriers to modern contraceptive use in Kinshasa, DRC. PloS one 2016;11(12):e0167560.
Ghule M, Raj A, Palaye P, et al. Barriers to use contraceptive methods among rural young married couples in Maharashtra, India: qualitative findings. Asian journal of research in social sciences and humanitie. 2015;5(6):18.
Mustafa G, Azmat SK, Hameed W, et al. Family planning knowledge, attitudes, and practices among married men and women in rural areas of Pakistan: Findings from a qualitative need assessment study. International journal of reproductive medicine 2015;2015(1):4-11.
Penfold S, Wendot S, Nafula I, et al. A qualitative study of safe abortion and post-abortion family planning service experiences of women attending private facilities in Kenya. Reproductive health 2018;15(1):1-8.
Borges AL, OlaOlorun F, Fujimori E, et al. Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study. Reproductive health 2015;12(1):1-0.
Gele AA, Musse FK, Shrestha M, et al. Barriers and facilitators to contraceptive use among Somali immigrant women in Oslo: A qualitative study. PloS one 2020;15(3):e0229916.
Ankomah A, Anyanti J, Adebayo S, et al. Barriers to contraceptive use among married young adults in Nigeria: a qualitative study. Int J Trop Dis Health 2013;3(3):267-82.