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Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania

BACKGROUND: Young adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existin...

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Autores principales: Sedekia, Yovitha, Jones, Caroline, Nathan, Rose, Schellenberg, Joanna, Marchant, Tanya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627429/
https://www.ncbi.nlm.nih.gov/pubmed/28974208
http://dx.doi.org/10.1186/s12889-017-4759-9
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author Sedekia, Yovitha
Jones, Caroline
Nathan, Rose
Schellenberg, Joanna
Marchant, Tanya
author_facet Sedekia, Yovitha
Jones, Caroline
Nathan, Rose
Schellenberg, Joanna
Marchant, Tanya
author_sort Sedekia, Yovitha
collection PubMed
description BACKGROUND: Young adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existing evidence on this topic focuses on women who have already started childbearing. Using primary qualitative data, we explored individual, community and health provider’s perceptions about using modern contraceptives to delay the first birth in a high fertility setting. METHODS: A descriptive qualitative study was conducted in Tandahimba district in southern Tanzania between December 2014 and March 2015. We conducted 8 focus group discussions with men and women and 25 in-depth interviews (18 with women, 4 with family planning service providers and 3 with district-level staff). Participants were purposively sampled. Data transcripts were managed and coded using Nvivo 11 software and we employed a thematic framework analysis. RESULTS: Three main themes emerged about using modern contraceptives to delay first birth: (1) the social and biological status of the woman (2) the type of contraceptive and (3) non-alignment among national policies for adolescents. Use of modern contraceptives to delay first birth was widely acceptable for women who were students, young, unmarried and women in unstable marriage. But long-acting reversible methods such as implants and intrauterine devices were perceived as inappropriate methods for delaying first birth, partly because of fears around delayed return to fecundity, discontinuation once woman’s marital status changes and permanently limiting future fertility. The support for use of modern contraceptives to delay a first pregnancy was not unanimous. A small number of participants from both rural and urban areas did not approve the use of contraceptive methods before the birth of a first baby at all, not even for students. There was lack of clarity and consistency on the definition of ‘young’ and that had direct implications for access, autonomy in decision-making, confidentiality and consent for young people. CONCLUSIONS: Women who wish to delay their first birth face challenges related to restrictions by age and method imposed by stakeholders in accessing and provision of modern contraceptives. There is a need for a clearly communicated policy on minimum age and appropriate method choice for delayers of first birth.
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spelling pubmed-56274292017-10-12 Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania Sedekia, Yovitha Jones, Caroline Nathan, Rose Schellenberg, Joanna Marchant, Tanya BMC Public Health Research Article BACKGROUND: Young adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existing evidence on this topic focuses on women who have already started childbearing. Using primary qualitative data, we explored individual, community and health provider’s perceptions about using modern contraceptives to delay the first birth in a high fertility setting. METHODS: A descriptive qualitative study was conducted in Tandahimba district in southern Tanzania between December 2014 and March 2015. We conducted 8 focus group discussions with men and women and 25 in-depth interviews (18 with women, 4 with family planning service providers and 3 with district-level staff). Participants were purposively sampled. Data transcripts were managed and coded using Nvivo 11 software and we employed a thematic framework analysis. RESULTS: Three main themes emerged about using modern contraceptives to delay first birth: (1) the social and biological status of the woman (2) the type of contraceptive and (3) non-alignment among national policies for adolescents. Use of modern contraceptives to delay first birth was widely acceptable for women who were students, young, unmarried and women in unstable marriage. But long-acting reversible methods such as implants and intrauterine devices were perceived as inappropriate methods for delaying first birth, partly because of fears around delayed return to fecundity, discontinuation once woman’s marital status changes and permanently limiting future fertility. The support for use of modern contraceptives to delay a first pregnancy was not unanimous. A small number of participants from both rural and urban areas did not approve the use of contraceptive methods before the birth of a first baby at all, not even for students. There was lack of clarity and consistency on the definition of ‘young’ and that had direct implications for access, autonomy in decision-making, confidentiality and consent for young people. CONCLUSIONS: Women who wish to delay their first birth face challenges related to restrictions by age and method imposed by stakeholders in accessing and provision of modern contraceptives. There is a need for a clearly communicated policy on minimum age and appropriate method choice for delayers of first birth. BioMed Central 2017-10-03 /pmc/articles/PMC5627429/ /pubmed/28974208 http://dx.doi.org/10.1186/s12889-017-4759-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Sedekia, Yovitha
Jones, Caroline
Nathan, Rose
Schellenberg, Joanna
Marchant, Tanya
Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania
title Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania
title_full Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania
title_fullStr Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania
title_full_unstemmed Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania
title_short Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania
title_sort using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627429/
https://www.ncbi.nlm.nih.gov/pubmed/28974208
http://dx.doi.org/10.1186/s12889-017-4759-9
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