The socio-demographic characteristics of informants are summarized in Table 2. The median age of women was 38.5 years. All 15 male partners of the women interviewed were older than their female partners. Christianity was the most common religion among all informants. Most (57%) of the FP providers were community health nurses with a median age of 31 years. Injectables were the most commonly used MCMs, whereas periodic abstinence was prevalent among traditional contraceptive users. Five male partners had ever used a male condom, but only two were current users.
Table 2. Socio–demographic characteristics of the informants
Characteristics
|
Women
|
Male partner
|
FP providers
|
Total
|
Age group (years)
|
N = 22
|
N = 15
|
N = 7
|
N = 44
|
25 – 29
|
0
|
0
|
3
|
3
|
30 – 34
|
0
|
0
|
3
|
3
|
35 – 39
|
12
|
2
|
1
|
15
|
40 – 44
|
6
|
6
|
0
|
12
|
45 – 49
|
4
|
6
|
0
|
10
|
Above 50
|
0
|
1
|
0
|
1
|
Educational level
|
N = 22
|
N = 15
|
N = 7
|
N = 44
|
No education
|
2
|
0
|
0
|
2
|
Primary
|
5
|
0
|
0
|
5
|
Secondary
|
8
|
6
|
0
|
14
|
Tertiary
|
7
|
9
|
7
|
23
|
Religion
|
N = 22
|
N = 15
|
N = 7
|
N = 44
|
Christianity
|
21
|
14
|
6
|
41
|
Muslim
|
1
|
1
|
1
|
3
|
Occupation
|
N = 22
|
N = 15
|
N = 7
|
N = 44
|
Government worker
|
6
|
8
|
7
|
21
|
Self employed
|
13
|
7
|
0
|
20
|
Homemaker
|
3
|
0
|
0
|
3
|
Type of modern contraceptives used - users (current & previous users)
|
N = 22a
|
N = 15 b
|
NA
|
N = 27
|
Injectables
|
14
|
NA
|
NA
|
14
|
Pills
|
5
|
NA
|
NA
|
5
|
Implants
|
2
|
NA
|
NA
|
2
|
IUD
|
1
|
NA
|
NA
|
1
|
Male condom
|
NA
|
5
|
NA
|
5
|
Type of Traditional contraceptive method used among TCMUs
|
N = 11c
|
N = 8d
|
NA
|
N = 19
|
Period abstinence method
|
11
|
2
|
NA
|
11
|
Withdrawal
|
NA
|
1
|
NA
|
11
|
a Frequency of MCMs used among all women
b Frequency of MCMs used among all male partners
c Type of TCMs used among TCMUs women
d Type of TCM used among male partners of TCMUs
|
It was revealed during the IDIs that almost all non-users of modern contraceptive methods used traditional contraception, which was not considered a form of contraception by the informants. One informant did not use any form of contraception because of her plan to get pregnant. In the study,the term MCM was used equivalent to contraception among informants.Two major themes were identified: facilitators of contraceptive use and barriers to contraceptive use.
Factors that promote the use of modern contraceptives
This theme describes the factors that promoted the use of moderncontraception, such as achieved desired family size, counselling by health staff, health reasons, andinfluence of the male partner.
Seven informants who used MCMs indicated that they had achieved the desired family size.
“After given birth to four children, I decided to do the five years family planning [Jadelle®], so when I got to the clinic, I told them what I wanted to do.” (MCMU 3).
Two women who were users of TCM expressed their intention to use MCMs after giving birth to the number of children they desire.
“When I give birth to the 5 children I desire, then I will do family planning to prevent any unplanned pregnancy.” (TCMU 2)
Among seven couples there were conflicting views on the achievement of the desired family size. Four husbands indicated that they had achieved the desired family size; however, their wives wanted to have one or two more children.
Five informants mentioned that counselling and health education by health workers encouraged them to use MCMs. A mother of five children on her experience with health workers’ advice to use MCMs stated that:
“For me, if they [the doctors] had not told me to come and do it, I wouldn’t have done family planning.” (MCMU 5).
Some informants mentioned that pregnancy at an advanced maternal age was dangerous. A couple agreed on female sterilization after their 5th children because of perceived risk to poor maternal outcomes in subsequent pregnancies.
“When my wife gave birth to the 5th child, she bled profusely. I was worried about her life and health if she gets pregnant again. So, we agreed and the doctors did the sterilization for her.” (HMCMU 6)
Husbands played a significant role in choosing and using MCMs. Eight male partners confirmed this. After making a joint decision to plan their family, a husband of an informant accompanied her to buy the pills at a drug store as she was shy because it was her first time using an MCM. However, among TCM users, two informants were discouraged by their husbands from using modern contraceptives because of the fear of side effects.
“I will not recommend women to use the modern contraceptives. During their unsafe period, their husbands can abstain from sex or use the male condom.” (HTCMU 6)
Barriers to modern contraceptives use
This theme describes factors that were perceived to hinder modern contraceptive use, such as religious or socio-cultural reasons, experience or fear of side effects, rumor or misconceptions, and the belief that contraceptive use is a matter for women.
Socio-cultural factors were prominent among men as reasons for the non-use of male condoms. Eight male partners mentioned that using a male condom was a common practice among unmarried young men who engaged in premarital sex. Married men who used male condoms were seen as promiscuous.
“Most of the community members think that a married man should not use male condom, it is the young men who are not married who should use it. When they see a married man going to buy it, they think that he is cheating on his wife.” (HTCMU 5).
The FP providers stated that the activities of some Pastors discouraged women from using MCMs.
“There is a Pastor in community X, who tells his congregation not to do family planning, so most of the women there do not do it. Others hide and come for family planning.” (FPP 3).
The experience and fear of side effects prevented five women and two husbands from using MCMs. Seven informants had experienced some side effects. Most (five out of seven) of these informants used Depo Provera.
“Some of us have used family planning before but we have to stop because of the side effects.” (TCMU 8,).
Five informants had never used MCMs because of the side effects their friends and relatives experienced. Two male informants using male condoms discontinued because of the reaction of their wives. Additionally, a 41-year-old husband stopped using male condoms when he experienced side effects.
The fear of side effects caused by MCMs influenced the choice for TCMs among five informants. Three informants switched from MCM to TCM usage due to MCM side effects.
“When I started experiencing irregular menses and heart palpitations, I thought that it was time to stop using contraception before I encounter something worse.” (TCMU 1)
In contrast, a 46-year-old mother of five children had not experienced any side effects after using Norigynon, monthly injectables, for five years.
Five out of seven family planning providers indicated that rumors/misconception was a primary concern that prevented the target group from accessing MCMs.
“Some also says they do not have their menses so the blood stay in their uterus which causes fibroid.” (TMCU 3,).
Four male partners indicated that they considered family planning a woman’s issue and did not encourage men to use male condoms. Not all men disapproved of the use of male condoms. For example, two male partners encouraged men to use male condoms because they considered them effective and without side effects.
“When I hear of the side effects of contraceptives, I think men should be encouraged to use the male condom to protect their wives from unplanned pregnancy.” (HTCMU 10).