Socio-demographic profile of participants in the survey
A total of 1,410 individuals participated in the study, majority (1143; 81%) of whom were from Kigungu (Table 1). More than two thirds (911; 65%) of the participants were aged 15-29 years. Slightly more than a third (514; 36%) were engaging in fishing or a fishing related activity. Most (590; 42%) of them were Catholics while half (706; 50%) of them had attained only up to primary level of education with very few (106; 8 %) in both villages reaching the tertiary education level. Most (1,043; 74%) of the participants had stayed in the community for more than twelve months. Majority (1,157; 82%) of the participants reported being in a sexual relationship even though just over a half (810; 58%) of the participants were married. In both villages, those who reported having multiple sexual partners in the past 12 months were fewer (534; 38%) than those who reported not having multiple sexual partners (876; 62%) in the past 12 months. Nearly all participants said the ideal number of children for a couple was four or fewer children (1134; 80%) and the ideal spacing interval was 2 or more years (136; 97%).
.
Table 1: Socio-demographic profile of participants in the cross sectional survey stratified by village
Characteristic
|
Total (N=1410) n (col %)
|
Kigungu (n=1143) n (col %)
|
Nsazi (n=267) n(col%)
|
Chi-Square
P-value
|
Mean Age(SD)
|
27.5(7.2)
|
27.1(7.1)
|
29.1(7.4)
|
<0.001
|
Median Age(IQR)
|
26(22-32)
|
25(21-32)
|
28(23-34)
|
<0.001
|
Age group (Years)
|
|
|
|
0.011
|
15-29
|
911(65)
|
759(66)
|
152(57)
|
|
30-39
|
397(28)
|
308(27)
|
89(33)
|
|
40+
|
102(7)
|
76(7)
|
26(10)
|
|
Tribe
|
|
|
|
0.111
|
Muganda
|
631(45)
|
512(45)
|
119(44)
|
|
Munyankole
|
129(9)
|
114(10)
|
15(6)
|
|
Musoga
|
96(7)
|
71(6)
|
25(9)
|
|
Mukiga
|
31(2)
|
24(2)
|
7(3)
|
|
Munyarwanda
|
123(9)
|
103(9)
|
20(8)
|
|
Other▲
|
400(28)
|
319(28)
|
81(30)
|
|
Occupation
|
|
|
|
<0.001
|
Farming
|
33(2)
|
28(2)
|
5(2)
|
|
Fishing/Fishing related
|
514(36)
|
380(33)
|
134(50)
|
|
Trade/business
|
275(20)
|
234(20)
|
41(15)
|
|
House wife
|
124(9)
|
92(8)
|
32(12)
|
|
Otherβ
|
464(33)
|
409(36)
|
55(21)
|
|
Religion
|
|
|
|
0.001
|
Catholic
|
590(42)
|
478(42)
|
112(42)
|
|
Protestant/Anglican
|
339(24)
|
265(23)
|
74(27)
|
|
Muslim
|
238(17)
|
182(16)
|
56(21)
|
|
Other*
|
243(17)
|
218(19)
|
25(9)
|
|
Highest Education level
|
|
|
|
0.001
|
No formal education
|
82(6)
|
70(6)
|
12(6)
|
|
Primary level
|
706(50)
|
554(48)
|
152(57)
|
|
Secondary level
|
516(37)
|
419(37)
|
97(36)
|
|
Tertiary level
|
106(8)
|
100(9)
|
6(2)
|
|
Sex
|
|
|
|
0.057
|
Male
|
697(49)
|
579(51)
|
118(44)
|
|
Female
|
713(51)
|
564(49)
|
149(56)
|
|
Marital status
|
|
|
|
<0.001
|
Single/ Never Married
|
343(15.7)
|
301(26.3)
|
42(15.7)
|
|
Not married
|
810(57.5)
|
652(57.0)
|
158(59.2)
|
|
Divorced/Separated/Widowed
|
257(18.2)
|
190(16.6)
|
67(25.1)
|
|
Duration of stay
|
|
|
|
<0.001
|
Months
|
367(26)
|
266(23)
|
101(38)
|
|
Years
|
1043(74)
|
877(77)
|
166(62)
|
|
Are you currently in a sexual relationship?
|
|
|
|
0.008
|
Yes
|
1157(82)
|
923(81)
|
234(88)
|
|
No
|
253(18)
|
220(19)
|
33(12)
|
|
Having multiple sexual partners in past 12 months
|
|
|
|
0.026
|
No(< 2 partners)
|
876(62)
|
726(64)
|
150(56)
|
|
Yes(≥ 2 partners)
|
534(38)
|
417(36)
|
117(44)
|
|
Ideal Number of children for a couple
|
|
|
|
0.007
|
Said ≤4 Children
|
1134(80)
|
935(82)
|
199(75)
|
|
Said >4 Children
|
276(20)
|
208(18)
|
68(25)
|
|
Ideal birth spacing interval
|
|
|
|
0.284
|
Said < 2 years
|
48(3)
|
41(4)
|
7(3)
|
|
Said ≥ 2 years
|
1362(97)
|
1102(96)
|
260(97)
|
|
▲ (Mugisu, Itesot, Non-Ugandan), β (Sex worker, Teacher, Security personnel and others), * (Pentecostal/ Born again, Traditional African, No religion)
Knowledge of family planning methods
Almost all (1,333; 94.5%) the participants were aware or knew at least one FP method (Table 2). Pills (1027; 77%), injectable hormonal methods (1004; 75%), implants (776; 58%) condoms (607; 52%) and IUDs (636; 48%) were the most commonly known methods in both villages. Knowledge of specific methods tended to be slightly higher among participants in Kigungu than those in Nsazi. Knowledge of permanent methods (vasectomy and bilateral tubal ligation) was low in both villages and it ranged between 3.2% and 9.6%. Knowledge of natural or traditional methods (periodic abstinence, calendar, breast-feeding rhythm/withdrawal, moon beads) was also low in both villages ranging between 0.4% and 13.8%. Some methods such as emergency pills and spermicides were not known in Nsazi.
Table 2: Knowledge of family planning methods
Methods
|
Number (N=1410)
|
Kigungu (N=1143)
|
Nsazi(N=267)
|
Knowledge of any FP method
|
1,333 (94.5%)
|
1086 (95%)
|
247 (92.5%)
|
Knowledge of specific methods*
|
Number (N=1333)
(n, %)
|
Number (N=1086)
(n, %)
|
Number (N=247)
(n, %)
|
Pills
|
1027(77.0)
|
843 (77.6)
|
184(74.5)
|
Injectable hormonal methods
|
1004(75.3)
|
812 (74.8)
|
192(77.7)
|
Implants
|
776(58.2)
|
621(57.1)
|
155(62.8)
|
Condoms
|
697(52.3)
|
623(57.4)
|
74(30)
|
IUD
|
636(47.7)
|
503(46.3)
|
133(53.8)
|
Rhythm
|
155(11.6)
|
150(13.8)
|
5(2)
|
Vasectomy
|
112(8.4)
|
104(9.6)
|
8(3.2)
|
Tubal Ligation
|
97(7.3)
|
89(8.2)
|
8(3.2)
|
Periodic Abstinence
|
78(5.9)
|
74(6.8)
|
4(1.6)
|
Calendar
|
54(4.1)
|
52(4.8)
|
2(0.8)
|
Breast feeding/LAM
|
40(3.0)
|
39(3.6)
|
1(0.4)
|
Emergency Pill
|
34(2.6)
|
34(3.1)
|
0(0)
|
Spermicide
|
31(2.3)
|
31(2.9)
|
0(0)
|
Herbs
|
28(2.1)
|
24(2.2)
|
4(1.6)
|
Moon beads
|
22(1.7)
|
18(1.7)
|
4(1.6)
|
Diaphragm
|
5(0.4)
|
4(0.4)
|
1(0.4)
|
Foam
|
3(0.2)
|
3(0.3)
|
0(0)
|
other
|
1(0.1)
|
1(0.1)
|
0(0)
|
*Knowledge of each method was assessed independently out of 100%
|
|
Family planning knowledge classification
When participants who knew at least one FP method were further assessed on knowledge of FP methods and their side effects, their mean total score was 11 (17%). Of the 1,333 participants who knew at least one FP method, slightly above a third (502; 38%) had good knowledge on FP methods and their side effects. Majority (205; 83%) of the participants in Nsazi had poor knowledge (Figure 1).
Correlates of knowledge of FP in FCs
At unadjusted analysis, statistically significant correlates of good knowledge of FP included; sex, type of employment, level of education, village of residence, marital status, duration of stay in the village and currently being in a sexual relationship. After adjustment, factors that remained statistically significantly associated with good knowledge of FP were sex, village of residence, marital status and currently being in a sexual relationship. Good knowledge of FP was significantly higher among females than males (aOR: 1.92 95% CI: 1.39-2.67). It was also significantly higher among residents of Kigungu than Nsazi (aOR: 4.01 95% CI: 2.77-5.81), among those who were married compared to those who were single (Never married) (aOR: 1.59 95% CI: 1.11-2.28) and among those currently in a sexual relationship compared to those who were not (aOR: 1.75 95% CI: 1.18-2.60).
Table 3: Correlates of Knowledge of Family planning in fishing communities of L. Victoria, Uganda
Characteristic
|
Total (N=1333) n (col %)
|
Good knowledge (N=502) n (col %)
|
uOR 95%CI
|
p-value
|
aOR 95%CI
|
P-value
|
Age group (Years)
|
|
|
|
0.323
|
|
|
15-29
|
861(64.6)
|
329(65.5)
|
Ref
|
|
|
|
30-39
|
380(28.5)
|
145(28.9)
|
0.99(0.79-1.28)
|
|
1.04(0.79-1.39)
|
0.766
|
40+
|
92(6.9)
|
28(5.6)
|
0.71(0.44-1.13)
|
|
0.83(0.50-1.38)
|
0.467
|
Sex
|
|
|
|
<0.001
|
|
|
Male
|
633(47.5)
|
198(39.4)
|
Ref
|
|
|
|
Female
|
700(52.5)
|
304(60.6)
|
1.69(1.35-2.11)
|
|
1.92(1.39-2.67)
|
<0.001
|
Tribe
|
|
|
|
0.407
|
|
|
Muganda
|
603(45.2)
|
229(45.6)
|
Ref
|
|
|
|
Munyankole
|
121(9.1)
|
46(9.2)
|
1.0(0.67-1.50)
|
|
|
|
Musoga
|
91(7.0)
|
42(8.4)
|
1.40(0.89-2.18)
|
|
|
|
Mukiga
|
29(2.2)
|
13(2.6)
|
1.33(0.64-2.81)
|
|
|
|
Munyarwanda
|
116(8.7)
|
38(7.6)
|
0.80(0.52-1.21)
|
|
|
|
Other▲
|
373(28.0)
|
134(26.7)
|
0.92(0.70-1.20)
|
|
|
|
Occupation
|
|
|
|
0.004
|
|
|
Farming
|
34(2.6)
|
12(2.4)
|
Ref
|
|
|
|
Fishing/Fishing related
|
471(35.3)
|
147(29.3)
|
0.83(0.40-1.73)
|
|
1.06(0.49-2.30)
|
0.875
|
Trade/business
|
435(32.6)
|
179(35.7)
|
1.28(0.62-2.66)
|
|
1.09(0.50-2.35)
|
0.83
|
House wife
|
123(9.2)
|
45(9.0)
|
1.06(0.48-2.34)
|
|
0.64(0.27-1.50)
|
0.306
|
Otherβ
|
270(20.3)
|
119(23.7)
|
1.44(0.69-3.04)
|
|
1.28(0.58-2.79)
|
0.542
|
Highest Education level
|
|
|
|
0.067
|
|
|
No formal education
|
80(6.0)
|
27(5.4)
|
Ref
|
|
|
|
Primary level
|
652(48.9)
|
231(46.0)
|
1.08(0.66-1.76)
|
|
1.20(0.72-2.00)
|
0.488
|
Secondary level
|
498(37.4)
|
210(41.8)
|
1.43(0.87-2.35)
|
|
1.63(0.96-2.77)
|
0.071
|
Tertiary level
|
103(7.7)
|
34(6.8)
|
0.97(0.52-1.80)
|
|
1.12(0.57-2.22)
|
0.725
|
Religion
|
|
|
|
0.584
|
|
|
Catholic
|
560(42.0)
|
202(40.2)
|
Ref
|
|
|
|
Protestant/Anglican
|
324(24.3)
|
126(25.1)
|
1.13(0.85-1.50)
|
|
|
|
Muslim
|
217(16.3)
|
89(17.7)
|
1.23(0.89-1.70)
|
|
|
|
Other*
|
232(17.4)
|
85(16.9)
|
1.02(0.75-1.41)
|
|
|
|
Residence
|
|
|
|
<0.001
|
|
|
Nsazi
|
267(20)
|
42(8.4)
|
Ref
|
|
|
<0.001
|
Kigungu
|
1143(85.7)
|
460(91.6)
|
3.89(2.52-5.11)
|
|
4.01(2.77-5.81)
|
|
Marital status
|
|
|
|
<0.001
|
|
|
Single(Never Married)
|
311(23.0)
|
92(18.3)
|
Ref
|
|
|
|
Married
|
777(58.3)
|
327(65.1)
|
1.73(1.30-2.29)
|
|
1.59(1.11-2.28)
|
<0.001
|
Divorced/Separated/Widowed
|
245(18.4)
|
83(16.5)
|
1.22(0.85-1.75)
|
|
1.37(0.90-2.08)
|
0.141
|
Duration of stay
|
|
|
|
0.009
|
|
|
< 12 Months
|
343(25.7)
|
109(21.7)
|
Ref
|
|
|
|
≥ 12 Months
|
990(74.3)
|
393(78.3)
|
1.41(1.09(1.83)
|
|
1.27(0.96-1.68)
|
0.096
|
Are you currently in a sexual relationship?
|
|
|
|
<0.001
|
|
|
No
|
1105(82.9)
|
60(11.9)
|
Ref
|
|
|
|
Yes
|
228(17.1
|
442(88.1)
|
1.87(1.36-2.57)
|
|
1.75(1.18-2.60)
|
0.005
|
Having multiple sexual partners in past 12 months
|
|
|
|
0.062
|
|
|
No(< 2 partners)
|
834(62.6)
|
330(65.7)
|
Ref
|
|
|
|
Yes(≥ 2 partners)
|
499(37.4)
|
172(34.3)
|
0.80(0.64-1.01)
|
|
1.00(0.76-1.32)
|
0.98
|
Ideal number of children
|
|
|
|
0.436
|
|
|
Said ≤4 Children
|
1077(80.8)
|
411(81.9)
|
Ref
|
|
|
|
Said >4 Children
|
256(19.2)
|
91(18.1)
|
0.89(0.67-1.19)
|
|
|
|
▲ (Mugisu, Itesot, Non-Ugandan), β (Sex worker, Teacher, Security personnel and others), * (Pentecostal/ Born again, Traditional African, No religion) (uOR: Unadjusted odds ratio, aOR: Adjusted odds ratio; CI: Confidence Interval)
Sources of family planning information
When participants were asked to mention the sources of FP information that they knew existed in their village, nearly all (1212; 91.1%) indicated governmental hospitals, more than half (870; 65.3%) mentioned private hospitals or clinics while less than a third (336; 25.2%) mentioned non-governmental organizations (NGOs). Only a few in both villages mentioned Traditional Birth Attendants (TBAs) as sources of FP information. Kigungu (44; 4.1%), Nsazi (3; 1.2%) respectively (Table 4). Other sources included; pharmacy or drug shops, family planning clinics, drug or medicine vendors, ordinary retail shops and friends among others.
Table 4: Sources of family planning information known*
Source
|
Total (N=1333)
(n, %)
|
Kigungu (N=1086)
(n, %)
|
Nsazi (N=247)
(n, %)
|
Government hospital
|
1215(91.1)
|
1009(92.9)
|
206(83.4)
|
Private hospital/clinic
|
870(65.3)
|
727(66.9)
|
143(57.9)
|
Non-governmental Organizations(NGOs)
|
336(25.2)
|
301(27.7)
|
35(14.2)
|
Pharmacy/drug shop
|
140(10.5)
|
131(12.1)
|
9(3.6)
|
Family planning clinics
|
131(9.8)
|
115(10.6)
|
16(6.5)
|
Drug/Medicine vendors
|
54(4.1)
|
53(4.9)
|
1(0.4)
|
Ordinary shop
|
48(3.6)
|
39(8.3)
|
9(3.6)
|
Traditional Birth Attendants(TBAs)
|
47(3.5)
|
44(4.1)
|
3(1.2)
|
Others
|
32(2.4)
|
32(2.9)
|
0(0)
|
*Each source was assessed independently out of 100%
|
Findings from the qualitative aspect of the study
Each FGD comprised of 8-11 members. IDIs were conducted with significant members of the community including; a community advisory board member, religious leader, political/ local council leader, commercial sex worker, TBA, Village Health Team member (VHT) and some other recognized community leaders. The FGDs and IDIs comprised of 47 participants (Table 5). FGDs lasted between 65-103 minutes while the IDIs lasted between 37-75 minutes. We identified four themes relevant to knowledge of FP which included: 1) General community understanding and awareness of FP, 2) Beliefs and Attitudes towards FP, 3) Known sources of information on FP with their related challenges and 4) perceived reasons for or choices of preferred methods.
Table 5: Description of FGD and IDI participants
|
FGD Description
|
Number in Group
|
Duration in Minutes
|
Fishing Community
|
1.
|
Females
|
11
|
90
|
Nsazi
|
Aged 25-49 years
|
|
|
|
|
|
|
|
2.
|
Males
|
8
|
103
|
Kigungu
|
Aged 25-49years
|
|
|
|
|
|
|
|
3.
|
Females
|
9
|
65
|
Kigungu
|
Aged 15-17years
|
|
|
|
|
|
|
|
4.
|
Males
|
9
|
85
|
Nsazi
|
Aged 15-17years
|
|
|
|
|
|
|
|
|
IDI Description
|
|
|
|
1.
|
Community Advisory Board Member
|
|
37
|
Kigungu
|
2.
|
Religious leader
|
|
56
|
Kigungu
|
3.
|
Political/Local Council leader
|
|
61
|
Nsazi
|
4.
|
Medical Personnel
|
|
70
|
Kigungu
|
5.
|
Representative from High risk group(Fisherman)
|
|
63
|
Nsazi
|
6.
|
Traditional Birth Attendant
|
|
45
|
Nsazi
|
7.
|
Female Peer leader aged 25 years
|
|
72
|
Kigungu
|
8.
|
Female Sex worker aged 17 years
|
|
50
|
Nsazi
|
9.
|
Male Peer leader aged 27 years
|
|
75
|
Kigungu
|
10.
|
Male Youth leader aged 19 years
|
|
55
|
Nsazi
|
General community understanding and awareness of FP
The first theme which emerged revealed that the community members generally understood the concept of FP and that they were all aware of at least one FP method. The Methods that were mentioned included pills, injectable methods such as Depo-Provera® or injectaplan®, condoms, implants, intra-uterine device, vasectomy, bilateral tubal ligation, withdrawal, calendar method, breast feeding and abstinence. Although the awareness of FP methods was high, participants didn’t seem to know much about how and for how long most methods work. While some appreciated that FP was for both limiting the number of births and allowing a good spacing interval between births, there were others who thought FP may affect future fertility or even induce permanent sterility. A respondent in an in-depth interview said, “The understanding of family planning in this community is that it is used to completely stop one from getting children and yet it should really be for spacing births. Majority think that when you use family planning you stop giving birth because your eggs get damaged.”(Female, 48 years)
Like what was observed in the survey, most of the community members were mostly aware of modern FP methods like pills, injectable hormonal methods, implants, intra-uterine devices and condoms. There were participants who knew about both modern and natural or traditional methods of FP. They however mentioned the complexity of using the natural or traditional methods which they said were not reliable. Many of the participants knew that condoms can prevent both pregnancy and sexually transmitted infections (STIs) and commented that condoms were popular. They however said that using condoms consistently was difficult especially for the men who think that condoms reduce sexual satisfaction. A few thought that condoms are the only FP method for men. There are others who said condoms were difficult to use in a married setting resulting in mistrust and misunderstandings in the home. Some expressed concerns about limited knowledge on condom use among the youth saying that the youth may be stigmatised and shy away from getting the required FP knowledge before engaging in sexual activities.
Some participants didn’t know about the female condom and the few who knew about it neither knew how it works nor where it can be accessed if one wanted to use it.
Some of the knowledge community members had about FP was inaccurate. Although many have heard about injectable methods for females, there are those who said that they heard that men too have injectable hormonal methods of FP. Some said that vasectomy can make a man fail to get an erection or release sexual fluids.
Like the female condom, some modern FP methods were either not known or not mentioned at all by the focus group or interview participants such as the diaphragm, spermicides, dermal patch and others. Some participants mentioned ineffective methods such as use of herbs and remains of an umbilical cord to prevent conception. One IDI participant who is a TBA said, “….I also know some herbs that one can use if they don’t want to use those other family planning methods I have listed”. (Female, 48 years) The use of herbs was attributed to low levels of education by some participants who doubted their effectiveness. The use of remains of an umbilical cord was cited by some as a medically unproven FP method.
Beliefs and Attitudes towards FP
It was noted that people had divergent beliefs and attitudes towards FP. Although some were supportive of FP, negative and incorrect beliefs still exist concerning effects of FP on women’s reproductive health and health in general. We observed that some participants believed that FP can lead to sterility, cancer of the uterus, abnormal uterine masses and foetal abnormalities or disability. A participant from a focus group of males aged 16-17 years said,” people fear to use a coil [IUD] because they think it can cause cancer or lead to barrenness”. Because the menstrual cycle changes in some women who are using FP, some participants believe that women who miss their periods, a side effect to some methods of FP, end up getting uterine masses.
Side effects of some FP methods were pointed out such as weight gain or loss, menstrual irregularities or excessive prolonged bleeding, loss of sexual desire and reduced vaginal secretions. Some said that prolonged bleeding, loss of sexual desire and reduced vaginal secretions interfere with sexual activities which later result into family disputes. A participant in a focus group of males aged 15-17 years said,” Family planning is a long term issue which requires one to decide on what to do during the long periods of ‘no sex’ depending on the methods of choice used; some family planning methods make women lose their sexual desire. Some men cannot do without sex for a long time and that creates problems in the family.” There are still some who report that some FP methods cause congenital abnormalities or abnormal features in those children born to mothers using FP. Some do not trust information on FP because they think health workers promote FP for monetary gains.
Most of the participants think that FP should be used by women and youth. They attribute this to the shift in gender roles where women in FCs bear the burden of fending for the homes and children. The youth are thought to have very little information on FP and yet they are reported to be mobile and promiscuous. A participant in an in-depth interview said,” The men here tend to have many women. So if you get many children, you as the woman will suffer because you will bear the burden of feeding them, treating them and taking them to school. Our husbands these days neglect their roles of being heads of families. The women do everything. Because women are left to do everything, they end up engaging in other sexual relationships to get money.” (Female, 40 years)
Another participant said,” Women are the ones who should use family planning because women these days have responsibilities like looking for food to feed the children, taking the children for treatment when they fall sick, buying clothes and paying school fees”. (Female, 17 years) Others said that because of their vulnerability FP should be a woman’s responsibility.
There are some community members who believed that FP was for educated people and yet they thought there were few educated people in FCs.
Men’s awareness of FP was thought to be low compared to that of the women and some report shame in attending FP sessions. One participant in an in-depth interview said,” It is only a small number of men who have attended family planning sensitisation meetings. ”The men feel ashamed to go with their wives to family planning sessions, they know it is a ‘woman’s thing’. Because of this, most of the men do not know much about family planning issues.” (Male, 45 years)
It was observed that both men’s attitudes and their work schedules may hinder them from attending sensitization meetings. Health education campaigns to improve beliefs and attitudes of men towards FP are needed[42].
Known sources of information on FP and related challenges
Community members get information on FP from various sources, some of which are formal and trusted while others are informal and doubted. The formal sources of information on FP include; health facilities (both governmental and non-governmental), private clinics and media (print, audio and visual). Some of the informal sources include places of worship (churches and mosques), peers, schools, health outreach sessions and village meetings. Regarding sensitization by health workers, the issue of language barrier was one that was mentioned as a challenge to awareness. Because FCs attract job-seekers from across Uganda, there are those who are disadvantaged when they go to health centres where the staff only know English and the village’s local language.
A new trend of using social media as a source of FP knowledge was cited although it was thought to be limited to those with smart phones and computers with internet. One participant from a focus group of males aged 15-17 years said,”…only updated youth get information about family planning from social media. The reason is not many people are educated enough to use social media or afford it but a few are there”.
Traditional “Aunties” were also known to provide information on FP even though they were thought to lack formal training. In the Ugandan context, a traditional “Auntie” is a woman (usually advanced in age) who counsels other women on family issues and is entrusted by community members to do so based on her past experience.
VHTs were noted to be another source of information, especially to those who are unable to access health centres due to long distances or stigma. These VHTs, however, were often reported as insufficient sources of FP information. They refer those who require information on long term or permanent methods to big health centres.
Perceived reasons for preferred methods.
In these communities, different factors were reported to inform FP method choice. Some members said that some health facilities or clinics sell specific FP methods and attendees get these methods if they can afford them. A participant from a focus group of female participants aged 15-17 years said, “If you go to the government health centres, it’s assumed that the medicines or services are free, but at times the health workers demand for some money before the services are provided. So if you have no money, you are denied the service”.
Others attributed choice of methods to their availability, known side effects of the methods, health worker skills and behaviour, invasiveness of the methods and preference of spouse. A participant from a focus group of female participants aged 15-17 years said, “Some preferred family planning methods are not readily available at the health centres, and usually the health centres stock methods known to be demanded by most clients, who use the services. A client may want a tubal ligation but health centres cannot do it. They end up referring the client who may not even go where they are referred because they don’t have money for transport.”