Abstract
Recent research from Kinshasa, DRC, has shown that only one in five married women uses modern contraception; over one quarter have an unmet need for family planning; and almost 400 health facilities across Kinshasa report that they provide modern contraception. This study addresses the question: with reasonable physical access and relatively high unmet need, why is modern contraceptive prevalence so low? To this end, the research team conducted 6 focus groups of women (non-users of any method, users of traditional methods, and users of modern methods) and 4 of husbands (of users of traditional methods and in non-user unions) in health zones with relatively strong physical access to FP services. Five key barriers emerged from the focus group discussions: fear of side effects (especially sterility), costs of the method, sociocultural norms (especially the dominant position of the male in family decision-making), pressure from family members to avoid modern contraception, and lack of information/misinformation. These findings are very similar to those from 12 other studies of sociocultural barriers to family planning in sub-Saharan Africa. Moreover, they have strong programmatic implications for the training of FP workers to counsel future clients and for the content of behavior change communication interventions.
Highlights
The DRC is the third most populous country in sub-Saharan Africa, with roughly 77 million people [1]
The study was based on ten focus group discussions among women and husbands of women aged 20–34 who had at least two children. (In addition, eight focus groups were conducted among unmarried females and males aged 15–19; the findings are presented in a separate publication.) The rationale was to obtain data from adults in their peak child-bearing years
The hours of focus group discussions and pages of transcriptions were synthesized to identify the primary reasons for non-use of contraception among married couples in Kinshasa
Summary
The DRC is the third most populous country in sub-Saharan Africa, with roughly 77 million people [1]. The country faces high population growth, increasing at a rate of 3.1% per year, which results in a doubling of the population every 22 years. The total fertility rate (TFR) is high at 6.6 children. As of 2013–14 only 7.8% of married women of reproductive age nationwide used modern contraception [2]. The capital city of the DRC, has an estimated population of approximately 10 million people. The 2013–14 DHS showed Kinshasa to have lower fertility (TFR of 4.4 children) and a higher modern contraceptive prevalence rate (mCPR of 19.0%) than any other province in the country. (In 2015 the provinces were subdivided, so that currently the DRC has 26
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