Barriers to preventing unintended pregnancies and sexually transmitted infections as experienced by women in Fort Dauphin, southeast Madagascar

Abstract

Objectives As part of a broader investigation into maternal and child health, this study aimed to explore barriers to preventing unintended pregnancies and sexually transmitted infections (STIs) for women in southeast Madagascar, in order to inform the development of interventions by a local non-governmental organisation.Methods A year-long mixed methods study was conducted. Qualitative information was obtained from 246 participants through focus groups, single-event and serial qualitative interviews. Quantitative data was collected through a closed-ended questionnaire with a sample of 373 women of reproductive age. Data was analysed using pre-determined and emerging themes.Results Family planning and sexual health services are not well integrated into other health services, nor routinely offered. Barriers to contraceptive use include actual or perceived side effects of hormonal methods, inaccurate information from health providers, and lack of support from partners or family members. STI prevalence is high, concurrent sexual relationships are common, and condom use is limited.Conclusions Women's ability to prevent unintended pregnancies and STIs could be improved through measures aiming to dispel misconceptions about eligibility for and perceived risks of hormonal contraceptives, increase support for family planning among partners and families, and reframe the socio-cultural meaning of condom use in sexual relationships.Chinese 摘要目的 作为一个广泛的妇幼健康调查的一部分，本研究的目的是为了探寻那些影响妇女预防非意愿妊娠和性传播疾病的的主要因素，来促进马达加斯加东南部当地的非政府组织的干预工作。方法 通过一年的时间，采取多种形式的调查。通过对246名妇女分别按照不同人群组，深度访谈以及系列访谈获得定性数据。定量数据通过对373名育龄妇女进行封闭式问卷调查来获得。数据的分析按照事先决定形成的主题进行。结果 计划生育和性健康的服务并没有很好的纳入当地的其他健康服务中，或者说不是常规的提供。妨碍避孕药使用的主要因素包括激素类避孕方法使用中实际发生的副反应以及妇女臆想的副反应，服务机构从业人员提供的不正确信息，缺少来自性伴侣或者家庭成员的支持。性传播疾病的发病率高，多个性伴侣的现象普遍，但是避孕套的使用十分有限。结论 妇女防范非意愿妊娠和性传播疾病的能力需要提高。需要采取各项措施，帮助妇女了解避孕药的效果以及副反应，去除妇女对激素类避孕药使用的偏见，促进家庭成员和性伴侣对计划生育和避孕的支持，在性关系中重新构建避孕套使用的社会-文化意义。关键词妇女健康；性健康；性传播疾病；避孕套使用