Abstract
BackgroundWith a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members.MethodsAn explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n = 132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes.ResultsThe overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09–10.27 p = 0.038), those that have completed secondary school and having four or less children were significantly associated with use of family planning (aOR 1.72 (95%1.35–2.01) p = 0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning.ConclusionGiven that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.
Highlights
With a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world
In the Burundian context, community members agree that large family sizes are difficult to maintain, yet use of family planning remains consistently low
This study explored the factors behind this low utilisation of family planning in two health districts located in the South of Burundi
Summary
With a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning has been linked to improvements in maternal health outcomes. In spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members. With a fertility rate of 5.4 children to a woman, Burundi has been classified as among the top ten countries with the highest fertility, placing just seventh after Niger, Somalia, the Democratic Republic of the Congo, Mali, Chad and Angola [3]. High fertility rate has been identified as a major contributor to poor health outcomes such as increased maternal and child morbidity and mortality. Hendrik et al (2014) found that short birth intervals negatively affect perinatal, neonatal and child health by increasing the incidence of preterm birth, low birth weight and perinatal death. [5]
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