Abstract
BackgroundReliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives.MethodsA convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data.ResultsWomen reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods.ConclusionWomen’s contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women’s choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.
Highlights
Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, and increase maternal mortality
A convenience sample was used to recruit participants from three clinics providing family planning (FP) in the Gaza Strip, two governmental clinics and one clinic run by a non-governmental organization (NGO) This clinic represents one of the largest NGO clinics providing sexual and reproductive health (SRH) services and reaches patients from the entire Gaza Strip, who attend this clinic
A total of 213 women completed the questionnaires, of which nine were excluded because more than three values were missing from their questionnaires, leaving 204 participants, including 123 (60.0%) from the NGO clinic as well as 47 (22.9%) and 34 (16.6%) from the two government clinics respectively
Summary
Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, and increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives. It has been estimated that the increase of contraceptive use over the last 20 years has reduced maternal mortality by 40% globally [1]. This is mainly achieved by reducing unintended pregnancies, increasing pregnancy spacing and reducing high risk pregnancies [2,3,4,5]. Worldwide different factors were identified, that impact on women’s contraceptive usage, but limited data are so far available from Palestine [8, 17,18,19,20,21]
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