Abstract
BackgroundDespite targeted interventions to improve contraceptive implant acceptability and uptake in rural Papua New Guinea (PNG), ongoing use of this method remains limited. Previous literature has suggested community attitudes and intrinsic factors within the decision-making process may be negatively impacting on implant uptake, however these elements have not previously been studied in detail in this context. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG.MethodsWe conducted 10 focus-group (FGD) and 23 in-depth interviews (IDI) using semi-structured topic guides. Key sampling characteristics included age, exposure or non-exposure to implants, marital status, education and willingness to participate in discussion. Four FGDs were held with women, four with men and two with mixed gender. IDIs were carried out with five women (current implant users, former implant users, implant never users), five men, five religious leaders (Catholic and non-Catholic), four village leaders and four health workers. Two in-depth interviews (four participants) were analysed as dyads and the remaining participant responses were analysed individually.ResultsMen were supportive of their wives using family planning but there was a community-wide lack of familiarity about the contraceptive implant which influenced its low uptake. Men perceived family planning to be ‘women’s business’ but remained strongly influential in the decision making processes around method use. Young men were more receptive to biomedical information than older men and had a greater tendency towards wanting to use implants. Older men preferred to be guided by prominent community members for decisions concerning implants whilst young men were more likely to engage with health services directly.ConclusionsIn communities where a couple’s decision to use the contraceptive implant is strongly coloured by gendered roles and social perceptions, having a detailed understanding of the relational dynamics affecting the decision-making unit is useful in targeting future healthcare interventions. Engaging groups who are reluctant to connect with health information, as well as those who are most influential in the decision making process, will have the greatest impact on increasing implant acceptability and uptake.
Highlights
The acceptability and uptake of long acting reversible contraception in many low and middle-income countries (LMIC) is shaped by a complex interplay of factors including organizational logistics, challenging geography, sparse human service resourcing issues and a lack of integration and understanding of the diversity of traditional knowledge and practices around reproductive health [1,2,3,4]
In communities where a couple’s decision to use the contraceptive implant is strongly coloured by gendered roles and social perceptions, having a detailed understanding of the relational dynamics affecting the decision-making unit is useful in targeting future healthcare interventions
Plain English summary Contraceptive implants are a reliable and reversible form of birth control which can effectively reduce the number of women who die from complications associated with childbirth
Summary
The acceptability and uptake of long acting reversible contraception in many low and middle-income countries (LMIC) is shaped by a complex interplay of factors including organizational logistics, challenging geography, sparse human service resourcing issues and a lack of integration and understanding of the diversity of traditional knowledge and practices around reproductive health [1,2,3,4]. Combined with traditional perceptions that menstrual blood, after child-bearing, is considered ‘dirty’ and ‘dangerous’ with the potential to cause ‘weakness’ in men, this resulted in an alternative social consensus emerging in which exposure to and awareness of reproductive health became recognised as the preserve and responsibility of women whilst men were better posited to attend to economic and financial matters [17, 20, 21] These social attitudes were found to persist in more recent studies from the highland provinces of PNG in which men acknowledged the value of family planning, but they continued to perceive it as ‘women’s business’ [22]. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG
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