Exploring the multilevel factors influencing women’s choices and utilisation of family planning services in Mufulira district, Zambia: A socio-ecological perspective

Abstract

:Family planning services are useful in helping couples and individuals realize their basic right to decide freely and responsibly if, when, and how many children to have. The study aimed at exploring the multilevel factors influencing women’s choices and utilisation of family planning services in Mufulira district of Zambia. A qualitative explorative study design that utilised two focus group discussions (n = 20) and in-depth interviews (n = 30) involving women of reproductive age was conducted in Mufulira district, Zambia. Convenient sampling was employed to select participants. In-depth interviews and focus group discussions were recorded, translated, and transcribed verbatim. Content analysis was utilised through code classification and theme identification. Data were imported into NVivo.x64 for coding and node generation. The study revealed overarching themes at the individual level such as distrust of hormonal contraception, misconceptions about the side effects of contraception, perceived side effects of contraceptives, perceived risk of infertility, and lack of adequate information on contraception. At the interpersonal level, themes were mainly centred on male partner influence such as male partner preference for a large family size, fear of partner infidelity, disruption of sexual pleasure, fear of intimate partner violence, and male partner disapproval of contraception use. At the institutional/organisation level, themes such as health providers’ negative attitudes, non-availability of preferred contraception, and lack of guidance and support from health workers were highlighted, and at the community level, we developed themes on the limited autonomy of women in making decisions and social expectations. Women’s choices and utilisation of family planning services are influenced by an interplay of multiple social-level factors. Interventions that address these influencing factors are needed to enhance the uptake of family planning services among women.