Family planning knowledge, experiences and reproductive desires among women who had experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study

Agatha Bula,Dawn M Kopp,Mercy Tsidya,Lameck Chinula,Jennifer H Tang,Suzanne Maman

doi:10.1186/s40834-018-0075-8

Abstract

BackgroundPerinatal mortality is unacceptably high in low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, the reproductive desires and family planning knowledge of women who have experienced a stillbirth or neonatal death in resource-poor settings are not well understood.MethodsWe examined family planning knowledge, contraceptive practices and barrier to contraceptive use among women who had experienced a poor obstetric outcome at Bwaila Hospital in Lilongwe, Malawi. We performed individual in-depth interviews or through focus group discussion with women who had experienced a stillbirth or early neonatal death, 4–8 weeks after their delivery. NVivo software was used to analyze data for recurrent patterns and themes, and central ideas were extracted to identify the data’s core meanings.ResultsWe interviewed 46 women who had experienced a poor obstetric outcome. Overall, women were aware of both modern and traditional family planning methods, and the majority were in favour of modern versus traditional methods. They also had knowledge about risks for future complications if they have a short inter-pregnancy interval. However, they faced conflict about whether to use family planning methods for their health, as suggested by their relatives and friends, or to have another child to fulfil their husband’s desire, especially among those with no living child. Some had fear about side effects, while others were concerned that use of family planning methods without involving the husband could bring misunderstandings within the family. A number of women had misconceptions about family planning methods, which also served as a barrier to their use.ConclusionAlthough women with a poor obstetric outcome are aware of modern family planning and its health benefits after their delivery, their decision to use a method is complicated by their own desire to protect their own health and the husband’s desire for a child, particularly among those women with no living children coupled with fear of side effects and misconceptions. These findings suggest the importance of counselling both the affected woman and her husband about the benefits of family planning use, even after a poor obstetric outcome, to jointly choose the method they feel comfortable to use and dispel any misconceptions.Trial registrationClinicaltrials.gov NCT02674542.

Highlights

Perinatal mortality is unacceptably high in low-income countries, including Malawi
Characteristics of women In total, 46 (76.7%) of the 60 enrolled women participated in focus group discussion (FGD) or in-depth interview (IDI); the remaining 14 enrolled women either could not be traced or declined continued participation in the study at the time that they were traced
The majority of women were in favour of modern family planning methods compared to natural family planning methods. This preference was based on their perception that women who normally use natural family planning methods, especially withdrawal, need to monitor their menstrual cycle each month to effectively prevent unwanted pregnancies, as opposed to using modern family planning methods. Their worry was that a woman could become pregnant if she does not monitor her menstrual cycle properly or if she has abnormal menstrual cycle as expressed in the quote below: As a result, we found that the majority of women discussed with their partners before they started using any FP methods and they were using the method which they agreed with their partner: “With natural methods, the woman does not use any medication at all, but just needs to monitor her menstrual cycle.” (IDI 016)

Summary

Introduction

Perinatal mortality is unacceptably high in low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. The reproductive desires and family planning knowledge of women who have experienced a stillbirth or neonatal death in resourcepoor settings are not well understood. Perinatal deaths account for 40% of infant mortality globally, resulting in about 3 million stillbirths and 4 million neonatal deaths yearly. The burden of perinatal mortality rate is unacceptably high in low-income countries, especially among those in sub-Saharan Africa and south central Asia, with an average perinatal mortality rate of 50 deaths per 1000 live births, compared with 10 deaths per 1000 live births in high-income countries [1, 2]. Progress in reducing neonatal mortality is being made in all regions; sub-Saharan Africa has seen one of the slowest reductions globally (1.5% per year from 2000 to 2010), and maternal and neonatal mortality remain major public health challenges [4]. Perinatal mortality is highest among women in which the previous pregnancy interval was less than 15 months (55 deaths per 1000 live births), followed by women with a first pregnancy (48 deaths per 1000 live births) [5]

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Results

Discussion

Conclusion