Abstract
BackgroundIn the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method. A qualitative study was needed to design effective and culturally appropriate interventions.MethodsWe used purposive maximum-variation sampling to select eight municipalities with a high proportion of residents in the poorest wealth quintile, including urban, rural, indigenous, and non-indigenous communities. We conducted 44 focus group discussions with 292 women, adolescent women, and men using semi-structured topic guides. We analyzed the data through recursive abstraction.ResultsThere were intergenerational and cultural gaps in the acceptability of family planning, and in some communities family planning use was greatly limited by gender roles and religious objections to contraception. Men strongly influenced family planning choices in many households, but were largely unreached by outreach and education programs due to their work hours. Respondents were aware of many modern methods but often lacked deeper knowledge and held misconceptions about long-term fertility risks posed by some hormonal methods. Acute physical side effects also dissuaded use. The implant was a new and highly acceptable method due to ease of use, low upkeep, and minimal side effects; however, it was perceived as subject to stock-outs. Adolescent women reported being refused services at health facilities and requested more reproductive health information from their parents and schools. Mass and social media are growing sources of reproductive health information.ConclusionsOur study identifies a number of barriers to family planning that have yet to be adequately addressed by existing programs in Chiapas’ poorest regions, and calls for reinvigorated efforts to provide effective, acceptable, and culturally appropriate interventions for these communities.
Highlights
In the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method
The findings will help the Ministry of Health of Chiapas develop and implement tailored interventions to improve family planning services for its most vulnerable populations. This was a qualitative study based on focus group discussions (FGDs) with women and men living in municipalities with a high concentration of residents in the country’s lowest wealth quintile
Acceptability of pregnancy depends on age, economic stability, and community Most urban focus group participants felt that society saw adolescent or unmarried pregnant women as irresponsible, and that these women and their children are sometimes rejected and harassed
Summary
In the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method. Disparities exist within Chiapas, and the Chiapas Ministry of Health has identified 30 of Chiapas’ poorest municipalities (listed in Additional file 1: Table S1), as measured by the Human Development Index, to receive targeted interventions through the results-based Salud Mesoamerica Initiative (SMI) [5]. These municipalities are characterized by a high proportion of residents in the lowest national wealth quintile, large indigenous populations, and frequent social unrest. Many residents participate in the Seguro Popular health insurance scheme and the Prospera conditional cash transfer program
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