Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi

N.C Ware,M Ndayizigiye,M C Smith Fawzi,C Thompson Lively

doi:10.1186/s12913-017-2144-0

Abstract

BackgroundFamily planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere.MethodsWe investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7).ResultsContraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services.ConclusionsWhere resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

Highlights

Planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings
In a multivariate analysis including all of these variables, the number of health professionals engaged and the number of types of contraceptives available were found to be statistically significant in increasing the uptake ratio (p < 0.001) (Table 4)
In resource-limited, rural locations in Africa, where access to information is scarce, availability of modern family planning methods alone will likely not ensure uptake, especially when access is limited to clinical settings

Summary

Introduction

Planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. The world’s population grows each year by approximately 80 million people. Most of this growth is concentrated in developing nations [2]. There are important negative consequences for health related to high fertility, impacting maternal and child morbidity and mortality, as well as economic development. By increasing the number of births, high fertility increases the number of times a woman is exposed to the risks of child bearing, e.g. unsafe abortions, iron deficiency anemia, and/or maternal death from hemorrhage or other complications [3,4,5]. Child malnutrition and mortality have been found to be positively associated with fertility rate, family size, and poverty across all the world’s regions [6]

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Conclusion