Use Of Family Planning Services Research Articles

Equity in family planning policies and programs in Uganda: conceptualization, dimensions and implementation constraints

BackgroundEquity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper aims to document the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda.MethodsA review of Ugandan literature and key informant interviews with 25 key stakeholders on equity in FP was undertaken between April and July 2020. We searched Google, Google Scholar and PubMed for published and grey literature from Uganda on equity in FP. A total of 112 documents were identified, 25 met the inclusion criteria and were reviewed. Data from the selected documents were extracted into a Google master matrix in MS Excel. Data analysis was done across the thematic areas by collating similar information. Data were analyzed using thematic content analysis approach.ResultsA limited number of documents had an explicit definition of equity, which varied across documents and stakeholders. The definitions revolved around universal access to FP information and services. There was a limited focus on equity in FP programs in Uganda. The dimensions most commonly used to assess equity were either geographical location, or socio-demographics, or wealth quintile. Almost all the key informants noted that equity is a very important element, which needs to be part of FP programming. However, implementation constraints (e.g. lack of quality comprehensive FP services, duplicated FP programs and a generic design of FP programs with limited targeting of the underserved populations) continue to hinder effective implementation of equitable FP programs in Uganda. Clients’ constraints (e.g. limited contraceptive information) and policy constraints (inadequate focus on equity in policy documents) also remain key challenges.ConclusionsThere is lack of a common understanding and definition of equity in FP programs in Uganda. There is need to build consensus on the definitions and measurements of equity with a multidimensional lens to inform clear policy and programming focus on equity in FP programs and outcomes. To improve equitable access to and use of FP services, attention must be paid to addressing implementation, client and policy constraints.

"You could find a good or a bad provider, I would say you just have to go and see": A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso.

This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women's motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15-19 and 20-24 and ever married women ages 15-24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women's demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women's (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence.

Assessment of Family planning services utilization among women of Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir

Objectives: To determine the percentage of women in Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir who use family planning services, and to determine the relationship between demographic characteristics and family planning service use (AJ&K). Study design and setting: A cross-sectional study was conducted in UC Bangoin (Rawalakot) Azad Jammu and Kashmir over the duration of 6 months, from 5 January to 5 July 2021. Methodology: A sample of 344 married women with the age range 18 to 45 was obtained. The study's assessment instrument was developed from an existing assessment tool (Reproductive health knowledge and services utilization among rural adolescence in Ethiopia 2014). It included 14 questions on demographics and 13 questions about the use of family planning services. Results: High utilization was 52% (n=179) while low utilization was 48% (n=165). Most of them had fear of side effects of using contraception (n=170, 48.9%). Chi-square test showed significant association (p-val =0.05) between fear of side effects of using contraception, decision of using contraception, education level, distance from home to hospital, number of children, exposure to mass media and utilization of family planning services. Conclusion: There was low family planning services utilization in that area. Study showed that there was a strong association between fear of side effects of using contraception, low education and low exposure to mass media with utilization of family planning services in Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir (AJ&K)

Barriers and facilitators to the implementation of cell phone interventions to improve the use of family planning services among women in Sub-Saharan Africa: A systematic review

Background: Mobile health (mHealth) interventions are being tested to improve contraceptive uptake in Sub-Saharan Africa (SSA). However, few attempts have systematically reviewed the mHealth programs to enhance family planning (FP) services among women in SSA. At the same time, more than half of low-income countries’ population have a cell phone. This review identifies and highlights facilitators and barriers to implementing cell phone interventions designed to target women FP services.Methods: Databases including PubMed, CINAHL, Epistemonikos, Embase, and Global Health were systematically searched for studies from January 1, 2010, to December 31, 2020, to identify various mHealth interventions used to improve the use of FP services among women in SSA. Two authors independently selected eligible publications based on inclusion/exclusion criteria, assessed study quality and extracted data using a pre-defined data extraction sheet. In addition, a content analysis was conducted using a validated extraction grid with a pre-established categorization of barriers and facilitators.Results: The search strategy led to 8,188 potentially relevant papers, of which 16 met the inclusion criteria. Most included studies evaluated the impact of mHealth interventions on FP services, access (n = 9), and use of FP outcomes (n = 6). At the same time, only one article was interested in implementing a mHealth intervention. The most-reported cell phone use was for women reproductive health education, contraceptive knowledge and use. Barriers and facilitators of the use of mhealth were categorized into three main outcomes: behavioral outcomes, data collection and reporting, and health outcomes. mHealth interventions addressed barriers to provider prejudice, stigmatization, discrimination, lack of privacy, and confidentiality. The studies also identified barriers to uptake of mHealth interventions for FP services, including decreased technological literacy and lower linguistic competency.Conclusions: The review provides detailed information about implementing mobile phones at different healthcare system levels to improve FP service outcomes. Barriers to uptake mHealth interventions must be adequately addressed to increase the potential use of mobile phones to improve access to Sexual and Reproductive Health (SRH) awareness and FP services.

A long way to go: engagement of men and boys in country family planning commitments and implementation plans.

Background:To reach global goals related to women and girls' access to modern family planning (FP) and gender equality, evidence shows that it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in six countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women's access to and use of FP services, and improve their knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men's and women's health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.

A long way to go: engagement of men and boys in country family planning commitments and implementation plans

Background: To reach global goals related to women and girls’ access to modern family planning (FP) and gender equality, evidence shows that it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios.Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in six countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women’s access to and use of FP services, and improve their knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men’s and women’s health-seeking behaviors and attitudes.Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.

Retraction.

Kuete M, Li C, Yang F, et al. Family planning services use: A shared responsibility between men and women of reproductive age in Hubei province, China, International Journal of Gynecology & Obstetrics 2021, (https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.13704). The above article, published online on 09 April 2021 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor-in-Chief, Michael Geary, the International Federation of Gynecology and Obstetrics, and John Wiley & Sons Ltd. The retraction has been agreed on as per the author's request. This is due to errors in reporting the dates the studies were conducted. Instead of the reported dates of between August 2017 and July 2019, the studies were conducted before 2012. This invalidates the conclusions because China's two-child policy was introduced in 2016, and the purpose of the study was to explore the effect of the two-child policy.

Retracted: Family planning services use: A shared responsibility between men and women of reproductive age in Hubei province, China.

Effective use of family planning (FP) services significantly improves sexual and reproductive health of both women and men. Recently, the Chinese government has launched the two-child policy allowing families to have an additional child. This study aimed to explore the population's interest for FP services, unmet needs, and expectations. A cross-sectional study using stratified random sampling was conducted in 102 counties of Hubei province and 17555 randomized individuals from rural, transitional, and urban areas were interviewed through a guided semi-structured questionnaire. The Han ethnicity dominated our population and number of living children per family ranged from zero to six. Although 81% reported FP services and sexual and reproductive health (SRH) as a shared responsibility, the contraceptives used excluding condoms, were mainly intrauterine devices (76%), tubal ligation (16%), and vasectomy (8%). Although 24% of participants had a history of contraceptive failure, effective contraceptive use after failure among men remained lower (6% for tubal ligation and vasectomy) and 74% of naive contraceptive users strongly rejected vasectomy. Demographic factors, awareness of FP services/SRH, discussing and making joint decisions, and gender discrepancies were strongly associated with unmet FP services/SRH needs (P<0.001). Family planning services use roughly varied with the population's unmet needs and expectations, which should be considered to sustain the strategies.

A long way to go: engagement of men and boys in country family planning commitments and implementation plans.

Background: Evidence shows that, to reach global goals related to women and girls' access to modern family planning (FP) and gender equality, it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in seven countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women's access to and use of FP services, and improve men's knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men's and women's health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

Impact of the village health center project on contraceptive behaviors in rural Jordan: a quasi-experimental difference-in-differences analysis

BackgroundAppropriate contraceptive use remains a major health challenge in rural Jordan. The Japan International Cooperation Agency implemented a project aimed at enhancing the capacity of village health centers (VHCs) to improve the quality and quantity of family planning (FP) services in rural Jordan in 2016–2018. Facility- and community-based approaches were integrated into the interventions. We evaluated the project’s impacts on contraceptive behaviors and the effectiveness of the two approaches.MethodsWe used a difference-in-differences analysis based on the project baseline and endline surveys, and logistic regression analysis to assess associations between eight primary outcomes and three secondary outcomes (impacts). The unit of intervention was five target VHCs; the unit of analysis was currently married women of reproductive age (15–49 years) in five intervention and five control villages.ResultsOverall, 2061 married women participated; 83.8% were in need of FP. Compared with the control villages, significant effects, ranging from + 0.4% points (pp) to + 11.5 pp., were observed in the intervention villages for six primary outcomes in these categories: increasing the use of FP services at VHCs, participation in health promotion activities, and changing the sources of reproductive health information. There was a trend toward improved secondary outcomes in the intervention villages, but no significant differences were observed between the intervention and control villages regarding modern contraceptive use (mCU; + 4.3 pp), traditional contraceptive use (tCU; − 0.5 pp), and spousal agreement on contraception (+ 5.1 pp). mCU was positively associated with five primary outcomes: obtaining contraceptives at VHCs [adjusted odds ratio (AOR) 3.44, 95% confidence interval (CI) 1.26–9.40], education sessions at VHC (AOR 7.41, 95% CI 1.60–34.39), health activities in communities (AOR 7.41, 95% CI 3.28–16.78), counseling by private doctor/clinic (AOR 0.62, 95% CI 0.40–0.97), and information gained through TV (AOR 0.50, 95% CI 0.32–0.76). Spousal agreement on contraception showed similar positive trends. tCU was associated only with TV.ConclusionsThe project had impacts on increased mCU and husbands’ perception of contraception in rural Jordan. The integration of facility- and community-based approaches may be effective in shifting from tCU to mCU in other rural areas.

Access to Communication Channels and Use of Family Planning among Women in Tanzania: Spatial and Socio-demographic Analysis

This study examined the relations and access to communication channels on the use of Family Planning (FP). Relationships between independent variables including access to communication channels and the use of FP services, and demographic characteristics were examined. This study used cross-sectional data from the Tanzania Demographic Health Survey and Malaria Indicator Survey (TDHS-MIS) of 2015-2016 from 11,127 women aged between 15-49 years. The sample was weighted to ensure representativeness. Univariate, bivariate and binary logistic regression analyses were used. Results in this study revealed a statically significant correlation between access to FP messages and use of family planning services (p&lt;.001). Access to radio, television, printed media, and mobile phones was observed more among women who were never in a union, those with tertiary education, women in urban areas and among those within a high wealth index. Use of FP services increased with the fluency of access to FP messages. Printed media predicted more likelihood in the use of FP at 0.460, p&lt;0.001; radio at 0.368, p&lt;0.001; health facilities at 0.284, p&lt;0.001 and education level at 0.276, p&lt;0.001. The study concludes that despite the fact that there was a correlation between access to FP messages and the use of FP, the use or not use of the same is also influenced by factors.

Overall user satisfaction with family planning services and associated quality care factors: a cross-sectional analysis

BackgroundStudies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations.Methods: Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction.ResultsAccording to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88–6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14–5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29–5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26–4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21–4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10–3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03–3.11).ConclusionsService providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.

Reproductive autonomy and family planning service use among young women in Ghana

Objectives: Reproductive autonomy has been associated with contraceptive use among U.S. and Ghanaian women. To understand whether reproductive autonomy might affect a young woman’s ability to navigate the health system, we examined the association between reproductive autonomy and family planning service use among young women in Ghana.

Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana.

ObjectiveUsing our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana.MethodsWe drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models.ResultsIn unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55).ConclusionsFindings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.

Quasi-experimental Study of Systematic Screening for Family Planning Services among Postpartum Women Attending Village Health and Nutrition Days in Jharkhand, India.

Background:Systematic screening helps increase family planning uptake through integration with other services, including immunization. Though successfully demonstrated at health facilities, this strategy has not been demonstrated in communities. This study assessed the effectiveness of systematic screening to increase postpartum family planning use during community health days in India without adversely affecting immunization services.Methods:The study was conducted during 180 individual Village Health and Nutrition Days in Jharkhand, India. All health workers were trained in postpartum family planning counseling. Intervention providers were also trained in systematic screening. 217 postpartum women aged 15–49 years participated in baseline and endline exit interviews and routine service statistics were analyzed from 2,485 facility visits at affiliated health centers.ResultsNo difference in family planning service use was found in the intervention group, but significantly fewer interviewed women reported receiving family planning services at endline in the comparison group (p = 0.014). Family planning acceptance at affiliated health centers increased significantly in intervention areas (p < 0.001) but not in comparison areas, while immunization service use increased in both groups (p = 0.002 intervention, p < 0.001 comparison).Conclusions:The use of the postpartum systematic screening tool appears to increase acceptance of family planning services when integrated with community-based services in Jharkhand.

Perceptions, attitude and use of family planning services in post conflict Gulu district, northern Uganda.

BackgroundNorthern Uganda was severely affected by two decades of civil war that led to the displacement and encampment of an estimated 1.6 million inhabitants. The objective of this study was to assess community perspectives, attitude and factors that influence use of family planning (FP) services in post conflict Gulu district.MethodsWe conducted a cross sectional study using multistage sampling technique. All three counties in the district were purposely selected. Two sub-counties per county and four parishes per sub-county were randomly selected. A total of 24 parishes (clusters) and 21 adult heads of households per cluster were randomly selected and interviewed. In total, 500 adults 117 males (23.4 %) and 383 females (76.6 %) were interviewed. We conducted 8 focus group discussions and 6 key informant interviews with family planning managers and service providers. Quantitative data were entered in EPI data and analyzed using STATA version 12. Qualitative data were analyzed manually using thematic content analysis.ResultsContraceptive prevalence rate was 47.5 %. Communities perceive FP as acceptable, beneficial and geographically, temporally and financially accessible. Factors associated with FP use included age 26–35 years (AOR 1.92, 95 % CI 1.18-3.10, p = 0.008), and 36–45 years (AOR 2.27, 95 % CI 1.21-4.25, p = 0.010), rural residence (AOR = 0.41, 95 % CI 0.24-0.71, p = 0.001), cohabitation (AOR = 2.77, 95 % CI 1.15-6.65, p = 0.023), and being a farmer (AOR 0.59, 95 % CI 0.35-0.97, p = 0.037). The main reason for non-use of family planning was fear of side effects 88.2 %. The main source of FP services was government health facilities 94.2 %.ConclusionUse of family planning is relatively high and communities view FP services as acceptable, beneficial and accessible. Family planning use is mainly determined by age, residence, occupation and marital status. Fear of side effects is the main impediment to FP use. There is need to increase awareness and effectively manage side effects of family planning in the settings.

Index to Volume 38

Index to Volume 38

Social and demographic disparities in preventive family planning service use among adult women in the United States

To examine factors associated with adult women’s use of preventive family planning services, 2006–2010.

The role of community-based health planning and services strategy in involving males in the provision of family planning services: a qualitative study in Southern Ghana.

BackgroundReproductive health and Family Planning (FP) services have been of global concern especially in developing countries where fertility rates are high. Traditionally FP services had always targeted females with little or no attention given to males. To ensure equitable distribution of health services, Ministry of Health (MOH), Ghana adopted the Community-Based Health Planning and Services (CHPS) as a nationwide health policy with the aim of reducing obstacles to physical and geographical access to health care delivery including FP services. However, not much is known about the extent to which this policy has contributed to male involvement in FP services. This qualitative descriptive study was therefore designed to explore male involvement in FP services in communities with well functioning CHPS and those with less or no functioning CHPS structures. The study further solicited views of the community on the health status of children.MethodsThis was a qualitative descriptive study and adapted the design of an ongoing study to assess the impact of male involvement in FP referred to as the Navrongo experiment in Northern Ghana. Twelve focus group discussions were held with both male and female community members, six in communities with functional CHPS and six for communities with less/no-functional CHPS. In addition, fifty- nine (59) in-depth interviews were held with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and Health Managers at both the districts and regional levels. The interviews and discussions were tape recorded digitally, transcribed and entered into QSR Nvivo 10© for analysis.ResultsThe results revealed a general high perception of an improved health status of children in the last ten years in the communities. These improvements were attributed to immunization of children, exclusive breastfeeding, health education given to mothers on childcare, growth monitoring of children and accessible health care. Despite these achievements in the health of children, participants reported that malnutrition was still rife in the community. The results also revealed that spousal approval was still relevant for women in the use of contraceptives; however, the matrilineal system appears to give more autonomy to women in decision-making. The CHPS strategy was perceived as very helpful with full community participation at all levels of the implementation process. Males were more involved in FP services in communities with functioning CHPS than those without functioning CHPS.ConclusionThe CHPS strategy has increased access to FP services but spousal consent was very important in the use of FP services. Involving males in reproductive health issues including FP is important to attain reproductive health targets.