Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents.
Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents.
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DOI：
10.1186/s12978-017-0392-4
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发表时间：
2017-10-17
影响因子：
3.4
通讯作者：
El Bcheraoui C
中科院分区：
文献类型：
--
作者：
Dansereau E;Schaefer A;Hernández B;Nelson J;Palmisano E;Ríos-Zertuche D;Woldeab A;Zúñiga MP;Iriarte EM;Mokdad AH;El Bcheraoui C
在墨西哥恰帕斯州最贫困的地区，50.2%需要避孕的女性没有使用任何现代方法。需要进行定性研究来设计有效且适合文化的干预措施。我们采用有目的的最大变异抽样方法，选择了最贫困五分之一居民比例较高的八个城市，包括城市、农村、土著和非土著社区。我们使用半结构化主题指南与 292 名女性、青少年女性和男性进行了 44 次焦点小组讨论。我们通过递归抽象来分析数据。对计划生育的接受程度存在代际和文化差距，在一些社区，计划生育的实施受到性别角色和宗教对避孕的反对的极大限制。男性对许多家庭的计划生育选择有很大影响，但由于工作时间的原因，他们基本上没有接触到外展和教育计划。受访者了解许多现代方法，但往往缺乏更深入的知识，并对某些激素方法带来的长期生育风险存在误解。严重的身体副作用也阻碍了使用。由于易于使用、维护成本低且副作用最小，该植入物是一种新的且高度可接受的方法；然而，人们认为它可能会缺货。据报告，青春期妇女在卫生机构被拒绝提供服务，并要求父母和学校提供更多生殖健康信息。大众媒体和社交媒体是生殖健康信息日益增长的来源。我们的研究确定了恰帕斯州最贫困地区现有计划尚未充分解决的一些计划生育障碍，并呼吁重新努力为这些社区提供有效、可接受且文化上适当的干预措施。本文的在线版本 (10.1186/s12978-017-0392-4) 包含补充材料，可供授权用户使用。
In 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. We 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. There 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. Our 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. The online version of this article (10.1186/s12978-017-0392-4) contains supplementary material, which is available to authorized users.
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