Applying a gender lens to social norms, couple communication and decision making to increase modern contraceptive use in Ethiopia, a mixed methods study.
Applying a gender lens to social norms, couple communication and decision making to increase modern contraceptive use in Ethiopia, a mixed methods study.
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DOI：
10.1186/s12978-022-01440-8
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发表时间：
2022-06-13
影响因子：
3.4
通讯作者：
Kaufman, Michelle
中科院分区：
文献类型：
--
作者：
Kapadia-Kundu, Nandita;Tamene, Habtamu;Ayele, Minyahil;Dana, Feleke;Heliso, Simon;Velu, Sanjanthi;Berhanu, Tsega;Alemayehu, Guda;Leslie, Lindsey;Kaufman, Michelle
关键词：
埃塞俄比亚是撒哈拉以南非洲人口第二多的国家，妇女的生殖健康状况有所改善。研究目标是（1）使用混合方法研究，以确定埃塞俄比亚四个地区避孕药具使用的决定因素，以及（2）探讨社会规范、性别平等规范、夫妻沟通和避孕药具使用之间的关系。该研究包括定量和定性方法。 2016 年，研究人员通过涵盖六个健康领域的结构化调查采访了总共 2770 名育龄女性（15-49 岁）。采用多阶段整群抽样技术确定了符合条件的家庭。研究人员利用与规模抽样成比例的概率，选择了 10% 的拟议目标 Wearda（240 个 Wearda 中的 24 个）。定性研究包括8次快速评估、16次深度访谈、24次关键知情人访谈以及16次焦点小组讨论。使用 NVivo 版本 8 分析定性数据。通过逻辑回归估计已婚妇女当前现代计划生育使用的调整优势比。避孕药具使用的主要影响因素是性别平等规范、高自我效能感和每周接触广播。定性数据表明，避孕药具的使用时间与 4-5 个孩子的理想家庭规模的社会规范有关。即使女性发起有关计划生育的对话，性别不平等在与控制决策的男性的夫妻沟通中也很明显。基于定性数据归纳分析的一项重要发现表明，夫妻沟通和决策的微观过程通常由男性优势决定。该研究确定了导致性别不平等的六个微观过程，需要进一步检查和研究。使用避孕药具的障碍包括不平等的夫妻沟通和妥协的决策。不平等的性别规范也是现代避孕药具使用的障碍。该研究建议使用性别视角来研究夫妻沟通和决策，目的是使这两个过程更加公平，以加速埃塞俄比亚采用现代计划生育方法。 2016-2017 年在埃塞俄比亚进行了一项涉及定量和定性混合方法的生殖健康研究。该研究的总体目标是（1）使用混合方法研究来确定埃塞俄比亚四个地区避孕药具使用的决定因素，以及（2）探讨社会规范、性别平等规范、夫妻沟通和避孕药具使用之间的关系。调查发现性别不平等规范是避孕药具使用的主要障碍。定性研究进一步探讨了性别维度以及性别规范、夫妻沟通和避孕药具使用决策之间的相互联系。数据显示，与性别平等男性（GEM）量表日常生活维度相关的性别规范与当前避孕药具的使用显着相关。定性部分为我们提供了有关埃塞俄比亚农村妇女在现代避孕药具使用情况下日常经历的深入数据。我们了解到，与期望生育数量和首次使用避孕药具的时间相关的社会规范是相互关联的。具体来说，女性和男性都告诉我们，大多数夫妇在家庭规模扩大、生育 4-5 个孩子之后才使用避孕药具。同样，选择生两个或更少孩子的夫妇被认为是“自私”和“对孩子不感兴趣”。夫妻沟通发生在决策的背景下，男性的决定通常会被接受，而女性的决定通常会被推迟或拒绝。项目应促进尊重女性的决策能力和公平的夫妻沟通。值得注意的是，这项研究发现夫妻沟通和决策的微观过程是性别化的，女性处于劣势。需要对性别情侣沟通的这些微观过程进行进一步的研究。
Ethiopia, sub-Saharan Africa’s second most populous country has seen improvements in women’s reproductive health. The study objectives are (1) using mixed methods research, to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication and contraceptive use. The study includes both quantitative and qualitative methods. Researchers interviewed a total of 2770 women of reproductive age (15–49 years) in 2016 using a structured survey covering six health areas. Eligible households were identified using a multi-stage cluster-sampling technique. Using probability proportionate to size sampling, the researchers selected 10% of the proposed target woredas (24 of 240 woredas). The qualitative study included 8 rapid assessments, 16 in-depth interviews, 24 key informant interviews, and 16 focus group discussions. Qualitative data were analyzed using NVivo version 8. Adjusted odds ratios were estimated for current modern family planning use among married women with logistic regression. The primary influencing factors for contraceptive use are gender equitable norms, high self-efficacy, and weekly exposure to the radio. Qualitative data indicate that the timing of contraceptive use is linked to the social norm of the desired family size of 4–5 children. Gender inequity is evident in couple communication with men controlling decision making even if women initiated conversations on family planning. A key finding based on an inductive analysis of qualitative data indicates that the micro-processes of couple communication and decision making are often dictated by male advantage. The study identified six micro-processes that lead to gender inequity which need to be further examined and researched. Barriers to contraceptive use include unequal couple communication and compromised decision making. Inequitable gender norms are also barriers to modern contraceptive use. The study recommends using a gender lens to study couple communication and decision making, with the goal of making both processes more equitable to accelerate the adoption of modern family planning methods in Ethiopia. A reproductive health study involving mixed quantitative and qualitative methods was conducted in Ethiopia in 2016–2017. The overall objectives of the study are (1) to use mixed methods research to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication, and contraceptive use. The survey identified gender inequitable norms as a major barrier to contraceptive use. The qualitative study further examined the gender dimension and the interlinkages between gender norms, couple communication, and decision making for contraceptive use. Data showed that gender norms related to the daily living dimension of the gender equitable men (GEM) scale are significantly associated with current contraceptive use. The qualitative component provides us with in-depth data on the daily experiences of rural Ethiopian women in the context of modern contraceptive use. We learned that social norms related to the desired number of children and the timing of first contraceptive use are interlinked. Specifically, both women and men told us that most couples do not use contraceptives until their family size is complete, after 4–5 children. Similarly, couples who opt for 2 or fewer children are termed “selfish” and “not interested in children.” Couple communication occurs within the context of decision making where men’s decisions are usually accepted, and women’s decisions are often deferred or rejected. Programs should promote respect for women’s decision-making abilities and equitable couple communication. Notably, this study finds that microprocesses of couple communication and decision making are gendered, featuring female disadvantage. Further research is required on these microprocesses of gendered couple communication.
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