Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda's Southern Kayonza District.
Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda's Southern Kayonza District.
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DOI：
10.9745/ghsp-d-14-00198
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发表时间：
2015-05-13
期刊：
影响因子：
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通讯作者：
Rich ML
中科院分区：
文献类型：
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作者：
Farmer DB;Berman L;Ryan G;Habumugisha L;Basinga P;Nutt C;Kamali F;Ngizwenayo E;St Fleur J;Niyigena P;Ngabo F;Farmer PE;Rich ML
社区成员和卫生工作者认识到间隔和限制生育的价值，但各种传统和性别规范限制了他们使用避孕措施。有限的方法选择、持续的副作用、交通费、缺货、漫长的等待时间和隐藏的服务成本也阻碍了避孕用具的使用。社区成员和卫生工作者认识到间隔和限制生育的价值，但各种传统和性别规范限制了他们使用避孕措施。有限的方法选择、持续的副作用、交通费、缺货、漫长的等待时间和隐藏的服务成本也阻碍了避孕用具的使用。虽然卢旺达在避孕覆盖率方面取得了令人印象深刻的进展，但对计划生育的需求仍未得到满足，获得优质生殖健康服务的障碍依然存在。卢旺达很少有研究从社区的角度定性地调查影响计划生育使用、护理障碍和服务质量的因素。我们对卢旺达南部Kayonza地区的社区对生殖健康和计划生育的看法进行了定性研究，该地区的总生育率是全国最高的。从2011年10月到2012年12月，我们对随机选择的男性和女性社区成员(n = 96人)、社区卫生工作者(n = 48人)和卫生机构护士(n = 15人)进行了访谈，他们代表了该地区Rwinkwau医院整个集水区内所有8个卫生中心的集水区。然后，我们进行了定向的内容分析，以确定关键主题，并对方法和信息群体的发现进行三角划分。访谈围绕以下几个主题展开：(1)生育信念：参与者认识到计划生育的好处，但出于文化和历史原因，往往希望有更多的家庭；(2)社会压力和性别角色：年轻和未婚的妇女面临严重的耻辱，丈夫行使决策权，但许多丈夫对计划生育没有很好的理解，因为他们认为这是妇女的事情；(3)获得高质量服务的障碍：自付费用、缺货、方法选择有限，以及等待时间长，但在设施中咨询时间短是常见的抱怨；(4)副作用：管理不善和对副作用的谣言和恐惧影响了避孕用具的使用。这些主题在许多参与者的叙述中反复出现，并影响了生殖健康决策，包括参加和保留计划生育计划。随着卢旺达继续完善其计划生育政策和方案，至关重要的是要解决社区对生育率和所需家庭规模、保健人员短缺和缺货的看法，并鼓励男子和男孩参与，加强对保健工作者的培训和指导以提供优质服务，并澄清和执行有关支付地方服务费用的国家政策。
Community members and health workers recognized the value of spacing and limiting births but a variety of traditional and gender norms constrain their use of contraception. Limited method choice, persistent side effects, transportation fees, stock-outs, long wait times, and hidden service costs also inhibit contraceptive use. Community members and health workers recognized the value of spacing and limiting births, but a variety of traditional and gender norms constrain their use of contraception. Limited method choice, persistent side effects, transportation fees, stock-outs, long wait times, and hidden service costs also inhibit contraceptive use. While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda’s southern Kayonza district, which has the country’s highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers’ catchment areas in the overall catchment area of the district’s Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman’s matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level.