Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study

BMC Public Health

Deodatus Kakoko²  Ruerd Ruben¹  Idda Mosha¹ 

[1] Centre for International Development Issues Nijmegen (CIDIN) University of Radboad, Th.v. Aquinostraat 4 Postbus 9104, Nijmegen 6500 HE, the Netherlands;School of Public Health and Social Sciences, Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania

关键词: Gender dynamics;    Perceptions;    Decisions making;    Family planning;   

Others  :  1162158
DOI  :  10.1186/1471-2458-13-523

 received in 2012-05-15, accepted in 2013-05-21,  发布年份 2013

【 摘 要 】

Background

Contraceptive use is low in developing countries which are still largely driven by male dominated culture and patriarchal values. This study explored family planning (FP) decisions, perceptions and gender dynamics among couples in Mwanza region of Tanzania.

Methods

Twelve focus group discussions and six in-depth interviews were used to collect information from married or cohabiting males and females aged 18–49. The participants were purposively selected. Qualitative methods were used to explore family planning decisions, perceptions and gender dynamics among couples. A guide with questions related to family planning perceptions, decisions and gender dynamics was used. The discussions and interviews were tape-recorded, transcribed verbatim and analyzed manually and subjected to content analysis.

Results

Four themes emerged during the study. First, “risks and costs” which refer to the side effects of FP methods and the treatment of side -effects as well as the costs inherit in being labeled as an unfaithful spouse. Second, “male involvement” as men showed little interest in participating in family planning issues. However, the same men were mentioned as key decision-makers even on the number of children a couple should have and the child spacing of these children. Third, “gender relations and communication” as participants indicated that few women participated in decision-making on family planning and the number of children to have. Fourth, “urban–rural differences”, life in rural favoring having more children than urban areas therefore, the value of children depended on the place of residence.

Conclusion

Family Planning programs should adapt the promotion of communication as well as joint decision-making on FP among couples as a strategy aimed at enhancing FP use.

【 授权许可】

   
2013 Mosha et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Westoff CF: Unmet need at the end of the century. DHS Comparative Reports No. 1. 2001. Calverton, Maryland: ORC Macro; 2001.
• [2]Bongaarts J, Bruce J: The causes of unmet need for contraception and social content of services. Stud Fam Plann 1995, 26(Suppl 2):57-75.
• [3]Campbell M, Nuriye NS, Malcolm P: Barriers to fertility regulation. A review of the literature. Stud Fam Plann 2006, 37(Suppl 2):87-98.
• [4]Darroch JE, Gilda S, Haley B: Contraceptive technologies: Responding to women’ needs. New York: Guttmacher Institute; 2011.
• [5]Colombia Demographic and Health Survey: Profamilia, Macro International, Inc. Colombia Demographic and Health Survey 2004–2005. Calverton, United States: Macro International, Inc.; 2005.
• [6]Uganda Bureau of Statistics (UBOS) and ORC Macro: Uganda Demographic and Health Survey 2000–2001. Calverton, Maryland, USA: UBOS and ORC Macro; 2001.
• [7]Sedgh G, Rubina H, Akinrinola B, Susheela S: Women with an unmet need for contraception in developing countries and their reasons for not using a method. Occasional Report. New York: Guttmacher Institute; 2007.
• [8]Bradley S, Hilary MS, Shane K, EK: Levels, trends and reasons for contraceptive discontinuation. DHS Analytical Studies 2009, 20:27-37.
• [9]Schuler SR, Maria EC, Susanna R: Misinformation, mistrust, and mistreatment: family planning among Bolivian market women. Stud Fam Plann 1994, 25:211-221.
• [10]Castle S: Factors influencing young Malians reluctance to use hormonal contraceptives. Stud Fam Plann 2003, 34(3):186-199.
• [11]Rutenberg N, Watkins SC: The buzz outside the clinics: conversations and contraception in Nyanza Province, Kenya. Stud Fam Plann 1997, 28:290-307.
• [12]Keesara S: Unpublished interviews. Ghana: ; 2009.
• [13]Hall MA, Stephenson RB, Juvekar S: Social and logistical barriers to the use of reversible contraception among women in a rural Indian village. J Health Popul Nutr 2008, 26:241-250.
• [14]Plummer ML, Wight D, Wamoyi JMG, Hayes RJ, Ross DA: Farming with your hoe in a sack; condom attitudes, access and use in rural Tanzania. Stud Fam Plann 2006, 37(Suppl 1):29-40.
• [15]Tuladhar H, Marahatta R: Awareness and practice of family planning methods in women attending gyne OPD at Nepal medical college teaching hospital. Nepal Med Coll J 2008, 10:184-191.
• [16]Obisesan KA, Adeyemo AA, Fakokunde BO: Awareness and use of family planning methods among married women in Ibadan, Nigeria. East Afr Med J 1998, 75:135-138.
• [17]Nadia DS, Campbell M, Seema M: Misinformation and fear of side-effects of family planning, culture, health & sexuality. An Int Res J Intervent Care 2012, 14(4):421-433.
• [18]Raine TR, Jennifer CG, Cherrie BB, Sadia H, Beth AB, Hernandez FA, Harper CC: Contraceptive decision-making in sexual relationships: young men’s experiences, attitudes and values. Cult Health Sex 2010, 12:373-386.
• [19]Bawah A: Spousal communication and family planning behavior in navrongo: a longitudinal assessment. Stud Fam Plann 2002, 33(Suppl 2):185-194.
• [20]Nzioka C: Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisors in Reproductive Health, WHO/PAHO. Geneva, Switzerland: World Health Organization; 2002.
• [21]Sharan M, Valente T: Spousal communication and family planning adoption: effects of a radio drama serial in Nepal. Int Fam Plan Perspect 2002, 28(Suppl 1):16-25.
• [22]Miriam H, Kate G, Dominick S, Brad K, Greg G: Changes in couples’ communication as a result of a male-involvement family planning intervention. J Health Commun 2012, 17(Suppl 7):802-819.
• [23]Kang Y, O’Donnell C, Sparks PL: The effect of spousal communication on contraceptive use in Central Terai, Nepal. J Patient Educ Couns 2010, 81:402-408.
• [24]Oyediran K, Isiugo-Abanihe U: Husband–wife communication and couple’s fertility desires among the Yoruba of Nigeria. Afr Popul Stud 2002, 17:61-80.
• [25]Soldan V: How family planning ideas are spread within social groups in rural Malawi. Stud Fam Plann 2004, 35:275-290.
• [26]Biddlecom A, Fapohunda B: Covert contraceptive use: prevalence, motivations, and consequences. Stud Fam Plann 1998, 29:360-372.
• [27]Grady WR, Klepinger DH, Nelson-Wally A: Contraceptive characteristics: the perceptions and priorities of men and women. Fam Plann Perspect 1999, 31:168-175.
• [28]Forste R, Morgan J: How relationships of U.S. men affect contraceptive use and efforts to prevent sexually transmitted diseases. Fam Plann Perspect 1998, 30:56-62.
• [29]Frost JJ, Darroch JE: Factors associated with contraceptive choice and inconsistent method use, United States. Perspect Sex Reprod Health 2008, 40:94-104.
• [30]Kimuna S, Adamchak D: Gender relations: husband–wife fertility and family planning decisions in Kenya. J Biosoc Sci 2001, 33:13-23.
• [31]Lasee A, Becker S: Husband–wife communication about family planning and contraceptive use in Kenya. Int Fam Plan Perspect 1997, 32:15-20.
• [32]Odejide T: Offering an Alternative to Illegal Abortion in Nigeria. New Era Nurs Image Int 1986, 2:39-42. 1. Calverton, Maryland: ORC Macro
• [33]Ezeh AC: Gender differences in reproductive orientation in Ghana: A new approach to understanding fertility and family planning issues in sub-Saharan Africa. Washington, DC: World Conference; 1991. [Paper presented at the Demographic and Health Surveys: 5–7]
• [34]Potts M: The unmet need for family planning. Sci Am Inc 2000, 382(1):88-93.
• [35]Greene ME: Changing women and avoiding men: gender stereotypes and reproductive health programmes. IDS Bull Inst Dev Stud 2000, 31(2):49-59.
• [36]Gage AJ: Women’s socio-economic status, position and contraceptive behaviour in Togo. Stud Fam Plann 1995, 26(5):264-278.
• [37]Hogan DP, Berhanu B, Hailemarian A: Household organization, women’s autonomy and contraceptive behavior in Southern Ethiopia. Stud Fam Plann 1999, 30:302-314.
• [38]Mason KO, Smith HL: Husbands’ Versus wives’ fertility goals and contraceptive use: the influence of gender context in five Asian countries. Demography 2000, 37:299-311.
• [39]DonaldP M: Gender equity in theories of fertility transition. Popul Dev Rev 2000, 26:427-439.
• [40]Dixon-Mueller R: The sexuality connection in reproductive health. Stud Fam Plann 1993, 24:269-282.
• [41]Jacobson JL: Transforming family planning programmes: toward a framework for advancing the reproductive rights agenda. Reprod Health Matters 2000, 8(Suppl 15):21-32.
• [42]United Republic of Tanzania: Tanzania demographic health survey. Dar es Salaam, Tanzania: National Bureau of Statistics (NBS) and ICF Macro; 2010.
• [43]Dahlgren L, Emmelin M, Winkvist A: Qualitative methodology for international Public Health. Department of Public Health and Clinical Medicine, Umea University; 2007.
• [44]Graneheim U, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2003, 24(Suppl 2):105-112.
• [45]Kaida A, Kipp W, Hessel P, Konde-lule J: Male participation in family planning: results from a qualitative study in mpigi district, Uganda. J Biosoc Sci 2005, 37:269-286.
• [46]Krakowiak-Redd D, Ansong D, Otupiri E, Tran S, Klanderud D, Boakye I, Dickerson T, Crookston B: Family planning in a sub- district near Kumasi, Ghana: side effects fears, unintended pregnancies and misuse of a medication as emergency contraception. Afr J of Repro Health 2011, 15(Suppl 3):121-132.
• [47]Casterine JB, Aurora EP, Biddlecom A: Factors underlying unmet needs for family planning in the Philippines. Stud Farm Plann 1997, 28(Suppl 3):173-191.
• [48]Fakeye O, Babaninyi O: Reasons for non use of family planning methods at Ilorin, Nigeria: male opposition and fear of methods. Trop Doct 1989, 19(Suppl 3):114-117.
• [49]Mwageni EA, Ankomah A, Powell RA: Attitudes of Men towards family planning in Mbeya region, Tanzania: a rural – urban comparison of qualitative data. J Biosoc Sci 1998, 30(Suppl 3):381-392.
• [50]Shah NM: The role of inter-spousal communication in the adoption of family planning methods. Pak Dev Rev 1974, 13:454-469.
• [51]Jessica DG, Michelle JH: ‘Marriage means having children and forming your family, so what is the need of discussion? Communication and negotiation of child bearing preferences among Bangladeshi Couples. Cult Health Sex 2007, 9(Suppl 2):185-198.
• [52]Speizer IS: Are husbands a barrier to women’s family planning use? The case of Morocco. Soc Biol 1999, 46(1–2):1-16.
• [53]Miriam H, Kate G, Dominick S, Brad K, GG: Changes in couples’ communication as a result of a male- involvement in family planning intervention. J Health Commun 2012, 17(7):802-819.
• [54]Aggleton P, Rivers K, Scott S: Use of the female condom: Gender relations and sexual negotiation. Sex and Youth: Contextual Factors Affecting Risk for HIV/AIDS. A Comparative Analysis of Multi-Site Studies in Developing Countries. Geneva: UNAIDS; 1999:104-145.
• [55]Khan ME, Townsend JW, D’Costa S: Behind closed doors: a qualitative study of sexual behaviour of married women in Bangladesh. Cult Health Sex 2002, 4:237-256.
• [56]Sujatha DS, Murthy MS: Husband-wife communication and fertility among two sects of Brahmin. J: Fam Welfare 1993, 39(Suppl 4):26-30.
• [57]Population Council and Interagency Gender Working Group (IGWG): Power in sexual relationships: an opening dialogue among reproductive health professionals. New York; 2001.
• [58]Blanc AK: The effect of power in sexual relationships on sexual and reproductive health: An examination of the evidence. Stud Fam Plann 2001, 32:189-213.