“I got peace and stability”: women’s perceptions of contraceptive use in Sidama, SNNPR, Ethiopia
ABSTRACT Most of the documented benefits of contraceptive service lack in-depth exploration of the lived experiences of service users. This study of contraceptive users in the Sidama Zone, Southern Region, Ethiopia; was conducted with the aim of improving the overall understanding of contraceptive use towards women’s health and empowerment. This knowledge enables alignment of contraceptive service provision with the International Conference on Population Development declaration of rights-based approach. The study employed a mixed method design. The quantitative aspects include use of a descriptive retrospective approach to generate a five year snapshot contraceptive use from health institutions. Percentages were used to compute the contraceptive prevalence in the last five years. The bulk of the study was a qualitative design using interpretive phenomenology- guided by a Heideggerian approach. Data were collected using key informant interviews, focus group discussions and individual in-depth interviews. Data were analyzed using an interpretive phenomenological analysis with hermeneutic circle approach. Results were presented in broad themes following the study questions. The findings of the study indicated that contraceptive use in the study area is steadily improving. In 2008 contraceptive prevalence was twenty- five percent and after five years, it reached forty- two percent. Injectable contraceptive is the leading method, with nearly three-fourth of current users on this method. Recently, every health post offers at least one long acting and two short acting methods. The qualitative finding revealed that women’s experiences regarding the benefits of contraceptive use is encouraging. Women explicated that contraceptive service is an emancipatory and transformative experiences for them as it enabled them to control their bodies, reproduction and fertility by averting unwanted pregnancy thereby engaging in various socio-economic, religious, and political affairs. Controlled fertility gave them more time to plan their livelihood issues. The study’s title, a participant quote, captures the sentiment well: “we got peace, rest and stability”. The study finding further revealed the unique contributions of the health extension program in improving access and convenience to contraceptive service by removing many cultural, gender, and linguistic barriers. The study concludes that contraceptive service pattern has improved greatly in access and coverage; however, the majority of current users are merely on a single method indicating gaps in expanding contraceptive method mix. Women’s experiences about internalizing contraceptive use benefits towards their empowerment and health are encouraging in that they wholeheartedly expressed that the service is emancipatory and transformative. However, there are grey areas from the perspectives of ensuring support from men and dominant community members such as elders. Moreover, there is observed disconnect in conceptualizing and practicing contraceptive service provision from a broader human rights premises among health care workers across the service delivery hierarchy. The research recommends the establishment of smooth and functional mechanisms to ensure all stakeholders involved in service provision develop a shared understanding about the human rights rationale and practice while providing contraceptive service. More efforts are needed to ensure sustainable contraceptive service use by removing the existing cultural and gender barriers. Efforts should be amplified to increase men’s involvement in the reproductive services. Further study is recommended to investigate the nature and factors that influence the incorporation of human rights rationale across the health care system.
Contraception, reproductive rights, women empowerment
Doctor of Philosophy (Ph.D.)
Community Health and Epidemiology
Community and Population Health Science