Community and provider perspectives on addressing unmet need for contraception: Key Findings from a formative phase research in Kenya, South Africa and Zambia (2015-2016)

  • Joanna Paula Cordero
  • Petrus S. Steyn
  • Peter Gichangi
  • Yolandie Kriel
  • Cecilia Milford
  • Margarate Munakampe
  • Irene Njau
  • Theresa Nkole
  • Adam Silumbwe
  • Jennifer Smit
  • James Kiarie
Keywords: Community participation, unmet need, family planning

Abstract

Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the ―active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used, facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts. 

Les besoins non satisfaits en matière de contraception restent un problème, en particulier dans les pays à revenu faible et intermédiaire. La participation communautaire ou la "participation active des populations touchées à toutes les étapes de la prise de décision et de la mise en oeuvre des politiques, des programmes et des services" est une condition préalable pour atteindre le niveau de santé optimal. La participation en tant qu'élément clé des cadres relatifs aux droits et à la qualité des soins peuvent augmenter les besoins satisfaits. Toutefois ceci n‘a été suffisamment aborde dans des programmes contraceptifs. Une méthodologie exploratoire qualitative comprenant des discussions de groupe et des entretiens approfondis avec des membres de la communauté, des prestataires de soins de santé et d‘autres parties prenantes a été menée pour identifier des domaines ou des domaines thématiques clés d‘action à travers lesquels les parties prenantes pouvaient être engagés. L‘étude menée au Kenya, en Afrique du Sud et en Zambie a exploré la connaissance et l‘utilisation des contraceptifs, les obstacles et les facilitateurs d‘accès, la qualité des soins et les pratiques participatives. Une analyse thématique a été utilisée, facilitée par NVivo ( version 10 QSR International) avec un seul livre de codes maître. En se basant sur les données des comtés, quatre domaines ont été sélectionnés: qualité des soins, prise de décision en connaissance de cause, acceptabilité et responsabilité. Ces domaines ont éclairé la théorie du changement d'un programme participatif visant à répondre à des besoins non satisfaits. Identifier les domaines généralisables possibles établit des résultats intermédiaires mesurables et comparables pour les programmes participatifs malgré la diversité des contexts africains.

Keywords: Community participation, unmet need, family planning

Afr J Reprod Health 2019; 23[3]: 106-119

Author Biographies

Joanna Paula Cordero
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva, Switzerland
Petrus S. Steyn
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva, Switzerland
Peter Gichangi
International Centre for Reproductive Health - Kenya (ICRH-K), P.O.Box 91109 – 80103, Mombasa, Kenya; Technical University of Mombasa, Tudor, Tom Mboya Street, P.O. Box 90420 - 80100, Mombasa Kenya
Yolandie Kriel
MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000, South Africa
Cecilia Milford
MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000, South Africa
Margarate Munakampe
Department of Health Policy and Management, School of Public Health, University of Zambia Nationalist Road, P.O Box 50110, Lusaka; Strategic Centre for Health Systems, Metrics and Evaluations (SCHEME), Department of Epidemiology and Biostatistics, University of Zambia Nationalist Road, P.O Box 50110, Lusaka
Irene Njau
KEMRI-Wellcome Trust Research Programme, CGMRC, PO Box 230-80108, Kilifi, Kenya
Theresa Nkole
Department of Obstetrics and Gynaecology, Levy Mwanawasa University Teaching Hospital, Lot 1222, Great East Road, Chainama Area, Lusaka, Zambia
Adam Silumbwe
Department of Health Policy and Management, School of Public Health, University of Zambia Nationalist Road, P.O Box 50110, Lusaka
Jennifer Smit
MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000, South Africa
James Kiarie
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva, Switzerland
Published
2019-11-17
Section
Articles

Journal Identifiers


eISSN: 1118-4841