背景:尽管近几十年来许多撒哈拉以南非洲国家在获得计划生育服务方面取得了进展,有效的产后早期避孕方法的进展仍然很低,产后早期避孕药的未满足需求很高。在埃塞俄比亚,产后早期现代避孕方法的摄取仍然低得令人无法接受。障碍/挑战尚未得到充分探索。对采用早期产后避孕方法的背景障碍和挑战的深入和详细的了解对于制定未来适合当地的干预措施至关重要。
目的:本研究旨在探讨在Dessie和Kombolcha地区分娩后采用早期产后现代避孕方法的障碍/挑战,在埃塞俄比亚东北部。
方法:在Dessie和Kombolcha镇地区进行了常规内容分析定性研究,埃塞俄比亚东北部使用理论目的抽样技术。共有57名研究对象参加。通过7次关键线人访谈,使用信息饱和规则确定样本量,6次深度访谈,和5个重点小组讨论,每个8-10名参与者。使用非结构化访谈指南收集数据,并使用数字录音机和现场笔记进行记录。使用不同的技术确保了研究的可信性。收集的数据被转录并从母语翻译成英语。采用Atlas-tiversion7软件进行常规内容定性数据分析。开放式编码,类别,次主题,开发了超范围的主题,并通过网络分析组织了障碍的概念模型。
结果:研究参与者引用的产后早期现代避孕的障碍和主题是相关知识,态度,家庭-社区,卫生机构,避孕方法,文化,宗教,生育欲望,性别问题,和误解。出现的知识相关障碍的子主题是缺乏对采取节育方法的时间的认识,不知道分娩后可能怀孕的时间,并没有承诺在分娩后尽早服用避孕药。此外,人们认为现代避孕药会导致母乳干涸,并且认为分娩后的生育能力低下是态度障碍。卫生设施的障碍是缺乏提醒和后续机制,零星的服务交付和开放时间,漫长的等待时间,以及取卡流程和提供商的方法。社会耻辱,孩子的性别偏好,宗教限制使用避孕药具是社区的障碍。
结论:一般个人,基于设施,方法相关,误解,社会,文化障碍被认为是产后早期现代避孕方法的障碍。需要寻求健康的行为干预措施,创新的避孕方法,以及设施级干预措施,以克服每个已确定的障碍。
BACKGROUND: Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in effective early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. In Ethiopia, early postpartum modern contraceptive method uptake is still unacceptably low. The barriers/challenges have not yet been sufficiently explored. A deep and detailed understanding of the contextualized barriers and challenges in the adoption of early postpartum contraceptive methods is crucial in developing future locally-appropriate interventions.
OBJECTIVE: This
study aimed to explore barriers/challenges to the uptake of early postpartum modern contraceptive methods after childbirth in Dessie and Kombolcha zones, in northeast Ethiopia.
METHODS: Aconventional content analysis qualitative
study was deployed in Dessie and Kombolcha town zones, northeast Ethiopia using a theoretical purposive sampling technique. A total of 57
study subjects were participated. The sample size was determined using the rule of information saturation through 7 key informant interviews, 6 in-depth interviews, and 5 focused-group discussions with 8-10 participants each. Data were collected using an unstructured interview guide and recorded using a digital audio recorder and field notes. The trustworthiness of the
study was assured using different techniques. The collected data were transcribed and translated from native language to English. Atlas-ti version7 software was used to facilitate conventional content qualitative data analysis approach. Open coding, categories, subthemes, and overreaching themes were developed, and a conceptual model of barriers was organized through network analysis.
RESULTS: Barriers to uptake of early postpartum modern contraception quoted by
study participants and themed were related knowledge, attitude, family-community, health facility, contraceptive method, cultural, religious, fertility desire, gender issues, and misconceptions. The sub-themes of knowledge-related barriers that emerged were lack of awareness of the time to take birth control methods, not knowing the time pregnancy is likely after childbirth, and not being committed to taking contraceptives early enough after childbirth. Moreover, beliefs that modern contraceptives cause breast milk to dry up and perceived low fecundability after childbirth were indicated as attitude barriers. Health facility barriers were lack of reminders and follow-up mechanisms, sporadic service delivery and opening time, long waiting time, and card withdrawal process and providers\' approach. Social stigma, child sex preference, and religious restrictions against contraceptive use were community barriers.
CONCLUSIONS: Generally individual, facility-based, method-related, misconceptions, societal, and cultural barriers were identified as hindrances to the uptake of early postpartum modern contraceptive methods. There is a need for health-seeking behavioral interventions, innovative contraceptive methods, and facility-level interventions to overcome each identified barrier.