Couples’ decision-making on post-partum family planning and antenatal counselling in Uganda: A qualitative study

Abstract

Background Although health workers have been trained to provide post-partum family planning (PPFP), uptake remains low in Uganda. An important reason is that women want the agreement of their partner, who is often absent at the time of delivery. In order to address this, we aimed to understand the views of couples and explore barriers and facilitators to implementation of antenatal couples’ counselling on PPFP in Uganda. Methods We conducted individual interviews with a purposive sample of 12 postpartum and 3 antenatal couples; and 34 focus groups with a total of 323 participants (68 adolescent women, 83 women aged 20–49, 79 men, 93 health workers) in four contrasting communities (urban and rural) in South-West and Central Uganda. These were recorded, transcribed, translated, and analysed thematically. Results Although most participants felt that it is important for partners to discuss family planning, half of the couples were unaware of each other’s views on contraception. Most had similar views on motivation to use family planning but not on preferred contraceptive methods. Most liked the idea of antenatal couples’ counselling on PPFP. The main barrier was the reluctance of men to attend antenatal clinics (ANC) in health facilities. Respondents felt that Village Health Teams (VHTs) could provide initial counselling on PPFP in couples’ homes (with telephone support from health workers, if needed) and encourage men to attend ANC. Suggested facilitators for men to attend ANC included health workers being more welcoming, holding ANC clinics at weekends and “outreach” clinics (in rural villages far from health facilities). Conclusion Antenatal couples’ counselling has the potential to facilitate agreement PPFP, but some men are reluctant to attend antenatal clinics. Counselling at home by VHTs as well as simple changes to the organisation of antenatal clinics, could make it possible to deliver antenatal couples’ counselling on PPFP.

“They will say you want to make their home die”: A mixed methods study to assess modern family planning use in partnered South Sudanese refugee and host populations in Northern Uganda

“…There is a plethora of studies published to date which focus on the sexual and reproductive health of refugee populations in Uganda [11][12][13][14][15][16][17][18][19] and Ugandan populations [20][21][22][23][24][25][26][27][28]. However, to our knowledge, there are no published studies focused on the sexual and reproductive health of both refugee and host populations, which is important to study given that both these populations are often living in close proximity to each other and have access to the same services, though experience different health outcomes [29].…”

Men’s motivations, barriers to and aspirations for their families’ health in the first 1000 days in sub-Saharan Africa: a secondary qualitative analysis

“…Other studies in SSA have explored the possibility of implementing couples counselling to improve communication. 26 could address and challenge beliefs about roles. The growing men's social movement on gender inequality calls for changes in beliefs about gender roles and in the division of labour, in the expectation that these will in turn change social structures.…”

Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol

“…Counselling of couples, focusing on male involvement have also been suggested, although all men do not willingly accompany women to antenatal clinic [ 45 – 47 ]. Studies in LMICs show that a substantial proportion of women did not use modern contraceptive methods in the first year after birth and maternal services were found to be the sole predictors in postpartum contraceptive use.…”

“…Counselling of couples, focusing on male involvement have also been suggested, although all men do not willingly accompany women to antenatal clinic [45][46][47].…”