Understanding modern contraception uptake in one Ethiopian community: a case study

Abstract

BackgroundIn the last decade, the proportion of Ethiopian women using contraceptive methods has increased substantially (from 14% in 2005 to 35% in 2016 among married women). Numerous factors have contributed to the increased uptake. An important one is the implementation of the Health Extension Program, a government-led health service delivery strategy that has deployed more than 38,000 health extension workers (HEWs) throughout the country. Key mechanisms underlying the success of this program are not well understood. Using a case study approach, the goal of this study is to describe how key features of local contexts, community perceptions, and messaging by HEWs have contributed to the increased use of modern contraception in one community in Ethiopia.MethodsWe conducted focus groups and individual interviews with men, women, adolescents, and key informants, including (HEWs), in Oromia, Ethiopia. We used a random sampling protocol to recruit all participants except key informants, with whom purposive sampling was used to ensure participants were knowledgeable on family planning in the village. Interviews were audio recorded, translated, transcribed, and then analyzed using applied thematic analysis and NVivo v.11 qualitative research software.ResultsWe identified four themes that may explain uptake of contraception: (1) HEWs are seen as trusted and valued community members who raised awareness about family planning; (2) the HEW messaging that contraception is useful to space pregnancies among married women was effective; (3) the message that spacing is healthy for mother and child was also effective; and (4) communicating to the entire community (including men, women, adolescents, and religious leaders), contributed to changing attitudes around contraception.ConclusionThe four aspects of the Health Extension Program approach increased uptake of contraception in our sample. In contexts where community health workers are valued by the health systems and local communities they serve, this type of approach to widening modern contraception use could help increase uptake and address unmet need. Understanding these granular aspects of the program in one local context may help explain how use of contraception increased in the country as a whole.

“You better use the safer one… leave this one”: the role of health providers in women’s pursuit of their preferred family planning methods

“…Health providers were central to supplying women with information about specific types of methods and differentiating between methods that women may have heard about within their social networks. Further, results indicate that HEWs were viewed as the most approachable and trustworthy providers for initial contact in learning about family planning; similar avenues of family planning knowledge dissemination have been observed in other Ethiopian studies [32,33], emphasizing the continued importance of expanding HEW services. Many respondents described positive interactions with providers, however, several experiences were characterized as negative and warrant further exploration.…”

Contraceptive use among sexually active female adolescent in Ethiopia: Trends and determinants insight from national demographic and health survey

“…Improvements in the contraceptive prevalence trends were more pronounced between 2005 to 2011 survey years. Possible explanations for this increment may be related to implementation of several interventions aimed at increasing demand for and access to sexual and reproductive health services among adolescents and youths by providing youth-friendly health services and innovative health extension worker program that brings health services including family planning to the communities' home (27,28) There is also a national political commitment to family planning in Ethiopia, governments and nongovernmental organizations have increased resource allocations for contraceptive security and deliver (29). Further, although much of contraception services are provided by government, provision of short term contraception methods by the private sectors can also played an important role in increasing young women's access to contraceptive services in Ethiopia (30).…”

“They Destroy the Reproductive System”: Exploring the Belief that Modern Contraceptive Use Causes Infertility

“…We developed the interview and focus group guides (Appendix A) based on the project's theoretical framework (Rogers ; Contractor and DeChurch ), a review of the literature, detailed feedback from co‐investigators in Mombasa and Nairobi, Kenya and our previous work on contraception uptake in Ethiopia (Sedlander et al. ). Additionally, we conducted five pilot interviews with key informants and three focus groups from nearby villages to ensure questions captured what we intended and were culturally relevant.…”