Women’s decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso

Abstract

Background In 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women’s lack of decision-making power. The objective of the study is to investigate women’s decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso. Methods A descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis. Results A conceptual framework describing women’s participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women’s decision-making power. Conclusion In light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women’s decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women’s health and empowerment.

Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: Results from a panel study in rural Burkina Faso

“…On the contrary, the COVID-19 pandemic likely contributed to the increase in contraceptive use in the panel, from 41% in February 2020 to 50% one year later. It is worth noting that Burkina Faso has implemented several interventions to increase access to family planning services over the last few years, notably by removing user fees for contraception and for postnatal visits [39]. The upward trend in contraceptive use has been steady and rapid since 2015; that year, the contraceptive prevalence rates in the Cascades and Centre-Ouest regions (where the study area is PLOS GLOBAL PUBLIC HEALTH located) were estimated to be 21% and 28%, respectively, while the national prevalence of unmet need for family planning reached 35% [40][41][42].…”

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“…It is noteworthy that women's sole decision-making does not necessarily improve with the provision of free or subsidized healthcare. Findings from Burkina Faso stated that even in the context of free maternal healthcare, husbands' authorization was still necessary for using maternal healthcare and women were deemed stubborn or domineering if they ventured on healthcare decisions alone ( 50 ). Interestingly, the study revealed that joint decision-making among couples was the most acceptable health-seeking behavior.…”

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“…Indeed, the policy has facilitated access to FP services, but previous literature suggests that user fee removal policies alone does not necessarily suggest increased women’s decision-making autonomy regarding FP [ 30 ]. Another study conducted in Burkina Faso after the removal of user fees for FP services reported increased marital tension [ 31 ]. In some instances, healthcare providers had to adapt their practices to guarantee women’s confidentiality and safety [ 31 ].…”

“…Another study conducted in Burkina Faso after the removal of user fees for FP services reported increased marital tension [ 31 ]. In some instances, healthcare providers had to adapt their practices to guarantee women’s confidentiality and safety [ 31 ].…”