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Abstract

Background

Preventing unwanted pregnancies, achieving optimal child spacing, and improving quality of life are benefits of modern family planning (FP). This study aimed to assess modern FP use, identify the factors influencing its use and determine the barriers to FP use among women of reproductive age.

Methods

A mixed-methods approach was conducted in the Iringa Region between March and July 2022. Conveniently, 368 women of reproductive age were included in the quantitative study, and 48 were purposively selected for the qualitative study based on reported barriers to using modern FP. Interviewer-administered questionnaires and interview guides were used for data collection. The factors of modern FP use were determined using multivariable logistic regression analysis. The p < 0.05 was considered to be significant. For qualitative data, all interviews were recorded and transcribed. Data were analyzed manually through thematic analysis.

Results

The prevalence of modern FP use was 181 (49%). Being married (adjusted odds ratio [AOR] = 5.44, 95% confidence interval [CI] = 1.77–16.73, p = .003), parity of 6 and more (AOR = 2.43, 95% CI = 1.99–5.95, p = .052), availability of modern FP methods (AOR = 1.71, 95% CI = 1.03–2.85, p = .038), and women with primary education level (AOR = 2.99, 95% CI = 1.03–3.25, p = .001), women with secondary and higher education (AOR = 3.53, 95% CI = 1.41–4.38, p = .001), were predictors for modern FP utilization. Four main themes merged (1) individual barriers, (2) hospital barriers, (3) cultural barriers, and (4) knowledge of modern FP methods.

Conclusion

The use of modern FP increases with women's education. There is a need for the government to invest in women's education and raise awareness and knowledge of the benefits of modern FP methods.

Keywords

child spacing pregnancy modern family planning use unwanted pregnancies unsafe abortion

Introduction

Family planning (FP) refers to the use of contraception to prevent unwanted pregnancies, achieve the desired family size, and adequate child spacing. Traditional and modern methods are available, with modern methods increasingly popular among women of reproductive age. Globally, modern FP use has risen from 35% in 1990 to 45% in 2021. In sub-Saharan Africa, modern FP use has almost doubled from 24% in 1990 to 56% in 2021 (UNDESA, 2022).

Despite an increase in modern FP use, unacceptably high unmet FP needs (37%) persist in sub-Saharan Africa (UNDESA, 2022). In Tanzania, there has not been any significant change in the use of modern FP over the years. Tanzania Demographic Health surveys reported that the use of modern FP among married women had remained significantly low from 20% in 2004/05 to 32% in 2015/2016 (MoH, 2022), as compared to the national target of 60% of FP use by 2020 (Welfare & National, 2013). The low use of FP methods subjects women to a high risk of unintended pregnancies which can lead to unsafe abortions and puts women at high risk of complications and/or maternal death (Adane et al., 2020)

In the Iringa region, the estimated unmet FP needs are 12.7% (NBS, 2023), which impedes social and economic advancement, as women may be less able to contribute to the region and the country as a whole. Additionally, this impacts the achievement of the Millenium Development Goal, target 3.7 which calls on countries “by 2030, to ensure universal access to sexual and reproductive healthcare services, including modern FP information and education, and the integration of reproductive health into national strategies and programmes” (United Nations, 2020; p. 1).

Adequate use of modern FP reduces maternal death by 44% for unplanned pregnancies and unsafe abortions (Bhatt et al., 2021; Chekole et al., 2019). Modern FP use increases interpregnancy interval by over 2 years, preventing maternal and child mortality (Dierickx et al., 2018). Modern FP use also enhances women's education and economic growth by reducing dependence and increasing participation in national production activities (Dierickx et al., 2018).

Review of Literature

Evidence from various studies suggests that modern FP use is influenced by factors such as education level, economic status, attitude toward FP use (Imtishal et al., 2023; Oumer et al., 2020), knowledge of modern FP methods, husband approval, couple's discussion, male involvement in FP use decisions, desire for additional children, previous use of contraception (Asif & Pervaiz, 2019; Kassim & Ndumbaro, 2022; Moon et al., 2021; Mulatu et al., 2020), religious affiliation, low family income, fertility preference, negative perceptions of FP, preference for unproven FP methods, limited access to reliable sources of FP information, household responsibilities, and poor male partner support on FP matters (Akamike et al., 2020; Apanga et al., 2020; Kassim & Ndumbaro, 2022).

The Tanzanian government has been working on improving the accessibility and affordability of high-quality modern FP services in both public and private health facilities (MoH, 2022). The government have integrated FP services into reproductive health services and collaborated closely with nongovernmental organizations (NGOs) and development partners to provide free reproductive health services, including FP services (UNFPA, 2018). Despite free services, some women buy FP methods from pharmacies to avoid long waiting times (Keesara et al., 2015). National policies prioritize scaling up and strengthening contraceptive use for all women in need of FP services (MoH, 2022). However, despite government efforts, the Iringa region has a low use rate of modern FP (12.7%) (NBS, 2023). This raises questions about the factors influencing modern FP use for women of reproductive age in the region and the barriers that women face in accessing it. Therefore, this study aims to evaluate the use of modern FP, identify factors affecting its use, and determine barriers to its use by women of reproductive age in the region by answering the following questions:

What is the level of modern FP use among women of reproductive age?

What are the factors that influence modern FP use?

What are the barriers hindering women of reproductive age from using modern FP?

Materials and Methods

Study Design and Area

A community-based cross-sectional study using quantitative and qualitative methods was conducted in three districts (Mufindi, Mafinga, and Iringa Municipal) of the Iringa region from March to July 2022. The study was conducted due to the high fertility rate of 5.2 births per woman in the region, which was estimated to have a population size of 840,404 by the National Bureau of Statistics in Tanzania in 2020, also, the region is reported to have low rate (12.7%) of modern FP use among women of reproductive age (NBS, 2023).

Study Population and Recruitment Criteria

The study included all women of reproductive age (18–49 years) who lived in the selected study sites and agreed to participate. Both married and unmarried women in this age group who had lived in the study area for at least 1 year were eligible for inclusion. Women who did not give consent were excluded from the study.

Sample Size Estimation for the Quantitative Part of the Study

The sample size for this study was calculated using the Kish-Leslie formula for quantitative studies (Kish, 1957). A confidence interval of 1.96 was used, corresponding to a 95% confidence level, with 32% proportional to women of reproductive age using modern FP use as reported in the Tanzania Demographic Health Survey (NBS, 2016). A significance level of 5% (α = 0.05) was applied. The final sample size was adjusted to account for a nonresponse rate of 10% resulting in a total sample size of 368 participants. For the qualitative part of the study, six focus group discussions (FGDs) were conducted across the three selected districts. The researchers selected two FGDs from each district and each FGD had eight women making a total of 48 women participating across all six FGDs.

Sampling Technique and Recruitment of Study Participants

Simple random sampling using the lottery replacement method was used to select three districts out of seven, two wards were selected from each of the three study districts, and six villages in each of the selected wards. Households (205) were selected using a proportionate sampling method followed by extracting the 368 study participants from the households using convenience sampling methods as shown in Figure 1. For the qualitative approach, 48 study participants who participated in the quantitative study were purposively selected based on their reported experienced barriers to modern FP use. The researchers aimed to understand in detail what the barriers were. Women who refused to continue with qualitative study were excluded. The study used a face-to-face approach to interview them.

Figure 1.

Flow chart for selection of study participants for the quantitative part of the study.

Definition of Variables

Participants were asked if they had used modern FP methods and responses were categorized as “yes” or “no.” The question was “Have you ever used a modern method of family planning?”

Data Collection Tools and Techniques

The study used an interviewer-administered questionnaire to collect relevant data. The questionnaire was adapted and modified from previous studies which were conducted in Western Ethiopia (Adane et al., 2020; Gizaw & Regassa, 2011), Nigeria (Ekpenyong et al., 2018), and Iraq (Alrawi, 2021). The questionnaire had three sections; sociodemographic characteristics, use of FP, and barriers to use of modern FP methods. The tools were prepared in English and translated into Swahili for easy understanding. The tools were pretested among 36 women of reproductive age, who were not included in the final study. Before using the questionnaire, its internal consistency was checked by calculating a Cronbach's alpha using data obtained from a pilot study which was found to be 0.782 for questions assessing barriers to using FP. Data were collected by the principal investigator and four assistant researchers (registered nurses) who were trained for 2 days before the process of data collection. In the qualitative part, the interview guide (Table 1) was used in FGD to collect qualitative data. During FGD conversations were recorded using an audiotape recorder and field notes were also taken, which took approximately 45 to 60 min. The discussions were conducted in Swahili with the aid of two skilled research assistants, BN/AJ, who have extensive experience in qualitative research. Probing questions were used when necessary to find out more detailed information regarding barriers to modern FP use. The study investigated different aspects of trustworthiness. To ensure the collected data was credible, researchers adopted the following strategies: peer debriefing, member checking, and prolonged engagement. Peer debriefing involved academic staff in the department who provided guidance and support from the proposal writing stage to the report of the findings. Member checking involved seeking approval from the participants for the transcripts and emerging codes from the interviews, establishing structural corroboration or coherence by testing all data to ensure that there were no internal conflicts or inconsistencies, and establishing referential adequacy. The research teams worked together to resolve any ambiguities in the coding process, categories, and themes. If the two researchers disagreed, they clarified definitions, collaborated, and continued with discussions until they reached a consensus. To ensure transferability, researchers used the purposive sampling method based on women who experienced barriers to using modern FP methods. To ensure privacy, data were collected in a separate location near the participant's residence. The FGD concluded that saturation was achieved when no new information was provided, and all data was transcribed into full text on the same day.

Table 1.

Interview Guide Used in the Qualitative Study to Assess the Barriers to the Use of Family Planning Among Women of Reproductive Age.

Qn	Can you tell us what are the barriers to women of reproductive age not using a family plan?
Probe	Can you tell us more about the contribution of family members as a barrier to family planning use?
Probe	What about your husband/partner's approval for the use of family planning?
Probe	Can you tell us more about the societal contribution as a barrier to family planning use?
Probe	What about religious contribution and teaching on modern family planning methods utilization?
Probe	Can you tell us more about social stigma and pressure regarding the use of family planning methods?
Probe	Can you tell us any belief that acts as a barrier to modern family planning utilization?
Qn	Are there any health effects that act as a barrier to the use of family planning methods?
Probe	Can you tell us more about the side effects of family planning?
Probe	Is there any thigh more that you want to share with us regarding health side effects and the use of family planning?
Probe	Is there any sense of lack of privacy and trust at health centers?

Data Analysis

Statistical analysis was performed using Statistical Package for Social Science (SPSS) version 25. Descriptive statistics were used to analyze the sociodemographic characteristics and the results were presented in proportions. Inferential statistics comprised binary logistic regression analysis for determining the predictors of modern FP utilization. All variables with p ≤.2 in univariate analysis were fitted into multivariable analysis for controlling confounding factors. Odds ratios (ORs) at 95% confidence interval (CI) were determined to assess the predictability of the independent variables. A two-tailed p < .05 was considered statistically significant.

In the qualitative part of the study, data were transcribed verbatim from the Swahili language to English and proofread by reading and re-reading by two researchers (BN/AJ) in the first instance to formulate units of meaning, followed by an interpretive phenomenological thematic data analysis approach. The researcher got familiarized with data, looked for similarities, and developed codes which were later polished to form subthemes and themes. Research teams cross-validated the emerging themes. The audio-recorded data were transcribed into full text on the same day but also field notes were taken parallel with the audio recorder and used as backup notes if the audio recorder failed. The interviews were transcribed and analyzed manually by thematic analysis.

Results

Sociodemographic Characteristics of the Study Participants

A total of 368 women of reproductive age were interviewed (response rate of 100%). The mean age of study participants was 20.5 ± 8.05 years ranging from 18 to 49 years. Most 155 (42.1%) of the study participants were aged 28 to 37 years. The majority 253 (68.8%) of the participants were married. Slightly more than half 203 (55.2%) of the participants had attained primary education and 200 (54.3%) were self-employed. More than half 206 (56.0%) of the study participants had a family income of less than 1.4 USD/100,000 TZS per day. The majority 232 (63.0%) of the study participants were Christians and 233 (63.3%) women had a history of use of FP methods (Table 2).

Table 2.

Sociodemographic Characteristics of the Study Participants (N = 368).

Variable	Frequency (n)	Percentage	Mean ± SD
Age (years)			20.5 ± 8.05
18–27	148	40.2
28–37	155	42.1
38–49	65	17.7
Religion
Christian	232	63
Catholic	111	30.2
Muslim	25	6.8
Marital status
Single	96	26.1
Married	253	68.8
Divorced/divorced	19	5.2
Education level
Informal	18	4.9
Primary	203	55.2
Secondary	147	39.9
Occupation status
Government employee	22	6
Self-employed	200	54.3
Housewife	146	39.7
Family income per month (TZS)			303,371 ± 202,718
<100,000	206	56
100,000–700,000	162	44
Parity			3.25 ± 1.269
0–2	111	30.2
3–4	230	62.5
5+	27	7.3
Number of live children			1.94 ± 0.242
1–2	115	31.3
3–5	201	54.6
5+	52	14.1
Previous use of modern FP methods
Yes	233	63.3
No	135	36.7

FP=family planning.

Prevalence of Modern Family Planning Methods Use

The prevalence of modern FP methods used by study participants at the time of data collection was 181 (49.2%) (Table 3).

Table 3.

Prevalence of Modern Family Planning Use Among Study Participants.

Variable	Frequency (n)	Percentage
Current use of modern FP
Yes	181	49.2
No	187	50.8

FP=family planning.

Reported Types of Modern Family Planning Methods Used by Study Participants

The most reported modern FP methods that were used by participants include implants 81 (44.8%), injectable 47 (25.9%), pills 31 (17.1%), male condoms 11 (6.1%), and intrauterine devices 11 (6. 1%) (Figure 2).

Figure 2.

Types of family planning methods utilized by study participants (N = 181).

Source of Modern Family Planning Methods Among Women

Most 150 (40.8%) of the study participants reported obtaining modern FP methods from government health facilities, while 15 (4.1%) obtained FP methods from private facilities, 6 (1.6%) from pharmacies, and 10 (2.7%) from outreach clinics (Figure 3).

Figure 3.

Source of modern family planning methods among study participants (N = 181).

Reasons for Discontinuation of Modern Family Planning Methods Use

Out of all the study participants, 233 individuals (63.3%) had stopped using contraceptive methods. Fear of side effects was the main reason cited by 94 (40.3%) participants. Other reasons were religious restrictions 22 (9.4%), long distances 14 (6.0%), partner opposition 13 (5.6%), preference for male babies 45 (19.3%), and intention to get pregnant 45 (19.3) (Figure 4).

Figure 4.

Reasons for discontinuation of modern family planning methods among women with a history of using them (N = 233).

Barriers to Modern Family Planning Use by Women of Reproductive Age

The majority 278 (75.5%) of study participants reported waiting long hours, 256 (69.6%) husbands’ disapproval and 192 (52.2%) experienced side effects were the most barriers reported by women during the survey. However, the Tanzania government has its policy of free access to FP use, most 156 (42.4%) of study participants don’t go to the health facility but instead go to the small shops to buy modern FP (Table 4).

Table 4.

Barriers to Modern Family Planning Use by Women of Reproductive Age (N = 368).

Variable	Frequency (n)	Percentage
Waiting long hours for the service at the clinic
Yes	278	75.5
No	90	24.5
Husband disapproval of modern FP use
Yes	256	69.6
No	112	30.4
Lack of FP preferred method
Yes	112	30.4
No	256	69.6
Experience of modern FP side effects
Yes	192	52.2
No	176	47.8
Informal payment for modern FP services in small shops
Yes	156	42.4
No	212	57.6
Long distance to a health facility
Yes	126	34.2
No	242	65.8
Desire and value of many children
Yes	156	42.4
No	212	57.6
Long queues at the family planning clinic.
Yes	199	54.1
No	169	45.9
Pressure from the husband's family to have many children
Yes	237	64.4
No	131	35.6
Inability to make decisions about family size
Yes	99	26.9
No	269	73.1
Lack of FP promotion by healthcare providers
Yes	230	62.5
No	138	37.5
Misconceptions and lack of accurate information
Yes	165	44.8
No	203	55.2

FP=family planning.

Multivariable Regression Analysis for Factors Associated With Modern Family Planning Use Among Study Participants

After controlling for confounders (religions and husband approval to utilize modern FP methods) in multivariable regression analysis, age, married women, education level of participant, parity of 3 to 5, and availability of FP methods at the facility were found to be statistically significantly associated with modern FP utilization. Women aged 18 to 27 years were 57.8% significantly less likely to utilize modern FP when compared to women aged 38 to 49 years (adjusted OR [AOR] = 0.42, 95% CI = 02–0.91, p = .028), however, married women were five times more likely to utilize modern FP compared to single women (AOR = 5.44, 95% CI = 1.77–16.73, p = .003). Women with primary education were almost three-fold more likely to utilize modern FP compared to women with informal education (AOR = 2.99, 95% CI = 01.03–3.25, p = .001), while women with a secondary and higher level of education were almost four-fold significantly more likely to utilize modern FP compared to women with informal education (AOR = 3.53, 95% CI = 1.41–4.38, p = .001), women with parity of 3 to 5 were almost four times more likely to utilize modern FP compared to women with parity of 0 to 2 (AOR = 3.97, 95% CI = 1.35–2.72, p = .959), women with six and more children were 2.43 times more likely to utilize modern FP compared to women with parity of 0 to 2 (AOR = 2.43, 95% CI = 1.99–5.95, p = .052) and availability modern FP methods was 1.71 more likely to influence FP use compared to unavailability of FP commodities (AOR = 1.71, 95% CI = 1.03–2.85, p = .038; Table 5).

Table 5.

Factors Associated With Use of Modern Family Planning Among Women of Reproductive Age (N = 368).

Variable	COR	95% CI		p-Value	AOR	95% CI		p-Value
Variable	COR	Lower	Upper	p-Value	AOR	Lower	Upper	p-Value
Age (years)
18–27	0.59	0.40	0.78	.001	0.42	0.20	0.91	.028
28–37	1.35	0.98	1.85	.066	0.63	0.31	1.29	.209
38–49	Ref
Religion
Christian	0.90	0.70	1.17	.431	0.83	0.51	1.38	.476
Muslim	1.78	0.79	4.02	.167	1.75	0.64	4.79	.274
Catholics	Ref
Marital status
Single	Ref
Widow/divorced	0.47	0.31	0.73	.001	2.92	0.88	9.68	.079
Married	1.34	1.05	1.72	.020	5.44	1.77	16.73	.003
Education level
Informal	Ref
Primary	2.60	0.93	7.29	.069	2.99	1.03	3.25	.001
Secondary/higher level	3.99	1.76	5.30	.944	3.53	1.41	4.38	.001
Parity
0–2	Ref
3–5	1.39	1.26	2.59	.000	3.97	1.35	2.72	.959
6+	1.50	1.15	1.95	.003	2.43	1.99	5.95	.052
Husband approval
Yes	Ref
No	0.79	0.60	1.05	.102	0.81	0.51	1.29	.379
Availability of FP
Yes	0.635	0.44	0.92	.015	1.71	1.03	2.85	.038
No	Ref

AOR= adjusted odds ratio; CI=confidence interval; COR=crude odds ratios; FP=family planning.

Findings of Qualitative Research Method

A total of 48 study participants from the selected communities participated in six focus group discussions (FGDs). Barriers were grouped into four themes: individual, hospital, cultural, and knowledge of modern FP methods.

Theme 1: Individual Barriers

Fear of Side Effects

Fear of side effects was reported by most of the participants as one of the bottlenecks for modern FP utilization. Rumors of side effects such as prolonged bleeding and infertility have contributed to increased fear among community members. Participants mentioned side effects as a barrier that hinders the use of modern FP services. This was also reported by one participant in the focus group discussion: “I had implants for three years, I experienced prolonged bleeding every month and spot most of the time, these side effects bring challenges on my marriage life, I decided to remove the implant” (M1P4 FGD).

Another participant reported

“I used injections for almost nine months and didn’t see my periods. I believed this was a side effect of the injections and worried that blood was accumulating in my abdomen, which could lead to a uterine tumor or infertility. As a result, I decided to stop using the injections.”(M12P3FGD)

Poverty

The majority of the participants in the study are currently unemployed and rely on their husbands for financial support. Due to their low financial status, some women are unable to afford basic medical supplies such as syringes, gloves, and even urine tests for pregnancy. This lack of financial resources often leads to the under use of modern FP methods. For instance, during one of the focus group discussions, a participant shared that

“My friend was unable to afford an implant insertion due to the cost of Tsh 4000 for the necessary hospital medical supplies. Unfortunately, her husband refused to give her money for modern FP methods.” (M2 P8 FGD)

Unsatisfactory Family Planning Services

Clients often have to wait in long queues before they are attended to, which can lead to delays and make it difficult for them to participate in daily economic activities. Many participants have cited long waiting times as one of the major barriers they face when trying to access modern FP services. This was also raised by one of the participants during FGD:

I arrived at the health facility at 7: am, but I had to wait until noon for modern FP services. Next time, I will go in the afternoon after my work (M10 P3FGD).

Opposition From Husband

In African culture, men hold the final decision-making power at the family level. Some women lack the authority to make decisions regarding fertility and FP utilization. They are required to seek permission from their husbands before using FP methods. Unfortunately, the majority of men prevent their wives from using FP, as they believe that the primary purpose of marriage is to bear children. During an FGD, one of the participants reported this issue:

My husband told me that, I permitted you to go with the baby at the under-five clinic only and not for family planning services, once I discover that you are utilizing modern family planning, I will harm you.” (M5P31 FGD)

“It is not easy to use modern FP methods without permission from our husbands because women have no power to decide. Also, convincing men on issues of FP is very difficult as our culture accepts many children as rich.” (M5P32 FGD)

Theme 2: Hospital Barrier

Effective FP services need the availability of a constant supply of FP commodities and hospital supplies. Stock out of FP commodities adversely affects women choosing the preferred FP methods and leads to underutilization. As shown in Table 5, 112 (30.4%) of the participants reported a lack of FP commodities as one of the barriers to the use of modern FP. This was also reported by one of the participants that:

I went to a health facility for implant insertion, but the health provider told me that there were no implants, the remaining commodity is IUCD because I don’t prefer IUCD, I went back home.” (M11P21 FGD)

Theme 3: Cultural Barriers That Hinder the Use of Modern Family Planning Methods

Societal Norms

Preference for many children is still being valued by some clans in rural villages. Some families have up to 10 children. Other women believe that they should give birth to all children until all eggs are finished in the ovary. Some women believe that by having many children, life will be improved. As shown in Figure 4, 5.17% of the participants who were not using modern FP reported that preference for male babies prevents them from using modern FP. One of the participants from the focus group discussion explained that:

In our culture women are not allowed to have fewer than 4 children, you will get pressure from your husband's family and mother-in-law, and they will ask you why don’t you add more children. you will be sent to different traditional healers available in the village to get treatment to unblock the tube to have another pregnancy. (M13 P33 FGD)

Religious Factors

In the conservative community, religion is an integral section of life and influences the use of modern FP. Religious teaching discourages the use of modern FP and advocates for natural FP. The effectiveness of the use of natural FP is challenging. As shown in Figure 4, 22 (18.9%) of the participants reported religion as a barrier that hinders the use of modern FP. The quotes below from participants explain how religion prevents using modern FP.

“Religious teaching prevents the use of modern FP methods but it encourages the use of natural FP methods for only those who are in a marriage, it is against God's will, the teachings said that those utilizing modern FP are killing and killing is a sin.” (M16 P13FGD)

Theme 4: Knowledge of Modern FP Methods

Low Awareness of Modern FP Methods

The majority of the participants are aware of different modern FP methods but others are not well informed on female condoms, and emergency contraceptives. Low awareness of modern FP prevents women from having the right to be informed of FP choices hence leading to underutilization. This has also been reported in the quantitative part of this study such as in Table 3, which presents 123 (33%) of the participants who reported to know female condoms. One of the participants from the focus group discussion reported that:

“I heard that there are female condoms, but I have never seen them in my life, and I don’t know how they are being utilized.” (M17 P1 FGD)

Misconception of Family Planning

Misconception on modern FP is a challenge that leads to low utilization. Any information that has an impact on future fertility brings fear among women in the community and must be rejected. One of the participants from the focus group discussion reported that:

“Oral pills are not good methods for family planning at all, women who utilize this method will never get children in their life, actually pills bring infertility.” (M18P25 FGD)

Discussion

The objective of the study was to assess modern FP use, identify the factors that influence modern FP use, and determine the barriers to modern FP use among women of reproductive age in the region. The prevalence of modern FP use in this study was higher than the reported rates in Guinea (12.8%), Bauchi (18.4%), Kenya (18.6%), Senegal (26.3%), Zambia (33.2%), Kagera and Mara, Tanzania (43%), Ethiopia (41.2%), and Burundi (23.8%) as documented by Sidibé et al. (2020), MS et al. (2018), Moon et al. (2021), Zegeye et al. (2021), Lasong et al. (2020), Massenga et al. (2021), Oumer et al. (2020), and Nkunzimana et al. (2021), respectively.

However, a higher prevalence of modern FP use was reported among women of reproductive age, with rates of 54.8% in Malawi (Forty et al., 2021), 54.7% in Jordan (Komasawa et al., 2020), and 63% in Kenya (Moon et al., 2021). The difference observed in the prevalence of modern FP use may be caused by differences in cultural beliefs (Ekpenyong et al., 2018), ethnicity (Zegeye et al., 2021), education level (Forty et al., 2021), religion (Akamike et al., 2020), partner support (Massenga et al., 2021), and FP services and different ways of providing health education from different settings globally (Komasawa et al., 2020; Sidibé et al., 2020).

This study found that being married was associated with modern FP use. This is similar to the findings in the studies done elsewhere. For example, in the study done in the Kagera and Mara region, Tanzania was reported that married women were more likely to utilize modern FP (Massenga et al., 2021). Another study which was done in Ethiopia reported that married women were more likely to use modern FP (Mulatu et al., 2020). Furthermore, it was observed that women with three to five children were associated with the use of modern FP methods. A similar finding was reported by various studies, such as the study conducted in rural Zambia (Lasong et al., 2020), Senegal (Zegeye et al., 2021), and Ethiopia (Endriyas et al., 2017). The reason that multipara women tend to use modern FP methods may be attributed to the reality of the increased cost of living in all aspects of life, such as food, healthcare services, and education.

Level of education influences health behavior, researchers found that women with secondary and/or higher levels of education were more likely to use modern FP methods. This is similarly reported by several previous studies, which reported a positive association between modern FP use and secondary and/or higher education levels in Rwanda (Kanakuze et al., 2020), Malawi (Forty et al., 2021), Ethiopia (Adane et al., 2020), rural Zambia (Lasong et al., 2020), northwest Ethiopia (Oumer et al., 2020), and Liberia (Tsegaw et al., 2022). The similarity observed may be attributed by the reality that education influences health behavior change. Women who have higher levels of education tend to be more empowered when it comes to making decisions about fertility control. Furthermore, women with higher levels of education are better equipped to comprehend health information related to the use of modern FP methods. It is also likely that women with more education have increased access to health services, including modern FP, as higher education can lead to higher income levels. Additionally, women with higher education levels are often employed or self-employed and tend to have fewer children due to busy schedules, as a result, they are more likely to utilize modern FP methods.

According to a recent study, women who did not receive approval from their husbands tended to use modern FP methods less frequently. However, this finding was not statistically significant. This result is consistent with previous studies conducted in the Mara region, Tanzania (Baritwa & Joho, 2024), Rural Eastern Ethiopia (Mulatu et al., 2020), Indonesia (Joesoef et al., 2016), Ethiopia (Chekole et al., 2019), and Turkey (Alan Dikmen et al., 2019). Traditionally in African culture, men are the head of the family, hence men had power in decision-making on issues of family size and FP utilization. Women prior use of FP needed to get approval from their husbands, the majority of men resisted the use of modern FP with their wives. This is among the barrier to access and choice of use of modern FP methods. This finding agrees with a study done in Congo and Tanzania (Baritwa & Joho, 2024; Muanda et al., 2017). This might be caused by the nature of patriarchal culture where men had the final say in reproductive health decisions. The lack of approval from husbands may be attributed to factors such as their level of education, inadequate knowledge about modern FP methods, cultural beliefs that having many children is a sign of prestige, and negative attitudes toward women who use modern FP methods, as some men may view them as promiscuous. Additionally, a husband who does not allow his wife to make decisions on reproductive issues exercises reproductive coercion (Baritwa & Joho, 2024; Silverman et al., 2020; Wood et al., 2020), which affects women psychologically (Silverman et al., 2020). Therefore, educational programs on modern FP methods must target men and women in the community.

In the current study, the availability of modern FP methods was positively associated with its utilization. The finding is in line with studies conducted in Bangladesh, the Democratic Republic of Congo (DRC), and Haiti (Fallon & Ijdi, 2022), Rural Eastern Ethiopia (Mulatu et al., 2020), in Ethiopia, Nigeria, and DRC (Riley et al., 2018), Nigeria (Akamike et al., 2020), and Bauchi state (MS et al., 2018).

In both quantitative and qualitative findings, it is indicated that several barriers may reduce the use of modern FP, including fear of side effects, opposition from husbands, religious factors, and waiting long times to be attended. Religious beliefs are a significant challenge in scaling up the use of modern FP services. Many community members do not use modern FP methods due to criticism from religious leaders and church members, which makes them afraid to use them (Muanda et al., 2017; Nakirijja, 2018). Furthermore, some community members believe that using modern FP methods is against God's will and is a sin. Similar findings were reported in previous studies conducted in Nepal (Bhatt et al., 2021), North West Tanzania (Sundararajan et al., 2019), and rural Burundi (Ndayizigiye et al., 2017). In this regard, it is essential for religious leaders to be well-informed about accurate information concerning FP, so they can share this knowledge appropriately. Encouraging women to have many children can increase their risks during pregnancy, potentially leading to higher rates of maternal morbidity and mortality. Moreover, women have the right to make decisions about their bodies and the number of children they wish to have, considering their health and financial circumstances. Families with low incomes often struggle to provide for their children's education, which can lead to children engaging in early employment, facing early pregnancies, or even becoming street children.

The negative health effects of modern FP have been overrated by the community due to their side effects. For instance, the loss of menses was believed to cause uterine tumor and infertility. In African culture, infertility is underrated, and women who cannot give birth often encounter social isolation, rejection, and are replaced by other women in their marriage. Therefore, any risks that threaten women's fertility should be avoided. Similar findings were reported from studies conducted elsewhere, for example, in Saudi Arabia (Abdel-Salam et al., 2020), Eastern Senegal (Cohen et al., 2020), Urban Gambia (Dierickx et al., 2018), and Tanzania (Mushy et al., 2020). To dispel rumors in the community, intervention is needed through the empowerment of community workers who can provide accurate information on modern FP and its side effects.

Also, the findings from both quantitative and qualitative studies indicated that many women do not use modern FP methods because their husbands do not permit them. This is consistent with studies conducted in various countries, including Tanzania (Baritwa & Joho, 2024), Pakistani (Sarfraz et al., 2023), India (Vishwakarma & Shekhar, 2022), and Uganda (Sarnak et al., 2021). Husband opposition to FP use may be due to several reasons, such as the belief that men are the decision-makers in the family and have control over their wives’ use of modern FP and child spacing. In addition, men in African regions often find it prestigious to have many children and consider the use of contraceptives as a threat to their masculinity. Male partners must be involved in health education and information, including learning about the advantages and disadvantages of modern FP methods. They need to understand that women have the right to make decisions about their own health, including the use of modern FP.

Both quantitative and qualitative data indicated that long waiting times to be attended by a healthcare provider are a prevalent issue. This is consistent with findings from various studies conducted in other regions, including peri-urban Nairobi (Hassan et al., 2022), the United States (Karra & Canning, 2020), and Appalachian (Swan et al., 2020). As a consequence, women may opt to purchase modern FP products from shops due to the discouragement caused by the long wait times.

Strengths

The use of both quantitative and qualitative approaches helped to explore detailed insights regarding modern FP use among women of reproductive age.

Limitations of the Study

The study was cross-sectional and relied on self-reporting of contraceptive use among women of reproductive age, which might not show a causal relationship.

Implications

This study has investigated the reasons for women not using modern FP methods and suggests that stakeholders such as policymakers and nongovernmental agencies should take action to address this issue. One suggestion is to provide educational interventions which emphasizing the importance of modern FP, clarify any misconceptions or concerns about side effects, and involve husbands in the process to ensure their understanding and approval of their wives using modern FP methods.

Conclusion and Recommendation

The proportion of modern FP use in the region is below the national target. To increase modern FP use there is a need to address solutions to the reported barriers to the utilization of modern FP methods by increasing the efforts on male involvement, raising awareness among community members including religious leaders on the benefits of modern FP methods, comprehensive counseling, and correct information regarding side effects of modern FP methods should be given to both partners for them to provide couple informed decision.

Footnotes

Acknowledgments

We appreciate the nonfinancial support which was provided by the University of Dodoma and we would also like to express our gratitude to all study participants, research assistants, and administrative leaders at all levels for their valuable contributions to this study.

Authors’ Contributions

The authors’ contributions to the research project are as follows: BN was responsible for conceptualizing the study, designing the research methodology, curating the data, analyzing the data, and writing the first draft of the manuscript. AAJ contributed by providing guidance and supervision throughout the study, conducting an in-depth literature search, and writing the first draft of the manuscript. All authors reviewed the final version of the manuscript and agreed to be held accountable for the intellectual content presented in the article.

Availability of Data and Materials

The data will be available upon special request from the University of Dodoma.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics Approval and Consent to Participate and Study Approval Number

This research was approved by the research ethical committee of the University of Dodoma (Ref. no. MA. MA.84/261/02/ issued on March 18, 2022. The study obtained informed consent from participants after fully explaining the study's objectives and procedures.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Angelina A. Joho

References

Abdel-Salam

D. M.

Albahlol

I. A.

Almusayyab

R. B.

Alruwaili

N. F.

Aljared

M. Y.

Alruwaili

M. S.

Alnasser

R. M.

(2020). Prevalence, correlates, and barriers of contraceptive use among women attending primary health centers in aljouf region, Saudi Arabia. International Journal of Environmental Research and Public Health, 17(10). https://doi.org/10.3390/ijerph17103552

Adane

A. A.

Bekele

Y. A.

Melese

Worku

G. T.

Netsere

H. B.

(2020). Modern Contraceptive Utilization and Associated Factors among Married Gumuz Women in Metekel Zone North West Ethiopia. 2020.

Akamike, I. C., Okedo-Alex, I. N., Eze, I. I., Ezeanosike, O. B., & Uneke, C. J. (2020). Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy. Contraception and Reproductive Medicine, 5(1), 1–11. https://doi.org/10.1186/s40834-020-00133-6

Alan Dikmen

Cankaya

Dereli Yilmaz

(2019). The attitudes of refugee women in Turkey towards family planning. Public Health Nursing, 36(1), 45–52. https://doi.org/10.1111/phn.12553

Alrawi

(2021). Exploring barriers to family planning service utilization and uptake among women in Iraq. Eastern Mediterranean Health Journal, 27(8), 818–825. https://doi.org/10.26719/emhj.21.015

Apanga

P. A.

Kumbeni

M. T.

Ayamga

E. A.

Ulanja

M. B.

Akparibo

(2020). Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: A large population-—based study. https://doi.org/10.1136/bmjopen-2020-041103

Asif, M. F., & Pervaiz, Z. (2019). Socio-demographic determinants of unmet need for family planning among married women in Pakistan. BMC Public Health, 19(1), 1226. https://doi.org/10.1186/s12889-019-7487-5

Baritwa, M. S., & Joho, A. A. (2024). Intimate partner violence influences modern family planning use among married women in Tanzania: Cross-sectional study. BMC Public Health, 24(1), 421. https://doi.org/10.1186/s12889-024-17666-z

Bhatt

Neupane

Karki

Bhatta

Thapa

Basnet

L. B.

Budhathoki

S. S.

(2021). Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study. PLoS ONE, 16(5), 1–16. https://doi.org/10.1371/journal.pone.0252184

10.

Chekole

M. K.

Kahsay

Z. H.

Medhanyie

A. A.

Gebreslassie

M. A.

Bezabh

A. M.

(2019). Husbands’ involvement in family planning use and its associated factors in pastoralist communities of Afar, Ethiopia. Reproductive Health, 16(1), 1–7. https://doi.org/10.1186/s12978-019-0697-6

11.

Cohen

Mendy

F. T.

Wesson

Protti

Cissé

Gueye

E. B.

Trupe

Floreak

Guichon

Lorenzana

Buttenheim

(2020). Behavioral barriers to the use of modern methods of contraception among unmarried youth and adolescents in eastern Senegal: A qualitative study. BMC Public Health, 20(1), 1–9. https://doi.org/10.1186/s12889-020-09131-4

12.

Dierickx

Rahbari

Longman

Jaiteh

Coene

(2018). “I am always crying on the inside”: A qualitative study on the implications of infertility on women’s lives in urban Gambia. Reproductive Health, 15(1), 1–11. https://doi.org/10.1186/s12978-018-0596-2

13.

Ekpenyong

Odejimi

(2018). Factors influencing utilisation of family planning services among female of reproductive age (15-45 years) in Bauchi local government area, Bauchi state. 3(2), 1–6. https://doi.org/10.15761/NPC.1000180

14.

Endriyas

Eshete

Mekonnen

Misganaw

Shiferaw

(2017). Contraceptive utilization and associated factors among women of reproductive age group in Southern Nations Nationalities and Peoples’ Region, Ethiopia : Cross-sectional survey, mixed-methods. Contraception and Reproductive Medicine, 1–9. https://doi.org/10.1186/s40834-016-0036-z

15.

Fallon

J. B.

Ijdi

(2022). Need for Standardized Measure of Modern Method Availability : Assessment of Indicators Using Health Facility Data from Three Country Contexts. https://doi.org/10.1111/sifp.12220

16.

Forty

Rakgoasi

S. D.

Keetile

(2021). Patterns and determinants of modern contraceptive use and intention to use contraceptives among Malawian women of reproductive ages (15–49 years). Contraception and Reproductive Medicine, 6(1), 1–12. https://doi.org/10.1186/s40834-021-00163-8

17.

Gizaw

Regassa

(2011). Correlates of family planning service utilization in urban Ethiopia: The case of Mojo Town. The Oriental Anthropologist, 11(2), 309–325. https://doi.org/10.1177/0976343020110208

18.

Hassan

Bhatia

Zinke-allmang

Shipow

Ogolla

Gorur

Cislaghi

(2022). SSM – qualitative research in health navigating family planning access during Covid-19 : A qualitative study of young women ‘ s access to information, support and health services in peri-urban Nairobi. SSM – Qualitative Research in Health, 2, 100031. https://doi.org/10.1016/j.ssmqr.2021.100031

19.

Imtishal

Mohammadnezhad

Baker

Khan

(2023). Predictors of knowledge, attitude, and practice (KAP) towards family planning (FP) among pregnant women in Fiji. Maternal and Child Health Journal, 27(5), 795–804. https://doi.org/10.1007/s10995-023-03618-3

20.

Joesoef

M. R.

Baughman

A. L.

Utomo

(2016). REPRTS husband’s approval of contraceptive use in metropolitan Indonesia: Program implications. 19(3), 162–168.

21.

Kanakuze

C. A.

Kaye

D. K.

Musabirema

Nkubito

Mbalinda

S. N.

(2020). Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: A mixed methods study. BMC Pregnancy and Childbirth, 20(1), 1–11. https://doi.org/10.1186/s12884-020-03337-5

22.

Karra

Canning

(2020). The effect of improved access to family planning on postpartum women: Protocol for a randomized controlled trial. JMIR Research Protocols, 9(8), 1–16. https://doi.org/10.2196/16697

23.

Kassim

Ndumbaro

(2022). Factors affecting family planning literacy among women of childbearing age in the rural Lake zone, Tanzania. BMC Public Health, 22(1), 1–11. https://doi.org/10.1186/s12889-022-13103-1

24.

Keesara

S. R.

Juma

P. A.

Harper

C. C.

(2015). Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya. BMC Health Services Research, 15(1), 1–8. https://doi.org/10.1186/s12913-015-0997-7

25.

Kish, L. (1957). Confidence intervals for clustered samples. American Sociological Review, 22(2), 154–165. https://www.jstor.org/stable/2088852

26.

Komasawa

Yuasa

Shirayama

Sato

Komasawa

Alouri

(2020). Demand for family planning satisfied with modern methods and its associated factors among married women of reproductive age in rural Jordan: A cross-sectional study. PLoS ONE, 15(3), 1–14. https://doi.org/10.1371/journal.pone.0230421

27.

Lasong

Zhang

Gebremedhin

S. A.

Opoku

Abaidoo

C. S.

Mkandawire

Zhao

Zhang

(2020). Determinants of modern contraceptive use among married women of reproductive age: A cross-sectional study in rural Zambia. BMJ Open, 10(3), 1–10. https://doi.org/10.1136/bmjopen-2019-030980

28.

Massenga

Noronha

Awadhi

Bishanga

Safari

Njonge

Kim

Y. M.

van Roosmalen

van den Akker

(2021). Family planning uptake in kagera and mara regions in Tanzania: A cross-sectional community survey. International Journal of Environmental Research and Public Health, 18(4), 1–16. https://doi.org/10.3390/ijerph18041651

29.

MINISTRY OF HEALTH, C. D., & GENDER, E. A. C. (2022). NATIONAL PLAN FOR REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH & NUTRITION (2021/2022–2025/2026) One Plan III.

30.

Ministry of Health (MoH) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and I. (2023). Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 Key Indicators Report. 1–23.

31.

Moon

T. D.

Okoth

Starnes

J. R.

Opiyo

Ressler

D. J.

Rogers

(2021). Determinants of modern contraceptive prevalence and unplanned pregnancies in Migori County, Kenya : Results of a cross-sectional household survey. 25, 29–40. https://doi.org/10.29063/ajrh2021/v25i1.4

32.

Odejimi

(2018). Factors influencing utilisation of family planning services among female of reproductive age (15-45 years) in Bauchi local government area, Bauchi state. Nursing and Palliative Care, 3(2), 0–6. https://doi.org/10.15761/npc.1000180

33.

Muanda

M. F.

Ndongo

G. P.

Messina

L. J.

Jane

(2017). Barriers to modern contraceptive use in rural areas in DRC. Culture, Health & Sexuality, 1058, 1–13. https://doi.org/10.1080/13691058.2017.1286690

34.

Mulatu

Sintayehu

Dessie

Deressa

(2020). Modern Family Planning Utilization and Its Associated Factors among Currently Married Women in Rural Eastern Ethiopia : A Community-Based Study. 2020.

35.

Mushy

S. E.

Tarimo

E. A. M.

Fredrick Massae

Horiuchi

(2020). Barriers to the uptake of modern family planning methods among female youth of Temeke District in Dar es Salaam, Tanzania: A qualitative study. Sexual & Reproductive Healthcare, 24, 100499. https://doi.org/10.1016/j.srhc.2020.100499

36.

Nakirijja

D. S.

(2018). Socio-economic determinants of access to and utilization of contraception among rural women in Uganda. 1–20. https://doi.org/10.21767/1791-809X.1000608

37.

Nations, U. (2020). Family planning and the 2030 agenda for sustainable development (data booklet). Family planning and the 2030 agenda for sustainable development (Data Booklet). https://doi.org/10.18356/e154e49d-en

38.

NBS. (2016). Tanzania Demographic and Health Survey and Malaria Indicator survey 2015-2016 (Issue 2015/16).

39.

Ndayizigiye

Fawzi

M. C. S.

Lively

C. T.

Ware

N. C.

(2017). Understanding low uptake of contraceptives in resource-limited settings: A mixed-methods study in rural Burundi. BMC Health Services Research, 17(1), 1–12. https://doi.org/10.1186/s12913-017-2144-0

40.

Nkunzimana, E., Ndoreraho, A., & Nyandwi, J. (2021). Uptake of modern contraceptive methods among Burundian women and associated factors: Analysis of demographic and health survey data, Burundi 2016–2017. The East African Health Research Journal, 5(1), 75.

41.

Oumer

Manaye

Mengistu

(2020). Modern contraceptive method utilization and associated factors among women of reproductive age in Gondar city, Northwest Ethiopia. Open Access Journal of Contraception, 11, 53–67. https://doi.org/10.2147/oajc.s252970.

42.

Riley

Garfinkel

Thanel

Esch

Workalemahu

Anyanti

Pope

Longfield

Bertrand

Shaw

(2018). Getting to FP2020 : Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC. 1–16. https://doi.org/10.7910/DVN/OJD10N

43.

Sarfraz

Hamid

Kulane

Jayasuriya

(2023). The wife should do as her husband advises’: Understanding factors influencing contraceptive use decision making among married Pakistani couples—qualitative study. PLoS ONE, 18(2), 1–19. https://doi.org/10.1371/journal.pone.0277173

44.

Sarnak

D. O.

Wood

S. N.

Zimmerman

L. A.

Karp

Makumbi

Kibira

S. P. S.

Moreau

(2021). The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women. PLoS ONE, 16(1), 1–15. https://doi.org/10.1371/journal.pone.0238662

45.

Sidibé

Delamou

Camara

B. S.

Dioubaté

Manet

El Ayadi

A. M.

Benova

Kouanda

(2020). Trends in contraceptive use, unmet need and associated factors of modern contraceptive use among urban adolescents and young women in Guinea. BMC Public Health, 20(1), 1–10. https://doi.org/10.1186/s12889-020-09957-y

46.

Silverman

J. G.

Challa

Boyce

S. C.

Averbach

Raj

(2020). Associations of reproductive coercion and intimate partner violence with overt and covert family planning use among married adolescent girls in Niger. EClinicalMedicine, 22, 100359. https://doi.org/10.1016/j.eclinm.2020.100359

47.

Sundararajan

Yoder

L. M.

Kihunrwa

Aristide

Kalluvya

S. E.

Downs

D. J.

Mwakisole

A. H.

Downs

J. A.

(2019). How gender and religion impact uptake of family planning: Results from a qualitative study in Northwestern Tanzania. BMC Women’s Health, 19(1), 1–10. https://doi.org/10.1186/s12905-019-0802-6

48.

Swan

L. E. T.

Auerbach

S. L.

Ely

G. E.

Agbemenu

Mencia

Araf

N. R.

(2020). Family planning practices in appalachia: Focus group perspectives on service needs in the context of regional substance abuse. International Journal of Environmental Research and Public Health, 17(4). https://doi.org/10.3390/ijerph17041198

49.

Tsegaw, M., Mulat, B., & Shitu, K. (2022). Modern contraceptive utilization and associated factors among married women in Liberia: Evidence from the 2019 Liberia demographic and health survey. Open Access Journal of Contraception, 13, 17–28. https://doi.org/10.2147/OAJC.S350117

50.

UNDESA. (2022). World Family Planning. In United Nations.

51.

UNFPA. (2018). Fact Sheet: Family Planni. 12.

52.

Vishwakarma

Shekhar

(2022). Covert use of reversible contraceptive methods and its association with husband’s egalitarian gender attitude in India. BMC Public Health, 22(1), 1–13. https://doi.org/10.1186/s12889-022-12882-x

53.

Welfare, M. of H. and S., & National. (2013). The United Republic of Tanzania Ministry of Health and Social Welfare National Family Planning Guidelines and Standards. 64.

54.

Wood

S. N.

Kennedy

S. R.

Akumu

Tallam

Asira

Hameeduddin

McGready

Zimmerman

L. A.

Kennedy

C. E.

Glass

Decker

M. R.

(2020). Reproductive coercion among intimate partner violence survivors in Nairobi. Studies in Family Planning, 51(4), 343–360. https://doi.org/10.1111/sifp.12141

55.

Zegeye

Ahinkorah

B. O.

Idriss-Wheeler

Olorunsaiye

C. Z.

Adjei

N. K.

Yaya

(2021). Modern contraceptive utilization and its associated factors among married women in Senegal: A multilevel analysis. BMC Public Health, 21(1), 1–13. https://doi.org/10.1186/s12889-021-10252-7

Factors Influencing Modern Family Planning Utilization and Barriers in Women of Reproductive Age in the Iringa Region,Tanzania: A Mixed-Methods Study

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Review of Literature

Materials and Methods

Study Design and Area

Study Population and Recruitment Criteria

Sample Size Estimation for the Quantitative Part of the Study

Sampling Technique and Recruitment of Study Participants

Definition of Variables

Data Collection Tools and Techniques

Data Analysis

Results

Sociodemographic Characteristics of the Study Participants

Prevalence of Modern Family Planning Methods Use

Reported Types of Modern Family Planning Methods Used by Study Participants

Source of Modern Family Planning Methods Among Women

Reasons for Discontinuation of Modern Family Planning Methods Use

Barriers to Modern Family Planning Use by Women of Reproductive Age

Multivariable Regression Analysis for Factors Associated With Modern Family Planning Use Among Study Participants

Findings of Qualitative Research Method

Theme 1: Individual Barriers

Fear of Side Effects

Poverty

Unsatisfactory Family Planning Services

Opposition From Husband

Theme 2: Hospital Barrier

Theme 3: Cultural Barriers That Hinder the Use of Modern Family Planning Methods

Societal Norms

Religious Factors

Theme 4: Knowledge of Modern FP Methods

Low Awareness of Modern FP Methods

Misconception of Family Planning

Discussion

Strengths

Limitations of the Study

Implications

Conclusion and Recommendation

Footnotes

Acknowledgments

Authors’ Contributions

Availability of Data and Materials

Declaration of Conflicting Interests

Ethics Approval and Consent to Participate and Study Approval Number

Funding

ORCID iD

References