Community and Provider Perspectives on Addressing Unmet Need for Contraception: Key Findings from a Formative Phase Research in Kenya, South Africa and Zambia (2015-2016)

Joanna Paula Cordero(1), Petrus S. Steyn(2), Peter Gichangi(3), Yolandie Kriel(4), Cecilia Milford(5), Margarate Munakampe(6), Irene Njau(7), Theresa Nkole(8), Adam Silumbwe(9), Jennifer Smit(10), James Kiarie(11),


(1) UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva
(2) UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva
(3) International Centre for Reproductive Health - Kenya (ICRH-K), P.O.Box 91109 – 80103, Mombasa, Kenya2; Technical University of Mombasa, Tudor, Tom Mboya Street, P.O. Box 90420 - 80100, Mombasa
(4) MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000,
(5) MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000,
(6) Department of Health Policy and Management, School of Public Health, University of Zambia Nationalist Road, P.O Box 50110, Lusaka5; Strategic Centre for Health Systems, Metrics and Evaluations (SCHEME), Department of Epidemiology and Biostatistics, University of Zambia Nationalist Road, P.O Box 50110, Lusaka
(7) MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000
(8) Department of Obstetrics and Gynaecology, Levy Mwanawasa University Teaching Hospital, Lot 1222, Great East Road, Chainama Area, Lusaka
(9) Department of Health Policy and Management, School of Public Health, University of Zambia Nationalist Road, P.O Box 50110, Lusaka
(10) MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000,
(11) UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva,
Corresponding Author

Abstract


Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the ―active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of
care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used,
facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible
generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts. (Afr J Reprod Health 2019; 23[3]: 106-119).

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