TY - JOUR
T1 - Covert use of contraception in three sub-Saharan African countries
T2 - A qualitative exploration of motivations and challenges
AU - Kibira, Simon P.S.
AU - Karp, Celia
AU - Wood, Shannon N.
AU - Desta, Selamawit
AU - Galadanci, Hadiza
AU - Makumbi, Fredrick E.
AU - Omoluabi, Elizabeth
AU - Shiferaw, Solomon
AU - Seme, Assefa
AU - Tsui, Amy
AU - Moreau, Caroline
N1 - Funding Information:
This study was conducted with support received from the Bill & Melinda Gates Foundation through two grants received by the Bill & Melinda Gates Institute for Population and Reproductive Health for the Performance Monitoring and Accountability 2020 (OPP1079004) and PMA Plus (OPP1163880) projects. The funding body was involved in the design of the parent study, but was not involved in the study design, data collection, analysis, interpretation, or writing of the present manuscript.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/6/5
Y1 - 2020/6/5
N2 - Background: The balance between increasing men's participation in family planning and rights-based initiatives favoring women's empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low- A nd middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women's decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women's choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries. Methods: Women aged 15-49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women's and girls' empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes. Results: Findings comprised three thematic areas: The practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure. Conclusions: Results indicate that while covert use of contraception is common, continued covert use is challenging, especially when side effects manifest. Covert use may further suggest women taking independent action, symbolizing some level of empowerment. Results underscore the importance of disentangling unique reasons for covert use and the severity of repercussions of disclosure.
AB - Background: The balance between increasing men's participation in family planning and rights-based initiatives favoring women's empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low- A nd middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women's decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women's choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries. Methods: Women aged 15-49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women's and girls' empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes. Results: Findings comprised three thematic areas: The practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure. Conclusions: Results indicate that while covert use of contraception is common, continued covert use is challenging, especially when side effects manifest. Covert use may further suggest women taking independent action, symbolizing some level of empowerment. Results underscore the importance of disentangling unique reasons for covert use and the severity of repercussions of disclosure.
KW - Contraception
KW - Covert use
KW - Decision-making
KW - Empowerment
KW - Partner dynamics
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U2 - 10.1186/s12889-020-08977-y
DO - 10.1186/s12889-020-08977-y
M3 - Article
C2 - 32503485
AN - SCOPUS:85085931916
SN - 1471-2458
VL - 20
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 865
ER -