'I have no choice': The perceptions of contraceptive use and abortion practices among women in the Democratic Republic of the Congo 公开

Swanson, Jen (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/cr56n1605?locale=zh
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Abstract

Background During the two recent wars (1996-1997 and 1998-2003), the Democratic Republic of the Congo (DRC) has had widespreadconflict, civil strife, and rampant poverty. Largely in Eastern DRC, rape and sexual violence against women are still used as weapons of war. The 2013-2014 Demographic Health Survey estimated a maternal mortality ratio of 846/100,000 live births during 2006-2013. Strict abortion laws, high fertility rates, low contraceptive prevalence and lack of emergency obstetric care contribute to the elevated number of maternal deaths. Objective This qualitative research study was conducted in multiple field sites within four provinces throughout the DRC, each with high fertility rates. This study explores the knowledge of contraception among women, community perceptions of desired fertility, barriers to contraceptive access, and the woman's contraceptive decision-making process during negotiations with the husband. This research study also sought to gain insights into abortion practices. Methods Women of reproductive age (n=32) and reproductive healthcare providers (n=10) were purposively sampled to participate in in-depth interviews, conducted in four languages (French, Lingala, Tshiluba, and Swahili) within Equateur, Kasai-Occidental, Maniema, and North-Kivu Provinces. Participant recruitment was done through health center visits, door-to-door recruitment, and snowball and convenience sampling. After thoroughly reading the data, code development and application were employed to accurately capture the emic perspective. Results Thematic analysis identified several key themes relating to socio-cultural influences on contraceptive use: 1) Beliefs associated with contraceptive use incorporated community perceptions along with stigmas and myths; 2) Women's lack of autonomy might be due in part to a patriarchal society; 3) Opinions of abortion practices involved counsel given to the women and the various methods used to abort. Discussion Through examining high fertility norms, barriers to contraceptive use, and gender hierarchies, along with the women's lack of independence, this study concludes that Congolese women are not autonomous in decisions about fertility and family planning, and these decisions are inextricably linked to men. This study also suggests that highly unwanted pregnancies and strict abortion laws may drive Congolese women to utilize dangerous methods to induce at-home abortions resulting in abortion-related infection, complications, and fatalities.

Table of Contents

Abstract .......................................................................................................................................... iv Acknowledgements ........................................................................................................................ vi Table of Contents .......................................................................................................................... vii Chapter 1. Introduction ................................................................................................................... 1 Chapter 2. Comprehensive Review of the Literature ...................................................................... 5 Introduction ................................................................................................................................. 6 Constant Conflict ........................................................................................................................ 7 Unsafe Abortion .......................................................................................................................... 8 High Fertility Rates ..................................................................................................................... 9 Low Contraceptive Prevalence ................................................................................................. 10 Specific Project Background ..................................................................................................... 11 Chapter 3. Manuscript ................................................................................................................... 13 3.1 Contribution of the Student ................................................................................................. 14 3.2 Abstract ............................................................................................................................... 15 3.3 Introduction ......................................................................................................................... 16 3.4 Methods ............................................................................................................................... 17 3.5 Results ................................................................................................................................. 24 3.6 Discussion ........................................................................................................................... 35 Chapter 4. Conclusion and Recommendations ............................................................................. 41 Tables and Figures ........................................................................................................................ 45 References ..................................................................................................................................... 50 Appendix ....................................................................................................................................... 54 1. In-Depth Interview Guide - Women of Reproductive Age (Latest Version) ................... 54 2. In-Depth Interview Guide - Reproductive Health Care Provider (Latest Version) ......... 59

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