Determinants of female and male sterilization uptake in crisis affected settings such as in the North Kivu province, Eastern of the Democratic Republic of Congo. Público
Nzau Mvuezolo, Jean Jose (Summer 2019)
Published
Abstract
Background Supporting Access to Family Planning and Post-Abortion Care in Emergencies (SAFPAC) has supported governments in Sub-Saharan Africa by integrating essential sexual and reproductive health services into new and ongoing humanitarian emergencies since 2011. SAFPAC’s work in the Democratic Republic of the Congo (DRCongo) aims to reduce unintended pregnancies and deaths from unsafe abortion. Among the many components of SAFPAC project in the DRCongo is the integration of female and male sterilization into the existing family planning programming in three health districts in North Kivu province affected by more than twenty years of social instability and war. Project’s interventions include strengthening skills and improving attitudes of healthcare providers, equipping health facilities, implementing a community engagement strategy to engage religious leaders, community health workers (CHWs) and previous clients of female and male sterilization to facilitate participatory dialogue sessions and share their testimonies through radio broadcasts. This study seeks to identify determinants that led to a steady uptake of female and male sterilization in the three health districts since the beginning of the integration of these two methods that started in January 2016.
Methods We conducted a mixed method study (qualitative and quantitative) using an explanatory sequential design model. We first conducted in September 2018, 330 surveys (56 clients of male sterilization, 130 clients of female sterilization and 144 female users of other modern contraceptives methods). The preliminary analysis of quantitative data was used to develop instruments for the collection of qualitative data in October when we conducted nine focus group discussions (106 participants) and key informant interviews (with four healthcare providers) using open-ended surveys. Epi 7 and SAS software were used to analyze quantitative data and MAXQDA for qualitative data from which emerged themes.
Results The results have revealed that individual, programmatic, and environmental factors were the key contributors to the steady uptake of female and male sterilization. Limited resources (p-value:.02) and partner health issues (p-value:.001) were found to be associated with the decision of men of adopting male sterilization.
For sterilized women, a history of c-section was associated with the decision of women to adopt female sterilization (p-value:.003) and for users of other modern contraceptive methods, the decision to shift to a sterilization method could be justifiable if this method was recommended by a physician. (p-value: .027)
Other programmatic and environmental factors including 1) the confidence of healthcare professional to provide sterilization methods, free services, the support from partner and the buy-in of local religious leaders (Adventists and other protestant leaders).
Conclusion A holistic approach aiming to identify and address barriers at multiple levels (individual, interpersonal, community and programmatic) is essential in integrating male and female sterilization into existing family planning programming. Further research is needed to determine the contribution of each factor and test the replication of the package of interventions in other contexts.
Table of Contents
Acronyms………………………………………………………………………………………....04
Table of contents ………………………………………………………………………………. 05
Introduction ……………………………………………………………………………………..06
Background …………………………………………………………………………….........06
Review of the literature ……………………………………………………………….......14
Methods ……………………………………………………………………………………….....25
Results …………………………………………………………………………………………....30
Discussion …………………………………………………………………………………….....53
Discussion
Limitations
Implications, recommendations and conclusion
References ……………………………………………………………………………………......61
List of tables
Table 1: Socio-demographic characteristics of respondents in Lubero, Butembo and Kyanna/DRC.
Table 2: Family planning and sterilization: Knowledge and previous utilization.
Table 3. Reasons for choosing sterilization.
Table 4: Elements of the enabling environment.
Table 5: Bivariate logistic regressions
List of figures
Figure 1: Contraceptive prevalence among married or in-union women aged 15 to 49 by method and region, 2015.
Figure 2. Percentage share of specific methods of all contraceptive use among married or in-union women aged 15 to 49 worldwide, 1994 and 2015.
Figure 3: Map of Health zones in North Kivu Province, Eastern of the DRCongo.
Figure 4: New users of female and male sterilization in 8 health facilities supported by the SAFPAC Initiative in North Kivu, from January 2016-June 2018.
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