"When there is unexpected pregnancy we call it a sin": Perceptions of Unintended Pregnancy in rural Malawi Open Access

Zolowere, Davie (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/s4655h192?locale=en
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Abstract

"When there is unexpected pregnancy we call it a sin": Perceptions of Unintended Pregnancy in rural Malawi.

By Davie Zolowere Background

Over half of all pregnancies in Malawi are unintended. Many of these pregnancies result in unsafe abortions, a major cause of maternal mortality. Rural communities are the most affected. Despite the high rates of unintended pregnancies in rural communities, the factors influencing unintended pregnancy remain unclear. Therefore, the aim of this study was to understand the meaning of unintended pregnancy and explore the factors influencing it's occurrence in these communities.

Methods

We conducted a cross-sectional study using focus group discussions and key informant interviews in rural communities with a high occurrence of unintended pregnancies in Mulanje district. Participants were purposively sampled, and data was transcribed verbatim, translated, coded using MAXQDA, and analyzed.

Results

Unintended pregnancies were described as those occurring outside of marriage. These pregnancies were stigmatized, considered sinful and most result in unplanned marriages. However, pregnancies within marriage are seen as blessings and mostly viewed as intended. Although we cannot determine causation, this study found that religious beliefs, transactional sex, sexual cleansing practices within a context of poor sex education, gender imbalance and poverty may influence occurrence of unintended pregnancies. The study also identified myths on contraception, alleged effective traditional methods and folklore methods as important barriers to modern contraceptive use.

Conclusion

The understanding of unintended pregnancy by these rural communities is different from definitions of unintended pregnancy used in survey epidemiology. Poor sex education, gender imbalance and poverty drive un-safe sexual practices culminating in unintended pregnancies.

Public Health Recommendations

There is need for measures that take into context these constructs to avoid biasing estimates of unintended pregnancies within marriage in these areas. Interventions to address unintended pregnancies in rural communities in Malawi should consider the local culture, economic issues, gender relations, and religious values.

Table of Contents

Table of Contents

Abstract..................................................................................................iv

Acknowledgments.....................................................................................v

Chapter 1. Introduction.............................................................................1

1.1 Introduction and Rationale...............................................................1

1.2 Problem Statement.....................................................................4

1.3 Purpose Statement.....................................................................6

1.4 Significance Statement................................................................6

1.5 Definition of Terms......................................................................7

Chapter 2. Literature Review......................................................................9

1.1 Introduction................................................................................9

1.2 The Meaning of Unintended Pregnancy..........................................10

1.3 Determinants of Unintended Pregancies.........................................14

1.4 Consequences of Unintend Pregnancies on Health Outcomes............18

1.5 Perceptions about Unintended Pregnancies....................................24

1.6 Summary of Review...................................................................26

Chapter 3. Methods and Results..................................................................29

3.1 Methods...............................................................................29

3.1.1 Introduction............................................................................29

3.1.2 Population and Sample.............................................................29

3.1.3 Procedures..............................................................................31

3.1.4 Instruments............................................................................36

3.1.5 Data Analysis..........................................................................37

3.1.6 Ethical Consideration................................................................42

3.1.7 Limitations and Delimitations.....................................................44

3.2 Results.................................................................................46

3.2.1 Meaning of Unintended Pregnancy..............................................46

3.2.2 Influences on Unintended Pregnancies in Rural Communities..........51

Chapter 4. Discussion, Conclusion and Recommendations.................................64

4.1 Discussion....................................................................................64

4.2 Conclusion....................................................................................72

4.3 Recommendations for Future Research.............................................73

4.4 Public Health Implications...............................................................74

5. Appendices..............................................................................................76

5.1 Key Informant Questionnaire Guide, English......................................76

5.2 Focus Group Discussion Guide, English..............................................77

5.3 Number of coded Segments per Transcript........................................79

5.4 Code Book....................................................................................80

5.5 Malawi National Health Sciences Research Committee Approval............81

6. References................................................................................................82

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