Utilization and barriers to family planning use among grand multiparous women at Kawempe national referral hospital

Abstract

Introduction: Uganda still has a high maternal mortality ratio despite implementations of various strategies by the Ministry of Health. There is limited information about level of utilization, and barriers to the use of family planning methods among grand multiparous women in Uganda. We determined the level, barriers and factors associated with utilization of family planning services among Grand multiparous women at Kawempe National Referral Hospital (KNRH) Methods: A cross-sectional study design with both qualitative and quantitative approaches was employed among 239 grand multi parous women. Quantitative data was collected using interviewer administered questionnaires and qualitative data through 8 in-depth interviews with the women. Modified Poisson regression was used to analyze the associated factors using STATA version 14. Thematic analysis was used to analyze the qualitative data. Ethical approval to conduct this study was obtained from SOMREC, UNCST and KNRH. Results. All women had heard about pills and injectables, followed by 99.6% male condoms, 99.2% implants, 96.2% IUDs, 84.5% withdraw, 79.9% lactational amenorrhea, 79.5% female sterilization, 74.9% rhythm method, 72.4% emergency contraceptives, 59% female condom, and 42.3% male sterilization. However, there was relatively low FP use (48.5%). Implants (35.3%), injectables (33.6%), and (15.5%) IUDs were the most commonly used. Not experiencing stigma when accessing FP at health facilities was significantly associated with FP utilization (aPR=2.32, p-value= 0.001). Major barriers of FP use were fear for side effects, fear for stigma from health facilities, influence by community and media, desire to have more children, experiences with pregnancy and child birth, timing of FP counseling, partner attendance of FP counselling, focus on community outreaches, and adequate counselling on FP benefits and risks. Conclusion: There was a high level of awareness of FP among grand multiparous women but low utilization. Implants, injectables and IUDs were the most commonly used. Not experiencing stigma from health workers when accessing FP at health facilities was significantly associated with the level of FP utilization. Major barriers of FP use were fear for side effects, fear for stigma from health workers, influence by community and media, desire to have more children, experiences with pregnancy and child birth.