Women living in crisis areas of Sub-Saharan Africa’s use of family planning: A review of the literature
Kelly Ackerson, PhD, WHNP-BC; Ruth Zielinski, PhD, CNM, FACNM
- Sigma Affiliation
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Purpose: Explore available research and summarize factors that inhibit or promote family planning and contraceptive use among refugee women and women from surrounding areas living in Sub-Saharan Africa. Too many women continue to die from pregnancy and childbirth related causes. While rates have decreased over the past two decades, maternal mortality remains very high in Sub-Saharan Africa. Family planning and use of modern contraceptives decrease maternal mortality, yet rates of use in Sub-Saharan countries with the highest rates of maternal death remain very low.
Methodology: A review of the literature published between 2006 and 2016 was conducted using Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, OVID, power search, and PubMed databases. Sixteen articles were chosen for full review. Findings were discussed within the framework of the Interaction Model of Client Health Behavior.
Results: Twelve studies met the inclusion criteria. Utilization of modern contraceptive methods was low. Women were socially influenced to avoid use of contraceptives by husbands and others in the community. Reasons included lack of trust in western medicine and desire to have large families. Barriers to access was affected by low socioeconomic status and proximity of clinics. Healthcare providers were believed to be unqualified, with many women being treated disrespectfully. Knowledge and understanding of contraceptives was low; many women knew different methods were available, however, many held misconceptions. Certain contraceptives were believed to cause death, infertility and side effects. These beliefs contributed to fear of use. This lack of knowledge and fear, even with the desire to space and limit births, affected motivation to use contraception.
In Sub-Saharan Africa, underuse of family planning services, thus contraceptive use, is a multi-factorial issue. New community based approaches are needed to educate women, men (husbands), community leaders as well as healthcare providers. It is imperative that researchers and women’s healthcare providers be culturally sensitive and address family planning uptake with a holistic approach.
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