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A personal recount about having a baby born prematurely

  • Secrete use however, is likely to put the women at greater risk of violence and desertion;
  • Related findings were reported in a United Kingdom study on risk, power and trust which reported that young women mobilized trust in male partners as a coping strategy[ 30 ];
  • Jill Stanek was a nurse at Christ Hospital in Oak Lawn, Illinois in 1999 when she discovered that babies born alive after failed abortions purposely were being left to die in the "soiled utility room," which, says Stanek, is a room where biohazard materials and soiled linens are disposed of;
  • Unmarried women using contraceptives are stigmatized and perceived to be either prostitutes or promiscuous.

Some women decided to use or not to use contraceptives independently from their partners. Some unmarried women also reported that they carried condoms in case of emergency in order to avoid pregnancy in unstable relations. Young women recounted using contraceptives secretly as a strategy to protect their interests, and counteract male partner disapproval. Secret use of contraceptives was said to prevent unwanted pregnancy.

At the same time conflicts with partners and families were avoided. Secret use was an enabling factor specific for young women. As a result the injection method was said to be the most common method used both by married and unmarried young women. Pregnancy is so stressful for women, your husband may not be supportive financially but only interested in alcohol. Participants in the focus groups claimed that previously people were more scared of HIV than pregnancy.

Fear of pregnancy and not HIV was reported to slowly aid adoption of contraceptive methods.

  1. Engaging respected community gatekeepers including teachers, parents, clergy, health care providers, local 'stars' and media into dialogue might be a plausible strategy. News Tue Aug 12, 2008 - 12.
  2. Young people do not have a regular sex life and their sudden unplanned sexual encounters make contraceptive use difficult. Journal of Obstetrics Gynecology.
  3. There appeared to be shifting of blame between men and women. For many women in their prime reproductive years such side effects contribute to poor adherence and contraceptive failure.
  4. Engaging respected community gatekeepers including teachers, parents, clergy, health care providers, local 'stars' and media into dialogue might be a plausible strategy.
  5. Discussion The results of this qualitative study elucidated a deeper understanding of why young people use or not use contraceptives.

AIDS takes long to show compared to pregnancy so you would rather have that than pregnancy that shows soon" Unmarried women's group 15-19 years Female participants reported that self preservation from pregnancy before marriage led to contraceptive use. Furthermore, worries of carrying a pregnancy, looking after the baby, the costs involved, and fear of negative consequences of abortion were enablers to contraceptives use. Most of them fear the burden of looking after the child.

Taking care of yourself and pregnancy is tough" Unmarried women's group 20-24 years Male counterparts reported fear of early forced marriage, being forced to leave school or being put in jail if found to have made a young girl pregnant as motivators for contraceptive use.

Selective contraceptive use was also reported with "on and off" partners and when the man suspected that the woman had a sexually transmitted infection. Changing attitude towards a small family size Both male and female participants recognized that having many children is difficult for working men and women.

Men did not want to have the responsibility of many children in terms of education and health care expenses.

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Young men and women stated that they often debated among peers about having fewer children. They further reported that free contraceptives in the public facilities helped use.

The women who already had children also stated that antenatal clinics were an important source of information to encourage contraceptive use. Discussion The results of this qualitative study elucidated a deeper understanding of why young people use or not use contraceptives.

The young people in the FGDs revealed individual, socio-cultural, economic, and institutional obstacles to contraceptive use. Fifty years after introduction of family planning in Uganda, utilization is still low and there are many challenges of translating policy and knowledge into practice The participants' perceptions indicate knowledge gaps and limited access to information as well as comprehensive family planning services. The study findings show that young people a personal recount about having a baby born prematurely strongly embedded misconceptions and profound fears which serve as obstacles to initiation and continuation of contraceptive use.

Many perceived contraceptives to be harmful and detrimental to health, and because of this they were reluctant to use them. The reported fear of infertility is a sign of the inherent need to have children and the importance that society places on child bearing. Young people seemed to lack knowledge about how contraceptives work and had made up their own ideas about the mechanism involved.

Additionally, young people placed considerable weight on the side effects of both hormonal and non hormonal contraceptive methods. Although few side effects are known to be life threatening [ 24 ], irregular heavy bleeding, loss of libido and weight gain are significant to young people, especially for women using contraceptives secretly.

For many women in their prime reproductive years such side effects contribute to poor adherence and contraceptive failure. Opposition from male partners was noted to partly stem from beliefs about such side effects. A study on sterility rumors in Africa asserted that in absence of the truth, rumors acquire credibility[ 25 ]. Research studies have linked limited knowledge about contraceptive methods and concerns about health and side effects to high unmet contraceptive needs in low-income countries [ 26 ].

Young people reported how fear immobilized them in decision making.

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They were afraid of several issues; for example; side effects, getting pregnant without contraception, church response, partners, parents and family reactions. Another study in Uganda identified parents as an obstacle to use of emergency contraceptives [ 27 ].

It is important to provide factual, correct information to demystify the misconceptions around contraception. Adequate clinical support is required to manage side effects, without this social marketing will continue to fail for hormonal contraceptives.

Previous interventions in Uganda have been based on the belief that lack of information is the basis of low contraceptive use [ 1728 ]. But lack of awareness is not the only obstacle to practice. The current social norms create significant conflicts, and dilemmas for young men and women, as sexual practices and life styles are changing. Our findings underline the contraceptive controversies and contradictions that exist based on powerful and persistent religious, cultural and social values.

Traditions and cultural practices that encourage high fertility are still strong in Uganda, which has been reported in reproductive health symposium in Uganda [ 11 ]. Our study findings revealed that young people experienced resistance and opposition to contraceptive use by adults including religious, political, and cultural leaders.

The leaders are pro-natal and spread negative messages that scare people from using contraceptives and contribute to spread of rumors, misunderstandings and criticisms in the communities.

Findings from this study revealed that young women are still bound by cultural norms that equate marriage and motherhood with female status and value, creating pressure on them to prove their fertility, which was also found in a study on adolescent motherhood in Uganda [ 29 ]. Our study findings illustrates that contraceptive programs should be sensitive to culture and traditional perspectives to birth control.

  • Some young men who were changing attitudes towards use of contraceptives were motivated by fear of imprisonment and forced marriage in case made a young girl pregnant;
  • It was further noted that providers restrict access to contraceptives to the unmarried and those with no children.

Success of programs will depend on responsiveness to young people's needs, use of appropriate cultural designs that promote social change while respecting the cultural values. Efforts need to focus on changing individual and societal motivations. Engaging respected community gatekeepers including teachers, parents, clergy, health care providers, local 'stars' and media into dialogue might be a plausible strategy.

Contradictive messages from male partners, parents, clergy, teachers, peers, media and health workers alongside social norms that condemn sex, contraceptives and pregnancy before marriage, imply that young people get mixed messages. Furthermore, peer pressure and pleasure from sex was noted to override fear of both pregnancy and HIV.

It was also shown that young men and women feared pregnancy more than HIV infection since the later take long to develop. Similar findings were reported in a study on emergency contraceptives[ 27 ]. This shows short term thinking and is an attitude that might fuel the HIV epidemic. Our results indicated that trust was built early in relationships and that sex without condoms was preferred. Related findings were reported in a United Kingdom study on risk, power and trust which reported that young women mobilized trust in male partners as a coping strategy[ 30 ].

Background

Condom use was mostly related to HIV prevention, which indicates that women are at risk of pregnancy as soon as the couple has overcome the fear of HIV.

Young people do not have a regular sex life and their sudden unplanned sexual encounters make contraceptive use difficult. Some participants noted that young women and men were using pregnancy to attract their partners into marriage, a finding that further demonstrate young people's short term planning perspective.

It is worth noting that the age of consent for heterosexual sex in Uganda is 18 years but sex is initiated much earlier.

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Condoms have a comparative advantage to other contraceptive methods; it can prevent both unwanted pregnancy, and STI including HIV. Promotion of condom for dual use would improve contraceptive usage rates.

  • There is need for more dialogue and open communication to delineate the secrecy and to de-stigmatize the use of contraception for sustainable use;
  • We further suggest more research on how to approach and discuss with men about the risks of unwanted pregnancy and excessive fertility;
  • Our results indicated that trust was built early in relationships and that sex without condoms was preferred;
  • There was urgent need and desire to use contraceptives despite the differences in motive and perspectives for young men and women;
  • Contradictive messages from male partners, parents, clergy, teachers, peers, media and health workers alongside social norms that condemn sex, contraceptives and pregnancy before marriage, imply that young people get mixed messages;
  • Babies born before 37 weeks are premature.

Use of social community networks to improve information, service and counseling might overcome socio-cultural or peer norms and foster skills in behavior change strategies. Our results underscore how conventional gender inequalities in terms of decision making and negotiation for contraceptive use are major obstacles to contraceptive use.

The participants described social cultural norms on gender roles that emphasize the man as the decision-maker in the family, including decisions on contraceptive use.

Men want and demand many children, and their fertility preference promotes unilateral decision making with a negative influence on female contraceptive use.

Our study highlighted limited couple discussions, frequent disagreements and partner violence when the woman wanted to initiate or continue using contraceptives.

Many young women seem to see fertility as a matter outside their control because of gendered cultural structures. Most women have limited access to resources and are financially dependent on their partners[ 31 ], which enhances women's sub-ordinate position.

Furthermore, women in polygamous relationships were said to compete for children as a means of security, which is another negative impact. While it will take time to change the social norms, decision to use contraceptives should be taken within a family. Would all young men and women use contraceptives if made available to them?

The answer is clearly no. There appeared to be shifting of blame between men and women. Both male and female opposition to contraception was noted although male partner opposition was more prominent due to men's power in decision making.

The opposition reflected fertility preference, fear of side effects, misconceptions, and doubts in the safety of the contraceptive methods. Research have reported that men's preference influence contraceptive use more than women's preference [ 28 ].

Our study findings reveal knowledge gaps and misinformation among men. Men are equal partners and male participation in contraception programs is essential.

Unmarried women using contraceptives are stigmatized and perceived to be either prostitutes or promiscuous. In contrast, sex experience by men was said to enhances their reputation among other men, which has also been noted elsewhere [ 32 ]. Studies have demonstrated difficulties to satisfy contraceptive needs in communities where contraceptives are believed to be only for married people [ 33 ].

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Increasing contraceptive use requires personalized, individualized strategies to men and women in accordance to cultural norms. The cost for transport and contraceptive commodities, made it prohibitive, especially for those without a disposable income.

Premature birth - information and support

Such structural impediments negatively affect contraceptive use rates among young people. Research studies have also noted how costs affect use [ 2932 ]. Integration of contraceptive services in social congregations, schools and other communal points is a plausible alternative to reduce costs. Furthermore, young men and women identified paternalistic, restrictive and judgmental attitudes among health care providers, coupled with unfriendly services, as obstacles to receiving contraceptives.

Young people who had overcome all the other obstacles were stopped at the service level. Negative response from health workers also serve as obstacles to initiation as well as to continuation of modern contraceptive methods among young people.

It was further noted that providers restrict access to contraceptives to the unmarried and those with no children. Strategies to strengthen health care provider's knowledge, skills and attitudes in youth friendly services are vital.

The provider's opinion influence services young people receive and their subsequent contraceptive behavior. Enabling factors are defined as factors that make it possible or easier for the individual or population to change their behavior [ 34 ].

This study identified enabling factors to contraceptive use including female strategies to overcome obstacles to contraceptive use, changing perceptions and changing attitudes towards family size. Secret use of contraceptives by some women was a strategy identified in our study to counteract traditional and social values. A similar finding was reported in a study in Ghana [ 31 ]. The secret use demonstrates the capacity of young women to take action in contexts where social norms prevent women from using contraceptives.