Factors influencing contraceptive use and sexual behaviour among women of reproductive age in Umlazi township, KwaZulu-Natal province, South Africa.

Abstract

Access to safe and effective contraceptive methods is one of the cornerstones of reproductive health, worldwide. However, the degree to which women manage various aspects of their sexual lives, including the prevention of unplanned or unwanted pregnancies, infant and maternal mortality, and exposure to HIV and AIDS, continues to raise questions relating to health promotion concerns. Despite the implementation of various government interventions, unplanned pregnancies, termination of pregnancies, and maternal mortality remain relatively high in South Africa. While HIV infection has been well documented in South Africa, the risky sexual behaviour of South Africans remains a concern. The aim of this study was to examine the factors that influence contraceptive use and sexual behaviour among women of reproductive age in Umlazi Township, KwaZulu-Natal Province, South Africa. The specific research objectives were as follows: 1. To map evidence on factors influencing contraceptive use and sexual behaviour in South Africa through a systematic scoping review. 2. To determine the proportion of women of reproductive age using contraceptives in Umlazi Township, KwaZulu-Natal, South Africa. 3. To examine women’s knowledge of different contraceptive methods in Umlazi Township, KwaZulu-Natal province, South Africa. 4. To determine contraceptive methods used by women in Umlazi Township, KwaZulu- Natal province, South Africa. 5. To identify factors influencing contraceptive use and sexual behaviour among women of reproductive age in Umlazi Township, both from a user and provider perspective. 6. To explore the experiences of women of reproductive age regarding contraceptive use and risky sexual behaviours in Umlazi Township, South Africa. Methods The was a mixed-methods study, which utilised primary level data to answer objectives two to six. A systematic scoping review was conducted to address the first study objective. The study was conducted in a clinic-based setting among women of reproductive age in Umlazi Township under eThekwini Municipality in KwaZulu-Natal. The healthcare providers from the selected clinics and women of reproductive age attending the selected facilities, participated in the study. For quantitative study, data were collected through a structured questionnaire, coded and entered into Epi data manager (version 4.6). Stata version 15 was used to conduct quantitative data analysis. Multivariable logistic regression model was used to assess the level of the association between the predictor and outcome variables and the p-value < 0.05 was considered statistically significant. For qualitative study, women from four primary health care facilities were recruited through a combination of convenience and criterion-based sampling techniques. Using NVivo version 11, two skilled researchers independently conducted thematic data analysis, as a mechanism for quality assurance, before the results were collated and reconciled. Results Overall, 471 eligible women and 35 healthcare workers participated in the quantitative study. Fifteen women participated in the qualitative study. The quantitative study found that more than half (51.8%) of the women were aged 18–24 years, and only a handful (18.3%) had a tertiary qualification. The majority were single (89.0%) and unemployed participants accounted for 54.0% of the total sample. This study found that women who had talked about condoms with their partner/s in the past 12 months were more likely (p=< 0.0001) to have used condoms during their last sexual intercourse. Older women (aged 35-49 years) were more likely (p=0.035) to have used a condom during their last sexual encounter, compared to their younger counterparts. However, women who were exposed to physical partner violence (hitting and/or slapping), those who had been diagnosed with HIV and those whose sexual partners were diagnosed with HIV, did not show a significant association with condom use at last sex. This study showed a high proportion (84.1%) of women using contraception in the sample. This study further indicated that women with a secondary level of education (p=0.053) or a tertiary level of education (p=0.040), were more likely to use contraceptive methods compared to women with a lower education status. Older women aged 25-49 years who experienced pregnancy, whether planned (p=0.038) or unplanned (p=0.001), were more likely to use a contraceptive method. Furthermore, more than a third of healthcare providers (37.1%) were unsure whether modern contraceptives cause users to become promiscuous, and more than half (57%) had negative attitudes toward adolescent girls exploring contraceptive methods. Poor working conditions, long queues, and contraceptive stock-outs were cited by health care providers as deterrents to providing quality sexual behaviour counselling and modern contraceptive education to users. The qualitative study found that women were concerned about unpleasant contraceptive side effects such as prolonged or irregular menstrual periods, bleeding, weight gain, and/or severe pains. Some women stopped using their preferred contraceptive method or opted for a different contraceptive method due to undesirable side effects and/or contraceptive stock outs. Women also raised concerns that they were not adequately counselled or informed on the use or potential negative effects of various contraceptive methods available at health care facilities. Furthermore, perceived negative attitudes towards young women by health care providers, long waiting times and concerns over contraceptive efficacy, contributed to reduced contraceptive uptake. Conclusion This study adds to our knowledge of women's concerns and issues related to contraception access and use in Umlazi Township, KwaZulu-Natal. This study found that numerous factors influence contraceptive use and sexual behaviour. The amount to which women engage in unprotected sexual activities highlights the urgent need for a comprehensive, integrative, and adaptive educational approach to altering women's sexual behaviours. It is vital to make concerted educational efforts to eliminate existing hurdles that prevent young women from using contraception. Family planning strategies tailored to the needs of different groups of women should be targeted, including prioritising education opportunities, given the many benefits associated with these. The availability of comprehensive counselling services to support women who are experiencing short-term side effects is critical in order to ensure that they are able to cope with side effects or switch to a different method rather than completely discontinuing contraceptive use in order to avoid unintended pregnancy.