essay on Barriers to effective family planning in Fiji.
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Answer:
The key barriers to the use of family planning included concerns about side effects of contraceptives, lack of knowledge about contraceptive methods, myths and misconceptions including fear of infertility, structural barriers such as staffing shortages at HIV clinics, and a lack of male focus in family planning methods ...
Answer:
This study explored barriers to and facilitators of using family planning services among HIV-positive men in Nyanza Province, Kenya. From May to June 2010, in-depth interviews were conducted with 30 men receiving care at 15 HIV clinics. The key barriers to the use of family planning included concerns about side effects of contraceptives, lack of knowledge about contraceptive methods, myths and misconceptions including fear of infertility, structural barriers such as staffing shortages at HIV clinics, and a lack of male focus in family planning methods and service delivery. The integration of family planning into HIV clinics including family planning counseling and education was cited as an important strategy to improve family planning receptivity among men. Integrating family planning into HIV services is a promising strategy to facilitate male involvement in family planning. Integration needs to be rigorously evaluated in order to measure its impact on unmet need for contraception among HIV-positive women and their partners and assure that it is implemented in a manner that engages both men and women.
1. Introduction
Many studies have demonstrated the diversity and complexity of reproductive intentions among people living with HIV in sub-Saharan Africa, which are influenced by personal, health-related, sociocultural, socioeconomic, and gendered factors [1–6]. Often HIV infection changes but does not eliminate fertility desires [1]. Some HIV-positive individuals believe that having children gives them reasons to live [1, 7, 8], and some bear children to avoid raising suspicions of HIV infection [8, 9]. Still others want to replace children who have died due to HIV [1, 8, 10]. However, many HIV-positive individuals want to avoid pregnancy due to financial reasons and being satisfied with the number of children they have [6]. Other deterrents to having children include fears of orphaning a child, of vertical transmission of HIV, and of infecting a negative partner during conception [1, 6, 7]. Several studies have shown that fertility desires differ by gender, that one partner’s fertility intentions can impact the other’s, and that men and women are influenced differently by community opinions regarding HIV and reproduction [1, 5, 8, 11, 12].
Unmet need for contraception and unintended pregnancy are prevalent among HIV-positive women and couples in sub-Saharan Africa [13, 14]. Based on evidence of cost-savings and demonstrated effectiveness of contraception in averting HIV-positive births [15, 16], the World Health Organization/United Nations Population Fund Glion Call to Action emphasizes family planning as one of four critical elements of a comprehensive prevention of mother-to-child transmission (PMTCT) of HIV strategy [17]. Integrating family planning into HIV care and treatment is being promoted by international public health agencies, local organizations, and some governments, including the government of Kenya, to ensure that HIV-positive individuals have access to comprehensive contraceptive counseling and services [18].
Traditionally, family planning programs have been directed towards women, since it is women who become pregnant and the majority of family planning methods are used by women. Moreover, women are more frequently in contact with the health care system because of their overall responsibility for family health, especially for the health of infants and children under five years of age. However, men are key decision-makers around use of contraceptives [6], and studies have shown that men usually want to be involved in reproductive decision-making [6, 19]. It has been shown that when men are involved in family planning, there are improvements in uptake of contraception [20]. Furthermore, reproductive health programs that target couples have been shown to be more effective at increasing contraceptive use than those directed to individuals [19, 21]. The move toward integrating family planning services into HIV care and treatment may offer an opportunity to engage with men and their partners to increase contraceptive uptake. Despite the growing body of literature about the complex reproductive desires of people living with HIV [8], there exist few in-depth studies about patient perspectives of integration of family planning and HIV services and even fewer focused solely on HIV-positiv