RESUMO
Contraceptive use is an important determinant of unintended pregnancy, but little is known about the social and structural factors that determine women's contraceptive use in rural Honduras. In this study, we aim to characterise the individual and social determinants of contraceptive use among women in rural Honduras. In 2011 and 2012, we conducted 14 interviews and 2 focus groups with women 18 years and older. In our analysis, we created a family-planning narrative for each participant and coded transcripts around key emergent themes related to these determinants. We found that social determinants--including poverty, gender dynamics and availability of family-planning methods--had a strong influence on contraceptive use among women in our sample. Study participants stated that they were faced with a difficult economic situation compounded by rising prices of basic goods and diminishing job opportunities. Paradoxically, at the same time that the economic situation led women to seek contraception, it also contributed to the structural barriers that limited their ability to obtain their method of choice and maintain continuous contraceptive use. Our findings suggest the need for multi-level efforts to create an enabling and sustainable environment for family planning among women in rural Honduras.
Assuntos
Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/provisão & distribuição , Acessibilidade aos Serviços de Saúde/tendências , Determinantes Sociais da Saúde , Saúde da Mulher/estatística & dados numéricos , Direitos da Mulher/tendências , Adolescente , Adulto , Anticoncepção/economia , Anticoncepção/métodos , Serviços de Planejamento Familiar/economia , Feminino , Grupos Focais , Acessibilidade aos Serviços de Saúde/economia , Honduras , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pobreza , Gravidez , Gravidez não Planejada , Pesquisa Qualitativa , Saúde da População Rural/economia , Saúde da População Rural/estatística & dados numéricos , Saúde da Mulher/economia , Direitos da Mulher/economia , Adulto JovemRESUMO
Cervical cancer is the leading cause of cancer death for women in Honduras, and sexual behaviour and low screening uptake are two major factors contributing to high rates of morbidity and mortality. A qualitative study was conducted to investigate barriers that prevent rural Honduran women from engaging in screening and ways that women overcome those barriers. This study examined examples of positive deviance, or individuals engaging in the uncommon but beneficial practise of screening. Amor por sí misma (self-love), and social support were identified as two constructs women employed to overcome barriers to screening. Participants defined self-love as the act of displaying care and concern for oneself and one's health and suggested that it compels women to participate in screening. Social support was defined as receiving tangible aid and advice from others that facilitated women's screening participation. Findings suggest that the concept of self-love could be used in future screening promotion efforts and that integrating social support would also be beneficial. Engaging men in sexual and reproductive health programming is suggested in order to ensure male partners offer social support for screening and to challenge the cultural, gender and sexual norms that place women at higher risk for cervical cancer.