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. 2017 Oct 17;14(1):129.
doi: 10.1186/s12978-017-0392-4.

Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents

Emily Dansereau  1 , Alexandra Schaefer  2 , Bernardo Hernández  2 , Jennifer Nelson  3 , Erin Palmisano  2 , Diego Ríos-Zertuche  3 , Alex Woldeab  2 , Maria Paola Zúñiga  3 , Emma Margarita Iriarte  3 , Ali H Mokdad  2 , Charbel El Bcheraoui  2
Affiliations

Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents

Emily Dansereau et al. Reprod Health. .

Abstract
in English, Spanish

Background: In the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method. A qualitative study was needed to design effective and culturally appropriate interventions.

Methods: We used purposive maximum-variation sampling to select eight municipalities with a high proportion of residents in the poorest wealth quintile, including urban, rural, indigenous, and non-indigenous communities. We conducted 44 focus group discussions with 292 women, adolescent women, and men using semi-structured topic guides. We analyzed the data through recursive abstraction.

Results: There were intergenerational and cultural gaps in the acceptability of family planning, and in some communities family planning use was greatly limited by gender roles and religious objections to contraception. Men strongly influenced family planning choices in many households, but were largely unreached by outreach and education programs due to their work hours. Respondents were aware of many modern methods but often lacked deeper knowledge and held misconceptions about long-term fertility risks posed by some hormonal methods. Acute physical side effects also dissuaded use. The implant was a new and highly acceptable method due to ease of use, low upkeep, and minimal side effects; however, it was perceived as subject to stock-outs. Adolescent women reported being refused services at health facilities and requested more reproductive health information from their parents and schools. Mass and social media are growing sources of reproductive health information.

Conclusions: Our study identifies a number of barriers to family planning that have yet to be adequately addressed by existing programs in Chiapas' poorest regions, and calls for reinvigorated efforts to provide effective, acceptable, and culturally appropriate interventions for these communities.

Antecedentes: En las regiones más pobres de Chiapas, México, el 50,2% de las mujeres que necesitan anticonceptivos no utilizan ningún método moderno de planificación familiar. Ante esto, este estudio cualitativo busca generar información para diseñar intervenciones eficaces y culturalmente apropiadas.

Metodología: Se utilizó un muestreo intencionado de máxima variación para seleccionar ocho municipios con una alta proporción de residentes en el quintil más pobre de la población, incluyendo comunidades urbanas, rurales, indígenas, y no indígenas. Se realizaron 44 grupos focales con 292 mujeres, adolescentes y hombres utilizando guías temáticas semi-estructuradas. Se analizaron los datos mediante abstracción recursiva.

Resultados: Hubo brechas intergeneracionales y culturales en la aceptación de la planificación familiar, y en algunas comunidades el uso de la planificación familiar estuvo fuertemente limitado por los roles de género y las objeciones religiosas a la anticoncepción. Los hombres influyeron fuertemente en las decisiones de planificación familiar en muchos hogares, pero en gran medida no asistieron a sesiones educativas por conflicto con sus horarios de trabajo. Los entrevistados conocían muchos métodos modernos, pero a menudo carecían de conocimientos más profundos y tenían ideas erróneas sobre los riesgos a largo plazo en la fertilidad relacionados a algunos métodos hormonales. Los efectos secundarios agudos también desalentaron el uso de métodos hormonales. Los implantes fueron identificados como un método nuevo y altamente aceptado debido a la facilidad de uso, bajo mantenimiento, y mínimos efectos secundarios; aunque existía la percepción de que estaban sujetos a desabasto. Las adolescentes informaron haber sido rechazadas de los servicios de salud y solicitaron más información sobre salud reproductiva de sus padres y escuelas. Los medios masivos y las redes sociales son fuentes crecientes de información sobre salud reproductiva.

Conclusiones: Nuestro estudio identifica una serie de obstáculos que aún no han sido abordados adecuadamente por los programas de planificación familiar existentes en las regiones más pobres de Chiapas, y subraya la necesidad de reforzar esfuerzos para proporcionar intervenciones eficaces, aceptables, y culturalmente apropiadas para estas comunidades.

Keywords: Chiapas; Contraception; Family planning; Mexico; Qualitative.

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Conflict of interest statement

Ethics approval and consent to participate

This study was determined to not meet the definition of “research,” and was therefore exempted from receiving Institutional Review Board (IRB) approval by the IRB at the University of Washington and partnering data collection agency, El Colegio de la Frontera Sur. Informed consent was obtained verbally from all focus group participants. In order to avoid collecting participants’ names and other identifying information, there was no written consent process.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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