Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey

BMJ Open. 2023 Feb 10;13(2):e061564. doi: 10.1136/bmjopen-2022-061564.

Abstract

Objective: In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP.

Design: Longitudinal study.

Setting: A community-based approach was used to investigate FP use in the North and South-Kivu regions.

Participants: Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up.

Primary and secondary outcomes: FP use and intention to use FP.

Results: The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052).

Conclusion: TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.

Keywords: EPIDEMIOLOGY; PUBLIC HEALTH; REPRODUCTIVE MEDICINE; SOCIAL MEDICINE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged, 80 and over
  • Democratic Republic of the Congo
  • Family Planning Services*
  • Female
  • Humans
  • Intention
  • Longitudinal Studies
  • Middle Aged
  • Sex Education
  • Theory of Planned Behavior*
  • Young Adult