Determinants of Family Planning Services Uptake among First-Time Parents in Uganda

Women who have given birth twice within two years make up 19% of the population, of whom 69% have an unmet contraception need. The high level of unmet need is accelerated by limited access to family planning services, inadequate family planning counseling, and lack of youth-friendly family planning services. Despite the high knowledge and awareness of modern contraceptive methods (90%), utilization remains low, in part due to low levels of education, lack of knowledge of the side effects of different contraceptive methods, identity, and prohibitive cultural, social, and religious norms. The USAID CDCS targeted to increase access and use of FP to low parity women including first-time parents. Research and observations over the past several years have pointed to the limited uptake of family planning services among first-time parents in Uganda as a challenge. Although there have been some successes in institutional capacity and service delivery improvement at the health facility level, many first-time parents are not using family planning services. The USAID SITES project conducted a study to investigate the individual and contextual socio-cultural, socio-economic, and environmental determinants of family planning services uptake among first-time parents as well as the barriers, gaps, and missed opportunities within the U.S. Government partner-supported implementing mechanisms of RHITES-N Acholi, RHITES-E, RHITES EC, RHITES-N Lango, and RHITES SW. The study utilized inductive and deductive approaches, making use of both quantitative and qualitative study methods. Quantitative data were collected from 906 first-time parents (91% female) using a questionnaire, while 591 men and women were interviewed using a focus group discussion guide. Overall, the median age was 22 (IQR 19-24) years, with 76% of participants less than 25 years old. At the regional level, RHITES SW had relatively older parents with 53% less than 25 years old. Overall, 84% of respondents reported having ever used family planning, with RHITES-N Acholi at 100%. The highest number of non-users was registered among participants 15-19 years old (24%). Across the RHITES regions, study findings revealed that the most sought-after family planning method was injectable at 62%, with 86% in RHITES-N Lango and 76% in RHITES-E, and the lowest rate was in RHITES-SW at 46%. The decision to use a family planning method was strongly influenced by the desire not to get pregnant and to ensure the spacing of children. The overall usage of a family planning method was 54%, ranging between 47% (RHITES EC) and 62% (RHITES SW). In cases where the male partner was supportive of family planning services uptake, the wife used a family planning method. This category of male partners escorted their wives to the health facility or provided money for transport. In some instances, the male partner participated in deciding which family planning method to use. The study findings highlight the importance of male partner support in increasing the uptake of family planning services among first-time parents. The study also identified several barriers to family planning services uptake among first-time parents, including lack of knowledge about family planning methods, fear of side effects, and cultural and social norms that discourage the use of family planning services. Additionally, the study found that health facility factors, such as long waiting times and inadequate counseling, also contributed to the low uptake of family planning services among first-time parents. The study's findings have important implications for the design and implementation of family planning programs in Uganda, highlighting the need for targeted interventions to address the specific needs and barriers faced by first-time parents.