Contraceptive use and decision-making in Guéra, Chad: a mixed-methods study

Area of Science:

• Reproductive Health
• Maternal Health
• Public Health

Background:

• Chad faces a high maternal mortality ratio and low modern contraceptive prevalence.
• Understanding barriers to contraceptive use is critical for reducing unmet need and maternal mortality.

Purpose of the Study:

• To investigate barriers and influences on women's decision-making regarding modern contraceptive use in Chad.
• To inform strategies for reducing unmet contraceptive need and improving maternal health outcomes.

Main Methods:

• A mixed-methods study was conducted in Guéra province, Chad.
• Included a longitudinal survey of women, focus group discussions, and in-depth interviews with healthcare providers and community leaders.

Main Results:

• Participant knowledge of modern contraceptive methods increased, with endline use at 20.5%.
• Key barriers included religious beliefs, community stigma, misconceptions (especially about long-acting reversible contraceptives), and spousal influence.
• Husbands significantly influenced contraceptive decision-making, acting as facilitators or barriers.

Conclusions:

• Increased awareness and contraceptive use were observed, exceeding the provincial rate.
• Community-based distribution of self-injectable contraceptives (DMPA-SC) should be explored.
• Tailored stigma reduction interventions and provider training are needed to promote equitable contraceptive service provision.