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Background: Intrauterine devices (IUDs) are one of the long-acting, safe and effective methods of contraception in women across the world. However, this method is underutilised in many countries, including Ethiopia. Several quantitative studies have been used to address this problem and generated a list of factors associated with this problem. However, this list lacks detailed and local contexts that are necessary to inform local solutions. The current study uses a qualitative method to explore determinants of IUDs underutilization among short term modern contraceptive users from the maternal health services in the study setting. The use of a qualitative study design is necessary to obtain and rich contextual details that can inform the development of locally appropriate strategies to increase the IUDs uptake in the study area and improve women’s reproductive health outcomes. Method: A qualitative study was conducted in Hossana town public health facilities, Southern Ethiopia from November 1–30, 2019. A total of thirteen in-depth interviews were conducted including with: 11 short term contraceptive users, one health centre head and one health extension worker. The interview guide comprised semi-structured questions. Interviews were audio recorded, transcribed and collected data analysed thematically. Result: The main key determinants of IUDs service underutilisation were identified from participants’ narratives, including: (1) poor knowledge about the benefits of IUDs, (2) insufficient counselling and ineffective delivery of health information to aid women in decision making, (3) the absence of trained health personals, and shortage of supplies. Conclusion: Results indicate that the poor utilisation of IUDs services is determined by both the service provider and the consumer related factors. Poor knowledge of short term users of contraception is a critical factor because without knowledge, clients may not use the available services effectively. The shortage of necessary supplies, poor provider–client relationships, and poor counselling by service providers are also service factors that act as barriers to uptake of IUDs. Efforts should be made to increase IUDs utilization by focusing on educating women about the importance of IUDs, improving counselling of mothers and strengthening the health systems, including allocating more resources to increase access to IUDs among the service users.
The study was conducted in Hossana town, the capital of Hadiya Zone, located 235 km far from Addis Ababa, the capital city of Ethiopia, and 194 km far from the regional city, Hawassa. According to the 2015/2016 Hossana town report, the town had a total population of 100,501, of which 50.73% were males and 49.27% were females. This study setting was purposively selected in consultation with regional health bureaus based on the low utilization of IUD as the main criteria. Between 1st and 30th November 2019, a qualitative inquiry using in-depth interviews was conducted with 13 participants. These comprised: 11 short term modern contraceptive service users from three health centers and two key informant Interviewees (KIIs) one of whom was the head of the health center and another, the urban health extension worker. These health centres have the similar characteristics including socio-demographic, sociocultural and low utilization of IUDs. The purposively selected short term contraceptive users were interviewed in the health center during their visits for short term family planning methods. Interviewees were invited from this set of participants until the saturation was reached including when there were no new ideas generated. The two key informants were selected based on their role in family planning service provision in the maternal health service program in Hossana town. The semi structured open ended interview collection guide was developed after defining the research objectives and reviewing relevant literatures. The tool was first developed in English then translated into a local language, Amharic. A pre-testing of the tool was carried out in Fonko health centre and Balesa health centre which are services outside of the study setting, Hossana town. Interviews were tape recorded and field notes taken. Interviews were conducted by the principal investigator (DW) and a trained data collector who was familiar with the qualitative data collection method and family planning services. The interviews lasted an average of 45 min and were held in a free room near the family planning departments. The key informants were interviewed in their offices as these were quiet and private. Data were transcribed verbatim and translated into English language. The two researchers (DW and AA who speak both English and Amharic fluently) critically read and reviewed all the transcripts for accuracy and completeness and analysed the data using a thematic analysis (TA) method for identifying and analysing patterns of meaning in qualitative dataset [31]. For the TA, an initial coding structure was developed through open coding method. In order to ensure the relevance and appropriateness of the coding structure, one coder (AA) conducted open coding of emergent themes associated with the study objectives. The second coder (DW) independently coded the same transcripts. Finally, the two coders reviewed the coded transcripts to reach consensus on coding structure and consistent code definitions which was used to code all transcripts and in organising themes and sub-themes, supported with key quotes and narrations. To ensure the quality of the data, data collectors were recruited from study communities and were trained. The appropriateness and relevance of the guides were ensured through expert reviews and pre-testing. To enhance inter-coder reliability, the researchers independently applied the code guide to a selected transcript, and then reviewed and resolved any differences. Reports of quotations for selected codes were generated and the researchers prepared content summaries of thematic findings. The Ethics approval was obtained from Wachemo University College of Medicine and Health Science institutional Review Board, and the research was conducted in accordance with the ethical principles. Permissions were obtained from relevant offices. Informed Written consent was obtained from all participants after explaining the study purpose and data collection procedures. All participants were anonymised for privacy purposes.
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