School-wide publications

Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/169

Browse

Filter results by typing the first few letters
Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    “Choosing Peace” or “Living in Fear”: Relational Mechanisms of Family Planning Non-Use Among Married Women in Bo City, Sierra Leone
    (2026-09-21) Blango, Victoria Nancy
    BACKGROUND: Despite near-universal awareness of family planning in Bo City, Sierra Leone, unmet need remains high among married women. Relational mechanisms influence reproductive health decisions in many African countries, yet little qualitative research has examined the specific relational barriers and facilitators to family planning among married women in Sierra Leone. METHODS: This qualitative study used in-depth interviews with married women (n=15), male partners (n=3), and community leaders (n=2), and focus group discussions with married women (n=2 groups), male partners (n=1 group), community leaders (n=1 group), and healthcare providers (n=1 group). Data were collected between February 24-28, 2025, and analysed using thematic analysis within a relational autonomy framework, following COREQ guidelines. RESULTS: Six relational mechanisms were identified. Partner alignment enables use through spousal cooperation, often triggered by economic pressures. The male veto blocks use through terminal spousal opposition at individual, interpersonal, and community levels. Women navigate these constraints through two distinct strategies: adaptive preferences, reframing non-use as voluntary choice to preserve household harmony (“choosing peace”), and covert practice - secret injectable use with persistent anxiety (“living in fear”). Religious interpretive variation shapes whether faith supports or opposes use. Extended family and polygamous dynamics create surveillance and fertility competition that constrain autonomy. Economic independence emerged as a cross-cutting enabling pathway. CONCLUSION: Reproductive health decisions are fundamentally relational. Providers should routinely screen for spousal opposition, develop confidentiality protocols for covert users, and offer couple-based counselling addressing shared economic concerns. Training providers to identify and respond to relational barriers is a practical strategy for reducing unmet need where family planning knowledge does not translate into practice.