This study aimed to assess the factors affecting contraceptive uptake among women attending public health facilities in Dodoma City Council. The study reveals that age was a significant factor affecting FP uptake, whereby the majority of the respondents associated with the uptake of modern contraceptives were in the aged between 25–34 years.
Similar results have been obtained in other studies in Ethiopia, where the results show that contraceptive use is highest among 24-35-year-olds [14]. The reason could be that this age category is usually married and, therefore, likely to get pregnant easily.
The use of DMPA injections was comparatively high at 39.7%, similar to the findings from the Tanzania Demographic Health Survey, which showed that women prefer Depo-Provera to any other modern family plan [10]. This drug is convenient and reliable since it is administered quarterly. Noncompliance is, therefore, likely to be minimal [7]. However, this result is contrary to that in Ghana, where condoms are the most widely used, probably due to the role condoms play in both the prevention of sexually transmitted infections and the control of unintended pregnancies [15].
The main determinants of contraceptive use were level of education, access to health facilities, the influence of social media, and neighbourhood. In this case, education was found to be the main source of information influencing awareness of modern contraceptive use. This is probably because the importance of family planning is relayed in schools, and women can make informed choices. However, this differs from other studies in Ghana, where television was identified as the main source of information influencing awareness on the uptake of modern contraceptives [16].
Reliable income had a positive correlation with the uptake of modern contraceptives. Individuals with higher monthly incomes are more likely to be aware of the need for child spacing so that they can have adequate time to work and, therefore, tend to use family planning more frequently. This finding is consistent with Edo state, Nigeria [17]. Residing close to health facilities was found to increase the use of modern contraceptive methods. The time and costs incurred to reach the facilities were minimal; this finding is consistent with that in Senegal, where people travelling long distances to reach health facilities are less likely to use contraceptives [18].
Most of the respondents were counselled on how to use contraceptives by healthcare providers. This service was found to be significantly associated with the increase in uptake of contraceptives. Counselling enhances interaction with clients and informs them on a broad range of contraceptive method choices. Health care providers trained in Family Planning counselling were found to be more useful to their clients’ satisfaction with using Family Planning methods. Pre-counselling improves the contraceptive uptake rate significantly [19].
The utilization of contraceptives is enhanced when couples are in agreement and support one another. In Ethiopia, women who discuss the issue of modern contraceptives with their husbands and are supported are more likely to use modern contraceptive methods than women who aren’t supported[20]. However, in this study, most respondents did not get support from their partners. Several studies are underscoring the challenge of culture to the uptake of family planning services [21, 22].
The majority of the respondents' traditional beliefs did not support the use of modern contraceptives, believing that they cause harm and the perception of having many kids as a sign of wealth. That explains why most studies point to the desire to have more children as a barrier to family planning. Moreover, in Africa, traditionally, women are considered responsible for increasing family size, and failure to do so attracts negative judgment from society [23].
The reported contraceptives that were often not available included implants, oral contraceptive pills, Copper T, and injectables. Comparatively, in some other sub-Saharan African countries, the proportion of health facilities that report experiencing contraceptive stock-outs in the past six months is estimated to be 50% or more [24]. The main reasons for stock-outs could be improper planning, forecasting, and quantification of contraceptives by less-skilled health workers and non-pharmaceutical personnel. Most providers reported that their health facilities order contraceptive replenishment from the Medical Stores Department through the electronic logistics management information system (e-LMIS).
The level of technology use in the health facilities was low; in most facilities, there was no internet system. This finding is consistent with that of Kenya, where most respondents reported that the level of technology affects the efficiency of medicines availability in their health facility [25]. Furthermore, there were significant health system and policy factors constraints. Health system and policy factors considered were the lack of privacy and confidentiality, limited information they provided to clients at a health facility, the lack of qualified health staff incentives, the lack of family planning standards & guidelines, and the financial implications of a full range of services. This finding is consistent with that of Ethiopia, which shows that the inadequate availability of key resources, such as trained staff, information, education, communication materials and other family planning guidelines and standards in clinics, is a major constraint to the performance of quality family planning services [26].
Strengths, limitations, and future research
Strengths
The study will help policymakers and planners to identify areas on which their programs and policies should focus shortly to improve the uptake of modern contraceptives. For donors and implementing partners, the study will enable them to know where they can support the service providers. The study findings will show the reasons behind the choice and uptake of contraceptives. This may form the basis for coming up with customized mitigation strategies to enhance the uptake
Limitations
There might have been biases of information from the participants; secondly, The study did not focus on private facilities offering modern contraceptive methods, and The study excluded male and female sterilization and the lactation amenorrhea method (LAM) as the modern methods of contraception.
Future Research
This survey was conducted in Dodoma City Council and might not represent the whole country. Therefore, it is recommended that the study be extended to other parts of the country in the future.