Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey

Abstract

ObjectiveIn the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP.DesignLongitudinal study.SettingA community-based approach was used to investigate FP use in the North and South-Kivu regions.ParticipantsOverall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up.Primary and secondary outcomesFP use and intention to use FP.ResultsThe mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective normswere negatively and significantly associated with intention to use FP (β=−0.572; p=0.003) whileperceived controlwas positively associated with intention to use FP (β=0.578; p<0.0001). Education andperceived controlwere positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), whileIntention to use FPwas positively and marginally significantly associated with the use of FP (β=0.583; p=0.052).ConclusionTPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.