Table 1

Barriers to uptake of family planning that may be addressed by educational seminar

Barrier identified in focus group dataRelevant studies from other regions in AfricaGoals for educational seminarPost-seminar results
Intrapersonal influences
Poor medical understanding about FP limits its uptake, particularly for menIn Uganda, limited knowledge about FP is a key determinant of men’s negative perception of and lack of engagement in FP21
  • Provide correct, simple medical explanations of the menstrual cycle and FP methods

  • Specifically increase men’s limited knowledge

  • Seminar attendees gained knowledge about FP

“That seminar educated us [about] what isn’t true, and that FP means spacing that would enable you to have healthier children.” [Male church leader]
“We were just giving birth to children using local FP methods. Some were inserted with some sticks and some drunk mixed ashes after having sex, we thought can prevent pregnancy, some continued to get pregnant even after using those local methods … However, after that seminar I realised that the best method is to use modern contraceptives … such as pills, loop and so on … I realised that it is better to plan the family using modern methods.” [Female church leader]
Myths and fears about side effects and harms are prevalentIn Uganda and Tanzania, misconceptions and fears about FP are major obstacles to its use for both women and men22–24
  • Explain side effects, address common myths, and provide medical facts

  • Seminar attendees understood myths and misconceptions surrounding FP to be untrue.

“In the past, I thought that if I use FP, I would deliver some disabled children, or a child who has no eyes or ears. After education, I know that FP has none of that. That is why I decided to use FP.” [Female church leader]
Many people perceive that FP is incompatible with religious beliefs
  • Discuss the various historical and religious traditions regarding FP and the Bible, which make different interpretations possible

  • Seminar attendees no longer saw FP as a sin, but rather came to see providing for one’s children as a moral duty.

“I am very happy about this seminar because I had doubt with one thing, I was thinking I will be going against God if I plan my family, but after being educated using biblical verses, I am now free to plan my family, I am asking you to continue teaching.” [Female church leader]
“The Bible hasn’t kept quiet: it says that a person who doesn’t take care of his family is doing something bad, so you are supposed to have the power of taking care of those children you have so that they can have their basic needs.” [Male church leader]
Interpersonal influences
Men are major decision-makers but lack knowledge about FPSeveral studies suggest that increasing male knowledge of FP could increase spousal communication on FP, elevating odds of a couple using FP22 25 26
  • Equip men with knowledge on FP

  • Increase likelihood of discussions about FP between men and women

  • Men had increased knowledge of FP

  • Communication about FP between partners was increased

“In the past, most families were broken because of misunderstanding of FP, but after getting this training, most men have understood about the benefits of FP.” [Male church leader]
“When we heard about FP taught in church, me and my husband went back home and we shared it very well… [using FP] is going well in the family.” [Female church leader]
Family members prioritise having many children and may perceive FP as taboo
  • Normalise discussions of FP within families

  • Seminar attendees shared their new positive perspective of FP with family members

“I have a married daughter, I will teach her [about FP] even in the presence of her husband. This is the best method, their children will have good intervals, they will take good care of them, they will give them good education.” [Female church leader]
Friends and neighbours spread false information about FP
  • Equip religious leaders with correct knowledge about FP

  • Build on influence of neighbours and friends

  • Seminar attendees shared correct information about FP and corrected misinformation

“After the seminar, I was encouraged and happy … I continue educating others that FP is very important. First of all, I would face my neighbour or friend and … educate and encourage her that you are supposed to change, the seminars that are organised and what is being taught should be adhered to for the welfare of our families.” [ Female church leader]
Religious leaders are highly influential and many are not equipped to discuss FPIn a survey in Malawi, use of modern contraception was significantly lower in congregations whose religious leader did not approve its use27
  • Equip religious leaders with knowledge to discuss FP within their communities

  • Leaders talked about FP in their churches

  • Congregations were more receptive of the message from pastors than others

“I would continue to encourage [pastors to preach about FP] because even when we were attending the clinic, [when] the doctors were advising us to use FP, we were ignoring [them] and relied on the Bible that told us to go and replenish the world. So when the doctors were telling us about using FP we thought they are lying to us, but when it was introduced in the church, we found that it is something useful. That is why we continued to encourage other people as well.” [Female church leader]
  • FP, family planning.