Exploring Variations and Decision-making Processes of the Utilization of Modern Contraceptive Methods During Protracted Violence and Political Instability in Rural Haiti

Abstract

Background Haiti's protracted sociopolitical instabilities greatly impact healthcare delivery, leading to low family planning coverage of 35%. Short-term contraceptive methods are predominant, making frequent and expensive visits to healthcare facilities necessary. These instabilities also cause disruptions in healthcare services, potentially resulting in missed follow-ups and unintended pregnancies ultimately. Methodology We investigated family planning utilization trends and decision-making in four Haitian communes during prolonged sociopolitical instabilities through a convergent mixed-method study. Secondary quantitative data on family planning service usage from healthcare facilities were collected, alongside data on major sociopolitical events from online newspapers. Linear regressions were employed to analyze the impact of these events on family planning usage. Qualitative data were gathered from in-depth interviews and focus group discussions across the communes. Then inductive content analysis was performed using Dedoose. Results During the study period, 163,179 women aged 15 to 49 utilized the six most common contraceptive methods across four healthcare facilities. Simultaneously, 188 sociopolitical events were recorded, with 80% being national, 10% local, and 10% regional events. In bivariate analysis, we found a negative correlation between stockout of common contraceptives and family planning service utilization -0.64 (95%CI: -0.79, -0.49), p.001. Strikes reduced family planning utilization -0.63 (95%CI: -2.6, 1.35) but, their effect was not statistically significant, p=0.53. Having more than two trained providers was positively correlated with family planning utilization, 1.99 (95%CI:1.8, 2.0). Surprisingly we found an increase in family planning service utilization during gang clashes 1.94 (95%CI: -0.02, 3.9), police-gang clashes 1.8 (95%CI:0.64, 2.9), and gang violence 1.8 (95%CI:0.68, 2.9). After controlling for confounders, the relationship between health facilities characteristics and family planning service utilization remained statistically significant. Inductive qualitative analysis revealed six main themes representing three barriers: 1) accessing healthcare facilities, 2) family planning side effects, and 3) workforce challenges. Additionally, three facilitators for family planning utilization emerged: 4) integrated services, 5) interpersonal influences, and 6) socio-economic challenges. Conclusion Prolonged sociopolitical events impact family planning access, creating both barriers and opportunities. These events may hinder the movement of people and goods, prompting proactive strategies by healthcare professionals and family planning users. Our recommendations include expanding storage capacity, promoting long-acting contraceptives, and improving community-based distribution. The observed positive correlation between family planning service utilization and sociopolitical instabilities suggests increased demand during crises. This highlights the need for timely provisioning of FP supplies to empower communities to navigate ongoing crises effectively.