Why do women abandon a contraceptive method? Designing a Qualitative Study
The puzzle:-
“Why do women abandon a contraceptive method in spite of the
fact that they do not want to conceive?”
Literature review:-
According to FP 2020 Population Council (2005), one third of
contraceptive users abandon the method in the first year and one half of the
users in the second year. Tolley et al
(2005) says that 45% of women do not get counseled prior to using a
contraceptive method and 40% are partially counseled. So it is very important
to investigate the reasons for this.
Reflexivity about the topic (Finlay, 2002):-
Knowing where I stand at the beginning:-
I am related to this topic of research, as I practice reproductive health and each day I come across women who discontinue a contraceptive method despite of the fact that they need it the most. This is very puzzling. I think that the counseling techniques need to be improved; I believe that a good counselor generates more contraceptive clients and about my potential research participants I feel that they only need reassurance along with the management of side effects to continue using a contraceptive method.
Considering where my interview questions come from:-
If I consider the side effects of contraceptives as the only reason women are abandoning them, then the questions will have a narrow base. My participants might have other reasons for abandoning a contraceptive i.e. the attitude of the service provider, side effects not being managed effectively, ineffective counseling techniques, non involvement of the male partner etc..
Self awareness in the
moment of generating data:-
I will focus on elaborating the information that the participant is providing rather than expressing my own views at the time of the interview. I will move back and forth experiencing the interview and reflecting on my own thoughts, to find out are how they related.
Reflecting after the
data generation interaction:-
Building rapport is the first and very important step in conducting an interview. I will reflect on what the response of the participant was and what I asked or said. I will also record my response to the participant. I will comment on my influence on the participant whether negative, positive or neutral (power dynamics).
Keeping track of
initial ideas and directions in analysis:-
After generating the data, I will record my initial responses i.e. was it expected, unexpected, giving rise to a new dimension. My personal background influencing my response will be that I am practicing in the field of the research topic, so I will take certain things for granted e.g. changes in the menstrual bleeding patterns, as compared to a researcher totally stranger to the topic.
Continue to be transparent about
decisions in analysis:-
I will be a
self critic on how are my ideas developing, based on the literature that I read
during my research. I will also consider alternative interpretations and
developing on new theory (Grounded theory).
Designing my study and the biases I will face!
While designing my study I will follow a flexible approach, but at the same time I will be drawing on a theoretical frame work. The theoretical framework that I think best suits my research is the ‘risk and health belief model’ (Willis et al, 2007). The study that I intend to design will be a longitudinal study, involving women who discontinue family planning methods. The research tool will be an in depth interview with the client. I will follow an interpretivist approach to view this aspect of the social world i.e. seeing the world through the eyes of my research participants (Avis, 2005).
I myself am a service provider in reproductive health; hence I may be biased about women discontinuing a method, who get services at the service outlet where I work. So, to avoid this I do not intend to include my service outlet in this study.
The research question:-
“What is the role of the service provider in dealing with women who are practicing family planning methods?”
Sub questions:-
“How contraceptives
affect the social life of women using them?”
“What are the
expectations of women from a contraceptive method they choose?”
“How counseling
regarding the side effects of a contraceptive method effect the decision of a
woman to continue using them?”
The data generation methods:-
I will use an “in depth interview” for data generation. The reason for choosing it is not only the privacy that is required but also the subjective space it provides for the participant to express her views about the contraceptives and the quality of the service being provided.
I will analyze the data by developing codes from the interviews. I will follow a flexible plan of enquiry, generating and analyzing the data simultaneously according to the experiences of the participants.
Recruitment of participants:-
My sample for the research participants will be from two family welfare centers in public sector and two in private sector in district Nowshera. The criteria for inclusion will be women of reproductive age i.e. 18yrs to 45yrs who have stopped using a contraceptive method from June 2014 to July 2015 and they did not want to conceive.
The women will be recruited for the interview by the family welfare assistant (acting as a gate keeper in the research) as a routine visit to their houses.
The Interview:-
I will interview the participants at their residence to attain methodological naturalism, taking an appointment in advance and ensuring my security. I will get an informed consent from all the participants, regarding what the interview is all about, while recruiting them. I will ensure them that it is all right not to answer a question which they do not want to answer.
The information provided and their identity will be confidential. I will get permission from the committee of ethics before conducting the interview. If some of the women did not want to be part of the interview, I will mention it in my study that how many of them did not take part and if possible, what were the reasons.
References:-
Avis, M. (2005), “Is
there an Epistemology for Qualitative Research?” .In Holloway, I
(ed).Qualitative Research in Health Care. Maidenhead: Open University Press
http://discovered.ed.ac.uk/44UOE_VU1:default_scope:44UOE_ALMA51137413870002466
“Contraceptive Discontinuation: Reason,
Challenges and Solution.”Dec. 08,
2005. FP 2020. Population Council Publications. www.familyplanning2020.org/resources/12019
Elizabeth Tolley, Sarah Loza, Laila Kafafi, Stirling
Cummings (2005), “The impact of menstrual
side effects on contraceptive discontinuation: Findings from a longitudinal
study in Cairo, Egypt”. International Perspectives on Sexual and
Reproductive health, Vol. 31. Issue 1, March 2005. https://www.guttmacher.org/about/journals/ipsrh/2005/03/impact-menstrual-side-effects-contraceptive-discontinuation-findings
Finlay L. (2002), “Outing the researcher: the provenance,
process and practice of reflexivity”. Qualitative Health Research 12(4): 531-545.
Willis K. (2007), “The essential role of social theory in
qualitative public health research.” Aust N Z
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