Women’s Perspectives on Menstrual Bleeding Side Effects of and Partner Opposition to Contraception and the Influence of These Factors on Contraceptive Use

Family planning has a notable impact on health, economic, social, and environmental outcomes, and it is key to the success of global development efforts; however, there are 214 million women in developing countries who wish to delay or limit childbearing but are not using a modern method of contraception. This dissertation research explored two under-studied contributors to unmet need for family planning—contraceptive-induced menstrual bleeding changes and partner opposition to contraception—in East and West Africa. I used data from nationally-representative household surveys and focus group discussions with women in Burkina Faso and Uganda to examine contraceptive-induced menstrual bleeding changes. In Burkina Faso, the predicted probability of women’s willingness to use a method that causes amenorrhea was higher for younger women, women living in rural areas, married women, current contraceptive users, and women from Mossi households compared to Gourmantche households. In Uganda, less wealthy women had a higher predicted probability of accepting amenorrhea. Qualitative analysis revealed a variety of reasons for women’s attitudes about amenorrhea and some differences by country; however, the relationship between these attitudes and contraceptive decision-making was similar in both countries. I examined the impact of partner opposition on current nonuse, past discontinuation, future nonuse, and discreet use without partner knowledge in 12 countries in East and West Africa using Demographic and Health Survey data. Discreet users and current nonusers were the most common types of women experiencing partner opposition. Future nonuse was notable in some countries in West Africa. Partner opposition was most consistently related to women’s position in their reproductive life course and partner’s higher fertility intentions. Women with higher socioeconomic status tended to have a lower risk of nonuse relative to discreet use when faced with partner opposition. By focusing on the perspectives of women, these findings can inform efforts to address unmet need for family planning via programs and interventions seeking to improve perceptions of current contraceptive methods, the development of new user-designed contraceptive methods, and improved practice guidelines for providers on family planning counseling. These efforts can help ensure the contraceptive needs of women and couples are met throughout their reproductive lifespans.Doctor of Philosoph