Awareness, attitudes and practices regarding contraceptive use among young women working in the informal sector in Kampala, Uganda
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Introduction: As the world’s population of 15-24-year-old young women grows beyond 600 million, countries need to address the increasing demand for modern contraception services and information that address their specific needs. However, although research on awareness, attitudes and practices among young women has been previously done, previous studies have focused on rural/urban married women, women in slums areas and female students but not on women working in the informal sector. Women in the informal sector may have special needs and barriers to access to information and services given that most of them are not well educated. Objective: The overall objective of this study was to assess the awareness, attitude and practice regarding contraceptives use among young women aged 15-24 years working in the informal sector in Kampala to generate information that can be useful in developing targeted interventions to utilization of modern contraception among young women aged 15-24 years working in the informal sector. Methods: Cross-sectional, mixed-method study was conducted among 343 young women aged 15-24 years working in the department of food handling and selling fresh fruits and vegetables in St Balikuddembe market in Kampala, Uganda. Quantitative data were collected on awareness, attitude, and practice regarding contraception use. Awareness of contraceptive methods was assessed by asking young women if they have ever heard about different contraceptives, while attitudes were measured using a five-point Likert scale for respondents to show their level of agreement or disagreement to statements about benefits of contraception. Finally, young women were asked if they were by then using any FP methods in order to document their contraceptive practices. On the other hand, qualitative data were collected among seven key informants on how best contraceptive use can be used improved among young women aged 15-24 years working in the informal sector in Kampala using a key informant interview guide. The seven key informants included the Public Health Officer (PHO) at St. Balikuddembe market, women leaders, VHT members and maternal and Child health staff at a private clinic near the market. Data analysis Quantitative data were entered into a computerized database using EpiData 3.0 and it was exported to Stata 13 where it was cleaned and analyzed. Data were also analyzed using univariate analysis. At the univariate level, the proportion of young women who have ever heard of and those who currently use contraception was determined. Qualitative data were analyzed manually following a thematic framework approach. Results: Of the 343 respondents, 32% (n=109) of the respondents were aged 15-19 years while 68% (n=234) were aged 20-24 years. Fifty-six per cent (192/343) of the respondents were in the department of food handling while 44% (151/343) were in the department of fresh fruit and vegetable selling. The highest level of education attained by most respondents was secondary level (53.6%, n=184). Slightly more than half of the respondents (51.6%, n=177) had no biological children while 52.7% (n=181) never married. Overall, (98%, n=336) were aware of any method of contraception; of these (97.3%, n=327) were aware of any modern methods of contraception while (99.1%, n=333) were aware of any traditional methods. Awareness of modern methods was highest for male condoms (91.0%, n=312), injectable (88.0%, n=302) and pills (86.3%, n=296). With regard to attitudes, we found that most respondents (54.5%, n=187) had a negative attitude towards use of any form of contraception while 45.6% (n=156) had a positive attitude towards use of any modern contraceptive methods. Sixty-six percent (n=227) believed that the negative effects outweigh the positive effects (benefits) of using contraceptives. Ninety-six per cent (n=328) of the young women reported that they had ever used any contraception; (60.3 %, n=207) had ever used any modern contraception and (76.6%, n=263) had ever used any traditional methods. Only 58.6% (n=201) reported that they were currently using any form of contraception, 35.3% (n=121) were currently using modern contraception and 40.2% (n=138) were currently using traditional methods of contraception. Forty-two per cent (n=86) of those who had ever used modern contraceptives stopped using them. The most common reasons given by respondents who stopped using contraceptives included, they are inconvenient to use (73.3%, n=99) and respondents themselves opposed use of contraception (64.0%, n=87). Current use of modern contraceptive methods was significantly higher among women aged 20-24 years compared to those aged 15-19 years (69.2% vs. 37.6%, P<0.0001). When asked how best contraceptive use can be improved among young women aged 15-24 years, respondents suggested five best ways this could be done, including: a) sensitisation of young women on benefits of contraceptive use; b) regular motivation of contraceptive service providers through giving them logistics; c) preferred contraceptive methods should be available at their sources of the contraceptive methods throughout the year; d) fear to use family planning methods should be addressed; and e) comfort at their sources of contraceptive methods should be improved. Conclusion: Most young women aged 15-24 years working in the informal sector were well aware of contraception. over but both modern and traditional contraceptive methods are still underused by the young women working in the informal sector. Despite the fact that many respondents, (97.3%, n=327) were aware of any modern method of contraception, their attitudes towards contraceptive use were poor and their contraceptive practice was low. Most respondents (54.5%, n=187) had a negative attitude towards any form of contraception and only 35.3%, n=121 were currently using any modern methods. Sensitization of young women aged 15-24 years working in the informal sector on benefits of using contraceptive methods to improve their attitude towards contraceptive use may be an important measure towards better use. In addition, young women ages 15-24 years working in the informal sector who don’t wish to have any more children, should be encouraged to consider long term methods like male and female sterilization.