Barriers to contraceptive use among people living with diabetes and/or hypertension: a qualitative study

Background:

Pregnancy in individuals with diabetes and/or hypertension, especially when undiagnosed, untreated, or uncontrolled, can result in severe consequences, including maternal and child mortality. Contraception is crucial for the management of pregnancy in individuals with diabetes and/or hypertension. However, the decision-making and experiences related to contraception use among this population in low- and middle-income countries are poorly understood. This study aims to explore the barriers to contraception use among sexually active men and women living with diabetes and/or hypertension.

Methods:

We conducted a qualitative study using the empirical phenomenological approach. We interviewed participants diagnosed with diabetes and/or hypertension, as well as stakeholders involved in providing care to individuals living with at least one of these two conditions and family planning service providers. Semi-structured interview guides were used, and data were collected through four focus group discussions, four in-depth interviews, and ten key informant interviews. All interviews were transcribed and analysed thematically.

Results:

People living with diabetes and/or hypertension encounter misunderstandings and various barriers when it comes to using contraception. These experiences were categorised into four main themes and nine sub-themes. The themes identified were: (i) lack of awareness/inadequate knowledge and misunderstanding, (ii) social and religious beliefs, (iii) barriers to available and affordable contraceptives, and (iv) lack of coordination between facilities providing family planning services and treatment and management for diabetes and/or hypertension.

Conclusion:

Findings provide a comprehensive understanding of the complexities and considerations involved in contraceptive use-related decision-making among individuals with diabetes and/or hypertension. These findings can be used in policymaking and programme development to promote contraceptive use and improve the reproductive health outcomes of this population.