Family Planning’s International Programmes presented research about barriers for contraception uptake in Kiribati at the 2016 DevNet Conference this week.

The research, Family Planning in South Tarawa, Kiribati: Usage and Barriers, had identified four key barriers reducing access and use of contraception in Kiribati.

This presentation highlighted how the findings of this research have informed the implementation of the Healthy Families Project.

Here we look at the barriers that exist, and how the Healthy Families Project is addressing them.

FOUR BARRIERS TO ACCESSING AND USING CONTRACEPTION

1. PRIORITISING FAMILY PLANNING

For many people in Kiribati, using family planning to control fertility is not a priority in their lives, and contraception often isn’t used until after having children:

• Many married couples don’t use contraception until after they have had all the children they want.
• Young married couples are expected to have a child very soon after marriage. 85 percent of married couples without children aren’t using any contraception.
• It’s very unlikely for a young person to use contraception the first time they have sex. 

The project addresses this by:

• Working with the Catholic Church to deliver information about natural family planning methods as part of the couples’ preparations for the wedding sacrament.
• Targeting married couples and promoting the importance of delaying or spacing children with contraception.
• Targeting young people to promote using contraception the first time they have sex.

2. PERSONAL, FAMILY AND SOCIAL BARRIERS

Through a community survey in South Tarawa, some of the social barriers to accessing contraception were highlighted:

• Religious opposition was the most commonly mentioned barrier, by both men and women.
• For women, concern about their husbands’ opinion was another significant barrier. Some women were afraid to talk to their husbands about family planning or faced opposition from them – often because family planning is perceived as somehow encouraging unfaithfulness.
• A lack of knowledge about family planning meant women in particular worried about the myths surrounding contraception, and/or about the side-effects. Some women were also not properly advised of possible side-effects. 

The project addresses this by:

• Engaging church leaders in sexual and reproductive health programmes
• Educating men on the benefits of family planning for the health of their families
• Creating promotion materials that address family planning myths
• Ensuring adequate and accurate information is provided about possible side-effects

3. GENERAL AWARENESS

Most people interviewed for the research thought that people in Kiribati were generally aware of family planning, but:

• Didn’t understand how family planning and reproduction actually worked.
• Weren’t aware of what contraception methods exist outside of the one they use.

The project addresses this by:

• Promoting awareness that condoms are a form of contraception and not just for protecting against STIs and HIV.
• Providing free condoms at places like shops, service stations, community centres – wherever the red and yellow “free condoms” sticker is displayed.
• Using ‘edutainment’ like dance or theatre to teach about sexual and reproductive health combined with practical skill-building activities (e.g. condom distributions)

4. SERVICE DELIVERY

The research found that for many people, visiting a clinic wasn’t the preferred way of accessing family planning services. There were concerns about:

• Confidentiality, especially visiting a clinic in a small community where they would likely see people they know. People also worried that staff would not treat their information as confidential or would tell their families.
• Young people (especially men) felt like the services weren’t designed for them and some worried that people judged them for going to the clinic. They wanted family planning services to be available in youth centres so it would be less obvious that they were getting family planning.
• Issues of accessibility, such as having to travel long distances at great cost, or difficulties attending clinics during work hours. 

 The project addresses this by:

• Ensuring that all staff are trained in confidentiality best practice.
• Integrating family planning services into youth-friendly spaces.
• Running home visitation programmes.

The Healthy Families Project in South Tarawa and six outer islands, is run in partnership by Family Planning and the Kiribati Family Health Association (KFHA), with the support of the New Zealand Aid Programme.

Findings from the research report are also being used to help guide the Kiribati Ministry of Health’s strategy for family planning.