User perspectives on the barriers and facilitators to the uptake of contraceptives in East Africa: a qualitative synthesis of evidence

Despite the established health benefits of contraceptive use conferred both to the mother and child, low contraceptive uptake and high unmet need for contraception remain significant in East Africa.To systematically synthesise qualitative evidence on the barriers and facilitators to contraceptive uptake in East Africa and develop lines of action from synthesised findings. A systematic review was conducted with relevant literature obtained from four databases (PubMed, CINHAL, Scopus, EMBASE). Results were meta-aggregated and developed into synthesised findings. 10 studies met the review inclusion criteria. Major barriers identified across the studies include myths and misconceptions leading to a fear of using contraceptives, financial costs, the role of gender norms and power dynamics, health service barriers and external influences that limit contraceptive uptake. Couple communication, awareness of costs associated with large families and certain religious denominations were seen to facilitate the use of contraception. In order to meet contraceptive needs in East Africa, policy reforms need to take place, integrating gender equality in to family planning policies as well as engaging local leaders in policy reforms. Social and behaviour change strategies are pivotal in family planning programmes to demystify existing myths and misconceptions. Community level engagement of local leaders can aid in altering cultural and societal practices undermining the uptake of contraceptives.