Access to public sector family planning services and modern contraceptive methods in South Africa: A qualitative evaluation from community and health care provider perspectives

PLOS ONE RESEARCH ARTICLE Access to public sector family planning services and modern contraceptive methods in South Africa: A qualitative evaluation from community and health care provider perspectives a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Kriel Y, Milford C, Cordero JP, Suleman F, Steyn PS, Smit JA (2023) Access to public sector family planning services and modern contraceptive methods in South Africa: A qualitative evaluation from community and health care provider perspectives. PLoS ONE 18(3): e0282996. https:// doi.org/10.1371/journal.pone.0282996 Editor: Funmilola M. OlaOlorun, College of Medicine, University of Ibadan, NIGERIA Received: June 6, 2021 Accepted: February 28, 2023 Published: March 17, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0282996 Copyright: © 2023 Kriel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The database is not publicly available as it contains information that could compromise research participants’ privacy Yolandie Kriel ID1,2*, Cecilia Milford1, Joanna Paula Cordero4, Fatima Suleman3, Petrus S. Steyn4, Jennifer Ann Smit1 1 MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa, 2 School of Public Health and Nursing, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, 3 Discipline of Pharmaceutical Science, College of Health Sciences, University of KwaZulu-Natal, Westville, South Africa, 4 Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland * Abstract Progress has been made to improve access to family planning services and contraceptive methods, yet many women still struggle to access contraception, increasing their risk for unintended pregnancy. This is also true for South Africa, where over fifty per cent of pregnancies are reported as unintended, even though contraception is freely available. There is also stagnation in the fertility rate indicators and contraceptive use data, indicating that there may be challenges to accessing contraception. This paper explores the evaluation of access to contraception from community and health care provider perspectives. This qualitative study explored factors affecting the uptake and use of contraception through focus group discussions (n = 14), in-depth interviews (n = 8), and drawings. Participants included male and female community members (n = 103) between 15 and 49 years of age, health care providers (n = 16), and key stakeholder informants (n = 8), with a total number of 127 participants. Thematic content analysis was used to explore the data using NVivo 10. Emergent themes were elucidated and thematically categorised. The results were categorised according to a priori access components. Overall, the results showed that the greatest obstacle to accessing contraception was the accommodation component. This included the effects of integrated care, long waiting times, and limited operational hours–all of which contributed to the discontinuation of contraception. Community members reported being satisfied with the accessibility and affordability components but less satisfied with the availability of trained providers and a variety of contraceptive methods. The accessibility and affordability themes also revealed the important role that individual agency and choice in service provider plays in accessing contraception. Data from the illustrations showed that adolescent males experienced the most geographic barriers. This study illustrated the importance of examining PLOS ONE | https://doi.org/10.1371/journal.pone.0282996 March 17, 2023 1 / 20 PLOS ONE and consent. However, some anonymised aspects of the datasets may be available upon request and with the permission of the Department of Sexual and Reproductive Health and Research, World Health Organization, and the MatCH Research Unit (MRU). Note that data sharing is subject to WHO data sharing policies and data use agreements with the participating research centre, MRU. For permission to access the database, please contact the MatCH Research Unit at . Funding: This work received funding through a grant received by UNDP-UNFPA-UNICEF-WHOWorld Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO) [Award 53405] from the Bill and Melinda Gates Foundation [OPP1084560] and the United States Agency for International Development (USAID) through the USAID/WHO Umbrella Grant 20162018. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exists. Abbreviations: CYPR, Couple’s year of protection rate; CPR, Contraceptive prevalence rate; DMPA, Depomedroxyprogesterone; FP, Family Planning; HCP, Health care provider; KI, Key Informant; KZN, KwaZulu-Natal; LMICs, Low- and middle-income countries; mCPR, Modern contraceptive prevalence rate; SRH, Sexual and Reproductive Health; SDP, Service Delivery Point; SA, South Africa; TFR, Total fertility rate. Access to modern contraception in South Africa: A qualitative study access as a holistic concept and to assess each component’s influence on contraceptive uptake and use. Introduction Family planning (FP) services and modern contraceptive methods are some of the most important public health strategies that can improve the lives of individuals, families, communities, and nations. Access to sexual and reproductive health (SRH) services, including family planning (FP) programmes and modern contraception, and contraception is a human right and a target set out by the Sustainable Development Goals (SDG) target 3.7 [1, 2]. At the London Summit in 2012, Family Planning 2020 (FP2020) was established with the goal to get an additional 120 million users onto contraception [3]. The SDG target, FP2020, along with General Comments No. 14 and No. 22 set out by the United Nations Committee on Economic, Social, and Cultural Rights [4], are driving goals for the international family planning community and nations, including South Africa (SA), to ensure equitable access to SRH services and contraceptive methods. Althoug (...truncated)