Influence of money on family planning decision-making for women and health care providers in Uganda: Findings from a qualitative study

An unmet need for family planning among Ugandan women remains. Because intrauterine devices (IUDs) are safe, effective, long-lasting, reversible, and cost-effective, an opportunity exists for IUDs to address the need. A key step to increasing IUD use in Uganda is to understand opportunities and barriers that may influence decision-making around family planning, both for women and health care providers. As a result, qualitative formative research was conducted to identify Ugandan perspectives about family planning, including IUDs. In-depth, semi-structured interviews were conducted in Uganda with 11 women of reproductive age and 9 health care providers from private healthcare facilities. Applying grounded theory to analyze data, the dominant theme that emerged was the influence of money on women and health care providers' decisions regarding family planning. Specifically, if a woman had limited finances, she used her finances to meet her family's needs (e.g. children's education) before her own, including obtaining contraceptives. For health care providers, money incentivized them to offer family planning services; even if the specific service was subsidized or free, as providers suggested patients would return for other unsubsidized services. Ensuring accessibility to IUDs was predicated on whether a provider felt there was sufficient long-term financial incentive. Although previous literature suggests that affordability is an important determinant to ensuring the uptake and continued use of family planning methods, the current study identified other money-related determinants that seemed to have greater influence on family planning decision-making for both populations. These findings offer important implications for future reproductive health research and practice.