A secret for survival: covert contraceptive use and the burden of male resistance to family planning in Kigezi, Uganda.

Abstract

In the rural highlands of Uganda’s Rubanda District, a region with a critically high maternal mortality rate, women’s attempts to plan their families are often shrouded in secrecy due to spousal opposition.While male opposition is a well-documented barrier to contraceptive use in sub-Saharan Africa, the literature lacks a deep, context-specific understanding of the dynamics driving this resistance in critically high-burden settings like the Rubanda District, Uganda, where women are compelled to resort to covert contraceptive use.This qualitative study explores the lived experiences of women to understand the underlying drivers of male resistance to Long-Acting Reversible Contraceptives (LARCs). Data were collected through a combination of eight in-depth interviews (IDIs) with individual participants and two focus group discussions (FGDs) comprising seven and nine women respectively. The findings indicate that male resistance is not monolithic but stems from a complex interplay of factors: deep-seated misinformation due to exclusion from health education, powerful socio-cultural norms that equate masculinity with high fertility, and the pervasive impact of alcohol abuse, which leads to the abdication of familial responsibilities. These barriers compel women to adopt contraception covertly, placing them at risk of marital conflict and domestic violence. This secrecy arises from the lack of husbands’ engagement in health programs and reflects women’s determination to safeguard their health and secure the wellbeing of their children. The paper amplifies these women’s voices, illuminating their silent struggle and emphasizing the urgent need for systemic interventions and health programs that actively involve men, challenge harmful social norms, and remove barriers to equitable and collaborative family planning.