Abstract
Objective
Uptake of permanent contraception among women remains low in sub-Saharan Africa compared
to other regions. We aimed to synthesize available evidence on barriers to, and facilitators
of permanent contraception with regards to tubal ligation among women in sub-Saharan
Africa.
Study Design
We reviewed literature on tubal ligation among African women published between January
1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science,
and Google scholar for quantitative, qualitative, and mixed methods studies which
reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan
Africa. Finally, we conducted a narrative synthesis and categorized our findings using
a framework based on the social ecological model.
Results
We included 48 articles in the review. Identified barriers to tubal ligation among
women included individual-level (myths and misconceptions, fear of surgery, irreversibility
of procedure, religious beliefs), interpersonal-level (male partner disapproval),
and organizational-level (lack of healthcare worker expertise and equipment) factors.
Facilitating factors included achievement of desired family size and perceived effectiveness
(individual-level), supportive male partners and knowing other women with permanent
contraception experience (interpersonal-level), and finally, subsidized cost of the
procedure and task-sharing with lower cadre healthcare workers (organizational-level).
Conclusions
Barriers to, and facilitators of permanent contraception among women in sub-Saharan
Africa are multilevel in nature. Strategies countering these barriers should be prioritized,
as effective contraception can promote women’s health and economic development in
sub-Saharan Africa. In addition to these strategies, more quantitative research is
needed to further understand patient-level factors associated with uptake of permanent
contraception among women.
Keywords
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Article Info
Publication History
Published online: January 24, 2019
Accepted:
December 27,
2018
Received in revised form:
December 24,
2018
Received:
February 16,
2018
Identification
Copyright
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