CHAPTER 5: RESULTS
5.4 SUMMARY OF FINDINGS
5.4.1. Women’s rights within marriages
In summary, the majority of participants stated that they were the ones who made the decision to get married at an early age. These participants have described living in an environment that supports and accepts early marriages, which impelled them to accept the marriage proposals. In line with the narrations above, these women mentioned being asked by their parents if they accepted the marriage proposal.These women believed that because they were given the option to accept or refuse the marriage proposal, they had decision-making power at the time. None of the women seemed to understand that because of the wide acceptance of early marriage practices in their community and the region’s poor economic conditions, their parents felt obliged to marry then at an early age. On the other hand, Fatima described that she made the decision herself to marry at an early age, although she had a good support system in her family to protect her from marrying at an early age. By constrast, four
134 participants indicated that they were forced by their family to get married, which highlights the vulnerability of girls when it comes to making their own decision regarding marriage acceptance. This scenario is even worse in circumstances where levels of poverty are high, and no structures are in place to protect girls when they face those dilemmas.
Furthermore, the majority of participants described feeling happy with their marriage, despite experiencing some marital issues. These included verbal abuse from the husband and family, the husband’s authority, financial resource difficulties and pressure from in-laws and other extended family members. Participants also stated that being married at an early age proved difficult to them because they did not have enough knowledge about marriage’s responsibilities, so they had to learn at an early age. A few participants indicated that their husbands were supportive and that they participated in all decisions related to family affairs.
For others, compliance with marriage traditions led them to accept their reality and fulfill their duties as wives (i.e. bear children, carry out household chores, take care of the children and the husband’s desires even if they feel overwhelmed). For some of these participants, being married at an early age was an expectation that could prove beneficial. Men, particularly the ones working in South Africa could afford to pay lobolo, gaining sympathy and approval of elders who would benefit from their daughter’s marriage.
Participants were not aware about the legal frameworks, including international agreements, to protect their SRHR. Women could not clearly explain the concept of SRHR.
However, through their own experiences, they share views related to the exercise of their SRHR. The majority of women interviewed believed that women need to be informed about SRHR to make good decisions and prevent unwanted pregnancy along with HIV and other STIs. They also mentioned that women should have the right to protect and use their bodies freely, to have sex with a partner of their choice, and to decide about the desired number of children. The majority of participants agreed that early marriage negatively affects women’s well-being and ultimately the exercise of their individual rights as a woman. Most women indicated that early marriage limits girls’ school attendance; increases maternal mortality, morbidity and early pregnancy; perpetuates IPV as well as takes girls’ freedom and opportunity for personal growth.
5.4.2. Findings about participants’ experiences of modern contraceptive use
Regarding their experiences of modern contraceptive use, all participants mentioned knowing about family planning and could name some of the modern contraceptive methods currently available. However, the majority of participants were familiar only with pills, injections and condoms, and only one spoke about IUDs. None of the participants mentioned
135 knowing or hearing about sterilisation and EC. They also described have used one or more modern contraceptives within their marriages. The elder participants started using modern contraceptive methods later in their lives. The younger ones seemed to be well informed about the benefits of the devices, had better access to contraceptives and started using them early in their marriages. The current socio-economic conditions of the country have improved and along with it, the provision of adequate health services, including modern contraceptive methods for women at reproductive age. A few differences were found, in terms of contraceptive use by women’s level of education. However, women with primary education level completed and with secondary attendance were more likely to have started using contraceptive methods early in marriage while women with no primary education completed were less likely to start using family planning methods early in their marriage. Most women understood the benefits of using family planning methods, namely: helping them plan the number of children they desire; improving their financial security; preventing unwanted pregnancy and ultimately maintaining the mothers’ and babies’ health; and preventing HIV and other STIs.
All the women described feeling uncertain about their future and of their family because of the financial struggles they face, and so, family planning methods are an important tool to help them plan their future properly. Participants in this study, particularly the young ones, mentioned having the desire to use family planning methods effectively. However, as hey continued to narrate their stories, participants shared experiences of challenges that prevented them from accessing and using modern contraceptives. Participants in this study described multiple determinants that influence women’s decision to use modern contraceptives effectively and regularly. One determinant described as preventing them from using methods such as pills and injections effectively and regularly was the fear of side effects. In this regard, some participants argued that these methods cause discomfort and sickness and might be one of the reasons for women deciding to stop or not use them at all.
Some women also described that financial difficulties can prevent women from accessing and using contraceptive methods of choice. For these participants, the local health facilities might not have a full stock of family planning methods or could be located at a distance from women’s residences. This means women needed to pay for transportation and other travel costs to access family planning methods. When asked to reflect on the community’s views regarding family planning, participants in this study believed that the community in Namaacha District have responded positively to family planning methods. Most participants believe that their communities are supportive to women using modern contraceptive methods,
136 and women support and motivate each other to adhere to family planning methods. Women in this study believe that the high costs of life, the absence of men in the families and increased responsibilities of women as primary caregivers of their families, influenced the community to have a positive outlook of family planning methods. Participants shared that communities, including local leaders and religious institutions understood the benefits of family planning methods for women’s and families’ well-being, so they motivate women in the community to make use of the devices. However, two women indicated not knowing about the community’s view regarding modern contraceptive methods since they believe it is the couple’s, and particularly the woman’s decision whether or not to use family planning methods without the interference of external actors.
Although women in this study believed that their community is supportive of women using family planning methods, the majority of participants agreed that husband and other extended family members such as mothers-in-law can negatively influence women’s decision to use modern contraceptive methods. The women interviewed believed that some husbands and other family members have control over women’s bodies and so they are the ones who might dictate whether or not they use these modern devices. Participants in this study also shared that fear of violence and of being kicked out from the family might lead women not to use family planning methods in compliance with the husband’s and family’s desires. Finally, women in this study shared that family traditions such as polygamy can pose difficulties to women since it is expected that they will bear as many children as possible. Thus, use of modern contraceptive methods may be limited.
Although modern contraceptives and information packages regarding its benefits are free and available through government and NGO channels, five women believed that some women individually make the decision not to use the devices. These participants mentioned that women are informed about the benefits of the different family planning methods and have easy access to the devices. However, they choose not to use those modern contraceptive methods due to their negative personal beliefs about it. These women give different justifications for their decision of not using family planning methods. Thus, they become their own barriers when it comes to exercise their SRH, including the effective and regular use of modern contraceptive methods.
5.4.3. Findings about participants’ experience of ANC attendance
With respect to their experience of ANC attendance, all participants described starting o attend ANC during the second and sixth month of gestation. Differences were encountered between the elder and younger participants regarding the period of initiation of ANC
137 attendance. Elder participants seemed not to have attended ANC in all their pregnancies, and they all started at a later stage of their pregnancies. The younger participants seemed to have attended ANC during all pregnancies and started early in pregnancy (see Table 5). Participants in this study described some of the service packages offered during their ANC appointments to prevent and treat some of the health complications derived from pregnancy. None of the participants described having attended four ANC appointments during normal pregnancies as recommended by the WHO ANC model. Women also mentioned being offered social and other support in preparation for delivery and baby care. Thus, women in this study believed that ANC attendance was the pass they needed to ensure delivering their babies in the local maternity ward with the assistance of skilled medical professionals. The majority of women indicated that they always followed the health professionals’ recommendations provided during ANC, which led them to deliver their babies in the maternity ward.
Despite acknowledging improvements in the provision of care for pregnant women, women also mentioned determinants that influenced their decision to start attending ANC early. In this regard, some participants described experiencing health complications during their pregnancies. These participants mentioned that they ignored some of the signs and never seek medical help, which in the case of Lucia caused an abortion. These participants understood that if they had sought medical care during pregnancy, some of the health complications could have been prevented and treated. For other participants such as Fatima, Paula and Tomasia, the health complications occurred during their pregnancies motivated them to use ANC services.
Additionally, participants mentioned that women’s low socio-economic status may prevent them from accessing ANC services. Women indicated that the low availability of health centres in the district allied with their lack of financial means can make it difficult for them to access these services when in need. Participants also indicated that the shortage of skilled health professionals and long waiting periods to be seen by a health professional might have influenced women’s decision not to regularly attend ANC.
On the other hand, participants mentioned that women’s personal beliefs may influence their decision to start attending ANC. For some, their strong connection with the traditions, fear of embarrassment, stigma around teenage pregnancy and no trust of modern medicine may prevent them from attending ANC. These women indicated that their community, including husbands and other extended family members do not interfere with women’s decision to attend ANC, and ultimately women are the ones who made the decision. However, they acknowledge the importance of husband and others’ involvement in motivating women to attend ANC, particularly the younger ones with no experience regarding pregnancy care. Thus, the
138 husband’s and community’s positive outlook about ANC may positively influence women’s decision to attend ANC.
The description of participant’s narration in this section provided information regarding the exercise of their individual rights, including use of modern contraceptive methods and ANC attendance during pregnancy. This information will be discussed in the next section in relation to the literature as well as the theory of gender and power, so the context in which women experience can be related to different other realities as discussed by different scholars.
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