Experiences, Perceptions and Decision-Making Regarding Contraceptive Use among Women of Reproductive Age in Rural and Urban Communities in Anambra State, Nigeria: A Qualitative Study

Abstract

Background: Modern contraceptives prevent unintended pregnancy, unsafe abortion and maternal and infant deaths, yet contraceptive use in Nigeria remains low and uneven. In Anambra State, the 2024 Nigeria Demographic and Health Survey (NDHS) found that 58.7% of sampled women used no method. Such statistics cannot explain why women who know about and accept contraception still do not use it.

Objectives: To explore (1) perceived barriers to contraceptive use, (2) women’s experiences of contraceptive use, including perceived effectiveness, side effects and interactions with healthcare workers, (3) how women make decisions about contraceptive use, and (4) the advice women offer to other women, comparing rural and urban communities in Anambra State.

Methods: A phenomenological qualitative design, guided by the Health Belief Model, was used as the qualitative strand of a parallel convergent mixed-methods study. Twelve women leaders (executive members of town women’s associations), one from each of 12 Local Government Areas (six urban, six rural) across the three senatorial zones, were purposively selected. In-depth interviews of about 45 minutes were held in English or Igbo during the women’s annual August meetings, using a semi-structured guide. Interviews were audio-recorded, transcribed verbatim and thematically analysed with NVivo, and continued until thematic saturation.

Results: Eight themes emerged. For barriers: (1) partner approval, authority and secrecy; (2) uneven access to services; (3) fear of side effects and bodily change; (4) misinformation and community narratives; and (5) context-dependent religious and cultural influence. For experiences: (6) perceived effectiveness and method experience; (7) health worker counselling and service encounters; and (8) contraception as family wellbeing. Decision-making ran along a continuum from joint agreement, through husband-led decisions, to covert individual use. Women’s advice was consistent across settings: seek counselling, obtain methods from health facilities, discuss with the partner where possible, and ignore rumours. Rural accounts described stronger partner control, fear of marital violence, privacy concerns, distance, transport costs, staff shortages and stock-outs, whereas urban accounts centred on side effects, provider competence and work schedules.

Conclusion: Women in Anambra State generally regard contraceptives as effective and beneficial, but use is constrained by partner authority, fear of bodily harm, misinformation, uneven service quality and religious or cultural norms, with rural women facing the heaviest combination of barriers. Programmes should combine client-centred counselling, couple and male engagement, confidential services, community-based correction of myths, and improved rural service delivery.