Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024

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However, in the pastoralist community, women were rooted in strong cultural and religious perspectives that promoted many children, discouraged the use of FP, had high male dominance, and had limited control over their life, including the use of FP. Objective To explore the barriers to LARC utilization among pastoralist women in southern Ethiopia. Methods This study used a qualitative descriptive study design and included thirty-three pastoralist women for focus group discussions and twelve key informants for IDI, who were purposefully selected from three pastoral districts. The participants were interviewed and explored the primary barriers to using LARCs. The principal researcher led the interview via a semi structured interview guide that allowed for flexibility in exploring issues aided by audio tape. The approach included a broad inductive thematic analysis, with significant concepts derived from transcripts. Results In this study, there are many barriers to LARC utilization organized into five themes, including myths and misconception (perceived side effects, FP is not suitable for women who work intensively and carry heavy objects and travel long distances), the desire to have many children (children are wealth and Gods gifts), religious belief, distances of health facilities and husband objection. Conclusion and recommendations Information education communication should be provided to address myths and misconceptions about the LARC during the FP intervention for pastoralist women via HEW, HCP, media, and community education. There is a need to enhance social opportunities by involving religious leaders and partners in decision-making and providing health information and counseling to religious leaders and couples in the community through HEW. As myths and misconceptions about LARC use emanate from a variety of concerns, this study may not cover all of them; therefore, future research is needed to investigate additional myths and misconceptions concerning contraception use. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-1520", "name": "Exploring barriers to long-acting reversible contraceptive utilization..." } } ] } Home Browse Exploring barriers to long-acting reversible contraceptive utilization... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Gelgelo D, Hailu Kassa D and Garoma S. Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1520 ( https://doi.org/10.12688/f1000research.159633.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] Dawit Gelgelo https://orcid.org/0000-0003-3352-1542 1 , Dejene Hailu Kassa 2 , Sileshi Garoma 3 Dawit Gelgelo https://orcid.org/0000-0003-3352-1542 1 , Dejene Hailu Kassa 2 , Sileshi Garoma 3 PUBLISHED 16 Dec 2024 Author details Author details 1 Public Health, Bule Hora University, Bule Hora, Oromia, 144, Ethiopia 2 Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia 3 Federal Ministry of health, Addis Ababa, Oromia, Ethiopia Dawit Gelgelo Roles: Conceptualization, Data Curation, Formal Analysis, Investigation Dejene Hailu Kassa Roles: Methodology, Project Administration, Resources, Software, Supervision Sileshi Garoma Roles: Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Health Services gateway. Abstract Background Ensuring comprehensive access to family planning improves gender equality, empowers women, and, eventually, reduces poverty. However, in the pastoralist community, women were rooted in strong cultural and religious perspectives that promoted many children, discouraged the use of FP, had high male dominance, and had limited control over their life, including the use of FP. Objective To explore the barriers to LARC utilization among pastoralist women in southern Ethiopia. Methods This study used a qualitative descriptive study design and included thirty-three pastoralist women for focus group discussions and twelve key informants for IDI, who were purposefully selected from three pastoral districts. The participants were interviewed and explored the primary barriers to using LARCs. The principal researcher led the interview via a semi structured interview guide that allowed for flexibility in exploring issues aided by audio tape. The approach included a broad inductive thematic analysis, with significant concepts derived from transcripts. Results In this study, there are many barriers to LARC utilization organized into five themes, including myths and misconception (perceived side effects, FP is not suitable for women who work intensively and carry heavy objects and travel long distances), the desire to have many children (children are wealth and Gods gifts), religious belief, distances of health facilities and husband objection. Conclusion and recommendations Information education communication should be provided to address myths and misconceptions about the LARC during the FP intervention for pastoralist women via HEW, HCP, media, and community education. There is a need to enhance social opportunities by involving religious leaders and partners in decision-making and providing health information and counseling to religious leaders and couples in the community through HEW. As myths and misconceptions about LARC use emanate from a variety of concerns, this study may not cover all of them; therefore, future research is needed to investigate additional myths and misconceptions concerning contraception use. READ ALL READ LESS Keywords Long-acting reversible contraceptive, pastoralist women, myth and misconception, southern Ethiopia. Corresponding Author(s) Dawit Gelgelo ( [email protected] ) Close Corresponding author: Dawit Gelgelo Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Gelgelo D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Gelgelo D, Hailu Kassa D and Garoma S. Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1520 ( https://doi.org/10.12688/f1000research.159633.1 ) First published: 16 Dec 2024, 13 :1520 ( https://doi.org/10.12688/f1000research.159633.1 ) Latest published: 16 Dec 2024, 13 :1520 ( https://doi.org/10.12688/f1000research.159633.1 ) Introduction Family planning is defined as the choice of individuals or couples to anticipate and attain their desired number of children and the spacing and timing of their births. 1 Ensuring universal access to family planning has a positive effect on gender equality, women’s empowerment, and, ultimately, poverty reduction. 2 , 3 Women and children are given particular attention in the health policy of Ethiopia. 2 , 4 Accordingly, the ministry is engaged in a range of efforts to improve the access to and quality of modern family planning services. As a result, the use of modern contraception increased from 6.3% in 2000 to 35% in 2016. 5 Long-acting reversible contraception (LARC), which includes IUCDs and subdermal implants, has many desirable attributes, such as highly effective protection against unwanted pregnancies and few contraindications. 6 They do not require the users’ ongoing effort for long-term and effective use following initial insertion, are cost-effective, do not require frequent visits for resupply, and are reversible with a rapid return to fertility after removal. 7 , 8 However, the proportion of women currently using long-acting contraceptives remains significantly lower than that of women using short-acting methods. 9 The Ethiopian demographic health survey (EDHS) 2016 reported that only 7.1% of women utilized the LARC, which was far from the global FP target of 2030. 10 , 11 Various studies conducted in Ethiopia have shown that the utilization of long-acting contraceptives is influenced by social, cultural, economic, and health system-related factors. In particular, women’s social status, access to education, and involvement in decision making on reproductive matters and social norms were found to be the major determinants of long-acting contraceptive use. 2 , 12 Furthermore, women in the pastoralist community are double marginalized as women and pastoralists. 13 In the pastoralist community, women feel that they are embedded in strong cultural and religious perspectives, which promote a high number of children, discourage the utilization of FP, increase male dominance and restrict the ability of women to control their lives, including FP use. 11 In addition, a multilevel and spatial analysis of geographic variation and associated factors of long-acting contraceptive use among reproductive-age women in Ethiopia revealed that living in a pastoralist community reduced the odds of LARC utilization in Ethiopia. 14 Therefore, this study aimed to explore the barriers to LARC utilization among pastoralist women in southern Ethiopia. Understanding the barriers to long-acting reversible contraception use is important for dispelling them and increasing the uptake of contraception. Methods Study design and participants A qualitative descriptive study design with a qualitative research approach was employed for this study. The study employed thirty-three pastoralist women aged (15–49 years) who were purposefully sampled from three pastoral districts for focus group discussion. Only married women were included. Four family planning coordinators, four religious leaders and four community figures were included in the key informant interviews. Procedures The interviews were conducted by health workers with experience in qualitative research methods. The number of FGDs was determined on the basis of the principles of saturation of information. Every member of the group contributed to any question asked before proceeding to another question. Married discussants representing different backgrounds in terms of gender, profession, education, and social status were included in the study. The IDIs were performed among well-known people in the community and included community figures, religious leaders and healthcare providers. The participants were interviewed, and their opinions about LARC and key barriers to its use were discussed. A semi structured interview aided by audio tape was conducted. The primary researcher led the interviews following a semi structured interview guide developed from the literature review 15 – 17 with the flexibility to explore topics as they arose. One facilitator facilitated the interview process. The interviews began with thirteen interview guide questions designed to explore participants’ opinions, followed by broader discussion among the group and suggestions. The interviews were audio recorded and transcribed verbatim. Data from the field notes were reviewed and verified by the participants. When transcribing, square brackets were used to denote nonverbal activities, and names or places were removed and replaced with non-identifying letters. The discussion was performed in the Afan Oromo language as preferred by the discussants and later translated into English during the transcript, with each FGD lasting for 60–90 minutes and the IDI lasting for 30–45 minutes. Trustworthiness To determine the accuracy and reliability of the data, the criteria of credibility, transferability, dependability, and confirmability were considered. 15 Data analysis The interview transcripts and field notes were analyzed through principles of inductive thematic analysis using systematic approach. The data collected from the focus groups and interviews were transcribed verbatim. First, the principal investigator transcribed verbatim, generated codes and themes, and then reviewed, interpreted, and described these codes and themes. 17 Other members of the research team analyzed the codes and themes, making adjustments and consolidating them as needed. The analytical process worked toward condensing the ideas to the point where key ideas were defined, described here as themes. Data analysis began while further interviews were being conducted; recruitment ceased when thematic saturation was reached. An independent researcher fluent in both Oromic and English reviewed the transcripts for accuracy and original meaning preservation during translation. Ethical considerations Ethical clearance was received from the Institutional Review Board (IRB) of Bule Hora University on March- 28/2024 with protocol number of 028/24/IHSGS. The study was conducted from March 30 to April 25, 2024. Married couples were notified of the purpose of the study as it attempt to improve knowledge and attitudes about family planning and contraception methods. This study obtained both verbal and written informed consent, which was approved by the Bule Hora University IRB committee. As a result, each study participant who could not read or write provided verbal consent, while literate participants provided written informed consent before to participating in the study. Result Sociodemographic profiles of the study participants In this study, the researcher enrolled a total of 46 participants: 33 reproductive age groups for the FGD and 12 key informants for the IDI (4 family planning coordinators, 4 religious leaders and 4 community figures). The mean age of the study participants was 29.5 years (range 18–47 years) ( Table 1 ). Table 1. Sociodemographic characteristics of the study participants to explore barriers to long-acting reversible contraceptive utilization among the pastoral community in southern Ethiopia. Variables Categories Frequency Ages 15-24 13 25-34 24 35-49 9 Education Unable to read and write(no formal education) 27 Literate (primary to college/university) 19 Religion Protestant 42 Wakefata 2 orthodox 2 Occupation Housewife 35 Governmental employs 4 Private employs 7 Current contraceptives use LARC 5 Others methods 19 Ever contraceptives use Yes 36 No 10 Barriers to long-acting reversible contraceptive utilization among pastoral communities in southern Ethiopia Emerged themes Five themes emerged from the analysis of the client’s focus group discussion and key informant interview data on barriers to long-acting reversible contraception utilization in pastoral communities. Theme 1: Perceived myths and misconceptions Subtheme 1.1: Perceived side effects (cancer, infertility, heavy and sudden bleeding, overweight, tininess, headache and stress ) : Some women never use contraception methods because of concerns about side effects. However, other women utilized FPs but discontinued them because of side effects. Almost all women reported bleeding as a major side effect of LARC. Some had personal encounters with adverse effects, whereas others were concerned with a rumor. When women were asked about the side effects of using LARCs, they stated the following: I have never used contraception because of what others have said about it. My husband encouraged me to use FP. However, others claim that it causes excessive bleeding. It makes women extremely thin. (Women participant 4, FGD) I have never used FP because of what others have said about it. They all focus on adverse effects. They claimed that this caused massive bleeding. (Female participant 5, FGD) On the other hand, some women experienced adverse effects and changed methods. Many women preferred long-acting reversible family planning over short-acting methods. When asked which methods are most acceptable to their bodies, two participants responded as follows: … I’m familiar with both FPs, which serve for three months and three years. However, the one that serves for three years is preferable. Because it is more suitable for women’s bodies. (Women participant 15, FGD) ……I have used both three months and three years of FP. The one placed into the arm is better than the others. (Female participants 8, FGD) Furthermore, some women noted that the adverse effects differ from one woman to another. They described their opinion as follows. …. When one FP is not suitable for their bodies, they should seek other methods. Therefore, instead of just ignoring the FP, they should choose the one that is most suitable for them. (Women participant 1, FGD ) …. FP side effects differ from women to women. For one FP that serves for three months, including myself, is suitable, but for others, the FP that serves for three years is suitable. (Female participant 9, FGD) Some participants associated LARC use with cancer and infertility. One woman was diagnosed with cancer after receiving LARC. The health professional did not inform her that the cancer was caused by the use of contraception. However, she had directly linked the cancer to the use of contraception. Another religious leader revealed his wife’s experiences with LARC use. He stated that his wife was unable to conceive again following the removal of the LARC. They expressed their viewpoint as follows: …. I used FPs three years after my second birth. However, it causes me to bleed heavily, and my family takes me to a medical facility, where they inform me that I have cancer. Because I was previously healthy, FP was the cause of my cancer. Personally, I have related my illness to FP. (Female Participant 6, FGD) ……My wife used FP for three years. She suffered from severe bleeding, headaches, body aches, stress, and weakness following FP use. Meanwhile, after removal of the FP, she was unable to conceive again. I think this is related to FP…. (Religious leader Participant 11, KII) Subtheme 1.2: FP is not appropriate for women who travel long distances: The women asserted that pastoral women travel long distances to find water and collect firewood. When asked about the barriers to FP use, particularly for pastoral women, two expressed their thoughts as follows: …. I want to space my children. However, I’m frightened to use FP. Because I walk a long way to the market, collect firewood, and draw water from the river … . Therefore, FP is unsuitable for me. (Female participant 6, FGD) FP is unsuitable for pastoral women. Women are not thrilled about using it. FP bleeding differs from typical menstrual bleeding. It happened unexpectedly while one was on the way to the market or somewhere. Additionally, our lives are built on migrating from one pace to another. Therefore, it is not suitable for us. (Women participant 2, FGD) Subtheme 1.3: FP is not suitable for women who work intensively and carry heavy objects: The women indicated that pastoral women carry heavy objects, such as grain, wood, and water, on their backs. Bleeding occurs suddenly during outdoor activities. When asked about the obstacles to FP use, particularly for pastoral women, the participants expressed their opinions as follows: ……However, in our case, using FP is unsafe. Because we are pastoralist women. Our regular activities include lifting massive amounts of objects such as wood, water, and grain. Therefore, the FP is not perfect for pastoral women. (Community figure participant 8, KII) Theme 2. Access issues: Some respondents highlighted the distance between health facilities and the need for frequent contact to receive services as barriers to FP utilization. When asked about pastoral women’s obstacles in accessing FP health services: Pastoral women are unable to visit health facilities frequently due to distance, especially those who have served for three months, who require frequent contact. For this reason, FPs that serve for three years are preferable for pastoral women. (Women participant 7, FGD) Theme 3: Desire to have many children Subtheme 3.1: Children are wealth: Many participants believe that having children is a sign of wealth. They believe that a family with many children might gain respect from the neighborhood and even provoke fear toward that family. This intention makes it possible for them to desire to have many children. They stated their opinion as follows: …. Having lots of kids is a good thing. According to Guji, those without clothing and family members are despised. Therefore, having a large family is a wonderful way to earn respect from others. However, having children with a plan is preferable. (Community figure participant 44, FGD) … Indeed, children are a blessing and are brought up by God. I desire a large family, so I do not care if living expenses rise. The resources needed to raise kids will come from God. (Women participant 25, FGD) Another participant argued that children are not riches, which is opposed to the aforementioned notion. According to them, a person should have children in accordance with his or her standards of living and be in charge of the children’s clothing, food, and education. The following is how these participants expressed their opinions: … I do not believe in the concept of children as wealth. Having children can be helpful depends on one’s standard of living. Because any one knows his standard of living. (Women participant 18, FGD) ….People say that children are rich. Therefore, they want to have more children. However, this is not good. God gave us obligations. He is not coming to support children’s food, education, or clothing. This is our responsibility.… (Women participant 11, FGD) Subtheme 3.2: Children are gifts of God: The participants strongly believe that children are God’s gifts. Some participants stated that while children are God’s gifts, they should be planned. Others, however, believe that preventing God’s gifts through the use of medications such as FP is sinful. They expressed their suggestions as follows: In our community, children are considered God’s gifts; therefore, they just give birth. I think that children are God’s gifts, but it is the family’s obligation to raise them. God, do not come and work on your farm. He does not come to clothe the children. (Female participants 31, FGD) …. As the gospel states, children are God’s gifts. However, God gave us responsibility. He is not coming to support children’s food, education, or clothing. This is our responsibility. Therefore, we should have children with prudence. (Women participant 2, FGD) Theme 4: Religious belief: Religion was one of the sociocultural issues identified as barriers to LARC utilization by participants from various perspectives. Some participants believe that the Bible does not oppose FP, whereas others believe that it does not support FP. When asked about sociocultural barriers to LARC utilization, several participants expressed their views as follows: …. The Bible does not contradict the FP. Our God is the God of the Plan. First, every creature was created according to the plan. Similarly, we should plan for every aspect of our lives, including our children. (Religious leader participant 10, KII) I do not think the Bible supports FP. The Bible encourages people to multiply and fulfill the land. However, considering the state of people’s economies, it is impossible to prevent them from using it. Personally, I firmly oppose the use of FPs for abortion, whether temporary or permanent. However, the second option is up to your faith. People could use reversible FPs for child spacing on the basis of their lifestyle standards. (Religious leader participant 11, KII) The other issue I have encountered as a health professional with FP is that some women consider using it for sin. They have stated that women giving birth through surgery is God’s punishment. Because they have used FP. Personally, I know women who came to me and stated they wanted the implanon removed because it was against their religion. (MCH coordinator participant 5, KII) Theme 5: Husband objection. Husband approval is a crucial factor in women’s FP usage. Some husbands encourage their wives to use FP, whereas others oppose it. When the women were asked about their spouses’ support for FP utilization, they expressed their opinions as follows: I have five children. After my fifth child, I used an implant. At the time, I kept it hidden from my husband. Because he knows he will not let me use it. After two and a half years, I removed it and informed my husband. Thankfully, he did not say anything. (Women participant 2, FGD) My husband does not support my choice to utilize FP. He claims that it is his obligation to raise children. It is not my business. He said that even if I have 30 children, he will raise them. (Women participant 23, FGD) The data has been coded and categorized into five main themes emerged from the analysis of the client’s focus group discussion and key informant interview data on barriers to long-acting reversible contraception utilization in pastoral communities : Perceived myth and misconception, distance of health facility, desire to have many children, religious belief and husband’s objection ( Table 2 ). Table 2. Summary of emerged main themes, subthemes, and codes extracted from the analysis of interviews. Main theme Subtheme Codes Perceived myths and misconception Perceived side effects LARC causes cancer, infertility, heavy and sudden bleeding, overweight, tininess, headache and stress FP is not appropriate for women who travel long distances Pastoral women travel long distances to find water, pastoral women travel long distances collect firewood FP is not suitable for women who work intensively and carry heavy objects FP is not suitable for pastoral women because they are carrying heavy objects on their backs, such as grain, fire wood, and water from river Access issues - Distance of health facilities, frequent contact health facilities to receive services, mobile life styles Desire to have many children Children are wealth A family with a lot of children might gain respect from the neighborhood, a family with a lot of children feared in community, children provide financial support for their parents as they older Children are gifts of God God is the one who provides children. Religious belief - The Bible does not oppose FP, the bible does not support FP, and women using FP giving birth through surgery is God's punishment. Husband objection - concealing FP use from the spouse, FP use is decided by the husband Discussion A descriptive qualitative study was conducted to explore the barriers to long-acting reversible contraceptive utilization among the pastoral community in southern Ethiopia. The study identified barriers to long-acting reversible contraceptive utilization in five organized themes: perceived side effects, perceived misconception, distance of health facilities, desire to have many children, religious belief and husband’s objection. According to the findings from this study, perceived adverse effects seem to be one of the barriers to LARC use. The perceived negative effects of LARC include cancer, infertility, severe bleeding, headaches, and stress. Women either experienced these adverse effects or heard about them. In this study, bleeding was the most commonly reported adverse effect among LARC users. This is especially difficult for pastoralist women who have a mobile lifestyle. They may have to walk long distances to obtain water, gather firewood, and go to the market. Furthermore, they cannot buy sanitary towels because they rely primarily on their husband’s income. According to the American Sexual Health Association, some people using a hormonal IUD may experience irregular bleeding, such as spotting between periods or heavier bleeding during a period. After a few months, bleeding may become lighter, menstrual cramps may decrease, and periods may disappear entirely. 16 , 18 Another major concern highlighted in this study is whether LARC causes cancer. The women believed that the absence of menstrual blood due to conception would accumulate unclean blood inside them, causing various types of cancer. According to the American College of Obstetricians and Gynecologists, there is insufficient evidence to know if the LARC increases the risk of cancer. 19 However, the IUCD is not indicated for anyone who has had gynecological cancer, such as cervical or uterine cancer. 20 One of the studies conducted on current hormonal contraception and the risk of endometrial cancer suggested that implants have a protective effect on the risk of ovarian cancer among women with breast cancer gene mutations. 21 Another concern addressed in this study was that participants linked infertility to contraceptive use. Some FGD discussants and KIIs noted some women’s inability to conceive again following LARC removal. The American College of Obstetricians and Gynecologists states that LARCs do not induce infertility or make it more difficult to conceive in the future. 19 Previously, there was worry that IUCD use could cause infertility due to an increased risk of sexually transmitted infections. While untreated STIs can cause pelvic infection, preventing some women from becoming pregnant, many studies have demonstrated that IUCDs do not increase STI infection rates or lead to infertility. 19 , 22 The study’s findings revealed that perceived misconceptions are among the most significant barriers to LARC utilization. Many women believe that pastoral lifestyles are unsuitable for LARC use. They generally believe that LARC is not allowed for those who engage in different daily activities. LARC has several contraindications, including pregnancy, current pelvic inflammatory disease, undiscovered irregular uterine bleeding, genital tract malignancy, and a history of specific cancers, such as breast cancer. 21 – 23 However, the idea that LARC use impedes daily life activities and is inappropriate for pastoralist women has no scientific basis. 18 , 22 , 23 Other challenges to LARC utilization among pastoralist women include a desire to have many children. Everyone, especially women, instinctively wants a large family and feels fulfilled by having many children, but the desire for children varies greatly between individuals, and many people may choose to have a smaller family or no children at all owing to personal preferences, life circumstances, and individual priorities. Similarly, some studies have found that the desire to have many children is a barrier to LARC utilization. 17 , 24 , 25 This study revealed that religious belief is one of the barriers to LARC use. In this study, religious leaders held different opinions on the use of LARCs. One religious leader supports the use of LARCs, whereas others condemn it. This finding is consistent with those of studies on barriers to contemporary contraception use in Ethiopia 26 and Uganda. 27 In general, the implications of this study’s findings for policy and practice are to enhance interventions that encourage the use of the LARC, which has an important role in the use of the LARC among pastoralist women. Understanding the local context of pastoral women’s issues can help to better target interventions. Strength and limitations The current research provides insight into the barriers to LARC utilization among pastoralist women. The researcher used purposive sampling techniques to recruit participants from the community with the help of a health extension worker. The data triangulation approach, which included FGD and KII, was used. However, this study included only a small sample of women from three pastoralist districts in southern Ethiopia, which may not represent the entire pastoral region of Ethiopia. Furthermore, because the interviewers were health care workers, there is a possibility of social desirability bias. Conclusion and recommendation Conclusion This study revealed that there are widespread beliefs and misconceptions concerning long-acting reversible contraceptive use among pastoralist women. In this study, there are many barriers to LARC use, including myth and misconception (perceived side effects, FP is not suitable for women who work intensively, carry heavy objects, and travel long distances), the desire to have many children (children are wealth and God’s gifts), religious beliefs, and the husband’s objection. Recommendation Information education communication should be provided to address myths and misconceptions about the LARC during the FP intervention for pastoralist women via HEW, HCP, media, and community education. In addition, there is a need to enhance social opportunities by involving religious leaders and partners in decision-making. This could be accomplished by providing health information and counseling to religious leaders and couples in the community through health extension workers. It is critical to improve their understanding and correct misconceptions, particularly with respect to perceived side effects. LARC services should be integrated into other health services and delivered on a continual basis via a produced national standard manual and trained health care personnel. As myths and misconceptions about LARC use emanate from a variety of concerns, this study may not cover all of them; therefore, future research is needed to investigate additional myths and misconceptions concerning contraception use. Data availability Underlying data Figshare: Supplementary file to Exploring barriers to LARC utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024. https://doi.org/10.6084/m9.figshare.27918621.v2 . 28 This project contains the following: • Verbatim Transcription Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: Supplementary file to Exploring barriers to LARC utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024. https://doi.org/10.6084/m9.figshare.27918621.v2 28 This project contains the following: • Interview Guide Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Reporting guidelines Figshare: Supplementary file to Exploring barriers to LARC utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024. https://doi.org/10.6084/m9.figshare.27918621.v2 28 This project contains the following: • COREQ checklist for qualitative study design Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments We would like to express our heartfelt gratitude to Bule Hora University, the data collectors who worked tirelessly to collect the data, and the participants in the study. Their contributions have been critical to the accomplishment of our study References 1. Aregay W, Azale T, Sisay M, et al. : Utilization of long acting reversible contraceptive methods and associated factors among female college students in Gondar town, northwest Ethiopia, 2018 : institutional based cross ‑ sectional study. BMC. Res. Notes. 2018; 11 : 11–16. 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Moreno MA: Long-acting reversible contraception for adolescents. JAMA Pediatr. 2016; 170 (5): 516. Publisher Full Text 24. Gashaye KT, Gebresilassie KY, Kassie BA, et al. : Reasons for modern contraceptives choice and long ‑ acting reversible contraceptives early removal in Amhara Region, Northwest Ethiopia ; qualitative approach. BMC Womens Health. 2023; 23 : 1–7. PubMed Abstract | Publisher Full Text | Free Full Text 25. Gebeyehu A, Asnake M, Dibaba Y, et al. : BARRIERS TO UTILIZATION OF LONG ACTING REVERSIBLE AND PERMANENT CONTRACEPTIVE METHODS IN ETHIOPIA : ABSTRACT.2018; 10 (3): 1–24. 26. Shumet T, Geda NR, Hassan JA: Barriers to modern contraceptive utilization in Ethiopia.2024. 27. Kamwesigye A, Amanya D, Nambozo B, et al. : Barriers and enablers to utilisation of postpartum long-acting reversible contraception in Eastern Uganda : a qualitative study.2024; 5 . 28. Gelgelo D, Hailu D, Garoma S: Supplementary file to Exploring barriers to LARC utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024. figshare. [Dataset]. 2024. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 16 Dec 2024 ADD YOUR COMMENT Comment Author details Author details 1 Public Health, Bule Hora University, Bule Hora, Oromia, 144, Ethiopia 2 Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia 3 Federal Ministry of health, Addis Ababa, Oromia, Ethiopia Dawit Gelgelo Roles: Conceptualization, Data Curation, Formal Analysis, Investigation Dejene Hailu Kassa Roles: Methodology, Project Administration, Resources, Software, Supervision Sileshi Garoma Roles: Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 16 Dec 2024, 13:1520 https://doi.org/10.12688/f1000research.159633.1 Copyright © 2024 Gelgelo D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Gelgelo D, Hailu Kassa D and Garoma S. Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1520 ( https://doi.org/10.12688/f1000research.159633.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 16 Dec 2024 Views 0 Cite How to cite this report: Cleland J. Reviewer Report For: Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1520 ( https://doi.org/10.5256/f1000research.175393.r358089 ) The direct URL for this report is: https://f1000research.com/articles/13-1520/v1#referee-response-358089 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Jan 2025 John Cleland , Faculty of Epidemiology and Population Health, London School of Hygieneand Tropical Medicine, London, UK Approved VIEWS 0 https://doi.org/10.5256/f1000research.175393.r358089 This paper reports the results of a qualitative study into barriers that limit uptake of long- acting contraceptive methods among pastoralists in southern Ethiopia. A total of 33 women of reproductive age participated in focus group discussions and 12 interviews ... Continue reading READ ALL This paper reports the results of a qualitative study into barriers that limit uptake of long- acting contraceptive methods among pastoralists in southern Ethiopia. A total of 33 women of reproductive age participated in focus group discussions and 12 interviews were conducted with key informants including religious and community leaders and health care providers. Audio recordings were transcribed, translated from Oromo into English, and analysed using an inductive thematic approach. The majority of participants were illiterate and about half were currently using a contraceptive method. The analysis revealed 5 major themes, with each illustrated by verbatim quotations. The methods, presentation of results and interpretation conform to high standards for a qualitative study. It would be useful to know how many focus group discussions were held. It should also be noted that some of the barriers (eg desire for large families) apply to short-acting as well as long-acting methods. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Fertility, family planning, child survival. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Cleland J. Reviewer Report For: Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1520 ( https://doi.org/10.5256/f1000research.175393.r358089 ) The direct URL for this report is: https://f1000research.com/articles/13-1520/v1#referee-response-358089 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 16 Dec 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 16 Dec 24 read John Cleland , London School of Hygieneand Tropical Medicine, London, UK Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Cleland J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Jan 2025 | for Version 1 John Cleland , Faculty of Epidemiology and Population Health, London School of Hygieneand Tropical Medicine, London, UK 0 Views copyright © 2025 Cleland J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This paper reports the results of a qualitative study into barriers that limit uptake of long- acting contraceptive methods among pastoralists in southern Ethiopia. A total of 33 women of reproductive age participated in focus group discussions and 12 interviews were conducted with key informants including religious and community leaders and health care providers. Audio recordings were transcribed, translated from Oromo into English, and analysed using an inductive thematic approach. The majority of participants were illiterate and about half were currently using a contraceptive method. The analysis revealed 5 major themes, with each illustrated by verbatim quotations. The methods, presentation of results and interpretation conform to high standards for a qualitative study. It would be useful to know how many focus group discussions were held. It should also be noted that some of the barriers (eg desire for large families) apply to short-acting as well as long-acting methods. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Fertility, family planning, child survival. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Cleland J. Peer Review Report For: Exploring barriers to long-acting reversible contraceptive utilization among the pastoralist women in southern Ethiopia: Qualitative study approach, 2024 [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1520 ( https://doi.org/10.5256/f1000research.175393.r358089) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1520/v1#referee-response-358089 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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