Abstract
Introduction/Aims:
Family planning has been recommended as one of the critical services needed to improve the health of women. Apart from the unavailability of services, high cost, logistical barriers and lack of awareness, indigenous Fijians or iTaukei are challenged by financial hardship and changing reproductive social norms. Therefore iTaukei women’s family planning behaviour was examined in light of these barriers. Specifically, the study aimed to assess family planning behaviour by investigating women’s knowledge, attitudes and practice of family planning in Fiji and New Zealand.
Methods:
A mixed method approach was used to investigate knowledge, attitudes and practice of family planning among iTaukei women. A descriptive survey was utilised to identify factors associated with knowledge, practice and unmet need for family planning while focus groups were used to gain a deeper understanding of the influences of family planning attitudes. Access barriers were investigated using both the descriptive survey and focus groups.
Results:
Overall, 352 iTaukei women (140 NZ participants, 212 Fiji participants) filled in a survey questionnaire. Fourteen focus groups were carried out (NZ 6, Fiji 8). The study found that tertiary educated women had higher odds of being aware of (OR 2.3, 95% CI: 1.3 – 6.2) and using family planning methods (OR 3.9, 95 % CI: 1.9-7.8), while living in New Zealand was associated with lower odds of having used family planning methods (OR 0.5, 95% CI: 0.2 – 0.9). There was no difference in the unmet need among women in both countries. About a quarter of the currently married women in both countries had an unmet need for family planning (Fiji 25%, NZ 26%). Significantly higher proportions of women in Fiji reported problems with not having a health facility nearby (Fiji 39%, NZ 22% P=0.002), concern there may not be a female provider (Fiji 51%, NZ 36%, P=0.010) and talking to a husband/partner about their health (Fiji 31%, NZ 16%, P=0.004).
The focus group study found that fragmented services made accessing health services difficult. In Fiji there was a need for an improvement in the way providers treated patients as negative experiences with health providers were commonplace. In New Zealand, privacy and confidentiality concerns compelled women to seek out non-Pacific providers as Pacific providers were considered negligent in this aspect of service delivery. New social norms around sexuality and reproduction made traditional value and belief systems difficult to maintain. For example, cultural traditions and taboo made having family planning discussion in the home and with spouses difficult; adapting to new social norms meant compromising traditional Christian values; and economic responsibilities and financial hardships drove neoliberalist perspectives of fertility leading to favourable attitudes towards family planning.
Conclusion
Despite the greater availability of services and higher standards of living experienced in New Zealand compared with Fiji, there was no improvement in unmet need among New Zealand participants. Even though cost and geographical access was more problematic in Fiji, sexual sensitivities (taboo), privacy and confidentiality were serious concerns among women in both countries. Understanding the compromises iTaukei make between traditional belief systems and new reproductive and family planning social norms can help health professionals and policy makers better cater services to meet the family planning needs of iTaukei women in New Zealand and Fiji.