Gendered power dynamics and women's negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya.
In sub-Saharan Africa, high burdens of HIV and unmet need for contraception often coexist. Research emphasises the need to engage men and couples in reproductive health, yet couples' negotiations around fertility and family planning in the context of HIV have been sparsely studied. This study examined the gendered power dynamics that frame women's and couples' negotiations of contraceptive use in western Kenya. We conducted 76 in-depth interviews with 38 couples, of whom 22 couples were concordant HIV-positive. Qualitative data were analysed using a grounded theory approach. Direct communication around contraception with men was often challenging due to perceived or expressed male resistance. A substantial minority of women avoided male reproductive decision-making authority through covert contraceptive use, with concern for severe consequences when contraceptive use was discovered. Many men assumed that family planning use signified female promiscuity and that infidelity motivated covert use. Men were more willing to use condoms to avoid HIV re-infection or on the recommendation of HIV care providers, which allowed some women leverage to insist on condom use. Our findings highlight the tension between male dominated reproductive decision making and women's agency and point to the need for gender transformative approaches seeking to challenge masculinities that negatively impact health.
a Department of Obstetrics and Gynecology , Oregon Health and Science University , Portland , USA.
Elizabeth K
EK
Harrington
b Department of Social and Behavioral Sciences , University of California , San Francisco , USA.
Shari
S
Dworkin
c Institute for Global Health , University of Southern California Keck School of Medicine , Los Angeles , USA.
Mellissa
M
Withers
d Research, Care, and Training Program, Center for Microbiology Research , Kenya Medical Research Institute , Kisumu , Kenya.
Maricianah
M
Onono
d Research, Care, and Training Program, Center for Microbiology Research , Kenya Medical Research Institute , Kisumu , Kenya.
Zachary
Z
Kwena
e Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital , University of California , San Francisco , USA.
Sara J
SJ
Newmann
D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior; D003657:Decision Making; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D066296:Grounded Theory; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D015995:Prevalence; D036301:Qualitative Research; D060728:Reproductive Health / Q000193:education; D012747:Sexual Partners; D018454:Spouses
HIV/AIDS; Kenya; gender; masculinity; reproductive health