Family planning services are essential in reducing maternal deaths as well as improving the reproductive and sexual health of women. Although family planning services are frequently focused on women, men are often the primary decision-makers. We conducted a study to explore male partner influence on women's choices and utilisation of family planning services in Mufulira district, Zambia. A qualitative explorative study design that utilised two focus group discussions (n = 20) and in-depth interviews (n = 30) involving women of reproductive age was conducted. Convenient sampling was employed to select participants. In-depth interviews and focus group discussions were recorded, translated, and transcribed verbatim. Content analysis was utilised through code classification and theme identification. Data were imported into NVivo.×64 for coding and node generation. The study revealed key themes on male partner influence on contraception use such as fear of infidelity, fear of physical abuse, preference for a large family size , disruption of sexual pleasure, and perceived side effects of contraceptives. These themes highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Participants described how their male partners exhibited prenatal attitudes and control over them thereby limiting their decision-making power on contraception use. Undesirable contraception side effects such as reduced vaginal lubrication contributed to sexual pleasure disruption among men. Concerns that women's use of contraception can lead to infidelity also contributed to male partner disapproval of contraception use. Understanding barriers to contraception utilisation presented by male partners is essential in preventing contraception discontinuation and can increase contraception uptake among women. Our findings highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Therefore, male partner education on family planning services is key. Also, men need to be incorporated as key stakeholders when planning and implementing family planning programmes.

Background: Globally, hormonal contraceptives have proved to be effective in the prevention of unwanted pregnancies. However, despite evidence of the many benefits associated with the use of hormonal contraceptives, concerns related to their safety and side effects have been reported. We conducted a study to explore the perspectives on the side effects of hormonal contraceptives among women of reproductive age in Kitwe district of Zambia. Methods: An explorative qualitative study was done among 32 women of reproductive age (18–45 years). Participants were selected conveniently as they accessed family planning services at a designated reproductive, maternal, and child health facility. Data collection was done through in-depth interviews (IDIs). Recruitment of participants and data collection continued until the saturation point was reached. The interviews were recorded, translated, and transcribed verbatim. Data were imported into NVivo.x64 for coding and node generation after which categories and themes were developed manually. Results: Overall, participants demonstrated a considerable amount of knowledge of family planning, recounting the economic and health benefits as well as demerits of family planning use. The main reasons for discontinuing and switching hormonal contraceptive methods were the desire to get pregnant and the fear of unpleasant side effects, including excessive bleeding or prolonged menstruation, headache, dizziness, lower abdominal/back pain, and weight gain. Most importantly, participants cited concerns about the delay in the resumption of fertility after the termination of contraception and how the side effects disrupted their daily activities at home. Conclusion: There is a need for family planning providers to offer family planning services that address the side effects of hormonal contraceptives during counselling and how women can manage them. Family planning services should adopt a patient-centred approach that takes into consideration the concerns regarding side effects and how this affects the quality of life among women. Also, there is a need to extend family planning services to include scheduled follow-ups and clinical management of contraceptive side effects among women.

Family planning services are useful in helping couples and individuals realize their basic right to decide freely and responsibly if, when, and how many children to have. The study aimed at exploring the multilevel factors influencing women’s choices and utilisation of family planning services in Mufulira district of Zambia. A qualitative explorative study design that utilised two focus group discussions (n = 20) and in-depth interviews (n = 30) involving women of reproductive age was conducted in Mufulira district, Zambia. Convenient sampling was employed to select participants. In-depth interviews and focus group discussions were recorded, translated, and transcribed verbatim. Content analysis was utilised through code classification and theme identification. Data were imported into NVivo.x64 for coding and node generation. The study revealed overarching themes at the individual level such as distrust of hormonal contraception, misconceptions about the side effects of contraception, perceived side effects of contraceptives, perceived risk of infertility, and lack of adequate information on contraception. At the interpersonal level, themes were mainly centred on male partner influence such as male partner preference for a large family size, fear of partner infidelity, disruption of sexual pleasure, fear of intimate partner violence, and male partner disapproval of contraception use. At the institutional/organisation level, themes such as health providers’ negative attitudes, non-availability of preferred contraception, and lack of guidance and support from health workers were highlighted, and at the community level, we developed themes on the limited autonomy of women in making decisions and social expectations. Women’s choices and utilisation of family planning services are influenced by an interplay of multiple social-level factors. Interventions that address these influencing factors are needed to enhance the uptake of family planning services among women.

Background: Adolescents’ risky sexual behaviours (RSB) are detrimental to their sexual and reproductive health (SRH) well-being and present a serious public health threat, particularly in low- and middle-income countries (LMICs). Aim: This study aims to assess RSB among Grade 12 school-going adolescents after exposure to comprehensive sexuality education (CSE). Setting: This study was conducted in Kitwe district, Zambia. Methods: This cross-sectional study included 807 Grade 12 pupils at 13 selected secondary schools. Data were collected using a structured questionnaire. Proportionate probability sampling involving 13 schools was employed. Risky sexual behaviours binary outcome variables were based on transactional sex, sex while drunk, multiple sexual partners, age-disparate sexual relationships, and condomless sex. We conducted univariate and bivariate analyses to summarise sociodemographic factors and fitted binary and multivariable logistic regression models. Results: The prevalence of RSB was 40.4%. Drinking alcohol (adjusted odds ratio [AOR] = 20.825; 95% CI [6.7–64.489]); ever had sex (AOR = 9.024; 95% CI [1.953–41.704]); school location (AOR = 6.50; 95% CI [1.61–26.24]); living with mother only (AOR = 4.820; 95% CI [1.328–17.493]); sex (male) (AOR = 2.632; 95% CI [1.469–4.713]), watching pornography (AOR = 1.745; 95% CI [1008–3.021]); religion (AOR = 0.472; 95% CI [0.250–0.891]) and attending religious functions (AOR = 0.317; 95% CI [0.118–0.848]) were significantly associated with RSB. Of the sexually active pupils, 221 (67.7%), 64 (19.6%) and 41 (12.5%) were in the low, medium and high-risk categories, respectively. Conclusion: Close to half of the respondents engaged in RSB. This is a significant number that needs intervention. The CSE programme needs to be linked with structural programmes that address the social drivers of RSB among adolescents. Contribution: The study provides a backdrop for evaluating current CSE strategies in LMICs.

Verbal abuse during childbirth constitutes a violation of women’s human rights and indicates poor maternal health care. The aim of the study was to investigate experiences and drivers of verbal abuse among women in Ndola and Kitwe health facilities. The study adopted a cross-sectional survey. Qualitative and quantitative data using questionnaires and focus group interviews were employed. The study was done in the Ndola and Kitwe districts of Zambia. The target population were women attending postnatal services who had a live birth within 28 days of delivery. Twenty clinics were randomly selected and a total of 306 women were recruited using convenient sampling. Eleven percent of the study population experienced verbal abuse during intrapartum care. A 1-year increase in age reduced the odds of experiencing verbal abuse (Adjusted Odds Ratio [AOR] 0.89, 95% CI: 0.80–0.99). Women who consumed alcohol more frequently experienced verbal abuse than women who never consumed alcohol (adjusted odds ratio [AOR] 5.91, 99% CI 2.12–16.51), and women with bleached skin color more often experienced verbal abuse than women with natural skin tone (AOR = 3.95, 95% CI 1.13–13.83). Further, women with a medium skin tone were less likely (AOR = 0.17, 95% CI = 0.03–0.84) to experience verbal abuse. Other key drivers of verbal abuse include language barriers, laziness, vomiting, lack of seriousness, crying, lack of cooperation, and moving around during labour. We conclude that women experience various forms of verbal abuse. Therefore, there is a need to implement interventions that tackle the multiplicity of factors that drive verbal abuse at the individual, structural, and policy level. Further, there is a need to enhance training in respectful maternity care among service providers.