Bawn, Caitlin E. M.; (2022) eHealth for family planning in Botswana: acceptability and feasibility. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

BACKGROUND: As many as 50% of pregnancies in Botswana are unintended, but only half of women in the country are currently using contraception. This thesis explores the barriers and facilitators for provision, choice and use of contraception in Botswana, and the feasibility and potential for an eHealth intervention in the field of family planning to address them. METHODS: I conducted a narrative review of factors influencing contraceptive choice, uptake and use in Botswana, and qualitative, semi-structured interviews with Batswana women (n=22), healthcare providers and key policy stakeholders in family planning (n=14), and Botswanabased eHealth experts (n=11). FINDINGS: Many Batswana women lack accurate, in-depth family planning knowledge, and experience extreme clinical and social barriers in accessing contraception. Socio-cultural barriers are more influential than physical access or availability, with partner control and patriarchal attitudes towards sex and gender the most prominent reason for women’s non-use of contraception, exacerbated by urban-rural disparity and education level. Botswana’s HIV epidemic has heavily dominated sexual health services and policy, leading to conflict between national approaches towards HIV and family planning. Key challenges for eHealth innovation in Botswana are related to inconsistent Wi-Fi infrastructure, a lack of national policy, and a reliance on external partners leading to unsustainable design and implementation of interventions. Suggestions for an eHealth intervention in family planning include using a range of media platforms to address varied levels of technological knowledge and access, and ensuring content is culturally appropriate and useful to intended users. CONCLUSION: There is a need, and desire, for more detailed, balanced, up-to-date family planning information for women, their partners, and the providers who counsel them. An eHealth intervention that adheres to the realities of technology and infrastructure limitations, and is Botswana-led in terms of content, design, and implementation, could be highly effective in addressing this gap.

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