Main Article Content
health workers, family planning, contraception, LARC
Introduction: It is estimated that in the Pacific region the unmet need for family planning is among the highest in the world. This study supports access to family planning based on evidence that impacts of contraceptive use range from improved health to socioeconomic benefits and sustainable development. This study hears from health workers providing essential family planning care to women and their families in Guadalcanal, Solomon Islands. This region was chosen for this study as it has a subnational disparity of highest unmet need for family planning in the Solomon Islands. The aim was to understand health workers’ perspectives on barriers to contraception in this region, and to hear their proposed solutions.
Methods: This mixed methods study was based on an exploratory descriptive research approach using a survey, which was distributed to health workers at rural and urban health centres in Guadalcanal, Solomon Islands. Fifty-six surveys comprised of 32 questions, both open and closed-ended, were completed and analysed. This included three demographic questions.
Findings: Health workers identified multiple structural, social, and service-driven barriers to meeting the contraceptive needs of women in their communities. Structural barriers include gender inequity and religious influence. Social and service barriers that may be more amenable to influence include misinformation and fear about contraceptive side effects; contraceptive stigma; and access to contraceptive training and education for health workers. Health workers expressed eagerness to address the unmet need for contraception in their communities and are a resource that should be prioritised in programmes seeking to expand access to contraception in the Solomon Islands. Health workers are embedded in their communities and insightful about health service complexities in their settings. They identified solutions including increased access to education and training for Long-Acting Reversible Contraception; increased efforts in raising community awareness and ways of encouraging contraceptive acceptance; and a continued investment in enabling environments both for health workers, and women.
Conclusions: This study affirms health workers as a key resource in addressing the unmet need for contraception in Guadalcanal, Solomon Islands, and calls for programme and policy solutions informed by their perspectives. The two main priorities they emphasised to help tackle the persistent problem of unmet need for contraception are an increase in their capability to provide contraceptive implants, and an increase in community education to boost acceptance of family planning care from women and their families.
1. UNFPA [Internet]. Family planning overview. 2021. Available from: https://www.unfpa.org/family-planning
2. WHO [Internet]. Contraception. World Health Organisation;2021. Available from: https://www.who.int/healt h-topics/contraception#tab=tab_1
3. UNFPA [Internet]. International conference on population and development. UNFPA; 2021. Available from: https://www.unfpa.org/icpd
4. Family Planning 2020 (FP2020) [Internet]. The arc of progress 2019-2020. FP2020; 2021. Available from: http://progress.familyplanning2020.org/
5. WHO [Internet]. Family planning/contraception methods. World Health Organisation;2021. Available from: https://www.who.int/en/news-room/fact-sheets/detail/family-planning-contraception
6. WHO [Internet]. Strategies toward ending preventable maternal mortality. World Health Organisation; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/153540/WHO_RHR_15.03_eng.pdf;jsessionid=8CC1AE49EF834471B3FEBC0344DDC34D?sequence=1
7. Tiebere, P. Trends in unmet need, contraceptive use and reproductive intensions in Samoa, Solomon Islands, and Vanuatu. [Abstract and conference presentation]. Pacific Society of Reproductive Health Conference, Port Moresby, Papua New Guinea. 2019, July 6-11.
8. Latu, R., & Nusair, P. A perspective on family planning- dealing with barriers. Pacific Journal of Reproductive Health, 2017; 1;6: 270-274.
9. Mola, G. Brian Spurret Oration. Pacific Journal of Reproductive Health, 2017; 1;6:321-327.
10. NICE. The Effective and appropriate use of long-acting reversible contraception. NICE clinical guidelines 2005; 30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK51051/
11. UNFPA. Solomon Islands: using data to inform FP prioritization (draft). UNFPA consultation on ending unmet need for family planning. UNFPA; 2019. Unpublished leaflet.
12. Harrington R. et al. Barriers and enablers to using contraceptives for family planning at Atoifi Hospital, East Kwaio, Solomon Islands. Pacific Journal of Reproductive Health 2020;1(10):586-597 DOI: 10.18313/pjrh.2020.003
13. Family Planning 2020, United Nations Foundation. Solomon Islands commitment maker since 2012. FP2020; 2021. Available from: http://www.familyplanning2020.org/solomon-islands
14. Panisi et al. A cross-sectional study of factors predicting antenatal patients’ knowledge of modern methods of contraception in Honiara, Solomon Islands. Pacific Journal of Reproductive Health 2019;1(9)500-505.
15. Hodge N., Slatyer B., & Skiller L. Solomon Islands health system review. World Health Organisation, Regional Office for the Western Pacific; 2015. Available from: https://www.slideshare.net/AP_Observatory/solomon-islands-health-system-review
16. Family Planning 2020 (FP2020) [Internet]. Solomon Islands
17. Commitment Maker Since 2012. FP2020; 2021. Available from: http://www.familyplanning2020.org/solomon-islands
18. Daniel B., & Harland T. Higher education research methodology. 2018; Routledge.
19. Nardi, P. Doing survey research. A guide to quantitative methods. 2018; Routledge.
20. Braun V., & Clarke V. Successful qualitative research: a practical guide for beginners. 2013; Sage Publications.
21. Homer, C., Tiebere, P., Nove, A., & Nove, M. The RMNCAH workforce report- what does it mean for midwives? [Abstract and conference presentation]. Society of Reproductive Health Conference 2019, July 6-11; Pacific Port Moresby, Papua New Guinea.
22. Homer C. Maternal health and the sustainable development goals -a new focus for the world and for our region. Pacific Journal of Reproductive Health. 2018;1(7):344-345. Doi: 10.18313/pjrh.2018.900
23. Homer C. & Mittermeier T. COVID-19 and sexual and reproductive health in the Pacific Islands. Pacific Journal of Reproductive Health 2020;1(12):614-615. Doi: 10.18313/pjrh.2020.004
24. Hunt, P. How to resist the human rights pushback. NZ Human Right Commissioner editorial. 2020, October 16; Dominion Post, p 20.
25. Bateson, N. Small arcs of larger circles. 2016; Triarchy Press.
26. Johns Hopkins University. High-impact practices in family planning (HIPs). Community health workers: bringing family planning services to where people live and work. 2021. Available from:
27. Crabtree, S., & Tolley, H. C. Governance for maternal and neonatal health. International Journal of Health Governance 2018; 23(1), 4-17. Doi: https://doi.org/10.1108/IJHG-06-2017-0030.
28. Raman, S., Nicholls, R., Pitakaka, F., Gapirongo, K., & Hou, L. Identifying and overcoming barriers to adolescent sexual and reproductive health in the Solomon Islands: perspectives and practices of health, education and welfare workers. Pacific Journal of Reproductive Health 2017; 1(6), 282-291. Doi: https://doi.org/10.18313/pjrh.2017.