Beliefs and perceptions of women towards bilateral tubal ligation; a qualitative study at Kawempe National Referral Hospital

Abstract

Introduction: Globally, the uptake of bilateral tubal ligation, a permanent method of contraception remains very low despite being the most effective contraceptive method. This study aimed to gain an in-depth understanding of beliefs and perceptions towards BTL among women in Uganda, a country where 44% of all pregnancies are unplanned with an abortion rate of 54 per 1000 women. Methodology: This was a qualitative phenomenological study conducted at Kawempe National Referral Hospital. Participants were recruited by purposive sampling to include women seeking family planning services (any method) at Kawempe National Referral hospital, Kampala Uganda. These were interviwed through focused group discussions and in-depth interviews. Inductive thematic analysis of the collected data was done using NVIVO version 12 software to generate data codes, themes and subthems. Results: Mothers were found to have a varied range of beliefs and perceptions towards BTL. Many participants perceived BTL as a permanent and effective method of contraception and exhibited confidence in long-term effectiveness. Women also believed that BTL gives them life convenience and an increased sexual freedom. However, sseveral participants expressed concerns about the irreversibility of BTL, with some describing the decision as a “final” step that leads to feelings of regret and loss of fertility. Participants also expressed worries about complications such as death in theatre, effect on sexual life and exposure to unnecessary side effects such as pain at the incision site and heavy menstrual bleeding. The influence of male partners was another major theme, with several participants reporting that their decision to undergo BTL was shaped by their spouse's opinions, either as encouragement or disapproval. Conclusion: While many women recognize the benefits of BTL, misconceptions, concerns about health risks, regret and fears of losing femininity, remain a point of concern among mothers. Addressing these concerns through enhanced education and involving partners in the decision-making process could improve women's understanding and acceptance of BTL.