Comparing ethics and Morality by Tafadzwa Munhapa

(Merriam Webster 2013)Ethics and morals are both used in the plural and are often regarded as synonyms, but there is some distinction in how they are used. Morals often describes one's particular values concerning what is right and what is wrong while Ethics are external standards that are provided by institutions, groups, or culture to which an individual belongs. For example, lawyers, policemen, and doctors all have to follow an ethical code laid down by their profession, regardless of their own feelings or preferences. Ethics can also be considered a social system or a framework for acceptable behavior. Morals are also influenced by culture or society, but they are personal principles created and upheld by individuals themselves

(R.C. Sproul  2015 [AL1] ) The English word “ethics” comes from the Greek word ethos. The word morals or morality comes from the word mores. The difference is that the ethos of a society or culture deals with its foundational philosophy, its concept of values, and its system of understanding how the world fits together. There is a philosophical value system that is the ethos of every culture in the world. On the other hand, mores has to do with the customs, habits, and normal forms of behavior that are found within a given culture.

(Surbhi S 2015) Much of the confusion between these two words can be traced back to their origins. For example, the word "ethic" comes from Old French (etique), Late Latin (ethica), and Greek (ethos) and referred to customs or moral philosophies. "Morals" comes from Late Latin's moralis, which referred to appropriate behavior and manners in society. So, the two have very similar, if not synonymous, meanings originally. Morality and ethics of the individual have been philosophically studied for well over a thousand years. The idea of ethics being principles that are set and applied to a group (not necessarily focused on the individual) is relatively new, though, primarily dating back to the 1600s. The distinction between ethics and morals is particularly important for philosophical ethicists. Ethics and morals relate to “right” and “wrong” conduct. While they are sometimes used interchangeably, they are different: Ethics refer to rules provided by an external source, for example, codes of conduct in workplaces or principles in religions. Morals refer to an individual’s own principles regarding right and wrong.

(Merriam Webster 2013)The difference between ethics and morals can seem somewhat arbitrary to many, but there is a basic, albeit subtle, difference. Morals define personal character, while ethics stress a social system in which those morals are applied. In other words, ethics point to standards or codes of behavior expected by the group to which the individual belongs. This could be national ethics, social ethics, company ethics, professional ethics, or even family ethics. So while a person’s moral code is usually unchanging, the ethics he or she practices can be other-dependent.[AL2] 

When considering the difference between ethics and morals, it may be helpful to consider a criminal defense lawyer. Though the lawyer’s personal moral code likely finds murder immoral and reprehensible, ethics demand the accused client be defended as vigorously as possible, even when the lawyer knows the party is guilty and that a freed defendant would potentially lead to more crime. Legal ethics must override personal morals for the greater good of upholding a justice system in which the accused are given a fair trial and the prosecution must prove guilt beyond a reasonable doubt[AL3] .

Some lecture series include question and answer sessions in which members of the audience can engage with the speaker to bring up specific questions and issues. Some schools also have a campus ethics curriculum, and they may require that their students take one or more ethics classes during the course of their study.

Personal ethics is a category of philosophy that determines what an individual believes about morality and right and wrong. for example the Confucianism idea which states that we should respect our parents and  ancestors to be good and take care of them,show love, respect, courtesy and support and lastly it says display sorrow for their sickness and death  This is usually distinguished from business ethics or legal[AL4]  ethics.

The prosecution and court must also deal with the difference between ethics and morals. In some cases past actions of the accused might resonate with the current charge, but are kept out of evidence so as not to prejudice the jury. In a sense, the prosecutor “lies by omission” in representing the case, never revealing the prejudicial evidence. The same prosecutor, however, would likely find it reprehensible to fail to tell a friend if her date had a potentially dangerous or suspect history.

Another area in which ethics and morals can clash is at the workplace where company ethics can play against personal morality. Corporate greed that blurs its own ethical lines coupled with unreasonable demands on time can lead to having to choose between a stressful, demanding and consuming work ethic, and family obligations seen as moral obligations to spouse and children. Conversely, people lose jobs every day because of poor personal morals, employee theft being a common reason for dismissal.[AL5] 

In society, we are all faced with the butting heads of ethics and morals. Abortion is legal and therefore medically ethical, while many people find it personally immoral. Fundamentalists, extremists, and even mainstream theists all have different ideas about morality that impact each of our lives, even if indirectly through social pressures or legal discrimination.

In the case of homosexuality, many believe it is morally wrong, yet some of the same people also believe it is unethical to discriminate legally against a group of people by disallowing them the same rights afforded heterosexuals. This is a plain example of ethics and morals at battle. Ethics and morals are central issues as the world strives to overcome current challenges and international crossroads. Hopefully, in the coming years, a growing understanding will lead to peaceful and productive solutions.

Morals and ethics may seem to be the same thing, but depending on the definition used, they have slight differences in meaning. Morality can be the basis of ethics. The personal moral compass of many people can decide how the majority of a society views something, similar to the way numerous individual brushstrokes in a painting combine to create an overall design. One example of this is the worldview held by individuals and society that such actions as rape, theft and murder are wrong.

Strong personal convictions can sometimes end up at odds with the accepted norm, however. Slavery, for example, was widely accepted in many nations throughout history but the moral compass of some individuals convinced them slavery wasn't right and so they took a stand against it, sometimes even at the risk of their lives. At other times, the disagreement is more subtle. Not everyone agrees with the viewpoint of their society regarding such actions as adultery, recreational drug use or abortion. What some condemn others may accept, or vice vesa. Morality and ethics, like any philosophy, are subject to change over time.. Deeply held personal beliefs usually stick with individuals throughout their life, but might change due to profoundly positive or negative experiences. Some examples are ideas including the importance of honor, honesty and hard work that children learn from parents or other role models. (www.annabelbeerel.com)

Aristotle states that happiness isn’t physical pleasure, but harmonizing the mind with virtue. What feels the best for the most is virtue. The intellectual and emotional parts of the mind create intellectual and moral types of virtue. This virtue is expressed from the mind by voluntary action.

Kant’s moral philosophy proposes that practical reason in accordance with moral imperatives should drive right actions. Duty should guide right action. Acting according to what is willed to be universal law is the “Categorical Imperative” that should guide behavior. Human beings are ends rather than the means to achieving the happiest possible life.

Aristotle states that a life of ultimate happiness and fulfillment is a life of solitary contemplation. However, he suggests that this state of being can’t be realized by mere mortals. He argues that the greatest happiness can be achieved by following moral values to live a busy life of politics and public splendor

In the first instance, ethics is called a normativescience; it’s the study of norms or standards by which things are measured or evaluated. Morality, on the other hand, is what we would call a descriptive science which is a method to describe the way things operate or behave. Ethics are concerned with the imperative and morality is concerned with the indicative. What do we mean by that? It means that ethics is concerned with “ought-ness,” and morality is concerned with “is-ness.”

(R.C. Sproul 2015) Ethics is normative and imperative. It deals with what someone ought to do. Morality describes what someone is actually doing, particularly as we understand it in light of our Christian faith, and also in light of the fact that the two concepts are confused, merged, and blended in our contemporary understanding.

What has come out of the confusion of ethics and morality is the emergence of what we call “statistical morality.” This is where the normal or regular becomes the normative. Here’s how it works: to find out what is normal, we do a statistical survey, we take a poll, or we find out what people are actually doing. For example, suppose we find out that a majority of teenagers are using marijuana. We then come to the conclusion that at this point in history, it is normal for an adolescent to indulge in the use of marijuana. If it is normal, we deem it to be good and right.

Ultimately, the science of ethics is concerned with what is right, and morality is concerned with what is accepted. In most societies, when something is accepted, it is judged to be right. But oftentimes, this provokes a crisis for the Christian. When the normal becomes the normative, The Christian concept of ethics is on a collision course with much of what is being expressed as morality. This is because we do not determine right or wrong based on what everybody else is doing. For example, if we study the statistics, we will see that all men at one time or another lie. That doesn’t mean that all men lie all the time, but that all men have indulged in lying at some time or another. If we look at that statistically, we would say that one hundred percent of people indulge in dishonesty, and since it’s one hundred percent universal, we should come to the conclusion that it’s perfectly normal for human beings to tell lies. Not only normal, but perfectly human. If we want to be fully human, we should encourage ourselves in the direction of lying. Of course, that’s what we call a reductio ad absurdum argument, where we take something to its logical conclusion and show the folly of it. But that’s not what usually occurs in our culture. Such obvious problems in developing a statistical morality are often overlooked. The Bible says that we lean toward lying, and yet we are called to a higher standard. As Christians, the character of God supplies our ultimate ethic, the ultimate framework by which we discern what is right, good, and pleasing to Him

References                                             

R.C. Sproul Oct 14, 2015How Can I Develop a Christian Conscience

Shawn R. Beals, Courant Community, "Middletown Ethics

(Surbhi S 2015) Difference between ethics and morality

www.annabelbeerel.com

Merriam Webster 2013 the difference between ethics and morality

The bible

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 [AL1]Only the surname is needed

 [AL2]Good points

 [AL3]Indicate source please

 [AL4]Quote source of information

 [AL5]Good points

 [AL6]Use the APA referencing system

Geography (Series ) By Tafadzwa Munhapa

                                                 

1 – Define geomorphology (4)

The word geomorphology derives from three Greek words: gew(the Earth), morfh(form), and logo~ (discourse). Geomorphology is therefore ‘a discourse on Earth forms’. The term was coined sometime in the 1870s and 1880s to describe the morphology of the Earth’s surface (e.g. de Margerie 1886, 315), was originally defined as ‘the genetic study of topographic forms’ (McGee 1888, 547) Geomorphology investigates landforms and the processes that fashion them. Form, process, and the interrelationships between them are central to understanding the origin and development of landforms. The earth is a dynamic place and nothing on earth is static, that’s where the study of geomorphology comes into play.

2- Discus the roll of historical and functional geomorphology in the study of different landforms (15)

Origins and life of the earth is staged by geographers into four eras and the eras are as follows Proterozoic, Palaeozoic, Mesozoic, and Cenozoic

Archean Eon, also spelled Archaean Eon, the earlier of the two formal divisions of Precambrian time (about 4.6 billion to 541 million years ago) and the period when life first formed on Earth. The Archean Eon began about 4 billion years ago with the formation of Earth’s crust and extended to the start of the Proterozoic Eon 2.5 billion years ago; the latter is the second formal division of Precambrian time. The start of the Archean Eon is only defined by the isotopic age of the earliest rocks. Prior to the Archean Eon, Earth was in the astronomical (Hadean) stage of planetary accretion that began about 4.6 billion years ago; no rocks are preserved from this stage. Archean oceans were likely created by the condensation of water derived from the outgassing of abundant volcanoes. Iron was released then (as today) into the oceans from submarine volcanoes in oceanic ridges and during the creation of thick oceanic plateaus. This ferrous iron (Fe²⁺) combined with oxygen and was precipitated as ferric iron in hematite (Fe₂O₃), which produced banded-iron formations on the flanks of the volcanoes. . The second oldest rocks are the 4-billion-year-old Acasta granitic gneisses in northwestern Canada, and a single relict zircon grain dated to 4.2 billion years ago was found within these gneisses. Archean rocks mostly occur in large blocks hundreds to thousands of kilometers across, such as in the Superior and Slave provinces in Canada; the Pilbara and Yilgarn blocks in Australia; the Kaapvaal craton in southern Africa; the Dharwar craton in India; the Baltic, Anabar, and Aldan shields in Russia; and the North China craton.

The Paleozoic is bracketed by two of the most important events in the history of animal life. At its beginning, multicelled animals underwent a dramatic "explosion" in diversity, and almost all living animal phyla appeared within a few millions of years. At the other end of the Paleozoic, the largest mass extinction in history wiped out approximately 90% of all marine animal species. The causes of both these events are still not fully understood and the subject of much research and controversy. The Paleozoic took up over half approximately 300 million years ago. . During the Paleozoic there were six major continental land masses; each of these consisted of different parts of the modern continents. For instance, at the beginning of the Paleozoic, today's western coast of North America ran east-west along the equator, while Africa was at the South Pole. These Paleozoic continents experienced tremendous mountain building along their margins, and numerous incursions and retreats of shallow seas across their interiors. Many Paleozoic rocks are economically important. For example, much of the limestone quarried for building and industrial purposes, as well as the coal deposits of western Europe and the eastern United States, were formed during the Paleozoic. The Paleozoic is divided into six periods: the Cambrian, Ordovician, Silurian, Devonian, Carboniferous. On a global scale, the Paleozoic was a time of continental assembly. The majority of Cambrian landmasses were gathered together to form Gondwana, a supercontinent made up of the present-day continents of Africa, South America, Australia, and Antarctica and the Indian subcontinent.

The Mesozoic Era is commonly subdivided into three geologic periods: Triassic (252 to 201.3 million years ago), Jurassic (201.3 to 145 million years ago), Cretaceous (145 to 66 million years ago).The Mesozoic Era begins in the wake of the largest extinction in Earth's history. This extinction took place 252 million years ago and resulted in 96% of marine life and 70% of terrestrial life dying out. The cause of the extinction is not fully understood, but eventually it led to dinosaurs dominating the planet for 135 million years. The Mesozoic Era began with today's continents combined into one large land mass known as Pangea, which was surrounded by a single global ocean called Panthalassa.

During the Jurassic Period, a rift between modern day Africa and South America began to split Pangea apart. This began the formation of the continents as we know them today. Even today, this same rift continues to spread the coasts of the Atlantic further apart.

It is believed that the Mesozoic Era was a dry climate for most of the time due to the abundance of evaporates, which is a type of mineral that only forms in dry climates. Fossils from the Mesozoic also indicate a warm and dry climate.

The Cenozoic Era began 65 million years ago with an asteroid impact that killed off a majority of the dinosaurs and ends at the present day. The Cenozoic is commonly divided into three periods:Paleogene (65.5 to 23.03 million years ago),Neogene (23.03 to 2.6 million years ago),Quaternary (2.6 million years ago to present). A picture of the Earth at the beginning of the Cenozoic Era would look somewhat similar to a picture of the Earth today. The supercontinent of Pangea that existed during the time of the dinosaurs had split apart by the Cenozoic, and the continents were on their paths to where they are today. In the Cenozoic Era, the Earth began a long period of cooling, caused in part by the continents shifting into their current positions. As South America separated from Antarctica, a global current of cold water was brought to the surface, cooling the surface temperature of the ocean and the atmosphere. The Quaternary Period is a geologic time period that encompasses the most recent 2.6 million years — including the present day. Part of the Cenozoic Era, the period is usually divided into two epochs — the Pleistocene Epoch, which lasted from approximately 2 million years ago to about 12,000 years ago, and the Holocene Epoch, which began about 12,000 years ago. The Quaternary Period has involved dramatic climate changes, which affected food resources and brought about the extinction of many species. The period also saw the rise of a new predator: man.

Historical geomorphology tends to focus around histories or trajectories of lands cape evolution and adopts a sequential, chronological view Largely, historical geomorphology and process geomorphology are complementary and go hand-in-hand, so that historical geomorphologists consider process in their explanations of landform evolution Aristotle (384–322 BC) conjectured that land and sea change places, with areas that are now dry land once being sea and areas that are now sea once being dry land. Historical geomorphology is the study of landform evolution or changes in landforms over medium and long timescale.

Geomorphic processes are the multifarious chemical and physical means by which the Earth’s surface undergoes modification. They are driven by geological forces emanating from inside the Earth (endogenic or endogene processes), by forces originating at or near the Earth’s surface and in the atmosphere (exogenic or  exogene  processes), and by forces coming from outside the Earth (extraterrestrial processes, such as asteroid impacts). They include processes of transformation and transfer associated with weathering, gravity, water, wind, and ice. Although the study of geomorphology has been around since the ancient times,The first official geographic model was proposed between 1884 and 1899 by the American geographer William Morris Davis. His geographic cycle model was inspired by theories of Uniformitarianism and attempted to theorize the development of various landform features. The land surface of Earth is the consequence of specific, natural processes acting across some interval of time.  It follows that any landscape is not static, but is changing in some (probably) predictable way. So geomorphologists (and geomorph students) must acquire the habit of thinking historically when  trying  to interpret how a landscape came to be.

The processes that we take seriously as possible causes for landscapes are uniformitarian ones.  That is, they are processes we can actually see happening today or that are at least compatible with physical, chemical, and biological constraints that are well understood.  One idea for the evolution of a strange part of Montana (the Channeled Scablands) was rejected for many years, not because it was physically unreasonable, but because the source of the enormous energy for accomplishing it was not clear.  When it became obvious that such a source not only could exist, but must have existed, the hypothesis was greeted with a new respect.  The process itself was invisible, but it was physically possible to accomplish without recourse to magic, so eventually it was accepted. 

Geomorphic processes work in ways that are predictable, at least in their broad terms.  Tectonic events create structures that uplift and/or depress land in specific ways.  Weathering in specific climates will attack the rocks thus uplifted in pretty specific ways, and erosional agents will remove the loose regolith, transport it away, and eventually deposit it in fairly predictable ways.  Thus if we know how an area has been uplifted and what the weathering and transporting agents affecting it are, we can make a pretty good guess as to what the area will eventually look like.  In fact, we can predict what it will look like at different times in its evolutionary history.  Because we are convinced of this general predictability, we think of landscapes evolving under the influence of geomorphic systems

 Functional geomorphology are geomorphologic processes and are as follows: Fluvial geomorphologic processes, these are those related to rivers and streams. The flowing water found here is important in shaping the landscape in two ways. First, the power of the water moving across a landscape cuts and erodes its channel. As it does this, the river shapes its landscape by growing in size, meandering across the landscape, and sometimes merging with other rivers forming a network of braided rivers.The paths rivers take depend on the topology of the area and the underlying geology or rock structure found where it's moving.In addition, as the river carves its landscape it carries the sediment it erodes as it flows. This gives it more power to erode as there is more friction in the moving water, but it also deposits this material when it floods or flows out of mountains onto an open plain in the case of an alluvial fan

The mass movement process, also sometimes called mass wasting, occurs when soil and rock moves down a slope under the force of gravity. The movement of the material is called creeping, slides, flows, topples, and falls. Each of these is dependent on the speed of movement and composition of the material moving. This process is both erosional and depositional.

Glaciers are one of the most significant agents of landscape change simply because of their sheer size and power as they move across an area. They are erosional forces because their ice carves the ground beneath them and on the sides in the case of a valley glacier which results in a U-shaped valley. Glaciers are also depositional because their movement pushes rocks and other debris into new areas. The sediment created by the grinding down of rocks by glaciers is called glacial rock flour. As glaciers melt, they also drop their debris creating features like eskers and moraines.

Weathering is an erosional process that involves the chemical break down of rock (such as limestone) and the mechanical wearing down of rock by a plant’s roots growing and pushing through it, ice expanding in its cracks, and abrasion from sediment pushed by wind and water. Weathering can, for example, result in rock falls and eroded rock like those found in Arches National Park, Utah.

3 Outline reasons why explanation of most landforms needs element from different spectrum of approaches

When James Cook and his crew first saw New Zealand, in 1769, they probably believed the land had been shaped by the biblical Great Flood. But why was this dramatic landscape so different from England? A century later, science had begun to find the answers – in particular, it had become clear that the land was constantly changing.Traditionally the ‘geographical cycle’, expounded by William Morris Davis, was the first modern theory of landscape evolution, His geomorphic cycle model was inspired by theories of uniformitarianism and attempted to theorize the development of various landform features.

Austrian climatologist Alfred Wegener used the fit of opposing coastlines as one of the pieces of evidence to support his hypothesis of continental drift. Continental drift proposed that the continents were once assembled together as a single supercontinent Wegener named Pangaea. Wegener was unable to suggest a suitable mechanism to explain the motion of the continents across Earth's surface and his hypothesis received relatively little support until technology revealed the secrets of the ocean floor. Scientists gradually amassed additional data that would resurrect Wegener's hypothesis over 30 years after his death. By the 1960s the building blocks were in place to support a new hypothesis, Seafloor spreading, that would provide the mechanism for continental drift. Together these concepts would become the theory of plate tectonics.

The theory of plate tectonics provides an example of the evolution of scientific thought. The first two sections of the chapter reveal the basic observations that were used to make predictions on the geologic processes that shaped the face of Earth. The theory of plate tectonics links Earth’s internal processes to the distribution of continents and oceans

Rock cycle process also needs to be considered on explanation of different formations forms. Like landforms, many rocks do not remain in their original form indefinitely but instead, over a long term, tend to undergo processes of transformation. The rock cycle is a conceptual model for understanding processes that generate, alter, transport, and deposit mineral origin

Ancient Greek and Roman philosophers wondered how mountains and other surface features in the natural landscape had formed. Aristotle, Herodotus, Seneca, Strabo, Xenophanes, and many others discoursed on topics such as the origin of river valleys and deltas, and the presence of seashells in mountains. Aristotle (384–322 BC) conjectured that land and sea change places, with areas that are now dry land once being sea and areas that are now sea once being dry land.

Some geomorphologists, mainly the ‘big names’ in the field, have turned their attention to the long-term change of landscapes. Starting with William Morris Davis’s ‘geographical cycle,he stated that several theories to explain the prolonged decay of regional landscapes have been promulgated. Walther Penck offered a variation on Davis’s scheme. According to the Davisian model, uplift and planation take place alternately. But, in many landscapes, uplift and denudation occur at the same time. The continuous and gradual inter action of tectonic processes and denudation leads to a different model of landscape evolution, in which the evolution of individual slopes is thought to determine the evolution of the entire landscape (Penck 1924, 1953). Three main slope forms evolve with different combinations of uplift and denudation rates. First, convex slope profiles,

Gossman (1970) Slope recession, which produces a pediplain and slope decline, which produces a peneplain, resulting from waxing development form when the uplift rate exceeds the denudation rate.Second,straight slopes, resulting from stationary (or steady-state) development, form when uplift and denudation rates match one another. And, third, concave slopes, resulting from waning development form when the uplift rate is less than the denudation rate. According to Penck’s arguments, slopes may either recede at the original gradient or else flatten, according to circumstances.

 Many authers claim that Penck advocated ‘parallel retreat of slopes’, but this is a false belief (Simons 1962). Penck (1953, 135–6) argued that a steep rock face would move upslope, maintaining its original gradient, but would soon be eliminated by a growing basal slope. If the cliff face was the scarp of a tableland, however, it would take a long time to disappear. He reasoned that a lower-angle slope, which starts growing from the bottom of the basal slope, replaces the basal slope. Continued slope replacement then leads to a flattening of slopes, with steeper sections formed during earlier stages of development sometimes surviving in summit areas (Penck 1953, 136–41). In short, Penck’s

complicated analysis predicted both slope recession and slope decline, a result that extends Davis’s simple idea of slope decline. Field studies have confirmed that slope retreat is common in a wide range of situations. However, a slope that is actively eroded at its base (by a river or by the sea) may decline if the basal erosion should stop. Moreover, a tableland scarp retains its angle through parallel retreat until the erosion removes the protective cap rock, when slope decline sets in (Ollier and Tuddenham 1962). Common to all these theories is the assumption that, however the land surface may appear at the outset, it will gradually be reduced to a low-lying plain that cuts across geological structures and rock types. These planation surfaces or erosion surfaces are variously styled peneplains, panplains, etchplains, and so forth. Cliff Ollier (1991, 78) suggested that the term palaeoplain is preferable since it has no genetic undertones and simply means ‘old plain. It is worth bearing in mind when discussing the classic theories of landscape evolution that palaeoplain formation takes hundreds of millions of years to accomplish, so that during the Proterozoic aeon enough time elapsed for but a few erosion surfaces to form. In southeastern Australia, the palaeoplain first described by Edwin Sherbon Hills is still preserved along much of the Great Divide and is probably of Mesozoic

Lester Charles King  was known for his theories on scarp retreat. He offered a very different view of the origin of continental landscaping than that of William Morris Davis. King's ideas were an attempt at refuting Davis' cycle of erosion they were themselves of cyclical nature and contributed to what Cliff Ollier has called "Davis bashing" the ridicule of cyclical theories in geomorphology, in particular Davis' ones. Critics did however not propose alternative models. For him, the weathering of physical factors in arid areas causes the erosion of the hills, the deposition of the weathered material (pediments) and the deposition of these material in lower altitudes, contributing to the formation of the pediplain. King was a supporter of the Expanding Earth hypothesis. L C King said landforms evolved through out history in his pediplanation theory which explains the formation of inselbergs  Arthur N Strahler (1952) in his book (Dynamic basis of geomorphology) proposed a system of geomorphology grounded in basic principles of mechanics and fluid dynamics that he hoped would enable geomorphic processes to be treated as manifestations of various types of shear stresses. So in general processes of landform formations is filled with multitudes of approaches which means the only answer is the creator who knows when and how the landforms were created. learning how landforms evolved using approaches by some authors is good, but to some extent that can be opposed by some scientific researches and will leave us with no absolute answer

REFERENCES

N Strahler (1952) The Dynamic basis of geomorphology

Cliff Ollier (1991, 78)  Ancient  landforms

Richard John Huggett   (2002, 2007, 2011)   Fundamentals of Geomorphology

Robert E.Gabler,James F.Petersen,L.Michael Trapasso  Essentials of Physical Geography,Eighth Edition

Penck(1953,135–6)                                                                                                                                                              Journal by Jijo Sudarshan Endogenic Forces and Evolution of Land forms.

Hobart M King    the Geographic Time Scale

An assessment of contraception as a reproductive right in Gweru, Ward 6, Midlands Province, Zimbabwe

GREAT ZIMBABWE UNIVERSITY

FACULTY OF SOCIAL SCIENCES

An assessment of contraception as a reproductive right in Gweru, Ward 6.

                                                            By

                                          TAKAWIRA ADMIRE

                        

                                                        M151900

Dissertation submitted in partial fulfilment of the requirement of the Master Degree in Demography and Population Studies.

                                                2016

                               SUPERVISED BY MR M.SHOKO

DECLARATION

I Takawira Admire do hereby declare that this thesis is a result of my original effort and work, and that the best of my knowledge, findings have never been presented to Great Zimbabwe University or elsewhere for the award of any academic qualification. Where assistance has been sought, it has been acknowledged accordingly.

Takawira Admire

Signature………………………………………….

Date……………………………………………….

Supervisor: Mr. M Shoko

Signature…………………………………………….

Date………………………………………………….

                  

ACKNOWLEDGEMENTS

 I would like to thank the almighty God, with whom all and through him all things exist. My gratitude goes to my supervisor, Mr. M.Shoko, who would step out of his way to assist me in coming up with a complete proposal. My fervent gratitude also goes to my friend, Mr. Peter Mujuru, who became a pillar of support to my project. I would like to the thank the staff at Zimbabwe National Family Planning council,Gweru,Gweru City Council Department of Health, Ministry of Health and Child Care Gweru for taking time off their busy schedules to entertain my research questions.

My fellow workmates at the Ministry of Women Affairs, Gender and Community Development, stood aloof for their moral support and encouragement, my classmate for the demography class for their open minded criticism which only saves to strengthen my research acumen. My special thanks go to my wife, Abigail who was the first to encourage me to further my study, my daughter Shalom Takawira, who was always by my side when I would carry extra work at home. I would want to thank my father, Mr. E.M. Takawira, for his encouragement and support during my study period.

                             

 DEDICATION

To my beautiful wife, Abigail and our special children, Shalom Ruvarashe and Tinotendashe Admire, who was a pillar of support to me? Their existence was the energy that propelled me to greater heights. This dissertation is also dedicated to my father, who famously said to me, “A person should not be like a wheelbarrow, which when you push and leave it, it will not change its spot until pushed again”. I refused to be a wheelbarrow and here I am!

           ABSTRACT

This research assessed contraception as a reproductive right issue in Gweru urban, in Mutapa ward 6.The research used data triangulation in order to draw maximum results on how contraception has been treated as a reproductive right or non- reproductive right issue. The research analysed contraception from a rights based perspective zeroing on key components which are availability, accessibility, affordability and acceptability. Data was gathered using both quantitative and qualitative techniques. Under qualitative methods, Focus group discussions and key informant interviews were used in this research. Quantitative data was collected using questionnaires and analysed using SPSS version 18.The research concluded that, though on paper, contraception is treated as a reproductive right, but in actual use it becomes more of a privilege owing to non- fulfillment of the key components that makes contraception a right.

                TABLE OF CONTENTS

DECLARATION…………………………………………………………

ACKNOWLEDGEMENTS……………………………………………..

DEDICATION……………………………………………………………

TABLE OF CONTENTS…………………………………………………

LIST OF TABLES………………………………………………………

LIST OF FIGURES………………………………………………………

LIST OF ABBREVIATIONS……………………………………………

DEFINITION OF TERMS………………………………………………

1. INTRODUCTION……………………………………………………

1.1Background and organizing framework…………………………………………………………

1.2Statement of the problem………………………………………

1.3Justification of study……………………………………………

1.4Key research questions………………………………………….

1.5Conceptual framework…………………………………………….

2. LITERATURE REVIEW

2.1Introductions………………………………………………………

2.2The history of reproductive rights and reproductive health

2.3International Commitments and agreements made in the field of reproductive health and rights………………………………………

2.4Human rights in the provision of contraception………………….

2.5Proximate determinants of contraception usage…………………

2.6Mediating variables…………………………………………………

2.7Contraception status in Zimbabwe

2.8Historical background of contraceptive methods ever used……..

3. METHODOLGY

3.1Description of study area………………………………………

3.2Research population……………………………………………..

3.3Sampling technique……………………………………………..

3.4Research Design………………………………………………….

3.5Research methods and Data sources………………………………

3.6Data collection Techniques………………………………………..

3.6.1Quantitative Data…………………………………………………

3.6.2Key informant interviews……………………………………….

3.6.3Focus group discussions…………………………………………

3.7Data collection Tasks……………………………………………..

3.8Data analysis………………………………………………………

3.9Challenges expected in the field…………………………………..

3.9.1 Ethical considerations………………………………………….

4. RESULTS

4.1 Socio-demographic characteristics of respondents…………………..

4.2Reproductive rights knowledge of respondents……………………….

4.3Contraception usage and behavior…………………………………….

4.4Findings from key informant interviews with health personnel……..

4.5 Findings from group discussions……………………………………..

4.5.1 Contraception knowledge and use…………………………

5. DISCUSSION OF RESULTS

5.1introduction

5.2Contraception usage in Mtapa

5.3Contraceptive availability, affordability, accessibility and quality

5.4Reproductive rights knowledge

5.5Reccomendations

5.6 Conclusion

LIST OF FIGURES

Figure 1.1.Diagrammatic conceptual framework on use of contraception methods…………………………………………………………………..

Figure 1.2 Picture of contraception methods used……………………..

Figure 4.1.1Age of respondents………………………………………….

Figure 4.1.2Occupation status of respondents………………………….

Figure 4.1.3Demographic characteristics of respondents by religion…

Figure 4.1.4Distribution of respondents by marital status……………..

Figure 4.1.5Number of children born to respondents………………….

Figure 4.1.6 Distribution of respondents by person lived with…………….

Figure 4.1.7Source of reproductive rights information……………………

Figure 4.1.8Percentage Distribution on whether reproductive rights are respected or not…………………………………………………………………..

Figure 4.2.1: Percentage distribution by hearing about contraception methods.

Figure 4.2.2: Percentage distribution by use of contraception…………………..

LIST OF TABLES

Table1:…………………………..

LIST OF ABBREVIATIONS

CBD                                         Community Based Distributors

CDC                                         Centre for Drug Control

CEDAW                                   Convention on the Elimination of All Forms of Discrimination Against Women

CPR                                          Contraceptive Prevalence Rate

DHS                                         Demographic Health Survey

EA                                            Enumeration Areas

FDA                                         Food and Drug Administration

FP                                             Family Planning

HIV                                          Human Immuno deficiency Virus

ICPD                                        International Conference on Population and Development

IEC                                           Information Education and Communication

IUD                                          Intrauterine Device

MDG                                        Millennium Development Goals

MOH & CC                              Ministry of Health and Child Care

MICS                                        Multiple Indicator Cluster Survey

PoA                                           Program of Action

RH                                            Reproductive Health

SPSS                                         Statistical Package for Social Sciences

SSA                                          Sub- Saharan Africa

STI                                           Sexually Transmitted Infections

UNDP                                      United Nations Development Program

UNPF                                       United Nations Population Fund

WHO                                        World Health Organization

ZNFPC                                     Zimbabwe National Family Planning Council

ZSA                                          Zimbabwe Statistical Agency                          

DEFINATION OF TERMS

Family Planning: A program to regulate the number and spacing of children in a family

through the practice of contraception or other methods of birth control.

Contraceptive Prevalence rate: Is the proportion of women of reproductive age who

are using (or whose partner is using) a contraceptive method at a given point in time.

1. BACKGROUND AND ORGANISING FRAMEWORK.

1.1  Background

Ever since mankind came into existence, sexual relations were always a part of man’s way of ensuring survival from one generation to another through child birth. Whilst in ancient times, numbers were important in building empires, things gradually changed, as numbers meant more mouth to feed and take care of. This resulted in desire by man to have control over their own reproductive behaviours.Control in terms of determine number of children one would want to have, spacing of children and to ultimately stop child birth. The transition from uncontrolled birth rates to controlled ones was not a smooth transition as it was fraught with experiments in contraception sometimes with fatal consequencies.The transition was also characterized by violations of people’s rights with notable examples being India’s forced sterilization program and China’s one child policy. In light of violations on the rights of individuals in as far as reproduction was concerned, there were growing calls for conference to address issues raised and to reach consensus on how reproduction should be approached without infringing on the rights of individuals. This led to a series of international conferences on population from Bucharest in 1974 to Cairo in 1994.However, all conferences prior to the 1994 Cairo conference had a bias towards demographics. The Cairo conference saw a great paradigm shift from human demographics to human rights, reproductive health and individual choice, (UNFPA 2012).Research has shown that, a human rights based family planning intervention would ensure that women would be empowered to complete school and start families when they are ready, (UNFPA 2012).

The issue of reproductive rights provides people with a platform to make choices on contraception and their behavior is guided by information that is at an individual’s disposal .A rights based approach would allow government to control population growth for the sake of enhancing people ‘s productive capacities. In order for fertility to fall, there was need for individuals to take control of their own plans in terms of reproduction and there was also need for political will to defend those rights. Principle 1 of the Cairo Programme of Action (1994) endorses the freedom of individuals as set forth in the universal declaration of human rights.

The rights based approach became the basis of advocating for freedom of choice in terms of family planning.Priciple 8 of the Cairo Program of Action clearly shows the decision of rights based approach to family planning as it states  people ‘s rights to enjoy the best possible standards of physical and mental health. States had a responsibility to safeguard reproductive rights of individuals, which include universal access to health-care services, reproductive health care, family planning and sexual health. Reproductive health-care programs should be expanded to include all services without infringing on anyone’s right. Every human being should decide freely, without coercion, the number and spacing of their children and information to make those decisions should be made available. All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so (UNFPA, 2012).

UNFPA 2013 Report states that, the provision of contraception services must be free from coercion and discrimination, ensure informed decision making, respect privacy, and confidentiality and respect of all persons. John Cleland et al (2006) noted that, family planning programs have contributed greatly in increasing the prevalence rate of contraception from less than 10% to 60% and in reducing fertility levels in developing countries by half. Despite the role that contraception played in the control of population, there was need for strategies in its provision. This was echoed by John Cleland et al (2006), who highlighted that, there should be no contradiction to exist between respect for reproductive rights and strong advocacy for smaller families and for mass adoption of effective contraceptive methods.

 Currently 867 million women of childbearing age in developing countries have a need for  modern contraceptives,645 million have access to them,(UNFPA 2012).According to WHO (2014), an estimated 222 million women have unmet need for modern contraception and that need is greatest where the risk of maternal mortality is high. WHO (2014) noted that, in the least developed countries, 6 out of 10 women who do not want to get pregnant, or who want to delay the next pregnancy, are not using any method of contraception. Increasing contraception prevalence prevents unintended pregnancies and reduces maternal mortality and infant mortality and morbidity. In Zimbabwe, according to the Multiple Indicator Cluster survey 2014, contraceptive prevalence rate for use of modern contraceptive is 66, 5%, while about 0.5% of women use traditional methods.33% is using neither traditional nor modern contraception. The unmet need for contraception according to MICS (2014) is at 10.4%.

The four key barriers to contraceptive are, insufficient knowledge about contraceptive methods and how to use them, fear of social disapproval, fear of side effects and health concerns, and women’s perceptions of husband’s opposition (John Cleland et al 2005).The provision of contraception need to address the barriers identified.

1.2PROBLEM STATEMENT

Worldwide, there are treaties and constitutions that were signed to safeguard people’s access to contraceptive information and services. Despite commitments made by various governments and international bodies, WHO 2014, estimates that there are around 222 million women who have an unmet need for contraception and the need is greatest where the risk of maternal death is high.6 out of 10 women in least developing countries who do not want to get pregnant or to postpone getting pregnant, are not using any contraception. Unmet need is high among adolescents, the poor, those living in rural areas and urban slums among other vulnerable groups. In Developing countries addressing unmet need would prevent 54 million unintended pregnancies (of whom 16 million are unsafe) and 7 million miscarriages as well as preventing 79000 maternal deaths and 1.1 million infant deaths.

In Sub Saharan Africa, in2010, contraceptive use among women was lower compared to women in other regions.23 percent of married women are using family planning in Sub Saharan Africa with 18 percent using modern method whilst 5 percent use traditional method. Sub Saharan women have a 1 in 22 lifetime risk of maternal death, compared to a risk of 1 in 7,300 for women in developed regions. Although Zimbabwe experienced a rise in contraception prevalence from 38 percent to 65 percent, the total is still low by world standards. Currently in Zimbabwe, current use of contraception for women who are married or in unions are 67 percent, with 66, 5 percent using modern methods.33percent of women were not using any method of contraception. Unmet need in Zimbabwe is 10, 4 percent which is higher than world standards (MICS 2014). Family planning coordination is still weak in Zimbabwe (Chitereka and Nduna, 2010).

1.3 JUSTIFICATION OF THE STUDY

WHO 2014 states that, unmet need is high in areas like urban slums, where there is limited access to information and services related to contraception. The researcher is prompted to carry out a study in one of the urban slums in Zimbabwe, to assess whether human rights elements have been incorporated into the provision of family planning services to women in the reproductive ages of 15-49.A micro analysis is essential in getting a closer look at family planning utilization within urban slums. The researcher have not come across a study on contraception usage focusing on urban slums and therefore the knowledge gained will be useful for government and other development partners in programming as far as reproduction is concerned.

1.4 OBJECTIVES OF THE STUDY

·         To analyse contraception as a right issue in Zimbabwe with focus on its programming in urban slums.

·         To assess level of reproductive rights knowledge amongst women aged between 15-49 years in Gweru, Mtapa ward 6.

·         To analyze, at micro level barriers to contraception usage amongst women between 15-49 years in Gweru Mtapa ward 6.

1.5 KEY RESEARCH QUESTIONS

1. To what extend has the government of Zimbabwe behold the rights of women in terms of provision of contraception services in Gweru, Mtapa ward 6?

2. To what extend has contraception been treated as a reproductive right in Zimbabwe with focus on women between 15-49 years in Gweru, Mtapa ward 6?

3.Has the human rights factor been included in the provision of contraception  in Zimbabwe?

3. What are the barriers to contraception for women in the reproductive ages 15-49 in Gweru, Mtapa ward 6?

1.6 CONCEPTUAL FRAMEWORK

Contraceptive usage among women is influenced by various factors which include variables like age, education, occupation, and religion. Age is usually associated with choice of contraception, with young women likely not using contraception as they would want to bear children, whilst older women would be more likely to want to stop child bearing and would use contraception including permanent methods like sterilization. While socio-demographic variables have a bearing on contraception usage, there are also immediate variables on contraception usage that play a central role. The mediating factors include availability, accessibility, acceptability and quality and are important in facilitating linkages between socio-demographic factors and contraception behavior.

Availability has to do with functioning public health and healthcare facilities, goods and services as well as adequate programming. Health care facilities, commodities and services should be provided in a non- discriminatory manner to ensure accessibility. Users of family planning services should be comfortable with service provision to increase acceptability and this can increase uptake for family planning services. Health care facilities should have adequate standard medical care, choice of methods, information for users, technical competence and other services to ensure quality in the provision of family planning services.

Figure 1.1Diagrammatic Conceptual Framework on use of Contraception methods adapted from Gizaw and Regassa, (2011).

 

Conceptual framework showing the determinants of contraceptive service utilization.

2. LITERATURE REVIEW

2.1 Introduction

In 2015, the world population passed the 7 billion mark and is projected to reach 9 billion by 2050, (UNFPA 2015).Population growth rate is not uniform across the globe but growth is highest in the poorest countries where governments lack adequate resources to meet demand for goods and services. Family planning services is one of the services that have a direct bearing on population growth. In Sub-Saharan Africa, women give birth to three times as many children on average as women in more developed regions in the world, (UNFPA 2105).The differences may be attributed by the desire to have larger families in Sub Saharan Africa (SSA), but differences can also be attributed to limited and unequal access in the developing world to the means to prevent unintended pregnancies, (UNFPA 2015).

Globally, the contraceptive prevalence rate has increased by 0,1%,(UNDESA,2011).Singh and Darroch,2012 noted that, three out of every four sexually active women of reproductive ages 15 to 49,who are able to become pregnant, but are not pregnant or wanting to become pregnant, are currently using contraception. There is about 1, 52 billion women of reproductive age in the developing world and 845 million are in need of contraception. Globally, 222 million women have unmet need for contraception and the need is greatest in poor communities and marginalized sub populations, (UNFPA 2015).

Cohen 2011 states that,

 “Addressing women’s concerns about modern methods and helping women who stop using one method to find a new and effective one could reduce unintended pregnancies in Sub –Saharan Africa, South Central Asia and South East Asia by 60%, and reduce abortion in those regions by more than half.”

There are a number of reasons that contributes to high unmet need in Sub-Saharan Africa. Use of contraception is determined by an individual’s wealth, level of education, ethnicity, residence and effectiveness of family planning programs within countries.

THE RIGHTS BASED APPROACH TO CONTRACEPTION

The rights based approach to contraception is premised on the notion that, people have rights which are inalienable and indivisive.Freedom is the keyword used to denote how people chose to chart their way in terms of their sexuality. WHO 2014, notes that, in cases where rights are respected, people will have satisfying sexual life. People should have freedom to choose what they want according to the International Conference on Population outcomes. States therefore had an obligation to ensure that individuals have access to information and services that enable them to exercise their freedom. States has to ensure that even third parties do not interfere with the choices people make and laws and policies that limit people‘s freedom should be abolished.

Individual rights of people should be exercised in an environment free from discrimination and inequality. Discrimination could be on the basis of sex, language, religion, race or color.UNFPA 2014, notes that discrimination has also been extended to age, perceived sexual orientation, marital status, health status and pregnancy. Of particular importance is the role of women in the provision of contraception. An estimated 222 women in the developing world lack the means to stop childbearing or to delay pregnancies. A rights based approach recognizes that women should be emancipated to make decisions about their reproductive lives and this would ensure that they have access to a wide range of contraception methods.

A right based framework entails that, marginalized groups be included in the family planning programme and violations of rights closely monitored. Where violations have been recorded, remedies should also provide. Accountability mechanisms should be included in the laws and policies within states so that, once formalized it becomes systematic to monitor both individual violations and those by health service providers. National governments have the obligation to ensure that their citizens are taught about their rights so that they are able to claim them, UNFPA 2012.

Participation and empowerment of people especially by young girls and women is also a key component of a right based approach to contraception. Empowerment of people ensured that they report violations whenever they occur. The key elements of a rights based approach to contraception are availability, accessibility, affordability and quality. These key elements define how a right based approach should be.

2.2THE HISTORY OF REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTH

Ever since mankind came into existence, they have always wanted to dominate their environment, including control over what happens to their bodies. According to Hill, (1997) people have always wanted to control actions before sex, during sex and after sex.Out of 8 reasons for sex, having a baby was found to be the least motivator to have sex.Men and women have been found to have been deciding on when and whether they can have a child. The journey towards freedom in terms of reproduction has not always been smooth but was characterized by dangers like consumption of harmful substances all in a bid to control reproduction. In a bid to control reproduction, the rights of individuals were often ignored, with various personalities fighting for freedom suffering jail and risking death.

One notable character that fought for the rights of people, especially women was an American woman named Margaret Sanger, (Planned Parenthood Report, 2012).Margaret Sanger opened the first birth control clinic in America in 1916.Sanger’s efforts were supported by Katharine Dexter McCormick, a rich widow who financed research on oral contraception (Chesler, 1992).The efforts of Sanger and McCormick led to the production of the first pill. Though it was not perfect but the pill heralded a new era in the reproduction history as it enable women to use contraception that separated vaginal intercourse and procreation, (Bullough and Bullough, 1990).Sanger also fought for women’s rights regarding the issue of condom use where condoms were prescribed to men to protect themselves from syphilis, whilst women could not enjoy that protection, (Planned Parenthood report, 2012).

2.3 INTERNATIONAL COMMITMENTS AND AGREEMENTS MADE IN THE FIELD OF REPRODUCTIVE HEALTH AND RIGHTS

The Universal Declaration of Human rights of 1948 formed the basis of other human rights commitments. It became a source of international customary law. In 1968, there was the Tehran Conference on Human rights, which declared an individual’s right to information, access and choice on the number and spacing of children. The Tehran Conference was immediately followed by the Convention on the Elimination of all forms of Racial Discrimination in 1969.This was to endorse the freedom of individuals in terms of who they are as human beings. In 1969, The United Nations General Assembly Declaration on Social Progress and Development was signed. Resolution 2542 emphasised on the provision to families of the knowledge and means necessary to enable them to exercise their rights, (UNFPA, 2010).

THE STATE OF CONTRACEPTION IN ZIMBABWE

In Zimbabwe, contraception  prevalence was reported to be 67 % for women currently married or in union.66, 5 percent use modern methods and the pill was reported to be the commonly used method, followed by injectable, (MICS 2014).33% of women in marital unions were not using any form of contraception.

Contraception usage was found to increase with women’s level of education. It also varied with the number of living children with low prevalence (7, 8%) among those with no surviving children. Contraception prevalence rate was at 65,6% for women with one child,72,8 percent for those with 2 and 78,1 % for those with three children,(MICS,2014).

Unmet need is defined as fecund women who are married or in a union and are not using any method of contraception but who wish to postpone the next birth or who wish to stop child bearing altogether,(MICS,2014).Currently ,unmet need in Zimbabwe is pegged at 10,4%.Total unmet need for Midlands province is pegged at 9,8%.Unmet in Zimbabwe has been found to be caused by cultural and religious beliefs, myths and misconceptions, lack of specialized training among the majority of  service providers and shortage of  Community Based Distributors(CBDs),(Chitereka and Nduna ,2010).

Zimbabwe is one of Southern African countries that had made significant gains in terms of increasing contraception prevalence.70 % of all sexually active women who were not pregnant were reported to be using modern methods. During the period 2006 to 2011, fertility rates increased from 3.8 to 4.1 despite the fact that there was increased use of contraception. According to Sayi 2015,Indicators collected on contraceptive use ignore the fact that women can quickly stop using one method and stop or change into another method within a short space of time.so if data is collected based on current trends it misleads the results. Sayi (2015) suggested that if there is need to research on how women face challenges in contraception, focus should be on contraception availability of options, women’s satisfaction with available methods, and availability of information on alternative methods.

According to ZHDS 2010-2011, married and never married women have different needs when it comes to contraception usage. They tend to discontinue at different rates, and use different methods.1 IN 5 women discontinue using a contraceptive method during first year of use(Sayi,2015).Most married women use oral contraception whilst never married use male condoms according to a research done by ZHDS 2010-2011.The majority of married women who use pills or other hormonal methods quit after the first year of use with the main reasons being that they were not prepared to deal with the side effects, and that service providers have not adequately addressed the question of side effects and what to do when there are side effects. The majority of never married women tend to rely on male condoms for contraception. It’s preferred because it offers dual protection, against HIV and other sexually transmitted diseases as well as pregnancy. One third of never married women discontinue use of male condoms and the reasons cited apart from wanting to become pregnant, were infrequent sex and searching for a more effective method, (Sayi, 2015).

1974 marked the beginning of world conferences on population. The first conference was held in Bucharest. Its 88 recommendations were the backbone of the future international conferences on population, with the International conference on population and development in 1994, Cairo being the landmark population conference. In 1976, the International Covenant on Economic, Social, and Cultural rights came into force. It emphasized the right of people to enjoy the highest attainable standard of physical and mental health. In 1979,The Convention on the Elimination of All Forms of Discrimination Against Women(CEDAW) came into force as a document that explicitly make specific references to family planning as key in ensuring health and well -being of families.

The International Conference on Population and Development (ICPD) in Cairo came into force. The conference was held in Cairo in 1994, and 179 Governments agreed on a 20 year Program of Action (PoA) to implement and monitor individual’s needs and rights. The Program of Action shifted attention from demographic targets to individual’s needs. Immediately after the 1994 Population conference, there was the 1995 Beijing Declaration and Platform of Action which broadens the right of women to family planning laid out in the ICPD Programme of Action.

In 2001, The Millennium Development Goals (MDGs) were formulated. The goals had clear targets and deadlines and the targets relevant to reproductive rights were: MDG-5 which states that Maternal mortality should be reduced by three quarters between 1990 and 2015.MDG-5Bstates that Universal  access to reproductive health should be achieved by 2015,(UNFPA,2010).In 2004,the 57^th  World Health Assembly was convened in which the World Health Organisation urged countries to implement new strategies in order to meet targets set out in the MDGs.A call was made to strengthen health systems in the provision of universal access to reproductive and sexual health care, with special attention to marginalized and poor groups, including adolescents and men.

In 2011The Committee on the Elimination of Discrimination against women issued a decision requesting all countries to guarantee women from all racial backgrounds timely and non-discriminatory access to appropriate maternal health services. All these treaties, conventions were all being inspired by a desire to give people control of their destinies and ensure that states are not left behind. They form a basis from which a rights based family planning framework was developed.

2.4 PROVISION OF CONTRACEPTION WITHIN THE HUMAN RIGHTS FRAMEWORK

WHO 2014, notes that standards of human rights human rights are directly or indirectly linked to family planning information and services. Direct linkage has been found to affect standards specifically referring to provision of family planning information and services whilst indirect linkage refers to standards relating to factors that inhibit uptake of services like lack of sexual education, which influence an individual’s access to, and use of contraceptive information.UNFPA 2012 report states that, people should make choices and bear the responsibility of deciding the number of children they want to have Decisions are to be made in an environment free of coercion, discrimination and violence.

“The value of a rights-based approach to family planning is that it treats individuals as full human beings in their own right, as active agents, not as passive beneficiaries”,(Wahowiak,2016).

Individuals are rights holders while governments are duty bearers that are responsible for delivering on rights, (WHO 2010). The international community agreed during the 1994 Cairo conference on population and development, services for family planning should be availed to all people who need it and States should create an environment that will enable couples and individuals to plan their families. WHO 2014, indicates that, reproductive rights should be provided in accordance with human rights principles and standards guiding provision of contraceptive information and services. The principles calls for:

1. Elimination of all forms of discrimination in the provision of contraceptive information and services
2.  
3. Accessibility  of contraceptive information and services
4. Acceptability of contraceptive information and services
5. Quality of contraceptive information and services
6. Informed decision making in provision of contraceptive information and services
7. Privacy and confidentiality in provision of contraceptive information and services
8. Participation in provision of contraceptive information services
9. Accountability in provision of contraceptive information and service

2.5 PROXIMATE DETERMINANTS OF CONTRACEPTION USAGE

Age at first marriage.

People engage in sexual activity for different reasons. Young people face different challenges in their reproductive rights issues.McQuestion, Silverman and Glassman, 2012 notes that, Sexual initiation is increasingly taking place outside marriage for adolescent girls. Early marriage among women leads to adverse effects. It leads to incomplete education, lack of decision making powers within the home and as such could not make decisions on use of contraception, thereby leading to poorly spaced pregnancies which can lead to adverse health consequencies.The more women delay marriages, the more they can finish school, increase decision making power on use of contraception and even gain knowledge on availability and choice of contraception they would want to use.

Marital Status

Although childbearing occurs mostly in legalized unions, in accordance in what is socially acceptable, adults’ needs for family planning may increase when they are single ,separated or divorced,(UNFPA,2011).Consensual unions are increasing every day and such unions are less stable and more fluid than formal marriages. Contraception is more likely to be used in consensual unions except in marriages especially in the face of increasing Sexually Transmitted diseases like HIV/AIDS.

Total living children

In a study done by Geda and Regassa (2010), women who had between 1 to 2 living children were 4.613 times more likely to use family planning services than women who had no living children. The probability of using family planning services was high among women who had 3 to 4 and above children. In Sub-Saharan Africa, when total living children happens to be girls, the likelihood of using contraception decreases as couples would need to have a boy child. As a result sex of the living children determines use or non-use of family planning.

Level of education

Level of education is closely associated with desired family size, contraceptive use and fertility,(UNFPA,2011).Lloyd 2009 found out that, adolescents in Sub -Saharan who are likely to become mothers are poor, uneducated and live in rural areas. Better educated  women marry later, use contraception more effectively, have greater knowledge about and access to contraception, exercise greater autonomy in reproductive decision –making and are aware of the consequences of unplanned babies,(Bongaarts,2010).Women with secondary education in Sub Saharan Africa  has been found to be more four times more likely to use contraception than those with no education,(Lloyd,2009).Educating women ensure that they enjoy the best attainable standard in terms of reproductive health.

Level of income

Income is closely tied to one’s level of education. An educated woman has a chance of getting a highly paying job and can afford to purchase any form of contraception, delay having children or space them as she works. Income improves women‘s chances of choosing the type of contraception method they like, access in terms of transport to a health facility, and the economics of having fewer children.

Partner’s approval of use of family planning

Opposition from a partner in regard to use of family plan reduce the likelihood of using contraception.UNFPA 2011, reported that women sometimes use covert methods such as injectables for fear of their husband’s disapproval. Rise of injectable use (6 percent to 20 percent) in Sub Saharan Africa is attributed to covert use by women, (Biddlecom and Fapohunda, 1998).

2.6 MEDIATING VARIABLES

Availability

Functioning public health and health-care facilities are key in ensuring contraception usage.Programmes should be in sufficient quantities to generate demand for family planning services.

Accessibility

The cost of contraception, distances to services, modern contraception prevalence play a key role in access to contraception.

Acceptability

Satisfaction of particular method, retention rate, uptake rate of new users and demand for the service are aspects which shows acceptability of methods. Hirsch, 2008, in a research found out that Catholic women from Mexico relied primarily on withdrawal and periodic abstinence as they said modern contraceptives were against their religious beliefs.

Quality

Quality has to do with adequate health facilities, choice of methods, and amount of information given to clients, level of technical competence, and the appropriate array of services. Providing good quality services that meet human rights standards attracts more clients and increase family planning use and reduces unintended pregnancy, (Creel, Sass and Yinger, 2002).

3. METHODOLOGY

3.1 DESCRIPTION OF STUDY AREA

The study was carried out in Zimbabwe, a country located in the Southern Part of Africa. Zimbabwe is home to a population of 13061239 according to the 2012 National census. Zimbabwe is divided into 10 administrative provinces. Midlands province is one of the administrative provinces in Zimbabwe. Midlands has a population of 1 614 941 according to 2012 National census. Midlands is further divided into 8 administrative districts. Gweru district is one of the districts in Midlands province and is the provincial capital.

The study was carried out in Gweru, the third largest city in Zimbabwe in terms of functions like commerce, transport and industry. The city was established in the late 1890s and attained municipality statuses in 1917.Gweru have 18 urban wards. Gweru urban has a population of about 157865 of which 73504 are males and 84361 are females,(Census 2012). The study  specifically focus on Mtapa, ward 6. Gweru’s suburbs are divided into high, medium and low density residential areas. The divisions emanated from colonial era in which residential status was allocated along racial lines. Among the high density suburbs are Mkoba, Mtapa, Senga, Mambo and Old Ascot and among the low density suburbs are Kopje, Lundi Park, South view and Riverside. Mtapa, ward 6 has a population of 7191 people of whom 3733 are females and 3458 are males according to 2012 National census. There are 1980 households with each household having an average size of 3.6.

3.2 RESEARCH POPULATION

The study population was based on women in the reproductive ages of 15 to 49 residents in Mtapa ward 6 and health service providers in health centers located within Mtapa catchment area. The 15-49 age groups were used because it is the standard rate used international and this helped for comparative purposes. The criteria included women within the reproductive ages 15 to 49 and resident in Mtapa and able to give informed consent. Health care workers providing family planning and related services were included in the study.

Exclusion criteria

1.  Those who were not willing to participate in the study
2. Health, mental condition rendering it impossible to obtain informed consent
3. Those who were too sick to give consent.

3.3 SAMPLING TECHNIQUE

In this research systematic sampling method, which is probability sampling was used. Systematic sampling relies on arranging the target population according to some ordering scheme and then selecting elements at regular intervals through that ordered list. The sample area was Mtapa ward 6. Enumeration areas (E.A) were used so that each and every person had an equal chance of being selected. Enumeration areas were used because they were manageable and easy to reach on foot. A list of households from the enumeration area were  written down .For the selected households, the first person to answer the door or to interface with the researcher were chosen as a research participant considering that they fit in the target population. That ensured an equal chance of selection to research targets, and it was done till the desired number was achieved. For service providers, one person per health center was interviewed.

Sample size

The sample size (n) was calculated using the following formula: n= (Zα/)*pq/

Where n= the desired sample size

Zα/=the standard normal deviate set at 1.96 corresponding to 95% confidence level

p=proportion of the women (15-49 years)

q=1-p (proportion of the total population excluding women between 15-19 years

d=maximum allowable error (Standard error) set at 0.05

Given that the total number of women in Mtapa ward 6 Ward 3733(census 2012) and the total number of women between 15-49 years was 261, the sample size was calculated as follows;

C.I =Confidence level set at 0, 95%

Sample size (n) =  = 100 women

3.4 RESEARCH DESIGN

A descriptive cross-sectional design, which examines variables ‘at the same time’ was utilized in this study. Both quantitative and qualitative research methods were used. This was ensure maximization of advantages shared by the two methods.

3.5  RESEARCH METHODS AND DATA SOURCES

Quantitative data was obtained from questionnaires administered to the target population. Qualitative data was obtained from Key informant interviews with service providers. Information was sought from service providers like Zimbabwe National Family Planning council, Gweru town council health department and Ministry of Health & Child care. Qualitative data was also gathered from focus group discussions with women in Mtapa.

3.6DATA COLLECTION TECHNIQUES

3.6.1Quantitative data

 The survey method was used to gather quantitative data as it had been observed that it was a quicker way of gathering data from many people. The questionnaire enables objectivity and validation of data on people‘s perceptions and feelings. The questionnaire was pre-coded and open ended questions were used for clarity. The questionnaire collected data on personal and socio-demographic characteristics, access to contraception information, availability and choice of methods. An English and Shona version of the questionnaire was developed to ensure language was not a barrier. The questionnaire was pretested on volunteers in the study area for purposes of error checking and time which a person would need to complete the questionnaire.Pre tested participants were not included in the final study.

3.6.2 Key Informants interview

A key informant interview guide was developed for health service providers. The key informant guide was segmented into four thematic areas of Accessibility, availability, acceptability, and quality. The interview was held with Nurse in Charge at Zimbabwe National Family Planning Council, The Nurse in Charge at Mtapa Polyclinic, The District Hospital Superintendent (Gweru), and One Community Based Distributor (CBD).

3.6.3 Focus Group discussions

Two focus group discussions were used to collect data on barriers to contraception, and reproductive rights. This was to supplement information gathered from questionnaires. Participation was based entirely on one’s willingness to participate in the discussions. Participants were from those who did not participate from any other parts of the study. Each group was made up of 9 participants to ensure the researcher had control over proceedings as a smaller group was manageable. The focus group discussion was held at Gweru polyclinic because it was accessible to everyone. Shona was the main language of communication used. The researcher moderated the flow of the discussion with one research assistant taking down important points.

3.7 DATA COLLECTION TASKS

 Data collection was done for a period covering 5 days in which 2 of the days were weekends. Weekends days were included so as to reach those who would be working during the week.

3.8 DATA ANALYSIS

Quantitative data from questionnaires was analyzed using SPSS version 18.0.Data have been presented using frequency tables and cross tabulations.

 Qualitative data from key informant interviews was analyzed as themes. Emerging issues from the discussion were documented. Responses provided by healthcare workers were grouped into themes and recurring statements and narratives were summarized.

v

3.9.1Ethical considerations

The researcher briefly introduced himself to the participants and explains that he had permission to conduct field study from Great Zimbabwe University, Gweru town council and Ministry of Health and child care. The researcher explained the purpose of the study to the participants. Participants were told about the nature of their participation that it was voluntary and they were free to discontinue participation at any given moment should they feel shortchanged or if they feel the research will bring negativity to their life. Participants were told the length of the research interview.

4. RESULTS

The research findings will be presented in this chapter. Sub-headings were used to organize findings. Organisation were as follows: socio-demographic characteristics of respondents, level of reproductive rights knowledge. Findings from key informants were organized into four thematic areas which are: accessibility, availability, acceptability and quality. Findings from focus group discussions were integrated into the four thematic areas under key informants interviews.

4.1 Socio-Demographic characteristics of respondents

A total of 100 questionnaires were administered to 100 women and the response rate was 100%.39% of the respondents were aged between 26 to 36 years and 49% were married(Table 4.1).The majority,48% of the respondents were educated up to tertiary level, whilst 5% had no education. About 34% were employed whilst 16% were unemployed. 42% of the respondents belonged to the Pentecostal religion whilst there was only one Muslim.  

Table 4.1
VARIABLE	PERCENTAGE
AGE GROUP
15-25	30
26-35	39
36-49	31
TOTAL	100
MARITAL STATUS
Single/Never married	27
Married	49
Divorced	16
Widowed	8
TOTAL	100
EDUCATIONAL STATUS
None	5
Primary	10
Secondary	37
Tertiary	48
TOTAL	100
OCCUPATION
Student	19
Unemployed	16
Self Employed	31
Employed	34
TOTAL	100
RELIGION
None	7
Protestant	13
Pentecostal	42
Apostolic Faith	21
Moslem	1
Other	16
TOTAL	100

RODUCTIVE RIGHTS KNOWLEDGE OF RESPONDENTS

Table 4.1.4  Distribution by Reproductive rights knowledge n=(100)
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	No answer	1	1.0	1.0	1.0
	Know their rights	66	66.0	66.0	67.0
	Do not know their rights	33	33.0	33.0	100.0
	Total	100	100.0	100.0

Reproductive rights knowledge

Respondents were asked whether they know their reproductive rights.66% of the respondents knew their reproductive rights, whilst 33% respondents were ignorant of what reproductive right was. Respondents were asked to list any rights that they know to cross check if they knew their rights. From the 66 respondents who said they knew their rights, only 40 of the respondents could list 2 or more rights. The most mentioned right, was the right to decide number of children.   Only one respondent did not state wether she knows her rights or not. Respondents were then asked where they learnt about their reproductive rights. 21% of the respondents knew their rights from the media, 17% knew their rights from health facilities, 14 percent knew rights from their peers, and 8% knew their rights from their husbands whilst 8% also knew their rights from seminars/training.

Respondents were then asked whether they thought their rights were being respected and 59% of the respondents thought that their reproductive rights were respected whilst 2% of the respondents felt that their rights were not being respected.26% were not sure whether their rights were being respected or not.13 % percent of the respondents did not respond to the question.

4.3 CONTRACEPTION USAGE AND BEHAVIOR

Respondents were asked whether they have used any form of contraception.73 percent of the respondents used contraception whilst 27 percent reported that they are not using any contraception.

60% of respondents in the age category 15-25 were using contraception while 40 % were not using any. In the 26-49 age category,90% of the respondents were using contraception while 10% were not using any.64% of the 36-49 age group were using contraception whilst 36% were not using any.

Table 4.3.2 marital status * use contraception Cross tabulation(n=100)
MARITAL STATUS		USE CONTRACEPTION		TOTAL
		YES	NO
	Single	12	15	27
	Married	45	4	49
	Divorced	11	5	16
	Widowed	5	3	8
TOTAL		73	27	100

Contraception usage was reportedly high within marital unions as opposed to those outside marital unions. Use of contraception was high (92%) among married women and lowest (44%) among single women.

TYPE OF METHOD USED		PERCENTAGE
	Modern Fp	69.0
	Traditional Fp	5.0
	Nothing	9.0
	Total	100.0

83% of the respondents used modern methods of family planning whilst 6 percent used traditional methods.11 percent reported that they were not using any of the methods.

82 percent of the respondents thought that it was advantageous to use contraception, while 14 percent did not see any advantage of using contraception.4 percent could not decide whether it was advantageous or not.

		Frequency	Percent
	No response	9	9.0
	Child spacing	49	49.0
	No need for more children	27	27.0
	Delay due to employment	6	6.0
	Delay due to school	7	7.0
	Other	2	2.0
	Total	100	100.0

The majority of the respondents used contraception for purposes of child spacing (49%), followed by those who did not wish to have more children (27%).

71 percent of the respondents get contraception when they need it, whilst 8 percent of the respondents could not get contraception when they are due.21 percent were not using contraception.

Table 4.3.5 Frequency distribution by  husband/partner support use of contraception(n=100)

58 percent of the respondents agreed that their husbands/partners support them to use contraception, whilst 8 percent of the respondents did not get support from their partners.7 percent reported that, they don’t know ether their partners approve or not, while 27 percent could not respond because they did not have partners.

Table 4.3.6 Frequency distribution by barriers to contraception use(n=100)

The major barrier to contraception cited by respondents was non-availability of methods (30%), followed by refusal by partner (24%).25% did not respond because they were not using contraception. Age group 15-25 reported that the major hindrance to contraception was non-availability of methods, 26-35 age group reported that refusal by partner was the major hindrance to contraception, whilst 36-49 age group reported that non availability of methods was the major hindrance.

what hinders you from using contraception * age range(n=100)
WHAT HINDERS YOU FROM USING CONTRACEPTION?		AGE RANGE			TOTAL
		15-25	26-35	36-49
		12	5	8	25
	Refusal by partner	4	14	6	24
	Religion beliefs	4	3	2	9
	Non availability of methods	7	13	10	30
	Inadequate finances	1	0	3	4
	Other	2	4	2	8
TOTAL		30	39	31	100

For the 15-25 age the major hindrance to contraception is non availability of methods, whilst the 26 – 35 age group’s major hindrance is refusal by partner. The 36-49 age group cited non availability of methods as a major hindrance to contraception.

Contraception method discussion with husband/Partner(n=100)

59 percent of the respondents reported that they discuss about contraception methods with their partners.16% percent did not discuss contraception methods with their partners.25% could not respond because they had no partners.

Across all age groups, more women discussed about contraception methods than those who did not discuss with their husbands or partners.

4.4FINDINGS FROM KEY INFORMANT INTERVIEWS WITH HEALTH PERSONNEL

4.4.1. Availability

Availability of methods

On availability of contraception, health personnel reported that the contraception methods were always available and stock outs were rare. However further investigation through focus group discussions revealed that, it’s only a few contraception methods that are available readily. Whereas the other methods or procedures are to be performed in clinics, their costs are prohibitive thereby forcing women to scramble for the fewer cheaper alternatives that will be available. The issue of emergency contraception is not fully explained to women as they think it is for survivors of sexual violence.Stockouts of emergency contraception are reported in Gweru usually during the opening period of Midlands state university. There is a weak supply chain of contraceptives from the Ministry of health to council run clinics. Women reported that, contraception was not a priority issue in terms of budgeting within the home, therefore they are forced to do away with the cheaper options, which are often discontinued due to health reasons.

Availability of trained personnel

Health personnel reported that, for community based distributors, most of the agents are old and are not as highly mobile as before. Women who participated in focus group discussions highlighted that, the service providers may be trained in the technical aspect of supplying contraceptives, but they lack in the customer relations aspect as they have sometimes prescribe contraceptives without explanations on its side effects and what to do when the side effects occur. Service providers cited limited resources for programs as a major obstacle towards educating women on the use of contraception. Funds for contraception methods were said to be enough, but funds for demand generation programs were limited even though they were budgeted for, sometimes the funds were not released. Health personnel from ZNFPC felt that the number of staff was adequate to meet demand for the services.

4.4.2Accessibility

On accessibility, the researcher found out that, there exists social norms restrict access to contraception. During focus group discussion, women cited that they had difficulties in trying to have the men wear a condom as they are supposed to be passive when it comes to sexual matters within the home. The issue of giving contraceptives especially to young adolescents has not been well received in Mtapa with women equating giving condoms to young women as giving them passport to go and indulge in sex.

The health personnel reported that even adolescents are provided with contraception methods of their choice but usually after counselling.Apart from social norms being a barrier in access to contraception, the cost of contraception is also prohibitive to many women. While it is the duty of the government to subsidies contraception methods, not all methods are subsidized. 4.4.3Acceptability

During focus group discussions women reported that, it was difficult for them to accept modern contraception as it is against their religion. They however cited that they use traditional methods like withdrawal and rhythm methods.However,they said they have discouragement from other women in society citing that the traditional methods are less effective compared to the modern methods. Findings from health personnel revealed that, in most instances traditional methods are not mentioned as alternatives to women, and the methods are not given much publicity even in the media and some health pamphlets.

Client retention as a reflection of acceptability

ZNFPC clinic cited that they serve an average of 27 people per day while Mtapa polyclinic serve an average of 30 women per day.ZNFPC cited that the retention rate is high from 97% to 100%.Health personnel felt that there are programs on Televisions and other media outlets that negatively portray family planning. These myths and misconceptions hamper efforts to increase uptake of contraception.

Health personnel felt that, long term methods of contraception are expensive for most women and the y should be subsidized .The long acting methods are costly to insert and you have to pay again for removal which is expensive.

4.4.4Quality

Quality of service provision

Women cited that, service providers take for granted that they know about contraception information therefore they just dispatch without proper counselling or the counselling session is just hurried as a formality. For adolescents, it’s usually done in a way that is sometimes threatening or seems to discourage them to use contraception when they have not become pregnant. In depth interview with health personnel revealed that, high retention rates of clients is a sign that they provide quality service and contraception methods to women. Clients are followed up especially for other services like Pap smear for cervical cancer screening.

Quality of methods

Complains of side effects of drugs were cited by women. They complained that, hormonal methods are carcinogenic (cancer causing).One health personnel with the Ministry of health explained that, they sometimes do not publicise or encourage use of natural methods since there haven’t been researches to establish the effectiveness of the methods.

4.5. FINDINGS FROM FOCUS GROUP DISCUSSIONS

4.5.1Contraception knowledge, and use.

Women reported that, they sometimes use available methods like pills not because it’s their prefer method, but because it’s cheaper and the only available option at the clinic apart from condoms. One woman had this to say,

“Ndinonwa mapiritsi asi handitoadi, ndingaite sei, murume haadi zvemakondomu,anoita nhumbu ndini,saka kushanda nezviripo ndiko kwandinotoiita.”(I take pills although I don’t like them, what I can do when my husband doesn’t want condoms, I am the one who gets pregnant, and so I use what is available.)

Woman reported that, they sometimes forget to take their pills because of fatigue after working hard during the day. This usually led to unplanned pregnancy. On whether they knew choices available to them, women reported that, some of the methods they only knew them from pictures but had never used them because they are expensive or they have adverse side effect. The Depo Provera was reported to causes headaches and weight gain by women. However, women who cited that, their husbands disapprove their use of contraception reportedly say they chose injection as it is not detectable and they would prefer to have the procedure in town far away from the nearest clinic where they fear being reported to their husbands by relatives or the nurses might comment on the issue one day in the presence of the husband.

Asked about their husband’s attitude towards family planning, one women had this to say,

“Baba vekwangu vakanditi uri mukadzi mukuru iwe,wona yekutamba,ini ndiripo kubata basa rangu chete,wether waita nhumbu or not ndezvako.”(My husband told me that I am a grown up woman, I should see what I should do so that I do not get pregnant, and he is there to sleep with me only, whatever the outcome he does not care).

5.0 DISCUSSION OF RESULTS

5.1 INTRODUCTION

Through combining qualitative and quantitative research methods, research objectives were met as set out in the beginning. The study was meant to assess whether   contraception was a reproductive right or not. The purpose of the study was to preempt the components of contraception provision in light of family planning.

5.2 CONTRACEPTION AS A REPRODUCTIVE RIGHT

In light of how contraception has been treated in Zimbabwe, particularly Mtapa area, the researcher found out that contraception is a reproductive right, but it’s being treated as a privilege. A right is inalienable, yet in Mtapa women reported that there are certain methods of contraception that are beyond their means due to cost, thus they are alienated from accessing them. The local clinics placed in urban slums of Mtapa do not have the same services as those clinics located in town, thus there seems to be a discriminatory tendency based on social economic status. For private providers of Contraception, the key word to them is profit and loss hence they do not readily follow up on clients to see progress on contraception quality and acceptability.

The human rights principle states that information on contraception should be readily available for people to make informed decisions freely on the choice of contraception methods, yet the study has found out that, traditional methods are shunned upon by health providers and they are not given much publicity in the media.

The issue of side effects of hormonal methods has not been adequately addressed with women complaining that, they are always referred from one method to another simply because the health providers in the private sphere do not want to lose business. On the part of the government there is lack of an appropriate accountability mechanism to monitor provision of contraception services in the private sector.

99% of the women have heard about contraception.73% of the women reported that they were using contraception while 27% were not using any contraception. Knowing that there is contraception did not translate to a similar percentage on use. Use of contraception was high among married women (92%) compared to single women (44%).This is because married women are exposed to the risk of pregnancy more than single women. The most preferred choice of contraception was modern methods (69%) and women have cited that modern methods are effective than the traditional method. The percentage of women who said that it was advantageous to use contraception was 82%, which saves to confirm that what the women said about effectiveness of modern methods of contraception during the focus group discussions.

One of the major reasons why women use contraception was the need to space children(49%)followed by the need to stop child bearing completely(27%).Women reported that, spacing of children would allow a women to recover from the effects of pregnancy and breastfeeding, as well as enabling one child to experience maximum attention from the mother. One women, during a focus group discussion said, today‘s economy demand that children are spaced so that when they go to school, a parent will have time to mobilize resources like fees and uniforms adequately if grades are spaced. One young woman reported that, contraception was good because she can focus on her studies, enjoy sex without worrying about pregnancy but she was worried about later effects on child bearing due to continued use of contraception.

5.3CONTRACEPTION AVAILABILITY, AFFORDABILITY, ACCESSIBILITY AND QUALITY

Despite the fact that, 71 % of the women acknowledged that they get contraception when they are due, it is the type of contraception that they get that worries them.71% of the women used the pill as the method of contraception, but it was not by choice that they chose pills. Pills, were easy to access due to cost as one key informant states that a dollar could buy three month’s supply of pills. Women cited that, they forgot to drink pills and usually results in unplanned pregnancy. One women had this to say about pills,

“Baba kana ndisingadi kuvaitira mwana vanobaya mapiritsi netsono opinda mhepo mimba yotobata, saka ndichida hangu jekiseni ravasingaone, asi mari yekubaiwa ndoyandinenge ndisina”. (When I refuse to have another baby ,My husband would prickle my pills with a needle so that I get pregnant, that’s why I prefer to use injection which he cannot see, but I don’t have the money for injection.)

This highlights that, when contraception is to be provided as a rights, then it has to be affordable to all women. Women complained that, the methods that they would really want are beyond their pockets hence they are forced to use methods that suits their pockets. They complained that they have to pay to have a Norplant and have to pay again to have it removed, which to them is costly and a preserve for the rich. The cheaper methods of contraception are often disadvantageous to women as for example one women had this to say during the focus group discussion,

“Mapiritsi ndinokanganwa kunwa,baba ndikavati pfekai kondomu havadi,hanzi rinondipedzera nguva yekubata basa rangu(interrupts sexual activity).Depo rinondinzwisa musoro,saka ndinotomboedza zvekuverebga mazuva angu(calendar/rhythm method) pamwe zvingandibatsira asi ndinoziva zvinogona kuwedzera njodzi yekubata pamuviri”.(I usually forget to take pills, my husband says a condom interrupts sexual activity and waste valuable time .Depo causes me to have headaches so I use rhythm method, maybe it will help although I knew that it’s not safe.)

Apart from the prohibitive cost of the contraception its side effects were noted as a barrier to effective family planning.

One of the major barriers to contraception that women cited was non availability of the method. On further analysis, it was noted that, on availability was not confined to cost only, but to lack of the method in terms of trained personnel who can offer the method to the actual contraceptives. Mtapa is serviced by one council run polyclinic, and 5 other health centers located in town where women can get contraception. Although the Ministry of health highlighted that, they seldom experience stock outs, women reported that, they oftentimes use the cheaper available methods just because it’s the only choice they have.

In terms of partner’s support for use of contraceptives, women reported that their partners would agree after they knew the type of contraception to be used first. This was because partners were reported that they did not prefer to use condom especially in marital unions. Women reported that their partners/husbands did not want to use barrier methods that interrupts sexual intercourse, despite the dual function of the condom. Male sterilization was also one of the methods that men did not want to hear about but at the same time they wanted their spouses to have tubal litigation. If contraception is provided in a right based framework where each partner can have their decision respected, it will greatly improve contraception usage.

5.4 REPRODUCTIVE RIGHTS KNOWLEDGE

66% percent of the women reported that they knew their reproductive rights, while 33 percent did not know what their rights were. However, of the 66% who said they know their rights, only 20% of them were able to list more than three rights. The most mentioned right women pointed out was the rights to decide number of children.Howevr the majority of the women reported that it was their husbands who decided on the number of children and usually the number was guided by the sex of the children. Husband prefer to have male children more than daughters.

59% of the women felt that their rights were being respected. However; respect for rights was not translating into increased use of contraception by women. The major source of reproductive rights information was the media. Women reported that, information from the media sometimes confuse them especially if they read about side effects caused by modern methods of contraception. If only more information about reproductive rights and contraception could be provided through healthy facilities where there are trained personnel, then women can grew in confidence over the use of contraception.

5.5RECOMMENDATIONS

Increasing uptake of contraception calls for increased information on reproductive rights and treating contraception as a right. People should know their right so as to defend them. The media should be carefully monitored so that information disseminated to people is not negatively affecting women’s confidence on the use of contraception. Government as the responsible authority should ensure that the provision of contraception is done in an atmosphere that respects people’s rights. Being a signatory to various international bodies that calls for the protection of rights, the government should make sure contraception is accessible,affordable,and the quality meet the World health Organisation standard. Enough funds should be budgeted so that no stock out are experienced during the time when demand is at its peak. Through the Ministry of Women Affairs, Gender and Community Development, more programs on empowerment of women would help to increase women‘s decision making within the home.

The traditional methods of contraception should be given same media coverage like the modern methods and enough research should be done on the efficiency of the traditional methods. Funds should be made available to health providers so that they can increase demand generation for the services and address misconceptions on the use of modern contraception. The issue of emergency contraception should be adequately addressed especially to adolescents so that their choices increase.

5.6 CONCLUSION

A rights based contraception programming relies much on the interaction between the rights holders and right protectors. While it is the responsibility of the government to ensure that rights are being respected. It is also prudent that, people should claim their rights and it calls for people to know what their rights are in the first place.

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APPENDICES

 Appendix I: Questionnaires to women in between 15 to 49 years - English

Version

Hello, my name is _______________________. I’m from___________________.

I am interested in your level of knowledge concerning contraception and reproductive rights.

I would want to know factors that drive you to use or not to use contraceptive methods. I would like to know concerns that you have in regards to contraception. I would like to ask you a few questions and would be very grateful if you would spend a little time talking with me. I will not write down your name, and everything you tell me will be kept strictly confidential. Your participation is voluntary, and you are not obliged to answer any questions you do not want to answer.

Do I have your permission to continue?

A. SOCIO - DEMOGRAPHIC DATA

Code. No.______________ Date of Interview:………/…………/…………………

Interview Schedule

Topic:

Section A – Demographic Data

In this section I will ask you questions about yourself. Please feel free to answer the questions to the best of your ability.

1.       How old are you? Years

1.15-25………………………………………………………………

2.26-35……………………………………………………………

3.36-49……………………………………………………………..                               

2. What is your marital status?

1. Single………………………………………………………….

2. Married………………………………………………………

3. Divorced ……………………………………………………

4. Widowed……… ……………………………………………

3. What is your level of education?

1. None …………………………………………………………..

2. Primary ………………………………………………………..

3. Secondary …………………………………………………….

4. Tertiary  ………………………………………………………..

4. What is your occupation?

1. Student ……………………………………………………

2. Unemployed……………………………………………

3. Self- employed…………………………………………     

4. Employed………………………………………………..    

5. What is your religion?

1. None …………………………………………………………….

2. Protestant……………………………………………………..

3. Pentecostal……………………………………………………

4. Apostolic Faith……………………………………………….

5. Moslem…………………………………………………………

6. Other……………………………………………………………

6. Whom do you live with at the moment?

Alone ……………………………………………………………..

Husband/Boyfriend………………………………………..

In-laws…………………………………………………………….

Parents…………………………………………………………….

7. How many children do you have?

Zero ………………………………………………

One………………………………………………….

Two and above…………………………………

B: REPRODUCTIVE RIGHTS KNOWLEDGE

8. Do you know your reproductive rights?

1. Yes……………………………………………………

2. No……………………………………………………..

9. if your response is “Yes”, where did you get information about your reproductive rights?

1. Media…………………………………………………

2. From peers………………………………………..

3. From husband/partner……………………..

4. Seminar/training……………………………….

5. Healthy Facility………………………………….

6. Other……………………………………………………………

10. Can you list any 5 reproductive rights that you know of?

1……………………………………………………………………………………..

2……………………………………………………………………………………..

3……………………………………………………………………………………

4……………………………………………………………………………………

5……………………………………………………………………………………

11. Are your reproductive rights being respected?

1. Yes……………………………………………………………………………

2. No…………………………………………………………………………….

3. Not sure………………………………………………………………….

SECTION C.CONTRACEPTION KNOWLEDGE AND USAGE

12. Have you ever heard of Contraceptive methods?

1. Yes………………………………………………….

2. No…………………………………………………..

13. If your response to Q.12 above is “Yes”, where did you get information about the

Contraceptive methods?

1. Media…………………………………………….

2. From peer………………………………………

3. From husband/partner…………………..

4. Seminar/training…………………………….

5. Health facility…………………………………

14. If your response to question 12. Above is “yes” Which types of contraceptive method do

you know? Put a tick if the respondents’ answer is Yes

1. Pills …………………….………………………….

2. Intrauterine device (IUCD)……………….

3. Injectable (Depo - Provera) …………….

4. Condom (female) ………………………………………………

5. Condom (male) …………………….……………………………

6. Vasectomy/Male sterilization …………………………...

7. Tubal ligation/female sterilization ……………….……

8. Emergency Contraception……………………………….

9. Periodic abstinence ………………………………………….

10. Prolonged breast feeding …………………….…………

11. Natural methods ……………………………………………

12. Others (specify)__________________________________

15. Are you using any contraceptive method?

1. Yes……………………………………………………………………..

2. No……………………………………………………………………..

If Yes,

16. What type of contraceptives methods are you using?

1. Modern FP methods……………………………………….

2. Traditional………………………………………………………

3. Nothing…………………………………………………………..

4. Others (Specify)____________________________

17. If your response to Q.15 above is “No”, why are you not using any contraceptives?

1. Spouse does not approve………………………………………..

2. It is against religion teaching…………………………………..

3. Afraid of side effects…………………………………………………

4. I do not know where to access them……………………….

5. Other…………………………………………………………………………………………………..

18. Do you think that there are any advantages with the use of contraceptive methods?

1. Yes…………………………………………………………………….

2. No…………………………………………………………………….

19. if your response to Q.18 above is” Yes” what are advantages with use of

contraceptive methods? Please write the responses to the space provided.

1……………………………………………………………………………………

2……………………………………………………………………………………

3………………………………………………………………………………

20. What would be the reasons for you to use contraceptives methods?

1. Child spacing………………………………………………………..

2. No need for more children…………………………………..

3. Delay due to employment…………………………………….

4. Delay due to school………………………………………………

5. Other (specify)________________________________________

21. Where do you always get the contraceptives?

1. Hospital/Health institutions…………………………………..

2. Drug vender/pharmacy…………………………………………….

3. Shop………………………………………………………………………..

4. Community Based Distributors agents (CBDs)……………

5. Other (specify)_______________________________

22. Do you get your contraceptive method when you are due?

1. Yes………………………………………………………………………………..

2. No………………………………………………………………………………….

23. If your response to Q.19 Above is “No”, why?

1. Clinic stocked out……………………………………………………………

2. Money for acquiring contraception…………………………………

3. Busy…………………………………………………………………………………

4. Other………………………………………………………………………………

24. What do you do when you do not get your contraceptive method from the clinic?

1. Purchase from the Pharmacy……………………………………..

2. Use of alternative method…………………………………………

3. Do not use any method…………………………………………….

4. Others (specify)………………………………………………………..

25. Where would be the most convenient place for you to get contraceptives?

1. Hospital/health institutions…………………………………….

2. Reproductive and Child Clinic………………………………….

3. Pharmacy…………………………………………………………………

4. At home /community based distributors………………..

5. Other (Specify)……………………………………………………………..

26. Does your husband/partner support if you want to use contraceptive methods?

1. Yes…………………………………………………………………………….

2. No……………………………………………………………………………..

3. I don’t know……………………………………………………………….

27. What would you regard as factors that will hinder you from using contraceptives?

1. Refusal by husband/partner………………………………………

2. Religion believes…………………………………………………………..

3. Non availability of FP methods……………………………………..

4. Inadequate financial support – for transport to visit health institution…….

5. Other (specify)………………………………………………………………………………………………………………………..

28. Do you discuss contraceptive methods with your husband/partner?

1. Yes………………………………………………………………

2. No……………………………………………………………….

29. If your response to Q. 29 above is “NO” why?

1. He does not approve…………………………………….

2. It is against cultural norms……………………………..

3. Others…………………………………………………………..

(specify)……………………………………………………………..

30. Whom do you prefer as service provider?

1. Female service providers for women…………………

2. Male service provider for men………………………….

3. Community Based Distributors (CBDs)…………………

4. No sex preference…………………………………………….

31. Whom would you comfortably talk to when you need to ask something about

Contraceptive methods?

1. Husband/Partner……………………………………………….

2. Relatives……………………………………………………………

3. Friends of opposite sex………………………………………

4. Friends of the same sex……………………………………

5. Health care providers……………………………………..

6. Others (specify)_______________________________________

32. Who decides on the number of children you have?

1. Husband/partner…………………………………………….

2. My self…………………………………………………………….

3. Family members/Close relatives……………………….

4. Parents…………………………………………….

5. Others (specify) _______________________________

33. Have you ever informed your partner of using contraceptive methods?

1. Yes; If the answer is “yes” give reasons to support your answer

……………………………………………………………………………………

……………………………………………………………………………………

2. NO; if the answer is “No” give reasons to support your answer

……………………………………………………………………………………

……………………………………………………………………………………

THANK YOU VERY MUCH.

Appendix ii:Questionnaires to women in between 15 to 49 years - Shona

Version

Kwaziwai,Zita rangu ndinonzi _______________________. Ndabva ku___________________.

Ndirikuitawo tsvakurudzo yezveruzivo rwekodzero dzevanhu maererano nezvekurongwa kwemhuri .

Ndingadewo kuziva zvikonzero zvinoita kuti mushandise kana kusashandisa nzira dzokuronga mhuri uye kana muine zvichemo maererano nenyaya dzekuronga mhuri.Ndichakubvunzaiwo mibvunzi mishomanana uye ndingave nekutenda kana mukandipawo mukana wekumbotaura nemi.Handinyori zita renyu,uye zvese zvatichataura nezvazvo zvichachengetedzwa.Zviri kwamuri kugamuchira kubvunzwa uku,uye munotenderwa kurega kudaira mibvunzo yamusingadi.

Ndingaenderera mberi here?

A. SOCIO - DEMOGRAPHIC DATA

Code. No.______________ Zuva reBzvunzurudzo:………/…………/…………………

Interview Schedule

Topic:

Chikamu chekutanga – Nhoroondo Yemubvunzwi

Muchikamu chino ndichakubvunzai  pamusoro peupenyu hwenyu. Sunungukai henyu kupindura mibvunzo sekuziva kwamunoita.

2.       Mune Makore manganic okuberekwa?

1.15-25………………………………………………………………

2.26-35……………………………………………………………

3.36-49……………………………………………………………..                                

2. Makamirasei panyaya dzewanano?

1. Handina kuroorwa………………………………………………

2. Ndakaroorwa………………………………………………………

3. Takarambana ……………………………………………………

4. Ndakafirwa nemurume……… …………………………………

3. Makadzidza kusvika parugwaro rwupi?

1. Handina kuenda kuchikoro ………………………….

2. Puraimari ………………………………………………………..

3. Sekondari …………………………………………………….

4. Kumakoreji  ………………………………………………………..

4. Munoita basa rei?

1. Ndirikuchikoro ……………………………………………………

2. Handishandi…………………………………………………

3. Ndinozvishandira…………………………………………     

4. Ndakabairwa chitupa……………………………………    

5. Munopinda Kereke ipi?

1. Handipindi kereke…………………………………………………………….

2.Ma Protestant……………………………………………………..

3. Ma Pentecostal……………………………………………………

4. Positori……………………………………………….

5. Moslem…………………………………………………………

6. Imwewo……………………………………………………………

6. Munogara nani?

1.Ndega ……………………………………………………………..

2.Murume wangu/Shamwarikomana………………

3.Vabereki vemurume………………………………………

4.Vabereki vangu…………………………………………………………….

7. Munevana vangani?

1.handina vana ………………………………

2.Umwe………………………………………………….

3.Vanopfuura vaviri…………………………………

CHIKAMU CHEPIRI: RUZIVO MAERERANO NEZVEKODZERO DZEKURONGA MHURI

8. Munoziva here kodzero dzenyu maererano nekuronga mhuri?

1. Hongu……………………………………………………

2. Kwete……………………………………………………..

9. Kana mhinduro yenyu iri “Hongu”, Munowana kupi ruzivo runechokuita nezvekuronga mhuri?

1. Mapepanhau……………………………………

2. Vamwe vezera rangu…………………………

3. Kubva kumurume wangu/umwe wangu……

4. Gungano redzidzo/Kudzidziswa………

5. Nzvimbo dzezveutano………………………

6. Zvimwewo……………………………………………………………

10. Mungadomawo here kodzerodzezvekuronga mhuri dzamunoziva?

1……………………………………………………………………………………..

2……………………………………………………………………………………..

3……………………………………………………………………………………

4……………………………………………………………………………………

5……………………………………………………………………………………

11. Kodzero dzenyu dzezvekuronga mhuri dzirikuteedzerwa here?

1. Hongu……………………………………………………………………………

2. Kwete…………………………………………………………………………….

3. Handina chokwadi……………………………………………………

CHIKAMU CHETATU.NZIRA DZEKUDZIVIRIRA PAMUVIRI,KUDZIZIVA NEKUDZITEEDZERA

12. Makambonzwa here nezvenzira dzekudzivirira pamuviri?

1. Hongu………………………………………………….

2. Kwete…………………………………………………..

13. Kana mhinduro yenyu pa Q.12 iri “Hongu”, ruzivo rwezvekudzivirira pamuviri munoruwana kupi?

1. Mumapepanhau…………………………

2. Kuvanhu vezera rangu………………

3. Kumurume/umwe wangu…………………..

4. Dzidziso dzegungano/Kudzidziswa

5. Nzvimbo dzezveutano…………………

14. Kana mhinduro yenyu pa 12. iri “Hongu” Ndedzipi nzira dzamunoziva dzekudzivirira pamuviri? Put a tick if the respondents’ answer is Yes

1. Mapiritsi …………………….………………………….

2. Intrauterine device (IUCD)……………….

3. Jekiseni (Depo - Provera) …………….

4. Makondomu (echidzimai) ……………………………

5.Makondomu (echirume) …………………….…………

6. Vasectomy/Male sterilization …………………………...

7. Tubal ligation/female sterilization ……………….……

8. Emergency Contraception……………………………….

9. Kurega zvebonde………………………………………….

10. Kuyamwisa mwana kwenguva yakareba …..

11. Nzira dzechinyakare ……………………………………………

12. Zvimwe (Tsanangura)__________________________________

15. Murikushandisa nzira dzekudzivirira pamuviri here?

1. Hongu……………………………………………………………………..

2. Kwete……………………………………………………………………..

Kana mati hongu,

16. Ndedzipi nzira dzamuri kushandisa?

1. Dzechizvinozvino……………………………………….

2. Dzechinyakare………………………………………………………

6. Handina dzandinoshandisa……………………………

7. Zvimwewo (Tsanangura)____________________________

17. Kana mhinduro yenyu pa Q.15 iri “Kwete”, Nei musina Nzira dzekudzivirira pamuviri dzamunoshandisa?

1. Murume wangu haadi………………………………………..

2. Hazvienderani nechitendero changu……………………

3. Ndinotya kuzorwara nenzira idzi…………………………

4. Handizivi kwekuwana nzira dzekuzvidzivirira pamuviri

5. Zvimwewo…………………………………………………………………………………………………..

18. Munofunga kuti kushandisa Nzira dzekudzivirira pamuviri kunobatsira here?

1. Hongu…………………………………………………………………….

2. Kwete…………………………………………………………………….

19. Kana mhinduro yenyu pa Q.18 iri” Hongu” Nzira dzekudzivirira pamuviri dzinobatsirei? .

1……………………………………………………………………………………

2……………………………………………………………………………………

3………………………………………………………………………………

20. Ndezvipi zvikonzero zvingaite kuti mude kudziviririra pamuviri?

1. Kupatsanura vana………………………………………………………..

2. Handichada kuzvara vamwe vana…………………………………..

3. Ndirikuda kumboseenza basa…………………………………….

4. Ndirikuda kumboenda kuchikoro……………………………

5. Zvimwewo (Tsanangura)________________________________________

21. Munowanzowanepi nzira dzekudziviririra pamuviri?

1. Chipatara/Nzvimbo dzezveutano…………………………………..

2. Vanotengesa munzira/Muchitoro chemishonga………

3. Muchitoro………………………………………………………………………..

4. Vanofamba vachipa vanhu munharaunda (CBDs)……………

5. Zvimwewo (Tsanangura)_______________________________

22.Munowana nzira dzekudzivirira pamuviri pese pamunodzida here?

1. Hongu………………………………………………………………………………..

2. Kwete………………………………………………………………………………….

23. Kana mhinduro yenyu pa Q.22 iri “Kwete”, nemhaka yei?

1. Hakuna Kuchipatara……………………………………………………………

2. Handina Mari yekutenga…………………………………

3. Handina nguva yekutsvaka…………………………………………

4. Zvimwewo………………………………………………………………………………

24. Munoita sei kana muchinge mashaya nzira dzekudzivivirira pamuviri?

1. Ndinotenga muzvitoro zvemishonga……………………………………..

2. Ndotsvaka dzimwe nzira…………………………………………

3. Handina chandinoshandisa…………………………………………….

4. Zvimwewo (Tsanangura)………………………………………………………..

25. Ndeipi nzvimbo yakanaka yekuwana nzira dzekudzivivirira pamuviri?

1. Kuchipatara/Nzvimbo dzezveutano…………………………………….

2. Nzvimbo dzezveutano hwekuronga mhuri nekuchengetwa kwevana………………………………….

3. Chitoro chemishonga…………………………………………………………………

4. Kumba /vanofamba vachipa vanhu munharaunda………………..

5. Zvimwewo (Tsanangura)……………………………………………………………..

26. Murume wenyu/Shamwari yepabonde inotsigira here kushandisa zvekudzivivrira pamuviri?

1. Hongu…………………………………………………………………………….

2. Kwete……………………………………………………………………………..

3. Handizivi……………………………………………………………….

27. Ndezvipi zvamungati zvinokutadzisai kuwana nzira dzekuzvidziviririra?

1. Ndinorambidzwa nemurume/Shamwari yepabonde………

2. Chitendero changu chinondirambidza……………………………

3. Hakuna nzira dzacho dzekudzivivirira pamuviri………………

4. Kushaya mari yakakwana – Yekuenda kunotenga uye yokutengesa nzira dzekudzivirira pamuviri…….

5. Zvimwe (Tsanangura)………………………………………………………………………………………………………………………..

28. Munombokururkura here nemururme wenyu nezvenzira dzekudzivivirira pamuviri ?

1. Hongu………………………………………………………………

2. Kwete……………………………………………………………….

29. Kana mhinduro pa Q. 28 iri “Kwete” Nmemhaka yei?

1. Murume haadi kuti tikurukure…………………………………….

2. Hazvienderani netsika dzedu……………………………..

3. Zvimwewo …… (Tsanangura)……………………………………………………..………………………………………………………..

30. Ndiani wamungade kuti akubatsirei panezvekuronga mhuri?

1. Mukadzi abatsire umwe mukadzi………………………

2. Murume abatsire umwe murume………………………….

3.  Chero anenge abatsira………………………………………

31. Ndiani wamungataura naye makasununguka kana pane zvamunoda kubvunza maererano nekudzivirira pamuviri?

1. Murume/Shamwari yepabonde……………………………………………….

2. Hama………………………………………………………………………………………

3. Shamwari dzeChirume………………………………………

4. Shamwari dzechikadzi……………………………………

5. Vezveutano……………………………………..

6. zvimwe (Tsanangura)_______________________________________

32. Ndiani anomisikidza uhwandu hwevana vamuchazvara?

1. Murume/Shamwari yepabonde…………………………………………….

2.Ndini…………………………………………………………….

3. Mhuri yese/Hama dzepedyo……………………….

4. Vabereki…………………………………………….

5. Zvimwe (Tsanangura) _______________________________

33. Makamboudza umwe wenyu here nezvekudzivirira pamuviri?

1. Kana mati hongu ipai zvikonzero zvinotsigira mhinduro yenyu.

……………………………………………………………………………………

……………………………………………………………………………………

2. Kana mati kwete,ipai zvikonzere zvinotsigira mhinduro yenyu.

……………………………………………………………………………………

……………………………………………………………………………………

Tinotenda,Mazviita.

Appendix III: Key informant interview guide for service providers

Hello, my name is _______________________. I’m from___________________.

I am interested in your level of knowledge concerning contraception and reproductive rights.

I would be grateful if you would spend a little time talking with me. I will not write down your

name, and everything you tell me will be kept strictly confidential. Your participation is

Voluntary and you are not obliged to answer any questions you do not want to answer.

Do I have your permission to continue?

Date:……………………

Name of the HF:………………………………………………………

Level of the HF service provider…………………………………………….

Title of the HF service provider…………………………………………………

Sex……………………………

Age………………………………….

KEY QUESTIONS

AVAILABILITY

1. How would you describe availability of contraceptive methods? Do you often experience stock outs? What happens when there are stock outs?

2. Are the funds budgeted for family planning enough? Are there any budgets set aside for demand generation for family planning services?

3. How many service providers are you in this facility? Is the number adequate to meet

the demand from the clients you are attending?

4. How long have you been working in this facility and this section/unit?

ACEESIBILITY

5. Do you ask women about their marital status when they come for services in your facility? Do you provide contraception to adolescents?

6. What contraceptive methods do women usually prefer in this health facility?

7. Is the cost for modern contraception affordable for women? What is the uptake rate for new users in Gweru Urban?

8. Why do you think it is important for women to use contraceptive

Methods? Why?

ACCEPTABILITY

9. How many clients does your facility serve per day? What is the rate of client retention for your services?

10. Are there any barriers that reduce acceptability of contraceptive methods?

11. What suggestions can you make to improve women’s use of contraceptive methods at this facility?

12. What would you propose as an alternative approach to increase the use of contraceptive methods among women attending health?

QUALITY

13. How would you describe the quality of contraceptive methods offered from this health facility?

14. Are you satisfied with the level of services you are offering your clients?

15. Do you follow up on your clients?

16. Is there any mechanism for you to judge client satisfaction?

THANK YOU VERY MUCH.

Appendix IV: Informed consent - English Version

ID. No _____________________

Consent to participate in this study

I am Takawira Admire. I am a student at Great Zimbabwe University.

Purpose of the Study

Dear respondent I would like to inform you that this is research study titled. An assessment of contraception as a reproductive right in Gweru, Ward 6.I would like to let you know about your right pertaining to participation in this study. This study is aiming at determining level of contraception use and reproductive rights knowledge among women in ward 6 regardless of marital status. Please be honest and true for betterment of the results that lead to better intervention and recommendations for future.

Benefits

The information you provide will help to increase our understanding level of contraception use as well as knowledge of reproductive rights. This will help in future programs to enhance use and safeguarding people’s rights in terms of reproductive health.

 In case of injury.

We do not anticipate that any harm be it physical or emotional to occur to you or your family as a result of participating in this study.

Confidentiality

We will protect your confidentiality to the best of our knowledge and ability. We will not write your name on the questionnaire or in any report/documents that might let anyone to

Identify you. Your name will not be linked with the research information in any way.

The investigators will put the data under lock and key.

Right and withdrawal alternatives

Your participation is voluntary. You may decline to participate in this study at any stage.

Your decision to participate or not will not be associated with your right to get public services from your Ward or street. There is no penalty in this study. If any damage will occur, it is not expected that there will be any damage for your participation as the respondent to this study.

Who to contact

If you have any questions about this study, you should contact the study Coordinator

OR the Principal Researcher, Takawira Admire. Great Zimbabwe University student. Mobile number 00263773409916

Signature………………………………………

Do you agree........................................................

Participant Agrees ……………………………….