Understanding how women from ethnic minorities access and experience contraception in the UK; using a Participatory Action Research Approach with Community Research Link Workers.

Problem

The benefits of contraception are well recognised and access to satisfactory family planning is a UN Sustainable Development Goal and human right. Despite free contraception in the UK, there are still unmet access needs. Unplanned pregnancies comprise 45% of pregnancies in England and carry increased risks for mother and baby,. In the UK, approximately 26% of women aged 16–49 years use hormonal methods of contraception, and 59.1% of women obtain contraception in general practice. Data on contraceptive access for women from Black, Asian and ethnic minority groups is lacking but it is strongly suspected that they are disadvantaged. Furthermore, ethnic minority women’s access to contraception is thought to have been disproportionately affected by the COVID pandemic compared to their Caucasian counterparts. There is little research looking into what women from ethnic minorities think of different contraceptive options and their experience of side effects. We wanted to study this to provide a better, more equal contraceptive service.

Approach

We used a Participatory Action Research Approach, with Community Research Link Workers (CRLW) at its centre. We recruited three CRLW who were trained in basic qualitative methods. They recruited and conducted 4 focus groups with women from south asian, black african and black caribbean communities. We also offered 1 to 1 interviews with one of the research team if preferable. The CRLW conducted the focus groups with researcher presence, these were in English with language support where needed. We recruited 31 women for focus groups (24 of whom were born outside the UK), 5 women were interviewed one to one. Transcripts were thematically analysed by the whole research team and a workshop was undertaken to define the themes.

Findings

Thematic analysis revealed four themes which addressed the research question. (1) contraception as part of a woman’s lifecycle (whole person), (2) external influences, (3) cultural considerations, (4) everyone is different (individuality). Side effects and myths about potential negative outcomes were key overarching themes which we will reflect on in further publications.

Consequences

Providing women with choices about contraception improves their health and the health of their family and children. We know that women from ethnic minorities find it more challenging to access contraceptive services in the UK. Our findings highlighted the specific challenges which can face women from ethnic minorities when accessing contraception. Being aware of these, whilst understanding the heterogeneity within ethnic groups, can allow for the provision of more equal contraceptive services and culturally competent practice. We need awareness that whilst services may be inclusive for one group may be excluding others. Tailoring services to populations is essential rather than a one-size-fits-all approach.Future interventions should prioritise participatory designs, and culturally appropriate materials, and shift focus to inclusive contraception research which has under-represented populations at the centre.