Informing the introduction of contraceptive implants in the Pacific: a mixed methods study of contraceptive beliefs and behaviours in Tonga

Abstract Objective: To explore the knowledge and attitudes underlying contraceptive use and non‐use among Tongan adults and investigate the potential acceptability of contraceptive implants. Methods: A mixed methods study was conducted that used two focus groups and a short self‐completed survey (n=109). Participants were recruited from a Tongan non‐governmental sexual and reproductive health clinic. Results: Contraceptive method discontinuation was high among the study group, with reasons for discontinuation often relating to misconceptions circulating in the community about the side effects of contraceptives. A high proportion (38%) reported using ‘natural’ contraceptive methods. A total of 47% of survey participants reported having heard of implants and 37% indicated they would be willing to try them. Conclusion: Current Tongan contraceptive uptake and continuation is hampered by misconceptions about side effects of methods and their risks, particularly among long‐acting and reversible methods. Contraceptive implants may be acceptable to Tongans given their arm placement, reversibility and long‐lasting effect. Implications: Efforts to improve contraceptive continuation in Tonga should focus on improving counselling on potential side effects for all methods. The introduction of contraceptive implants as an additional long‐acting reversible method should be considered

Contraceptive knowledge, attitudes, and use among adolescent mothers in the Cook Islands

BACKGROUND: While the adverse health outcomes and broader economic and social factors associated with adolescent motherhood are well documented globally, limited research on unplanned pregnancy and birth among young women in Pacific Island nations exists. The study addresses this gap in the literature by examining the social and contextual factors that inform contraceptive knowledge, attitudes, and use among young women in the Cook Islands. METHODS:Individual, in-depth interviews were conducted with ten women who became mothers before age twenty. Adolescents' contraceptive knowledge, attitudes, and behaviours were examined while taking into account the context in which they experienced an unplanned birth. FINDINGS: Five participants were not using a contraceptive method when they became pregnant, believing they would not become pregnant. The remaining participants were using oral contraception but doing so inconsistently. Four participants had a sexual debut prior to age 15. The findings suggest a need to expand comprehensive approaches to sexual and reproductive health education, increase access to long-acting reversible contraceptive methods, and decrease the stigma associated with accessing family planning services in order to more effectively prevent unplanned pregnancy among adolescents in the Cook Islands. INTERPRETATION:The findings provide insight into the factors contributing to high rates of adolescent pregnancy and birth in the Pacific region and suggest how public health advocates and health care providers might reduce reproductive health disparities in the Cook Islands and similar Pacific Island nations