Andersen, Hanne Bech

Osmani, Usna

Introduktion: Kvantitative data fra Tanzania påviser, at kvinder har adgang til billig moderne prævention, men at bivirkninger og frygt herfor forhindrer kvinders fortsatte brug. Idet præventionsudbydende organisationer forbinder øget brug af prævention med kvinders empowerment, fokuserer deres aktiviteter stadig på adgang til og tilgængelighed af moderne prævention. Organisationers manglende problematisering peger på en divergerende forståelse af barrierer for brug af prævention. Derfor søger dette speciale at afdække, hvordan præventionsudbydere forstår bivirkninger, samt hvordan organisationers målsætninger for præventionsindsatser forhindrer yderligere problematisering af bivirkninger. Metode: Studiets primære data består af syv interviews med ti nøglepersoner. Heriblandt er fem store præventionsudbydende organisationer i Tanzania repræsenteret, samt én nøgleperson fra Sundhedsministeriet i Tanzania og tre præventionsrådgivere. Gennem et kritisk perspektiv på empowerment samt begreberne ’biopower’ og ’governmentality’ undersøger vi, hvordan bivirkninger håndteres i praksis. For yderligere at forstå, hvorfor bivirkninger ikke problematiseres af organisationer, anvendes David Mosses teoretiske perspektiv på udviklingsinterventioners kendetegn til at analysere forholdet mellem forståelsen af bivirkninger og målsætningerne for præventionsindsatser. Resultater og konklusion: Præventionsudbydere mener, at kvinders oplevede bivirkninger skyldes indskrænkede muligheder for at træffe valg i forhold til prævention. Determinanterne for et ’forkert valg’ leder kvinder til at vælge en metode der ikke er tilpasset deres individuelle biomedicinske profiler. Yderligere mener præventionsudbydere, at problemer omkring bivirkninger er baseret på overdrivelse og udokumenteret frygt, som bunder i modstand mod moderne prævention. Vi konkluderer, at præventionsudbydere har en målsætning om at styre kvinders adfærd mod fertilitetsreduktion, delvis fordi organisationernes eksistensgrundlag afhænger af øget brug af prævention. Der fokuseres ikke på bivirkninger, fordi det vil øge modstanden mod moderne prævention i samfundet samt true præventionsindsatser og i sidste ende organisationernes eksistensgrundlag.Introduction and objectives: Quantitative data from Tanzania document that women have access to affordable modern contraceptives, but that side effects or the fear thereof is stopping them from a continued use. However, family planning organisations link an increased use of modern contraception to women’s empowerment and focus their activities on access and availability of contraception to increase uptake. The lack of organisational problematisation of contraceptive side effects points to a divergent identification of the problem. Thus, this study seeks to unpack how service provisioners understand contraceptive side effects, and how the objectives of family planning organisations hinder a further problematisation of side effects. Methodology: The primary data consist of seven interviews with ten key informants; five major family planning organisations from the private sector in Tanzania are represented in the data, as well as an informant from the Ministry of Health and three family planning advisors. We apply critical perspectives of empowerment as well as concepts of biopower and governmentality to unpack how side effects are addressed in family planning practices. To gain a deeper understanding of why contraceptive side effects are not problematised by organisations, we apply the theoretical perspective of David Mosse on the nature of development to analyse the relation between service provisioners’ understanding of side effects and the objectives of family planning. Findings and conclusion: Service provisioners find that women’s experiences of side effects are caused by constrained possibilities to exercise contraceptive choice. Determinants of ‘wrong choice’ make women choose a method not customized their individual biomedical profiles. Furthermore, the problem of side effects is mainly based on exaggeration and unsubstantiated fears due to resistance of modern contraception. We conclude that service provisioners seek to steer the reproductive behavior of women towards fertility-reduction partly because the organisational exigency is dependent on increased contraceptive uptake. Organisations do not focus on contraceptive side effects as that will add to the societal resistance, threaten family planning activities and ultimately the exigencies of organisations

It's a hill, and now it's a mountain - How family planning organisations understand and problematise contraceptive side effects in Tanzania

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