Factors influencing utilization of reproductive health services among imprisoned women in selected prisons in Uganda

Abstract

Background: There is increase in the numbers of incarcerated women in prison system. Many of these women are of reproductive age with many reproductive health related problems. Under such circumstances women in prisons need to access and use reproductive health services. There are prison system related challenges in organizing these services yet even where these services have been organized and made available, utilization of such services among women in prison is low in many settings in developing countries. This study assessed the factors influencing utilization of reproductive health services among imprison women in Uganda. Methods: The study used analytical cross sectional design that used both quantitative and qualitative data collection approaches among female inmates of at least six months old. Sample size was determined using hyper-geometric formula. Questionnaire used as data collection methods and researcher administered structured questionnaires as data collection tools. Stratified random sampling technique was used. Collected data was entered into and analyzed using SPSS version 20 at univariate, bivariate and multivariate levels. Univariate results were presented into frequencies and percentages. Bivariate analysis used chi-square/fishers and binary regression at 95% Confidence interval with subsequent chi-square/fisher’s value, Odds ratios. Probability values less than 0.05 were considered significant and multivariate analysis done for significant variables. Results: Nearly half 80(44.7%) of the imprisoned women were aged 21-30 years. There were 71 (39.66%) catholic and 54(30.17%) protestant women in the prisons. Less than a quarter (22.35%) of the women were married and 59(32.96%) were single and 92 (51.4%) and (72, 40.2%) attained primary and secondary education. Half 51.4% of the women in the prison received Reproductive Health Services which include; Antenatal care services, delivery services, Postnatal care services, HIV counseling and testing, HIV treatment and care, post abortion care and cervical cancer screening. Bivariate analysis using Chi-square/Fisher’s exact test found that education level (p=0.047), number of sexual partners engaged with (p=0.049), number of children (p=0.037), accessing fansidar (p<.001), bed nets (p<.001), provision of nutritional supplements (p=0.011), counseling before HIV test (p=0.017) and regular drug use (p=0.029) significantly influenced utilization of RHSs. Multivariate analysis showed that women who had no child (AOR=42.32, 95%CI: .1.73-1037, p=0.022) significantly increased utilization of RHS. On the other hand, those provided with bed nets (AOR=0.12, 95%CI: .04-.35, p<.001), nutritional supplements (AOR=0.39, 95%CI: .19-78, p=.009) and counseling before HIV test (AOR=0.38, 95%CI: .17-86, p=.020) significantly had lower odds for using reproductive health services. Conclusion: Adequate use of RHSs remained moderate in the prisons. There is need to strengthen health promotion and education to inmates on sexual and reproductive health issues. Encourage in-mates to avoid multiple sexual partners and seek timely services, advocate for girl child education and sexual health to prevent early sexual practices.