Sabrine Chengane
Accessing contraceptive services in Algeria: qualitative study of women’s lived experiences and key informants’ perspectives
Sabrine Chengane
University of Ottawa
schen391@uottawa.ca
Angel M. Foster
University of Ottawa
Background: Over the past decade, unmet contraceptive needs increased among married women of reproductive age in Algeria. Further, most research focused on married women with little information on the utilization of contraceptive services by unmarried women. Healthcare access is influenced by myriad characteristics and factors within and outside the healthcare system. Using the conceptual framework of access to health care proposed by Levesque and colleagues (2013), we centered lived experiences of married and unmarried women of reproductive age and insights from key informants in accessing contraceptive services within the Algerian health system across five dimensions of service accessibility.
Methods: Between June 2023 and September 2024, we conducted in-depth interviews with women of reproductive age (aged 15-49 inclusive) living in three regions across Northern and Southern Algeria. We used a multi-modal strategy for recruitment and a semi-structured guide to facilitate the interviews. We also conducted interviews during the same period with healthcare providers including physicians, pharmacists, gynecologists, and midwives. Additionally, we audio-recorded the interviews with the participants’ consent and transcribed and translated them into English. We used ATLAS.ti to manage the data and analyzed the interviews for content and themes using both deductive and inductive techniques.
Results: Our interviews with 18 healthcare providers offered perspectives informing the five dimensions of the healthcare access conceptual framework by Levesque and colleagues (2013): approachability, acceptability, availability and accommodation, affordability, and appropriateness. The existing infrastructure, workforce capacity and constraints, contraceptives availability and affordability emerged as factors influencing these dimensions. Our 20 in-depth interviews with women of reproductive age provided insights into their lived experiences, relating to societal expectations and cultural norms for seeking reproductive health services, contraceptives non-availability, and affordability of contraceptives. These experiences further explained the corresponding abilities to the key dimensions.
Conclusion: Although our results are not generalizable or representative, they highlighted the need to address elements beyond the health system, such as personal and social factors. Raising awareness about available contraceptive services among the population, addressing providers' perceptions and biases, and ensuring contraceptives availability are essential for fostering trust between service users and the health system, while promoting inclusivity and equity.
BIOGRAPHY
Sabrine Chengane is a population health researcher and global health enthusiast, currently pursuing a PhD in Population Health at the University of Ottawa. Her dissertation focuses on women’s contraceptive knowledge, attitudes, and practices in Algeria. She is an associate researcher at the research unit in social sciences and health, 'GRAS', at the University of Oran 2. With experience conducting research on sexual and reproductive health, occupational health, and mental health in diverse populations, Sabrine brings a multidisciplinary perspective to addressing critical health challenges. An alumna of the Fulbright Program, Sabrine holds a Master of Public Health with a concentration in Maternal and Child Health from the University of Nebraska Medical Center and a Doctor of Pharmacy degree from the University of Algiers. Her global health interests include health systems strengthening, maternal and child health, and the impacts of environment and climate change on health outcomes. In 2020, Sabrine received the Distinguished Student of Practice Award from the College of Public Health at the University of Nebraska Medical Center, and in 2021, she was inducted into the Gamma Omicron Chapter of the Delta Omega Honorary Society in Public Health in recognition of her academic excellence and contributions to public health.
Dr. Angel M. Foster is a Professor in the Faculty of Health Sciences at the University of Ottawa. A 1996 Rhodes Scholar, she holds a doctorate from the University of Oxford in Middle Eastern Studies, an MD from Harvard Medical School, and both master’s and bachelor’s degrees from Stanford University. Dr. Foster is a global abortion researcher and leads projects in 22 countries. She has authored more than 100 articles and co-edited three books; she also led the most recent revision of the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. Dr. Foster serves as the Chair of the Board of Directors of the National Abortion Federation, Canada, the Co-Chair of the Safe Abortion Care Sub-Working Group of the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) and the Editor-in-Chief of Perspectives on Sexual and Reproductive Health. The recipient of numerous awards in honours, she received the Guttmacher Institute’s 2017 Darroch Award for Excellence in Sexual and Reproductive Health Research and was inducted into the Canadian Academy of Health Sciences in 2023.