Women's contraceptive knowledge, attitudes, and practices in Algeria, Morocco, and Tunisia: a scoping review.

内容摘要

Although Algeria, Morocco, and Tunisia have made significant progress in family planning and remain committed to achieving socio-economic and sustainable development goals, recent years have seen a decline in contraceptive use and a rise in unmet contraceptive need. Our review aimed to explore available information and identify gaps in the literature on family planning in Algeria, Morocco, and Tunisia by synthesising published literature on women's contraceptive knowledge, attitudes, and practices in these three countries. Our review followed the framework outlined by Arksey and O'Malley [1] and revised by Levac and colleagues [2]. We conducted a comprehensive search of Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and Web of Science, a supplementary search in Google Scholar, and a hand search of ASJP, CAIRN.info, EMHJ, and La Tunisie Médicale. We included literature in Arabic, English, and French published between January 1990 and September 2024, focusing on women's contraceptive knowledge, attitudes, and practices in the Maghrib. We identified 671 articles from the databases and 70 reports from the supplementary and hand searches. After removing duplicates, conducting initial screens, and retrieving full texts we ultimately included 63 sources in our review. Existing literature revealed that, although contraceptive knowledge has increased over the past decades, gaps in knowledge and misinformation persist. Additionally, fear of side effects and rumours contribute to negative attitudes toward contraception. Through this review, we observed that specific contraceptive methods promoted by early family planning programmes, and the strategies used to promote them, may have had a lasting impact on contraceptive practices, even decades later. Our review highlights the importance of exploring changes in knowledge and attitudes and the factors that influence them, as well as women's lived experiences with contraceptive use and access to services. This knowledge can provide more contextually relevant evidence to inform effective family planning policies and interventions. Like many countries, Algeria, Morocco, and Tunisia have committed to advancing women’s status and health and promoting socio-economic development. A key avenue for achieving these goals is ensuring access to family planning and its essential component, contraception. Algeria, Morocco, and Tunisia have made significant progress in family planning since they introduced national initiatives in the 1960s. However, recent years have seen a decline in contraceptive use and a rise in unmet contraceptive need, reversing earlier trends. To understand this change, we sought to explore the extent of available information and identify gaps in the literature on women’s contraceptive knowledge, attitudes, and practices in these three countries. Using a rigorous methodology, we conducted a review of existing studies to summarise what is known on the topic and ultimately included 63 sources. Our study found that misinformation and lack of contraceptive knowledge persist. This knowledge gap, along with fear of side effects and common rumours, shape women’s attitudes toward contraception. These attitudes in turn affect their choice and use of contraceptives. We also observed that the strategies used in the design of early family planning programmes in these three countries, which promoted specific contraceptive methods, may have had a lasting influence on women’s practices. Overall, this review shows that research on contraception needs to focus more on women’s real-life experiences. By understanding these experiences and women’s perceptions and use of contraceptives, decision-makers can formulate more relevant and effective family planning policies and interventions.