Contraceptive use, challenges, and need among Central Asian female migrants
Contraception
Awarded 2014
Complex Family Planning Fellowship Research
Alexandra Golobof, MD
Northwestern Univesity
$45,278

Russia is one of the top receiving countries for labor migration, an increasing portion of whom are women. Migrant women struggle to obtain reproductive care. The number of women has persisted around 15% of legally employed migrants in Russia, with estimates ranging as high as 30-35%. As of 2008, over 50% of all labor migrants originate from Central Asia, where Tajikistan is the second largest source.  Prior studies documented increased risk of STI/HIV, decreased knowledge and negotiation skills of contraceptive and HIV preventative methods. Studies with migrants elsewhere have documented increased risk of unintended pregnancy and low rates of contraceptive use. However, little is known about contraceptive practices of Tajik migrant women. Therefore, the primary objective is to assess the knowledge, attitudes, practices, and barriers to contraception among Tajik migrant and non-migrant women.
This is a mixed methods study with 30 Tajik migrant and non-migrant women carried out in August-September 2015. Qualitative interviews were conducted in Russian, audio-recorded with participant’s permission, and translated at the time of transcription. The interviews were conducted using minimally structured ethnographic approach as well as a focused interview guide as described by Behavior Model for Vulnerable Populations. Quantitative surveys were used in comparative analysis.
Of 30 women, 27 were currently married. Of those, 17 were using no contraceptive method, 3 were using highly or moderately effective methods; one was pregnant. The remainder was using either a low efficacy, or a traditional contraceptive method. 56.7% reported having at least one abortion.
This study finds low effective contraceptive use among Tajik migrant women and their non-migrant peers. The study also highlights somewhat limited contraceptive knowledge, challenged by many myths, and overall low reproductive health literacy. Abortion remains commonplace. Tajik migrant women are further vulnerable as pregnancy tends to disrupt their labor migration, thereby limiting their earning power as family providers.
Several themes have emerged. Multiple myths and misconceptions about contraception exist and act as a barrier to adequate and effective contraceptive use among Tajik women. Although most women have heard about intrauterine devices (IUDs) and oral contraceptives, a limited number have any experience using these methods, with many lacking factual knowledge. Those who have had experience with modern contraceptives have also experienced high discontinuation rates, citing health problems as a result of contraceptive use that are unlikely to be related. Younger recently married women may be more vulnerable to misinformation and challenges in negotiating family planning within their new roles as wives.
In terms of gaining access to contraception, women did not discuss difficulty in accessing contraception or abortion services. Contraception and abortions are available and accessible both in Tajikistan and Russia, although both require payments, which given the current economic situation of the country, may still be somewhat prohibitive. Women’s actual use of contraception seems to be correlated to the degree of self-efficacy in understanding their own role in their own reproductive health. Partner’s support and open discussion about family planning also plays a positive role in women’s contraceptive use. Alternatively, reproductive coercion is frequent. Women reported pressure from their partners to bear children to increase family size as well as financial dependence on their partners, which frequently dictates their reproductive choices and limits their reproductive autonomy, regardless of their migration status. Because no prior studies on this population exist, this assessment can inform intervention opportunities with this at risk population to increase self-efficacy, contraception knowledge, and utilization.

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