Creating pathways for change to increase modern contraceptive uptake in rural Indonesia: A feminist qualitative research protocol

Family planning program has been globally shown to reduce maternal mortality by reducing both total and high-risk pregnancies. Despite the national implementation of this program since the 1970s, Indonesia still faces many challenges in achieving family planning goals. Low modern contraceptive prevalence rate (mCPR) remains a problem that impacts public health, population growth, economy, and welfare issues. It should be tackled, especially in rural areas, with multifactorial causes and diverse needs. Various programs have been developed globally to overcome this problem; however, each region has different characteristics and demands that should be understood. This feminist qualitative study, embedding participatory action research principles and adapting the first three steps of the six essential steps for quality intervention development (6SQuID), aims to develop a theory of change by understanding the rural populations needs and actively collaborating with multiple participant groups to increase modern contraceptive uptake. The target location is West Sumba Regency, one of Indonesias 100 lowest mCPR regencies and located in East Nusa Tenggara, which has the highest total fertility rate in Indonesia. Consisting of two rounds of data collection, this study includes different participant groups: rural women, men, mothers-in-law, religious figures, cultural leaders, community health workers, family planning educators, and family planning decision-makers with different strategies. We aim to recruit approximately 45 participants through purposive sampling, selecting participants based on the criteria for each group. The data collection methods are focus groups and semi-structured interviews. This study will encourage the community to collaborate and empower rural women to overcome their problems by identifying the reasons behind modern contraceptive refusal and developing a theory of change to reach the final goal: to create a meaningful change in modern contraceptive services. By understanding the diverse contexts and specific needs of the rural population, this study will be essential to transforming family planning programs. In doing so, it will significantly enhance reproductive and womens health while also addressing and reducing health disparities in rural communities.