Challenges faced by older women in Botswana in accessing services that address sexual and reproductive health, and family planning needs, in Botswana : original research

Objective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs. Design, setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata), using probability proportional to size. Outcome measures: The study estimated the percentage use of sexual and reproductive health services (including family planning services), unmet need for family planning and factors inhibiting use of these services. Results: The study revealed that 25% of the older women used some type of FP method. Of this number, 67.9% were aged 50-59 years, 17.4% 60-69 years, 10.1% 70-79 years, and 72% had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired immune deficiency syndrome, sexually transmitted infections and cervical cancer. Obstacles to accessing SRH and FP services were found to include illiteracy, lack of education, financial constraints, a perception that healthcare planners limited SRH needs to antenatal and obstetrical services, a cultural reluctance to discuss SRH in public and domestic issues. Conclusion: The study recommends comprehensive public health education for older women on human sexuality and fertility, contraceptive use, access to services, effective training programmes for healthcare providers on how to deal with older women's issues and better access to STI and cervical cancer screening services.