JMIR Publications

ABSTRACT

Background:

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.

Objective:

This study aims to develop a theory of change by understanding rural women’s needs and actively collaborating with multiple participant groups to increase modern contraceptive uptake. The theory of change will also be informed by the views of four distinct stakeholders who is responsible for providing contraceptive services (i.e. policy makers at regency and provincial level) in order to make informed recommendations.

Methods:

This feminist qualitative study embedding participatory action research principles adapts the first three steps of the six essential steps for quality intervention development. The target location is West Sumba Regency, one of Indonesia’s 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 (i.e. rural women and men, mothers-in-law, religious figures, cultural leaders, midwives, family planning educators, and policymakers) with different strategies. To ensure data saturation and trustworthiness, we aim to recruit up to 45 participants through purposeful sampling, selecting participants based on the criteria for each group. The data collection methods are focus groups and semi-structured interviews. We will analyze the data using reflexive thematic analysis.

Results:

The theory of change development focuses on women’s voices and incorporates various perspectives from rural communities, including the service providers and policymakers. Ethics approval has been obtained by the College of Medical, Veterinary, and Life Sciences (MVLS) Research Ethics Committee, University of Glasgow, UK, and the Public Health Faculty, University of Nusa Cendana, Indonesia. We anticipate that we will complete all data collections and analysis by December 2026.

Conclusions:

The ultimate goal of this study is to develop a theory of change to create a meaningful change in contraceptive services in rural areas. This study will contribute to encourage rural communities to collaborate and empower rural women to overcome their reproductive health problems. By understanding the diverse contexts and specific needs of the rural population, the results will be essential to transforming family planning programs. In doing so, it will significantly enhance women’s reproductive health while also addressing and reducing health inequalities in rural areas.