Pregnancy planning in Botswana: what dimensions matter to Batswana women?

Sara Randall, University College London
Christine Kgathi, University of Botswana
Neo Moshashane, University of Botswana
Boineelo Bula, University of Botswana
Chelsea Morroni, University College London

In the Botswana context of relatively low fertility combined with good access to education and health services and high HIV prevalence, facilitating pregnancy planning is an important stage in improving reproductive health services but little is known about the extent to which pregnancies are planned and what are the barriers to effective pregnancy planning. This research uses qualitative data from a study undertaken in Gaborone (2015) to investigate Batswana women’s perceptions and experience of different dimensions of pregnancy planning, and the constraints they encounter in pregnancy planning. Three university graduates undertook in-depth interviews in Setswana and/or English with 36 women of reproductive age from a wide range of social class, educational and fertility backgrounds, including both HIV positive and negative women. Our results suggest that women in Botswana are far from experiencing effective pregnancy planning as would be understood from a medical perspective. In the individual accounts of reproductive lives few women had planned their first pregnancy, and this often generated both physical and psychological repercussions throughout their reproductive lives. Apart from a few cases of teenage pregnancy where the girl had got pregnant very early in her first sexual relationship never having considered contraceptive use, lack of knowledge about contraceptive methods and inability to access services were not key barriers to pregnancy planning. However, Batswana women confront a constellation of constraints in different dimensions of life, including economic and employment uncertainty, high HIV prevalence, perceived unreliability of men, and the practical difficulties of managing and caring for children in frequently chaotic contexts, whilst simultaneously experiencing strong social pressure to become mothers. Their primary preoccupations around pregnancy planning are situated in the economic and social support sphere rather than corporeal preparedness. Individual level reproductive planning responding to physical needs and reproductive aspirations is uncommon.