Contraceptive Utilization and Lived Experiences of Women with Rheumatic Heart Disease Attending Uganda Heart Institute and Mbarara Regional Referral Hospital

Abstract

Introduction: Women with rheumatic heart disease (RHD) face high risks during pregnancy due to hemodynamic stress and teratogenic medications. Appropriate contraceptive use is therefore critical, yet little is known about utilization patterns and lived experiences among this population in Uganda. Methods: We conducted a mixed-methods study at Uganda Heart Institute and Mbarara Regional Referral Hospital. A cross-sectional survey of 84 women with RHD assessed contraceptive use, while in-depth interviews with 13 participants explored lived experiences. Quantitative data were analyzed descriptively, and qualitative data thematically using Van Manen’s existential framework. Results: Study found only 25 (29.7%) women reported using contraception, and 40% were using contra-indicated methods. Among those who discontinued, 34.6% cited side effects such as heavy bleeding, weight gain and palpitation. Notably, 69.6% of women on a teratogenic medication were not using contraception. Qualitative findings revealed themes of fear (of side effects and complications), communication gaps with health providers, hopelessness and frustration due to method failure, and ingenuity in coping strategies. These findings highlight limited counseling and high reliance on inappropriate methods, putting women at risk of unplanned and high-risk pregnancies. Conclusion: Contraceptive utilization among women with RHD in Uganda is low, inconsistent, and often involves unsafe methods. The absence of adequate counseling and reliance on contraindicated options underline the urgent need for multidisciplinary, guideline-based contraceptive counseling and support for women with RHD to prevent unplanned pregnancies and reduce maternal and fetal risks.