Factors Predicting Access to Contraceptive Services Among Reproductive-Age Female Migrant Workers

Abstract

Introduction Thailand employs a significant number of female migrant workers, many of whom are of reproductive age and exposed to the likelihood of pregnancy. Previous studies indicate that antenatal care (ANC) clinics are the most frequently utilized healthcare service among this population. Concurrently, pregnancy-related health complications are prevalent, particularly gestational diabetes mellitus (GDM) and neonatal abnormalities. Samut Prakan province ranks third in Thailand in terms of its migrant worker population. Notably, at Samut Prakan Hospital, female migrants accounted for 30.80% to 32.06% of total births between 2021 and 2023. Despite this burden, research examining access to contraceptive services and its associated factors among migrant workers in Thailand remains limited. Investigating these issues is crucial to promoting access to contraception and family planning, thereby mitigating health risks for both mothers and newborns.

Objectives This study aimed to examine factors predicting access to contraceptive services among female migrant workers of reproductive age. The predictive factors included age, nationality, health welfare, gravidity, contraceptive use, contraceptive knowledge, contraceptive beliefs, and the influence of contraceptive beliefs among family or peers.

Design This study employed a predictive research design.

Methodology The study sample consisted of 326 reproductive-age female migrant workers who received services at Samut Prakan Hospital between April 2024 and January 2025. Purposive sampling was employed based on the following inclusion criteria: 1) aged 15–49 years; 2) employed as a wage earner under any job category in Samut Prakan Province; 3) holding a legally valid migrant worker card; 4) having utilized contraceptive services in Thailand at least once; 5) able to communicate proficiently in spoken Thai without an interpreter or translation application; 6) literate in reading and writing their native language; and 7) providing informed consent to participate in the study. Exclusion criteria were unable to provide complete information or complete the questionnaire. The research instrument was a questionnaire comprising five parts: 1) demographic data, 2) contraceptive knowledge, 3) contraceptive beliefs, 4) the influence of contraceptive beliefs among family and peers, and 5) access to contraceptive services. Content validity was assessed, yielding Item-Objective Congruence (IOC) indices of .92 for contraceptive knowledge, .88 for contraceptive beliefs, .95 for family and peer influence, and .94 for access to contraceptive services. Internal consistency reliability was demonstrated by a Kuder-Richardson 20 (KR-20) coefficient of .71 for the contraceptive knowledge questionnaire. Additionally, Cronbach’s alpha coefficients for the contraceptive beliefs scale, the influence of contraceptive beliefs among family and p eers scale, and the access to contraceptive services scale were .88, .88, and .80, respectively. Data were analyzed using descriptive statistics, including percentages, means, and standard deviations, and predictive factors were identified using Stepwise multiple regression analysis.

Results The majority of reproductive-age female migrant participants were of Myanmar nationality (73.60%), followed by Cambodian (16.90%) and Lao (8.90%). The predominant age group was 26–30 years. Most participants lacked health insurance coverage (66.60%) and had been pregnant once (53.37%). Regarding contraceptive use, 96.93% reported prior contraceptive use, with oral contraceptive pills being the most common method (47.15%). Overall, participants demonstrated low contraceptive knowledge (59.81%), moderate contraceptive beliefs (70.55%), moderate family and peer influence (51.84%), and moderate access to contraceptive services (80.68%). Stepwise multiple regression analysis revealed that contraceptive beliefs and the influence of contraceptive beliefs among family or peers significantly predicted access to contraceptive services, jointly accounting for 14.0% of the variance (R2=.146). Contraceptive beliefs emerged as the strongest predictor (β=.248, p <.01), followed by the influence of contraceptive beliefs among family or peers (β=.204, p <.01).

Recommendations Nurse-midwives and healthcare providers can integrate clients’ contraceptive beliefs and the influence of contraceptive beliefs among family or peers into routine counseling and delivery of contraceptive services. Tailoring care to these factors can enhance access to contraceptive services and empower reproductive-age female migrant workers to select birth control methods that align with their specific and cultural contexts.