Contraceptive use by women in Accra, Ghana: results from the 2003 Accra Women's Health Survey

The study was to determine the predictors of use of modern contraception among women in Accra, Ghana. Data were collected by trained interviewers using questionnaires. Complete data for 2199 women were analysed using Stata 8.2. The study showed that educational status was the most significant predictor of contraceptive use. Women with no formal education had a 48% reduction in the odds of having ever used contraception and a 66% reduction in the odds of currently using contraception. Regular use of health facilities did not affect contraceptive use. Female education should continue to be a priority of the Ghanaian government. Education about family planning and the effects of having large families should be integrated into the school curriculum. Ghanaian health workers need to be active in promoting the use of modern contraceptive methods.

Barriers to sustained use of contraception in Nepal: quality of care, socioeconomic status, and method-related factors

Owing to previously limited data availability, low contraceptive prevalence, and predominance of permanent method use in Nepal, there have been few studies of contraceptive-use dynamics. The aim of this article is to examine contraceptive use dynamics in Nepal in light of the country's ongoing fertility transition and change in contraceptive method-mix. Drawing on the 2003 Contraceptive Acceptance and Use Patterns Survey of Nepal and the quality-of-care framework, a proportional hazards model is used to explore contraceptive discontinuation of injections and pills. Results show that source of method from non-government services, high level of information given, one-to-one counseling, satisfaction with services, and shorter travel time to source are associated with lower odds of discontinuation. Despite the experience of side effects, women in Nepal are highly motivated to regulate their fertility. Results suggest detailed information given to users can have significant influence on continuation of methods rather than merely providing information on alternative methods and group counseling.

Benefits of meeting the contraceptive needs of Ugandan women

This brief describes current patterns of contraceptive use in Uganda and documents the high costs associated with persistently high unmet need for modern contraceptives. Building on prior work and using national data sets to project estimates for 2008, we outline the net benefits to women and society of averting unintended pregnancies with current levels of use and under two scenarios of increased investment in modern contraception. Although enabling women to meet their childbearing preferences leads to an array of benefits--such as enhancing women's ability to go to school, enter the workforce and participate politically--we focus exclusively on the health and monetary savings from averting unintended pregnancy.

Preconception planning: are we making progress?

According to the American Diabetes Association, unplanned pregnancies in women with diabetes could lead to abnormal metabolic control, which causes fetal and maternal complications. Preconception planning can decrease these risks. This article reports on the progress in preconception planning over the past 2 years.

[Sensible family planning: do not have children too late, but not too early either]

Due to family planning, Dutch women are increasingly having their first child between 25 and 35 years of age. Compared to 13 other EU countries, Dutch women are having fewer children both earlier and later on in life. From 1970 onwards in the Netherlands, the mean age at first childbirth has increased by 5 years to 29.4 years. The main cause for the rising age at first childbirth is the decrease in the number of young mothers. In 2006, 7% of all childbearing women had their first child after the age of 36; this is just 4.7% higher than in 1970. The percentage of women remaining childless by delaying childbearing too long increased by 0.9%. Considering the social and medical problems in later life, it would not be wise to encourage women to have their babies at a young age, certainly not before the age of 23. Women planning a family should take into account the decline in natural fertility after the age of 35; the future mothers of the Netherlands seem to be planning and deciding wisely.

One-year assessment of women receiving sub-dermal contraceptive implant at Siriraj Family Planning Clinic

BACKGROUND

The single-rod Implantable contraceptive method, called 'Implanon', has been introduced for use in Thailand since the 1990s. The outstanding attribute was that it requires only a few minutes for insertion and removal as it has only one capsule. The single-rod implant was used in women at Siriraj Hospital in 2006. The present study looked at characteristics of women, complications of insertion and removal, menstrual events that occurred to women during one year of use and reason for removal of the method.

MATERIAL AND METHOD

This was a retrospective clinic based study. All women's record files were examined at Siriraj Hospital's Family Planning Clinic. There were 166 women enrolled to undergo this method, and only 89 women (54.6%) came back for the one-year follow-up visit. Women's accounts on irregularity of menses, complaints during method used and reason for discontinuation, pregnancy and body weight change were assessed.

RESULTS

Most women (68%) using the implant contraceptive method were 29 years of age with 74% of vocational or lower education. Their BMI was 22.66 +/- 4.06 Insertion time was about 1 minute with no difficulty or complication. Of those women, 40.4% of them considered having regular menstrual cycle and 30.3% had regular menstrual flow for a few months alternately with no menses for a few months. Prolonged menstrual bleeding was the most complaint in this group of women. Amenorrhoea was also reported. Vertigo had occurred to some women without reported medication. One woman asked for the removal of the method due to pain at the implanted site after 8 months of use. Removal time was around 2-3 minutes. There was no pregnancy that occurred in the course of one year of use.

CONCLUSION

Of 89 women using the implant contraceptive method, menstrual irregularity was the important issue that women complained about. However, the removal of the method in one woman was due to the pain at the implanted site. There was no difficulty or complications in insertion or removal of the implant. Close counseling about side effects of the method is emphasized during use to maintain long-term use or until completion of the duration of the device.

Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries

BACKGROUND

Increasing the coverage of key maternal, newborn, and child health interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. We have assessed equity and trends in coverage rates of a key set of interventions through a summary index, to provide overall insight into past performance and progress perspectives.

METHODS

Data from household surveys from 54 countries in the Countdown to 2015 for Maternal, Newborn and Child Survival initiative during 1990-2006 were used to compute an aggregate coverage index based on four intervention areas: family planning, maternal and newborn care, immunisation, and treatment of sick children. The four areas were given equal weight in the computation of the index. Standard measures were applied to assess current levels and trends in the coverage gap measure by wealth quintile.

FINDINGS

The overall size of the coverage gap ranged from less than 20% in Tajikistan and Peru to over 70% in Ethiopia and Chad, with a mean of 43% for the most recent surveys in the 54 countries. Large intracountry differences were noted, with a country mean coverage gap of 54% for the poorest quintiles of the population and 29% for the wealthiest. Differences between the poorest and the wealthiest were largest for the maternal and newborn health intervention area and smallest for immunisation. In 40 countries with more than one survey, the coverage gap had decreased by an average of 0.9 percentage points per year since the early 1990s. Declines greater than 2 percentage points per year were seen in only three countries after 1995: Cambodia, Mozambique, and Nepal. Country inequity patterns were remarkably persistant over time, with only gradual changes from top inequity (disproportionately smaller gap for the wealthiest) in countries with coverage gaps exceeding 40%, to linear patterns and bottom inequity (disproportionately greater gap for the poorest) in surveys with gaps below 40%.

INTERPRETATION

Despite most Countdown countries having made gradual progress since 1990, coverage gaps for key interventions remain wide and, in most such countries, the pace of decline needs to be more than doubled to reach levels of coverage of these and other interventions needed in the context of MDG 4 and 5. In general, in-country patterns of inequality are consistant and change only gradually if at all, which has implications for the targeting of interventions.

Reasons and correlates of contraceptive discontinuation in Kuwait

OBJECTIVES

(1) To examine the probability of discontinuation of various methods within 1, 2, and three years of use and the reasons for discontinuation; 2) to analyse the socio-demographic correlates of discontinuation.

METHODS

Data from a survey of Kuwaiti women in reproductive ages conducted in 1999 were used. Information on duration of use of modern and traditional methods, and reasons for discontinuation during the 72 months before the survey were analysed. Probabilities of discontinuation were estimated through multiple decrement life table analysis.

RESULTS

After 1 year, 30% of modern and 40% of traditional method users had discontinued; after 3 years, discontinuation increased to 66 and 70%, respectively. After 36 months, only 40% of IUD users discontinued compared with 74% of oral contraceptive users. The desire to become pregnant was the leading reason for discontinuation of most modern methods, while method failure was an equally important reason for traditional methods. Discontinuation was significantly more frequent among higher parity, non-working and Bedouin women, and among those who said Islam disapproves of contraception.

DISCUSSION

Contraception is used largely for spacing. More than two-thirds of the women studied had discontinued most methods after three years, except the IUD, which was used only by about 10% of them. Traditional methods are often discontinued due to method failure and may result in an unintended pregnancy. Better counselling is warranted for traditional methods. Health care for managing side effects of modern methods also needs improvement.

The impact of programs to increase contraceptive use among adult women: a review of experimental and quasi-experimental studies

CONTEXT

Because rates of unintended pregnancy, abortion and unintended birth are very high among adult women in the United States, it is important to identify interventions that can increase contraceptive use in this population.

METHODS

PubMed, PsycINFO and POPLINE were searched for experimental or quasi-experimental studies published between 1990 and 2005 that evaluated policies or programs designed to increase contraceptive use or reduce pregnancy among adult women in the United States. In addition, relevant journals were searched, experts were asked to provide further citations and several subsequently published articles were included.

RESULTS

Only 11 studies that assessed programs, and none that assessed policies, were found. The evaluated interventions offered pregnancy and STD prevention counseling (one study); provided contraceptives in settings other than family planning clinics (two studies); had women initiate contraceptive use during the medical visit (two studies); provided advance supplies of emergency contraception (four studies); or implemented systems to remind injectable contraceptive users about their next injection (two studies). The interventions generally had positive, albeit short-term, effects on contraceptive use; none reduced pregnancy rates. Programs that gave women a contraceptive during the visit were the most effective at increasing method use. Advance provision of emergency contraception increased the likelihood of its use and did not affect regular contraceptive use.

CONCLUSIONS

Very few studies have evaluated interventions to increase contraceptive use among adult women. A research plan that rigorously assesses the impact of different approaches to increasing contraceptive use among adult women should be an integral part of any long-term effort to prevent unintended pregnancy in the United States.

The effect of the hurricane Katrina disaster on sexual behavior and access to reproductive care for young women in New Orleans

OBJECTIVE

The Hurricane Katrina disaster caused rapid displacement of over a million persons in metropolitan New Orleans. The purpose of this study was to describe changes in sexual behavior and access to reproductive care pre- and postrapid displacement among a cohort of young women receiving family planning services before displacement.

METHODS

Women 16 to 24 years old, who were attending 2 public family planning clinics and enrolled in a vaginal douching prevention study, were located 5 to 6 months after Katrina and interviewed by telephone to elicit information about sexual behavior and access to reproductive care.

RESULTS

Women who were located were interviewed (N = 55). Of these, 96% were black, 62% were employed before the disaster, and the mean age was 22.1 (SD 2.1). In the 5 to 6 months after disaster, 86% lived in 3 or more places, 31% had returned to New Orleans, 17% needed health care but could not access it, 40% had not used birth control, and 2 (4%) experienced an unintended pregnancy as a result of lack of access to care. When compared with baseline, after the hurricane, women were less likely to have attended family planning services, to have used birth control, to have >1 sex partner, to have a vaginal odor or discharge.

CONCLUSION

Relief efforts for disasters causing rapid displacement of impoverished women should include reproductive care such as provision of contraception, condoms, and STI services, as well as linking women back into care.

The measurement of childbearing motivation in couples considering the use of assisted reproductive technology

Relatively little is known about the motivational antecedents to the use of assisted reproductive technology (ART). In this paper we measure the fertility motivations of infertile couples who are considering the use of ART, using an established instrument, the Childbearing Questionnaire (CBQ). Our sample consists of 214 men and 216 women who were interviewed at home after an initial screening for ART but before making a final decision. We conducted two sets of analyses with the obtained data. In one set, we compared the scores on scales and subscales of the CBQ for the males and females in our sample with the scores for males and females from a comparable normative sample. For these analyses we first examined sample and gender differences with a four-group analysis of variance. We then conducted a series of linear models that included background characteristics as covariates and interactions between sample, gender, and age and between those three variables and the background characteristics. The results showed the expected higher positive and lower negative motivations in the ART sample and a significant effect on positive motivations of the interaction between sample and age. In the second set of analyses, we developed several new subscales relevant to facets of the desire for a child that appear to be important in ART decision-making. These facets include the desire to be genetically related to the child and the desire to experience pregnancy and childbirth. A third facet, the desire for parenthood, is already well covered by the existing subscales. The results showed the new subscales to have satisfactory reliability and validity. The results also showed that the original and new subscales predicted the three facets of the desire for a child in a multivariate context. We conclude with a general discussion of the way our findings relate both to ART decision-making and to further research on the motivations that drive it.

Women's reproductive rights in the Amazon basin of Ecuador: challenges for transforming policy into practice

Despite advances made by Ecuador in developing policies on reproductive and sexual rights, implementation, and oversight remain a challenge, affecting in particular those living in the Amazon basin. This paper reports on an evaluation of sexual and reproductive health and rights (SRHR) in Orellana, Ecuador, the basis of which was the Health Rights of Women Assessment Instrument, which was altered to focus on government obligations, the reality of access and utilization of services, and the inequities and implementation challenges between the two. A community-based cross-sectional survey conducted in 2006 served to document the current status of SRHR Local female field workers interviewed 2025 women on three areas of womens reproductive health: delivery care, family planning, and pregnancy among adolescent girls age 10-19. The results suggest a reality more dismal than that of the official information for the area. Skilled delivery care, modern contraceptive use, and wanted pregnancies were conspicuously lower among indigenous women living in rural areas. Access to reproductive health services varied between rural and urban women. These significant differences in care--amongst others documented--raise concerns over the utility of national-level data for addressing inequities. The gaps evident in the validity of available information for monitoring policies and programs, and between national policy and action reveal that much still needs to be done to realize SRHR for women in the Amazon basin, and that current accountability mechanisms are inadequate.

Study of socio-demographic and health status of the people of Duwakot VDC, Bhaktapur district

AIMS AND OBJECTIVES

To know the population pattern, socio-economic status, socio cultural aspect and common prevailing disease of the Duwakot VDC of Bhaktapur district.

METHODOLOGY

This is a cross sectional descriptive study. Out of total 206 household, only 120 houses were purposively selected for the survey. A set of semi-structured questionnaire was administered to the representative member of the sample households.

RESULTS

Report obtained from the household survey, ward no. 3 and 4 of Duwakot, the total population of 120 household was found to be 658 and out of that male population was 329 and female population was also 329. That means 50% of population was male and 50% of population was female. Family size refers to the total number of people in the family. The family size depends upon numerous factors like duration of marriage, education of the people. Family planning services will promote the democratic principle that individuals be free to make choices for themselves. It is clear from the table that the more number of males than female respondents knew the family planning methods. Family planning helps not only to attain birth control, proper spacing and limitation of birth but also reduce the population growth and improve over all maternal and child health status including socio economic status. Out of 43 children, BCG, DPT, polio was taken by all children whereas 38 (88.4%) children had taken measles vaccine due to the age less than 9 months and only 5 (11.6%) children were found taken hepatitis B vaccine. It may be due to new invention.

The quality of family planning services in the United States: findings from a literature review

CONTEXT

Family planning services are frequently used and important services for American women, yet little is known about their quality. Service quality has important implications for women's reproductive health. If women do not receive adequate information and tools, and learn appropriate skills, from their providers, they may be hampered in their efforts to control their fertility.

METHODS

A variety of strategies, including database, journal and Internet searches, were used to identify published and unpublished U.S. studies on family planning service quality that came out between 1985 and 2005. Studies were categorized by their focus, and key points of their methodologies and findings were assessed.

RESULTS

Twenty-nine studies were identified, most of which were based on client surveys. Most conceptualized quality as a multidimensional construct, but a uniform definition of quality is lacking, and the domains studied have not been consistent. The available studies focus on four areas: assessments of quality, its correlates, its consequences for client behavior and attitudes, and clients' values and preferences regarding services. Relations between clients and service facility staff have typically been rated favorably, but communication, patient-centeredness and efficiency have been rated more poorly. Service quality varies by characteristics of the facility, provider, client and visit. Research on the consequences of service quality for clients' contraceptive behavior or risk of unintended pregnancy has been very limited and yielded mixed results.

CONCLUSIONS

Studies that assess service quality need stronger designs and greater consistency in measures used so that results are comparable.

Sexual intercourse and current contraceptive use among university students in Finland

OBJECTIVE

To ascertain the current frequency of sexual intercourse, the current use of contraceptives, the ever use of emergency contraception, and the ever experience of condom failure among Finnish university students.

STUDY DESIGN

The study population consisted of Finnish undergraduate university students (19-34 years of age) in 2004. The randomly selected sample comprised 5030 subjects. The data were collected by postal questionnaire, the response rate being 62.7%. Data were presented with frequency distributions and cross-tabulations. Chi-square test was used. Frequencies for women and men were presented and tested separately.

RESULTS

A total of 80% of students were currently practicing sexual intercourse. Approximately half of the female students currently used hormonal contraception and one-third used a condom. Almost half of the men currently used a condom. The simultaneous use of condom and hormonal contraception was rare. Condom failure was common. The ever use of emergency contraception appeared to be associated with condom failure.

CONCLUSION

Of Finnish university students 80% were sexually active and hormonal contraceptives were the most popular method of contraception among female students. The use of the condom should be practiced more often for prevention of sexually transmitted diseases.

Can family planning outreach bridge the urban-rural divide in Zambia?

Background

Zambia experienced declining aggregate fertility and increasing aggregate contraceptive use from 1990 to 2000. Yet, in rural Zambia, progress in family planning has lagged far behind the advances made in Zambia's urban areas. The contraceptive prevalence rate in Lusaka and other urban areas outstripped the rate in rural Zambia by nearly 25 percentage points (41.2 percent versus 16.6 percent) in 2001. The total fertility rate varied between urban and rural areas by 2.5 children (4.3 versus 6.9 children). This paper considers the urban-rural differentials in Zambia and assesses family planning outreach as a tool to narrow this divide.

Methods

This study uses the Zambia Demographic and Health Survey (DHS) data, collected between 2001 and 2002. Logistic regression techniques were employed to examine factors associated with contraceptive use. The first analysis tested modern contraceptive use versus traditional method use and no use. In addition, separate models were run for samples stratified by type of residence (rural or urban) to determine if different factors were associated with use by residence. A simulation determined the effect of all women receiving at least one household visit from a health worker if all other variables were held constant.

Results

Differences in modern contraceptive use between urban and rural areas persist (OR: 1.56, 95 percent CI: 1.24–1.96) even after adjusting for a number of demographic, socioeconomic, cognitive, and attitudinal factors. Household visits by a community health worker significantly increased the likelihood of modern contraceptive use among rural women (OR: 1.83; 95 percent CI: 1.29–2.58). If all rural women received at least one outreach visit per year, the prevalence rate for modern contraceptive methods would be expected to increase for this group by 5.9 percentage points, a marked increase but less than one-quarter of the total urban-rural differential.

Conclusion

Outreach in the form of health worker visits can improve access to family planning services, but it does not eliminate barriers to access or address continued high-fertility desires in Zambia. Until policymakers consider strategies that address both family planning demand creation and supply of services, progress in Zambia and the rest of sub-Saharan Africa will continue to lag behind the rest of the world.

Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa

Background

To present and compare population-based and antenatal-care (ANC) sentinel surveillance HIV prevalence estimates among women in a rural South African population where both provision of ANC services and family planning is prevalent and fertility is declining. With a need, in such settings, to understand how to appropriately adjust ANC sentinel surveillance estimates to represent HIV prevalence in general populations, and with evidence of possible biases inherent to both surveillance systems, we explore differences between the two systems. There is particular emphasis on unrepresentative selection of ANC clinics and unrepresentative testing in the population.

Methods

HIV sero-prevalence amongst blood samples collected from women consenting to test during the 2005 annual longitudinal population-based serological survey was compared to anonymous unlinked HIV sero-prevalence amongst women attending antenatal care (ANC) first visits in six clinics (January to May 2005). Both surveillance systems were conducted as part of the Africa Centre Demographic Information System.

Results

Population-based HIV prevalence estimates for all women (25.2%) and pregnant women (23.7%) were significantly lower than that for ANC attendees (37.7%). A large proportion of women attending urban or peri-urban clinics would be predicted to be resident within rural areas. Although overall estimates remained significantly different, presenting and standardising estimates by age and location (clinic for ANC-based estimates and individual-residence for population-based estimates) made some group-specific estimates from the two surveillance systems more predictive of one another.

Conclusion

It is likely that where ANC coverage and contraceptive use is widespread and fertility is low, population-based surveillance under-estimates HIV prevalence due to unrepresentative testing by age, residence and also probably by HIV status, and that ANC sentinel surveillance over-estimates prevalence due to selection bias in terms of age of sexual debut and contraceptive use. The results presented highlight the importance of accounting for unrepresentative testing, particularly by individual residence and age, through system design and statistical analyses.

Long-acting and permanent contraception: an international development, service delivery perspective

Recent scientific findings about long-acting and permanent methods of contraception underscore their safety, effectiveness, and wide eligibility for individuals who desire them. This has led to new guidance from the World Health Organization to inform national policies, guidelines, and standards for service delivery. Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception in general (and long-acting and permanent methods in particular) is large and growing because the largest cohorts in human history are entering their reproductive years. More than half a billion people will use contraception in developing countries (excluding China) by 2015, an increase of 200 million over levels of use in 2000. The health, development, and equity rationales that historically have underpinned and energized the international family planning effort remain valid and relevant today. Despite the other compelling challenges faced by the international health community, the need to make family planning services more widely available is pressing and should remain a priority.

Family planning advice and postpartum contraceptive use among low-income women in Mexico

CONTEXT

In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated.

METHODS

Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for.

RESULTS

Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method.

CONCLUSIONS

Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.