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Qureshi Z, Jamner A, Filippi V, Gwako G, Osoti A, Mehrtash H, Baguiya A, Bello FA, Compaore R, Gadama L, Kim CR, Msusa AT, Tunçalp Ӧ, Calvert C. Level and determinants of contraceptive uptake among women attending facilities with abortion-related complications in East and Southern Africa. Int J Gynaecol Obstet 2021; 156 Suppl 1:27-35. [PMID: 34676892 DOI: 10.1002/ijgo.13898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa. METHODS Cross-sectional data from Kenya, Malawi, Mozambique, and Uganda collected as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity. Medical record review and the audio computer-assisted self-interviewing system were used to collect information on women's demographic and clinical characteristics and their experience of care. The percentage of women who did not receive a contraceptive was estimated and the methods of choice for different types of contraceptives were identified. Potential determinants of nonreceipt of contraception were grouped into three categories: sociodemographic, clinical, and service-related characteristics. Generalized estimating equations were used to identify the determinants of nonreceipt of a contraceptive following a hierarchical approach. RESULTS A total of 1190 women with abortion-related complications were included in the analysis, of which 33.9% (n = 403) did not receive a contraceptive. We found evidence that urban location of facility, no previous pregnancy, and not receiving contraceptive counselling were risk factors for nonreceipt of a contraceptive. Women from nonurban areas were less likely not to receive a contraceptive than those in urban areas (AOR 0.52; 95% CI, 0.30-0.91). Compared with women who had a previous pregnancy, women who had no previous pregnancy were 60% more likely to not receive a contraceptive (95% CI, 1.14-2.24). Women who did not receive contraceptive counselling were over four times more likely to not receive a contraceptive (AOR 4.01; 95% CI, 2.88-5.59). CONCLUSION Many women leave postabortion care having not received contraceptive counselling and without a contraceptive method. There is a clear need to ensure all women receive high-quality contraceptive information and counselling at the facility to increase contraceptive acceptance and informed decision-making.
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Affiliation(s)
- Zahida Qureshi
- Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Alanna Jamner
- Independent Researcher, New York City, New York, USA
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - George Gwako
- Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adama Baguiya
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | | | - Rachidatou Compaore
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Zomba, Malawi
| | - Caron R Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ausbert Thoko Msusa
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ӧzge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Parsekar SS, Hoogar P, Dhyani VS, Yadav UN. The voice of Indian women on family planning: A qualitative systematic review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial. PLoS One 2021; 16:e0256479. [PMID: 34473750 PMCID: PMC8412258 DOI: 10.1371/journal.pone.0256479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch. Objective To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda. Methods A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care. Results Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition. Conclusion Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents’ fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.
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Steinberg JR, Marthey D, Xie L, Boudreaux M. Contraceptive method type and satisfaction, confidence in use, and switching intentions. Contraception 2021; 104:176-182. [PMID: 33621581 PMCID: PMC8286312 DOI: 10.1016/j.contraception.2021.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined whether contraceptive method type, satisfaction with use, and confidence in correct use were independently associated with switching intentions, a precursor of switching behaviors. STUDY DESIGN Data were from a probability-based sample survey carried out in Delaware and Maryland in 2016 and 2017 among women ages 18 to 44. Women's current contraceptive methods were classified into 5 categories: coitally-dependent methods (barrier methods, withdrawal, and natural family planning); oral contraceptive pills, patches, and rings; injections; implants; and intrauterine contraception (IUC). Satisfaction, confidence, and switching intentions were dichotomized into being very versus less satisfied, being completely versus less confident, and having very low versus not very low switching intentions. We conducted binomial logistic regression to examine whether method type, satisfaction, and confidence were independently associated with having very low switching intentions, adjusting for a range of covariates including sociodemographics, perceived health, religious attendance frequency, sexual, contraceptive, and reproductive experiences, and state of residence (Maryland or Delaware). RESULTS Among 1,077 women using reversible contraception, those using IUC relative to implants, pills, patches, or rings, and coitally-dependent methods were more likely to have very low switching intentions. Among all survey respondents, those who were very satisfied and those who were completely confident in correct use were also more likely to report very low switching intentions. CONCLUSIONS Using IUC, being very satisfied, and being very confident in correct use were independently associated with having very low switching intentions. IMPLICATIONS These results suggest that those using IUC have very low intentions to switch for reasons in addition to satisfaction-level with their method. Other aspects of using IUC such as ease of use, perceived barriers to switching, or having very low switching intentions before beginning IUC may be such reasons.
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Affiliation(s)
- Julia R Steinberg
- Department of Family Science, University of Maryland College Park, College Park, MD, United States; Maryland Population Research Center, University of Maryland College Park, College Park, MD, United States.
| | - Daniel Marthey
- Maryland Population Research Center, University of Maryland College Park, College Park, MD, United States; Department of Health Policy and Management, University of Maryland College Park, College Park, MD, United States
| | - Liyang Xie
- Maryland Population Research Center, University of Maryland College Park, College Park, MD, United States; Department of Health Policy and Management, University of Maryland College Park, College Park, MD, United States
| | - Michel Boudreaux
- Maryland Population Research Center, University of Maryland College Park, College Park, MD, United States; Department of Health Policy and Management, University of Maryland College Park, College Park, MD, United States
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Saya GK, Premarajan KC, Roy G, Sarkar S, Kar SS, Olickal JJ. Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India. Fam Pract 2021; 38:387-394. [PMID: 33367643 DOI: 10.1093/fampra/cmaa133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling. OBJECTIVE To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it. METHODS A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX). RESULTS The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems. CONCLUSIONS This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.
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Affiliation(s)
- Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kariyarath Cheriyath Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Zeal C, Paul R, Dorsey M, Politi MC, Madden T. Young women's preferences for contraceptive education: The importance of the clinician. Contraception 2021; 104:553-555. [PMID: 34139152 DOI: 10.1016/j.contraception.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We explored women's preferences for contraceptive education and assess the role of the clinician in delivering this education. STUDY DESIGN We recruited women ages 16 to 29 presenting for gynecologic care at 3 clinical sites. Respondents completed a survey about preferences for receipt of contraceptive information and trustworthiness of information sources. RESULTS We included 270 respondents' surveys (77.6% of approached). Clinicians were the most preferred (87.0%) and trusted (83.5%) source of contraceptive information, and 69.0% said a clinician's recommendation made a source more trustworthy. CONCLUSIONS Clinicians are a trusted source of contraceptive information; their recommendations of other educational resources may improve acceptance by patients.
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Affiliation(s)
- Carley Zeal
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics and Gynecology, Mercyhealth - Beloit. 2825 Prairie Ave Beloit, WI 53511, United States
| | - Rachel Paul
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Megan Dorsey
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Tessa Madden
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
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Contraceptive priorities among women seeking family planning services in Finland in 2017-2019. Contraception 2021; 104:394-400. [PMID: 34118269 DOI: 10.1016/j.contraception.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess how women's reproductive history, contraceptive experience and need of abortion care are associated with priorities for contraception. STUDY DESIGN In this cross-sectional survey study, we gathered information on women's history of births and abortions, previous use and satisfaction with contraceptive methods, and features of contraceptive methods they value most. Women were recruited at public family planning and outpatient abortion clinics in the capital region of Helsinki, Finland. RESULTS Of the 1006 women responding, 502 were recruited during visits for abortion care and 504 for contraceptive counseling. Women seeking abortion care more often had a history of abortion than women seeking contraceptive counseling (44% vs 11%), presented with a higher mean number of different contraceptive methods used (69% vs 55% with more than 2 previous methods), and were less often satisfied with the methods used (36% vs 60% satisfied with 2 out of 3 methods), p < 0.001 for all. In addition, women seeking abortion care had lower odds of prioritizing effectiveness (aOR 0.3, 95% CI 0.2-0.5), and higher odds of prioritizing lower hormonal levels or non-hormonal alternatives (aOR 2.0, 95% CI 1.3-3.2). There was no difference between the groups regarding priorities of lesser pelvic pain (aOR 0.7, 95% CI 0.5-1.1), regular period (aOR 01.2, 95% CI 0.8-1.9), or the method being easy to use (aOR 1.2, 95% CI 0.8-1.8). CONCLUSIONS There is a contrast between guidelines emphasizing effectiveness in postabortion contraception, and many women's contraceptive priorities. IMPLICATION STATEMENT Clinicians providing contraceptive counseling must be mindful of each individual's personal contraceptive priorities.
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Ineffective Pregnancy Prevention During Adolescence: Assisting Healthcare Providers in Portugal With Individualized Risk Assessment. J Prim Prev 2021; 42:385-407. [DOI: 10.1007/s10935-021-00637-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
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Bhatt N, Bhatt B, Neupane B, Karki A, Bhatta T, Thapa J, Basnet LB, Budhathoki SS. Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study. PLoS One 2021; 16:e0252184. [PMID: 34038439 PMCID: PMC8153486 DOI: 10.1371/journal.pone.0252184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Family planning methods are used to promote safer sexual practices, reduce unintended pregnancies and unsafe abortion, and control population. Young people aged 15-24 years belong to a key reproductive age group. However, little is known about their engagement with the family planning services in Nepal. Our study aimed to identify the perceptions of and barriers to the use of family planning among youth in Nepal. METHODS A qualitative explorative study was done among adolescents and young people aged 15-24 years from the Hattimuda village in eastern Nepal. Six focus group discussions and 25 in-depth interviews were conducted with both male and female participants in the community using a maximum variation sampling method. Data were analyzed using a thematic framework approach. RESULTS Many individuals were aware that family planning measures postpone pregnancy. However, some young participants were not fully aware of the available family planning services. Some married couples who preferred 'birth spacing' received negative judgments from their family members for not starting a family. The perceived barriers to the use of family planning included lack of knowledge about family planning use, fear of side effects of modern family planning methods, lack of access/affordability due to familial and religious beliefs/myths/misconceptions. On an individual level, some couples' timid nature also negatively influenced the uptake of family planning measures. CONCLUSION Women predominantly take the responsibility for using family planning measures in male-dominated decision-making societies. Moreover, young men feel that the current family planning programs have very little space for men to engage even if they were willing to participate. Communication in the community and in between the couples seem to be influenced by the presence of strong societal and cultural norms and practices. These practices seem to affect family planning related teaching at schools as well. This research shows that both young men and women are keen on getting involved with initiatives and campaigns for supporting local governments in strengthening the family planning programs in Nepal.
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Affiliation(s)
- Navin Bhatt
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bandana Bhatt
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Bandana Neupane
- Nepal Health Sector Support Programme (NHSSP)/DFID/Ministry of Health and Population, Kathmandu, Nepal
| | - Ashmita Karki
- Central Department of Public Health, Institute of Medicine, Kathmandu, Nepal
| | - Tribhuwan Bhatta
- Department of Electronics and Computer Engineering, Institute of Engineering, Tribhuvan University, Lalitpur, Nepal
| | - Jeevan Thapa
- Department of Community Health Sciences, School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Lila Bahadur Basnet
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Coulibaly A, Millogo T, Baguiya A, Tran NT, Yodi R, Seuc A, Cuzin-Kihl A, Thieba B, Landoulsi S, Kiarie J, Mashinda Kulimba D, Kouanda S. Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the Democratic Republic of the Congo: a secondary analysis of the Yam Daabo trial. Contracept Reprod Med 2020; 5:35. [PMID: 33292708 PMCID: PMC7686716 DOI: 10.1186/s40834-020-00137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Women who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use. Methods We conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching. Results In total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods’ discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8–8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p < 0.001). The main reason for discontinuation and switching was method-related (141 over 199), followed by partner opposition with 20 women. Conclusion The results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women’s partners and influential people in the community to counter inhibiting beliefs. Trial registration Pan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784).
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Affiliation(s)
- Abou Coulibaly
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS) , 03 B.P. 7047, Ouagadougou, 03, Burkina Faso. .,Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.
| | - Tieba Millogo
- Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.,Institut Africain de la Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso
| | - Adama Baguiya
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS) , 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Nguyen Toan Tran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland.,Institute of Demography and Socioeconomics (IDESO), University of Geneva, Boulevard du Pont d'Arve 40, 1211, Geneva, Switzerland.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW, 2007, Australia
| | - Rachel Yodi
- Programme National de Santé de la Reproduction, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Armando Seuc
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | - Asa Cuzin-Kihl
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | - Blandine Thieba
- Unité de formation et de recherche en Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso
| | - Sihem Landoulsi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | | | - Séni Kouanda
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS) , 03 B.P. 7047, Ouagadougou, 03, Burkina Faso.,Institut Africain de la Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso
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Huysman BC, Paul R, Nigaglioni Rivera A, Tal E, Maddipati R, Madden T. Patient and counselor satisfaction with structured contraceptive counseling by health center staff in federally qualified health centers. Contraception 2020; 103:97-102. [PMID: 33160909 DOI: 10.1016/j.contraception.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To characterize patient and counselor satisfaction with structured, tier-based contraceptive counseling provided by a nonclinician. STUDY DESIGN We conducted a planned secondary analysis of patient and counselor surveys from a study that enrolled women in 2 contraceptive care programs. All participants received structured contraceptive counseling from trained staff members. Women and counselors completed a confidential post-visit survey regarding satisfaction with counseling and medical mistrust. We used univariate and multivariable regressions to examine differences in high satisfaction with counseling (top score), perceived counselor influence, and perceived counselor judgment by participant characteristics. RESULTS Nine hundred forty-two participants completed surveys; most reported they felt respected (100.0%), trusted the counseling information (99.5%), and that counseling helped them choose a contraceptive method (83.8%). Black race, high school education, public insurance, an income below the federal poverty level, and enrollment site were associated with high medical mistrust. Participants with high medical mistrust were less likely to be highly satisfied with counseling (adjusted relative risk (RR) 0.72; 95% confidence interval [CI] 0.63-0.82), more likely to perceive influence (RR 1.77; 95% CI 1.37-2.28), and more likely to perceive judgment (adjusted odds ratio 8.91; 95% CI 3.61-22.01). Mostly, counselors felt they were able to answer participant questions (98.8%), establish good rapport (95.9%), and that participants understood the information presented (98.0%). CONCLUSIONS Overall, participants were satisfied with tier-based contraceptive counseling delivered by nonclinician staff members. Those with high levels of medical mistrust were less likely to be satisfied. The majority of women found the information beneficial in contraceptive decision making. IMPLICATIONS Overall, women reported high satisfaction with tier-based contraceptive counseling delivered by a nonclinician in 3 federally qualified health centers. However, women with high medical mistrust were less likely to report high levels of satisfaction and more likely to report perceived influence or judgment from the counselor.
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Affiliation(s)
- Bridget C Huysman
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Rachel Paul
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Adriana Nigaglioni Rivera
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Elana Tal
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ragini Maddipati
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Tessa Madden
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Hackett K, Henry E, Hussain I, Khan M, Feroz K, Kaur N, Sato R, Soofi S, Canning D, Shah I. Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study. BMJ Open 2020; 10:e039835. [PMID: 32967886 PMCID: PMC7513633 DOI: 10.1136/bmjopen-2020-039835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess: (1) the impact of a reproductive health program on modern contraceptive use from baseline to program close; (2) the sustained impact from baseline to follow-up 36 months later; and (3) the exposure-adjusted impact at program close and follow-up. DESIGN Retrospective, cross-sectional matched control study. SETTING Karachi, Pakistan. PARTICIPANTS 2561 married women aged 16-49 years. INTERVENTIONS The Willows Program, a community-based family planning counselling and referral program implemented from 2013 to 2015. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was community-level modern contraceptive prevalence rate (mCPR), measured for January 2013 (baseline), June 2015 (program close) and at follow-up 36 months later. A secondary outcome was exposure-adjusted mCPR (among women reporting a family planning home visit) at program close and at follow-up. RESULTS There was no significant effect on community-level mCPR at program close (2.4 percentage point increase in intervention over comparison; 95% CI -2.2 to 7.0) or at follow-up (1.9 percentage point decrease; 95% CI -6.7 to 2.8). Only 18% of women in the intervention area reported receiving a family planning visit in the preceding 5 years. Among those reporting a visit, we observed a significant 10.3 percentage point increase (95% CI 4.6 to 15.9) from baseline to close, and a non-significant 2.0 percentage point increase (95% CI -3.8 to 7.8) from baseline to follow-up, relative to matched women in the comparison area. The cost per new modern method user was US$1089, while the cost per user-year during the intervention period was US$455. CONCLUSIONS The program had a positive short-term effect on women who received a family planning visit; however, this effect was not sustained. Program coverage was low and did not significantly increase community-level family planning use. Findings highlight the need to increase community coverage of high-quality counselling and contextually relevant interventions for family planning demand generation.
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Affiliation(s)
- Kristy Hackett
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Henry
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Imtiaz Hussain
- Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mirbaz Khan
- Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khalid Feroz
- Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ryoko Sato
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sajid Soofi
- Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - David Canning
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Iqbal Shah
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Arora KS, Ponsaran R, Morello L, Katabi L, Behmer Hansen RT, Zite N, White K. Attitudes and beliefs of obstetricians-gynecologists regarding Medicaid postpartum sterilization - A qualitative study. Contraception 2020; 102:376-382. [PMID: 32858053 DOI: 10.1016/j.contraception.2020.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the attitudes and beliefs of obstetrician-gynecologists in the United States (US) regarding the Medicaid postpartum sterilization policy. STUDY DESIGN We recruited obstetrician-gynecologists practicing in ten geographically diverse US states for a qualitative study using the American College of Obstetricians and Gynecologists directory. We conducted semi-structured interviews via telephone, professionally transcribed, and analyzed using the constant comparative method and principles of grounded theory. RESULTS We interviewed thirty obstetrician-gynecologists (63.3% women, 76.7% non-subspecialized, and 53.3% academic setting). Participants largely described the consent form as unnecessary, paternalistic, an administrative hassle, a barrier to desired patient care, and associated with worse health outcomes. Views on the waiting period's utility and impact were mixed. Many participants felt the sterilization policy was discriminatory. However, some participants noted the policy's importance in terms of the historical basis, used the form as a counseling tool to remind patients of the permanence of sterilization, felt the policy prompted them to counsel regarding sterilization, and protected patients in contemporary medical practice. CONCLUSION Many physicians shared concerns about the ethics and clinical impact of the Medicaid sterilization policy. Future revisions to the Medicaid sterilization policy must balance prevention of coercion with reduction in barriers to those desiring sterilization in order to maximize reproductive autonomy. IMPLICATIONS Obstetrician-gynecologists are key stakeholders of the Medicaid sterilization policy. Obstetrician-gynecologists largely believe that revision to the Medicaid sterilization policy is warranted to balance reduction of external barriers to desired care with a process that enforces the need for counseling regarding contraception and reviewing patient preference for sterilization throughout pregnancy in order to minimize regret.
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Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, United States; Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States.
| | - Roselle Ponsaran
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Laura Morello
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Leila Katabi
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | | | - Nikki Zite
- Department of Obstetrics and Gynecology, University of Tennessee, Knoxville, TN, United States
| | - Kari White
- Steve Hicks School of Social Work and Department of Sociology, University of Texas at Austin, Austin, TX, United States
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Brunie A, Rademacher KH, Nwala AA, Danna K, Saleh M, Afolabi K. Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs. Gates Open Res 2020; 4:119. [PMID: 32908965 PMCID: PMC7463110 DOI: 10.12688/gatesopenres.13135.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Several organizations in Nigeria are leading pilot introduction programs of the levonorgestrel intrauterine system (LNG-IUS). We conducted a qualitative assessment of providers' experiences across the five programs and an analysis of service delivery costs in one program. Methods: We conducted 20 in-depth interviews (IDIs) with providers. We used project expenditure records to estimate incremental direct service delivery costs of introducing the LNG-IUS in 40 social franchise clinics supported by the Society for Family Health (SFH). We then compared the direct service delivery costs per couple years of protection (CYP) for the LNG-IUS to other family planning methods. Results: Providers appreciated the therapeutic benefits of the LNG-IUS, especially reduction of heavy bleeding. They said that women generally accepted bleeding changes with counseling but noted complaints about spotting and mixed acceptability of amenorrhea. Providers indicated being comfortable with both the insertion and removal process and believed their equipment and infection prevention protocols were adequate. Lack of awareness among women, limited availability, current pricing, and resistance to uterine placement among some women were perceived as barriers. The estimated direct service delivery cost of introducing the LNG-IUS in pilot settings, inclusive of up-front provider training costs, was USD 34 per insertion. Direct service delivery costs at a 'steady state' (i.e., without training costs included for any method) of the LNG-IUS per CYP was similar to that of other contraceptive methods distributed in Nigeria. Conclusion: Providers' positive experiences with the LNG-IUS and direct service delivery costs per CYP that align with those for other methods suggest that the LNG-IUS could be an important addition to the method mix in Nigeria. Product introduction strategies will need to address both the supply and the demand sides, as well as consider appropriate pricing of the LNG-IUS relative to other methods and particularly the copper IUD.
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Festin MPR. Overview of modern contraception. Best Pract Res Clin Obstet Gynaecol 2020; 66:4-14. [PMID: 32291177 DOI: 10.1016/j.bpobgyn.2020.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022]
Abstract
The large-scale initiatives to address the global unmet needs for family planning (FP) have gathered and compelled scientists, providers, program managers, and other stakeholders (including users) to re-examine the various methods of modern contraception, focusing on those that are proven to be more effective (long-acting reversible contraceptives and permanent methods), historically more widely used (oral contraceptives, condoms), and in development (male hormonal contraception). Implementing FP programs requires an understanding of the human rights principles underpinning the delivery of contraceptive services, the various indicators related to demand, need, and use (demand satisfied, unmet need, and contraceptive prevalence), and its effectiveness (perfect or correct use and typical use), which will be presented in this article. Tools and guidance documents developed using the best available evidence have also been listed in this review article. This issue will also look at new initiatives about providing care (self-care), and key population groups (post-pregnancy and adolescence). The clinical use of the methods should go hand in hand with the programmatic initiatives to ensure that women, men, or couple take up the appropriate method of choice and continue using these based on their reproductive health goals.
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Affiliation(s)
- Mario Philip R Festin
- Department of Obstetrics and Gynecology, University of the Philippines College of Medicine - Philippine General Hospital, Taft Avenue, Ermita, Manila, Philippines.
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