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Sack DE, Peetluk LS, Audet CM. Couples-based interventions and postpartum contraceptive uptake: A systematic review. Contraception 2022; 112:23-36. [PMID: 35577147 PMCID: PMC9968552 DOI: 10.1016/j.contraception.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Systematically review the existing evidence about couples-based interventions and postpartum contraceptive uptake and generate recommendations for future research. DATA SOURCES PubMed, Web of Science, PsycINFO, Embase, and CINAHL through June 7, 2021. STUDY SELECTION AND DATA EXTRACTION Studies with a couples-based intervention assessing postpartum contraceptive uptake. Two independent reviewers screened studies, extracted data, and assessed risk of bias with RoB-2 (Cochrane Risk of Bias 2) for randomized and ROBINS-I (Risk of Bias in Non-Randomized Studies - Interventions) for observational studies. Data were synthesized in tables, figures, and a narrative review. RESULTS A total of 925 papers were identified, 66 underwent full text review, and 17 articles, which included 18 studies - 16 randomized, 2 observational - were included. The lack of intervention and outcome homogeneity precluded meta-analysis and isolating the effect of partner involvement. Four studies were partner-required, where partner involvement was a required component of the intervention, and 14 were partner-optional. Unadjusted risk differences ranged from 0.01 to 0.51 in favor of couples-based interventions increasing postpartum contraceptive uptake versus standard of care. Bias assessment of the 16 randomized studies classified 8, 3, and 5 studies as at a high, some concern, and low risk of bias. Common sources of bias included intervention non-adherence and missing outcome data. One observational study was at a high and the other at a low risk of bias. CONCLUSIONS Future studies that assess couples-based interventions must clearly define and measure how partners are involved in the intervention and assess how intervention adherence impacts postpartum contraceptive uptake.
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Affiliation(s)
- Daniel E Sack
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Lauren S Peetluk
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn M Audet
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States
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Olakunde BO, Pharr JR, Adeyinka DA, Chien LC, Benfield RD, Sy FS. Spatial variations in family planning demand to limit childbearing and the demand satisfied with modern methods in sub-Saharan Africa. Reprod Health 2022; 19:144. [PMID: 35733204 PMCID: PMC9215060 DOI: 10.1186/s12978-022-01451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background There is an increasing demand for family planning to limit childbearing in sub-Saharan Africa (SSA). However, limited studies have quantified the spatial variations. This study examined: (i) the spatial patterns in the demand for family planning to limit childbearing and satisfied with modern methods, and (ii) the correlates of the demand for family planning to limit childbearing satisfied with modern methods in SSA. Methods This study analyzed secondary data on 306,080 married/in-union women obtained from Demographic Health Surveys conducted between 2010 and 2019 in 33 sub-Saharan African countries. We conducted exploratory spatial data analysis, with countries as the unit of analysis. We also performed regression analysis to determine the factors associated with demand for family planning to limit childbearing satisfied with modern methods in SSA. Results The mean percentage of women who demanded for family planning to limit childbearing by country was 20.5% while the mean prevalence of demand for family planning to limit childbearing satisfied with modern methods by country was 46.5%. There was a significant positive global spatial autocorrelation in the demand for family planning to limit childbearing (global Moran’s I = 0.3, p = 0.001). The cluster map showed the concentration of cold spots (low–low clusters) in western and central Africa (WCA), while hot spots (high–high clusters) were concentrated in eastern and southern Africa (ESA). Also, the demand for family planning to limit childbearing satisfied with modern methods showed significant positive global spatial autocorrelation (global Moran’s I = 0.2, p = 0.004) and concentration of cold spots in WCA. In the final multivariable regression model the joint family planning decision making (β = 0.34, p < 0.001), and antenatal care (β = 13.98, p < 0.001) were the significant factors associated with the demand for family planning to limit childbearing satisfied by modern methods. Conclusions There are significant spatial variations in the demand for family planning to limit childbearing and the demand satisfied by modern methods, with cold spots concentrated in WCA. Promoting joint decision making by partners and increasing uptake of antenatal care may improve the demand for family planning to limit childbearing satisfied with modern methods. In sub-Saharan Africa (SSA), studies have shown that the proportion of married women who want to stop having children has been increasing as well as the proportion using modern contraceptive methods among them. These studies also indicated that this proportion of women are higher in certain regions of Africa than the others. To extend these previous findings, we performed geographical analysis to assess how the proportion of married/in-union women who want to stop having children and the ones using modern methods among them differ geographically. Our findings indicated that neighboring countries where the proportion of married/in-union women who want to stop having children was higher than the overall average were concentrated in eastern and southern Africa (ESA), while neighboring countries in which the proportion of married/in-union women who want to stop having children was lower than the overall average were concentrated in western and central Africa (WCA). Similarly, the results also showed that neighboring countries where the proportion of married/in-union women using modern contraceptive methods among those who want to stop having children was lower than the overall average were concentrated in WCA. Our findings suggest that increasing joint decision making on family planning and uptake of antenatal care in SSA may improve the use of modern contraceptive methods among married/in-union women who want to stop childbearing.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA. .,Department of Community Prevention and Care Services, National Agency for the Control of AIDS, 3, Ziguinchor Street, off IBB Way, Wuse Zone 4, Abuja, Nigeria. .,Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria.
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.,Department of Public Health, National AIDS and STI Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | | | - Francisco S Sy
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
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Hegdahl HK, Musonda P, Svanemyr J, Zulu JM, Grønvik T, Jacobs C, Sandøy IF. Effects of economic support, comprehensive sexuality education and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia. Soc Sci Med 2022; 306:115125. [PMID: 35724585 DOI: 10.1016/j.socscimed.2022.115125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/14/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
Adolescent girls in Sub-Saharan Africa are at high risk of poor sexual and reproductive health outcomes. We present findings from a cluster-randomised trial in rural Zambia on the effects of economic support, comprehensive sexuality education (CSE) and community dialogue on sexual activity, contraceptive use and beliefs among adolescent girls. We recruited 157 schools in 2016, and all girls in grade 7 were invited to participate. Schools were randomised to either economic support, combined economic support, CSE and community dialogue, or control. Economic support consisted of unconditional cash transfers to girls and their guardians, and payment of school fees for girls continuing to grades eight and nine. CSE and community dialogue meetings focused on practices around girls' fertility, marriage and education. The interventions lasted two years from 2016 to 2018, with follow-up for another two years. The effects on outcomes were measured in 2018 and 2019 and compared using generalised estimating equations. We found that economic support lowered sexual activity (risk ratio (RR) 0.70; 95% C.I. 0.54 to 0.91), with a small added benefit of CSE and community dialogue. Economic support and the additional CSE and community dialogue were effective in lowering unprotected sexual activity (RR 0.53 for combined support vs. control; 95% C.I. 0.37 to 0.75). There was no evidence of intervention effects on contraceptive use among those ever sexually active, but the addition of CSE and community dialogue improved contraceptive use among those recently sexually active (RR 1.26; 95% C.I. 1.06 to 1.50) and knowledge regarding contraceptives (RR 1.18; 95% C.I. 1.01 to 1.38) compared to economic support alone. Perceived community support regarding contraceptives was lower in both intervention arms compared to the control. These findings indicate that economic support in combination with CSE and community dialogue can improve the sexual and reproductive health of adolescent girls.
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Affiliation(s)
- Hanne Keyser Hegdahl
- Centre for International Health, University of Bergen, Årstadveien 21 (Overlege Danielsens Hus), 5006, Bergen, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, NO-5020, Bergen, Norway.
| | - Patrick Musonda
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Joar Svanemyr
- Chr. Michelsen Institute, P.O. Box 6033, N-5892, Bergen, Norway
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Taran Grønvik
- Centre for International Health, University of Bergen, Årstadveien 21 (Overlege Danielsens Hus), 5006, Bergen, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, NO-5020, Bergen, Norway
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Ingvild Fossgard Sandøy
- Centre for International Health, University of Bergen, Årstadveien 21 (Overlege Danielsens Hus), 5006, Bergen, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, NO-5020, Bergen, Norway
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Engström E, Målqvist M, Niemeyer Hultstrand J. Family planning practices and women's impression of the reproductive life plan in Eswatini. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100723. [PMID: 35413607 DOI: 10.1016/j.srhc.2022.100723] [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: 08/12/2021] [Revised: 02/15/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Family planning is limited and unplanned pregnancies are common in Eswatini. The Reproductive Life Plan (RLP) is a counselling tool to improve pregnancy planning. Mentor mothers, i.e. community health workers, were trained in using an adapted RLP and introduced it into family planning discussions with their clients. This study evaluates the clients' impression of the RLP and investigates their family planning practices. METHOD Data were collected in 2018 from anonymous questionnaires filled out by the clients: mothers or pregnant women aged 15-44 years. The questionnaire comprised 20 questions on demographic background, fertility desires, pregnancy planning as well as quality and perceived need for family planning support. Chi-square tests or Fisher's exact test were used for group comparisons. RESULTS 199 women were included. Most women (74%) chose the option that family planning discussions using the RLP had helped them 'very much'. A majority also had a perceived need for these discussions as 70% wanted to have more support from their mentor mother and 92% wanted more information about family planning. Women with lower educational level and younger women wanted more support compared to women with higher educational level and older women (p < 0.001 and p = 0.028). The unmet need for family planning was 22%. CONCLUSION The introduction of the RLP used by mentor mothers was well received among women but most of them requested more family planning support. Using the RLP may help women in this context achieve their reproductive goals.
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Affiliation(s)
- Ellinor Engström
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Sweden
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Tesema ZT, Tesema GA, Boke MM, Akalu TY. Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey. BMC Womens Health 2022; 22:181. [PMID: 35585626 PMCID: PMC9118760 DOI: 10.1186/s12905-022-01769-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of sub-Saharan Africa. METHODS Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the best-fitted model. RESULTS The pooled estimate of modern contraception use in sub-Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [AOR = 1.38 (1.33, 1.42)], middle [AOR = 1.17, (1.14, 1.21)], rich wealth status [AOR = 1.29 (1.25, 1.34)], media exposure [AOR = 1.25 (1.22, 1.29)], and postnatal care (PNC) utilization [AOR = 1.25 (1.22, 1.29)] had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility [AOR = 1.74 (1.69, 1.79)] and birth order 2-4 [AOR = 1.36 (1.31, 1.41)] had higher odds of modern contraceptive utilization. On the other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] decreased the odds of modern contraceptive utilization. CONCLUSION The uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention needs to be given to rural residents, illiterate women, and communities with low wealth status.
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Affiliation(s)
- Zemenu Tadesse Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Muluneh Boke
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nketiah-Amponsah E, Ampaw S, Twumasi Baffour P. Socioeconomic determinants of use and choice of modern contraceptive methods in Ghana. Trop Med Health 2022; 50:33. [PMID: 35581604 PMCID: PMC9116020 DOI: 10.1186/s41182-022-00424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The slow pace of fertility decline in Africa relative to other parts of the world has important implications for the region's economic development. Modern contraceptive use is seen as important population control and family planning strategy by governments worldwide. This paper examines the socioeconomic determinants of modern contraceptive use and choice among Ghanaian men and women. METHODS We use the most recent and nationally representative Ghana Demographic and Health Survey conducted in 2014. The analysis is observational, with no causal implications. Bivariate and multivariate methods are used to analyse the data. We first use logistic regression to explore the correlates of modern contraceptive use among Ghanaian men and women. Second, we explore the socioeconomic factors influencing the choice of modern contraceptive methods among contraceptive users using multinomial logistic regression. We classify the modern methods of contraception into three groups: long-acting reversible contraceptives (LARC), short-acting contraceptives (SAC), and permanent contraceptives. RESULTS Marital status proves to be the most significant predictor for both men and women, with women in monogamous unions having a greater propensity to use modern methods of contraception (OR = 1.4, p < 0.00). We also find that different factors affect the use and choice of modern methods of contraception among men and women in Ghana. Muslim men had a higher likelihood than Catholics to choose the permanent (sterilisation) method (OR = 11.9, p < 0.05), while their female counterparts were 0.25 times less likely to choose sterilisation over SAC (p < 0.05). Moreover, women who ever tested for HIV had higher use of LAC than the SAC ((RRR = 1.6, p < 0.01). The modern contraceptive users (women) with at most basic education were more likely than those with tertiary education to choose LAC over SAC. Finally, rural women with health insurance were 0.75 times (p < 0.01) less likely to use modern methods of contraception. CONCLUSIONS The paper reiterates the need to intensify and sustain public health education on the health benefits of using modern methods of contraception among the adult population. The paper suggests that including family planning services on Ghana's national health insurance benefits package is commendable. It can promote modern contraceptive use and curtail unwarranted population growth.
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Affiliation(s)
| | - Samuel Ampaw
- School of Economics, University of Nottingham Ningbo China, Ningbo, People's Republic of China.
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Macleod CI, Reynolds JH, Delate R. Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion. Public Health Rev 2022; 43:1604376. [PMID: 35646420 PMCID: PMC9131513 DOI: 10.3389/phrs.2022.1604376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.
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Affiliation(s)
- Catriona Ida Macleod
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
| | | | - Richard Delate
- 2gether 4 SRHR, United Nations Population Fund, Johannesburg, South Africa
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Nanvubya A, Wanyenze RK, Abaasa A, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Bagaya B, Chinyenze K, Price MA, Van Geertruyden JP. Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of Lake Victoria in Uganda: a randomized controlled trial. BMC Health Serv Res 2022; 22:506. [PMID: 35421987 PMCID: PMC9012015 DOI: 10.1186/s12913-022-07898-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Family planning knowledge is poor and use is low in Ugandan fishing communities. We compared the effectiveness of enhanced family planning (FP) education with routine counselling on FP knowledge and use.
Methods
Individuals aged 15–49 years were randomly assigned to intervention or control arm. The intervention constituted enhanced FP education based on a simplified handout extracted from the WHO FP guidance tool called, “Family planning: A global handbook for FP providers” which participants took home for additional reading. The control arm constituted FP counselling following Uganda Ministry of Health guidelines. FP knowledge score and contraceptive prevalence rate (CPR) were compared between trial arms at baseline and at 12 months. Negative binomial regression models were used to estimate the effect of the intervention on FP knowledge and use.
Results
Overall, 1410 participants were screened to enrol 1004 (502 per study arm, 48.5% women). Subsequently, 384 (76.5%) and 383 (76.3%) completed the 12 months’ follow-up in the intervention and control arms respectively. At baseline, a median FP knowledge score of 8 and a < 70% FP knowledge score was observed for all participants with a CPR of 36.8%. At month-12, the median FP knowledge score improved in both arms, higher in the intervention arm than the control arm (46 vs 30; p < 0.001). In the intervention arm, 304 (79.2%) had a score of ≥70 compared with 21 (5.5%) in the control arm (p < 0.001). In the negative binomial regression model, the change in FP knowledge score was 47% higher in the intervention arm than in the control arm (score ratio: 1.47, 95%CI: 1. 43-1.51, p < 0.001). The change in CPR was 16% higher in the intervention arm than in the control arm (Prevalence ratio: 1.16, 95%CI: 1.01-1.34, p < 0.040).
Interpretation
Enhanced FP education using a simplified FP education handout was more effective in increasing FP knowledge and use compared to routine FP counselling for people living in fishing communities. Innovative FP education interventions are recommended for improving FP knowledge and optimizing uptake in remote-rural settings where literacy levels are low.
Trial registration
The study was registered by the Pan African Clinical Trial Registry on 03 July 2021 with a Trial Registration Number PACTR202107891858045. “Retrospectively registered”.
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Tolley EE, Zissette S, Taylor J, Hanif H, Ju S, Schwarz J, Thurman A, Tyner D, Brache V, Doncel GF. Acceptability of a Long-Acting, Multipurpose Vaginal Ring: Findings from a Phase I Trial in the U.S. and Dominican Republic. J Womens Health (Larchmt) 2022; 31:1343-1352. [PMID: 35363574 PMCID: PMC9527051 DOI: 10.1089/jwh.2021.0394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Women worldwide face risks from pregnancy, HIV, and other sexually transmitted infections (STIs). To date, highly effective contraceptive methods provide no HIV/STI protection, and HIV prevention products, excluding condoms, provide no pregnancy protection. Intravaginal rings (IVRs) delivering antiretrovirals and contraceptives are a promising multipurpose prevention technology (MPT). Methods: Embedded within a Phase I randomized, placebo-controlled trial, we examined acceptability of continuous versus interrupted use of a 90-day MPT IVR among 47 low-risk women in Norfolk, Virginia and the Dominican Republic. A baseline survey assessed menstruation attitudes, risk perceptions and trial-related motivations. Follow-up surveys (M1/M3) examined user experiences with and preferences for IVR attributes; 18 women also participated in two in-depth interviews. Results: Most women rated the IVR's flexibility and smoothness (86%) and ease of insertion/removal (76%) as very acceptable. Fewer women similarly rated the IVR size (57%) and changes in color from menstruation (52%). Most participants experienced no changes or less bleeding. Those reporting more/heavier bleeding (20% M1, 15% M3) disliked the change. Overall, women preferred a 3-month (75%) to a 1-month IVR (7.5%) or a bimonthly injectable (10%). In qualitative interviews, women were willing to continuously use an IVR for 6–12 months, providing it did not “degrade” inside the body. Reasons for trial participation and prevention preferences, menstrual attitudes, and perceived IVR benefits and doubts varied by site. Conclusions: Findings provide strong evidence of demand for an MPT IVR that protects from pregnancy and HIV/STIs, lasts longer than 1 month, minimally disrupts menstrual bleeding, and is in women's control. numberClinicalTrials.gov: #NCT03279120.
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Affiliation(s)
- Elizabeth E Tolley
- Behavioral, Epidemiological & Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | - Seth Zissette
- Rollins School of Public Health, Emory University, Department of Epidemiology (PhD Student), Atlanta, GA, USA
| | - Jamilah Taylor
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Homaira Hanif
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Susan Ju
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jill Schwarz
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Andrea Thurman
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Angdembe MR, Sigdel A, Paudel M, Adhikari N, Bajracharya KT, How TC. Modern contraceptive use among young women aged 15-24 years in selected municipalities of Western Nepal: results from a cross-sectional survey in 2019. BMJ Open 2022; 12:e054369. [PMID: 35338056 PMCID: PMC8961113 DOI: 10.1136/bmjopen-2021-054369] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the modern contraceptive prevalence rate (mCPR) and its predictors among young women aged 15-24 years. DESIGN Cross-sectional analysis of Adolescent Youth Project baseline survey. SETTING 29 municipalities within Lumbini Province and Sudurpaschim Province in Western Nepal. PARTICIPANTS 683 young women aged 15-24 years who were living in the catchment area of the selected 30 private OK network health facilities at the study sites from November to December 2019 and who provided informed consent or assent. OUTCOME MEASURE mCPR among young women aged 15-24 years. RESULTS The mean age of the respondents was 19 years, 61.7% never had sex and 63.9% were unmarried. The mCPR was 11.9% (95% CI 9.5 to 14.8). Of those who reported using a modern method of contraception, injectables (37.9%) were the most common, followed by male condom (35.9%) and implants (8.8%). Majority (86.4%) of the respondents reported currently not using any method of contraception. In the binary logistic regression analysis, the odds of contraceptive use were higher among women aged 20-24 years (adjusted OR (AOR)=5.50, 95% CI 2.94 to 10.29) and those of Janajati caste/ethnicity (AOR=2.08, 95% CI 1.16 to 3.71), while the odds were lower among women who faced high level of barriers (individual, family/societal, service provider and health facility barriers) to contraceptive use (AOR=0.36, 95% CI 0.14 to 0.98). CONCLUSIONS The mCPR among young women aged 15-24 years was low but similar to the national level. Sexual and reproductive health programmes aiming to improve the mCPR in this population of young women should consider the reported level of sexual activity. Reaching young women to improve their knowledge and self-efficacy for contraception is critical to ensure they can access contraception when needed. The focus should be on reaching not just young women but also key influencers and service providers and making health facilities adolescent-friendly to reduce barriers to contraceptive uptake and to realise self-efficacy.
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Affiliation(s)
| | - Anil Sigdel
- Population Services International, Lalitpur, Nepal
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Anderson EJ, Hinson L, Berhe H, Berhane K, Warholak T, Equar A, Hailu D, Abraha A. Validation and Assessment of a Tool to Measure Psychosocial Readiness to Use Modern Contraceptives among Women in Tigray, Ethiopia. Stud Fam Plann 2022; 53:209-225. [PMID: 35278249 DOI: 10.1111/sifp.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Social norms, beliefs, and attitudes around modern contraception (MC) use can influence the decision to take up a method, but susceptibility to these factors varies between individuals. The effect of psychosocial readiness to use MC at the individual level is not established for women in Ethiopia. Data from 349 women were used for validity and reliability testing of a 12-item MC psychosocial readiness scale. A rating-scale Rasch model tested for unidimensionality, rating scale functioning, and construct and content validity. Multiple linear regression assessed the effect of respondent characteristics on MC psychosocial readiness scores. The psychometric properties of the univariate MC psychosocial readiness scale were satisfactory after the stepwise removal of two items. Prior MC use, socioeconomic status, geographic zone, and education were significantly associated with increased endorsement of MC psychosocial readiness. The 10-item scale measures the extent of endorsement of MC psychosocial readiness for childbearing women in Tigray, Ethiopia. Further research should qualitatively explore the identified influence of education on MC psychosocial readiness.
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Dehingia N, Barker KM, Raj A. Relationship between adolescent friendship networks and contraceptive use and unintended pregnancies in early adulthood in the United States. Contraception 2022; 110:36-41. [PMID: 35202618 DOI: 10.1016/j.contraception.2022.02.003] [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: 06/25/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the relationship between reproductive attitude of friends during adolescence, and unintended pregnancy outcomes and contraceptive non-use during early adulthood. STUDY DESIGN We used longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (n=1866). Adolescent friendship network structures were constructed from the first wave of data to assess reproductive attitudes of friends, measured via three sub-scales: attitude towards contraceptive use, attitude towards sex in adolescence, and attitude towards pregnancy in adolescence. We then used multi-level logistic regression to examine the relationship of friends' reproductive attitudes in adolescence with unintended pregnancy and contraceptive non-use in adulthood. RESULTS Around one-third of the sample experienced at least one unintended pregnancy, and 12% reported contraceptive non-use. Being friends with individuals who are not accepting of adolescent pregnancy reduced the likelihood of an unintended pregnancy in young adulthood (Adjusted Odds Ratios [aOR]: 0.79; 95% CI: 0.67-0.94); this association varied by sex, being significant only for females (aOR:0.75; 95% CI: 0.58 - 0.96). Additionally, friends' acceptability of adolescent sex increased the odds of contraceptive use in later life. Individuals with friends who held negative attitude toward contraceptive use during adolescence were more likely to be non-users in later life (aOR:1.37; 95% CI: 1.03-1.81). CONCLUSIONS Our results suggest a relationship between adolescent social networks and reproductive health outcomes in young adulthood, highlighting the importance of friendship networks for young individuals' reproductive well-being. IMPLICATIONS Attitudes held by adolescent friends regarding contraceptive use, adolescent sex, and adolescent pregnancy have significant, and distinct associations with an individuals' later-life reproductive health outcomes. Future research should consider evaluation of social network-based sexual and reproductive health interventions aimed at adolescents.
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Affiliation(s)
- Nabamallika Dehingia
- Joint Doctoral Program - Public Health, San Diego State University (SDSU) & University of California San Diego (UC San Diego), California, United States of America; Center on Gender Equity and Health, School of Medicine, UC San Diego, La Jolla, California, United States of America.
| | - Kathryn M Barker
- Center on Gender Equity and Health, School of Medicine, UC San Diego, La Jolla, California, United States of America
| | - Anita Raj
- Center on Gender Equity and Health, School of Medicine, UC San Diego, La Jolla, California, United States of America
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Mutumba M. Mass media influences on family planning knowledge, attitudes and method choice among sexually active men in sub-Saharan Africa. PLoS One 2022; 17:e0261068. [PMID: 35085245 PMCID: PMC8794141 DOI: 10.1371/journal.pone.0261068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
Men are underrepresented in family planning (FP) research, and despite the widespread promotion of FP through mass media, there is no systematic evaluation on how mass media exposure influences their FP knowledge, attitudes and behavior. Using Demographic and Health Survey (DHS) data from 31 countries in Sub-Saharan Africa (SSA), collected between 2010 and 2019, this paper examines the associations between three types of traditional mass media (radio, television and print) with FP knowledge, attitudes and method choices among reproductive age men in SSA, relative to other socio-cultural factors. Estimates to quantify the relative contribution of each type of mass media, relative to other evidence-based socio-cultural influences on FP outcomes, were derived using the Shorrocks-Shapley decomposition. Radio exposure had the largest impact on FP knowledge, attitudes and method choice, accounting for 26.1% of the variance in FP knowledge, followed by Television (21.4%) and education attainment (20.7%). Mass media exposure had relatively minimal impact on FP method choice, and between the three types of mass media, television (8%) had the largest influence on FP method choice. Print media had comparatively lesser impact on FP knowledge (8%), attitudes (6.2%) and method choice (3.2%). Findings suggest that mass media exposure has positive influences on FP knowledge, attitudes and method choice but its influence on FP knowledge, attitudes and method choice is smaller relative to other socio-cultural factors such as education, household wealth and marital status. As such, efforts to increase FP uptake in Sub-Saharan Africa should take into consideration the impact of these socio-cultural economic factors.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
- * E-mail:
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Humphries H, Upfold M, Mahlase G, Mdladla M, Gengiah TN, Abdool Karim Q. Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision. PLoS One 2022; 17:e0262043. [PMID: 35025908 PMCID: PMC8758078 DOI: 10.1371/journal.pone.0262043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/15/2021] [Indexed: 12/05/2022] Open
Abstract
Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Africa. HCWs listed the long-acting nature of the contraceptive implant as a key benefit, helping to overcome healthcare system barriers like heavy workloads and understaffing. However, challenges like side effects, migration of the implant, stakeholder buy-in and inconsistent training on insertion and removal hampered the roll-out of the contraceptive implant. For PrEP implants, HCWs preferred long-acting products that were palpable and biodegradable. Our findings highlighted that the characteristics of PrEP implants that are perceived to be beneficial by HCWs may not align with that of potential users, potentially impacting the acceptability and uptake of PrEP implants. Further our data highlight the need for sustained and multi-pronged approaches to training HCWs and introducing new health technologies into communities. Finding a balance between the needs of HCWs that accommodate their heavy workloads, limited resources at points of delivery of care and the needs and preferences of potential users need to be carefully considered in the development of PrEP implants.
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Affiliation(s)
- Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Michele Upfold
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Gethwana Mahlase
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Makhosazana Mdladla
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tanuja N. Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Hernandez JH, Babazadeh S, Anglewicz PA, Akilimali PZ. As long as (I think) my husband agrees…: role of perceived partner approval in contraceptive use among couples living in military camps in Kinshasa, DRC. Reprod Health 2022; 19:6. [PMID: 35022043 PMCID: PMC8756630 DOI: 10.1186/s12978-021-01256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Male partner's approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men's support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women's perception of their partner's opinion. METHODS This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. RESULTS Results confirm women are poorly aware of their partner's opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner's actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner's approval. CONCLUSIONS Women's perceptions of partner's approval are much stronger determinant of contraceptive use than the latter's actual opinion, and stereotyping men's opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women's capacity to negotiate contraceptive use.
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Affiliation(s)
- Julie H Hernandez
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.
| | - Saleh Babazadeh
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Philip A Anglewicz
- Department of Population, Family, and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pierre Z Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey. BMC Pregnancy Childbirth 2022; 22:17. [PMID: 34991501 PMCID: PMC8734335 DOI: 10.1186/s12884-021-04371-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. Methods The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. Results Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30–34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15–19 years (AOR = 0.55; 95% CI: 0.32–0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3–4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1–2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. Conclusion The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.
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Akoth C, Oguta JO, Kyololo OM, Nyamu M, Ndirangu MN, Gatimu SM. Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study. Front Glob Womens Health 2022; 2:669760. [PMID: 34977861 PMCID: PMC8716368 DOI: 10.3389/fgwh.2021.669760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya. Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions. Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend. Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.
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Affiliation(s)
- Catherine Akoth
- Institute of Tropical and Infectious Diseases, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - James Odhiambo Oguta
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.,Health Section, UNICEF, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Martin Nyamu
- Institute of Tropical and Infectious Diseases, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Samwel Maina Gatimu
- School of Economics, University of Nairobi, Nairobi, Kenya.,Diabetic Foot Foundation of Kenya, Nairobi, Kenya
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Obare F, Mbow F, RamaRao S, Hazra A. Husbands’ concerns and experiences with the progesterone vaginal ring in three sub-Saharan African countries: a mixed methods study. Sex Reprod Health Matters 2022; 29:2104680. [PMID: 35975870 PMCID: PMC9387313 DOI: 10.1080/26410397.2022.2104680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The introduction of progesterone vaginal ring (PVR) in sub-Saharan Africa calls for insights on the product’s role in promoting women’s autonomy regarding their reproductive decision-making and behaviour. Such insights could inform the positioning of the method within family planning programmes in the region. In this paper, we explore husbands’ experiences with PVR as perceived by their wives and as reported by husbands of a subset of women users in Kenya, Nigeria, and Senegal. We discuss how such experiences might influence women’s rights and autonomy regarding their reproductive decisions and contraceptive behaviour. We use a mixed-methods approach drawing on data from quantitative interviews with 174 women and qualitative in-depth interviews with 10 husbands of a subset of the women in the three countries. The findings show that husbands appreciated PVR’s attributes relating to user-control (women could insert and remove the method themselves), ease of use, and non-interference with sex and flow of breast milk. Wives’ perceptions of their husbands’ experiences regarding PVR’s non-interference with sex were consistent with the husbands’ own reports. In addition, health care providers played important roles in supporting sustainable use of the method through giving information, counselling, and assisting women who experienced ring slippage to manage those challenges. The findings suggest that self-managed health technologies such as PVR could expand women’s choices and control over their reproductive decisions. The findings further suggest that sustainable use of such products could require linkages with appropriate health systems structures to address challenges with use if and when they arise.
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Affiliation(s)
- Francis Obare
- Associate, Population Council, Avenue 5, Rose Avenue, P.O. Box 17643, Nairobi 00500, Kenya
| | - Fatou Mbow
- Country Representative, Population Council, Dakar, Senegal
| | | | - Avishek Hazra
- Senior Program Officer, Population Council, New Delhi, India
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Olakunde BO, Pharr JR. The demand for family planning to limit childbearing satisfied with female permanent contraception in Sub-Saharan Africa: a meta-analysis of demographic and health surveys. EUR J CONTRACEP REPR 2021; 27:189-198. [PMID: 34906028 DOI: 10.1080/13625187.2021.2012760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the percentage of the demand for family planning to limit childbearing satisfied with female permanent contraception (FPC) in sub-Saharan Africa (SSA) and the disparities by sociodemographic characteristics (educational status, wealth, religion, and area of residence). STUDY DESIGN This study was a secondary data analysis of Demographic and Health Surveys conducted in SSA. Countries with a standard DHS conducted between 2010 and 2019 were eligible for inclusion. We performed a meta-analysis with a random-effects model to estimate the percentage of the demand for family planning to limit childbearing satisfied with FPC and differences by sociodemographic characteristics. RESULTS Demographic and Health Surveys (2010-2018) of 33 countries, with a total of 67,476 women with a demand for family planning to limit childbearing were included in this study. The pooled percentage of the demand for family planning to limit childbearing satisfied with FPC was 4.13% (95%CI = 2.43-6.23%, I = 99.36%, p = 0.001). The percentage ranged from 0.26% (95%CI = 0.10-0.67) in Angola to 26.85% (95%CI = 25.86-27.85%) in Malawi. The demand for family planning to limit childbearing satisfied with FPC was significantly higher in women from rich households (PR = 1.41, 95%CI = 1.21-1.65, p < 0.001). However, the differences by educational status, religion, or area of residence were not statistically significant. CONCLUSIONS The uptake of FPC among women with a demand for family planning to limit childbearing is low in many countries in SSA. Multilevel interventions are needed to address the barriers that may be limiting informed and voluntary uptake of FPC in SSA.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria.,Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
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Gualeni B, Hughes L, Stauber I, Ackers L, Gorman A, Gashuga D, Dzabala N, Chimimba F, Chikowe I, Coulman SA, Birchall JC. Human-centred design of a new microneedle-based hormonal contraceptive delivery system. Gates Open Res 2021; 5:96. [PMID: 35492866 PMCID: PMC9020198 DOI: 10.12688/gatesopenres.13233.3] [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] [Accepted: 11/26/2021] [Indexed: 11/28/2022] Open
Abstract
Background: It is estimated that 225 million women worldwide have an unmet need for family planning, and more than half live in low- and middle-income countries. Increasing the choice of contraceptive methods available can reduce this unmet need. Microneedle drug delivery systems represent a new technology for minimally invasive self-administration of contraceptives. We explored stakeholders’ views on different aspects of a proposed microneedle-based hormonal contraceptive delivery system. The feedback was used to iteratively develop this delivery system. Methods: Focus group discussions and semi-structured interviews were conducted with potential stakeholders (women and trans males of childbearing age, their partners, and health professionals and organisations that provide family planning advice and contraception services) in Uganda, The Gambia, Malawi, and the UK, exploring concept acceptability and gathering feedback on different aspects of design and usability of the proposed delivery system. Results: Participants viewed the concept of a new, microneedle-based contraceptive favourably. In Uganda, participants were presented with 7 different prototype applicators and identified desirable features of a preferred delivery device; their input reducing the number of prototypes that were subsequently evaluated by stakeholders in The Gambia and the UK. Participants in these countries helped to identify and/or confirm the most desirable characteristics of the applicator, resulting in design consolidation into a refined concept applicator. The final, optimised applicator prototype was validated during user research in Malawi. This human-centred design approach was also used to iteratively develop an information leaflet for the device. During these user studies, other preferred aspects of a contraceptive delivery system were also evaluated, such as anatomical site of application, duration of action, and return to fertility. Conclusions: A new microneedle-based contraceptive delivery system was iteratively developed using a human-centred design approach and was favourably received by potential stakeholders. The product is now being refined for testing in pre-clinical studies.
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Affiliation(s)
- Benedetta Gualeni
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Isabelle Stauber
- Maddison Limited, Walnut Tree Yard, Lower Street, Fittleworth, RH20 1JE, UK
| | - Louise Ackers
- School of Health and Society, University of Salford, Allerton Building, Salford, M6 6PU, UK
- Knowledge for Change, Plot 39 Saaka Road, Kagote, Fort Portal, P.O. Box 392, Uganda
| | - Angela Gorman
- Life for African Mothers, Suite 18, Big Yellow Storage, Cardiff, CF10 5DL, UK
| | - Dorothy Gashuga
- Knowledge for Change, Plot 39 Saaka Road, Kagote, Fort Portal, P.O. Box 392, Uganda
| | - Nettie Dzabala
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi
| | - Frider Chimimba
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi
| | - Ibrahim Chikowe
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi
| | - Sion A. Coulman
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - James C. Birchall
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
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Abstract
PURPOSE OF REVIEW Myths and misconceptions about family planning are pervasive around the world and can adversely affect both initiation and continuation of family planning services. Here, we review the current literature and identify major themes among them to better understand these myths and misconceptions. RECENT FINDINGS Myths and misconceptions regarding family planning are a global phenomenon with the most recent studies focused on sub-Saharan Africa and West Africa.The belief that family planning negatively impacts future fertility was mentioned in all studies reviewed.Other major themes include misconceptions about the adverse effects, complications, mechanisms of action, and reproductive health. SUMMARY Myths and misconceptions regarding family planning are widespread. Current literature suggests that there is a globally prevalent belief that family planning negatively impacts future fertility. Misconceptions related to adverse effects and mechanism of action were also identified. There is overall poor knowledge of sexual and reproductive health in the populations studied. Recent studies focus primarily on sub-Saharan Africa and West Africa. These findings and lessons learned may be helpful in customizing contraceptive counseling and increasing both global access to family planning and satisfied clients.
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Obare F, Odwe G, Cleland J. Men's needs and women's fears: gender-related power dynamics in contraceptive use and coping with consequences in a rural setting in Kenya. CULTURE, HEALTH & SEXUALITY 2021; 23:1748-1762. [PMID: 32795154 DOI: 10.1080/13691058.2020.1807605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
This paper examines gender-related power influences on contraceptive use and coping with consequences in a rural setting in Kenya. Data come from in-depth interviews conducted in 2018 with 42 women who participated in a longitudinal study implemented in Homa Bay County. Data were analysed using an exploratory inductive content analytic approach. The findings show that the key drivers of gender-related power influence on contraceptive use and coping with consequences included: 1) the extent to which the women managed to provide sex and sexual pleasure to their partners when they were using contraception; 2) men's readiness to provide permission and resources that women needed and the latter's ability to overcome challenges in obtaining the same from their partners; and 3) women's fears concerning infidelity and partner violence, which influenced the actions they took to reduce instances that could make their partners suspect them of engaging in extra-marital affairs, drive their partners into such affairs, or encourage their partners to direct emotional or physical violence on them. Findings suggest the need for gender-transformative actions combining empowerment programmes for women with information, education and communications activities targeting both men and women.
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Affiliation(s)
| | | | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Birabwa C, Chemonges D, Tetui M, Baroudi M, Namatovu F, Akuze J, Makumbi F, Ssekamatte T, Atuyambe L, Hernandez A, Sewe MO. Knowledge and Information Exposure About Family Planning Among Women of Reproductive Age in Informal Settlements of Kira Municipality, Wakiso District, Uganda. Front Glob Womens Health 2021; 2:650538. [PMID: 34816206 PMCID: PMC8594013 DOI: 10.3389/fgwh.2021.650538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda. Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance. Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP. Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Dennis Chemonges
- Department of Programs, Population Services International Uganda, Kampala, Uganda.,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.,School of Pharmacy, Waterloo University, Waterloo, ON, Canada.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Joseph Akuze
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Alison Hernandez
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maquins Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
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Liu Z, Lin Z, Cao W, Li R, Liu L, Wu H, Tang K. Identify Key Determinants of Contraceptive Use for Sexually Active Young People: A Hybrid Ensemble of Machine Learning Methods. CHILDREN (BASEL, SWITZERLAND) 2021; 8:968. [PMID: 34828681 PMCID: PMC8622295 DOI: 10.3390/children8110968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/09/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
Sexually active young people face an increasing public health burden of unintended pregnancies and sexually transmitted diseases due to improper contraception. However, environmental and social factors related to young people's contraception remain unclear. To identify the key factors, we applied ensemble machine learning methods to the data of 12,280 heterosexual Chinese college students who reported sexual intercourse experience in the National College Student Survey on Sexual and Reproductive Health in 2020 (NCSS-SRH 2020). In the order of variable importance, convenient access to contraceptives, certain attitudes towards sex, sexual health knowledge level, being an only-child, and purchasing a bachelor's or master's degree were positively associated with a high frequency of contraceptive use. In contrast, smoking, free access to contraceptives, a specific attitude towards marriage, and negotiation with a sexual partner were negatively associated with a higher frequency of contraceptive use. Our analysis provides insights into young people's contraceptive use under a typically conservative culture of sexuality. Compared to previous studies, we thoroughly investigated internal and external factors that might impact young people's decision on contraception while having sex. Under a conservative culture of sexuality, the effects of the external factors on young people's contraception may outweigh those of the internal factors.
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Affiliation(s)
- Zongchao Liu
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing 100084, China; (Z.L.); (Z.L.); (H.W.)
- Department of Biostatistics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Zhi Lin
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing 100084, China; (Z.L.); (Z.L.); (H.W.)
- School of Public Health, Peking University, Beijing 100083, China
| | - Wenzhen Cao
- Shantou University Medical College, No. 22 Xinling Road, Shantou 515041, China;
- School of Public Health, Shantou University, No. 243 Daxue Road, Shantou 515063, China
| | - Rui Li
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA;
| | - Lilong Liu
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China;
| | - Hanbin Wu
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing 100084, China; (Z.L.); (Z.L.); (H.W.)
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing 100084, China; (Z.L.); (Z.L.); (H.W.)
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Factors Associated with Condom Knowledge, Attitude, and Use among Black Heterosexual Men in Ontario, Canada. ScientificWorldJournal 2021; 2021:8862534. [PMID: 34566521 PMCID: PMC8463252 DOI: 10.1155/2021/8862534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/03/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
African, Caribbean, and Black (ACB) men living in Canada share a heightened risk of HIV infection and the associated risk factors such as suboptimal use of family planning services such as condom use. In this study, we assessed the factors associated with knowledge, attitude, and condom use among ACB men in Ontario. Methods. This was a cross-sectional study that surveyed heterosexual ACB men regardless of their residency status living in Ontario (n = 430). This is a part of a larger mixed methods study informed by critical race theory, intersectionality, and community-based participatory research (CBPR). Outcome variables were knowledge of condom use, attitude towards condom use, and actual use of condom during the last 12 months. Results. Of 430 participants, 77.70% has good knowledge of condom use as a protection against HIV transmission, 31.77% had positive attitude towards condom use, and 62.43% reported using condom regularly with casual partners during the last 12 months. Men who were currently married had more positive attitude towards condom use compared with their unmarried counterparts (odds ratio = 1.46, 95% CI = 1.20, 1.78). Canadian residents were found to have higher odds of having correct knowledge of condom (odds ratio = 1.31, 95% CI = 1.11, 1.55), and positive attitude towards condom use (odds ratio = 1.44, 95%CI = 1.09, 1.92). Men who visited sexual health clinics showed a positive association with having correct knowledge of condom (odds ratio = 1.78, 95% CI = 1.30, 2.44) and reported experiences of difficulty in accessing sexual health. This showed a negative association towards condom use (odds ratio = 0.45, 95% CI = 0.21, 0.97]. Conclusion. A considerable percentage of heterosexual ACB men did not have correct knowledge regarding the protective effect of condom use against HIV and positive attitude towards the use of condom. Several sociodemographic and healthcare-related factors were significantly associated with knowledge, attitude, and use of condom.
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76
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Bolarinwa OA, Nwagbara UI, Okyere J, Ahinkorah BO, Seidu AA, Ameyaw EK, Igharo V. Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries. Int Health 2021; 14:492-500. [PMID: 34405873 PMCID: PMC9450634 DOI: 10.1093/inthealth/ihab053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/10/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Long-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA). Methods Secondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15–49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05. Results The prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child. Conclusions The use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Ugochinyere Ijeoma Nwagbara
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast,PMB, Ghana
| | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast,PMB, Ghana.,College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Queensland, QLD4811, Australia.,Department of Estate Management, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana
| | | | - Victor Igharo
- John's Hopkins Centre for Communications Programs, 111 Market Place Suite 310 Baltimore, MD, USA
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77
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Some SYM, Pu C, Huang SL. Empowerment and use of modern contraceptive methods among married women in Burkina Faso: a multilevel analysis. BMC Public Health 2021; 21:1498. [PMID: 34344339 PMCID: PMC8336087 DOI: 10.1186/s12889-021-11541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso. METHODS We analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors. RESULTS Overall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS. CONCLUSIONS Empowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights. TRIAL REGISTRATION No clinical trial has been performed in this study.
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Affiliation(s)
- Sylvain Y. M. Some
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Christy Pu
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Song-Lih Huang
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
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Gualeni B, Hughes L, Stauber I, Ackers L, Gorman A, Gashuga D, Dzabala N, Chimimba F, Chikowe I, Coulman SA, Birchall JC. Human-centred design of a new microneedle-based hormonal contraceptive delivery system. Gates Open Res 2021; 5:96. [DOI: 10.12688/gatesopenres.13233.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is estimated that 225 million women worldwide have an unmet need for family planning, and more than half live in low- and middle-income countries. Increasing the choice of contraceptive methods available can reduce this unmet need. Microneedle drug delivery systems represent a new technology for minimally invasive self-administration of contraceptives. We explored stakeholders’ views on different aspects of a proposed microneedle-based hormonal contraceptive delivery system. The feedback was used to iteratively develop this delivery system. Methods: Focus group discussions and semi-structured interviews were conducted with potential stakeholders (women and trans males of childbearing age, their partners, and health professionals and organisations that provide family planning advice and contraception services) in Uganda, The Gambia, Malawi, and the UK, exploring concept acceptability and gathering feedback on different aspects of design and usability of the proposed delivery system. Results: Participants viewed the concept of a new, microneedle-based contraceptive favourably. In Uganda, participants were presented with 7 different prototype applicators and identified desirable features of a preferred delivery device; their input reducing the number of prototypes that were subsequently evaluated by stakeholders in The Gambia and the UK. Participants in these countries helped to identify and/or confirm the most desirable characteristics of the applicator, resulting in design consolidation into a refined concept applicator. The final, optimised applicator prototype was validated during user research in Malawi. This human-centred design approach was also used to iteratively develop an information leaflet for the device. During these user studies, other preferred aspects of a contraceptive delivery system were also evaluated, such as anatomical site of application, duration of action, and return to fertility. Conclusions: A new microneedle-based contraceptive delivery system was iteratively developed using a human-centred design approach and was favourably received by potential stakeholders. The product is now being refined for testing in pre-clinical studies.
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Akoth C, Oguta JO, Gatimu SM. Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study. BMC Public Health 2021; 21:1316. [PMID: 34225673 PMCID: PMC8256600 DOI: 10.1186/s12889-021-11375-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya. Methods We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions. Results The prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95% CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR 0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–0.99) reduced the odds of CCU. Conclusion About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make independent choices.
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Affiliation(s)
- Catherine Akoth
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
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Coleman JN, Milford C, Mosery N, Choi KW, Greener LR, Matthews LT, Harrison A, Bangsberg DR, Safren SA, Smit JA, Psaros C. "I did not plan … that is what hurts": Pregnancy intentions and contraceptive use among pregnant young women in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:149-157. [PMID: 34003077 PMCID: PMC9996636 DOI: 10.2989/16085906.2021.1914693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unintended pregnancy impacts many young women in South Africa, and rates of consistent contraceptive use among this population are suboptimal. Limited empirical work has investigated reasons for inconsistency between pregnancy intention and contraceptive use behaviour with data collected during pregnancy. We explored pregnancy intentions and discordance between intentions and contraceptive use prior to conception among young pregnant women in KwaZulu-Natal, South Africa. In-depth qualitative interviews were conducted with 35 women during pregnancy (mean age = 19.3; range = 18-21) in 2011 and 2012. Data were analysed using content analysis. All participants reported unintended pregnancies; almost half were not using contraception near conception. Reasons for not intending to become pregnant spanned personal, social, health, and economic domains. Participants living with HIV (n = 13) expressed specific concerns related to impacts of pregnancy on HIV disease management and fear of transmission of HIV to the infant. Discordance between pregnancy intentions and contraceptive use prior to conception was attributed to personal, social, health and structural domains. Findings indicate a need for interventions that address barriers to contraceptive use in order to minimise unintended pregnancy and support safe, desired pregnancies among young women.
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Affiliation(s)
- Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Cecilia Milford
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Karmel W Choi
- School of Public Health, Harvard University, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Letitia Rambally Greener
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
- Wits Reproductive Health and HIV Institute, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynn T Matthews
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, USA
| | - Abigail Harrison
- Department of Behavioral Sciences, School of Public Health, Brown University, Providence, USA
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University – Portland State University, Portland, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, USA
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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Svanemyr J, Moland KM, Blystad A, Zulu JM, Sandøy I. Norms and sexual relations among adolescents in the context of an intervention trial in rural Zambia. Glob Public Health 2021; 17:1652-1664. [PMID: 34193012 DOI: 10.1080/17441692.2021.1947343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
High levels of adolescent pregnancy and child marriage rates in low- and middle-income countries is an issue of concern to many stakeholders, including in Zambia where almost one-third of women give birth before age 18. The aim of this paper is to explore and analyse social norms concerning adolescents' sexual behaviour within the context of an intervention trial in rural communities in southern Zambia. It is based on a qualitative study applying individual interviews, focus group discussions and participatory research methods. We apply the distinction between injunctive and descriptive norms to demonstrate that adolescent girls are caught between conflicting norms. Injunctive norms express that premarital sex, contraceptive use, and discussions about sex between adults and youths are socially condemned. At the same time poor girls are reported to feel pressure towards having sexual relations for the economic benefits such relations can bring, and this practice is considered so common that it amounts to a descriptive norm. Norms and structural conditions combine to create a disabling and disempowering environment for adolescent sexual and reproductive health, which limits girls' agency and exposes them to unwanted pregnancies.
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Affiliation(s)
- Joar Svanemyr
- Chr. Michelsen Institute, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Karen-Marie Moland
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Astrid Blystad
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Joseph M Zulu
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ingvild Sandøy
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
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Ouédraogo AM, Baguiya A, Compaoré R, Cissé K, Dahourou DL, Somé A, Tougri H, Kouanda S. Predictors of contraceptive method discontinuation among adolescent and young women in three West African countries (Burkina Faso, Mali, and Niger). BMC Womens Health 2021; 21:261. [PMID: 34187435 PMCID: PMC8240211 DOI: 10.1186/s12905-021-01326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effective use of contraception among adolescents and young women can reduce the risk of unintended pregnancies. However, the prevalence of contraceptive use remains low in this age group. The objective of this study was to estimate the rate of contraceptive method discontinuation among adolescents and young women and to identify its associated factors in Burkina Faso, Mali, and Niger. METHOD This was a secondary analysis of data from Demographic and Health Surveys of Burkina Faso (2010), Mali (2012-2013), and Niger (2012). The dependent variable was the time to discontinuation of contraceptive methods. Independent variables were represented by sociodemographic, socioeconomic, and cultural characteristics. Mixed-effects survival analysis with proportional hazards was used to identify the predictors. RESULTS A total of 2,264 adolescents and young women aged 15 to 24 years were included in this analysis, comprising 1,100 in Burkina Faso, 491 in Mali, and 673 in Niger. Over the last five years, the overall contraceptive discontinuation rate was 68.7% (50.1% in Burkina Faso, 59.6% in Mali, and 96.8% in Niger). At the individual level, in Burkina Faso, occupation (aHR = 0.33), number of living children (aHR = 2.17), marital status (aHR = 2.93), and region (aHR = 0.54) were associated with contraceptive discontinuation. Except for education and marital status, we found the same factors in Mali. In Niger, a women's education level (aHR = 1.47) and her partner (aHR = 0.52) were associated with discontinuation. At the community level, the region of origin was associated with discontinuation of contraceptive methods. CONCLUSION Most adolescents and young women experienced at least one episode of discontinuation. Discontinuation of contraceptive methods is associated with the level of education, occupation, number of children, marital status, and desire for children with the spouse. Promotion of contraceptive interventions should target adolescents, young women, and their partners, as well as those with a low education level or in a union.
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Affiliation(s)
- Adja Mariam Ouédraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Rachidatou Compaoré
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Kadari Cissé
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Anthony Somé
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Halima Tougri
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
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Aventin Á, Gordon S, Laurenzi C, Rabie S, Tomlinson M, Lohan M, Stewart J, Thurston A, Lohfeld L, Melendez-Torres GJ, Makhetha M, Chideya Y, Skeen S. Adolescent condom use in Southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators. BMC Public Health 2021; 21:1228. [PMID: 34172027 PMCID: PMC8234649 DOI: 10.1186/s12889-021-11306-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group. METHODS This review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a 'best-fit' framework synthesis approach. RESULTS We coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors. CONCLUSION SRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.
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Affiliation(s)
- Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Sarah Gordon
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Stephan Rabie
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Cape Town, South Africa
| | - Mark Tomlinson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jackie Stewart
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Allen Thurston
- School of Education, Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland
| | - Lynne Lohfeld
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Moroesi Makhetha
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- World Vision, Maseru, Lesotho
| | - Yeukai Chideya
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
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84
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Odwe G, Wado YD, Obare F, Machiyama K, Cleland J. Method-specific beliefs and subsequent contraceptive method choice: Results from a longitudinal study in urban and rural Kenya. PLoS One 2021; 16:e0252977. [PMID: 34143804 PMCID: PMC8213138 DOI: 10.1371/journal.pone.0252977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Evidence from sub-Saharan Africa, including Kenya, shows that negative beliefs about contraceptive methods are associated with non-use. However, little is known about the relationship between contraceptive beliefs and subsequent method choice. Methodology We used data from a two-year longitudinal survey of married women aged 15–39 years at enrollment from one urban site (Nairobi) and one rural site (Homa Bay) in Kenya. Analysis entails descriptive statistics and estimation of a conditional logit analysis to examine associations between method-specific beliefs and choice of injectables, implants or pills among women who were not using any method or were pregnant at baseline (round 1) but adopted these methods at 12-month follow-up (Nairobi, n = 221; Homa Bay n = 197). Results Beliefs about pills, injectables and implants among non-users were generally negative. With the partial exception of the pill in Nairobi, the majority thought that each method was likely to cause serious health problems, unpleasant side effects, menstrual disruption, and would be unsafe for long-term use. In both sites, satisfied past use of a method and the perception that a method is easy to use had a major influence on method choice. Concerns about menstrual disruption and safety for long-term use were unimportant in both sites. There were some marked differences between the two sites. Beliefs about long-term fertility impairment and perceived husband approval had strong influences on choice of injectables, implants or pills in the urban site but not in the rural site. Conclusion The relative importance of beliefs, some erroneous, in predisposing women to choose one method over another appears to be conditioned by the social context. There is need for family planning counseling programmes to pay attention to erroneous beliefs and misconceptions about contraceptives.
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Affiliation(s)
| | | | | | - Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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85
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Mutua MK, Wado YD, Malata M, Kabiru CW, Akwara E, Melesse DY, Fall NA, Coll CVN, Faye C, Barros AJD. Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa. Reprod Health 2021; 18:116. [PMID: 34134700 PMCID: PMC8210345 DOI: 10.1186/s12978-021-01076-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.
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Affiliation(s)
- Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya.
| | - Yohannes D Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Monica Malata
- Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | | | | | - Dessalegn Y Melesse
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Ndèye Awa Fall
- African Population and Health Research Center, Nairobi, Kenya
| | - Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cheikh Faye
- African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
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Gualeni B, Hughes L, Stauber I, Ackers L, Gorman A, Gashuga D, Dzabala N, Coulman SA, Birchall JC. Human-centred design of a new microneedle-based hormonal contraceptive delivery system. Gates Open Res 2021; 5:96. [DOI: 10.12688/gatesopenres.13233.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is estimated that 225 million women worldwide have an unmet need for family planning, and more than half live in low- and middle-income countries. Increasing the choice of contraceptive methods available can reduce this unmet need. Microneedle drug delivery systems represent a new technology for minimally invasive self-administration of contraceptives. We explored stakeholders’ views on different aspects of a proposed microneedle-based hormonal contraceptive delivery system. The feedback was used to iteratively develop this delivery system. Methods: Focus group discussions and semi-structured interviews were conducted with potential stakeholders (women and trans males of childbearing age, their partners, and health professionals and organisations that provide family planning advice and contraception services) in Uganda, The Gambia, Malawi, and the UK, exploring concept acceptability and gathering feedback on different aspects of design and usability of the proposed delivery system. Results: Participants viewed the concept of a new, microneedle-based contraceptive favourably. In Uganda, participants were presented with 7 different prototype applicators and identified desirable features of a preferred delivery device; their input reducing the number of prototypes that were subsequently evaluated by stakeholders in The Gambia and the UK. Participants in these countries helped to identify and/or confirm the most desirable characteristics of the applicator, resulting in design consolidation into a refined concept applicator. The final, optimised applicator prototype was validated during user research in Malawi. This human-centred design approach was also used to iteratively develop an information leaflet for the device. During these user studies, other preferred aspects of a contraceptive delivery system were also evaluated, such as anatomical site of application, duration of action, and return to fertility. Conclusions: A new microneedle-based contraceptive delivery system was iteratively developed using a human-centred design approach and was favourably received by potential stakeholders. The product is now being refined for testing in pre-clinical studies.
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87
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Nastiti AA, Pradanie R, Sari DR. Choosing intrauterine device of mothers in rural area, Indonesia: Based on Health Belief Model Theory. ENFERMERIA CLINICA 2021. [PMID: 33849196 DOI: 10.1016/j.enfcli.2020.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aimed to identify the correlation between perceived susceptibility, perceived seriousness, perceived benefit, self-efficacy, perceived barrier, cues to action, and the choice of using the intrauterine device. A cross-sectional study was carried out to 109 mothers in Ngudikan Village. Data were collected using questionnaires. The data was analyzed using the Spearman Rank correlation with a level of significance α=0.05. The result show that there is a correlation between perceived susceptibility (p=0.000; r=0.436), perceived seriousness (p=0.000; r=0.402), perceived benefits (p=0.033; r=0.204), perceived barriers (p=0.00, r=-0.614), perceived self-efficacy (p=0.008; r=0.253) and cues to action (p=0.006; r=0.261) had a correlation with the choice of intrauterine device in Nganjuk, Indonesia. Perceived susceptibility, perceived seriousness, perceived benefits, self -efficacy, and cues to action will affect the decision of mothers in choosing an intrauterine device. This study recommended further research on a transcultural nursing approach to follow up on the result of this study.
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Affiliation(s)
- Aria Aulia Nastiti
- Maternity and Pediatric Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia.
| | - Retnayu Pradanie
- Maternity and Pediatric Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Desy Ratna Sari
- Maternity and Pediatric Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
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Snopkowski K, Nelson JJ. Fertility intentions and outcomes in Indonesia: Evolutionary perspectives on sexual conflict. EVOLUTIONARY HUMAN SCIENCES 2021; 3:e33. [PMID: 37588532 PMCID: PMC10427277 DOI: 10.1017/ehs.2021.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Differential fertility preferences for men and women may provide insights into human sexual conflict. We explore whether pairbonded couples have different preferences for future offspring, which socioecological factors are associated with these preferences, and who achieves their desired fertility over time. We utilise the Indonesia Family Life Survey (IFLS), a longitudinal survey which collected data from 1993 to 2015, to compare desired future fertility for 9655 couples and follow couples who had divergent preferences. The majority of couples (64.8%) want the same number of future offspring. In 20.7% of couples, husbands want more future offspring than their wives, while the reverse occurs in 14.5% of couples. Living in villages with the husband's or the wife's parent(s) is associated with having divergent preferences for future offspring, where there is a higher likelihood that women prefer more offspring than their husbands. When examining fertility outcomes, women, particularly those who marry at older ages, are more likely to achieve their desired preference. Contrary to previous research, we do not find that living near one's natal kin or having increased autonomy increases an individual's likelihood of achieving desired fertility outcomes.
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Affiliation(s)
- Kristin Snopkowski
- Department of Anthropology, 1910 University Drive, Boise State University, Boise, ID83725, USA
| | - James Joseph Nelson
- Department of Anthropology, 1910 University Drive, Boise State University, Boise, ID83725, USA
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Bhushan NL, Fisher EB, Maman S, Speizer IS, Gottfredson NC, Phanga T, Vansia D, Pettifor AE, Rosenberg NE. Communication, social norms, and contraceptive use among adolescent girls and young women in Lilongwe, Malawi. Women Health 2021; 61:440-451. [PMID: 33941050 PMCID: PMC8182971 DOI: 10.1080/03630242.2021.1917479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 01/09/2023]
Abstract
In Malawi, 50% of adolescent girls and young women (AGYW) have had a first child by age 19 and 45% report their pregnancies as unintended or mistimed. Yet, uptake of contraception remains low. Understanding how interactions with social ties impact AGYW contraceptive use might explain low uptake beyond individual and environmental factors. Data are from Girl-Power, a study among sexually active AGYW, aged 15-24, in Malawi. We used logistic regression models to examine whether contraceptive communication and social norms (descriptive and injunctive) were associated with contraceptive use (non-barrier methods and condoms) and how associations differed across social ties (older women in the family, peers, and partners). The sample included 942 participants: 28% reported using non-barrier methods and 66% reported using condoms. Contraceptive communication with older women in the family (aOR: 1.48, 95% CI: 0.99, 2.20), peers (aOR: 3.12, 95% CI: 1.96, 4.96), and partners (aOR 5.15, 95% CI: 3.13, 8.48) was associated with non-barrier method use. Descriptive norms were associated with non-barrier methods among peers (aOR 2.57, 95% CI: 1.63, 4.96) but not among older women in the family (aOR: 1.22, 95% CI 0.80, 1.88). There were no associations among contraceptive communication, social norms, and condom use across older women in the family, peers, and partners. The findings highlight the need to consider the influence of social ties in the design of future family planning interventions and suggest that interventions that encourage interpersonal communication about contraception and target peer-based descriptive norms have the potential to impact uptake of non-barrier methods.
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Affiliation(s)
- Nivedita L Bhushan
- University of North Carolina Project, Lilongwe, Malawi
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Edwin B Fisher
- Department of Health Behavior, University of North Carolina, Chapel Hill, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina, Chapel Hill, USA
| | - Ilene S Speizer
- Department of Maternal Child Health, University of North Carolina, Chapel Hill, USA
| | - Nisha C Gottfredson
- Department of Health Behavior, University of North Carolina, Chapel Hill, USA
| | | | | | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Nora E Rosenberg
- University of North Carolina Project, Lilongwe, Malawi
- Department of Health Behavior, University of North Carolina, Chapel Hill, USA
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Belaid L, Atim P, Ochola E, Omara B, Atim E, Ogwang M, Bayo P, Oola J, Okello IW, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Community views on short birth interval in Northern Uganda: a participatory grounded theory. Reprod Health 2021; 18:88. [PMID: 33910570 PMCID: PMC8080315 DOI: 10.1186/s12978-021-01144-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda. METHODS Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing. RESULTS Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands' consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives. CONCLUSIONS The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women's capacity to practice child spacing.
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Affiliation(s)
- Loubna Belaid
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Pamela Atim
- Department of Public Health, Gulu University, Laroo Division, Gulu Municipality 166, Gulu, Uganda
| | | | - Bruno Omara
- Gulu University, Gulu Municipality 166, Gulu, Uganda
| | | | - Martin Ogwang
- St Mary’s Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | - Pontius Bayo
- St Mary’s Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | | | | | - Ivan Sarmiento
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Laura Rojas-Rozo
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Kate Zinszer
- University of Montreal, 7101 Av du Parc, Montreal, QC H3N 1X9 Canada
| | | | - Neil Andersson
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Igras S, Burgess S, Chantelois-Kashal H, Diakité M, Giuffrida M, Lundgren R. Pathways to Modern Family Planning: A Longitudinal Study on Social Influence among Men and Women in Benin. Stud Fam Plann 2021; 52:59-76. [PMID: 33559166 PMCID: PMC8048892 DOI: 10.1111/sifp.12145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite improvements in family planning (FP) knowledge and services in West Africa, unmet need for FP continues to grow. Many programs apply a demographically and biologically driven definition of unmet need, overlooking the complex social environment in which fertility and FP decisions are made. This longitudinal, qualitative cohort study captures the changing nature of FP need, attitudes and behaviors, taking into account life context to inform understanding of the complex behavior change process. Purposively sampled, 25 women and 25 men participated in three rounds of in‐depth interviews over 18 months. Analyses used a social network influence lens. Findings suggest alignment of six foundational building blocks operating at individual, couple, services, and social levels is essential to meet FP need. If one block is weak, a person may not achieve met need. Women and men commonly follow five pathways as they seek to fulfill their FP need. Some pathways achieve met need (determined users, quick converters), some do not (side effect avoiders), and some do not lead to consistent FP outcomes (male‐priority decision makers, gender–egalitarian decision makers). Findings clarify the role of social determinants of FP and offer insight into program approaches informed by user typologies and return on program investments.
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Affiliation(s)
- Susan Igras
- Susan Igras, Mariam Diakité, Institute for Reproductive Health, Center for Child and Human Development, Georgetown University, Washington, DC, USA
| | | | | | - Mariam Diakité
- Susan Igras, Mariam Diakité, Institute for Reproductive Health, Center for Child and Human Development, Georgetown University, Washington, DC, USA
| | - Monica Giuffrida
- Monica Giuffrida, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecka Lundgren
- Rebecka Lundgren, Division of Infectious Disease and Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, CA, USA
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Sarnak DO, Tsui A, Makumbi F, Kibira SPS, Ahmed S. A Panel Study of Fertility Preferences and Contraceptive Dynamics in the Presence of Competing Pregnancy Risks in Uganda. Demography 2021; 58:295-320. [PMID: 33834246 DOI: 10.1215/00703370-8937285] [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: 11/19/2022]
Abstract
Although many studies have examined the influence of women's fertility preferences on subsequent fertility behavior and the role of contraceptive use intentions on unmet need, very few have explored their concurrent effects on contraceptive use dynamics. This study examines the independent concurrent effects of women's fertility preferences and contraceptive intentions on subsequent adoption and discontinuation, treating pregnancy as a competing risk factor that may alter contraceptive need. The data are derived from a 2018 follow-up survey of a 2014 national sample of 3,800 Ugandan female respondents of childbearing age. The survey included a contraceptive calendar that recorded pregnancy, birth, and contraceptive event episodes, including reasons for discontinuation. We use competing risk regression to estimate the effect of fertility preferences and contraceptive intentions on the cumulative incidence function of contraceptive behaviors, accounting for intervening pregnancy, female background covariates, loss to follow-up, and complex survey design. We find that women's contraceptive intentions significantly increase the rate of contraceptive adoption. After having adopted, women's contraceptive intentions have been realized and do not prolong use. The risk of discontinuation among women who adopted after baseline was significantly higher than for those using at baseline, irrespective of their initial intentions. The effectiveness of the type of contraceptive method chosen significantly lowered discontinuation risk. Fertility preferences were not significantly associated with either time to adoption or discontinuation. The pace of the fertility transition in this sub-Saharan African setting is likely being shaped by reproductive regulation through the intentional use of contraception that enables spacing births.
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Affiliation(s)
- Dana O Sarnak
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Tsui
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fredrick Makumbi
- Epidemiology and Biostatistics Department, School of Public Health, Makerere University, Kampala, Uganda
| | - Simon Peter Sebina Kibira
- Community Health and Behavioral Sciences Department, School of Public Health, Makerere University, Kampala, Uganda
| | - Saifuddin Ahmed
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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93
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Eroğlu K, Koruk F, Koruk İ, Çelik K, Güner P, Kiliçli A. Women's reproductive behaviour and perspectives on fertility, and their modifying factors, in a Turkish province with a high fertility rate. EUR J CONTRACEP REPR 2021; 26:139-147. [PMID: 33403875 DOI: 10.1080/13625187.2020.1857355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Population growth is an important public health problem with economic, social, cultural and political consequences. The aim of the study was to determine the reproductive behaviour and perspectives on fertility of women in Sanliurfa, the city with the highest fertility rate in Turkey. METHODS The quantitative dimension of the study was carried out using a mixed methods approach in which 300 women were interviewed and a questionnaire was completed; the qualitative dimension was carried out through in-depth individual interviews with 14 women, using a semi-structured interview form. Analysis of the qualitative data was done using a content analysis technique. RESULTS The median number of children was three (range 0-10). Women with no or a low level of education tended to have a greater number of children. Preference for a particular sex of child was one reason behind the higher number of children. These two factors were main causes of an increased number of children. Women with no or a low level of education (odds ratio [OR] 9.1) and women who expressed a preference for a male child (OR 5.9) had more children compared with other women. Participants regarded a male child as more valuable than a female child and that having many children strengthened the family. Parents regarded their sons as insurance for their old age. Having an induced abortion was perceived as a sin. CONCLUSION The results showed that cultural norms and values significantly affected fertility rates.
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Affiliation(s)
| | - Fatma Koruk
- Department of Nursing, Faculty of Health Sciences, Harran University, Sanliurfa, Turkey
| | - İbrahim Koruk
- Department of Public Health, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Kezban Çelik
- Department of Sociology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Perihan Güner
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Ayşegül Kiliçli
- Mehmet Akif Inan Training Research Hospital, Sanliurfa, Turkey
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94
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Crawford EE, Atchison CJ, Ajayi YP, Doyle AM. Modern contraceptive use among unmarried girls aged 15-19 years in South Western Nigeria: results from a cross-sectional baseline survey for the Adolescent 360 (A360) impact evaluation. Reprod Health 2021; 18:6. [PMID: 33407604 PMCID: PMC7789376 DOI: 10.1186/s12978-020-01056-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Adolescents 360 (A360) is an initiative being rolled out across Nigeria with the aim of increasing voluntary modern contraception use among women aged 15 to 19 years. Using evaluation study baseline data, we identified sexuality, fertility and contraceptive use characteristics of young unmarried girls in South Western Nigeria. METHODS A cross-sectional baseline survey of unmarried girls aged 15 to 19 years was conducted in Ogun state, Nigeria in August 2017. A clustered sampling design was used. We identified determinants of modern contraceptive use in this subpopulation using logistic regression. RESULTS Of 12,024 women interviewed, 15.3% reported sexual intercourse in the past year. The majority of respondents (79.6%, 9525/11,967) had heard of contraception. 45.3% of sexually active respondents were using a modern contraceptive method. Of those using any method of contraception, male condoms (50.3%) were the most widely used modern method followed by the emergency contraceptive pill (16.7%). Following adjustment for socio-demographic characteristics, there was evidence that the use of modern contraception was positively associated with having never given birth, living in an urban area, current enrolment in education, high level of education, high socioeconomic status, exposure to information about contraception, perceived social support for contraception, and self-efficacy for contraception. CONCLUSIONS In South Western Nigeria, unmarried sexually active adolescent girls have relatively low levels of modern contraceptive use. Programmes should aim to increase access to modern contraception and to increase social support and acceptability of contraceptive use.
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Affiliation(s)
- Emily E. Crawford
- Binomial Optimus Limited, Blue Hill, PLOT 538 Natasha Akpoti Street Kado, Abuja, FCT Nigeria
| | - Christina J. Atchison
- Imperial College London, School of Public Health, St Mary’s Hospital, Norfolk Place, London, W2 1PG UK
| | - Yewande P. Ajayi
- Binomial Optimus Limited, Blue Hill, PLOT 538 Natasha Akpoti Street Kado, Abuja, FCT Nigeria
| | - Aoife M. Doyle
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
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95
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Olakunde BO, Pharr JR, Chien LC, Benfield RD, Sy FS. Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa. PLoS One 2020; 15:e0243316. [PMID: 33320877 PMCID: PMC7737965 DOI: 10.1371/journal.pone.0243316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Female permanent contraception is a cost-effective contraceptive method that can help clients with the desire to limit childbearing achieve their reproductive intention. However, despite its benefits, the use of FPC remains low in sub-Saharan Africa (SSA), and limited studies have examined the correlates of its uptake. In this study, we assessed the individual- and country-level factors associated with the use of FPC among married or in-union women using modern contraceptive methods to limit childbearing in SSA. Methods This study was a secondary data analysis of individual- and country-level data obtained from the Demographic and Health Surveys (DHS) Program and three open data repositories. The study included 29,777 married or in-union women aged 15–49 years using modern contraceptive methods to limit childbearing from DHS conducted in 33 sub-Sahara African countries between 2010 and 2018. We performed descriptive statistics and fitted multilevel logistic regression models to determine the predisposing, enabling, and need factors associated with the use of FPC. Results Approximately 13% of the women used FPC. About 20% of the variance in the odds of using FPC was attributable to between-country differences. In the full model, the significant individual-level factors associated with the use of FPC compared with other modern contraceptive methods were: age (odds ratio [OR] = 1.10; 95%CI = 1.08–1.12), living children (OR = 1.11, 95%CI = 1.04–1.16), high household wealth (OR = 1.39, 95%CI = 1.18–1.64), rural residence (OR = 0.83, 95% CI = 0.71–0.97), joint contraceptive decision with partner (OR = 1.68, 95% = 1.43–1.99), contraceptive decision by partner and others (OR = 2.46, 95% = 1.97–3.07), and the number of living children less than the ideal number of children (OR = 1.40, 95%CI = 1.21–1.62). The significantly associated country-level factors were births attended by skilled health providers (OR = 1.03, 95%CI = 1.00–1.05) and density of medical doctors (OR = 1.37, 95%CI = 1.01–1.85). Conclusions Our results suggest that both individual- and country-level factors affect uptake of FPC in SSA. Increasing geographic, economic, and psychosocial access to FPC may improve its uptake in SSA.
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Affiliation(s)
- Babayemi O. Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- * E-mail:
| | - Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Rebecca D. Benfield
- School of Nursing, University of Nevada, Las Vegas, NV, United States of America
| | - Francisco S. Sy
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
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96
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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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97
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From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment. PLoS One 2020; 15:e0242345. [PMID: 33206705 PMCID: PMC7673533 DOI: 10.1371/journal.pone.0242345] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. METHODS Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. RESULTS Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users. CONCLUSION By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals.
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98
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Nanvubya A, Wanyenze RK, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Kamacooko O, Chinyenze K, Price M, Van Geertruyden JP. Correlates of knowledge of family planning among people living in fishing communities of Lake Victoria, Uganda. BMC Public Health 2020; 20:1642. [PMID: 33143684 PMCID: PMC7607714 DOI: 10.1186/s12889-020-09762-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 10/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Knowledge of family planning (FP) is a key determinant of contraceptive use which ultimately plays a role in attainment of good health and in conduct of clinical research. People living in fishing communities (FCs) have limited access to health services including FP and are targeted for future clinical research but their knowledge of FP and its correlates are scantily known. We determined correlates of knowledge of FP among people living in FCs of L. victoria in Uganda to inform future FP education programs in FCs. Methods We conducted a comparative cross-sectional survey among participants aged 15–49 years from Kigungu and Nsazi. Participants were asked if they were aware of any FP method. All those who responded in the affirmative were further asked to mention what FP methods they had heard of or knew. Those who reported knowledge of at least one FP method were asked a series of questions about FP methods and their side effects. Knowledge was categorized into good or poor knowledge based on their mean total score. Poor knowledge constituted a score below the mean while good knowledge constituted a score of more than or equal to the mean total score. To further explore attitudes and perceptions of FP, ten in-depth interviews and four focus group discussions were conducted. Results Of the 1410 screened participants, 94.5% were aware of at least one FP method. Pills and injectable hormonal methods were the most commonly known methods. Slightly over a third (38%) had good knowledge of FP. Correlates of knowledge of FP were; being female (aOR: 1.92 95% CI: 1.39–2.67), residing in Kigungu (aOR: 4.01 95% CI: 2.77–5.81), being married (aOR: 1.59 95% CI: 1.11–2.28) and currently being in a sexual relationship (aOR: 1.75 95% CI: 1.18–2.60). Concerns about safety and effectiveness of some modern FP methods exist. Misconceptions on effects of FP like sterility, cancers and foetal abnormalities were common. Conclusion FP awareness among people living in FCs of L. Victoria in Uganda is high. However, good knowledge about specific methods tends to be low. Correlates of knowledge of FP include gender, residence, marital status and sexual engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09762-7.
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Affiliation(s)
- Annet Nanvubya
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda. .,Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Rhoda K Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Teddy Nakaweesa
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Juliet Mpendo
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Barbarah Kawoozo
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Francis Matovu
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Sarah Nabukalu
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Geoffrey Omoding
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Jed Kaweesi
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - John Ndugga
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | | | | | - Matt Price
- IAVI, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
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99
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Factors influencing women's decisions regarding birth planning in a rural setting in Kenya and their implications for family planning programmes. J Biosoc Sci 2020; 53:935-947. [PMID: 33092660 DOI: 10.1017/s0021932020000620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper explores factors influencing women's decisions regarding contraceptive uptake, switching and discontinuation, and the implications of those decisions for family planning programmes. Data were from in-depth interviews that were conducted in 2018 with 42 women who participated in a longitudinal research project implemented in Homa Bay County of Kenya. Participants comprised women who were aged 15-39 years at the time of recruitment into the study and who discontinued using injectables or implants between the first and second rounds of data collection. Data were analysed using an exploratory inductive content analytic approach. The findings show that uptake of contraception was largely driven by concerns about the negative consequences of frequent childbirth on individual health and household socioeconomic well-being. Most women discontinued methods because of dissatisfaction but, instead of abandoning contraception altogether, switched to alternative methods, albeit sometimes less-effective ones. However, some women had difficulties in identifying an appropriate new method after experiencing side-effects, contraceptive failure or stock-out of their current method. Securing the cooperation of sexual partners was an additional problem especially for women whose partners did not support contraception. The findings suggest that concerns about the negative consequences of frequent childbirth outweigh challenges associated with contraceptive use. This presents an opportunity for family planning programmes to improve contraceptive uptake and continuation by addressing the health system challenges related to commodity stock-out and poor quality of care, as well as the concerns of men.
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100
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Jeena PM, Asharam K, Mitku AA, Naidoo P, Naidoo RN. Maternal demographic and antenatal factors, low birth weight and preterm birth: findings from the mother and child in the environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth 2020; 20:628. [PMID: 33076865 PMCID: PMC7574237 DOI: 10.1186/s12884-020-03328-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birthweight (LBW) and preterm birth (PB) remain the leading cause of morbidity and mortality in neonates worldwide. The aim of this study was to identify maternal demographic and antenatal factors associated with PB and LBW among low socio-economic communities. METHODS Pregnant women (n = 1099) were recruited in the first trimester into the Mother and Child in the Environment (MACE) birth cohort in Durban, South Africa. Maternal factors such as demographic information, health status, residential area, occupational, personal and environmental smoking and biomass fuel use were obtained through standardised interviews, while clinical status was obtained in each trimester and antenatal information on HIV status and treatment, syphilis and conditions such as pregnancy induced hypertension, diabetes etc. was extracted from the antenatal assessments. Key outcomes of interest were preterm birth and low birthweight. The latter data was obtained from the clinical assessments performed by midwives at delivery. Logistic regression models identified factors associated with PB and LBW. RESULTS Of the 760 live births, 16.4 and 13.5% were preterm and LBW, respectively. Mothers who delivered by caesarean section had an increased odds of having LBW babies (Adjusted odds ratio (AOR): 1.7; 95% CI: 1.1-2.7) and PB (AOR: 1.7, 95% CI: 1.1-2.7) versus normal vaginal deliveries. Mothers > 30 years (AOR: 1.8, 95% CI: 1.1-2.9) and current smokers (AOR: 2.7, 95% CI: 1.3-5.8) had an increased odds of having PB babies. Compared to younger mothers and non-smokers respectively. An effect of PB and LBW was seen among mothers with high BMI (25.0-29.9 kg/m2) (PB: AOR: 0.5, 95% CI: 0.3-0.9 and LBW: AOR: 0.5, 0.5, CI: 0.3-0.8), and obese BMI (> 30 kg/m2) (PB: AOR: 0.5, 95% CI: 0.3-0.9 and LBW: AOR: 0.4, CI: 0.2-0.7). Maternal HIV (PB AOR: 1.4 and LBW AOR: 1.2) and history of sexually transmitted infections (PB AOR: 2.7 and LBW AOR: 4.2) were not statistically significant. CONCLUSION Maternal age, cigarette smoking and caesarean delivery were associated with LBW and PB. Findings highlight the need of maternal health interventions to improve new-born health outcomes.
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Affiliation(s)
- Prakash M. Jeena
- Discipline of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
| | - Aweke A. Mitku
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
| | - Pragalathan Naidoo
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
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