Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind?

Misconceptions and Unmet Need for Modern Contraception among Cambodian Females: A Mix Methods Study

(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an ‘unmet need for modern contraception’ instead of the current classification which presumes they have a ‘met need’. (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15–29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15–29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted; (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception; (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.

Adaptation and validation of social accountability measures in the context of contraceptive services in Ghana and Tanzania

BACKGROUND

Changes in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. However, there is little consensus on how best to measure these latent changes. This paper reports on the adaptation and validation of measures that capture these changes in Tanzania and Ghana.

METHODS

The CaPSAI theory of change determined the dimensions of the measure, and we adapted existing items for the survey items. Trained data collectors used a survey to collect data from 752 women in Tanzania and 750 women in Ghana attending contraceptive services. We used reliability analysis, exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country.

RESULTS

The measure has high construct validity and reliability in both countries. We identified several subscales in both countries, 10 subscales in Tanzania, and 11 subscales in Ghana. Many of the domains and items were shared across both settings.

CONCLUSION

The study suggests that the multi-dimensional scales have high construct validity and reliability in both countries. Though there were differences in the two country contexts and in items and scales, there was convergence in the analysis that suggests that this measure may be relevant in different settings and should be validated in new settings.

TRIAL REGISTRATION

ACTRN12619000378123 .

Does gender equality and availability of contraception influence maternal and child mortality? A systematic review

BACKGROUND

Current global maternal and child health policies rarely value gender equality or women's rights and are restricted to policies addressing clinical interventions and family planning. Gender equality influences the knowledge, autonomy and utilisation of contraception and healthcare, thereby affecting maternal and child health. This systematic review aims to analyse the concurrent effect of gender equality and contraception on maternal and under-5 child mortality.

METHODS

A systematic review was conducted to investigate the current evidence. Studies were eligible if three themes-namely, indicators of gender equality (such as female education, labour force participation, gender-based violence), contraception, and maternal or child mortality-were present together in a single article analysing the same sample at the same time.

RESULTS

Even though extensive literature on this topic exists, only three studies managed to fit the selection criteria. Findings of two studies indicated an association between intimate partner violence (IPV) and infant mortality, and also reported that women's contraceptive use increased the risk of IPV. The third study found that the mother's secondary education attainment significantly reduced child mortality, while the mother's working status increased the odds of child mortality. The researchers of all included studies specified that contraceptive use significantly reduced the risk of child mortality.

CONCLUSION

Improvement in gender equality and contraception concurrently affect the reduction in child mortality. These findings provide strong support to address the research gaps and to include a gender equality approach towards maternal and child health policies.

Patterns of contraceptive use among Thai women aged ≥40 and at risk of pregnancy

OBJECTIVES

The aims of the study were to identify the patterns of contraceptive use among Thai women aged ≥40 years and the reasons for not using contraception.

METHODS

This cross-sectional study included sexually active women aged 40-49 years in Khon Kaen, Thailand. Information on contraceptive practice and reasons for not using contraception was collected through a self-reported questionnaire. The unmet need for a modern method of contraception and the unmet need for any method of contraception were calculated based on the percentage of participants who were not using contraception but who wanted to postpone or prevent pregnancy.

RESULTS

Of 400 women, 75.5% were currently using some form of contraception, with female sterilisation being the most used (35%). The main reasons for not using contraception included perceived low risk of pregnancy, health concerns, infrequent sexual intercourse and wish to become pregnant. The unmet need for a modern method of contraception was 23.3% (95% confidence interval [CI] 0.20%, 0.29%). Having children was a significant protective factor (adjusted odds ratio [OR] 0.18; 95% CI 0.08, 0.37; p = 0.000). The unmet need for any method of contraception was 12% (95% CI 0.09%, 0.16%). Previous abortion was a significant risk factor for not using any contraception (adjusted OR 2.23; 95% CI 1.12, 4.44; p = 0.022).

CONCLUSION

Although the use of contraception was common, some participants displayed a lack of knowledge and/or did not practise family planning. Our findings address the importance of improving knowledge about the risks of pregnancy and the need for effective contraception in this population.

Use of modern contraceptives among advanced-level secondary school girls in the Rukwa Region, Tanzania, 2018

OBJECTIVES

To determine contraceptive uptake, reasons for non-use and predictors of use.

METHODS

We conducted a cross-sectional study among girls in advanced-level secondary schools in the Rukwa region of Tanzania. Using probability proportional to size (PPS), we recruited a random sample of 660 girls out of 1447-targeted participants. A tool for data collection was a questionnaire. Data analyses included univariate analysis to describe study participants and Poisson regression analysis to assess the effect of independent factors to the dependent variable. A 5%-level of significance was used in multivariate analysis.

RESULTS

More than 40% of the girls report being sexually active and only 25% reported current use of modern contraceptives. The main reported main method being use of male condoms (93%). Barriers for non-use of contraceptives included fear of side effects, fear of being perceived or labeled as promiscuous, inadequate knowledge about contraceptives and for religious reasons. The predictor for using modern contraceptives was attending class sessions about modern contraceptives.

CONCLUSIONS

Although girls in advanced-level secondary schools are sexually active, the use of modern contraceptives is still low. Girls report several barriers frustrating their intention to use contraceptives, mainly based on misconceptions and lack of knowledge.

Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys

Background

Contraception is a key component of sustainable development, empowering women, reducing the risk of maternal and child mortality and promoting economic growth. It is part of the Sustainable Development Goals agenda, where the aim is to achieve universal access to sexual and reproductive health. Our objective was to evaluate trends and inequalities in modern contraceptive prevalence, and according to the type of modern contraceptive, in 11 low- and middle-income countries that are partners of the Family Planning 2020 initiative.

Methods

Analyses were performed using 62 Performance Monitoring and Accountability 2020 (PMA2020) surveys from 11 countries. Forty surveys were nationally representative, while 22 had regional coverage. Regional surveys were analyzed separately, totalizing 15 geographies from 11 countries. We described trends on modern contraceptive prevalence, and its subtypes (short- and long-acting reversible contraceptives, and permanent methods), by calculating absolute average annual changes. Absolute inequalities on the prevalence of modern contraceptives were assessed for the most recent survey of each geography using the slope index of inequality, and according to wealth, education and age.

Results

The overall prevalence of modern contraception increased in most geographies analyzed, reaching a 7.2 percentage points increase per year in Lagos, Nigeria. This increase was mostly influenced by the long-acting reversible contraceptives, which increased in 73% of the geographies. Although the largest share of modern contraception is represented by short-acting reversible contraceptives, these are reducing and giving space for the long-acting methods. The exception was Rajasthan, India, where the permanent methods accounted for 70% of the modern contraception share, and their prevalence was almost 40%. Inequalities were identified in favor of richer, older and better educated women.

Conclusions

Out of the 15 geographies analyzed, 11 demonstrated an increase in overall modern contraceptive use – mainly driven by the uptake of long-acting reversible contraception. However, even in the groups with the highest prevalence, modern contraceptive use was at most 60% in most geographies. So, we are far from reaching the desired universal coverage proposed by the Sustainable Development Goals.

Demand for family planning satisfied with modern methods and its associated factors among married women of reproductive age in rural Jordan: A cross-sectional study

Background

A novel indicator, ‘percentage of women of reproductive age who are sexually active and who have their demands for FP satisfied with modern contraceptive methods (mDFPS)’, was developed in 2012 to accelerate the reduction of unmet needs of family planning (FP). In Jordan, unmet needs for modern contraception remain high. To address this situation, this study measured the mDFPS and identified its associated factors in rural Jordan.

Methods

This cross-sectional study included married women of reproductive age (15–49 years) from ten villages in Irbid Governorate, Jordan, where advanced health facilities are difficult to reach. A two-stage stratified sampling with random sampling at the household stage was used for this field survey which was conducted between September and October 2016. Univariate analysis was used to assess the differences between mDFPS and unmet mDFPS groups. Logistic regression analysis was performed to identify the correlates of mDFPS.

Results

Of 1019 participants, 762 were identified as needing modern contraception. mDFPS coverage accounted for 54.7%. The most significant factors associated with mDFPS were the husband’s agreement on FP (adjusted odds ratio [AOR]: 15.43, 95% confidence interval [CI]: 5.26–45.25), knowledge of modern contraceptives (AOR: 8.76, 95% CI: 5.72–13.40), and lack of awareness of the high risk of conception in the postpartum period (AOR: 2.21, 95% CI: 1.41–3.47). Duration of current residence, receipt of FP counselling at health centres and number of living children were also correlated. In addition, 95.3% of local women were aware of the presence of health centres that were mostly located in a 10-minute walking distance.

Conclusion

To increase mDFPS, this study suggested that accelerating male involvement in FP decision-making is necessary through community-based health education. Furthermore, expanding FP services in village health centres and improving the quality of FP counselling in public health facilities are required to correct misconceptions about modern methods among rural women.

Human fertility in relation to education, economy, religion, contraception, and family planning programs

Background

The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study.

Methods

We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically.

Results

In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita.

Conclusions

These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.

Time trends in demand for family planning satisfied: analysis of 73 countries using national health surveys over a 24-year period

Background

Universal access to family planning is key to extend its health and economic benefits worldwide. Our aim was to track progress in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in low- and middle-income countries (LMICs).

Methods

Analyses were based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys carried out between 1993 and 2017 in 73 LMICs, using data for married women aged 15-49 years. We estimated trends in mDFPS coverage by country and world region and evaluated trends in wealth-based inequalities. The analyses pooling all countries together were stratified by wealth quintiles, area of residence and woman’s age. mDFPS coverage in 2030 for each country was predicted using a linear model.

Results

Overall, mDFPS increased and poor-rich gaps narrowed. Eastern & Southern Africa showed an average increase of 1.5 percentage points (p.p.) a year, being the region with the fastest progress. West & Central Africa had an increase in mDFPS of 1 p.p. a year but current coverage is still below 40%. Generally, inequalities were reduced, except for West & Central Africa and Europe & Central Asia where almost no change was observed. The country with the fastest progress in mDFPS was Rwanda, with an increase of 5 p.p./y, while Timor Leste had the fastest reduction in absolute inequality, less 3.8 p.p./y. Inequalities by area of residence were reduced, but large gaps remain. A similar trend was observed for different age groups. If the current trend is not accelerated, 44 countries will not achieve universal coverage in mDFPS by 2030.

Conclusions

Generally, mDFPS is increasing and inequalities are decreasing. However, progress is slow in some regions, especially West & Central Africa, where low coverage is combined with high levels of inequalities. Efforts to increase family planning coverage must be prioritized in countries where progress is slow or inexistent.

Estimating progress towards meeting women's contraceptive needs in 185 countries: A Bayesian hierarchical modelling study

BACKGROUND

Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. Monitoring progress towards these outcomes is well established for women of reproductive age (15-49 years) who are married or in a union (MWRA). For those who are not, limited data and variability in data sources and indicator definitions make monitoring challenging. To our knowledge, this study is the first to provide data and harmonised estimates that enable monitoring for all women of reproductive age (15-49 years) (WRA), including unmarried women (UWRA). We seek to quantify the gaps that remain in meeting family-planning needs among all WRA.

METHODS AND FINDINGS

In a systematic analysis, we compiled a comprehensive dataset of family-planning indicators among WRA from 1,247 nationally representative surveys. We used a Bayesian hierarchical model with country-specific time trends to estimate these indicators, with 95% uncertainty intervals (UIs), for 185 countries. We produced estimates from 1990 to 2019 and projections from 2019 to 2030 of contraceptive prevalence and unmet need for family planning among MWRA, UWRA, and all WRA, taking into account the changing proportions that were married or in a union. The model accounted for differences in the prevalence of sexual activity among UWRA across countries. Among 1.9 billion WRA in 2019, 1.11 billion (95% UI 1.07-1.16) have need for family planning; of those, 842 million (95% UI 800-893) use modern contraception, and 270 million (95% UI 246-301) have unmet need for modern methods. Globally, UWRA represented 15.7% (95% UI 13.4%-19.4%) of all modern contraceptive users and 16.0% (95% UI 12.9%-22.1%) of women with unmet need for modern methods in 2019. The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 75.7% (95% UI 73.2%-78.0%) globally, yet less than half of the need for family planning was met in Middle and Western Africa. Projections to 2030 indicate an increase in the number of women with need for family planning to 1.19 billion (95% UI 1.13-1.26) and in the number of women using modern contraception to 918 million (95% UI 840-1,001). The main limitations of the study are as follows: (i) the uncertainty surrounding estimates for countries with little or no data is large; and (ii) although some adjustments were made, underreporting of contraceptive use and needs is likely, especially among UWRA.

CONCLUSIONS

In this study, we observed that large gaps remain in meeting family-planning needs. The projected increase in the number of women with need for family planning will create challenges to expand family-planning services fast enough to fulfil the growing need. Monitoring of family-planning indicators for all women, not just MWRA, is essential for accurately monitoring progress towards universal access to sexual and reproductive healthcare services-including family planning-by 2030 in the SDG era with its emphasis on 'leaving no one behind.'

Partner Discussion as a Mediator of the Effects of Mass Media Exposure to FP on Contraceptive Use among Young Nigerians: Evidence from 3 Urban Cities

Evidence suggests that despite high knowledge of family planning (FP), unwanted pregnancies and birth rates remain high among young Nigerians. There is a critical gap in understanding the nexus between exposure to FP information and contraception practices among this population. This study aimed to fill this gap and tested a pathway of the impact of media exposure to FP messages on modern contraceptive use. Data came from a 2018 cross-sectional baseline survey of young people aged 15-24 in three urban centers in Nigeria - Lagos, Kaduna, and Kano. This was part of an impact evaluation of a television-based drama designed to improve contraceptive use among young individuals. The study was limited to 777 young men and women who were sexually active. We found evidence of the mediation effect of media exposure to FP messages on partner discussion about FP, which in turn was associated with an increased likelihood of modern contraceptive use. Contraceptive self-efficacy also had positive associations with contraception. Our study elucidated a potential pathway through which media communication programs can significantly contribute to increased modern contraceptive use and underlined the importance of providing young people in Nigeria with opportunities to learn and practice obtaining and using contraception.

A multidimensional approach to inform family planning needs, preferences and behaviours amongst women in South Africa through body mapping

Background

In recent decades there have been great improvements in the reproductive health of women in low- and middle-income countries and increases in the use of modern contraceptive methods. Nonetheless, many women are not able to access information, contraceptive technologies and services that could facilitate preventing unintended pregnancies and planning the number and timing of desired pregnancies.

In South Africa, the contraceptive prevalence rate is 64.6%. However, this relatively high contraceptive prevalence rate masks problems with quality contraceptive service delivery, equitable access, and women’s ability to correctly and consistently, use contraceptive methods of their choice. This study set out to understand the specific family planning and contraceptive needs and behaviours of women of reproductive age in South Africa, through a lived experience, multisensory approach.

Methods

Participatory qualitative research methods were used including body mapping workshops amongst reproductive aged women recruited from urban and peri urban areas in the Western Cape South Africa. Data including body map images were analysed using a thematic analysis approach.

Results

Women had limited biomedical knowledge of the female reproductive anatomy, conception, fertility and how contraceptives worked, compounded by a lack of contraceptive counseling and support from health care providers. Women’s preferences for different contraceptive methods were not based on a single, sensory or experiential factor. Rather, they were made up of a composite of sensory, physical, social and emotional experiences underscored by potential for threats to bodily harm.

Conclusions

This study highlighted the need to address communication and knowledge gaps around the female reproductive anatomy, different contraceptive methods and how contraception works to prevent a pregnancy. Women, including younger women, identified sexual and reproductive health knowledge gaps themselves and identified these gaps as important factors that influenced uptake and effective contraceptive use. These knowledge gaps were overwhelmingly linked to poor or absent communication and counseling provided by health care providers. Body mapping techniques could be used in education and communication strategies around sexual and reproductive health programmes in diverse settings.

Competency assessment of the medical interns and nurses and documenting prevailing practices to provide family planning services in teaching hospitals in three states of India

Objectives

The objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India.

Study design

A cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills.

Results

About 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training.

Conclusions

Knowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.

Task sharing for family planning services, Burkina Faso

PROBLEM

In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services.

APPROACH

Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels.

LOCAL SETTING

In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010.

RELEVANT CHANGES

Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported.

LESSONS LEARNT

The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success.

Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys

Background

Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women).

Methods

We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman’s age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones.

Results

On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were “health concerns” and “infrequent sex,” but the prevalence of each reason varied substantially across countries. Nonuse due to “opposition from others” was higher among married than unmarried women; in turn, the prevalence of nonuse due to “lack of access” or “lack of knowledge” was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to “lack of access.” Pro-rich inequality was detected for reasons “health concerns,” “infrequent sex,” and “method-related”, while the reasons “other opposed,” “fatalistic,” “lack of access,” and “lack of knowledge” were linked to patterns of pro-poor inequality.

Conclusions

Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).

Not all inequalities are equal: differences in coverage across the continuum of reproductive health services

Reducing inequalities in health service coverage is central to achieving the larger goal of universal health coverage. Reproductive health services are part of evidence-based health interventions that comprise a minimum set of essential health interventions that all countries should be able to provide. This paper shows patterns in inequalities in three essential reproductive health services that span a continuum of care—contraceptive use, antenatal care during pregnancy and delivery at a health facility. We highlight coverage gaps and their impacts across geographical regions, key population subgroups and measures of inequality. We focus on reproductive age women (15–49 years) in 10 geographical regions in Africa, Asia and Latin America and the Caribbean. We examine inequalities by age (15–19, 20–24, 25–34 and 35–49 years), household wealth quintile, residence (rural or urban) and parity. Data on service coverage and the population in need are from 84 nationally representative surveys. Our results show that dominant inequalities in contraceptive coverage are varied, and include large disparities and impact by age group, compared with maternal health services, where inequalities are largest by economic status and urban–rural residence. Using multiple measures of inequality (relative, absolute and population impact) not only helps to show if there are consistent patterns in inequalities but also whether few or many different approaches are needed to reduce these inequalities and where resources could be prioritised to reach the largest number of people in need.

Contraception in adolescence: the influence of parity and marital status on contraceptive use in 73 low-and middle-income countries

Background

There is still a large gap in relation to effectively meet the contraceptive needs and family planning goals of adolescents. Our aim was to describe how having a partner and children impact on contraceptive behavior of sexually active female adolescents from low and middle-income countries (LMICs).

Methods

Analyses were based on the most recent Demographic and Health Surveys and Multiple Indicator Surveys carried out since 2005 in 73 LMICs with available data for sexually active women aged 15–19 years. Modern contraceptive prevalence and demand for family planning satisfied with modern methods of contraception (mDFPS) were estimated among three subgroups of adolescents considering their parity and marital status- not married, married without children, and married with children – at national and regional levels.

Results

Female adolescents who were married with no children presented the lowest median modern contraceptive prevalence in all world regions, ranging from 2.9% in West & Central Africa to 29.0% in Latin America & Caribbean. Regarding mDFPS, the lowest coverage for married adolescents without children was found in West & Central Africa (12.6%), whereas Latin America & Caribbean presented the highest (50.4%). In East Asia & Pacific, not married adolescents were the group with the lowest mDFPS (17.1%). In 12 countries, mDFPS was below 10% among married adolescents without children: Angola, Chad, Congo, Congo DR, Guinea, Mozambique, Niger, Nigeria, and Senegal in Africa, Philippines and Timor-Leste in Asia and Guyana in Latin America & Caribbean.

Conclusions

In most countries, modern contraceptive prevalence and mDFPS were particularly low among married female adolescents without children, which should be considered a priority group for intervention. The findings suggest that social norms regarding marriage and fertility expectations and other cultural barriers have a role at least as relevant as contraceptive availability. All these aspects need to be considered in the design of family planning strategies to effectively increase modern contraceptive use among adolescents everywhere, particularly in conservative contexts.

Electronic supplementary material

The online version of this article (10.1186/s12978-019-0686-9) contains supplementary material, which is available to authorized users.

Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators

OBJECTIVE

Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa.

STUDY DESIGN

We reviewed literature on tubal ligation among African women published between January 1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science, and Google scholar for quantitative, qualitative, and mixed methods studies which reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan Africa. Finally, we conducted a narrative synthesis and categorized our findings using a framework based on the social ecological model.

RESULTS

We included 48 articles in the review. Identified barriers to tubal ligation among women included individual-level (myths and misconceptions, fear of surgery, irreversibility of procedure, religious beliefs), interpersonal-level (male partner disapproval), and organizational-level (lack of healthcare worker expertise and equipment) factors. Facilitating factors included achievement of desired family size and perceived effectiveness (individual-level), supportive male partners and knowing other women with permanent contraception experience (interpersonal-level), and finally, subsidized cost of the procedure and task-sharing with lower cadre healthcare workers (organizational-level).

CONCLUSIONS

Barriers to, and facilitators of permanent contraception among women in sub-Saharan Africa are multilevel in nature. Strategies countering these barriers should be prioritized, as effective contraception can promote women's health and economic development in sub-Saharan Africa. In addition to these strategies, more quantitative research is needed to further understand patient-level factors associated with uptake of permanent contraception among women.