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Wooten S, Hurley E, Schuetz N, Miller MK, Rodean J, Rupe E, Lewis K, Boncoeur MD, Masonbrink AR. Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers. BMC Womens Health 2024; 24:305. [PMID: 38778309 PMCID: PMC11110254 DOI: 10.1186/s12905-024-03136-6] [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: 07/10/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. METHODS We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. RESULTS Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. CONCLUSIONS While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.
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Affiliation(s)
- Shelbie Wooten
- Pediatric Hospital Medicine, Children's Mercy Kansas City, 2401 Gilham Rd, Kansas City, MO, 64108, USA.
| | - Emily Hurley
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Population Health, Medical Center, University of Kansas, Kansas City, MO, USA
| | - Nikolaus Schuetz
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Melissa K Miller
- Pediatric Hospital Medicine, Children's Mercy Kansas City, 2401 Gilham Rd, Kansas City, MO, 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Emily Rupe
- University of Kansas School of Medicine, Wichita, KS, USA
| | - Kemi Lewis
- Pediatric Hospital Medicine, Children's Mercy Kansas City, 2401 Gilham Rd, Kansas City, MO, 64108, USA
| | | | - Abbey R Masonbrink
- Pediatric Hospital Medicine, Children's Mercy Kansas City, 2401 Gilham Rd, Kansas City, MO, 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Myat SM, Pattanittum P, Sothornwit J, Ngamjarus C, Rattanakanokchai S, Show KL, Jampathong N, Lumbiganon P. School-based comprehensive sexuality education for prevention of adolescent pregnancy: a scoping review. BMC Womens Health 2024; 24:137. [PMID: 38383384 PMCID: PMC10882910 DOI: 10.1186/s12905-024-02963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Adolescent pregnancy is a global public health problem. Numerous approaches for Comprehensive Sexuality Education (CSE) delivery in schools have been implemented around the world. Previous reviews on CSE did not follow the International Technical Guidance on Sexuality Education (ITGSE) because CSE is very diverse in terms of population, interventions, settings and outcomes. We conducted this scoping review to identify and map the evidence of school-based CSE for prevention of adolescent pregnancy with emphasis on adolescents' contraceptive use, unintended pregnancy and abortion. METHODS We searched PubMed, CENTRAL, Scopus, ISI Web of Science, CINAHL, and WHO ICTRP to identify potential eligible studies from their inception to 4th Nov 2023.We included randomized controlled trials (RCTs) and non-RCTs of CSE implemented in public or private schools for adolescents. CSE was defined as a multi-session intervention in school that covered topics including contraception, pregnancy, abortion, and HIV/STI. School-based interventions were the main intervention that may be either stand-alone or multicomponent. There was no limitation on study's geographical area, but only English-language studies were considered. Two reviewers selected and extracted data independently, discussed for consensus or consulted the third reviewer if there were discrepancies for final conclusion. Data were presented using figures, map and table. RESULTS Out of 5897 records, 79 studies (101 reports) were included in this review. Most studies were conducted in the United States and other high-income countries in secondary or high schools with cluster RCTs. All studies included participatory methods. Almost all studies included Sexual and Reproductive Health which is the eighth concept of CSE. Very few studies reported the prespecified primary outcomes of contraceptive use during last sex, unintended pregnancy and abortion and hence this highlighted the gaps of available evidence for these outcomes. The number of concepts, components, duration and providers of CSE varied across the included studies. However, none of the interventions identified in this scoping review adhered to the ITGSE recommended approach. CONCLUSIONS Our scoping review shows gaps in school-based CSE implementation in terms of completeness of concepts, components, providers, duration and outcomes recommended by ITGSE.
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Affiliation(s)
- Su Mon Myat
- Department of Public Health, School Health Division, Ministry of Health, Naypyidaw, Myanmar
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Jen Sothornwit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chetta Ngamjarus
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kyaw Lwin Show
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
- Department of Medical Research, Ministry of Health, Naypyidaw, Myanmar
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Afzal F, Das A, Chatterjee S. Drawing the Linkage Between Women's Reproductive Health, Climate Change, Natural Disaster, and Climate-driven Migration: Focusing on Low- and Middle-income Countries - A Systematic Overview. Indian J Community Med 2024; 49:28-38. [PMID: 38425973 PMCID: PMC10900460 DOI: 10.4103/ijcm.ijcm_165_23] [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: 03/15/2023] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background One of the most important aspects of women's well-being and welfare is RSH (reproductive and sexual health). Reproductive health is not an exception to the threat that CCC (climate change and climate crisis) poses to numerous facets of public health. Firstly, the present review seeks to identify the influence of climatic changes, natural disasters, and climate-driven migration on RSH. Secondly, to identify knowledge gaps regarding the same. Material and Methods Two databases (Scopus and PubMed) were scanned using Boolean operation. The literature search aimed to find records pertaining to topics of RSH and climate change. Using the PRISMA-ScR method, records were screened and shortlisted based on established inclusion criteria. This literature search was carried out in November 2022. In the shortlisted records, preference for the comprehensive review articles was given. Results The present review is based on 38 records that collectively revealed that climate crisis and natural disasters have many negative impacts on female reproductive health. These effects are observed in different phases of life, ranging from teenage to menopause. The unique strength of the present review is that it draws a relationship between female reproductive health and the direct as well as indirect effects of the CCC. The available literature about LMICs is predominantly confined to drought, flood, and earthquake. Disasters like tsunamis, cyclones, and avalanches remain unexplored. Conclusion From the available literature, it is quite evident that CCC has an adverse effect on a woman's reproductive life as well as a bearing on future generations' health. Filling these knowledge gaps is pivotal for designing more effective disaster and health policies. Policymakers should take into consideration these detrimental effects while designing health schemes and policies for females.
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Affiliation(s)
- Fahad Afzal
- Institute of Health Management Research, IIHMR University, Jaipur, Rajasthan, India
| | - Arindam Das
- Institute of Health Management Research, IIHMR University, Jaipur, Rajasthan, India
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Akwara E, Chandra-Mouli V. Good progress in a number of areas of ASRH, but there is much more that needs to be done. Sex Reprod Health Matters 2023; 31:2266657. [PMID: 37870260 PMCID: PMC10595384 DOI: 10.1080/26410397.2023.2266657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
- Elsie Akwara
- Social Statistician and Consultant, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Formerly Scientist, Human Reproduction Programme, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Li H, Pu Y, Li Z, Jin Z, Jiang Y. Socioeconomic inequality in teenage pregnancy in Papua New Guinea: a decomposition analysis. BMC Public Health 2023; 23:2184. [PMID: 37936107 PMCID: PMC10631214 DOI: 10.1186/s12889-023-17067-8] [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: 11/06/2022] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Teenage pregnancy is a global public health issue, and it poses a serious threat to the health and socioeconomic status of mothers and their newborn children. Although Papua New Guinea has recorded one of the highest teenage pregnancy rates among Asia-Pacific countries, few studies have conducted research on the related inequality in the country. Therefore, this study aimed to assess socioeconomic inequality in teenage pregnancy and its contributing factors in Papua New Guinea. METHODS Data for this cross-sectional study were obtained from the 2016-2018 Papua New Guinea Demographic and Health Survey. The analytical sample consisted of 2,864 girls aged 15-19 years. We employed Erreygers normalized concentration index (ECI) and concentration curves to measure and depict socioeconomic inequality in teenage pregnancy. Decomposition analysis was likewise performed to identify the contributions of determinants to the observed inequality. RESULTS Weighted ECI for teenage pregnancy was - 0.0582 (P < 0.001), thereby indicating that teenage pregnancy in Papua New Guinea is disproportionately concentrated among poor girls. Decomposition analysis suggested that education level (65.2%), wealth index (55.2%), early sexual debut (25.1%), region (8.5%), and sex of household head (4.1%) are the main determinants explaining the pro-poor socioeconomic inequality in teenage pregnancy. CONCLUSIONS A pro-poor socioeconomic inequality of teenage pregnancy was present in Papua New Guinea. This inequality may be alleviated by such interventions as ensuring that teenage girls receive education; implementing poverty alleviation projects, eliminating child, early, and forced marriages; strengthening promotion for household head to support teenagers in accessing sexual and reproductive health education; improving geographical accessibility to health facilities on contraceptive services, and taking necessary precautions and responses to sexual misconduct.
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Affiliation(s)
- Hao Li
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Yiran Pu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zhen Li
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Ziyang Jin
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Daniel AK, Casmir E, Oluoch L, Micheni M, Kiptinness C, Wald A, Mugo NR, Roxby AC, Ngure K. "I was just concerned about getting pregnant": Attitudes toward pregnancy and contraceptive use among adolescent girls and young women in Thika, Kenya. BMC Pregnancy Childbirth 2023; 23:493. [PMID: 37403049 DOI: 10.1186/s12884-023-05802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) have a high incidence of unplanned pregnancies, especially in low-resource settings. AGYW assess the overlapping risks of pregnancy, contraception, and STIs as they navigate relationships. Few studies have examined how AGYW consider the comparative risks of their decisions around sexual and reproductive health in this context or how risk perception influences contraceptive use. METHODS Twenty in-depth interviews (IDIs) and 5 focus group discussions (FGDs) were conducted with a subset of sexually active AGYW enrolled in the Girls Health Study (GHS), a longitudinal cohort study in Thika, Kenya, assessing HSV-2 incidence in a cohort of AGYW aged 16-20. Interview questions were focused on perspectives and decision-making around sexual and reproductive health. Interviews were conducted in both English and Kiswahili, transcribed, and coded using inductive and deductive approaches to identify emerging themes. RESULTS Misconceptions about long-acting reversible contraceptives (LARCs), injectables, and daily oral contraceptive pills strongly disincentivized their use among AGYW. Participants described pregnancy as undesirable, and AGYW reported prioritizing contraceptive methods that were effective and reliable in pregnancy prevention, even if not effective in preventing STI/HIV infection. Participants reported that AGYW relied heavily on emergency contraceptive (EC) pills for pregnancy prevention. CONCLUSIONS Though the goal of avoiding unintended pregnancy was common, this did not suffice to motivate the uptake of long-term contraceptives among AGYWs. Given the convenience, cost-effectiveness, and lower perceived risk of side effects, EC pills were more likely to be accepted as a form of contraception. Understanding the reasons for AGYW's acceptance of certain contraceptive methods over others can help future interventions better target communication and counseling about contraception and influence key drivers of AGYW behavior and decision-making around sexual and reproductive health.
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Affiliation(s)
| | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Partners in Health Research and Development, Thika, Kenya
| | - Lynda Oluoch
- Partners in Health Research and Development, Thika, Kenya
| | - Murugi Micheni
- National Syndemic Disease Control Council, Nairobi, Kenya
| | | | - Anna Wald
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nelly Rwamba Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- University of Washington, Seattle, WA, USA
| | - Alison C Roxby
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Box 19704-00202, Nairobi, Kenya.
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Maurya C, Muhammad T, Thakkar S. Examining the relationship between risky sexual behavior and suicidal thoughts among unmarried adolescents in India. Sci Rep 2023; 13:7733. [PMID: 37173519 PMCID: PMC10182050 DOI: 10.1038/s41598-023-34975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 05/10/2023] [Indexed: 05/15/2023] Open
Abstract
Addressing the problem of suicidal thoughts in adolescents requires understanding the associated risk factors. Multiple studies have shown that risky sexual behavior affected the adolescents' psychological health that leads to their suicidal thoughts, behaviors and attempts. This study aimed to identify the association between various risky sexual behaviours and suicidal thoughts among unmarried adolescents in India. We used data collected from 4221 unmarried adolescent boys and 5987 unmarried adolescent girls aged 10-19 years, from the two rounds of the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey. Descriptive analysis was done to observe changes in the selected variables from wave-1 to wave-2. Random effect regression analysis was used to estimate the association of suicidal thoughts among unmarried adolescents with their risky sexual behaviours. The percentage of adolescent boys having suicidal thoughts increased from 1.35% in wave 1 to 2.19% in wave 2. Among adolescent girls, the percentage increased from 2.92% in wave 1 to 5.05% in wave 2. A proportion of 3.26% adolescent boys had more than one sexual partner during wave 1 whereas in wave 2, it rose to 8.71%, while in case of adolescent girls, the estimates only increased from 0.26% at wave 1 to 0.78% at wave 2. Nearly 4.55% boys and 1.37% girls had early sexual debut. Almost five percentage boys were sexually active at wave 1 whereas in wave 2, it rose to 13.56%, while among adolescent girls, the estimates decreased from 1.54% at wave 1 to 1.51% at wave 2. Contraceptive use increased over time among both adolescent boy and girls. Also, a large proportion of adolescent boys reported watching pornography (27.08% at waive 1 and 49.39% at wave 2) compared to adolescent girls (4.46% at wave 1 and 13.10% at wave 2). Adolescents who had more than one sexual partner [Coef: 0.04; p < 0.001], exposed to early sexual debut [Coef; 0.019; p < 0.01], sexually active [Coef: 0.058; p < 0.001] and reported watching pornography [Coef: 0.017; p < 0.001] were more likely to have suicidal thoughts. Adolescent boys and girls with risky sexual behaviors are likely to be at a higher risk of suicidal ideation, and thus, they should be treated with special care and attention by local healthcare practitioners.
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Affiliation(s)
- Chanda Maurya
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - T Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India.
| | - Shriya Thakkar
- Department of Sociology, Louisiana State University, 26, Stubbs Hall, Baton Rouge, LA, 70803, USA
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Srivastava S, Mohanty P, Muhammad T, Kumar M. Socio-economic inequalities in non-use of modern contraceptives among young and non-young married women in India. BMC Public Health 2023; 23:797. [PMID: 37127678 PMCID: PMC10150497 DOI: 10.1186/s12889-023-15669-w] [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: 05/18/2022] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities. METHODS The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study. RESULTS The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p < 0.001). Women from non-young age group had 39% significantly lower odds of non-use of modern contraceptive use than women from young age group (15-24 years) [AOR: 0.23; CI: 0.23, 0.23]. The value of concentration quintile was -0.022 for young and -0.058 for non-young age groups which also confirms that the non-use of modern contraceptives was more concentrated among women from poor socio-economic group and the inequality is higher among non-young women compared to young women. About 87.8 and 55.5% of the socio-economic inequality was explained by wealth quintile for modern contraceptive use in young and non-young women. A higher percent contribution of educational status (56.8%) in socio-economic inequality in non-use of modern contraceptive use was observed in non-young women compared to only -6.4% in young women. Further, the exposure to mass media was a major contributor to socio-economic inequality in young (35.8%) and non-young (43.2%) women. CONCLUSION Adverse socioeconomic and cultural factors like low levels of education, no exposure to mass media, lack of or limited knowledge about family planning, poor household wealth status, religion, and ethnicity remain impediments to the use of modern contraceptives. Thus, the current findings provide evidence to promote and enhance the use of modern contraceptives by reducing socioeconomic inequality.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Parimala Mohanty
- Institute of Medical Sciences & Sum Hospital, Siksha "O" Anusandhan Deemed to Be University, Bhubaneswar, Odisha, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Manish Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
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Kamuyango A, Yu T, Ao CK, Hu SC, Salim LA, Sulistyorini Y, Li CY. Associations of Urban Residence and Wealth Index With Various Sources of Contraceptives Among Young Women Aged 15-24 Years in 25 Sub-Saharan African Countries. J Adolesc Health 2023; 72:599-606. [PMID: 36599761 DOI: 10.1016/j.jadohealth.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Appreciating user differences in contraceptive sources is essential for improving contraceptive access and safeguarding an equitable and sustainable future. Therefore, this study explored whether urban residence and individual wealth are associated with where women access contraception (e.g., government, private, or nongovernmental organization provider) and assessed whether these associations are modified by the income level in the respondents' country of residence. METHODS We analyzed the cross-sectional data of Demographic Health Surveys conducted between 2009 and 2020 in 25 countries. The final data set included 25,081 young women aged between 15 and 24 years who are using contraceptives. Multinomial logistic regression models were established to assess the associations of our outcome variable, namely, various contraceptive sources, with our main independent variables, namely, urban residence and wealth index. We also assessed the potential effect modification by country income level on the above associations. RESULTS We observed obvious urban-rural and rich-poor disparities in odds of using contraceptive sources. Generally, living in urban residences and being wealthy were positively associated with all sources of contraceptives. However, these associations were mostly modified by country income level. People living in urban residences utilized more private sources, especially in low-income (beta coefficient, B = 0.973) and upper-middle-income countries (B = 1.361). Young women in urban areas across all analyzed countries were also more likely to use contraceptives from other sources (B = 0.267). In addition, women from poor households were less likely to use private sources (B = -1.166) and other sources (B = -0.547). DISCUSSION Even though young women may prefer private sources of contraceptives due to their confidentiality and flexible hours, these sources carry more benefits for rich and urban young women than for poor and rural women. The differential accessibility and affordability may account for the observed urban-rural and rich-poor disparities in using contraceptive sources, respectively, and the income level of a country is likely to modify such disparities.
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Affiliation(s)
- Asantesana Kamuyango
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chon-Kit Ao
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Healthy Cities Research Center, Research and Services Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Lutfi Agus Salim
- Division of Biostatistics and Demography, Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Yuly Sulistyorini
- Division of Biostatistics and Demography, Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Biostatistics and Demography, Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Masonbrink AR, Hurley EA, Schuetz N, Rodean J, Rupe E, Lewis K, Boncoeur MD, Miller MK. Sexual behaviors, contraception use and barriers among adolescents and young adults in rural Haiti. BMC Womens Health 2023; 23:137. [PMID: 36973773 PMCID: PMC10045756 DOI: 10.1186/s12905-023-02268-5] [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: 09/06/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) in Haiti experience a high unintended pregnancy rate, in part due to unmet contraception needs. Little is known about AYA opinions of and experiences with contraception that may explain remaining gaps in coverage. We aimed to describe barriers and facilitators to contraception use among AYAs in Haiti. METHODS We conducted a cross-sectional survey and semi-structured qualitative interviews with a convenience sample of AYA females aged 14-24 in two rural communities in Haiti. The survey and semi-structured interviews assessed demographics, sexual health and pregnancy prevention behaviors and explored contraception opinions and experiences according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control. We used descriptive statistics to report means and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through inductive coding and team debriefing. RESULTS Among 200 survey respondents, 94% reported any past vaginal sexual activity, and 43% reported ever being pregnant. A large majority were trying to avoid pregnancy (75%). At last sexual activity, 127 (64%) reported use of any contraceptive method; Among them, condoms were the most common method (80%). Among those with previous condom use, most reported use less than half the time (55%). AYAs were concerned about parental approval of birth control use (42%) and that their friends might think they are looking for sex (29%). About one-third felt uncomfortable going to a clinic to ask for birth control. In interviews, AYAs desired pregnancy prevention but frequently noted concerns about privacy and parental, community and healthcare provider judgement for seeking care for reproductive health needs. AYAs also noted a lack of contraception knowledge, evident by frequent misconceptions and associated fears. CONCLUSION Among AYAs in rural Haiti, a large majority were sexually active and desire pregnancy avoidance, but few were using effective contraception due to numerous concerns, including privacy and fear of judgement. Future efforts should address these identified concerns to prevent unintended pregnancy and improve maternal and reproductive health outcomes in this population.
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Affiliation(s)
- Abbey R Masonbrink
- Children's Mercy Hospital, Kansas City, MO, US.
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, US.
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gilham Rd, Kansas City, MO, 64108, US.
| | - Emily A Hurley
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, US
- Division of Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, US
- Department of Population Health, University of Kansas Medical Center, Kansas City, MO, US
| | - Nikolaus Schuetz
- Division of Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, US
| | | | - Emily Rupe
- University of Kansas School of Medicine, Wichita, KS, US
| | - Kemi Lewis
- Children's Mercy Hospital, Kansas City, MO, US
| | | | - Melissa K Miller
- Children's Mercy Hospital, Kansas City, MO, US
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, US
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Catalao R, Chapota H, Chorwe-Sungani G, Hall J. The impact of depression at preconception on pregnancy planning and unmet need for contraception in the first postpartum year: a cohort study from rural Malawi. Reprod Health 2023; 20:36. [PMID: 36849991 PMCID: PMC9972717 DOI: 10.1186/s12978-023-01576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The impact of depression on women's use of contraception and degree of pregnancy planning in low-income settings has been poorly researched. Our study aims to explore if symptoms of depression at preconception are associated with unplanned pregnancy and nonuse of contraception at the point of conception and in the postpartum period. METHODS Population-based cohort of 4244 pregnant women in rural Malawi were recruited in 2013 and were followed up at 28 days, 6 months and 12 months postpartum. Women were asked about symptoms of depression in the year before pregnancy and assessed for depression symptoms at antenatal interview using the Self-Reporting Questionnaire-20, degree of pregnancy planning using the London Measure of Unplanned Pregnancy and use of contraception at conception and the three time points postpartum. RESULTS Of the 3986 women who completed the antenatal interview, 553 (13.9%) reported depressive symptoms in the year before pregnancy and 907 (22.8%) showed current high depression symptoms. History of depression in the year before pregnancy was associated with inconsistent use of contraception at the time of conception [adjusted relative risk (adjRR) 1.52; 95% confidence interval (1.24-1.86)] and higher risk of unplanned [adjRR 2.18 (1.73-2.76)] or ambivalent [adj RR 1.75 (1.36-2.26)] pregnancy. At 28 days post-partum it was also associated with no use of contraception despite no desire for a further pregnancy [adjRR 1.49 (1.13-1.97)] as well as reduced use of modern contraceptives [adj RR 0.74 (0.58-0.96)]. These results remained significant after adjusting for socio-demographic factors known to impact on women's access and use of family planning services, high depression symptoms at antenatal interview as well as disclosure of interpersonal violence. Although directions and magnitudes of effect were similar at six and 12 months, these relationships were not statistically significant. CONCLUSIONS Depression in the year before pregnancy impacts on women's use of contraception at conception and in the early postpartum period. This places these women at risk of unplanned pregnancies in this high fertility, high unmet need for contraception cohort of women in rural Malawi. Our results call for higher integration of mental health care into family planning services and for a focus on early postnatal contraception.
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Affiliation(s)
- Raquel Catalao
- grid.37640.360000 0000 9439 0839King’s College London and South London and the Maudsley NHS Foundation Trust, London, UK
| | - Hilda Chapota
- Parent and Child Health Initiative Trust (PACHI) Program, Lilongwe, Malawi
| | - Genesis Chorwe-Sungani
- grid.10595.380000 0001 2113 2211Mental Health at Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
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Nuwamanya E, Babigumira JB, Svensson M. Cost-effectiveness of increased contraceptive coverage using family planning benefits cards compared with the standard of care for young women in Uganda. Contracept Reprod Med 2023; 8:21. [PMID: 36782307 PMCID: PMC9926799 DOI: 10.1186/s40834-022-00206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/04/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Uganda has a high population growth rate of 3%, partly due to limited access to and low usage of contraception. This study assessed the cost-effectiveness of the family planning benefits cards (FPBC) program compared to standard of care (SOC). The FPBC program was initiated to increase access to modern contraception among young women in slums in Kampala, Uganda. METHODS We developed a decision-analytic model (decision tree) and parameterized it using primary intervention data together with previously published data. In the base case, a sexually active woman from an urban slum, aged 18 to 30 years, was modelled over a one-year time horizon from both the modified societal and provider perspectives. The main model outcomes included the probability of unintended conception, costs, and incremental cost-effectiveness ratio (ICER) in terms of cost per unwanted pregnancy averted. Both deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the modelling results. All costs were reported in 2022 US dollars, and analyses were conducted in Microsoft Excel. RESULTS In the base case analysis, the FPBC was superior to the SOC in outcomes. The probability of conception was lower in the FPBC than in the SOC (0.20 vs. 0.44). The average societal and provider costs were higher in the FPBC than in the SOC, i.e., $195 vs. $164 and $193 vs. $163, respectively. The ICER comparing the FPBC to the SOC was $125 per percentage reduction in the probability of unwanted conception from the societal perspective and $121 from the provider perspective. The results were robust to sensitivity analyses. CONCLUSION Given Uganda's GDP per capita of $1046 in 2022, the FPBC is highly cost-effective compared to the SOC in reducing unintended pregnancies among young women in low-income settings. It can even get cheaper in the long run due to the low marginal costs of deploying additional FPBCs. TRIAL REGISTRATION MUREC1/7 No. 10/05-17. Registered on July 19, 2017.
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Affiliation(s)
- Elly Nuwamanya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, 40530, Uganda. .,GHE Consulting, P.O Box 27011, Kampala, Uganda. .,Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, P. O Box 414, 40530, Gothenburg, Sweden.
| | | | - Mikael Svensson
- grid.8761.80000 0000 9919 9582Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, P. O Box 414, 40530 Gothenburg, Sweden
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Díaz-Alvites AL, Yrala-Castillo G, Al-kassab-Córdova A, Munayco CV. Associated factors, inequalities, and spatial distribution of the use of modern contraceptive methods among women of reproductive age in Peru: a population-based cross-sectional study. BMC Public Health 2022; 22:2267. [PMID: 36471291 PMCID: PMC9720945 DOI: 10.1186/s12889-022-14629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The use of contraceptive methods in Peru has remarkably increased in recent decades. Nevertheless, despite the completeness and accessibility of family planning methods, modern contraceptive methods utilization in Peru remains below the South American average. Thus, this study aimed to elucidate the factors associated with modern contraceptive use, as well as the presence of inequalities and the spatial distribution in Peruvian women aged 15-49 years in 2019. METHODS A secondary data analysis was conducted using information from the 2019 Peruvian Demographic and Health Survey. We performed descriptive statistics, bivariate analysis, and Poisson multiple regression. Inequalities were estimated through concentration curves and Erreygers' normalized concentration index. Spatial analysis included choropleth map, Global Moran's I, Kriging interpolation and Getis-Ord-Gi* statistic. RESULTS The prevalence of modern contraceptive use was 39.3% among Peruvian women of reproductive age. Modern contraceptive use was directly associated with youth (aPR 1.39), women having their first sexual intercourse before the age of 18 (aPR 1.41), and being married but not together (aPR 1.87). In addition, speaking Quechua or Aymara (aPR 0.87) and having no children (aPR 0.59) were inversely associated with utilization of modern contraceptives. We found the presence of inequalities in the use of contraceptive methods (pro-rich distribution), although the magnitude was low. Spatial analysis unveiled the presence of a clustered distribution pattern (Moran's Index = 0,009); however, there was inter-departmental and intra-departmental heterogeneity in the predicted prevalence of the use of modern contraceptives. In addition, significant hot and cold spots were found in Peru. CONCLUSION Two out of five Peruvian women of reproductive age used modern contraceptives. It was associated with younger women's age, younger age at first sexual intercourse, being married or cohabitant, among others. No substantial inequality was found in modern contraceptive use. The prevalence was heterogeneous at the intra- and inter-departmental level. Those departments located in the south, south-east, and north-east had the lowest prevalence. Therefore, nonfinancial barriers must be tackled through multi- and cross-sectoral efforts and continue to universally provide modern contraceptives.
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Affiliation(s)
- Ana Lucía Díaz-Alvites
- grid.441917.e0000 0001 2196 144XFaculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ,grid.441917.e0000 0001 2196 144XSociedad Científica de Estudiantes de Medicina de La Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC), Lima, Peru
| | - Gonzalo Yrala-Castillo
- grid.441917.e0000 0001 2196 144XFaculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ,grid.441917.e0000 0001 2196 144XSociedad Científica de Estudiantes de Medicina de La Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC), Lima, Peru
| | - Ali Al-kassab-Córdova
- grid.441908.00000 0001 1969 0652Center of Excellence in Economic and Social Research in Health, Universidad San Ignacio de Loyola, Lima, Peru
| | - César V. Munayco
- grid.441917.e0000 0001 2196 144XFaculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Contraceptive use among female head porters: implications for health policy and programming in Ghana. Heliyon 2022; 8:e11985. [PMID: 36506400 PMCID: PMC9732301 DOI: 10.1016/j.heliyon.2022.e11985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/10/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Despite the growing literature on the barriers to contraceptives use among women, the perspective of female head porters has not been exhaustively researched. Using Bronfenbrenner's socio-ecological theory, we explore the factors that influence the contraceptive decision-making of migrant female head porters in the Kumasi Metropolis and the implications for health policy and planning. Methodology A case study of female head porters in the Kumasi Metropolis was conducted. We employed a qualitative approach in the collection and analysis of the data. A combination of cluster, purposive, and convenience sampling procedures was used to select 48 migrant female head porters to participate in semi-structured in-depth interviews. The data collected were analyzed using the thematic analytical framework. Results We found the main barriers to the uptake of contraception among the head porters to include high cost of contraceptives, perceived side effects associated with contraceptive use, and the disapproval of a male sexual partners. Conclusion The findings indicate that head porters' contraceptive decision-making is largely influenced by their social and economic circumstances. To address these, we recommend a carefully tailored approach, starting with a free National Health Insurance Scheme (NHIS) enrollment policy for all head porters in the country. There is also the need for the Ghana Health Service, and NGOs in health to work together to create effective awareness among female head porters on the benefits and misconceptions of contraception by incorporating culturally appropriate education that would facilitate the adoption of positive attitudes towards contraception. Additionally, NGOs in health in collaboration with the health facilities should initiate a process that encourages joint reproductive health decision-making among partners which recognises the added value of men's participation. We argue that men's active participation in contraception decision-making could potentially address their scepticism towards uptake.
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Mpunga DM, Chenge FM, Mambu TNM, Akilimali PZ, Mapatano MA, Wembodinga GU. Determinants of the use of contraceptive methods by adolescents in the Democratic Republic of the Congo: results of a cross-sectional survey. BMC Womens Health 2022; 22:478. [DOI: 10.1186/s12905-022-02084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Family planning (FP) is an effective strategy to prevent unintended pregnancies of adolescents. We aimed at identifying the socio-demographic factors underlying the low use of contraceptive methods by teenage girls in the Democratic Republic of the Congo (DRC).
Methods
A secondary analysis targeting teenage girls aged 15–19 was carried out on the Performance, Monitoring and Accountability project 2020 (PMA 2020) round 7 data, collected in Kinshasa and Kongo Central provinces. The dependent variable was the “use of contraceptive methods by sexually active teenage girls”, calculated as the proportion of teenagers using modern, traditional or any contraceptive methods. Independent variables were: level of education, age, province, religion, marital status, number of children, knowledge of contraceptive methods and household income. Pearson's chi-square and logistic regression tests helped to measure the relationship between variables at the alpha significance cut point of 0.05.
Results
A total of 943 teenagers were interviewed; of which 22.6, 18.1 and 19.9% used any contraceptive method respectively in Kinshasa, Kongo Central and overall. The use of modern contraceptive methods was estimated at 9.9, 13.4 and 12.0% respectively in Kinshasa, Kongo Central and overall. However, the use of traditional methods estimated at 8.0% overall, was higher in Kinshasa (12.7%) and lower (4.7%) in Kongo Central (p < .001). Some factors such as poor knowledge of contraceptive methods (aOR = 8.868; 95% CI, 2.997–26.240; p < .001); belonging to low-income households (aOR = 1.797; 95% CI, 1.099–2.940; p = .020); and living in Kongo central (aOR = 3.170; 95% CI, 1.974–5.091; p < .001) made teenagers more likely not to use any contraceptive method.
Conclusion
The progress in the use of contraceptive methods by adolescent girls is not yet sufficient in the DRC. Socio-demographic factors, such as living in rural areas, poor knowledge of FP, and low-income are preventing teenagers from using FP methods. These findings highlight the need to fight against such barriers; and to make contraceptive services available, accessible, and affordable for teenagers.
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Burchett HED, Griffin S, de Melo M, Picardo JJ, Kneale D, French RS. Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14414. [PMID: 36361287 PMCID: PMC9658296 DOI: 10.3390/ijerph192114414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Sally Griffin
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | | | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Burchett HED, Kneale D, Griffin S, de Melo M, Picardo JJ, French RS. Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11715. [PMID: 36141987 PMCID: PMC9517431 DOI: 10.3390/ijerph191811715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Sally Griffin
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | | | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Khan MN, Harris ML, Huda MN, Loxton D. A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh. Sci Rep 2022; 12:15165. [PMID: 36071170 PMCID: PMC9452522 DOI: 10.1038/s41598-022-19559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women's homes, on the occurrence of unintended pregnancy that resulted in a live birth. We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5051 women of reproductive age, who had at least one live birth within 3 years of the survey. The outcome variable was women's intention to conceive at their most recent pregnancy that ended with a live birth. The major explanatory variables were the health facility level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables adjusting for individual, household, and community-level factors. Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancies that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women's homes.The availability of health facilities near women's homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and to increase the number of health facilities are recommended.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia.
| | - Melissa L Harris
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Md Nazmul Huda
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbeltown, NSW, 2560, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
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Mekonnen AG, Odo DB, Nigatu D, Amare NS, Tizazu MA. Determinants of adolescents' contraceptive uptake in Ethiopia: a systematic review of literature. Contracept Reprod Med 2022; 7:16. [PMID: 36045379 PMCID: PMC9434896 DOI: 10.1186/s40834-022-00183-y] [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: 09/23/2021] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Various studies have identified different factors that affect adolescent contraceptive uptake in different parts of Ethiopia. However, varying results were reported across primary studies and those results need to be systematically collated to inform policies. Therefore, this systematic review aimed to synthesize the findings of those primary studies to obtain more robust and representative evidence about adolescent contraceptive uptake in Ethiopia. Methods Five databases (MEDLINE via PubMed, Google Scholar, Scopus, Science Direct and CINAHL) were searched for papers published from January 2000 up to June 2021 in English. We limited our search to start on January 2000 as the health of adolescents have been given more attention after this period and to avoid time-lapsed biases. Seven studies were included in this systematic review. We used the Newcastle-Ottawa Scale and the Mixed Methods Appraisal Tool for quality assessment of the selected studies. Results Determinants of adolescent contraceptive utilization were focused on four levels: individual, socio-cultural, healthcare service and knowledge related factors. Individual-related factors that influence adolescents’ contraceptive uptake include; being in the age group of 10–15 years, not currently enrolled in school and being from low-income families, while socio-cultural factors include: lack of discussion with family members, arranged marriage, pressure from a partner, harmful traditional practices, discussion with peer groups and sexual partners. Healthcare service-related factors include; lack of information about contraceptives during health facility visits, lack of privacy during service provision and inconvenient service hours at health facilities, and not visiting health facilities, whereas, knowledge related factors include; having knowledge of contraceptive methods and being heard about contraceptives from media. Also, the proportion of adolescent contraceptive uptake ranged from 12 to 79%. Conclusions In this systematic, individual, socio-cultural, health-care-related, and knowledge-related characteristics have all been identified as influencing adolescents’ contraceptive uptake in Ethiopia. Hence, integrated interventions aimed at overcoming barriers to adolescent contraceptive uptake would be beneficial to improving adolescent contraceptive utilization in Ethiopia.
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Affiliation(s)
- Alemayehu Gonie Mekonnen
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | | | - Dabere Nigatu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nakachew Sewnet Amare
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Michael Amera Tizazu
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Knowledge and attitude on sexually transmitted infections and contraceptive use among university students in Bhutan. PLoS One 2022; 17:e0272507. [PMID: 35921369 PMCID: PMC9348698 DOI: 10.1371/journal.pone.0272507] [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: 11/01/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
The unmet needs of contraception can lead to unintended pregnancy and transmission of sexually transmitted infections (STI). Therefore, this study aimed to evaluate the contraception use, knowledge, and attitude on STI among students under Royan University of Bhutan (RUB).
Methods
This was a cross-sectional study using an online questionnaire. The questionnaire was developed in Google forms and the link was shared through the college WeChat groups. The questionnaire consisted of four parts on socio-demographic, sexual behaviour and contraceptive use, knowledge, and attitude on STIs. All the students under RUB were invited to participate voluntarily in this study. The socio-demography was presented in frequency and proportion.
Result
A total of 1,283 students participated in this survey and 55.0% (701) were females. Of this, 29.4% (377) were sexually active and 94.4% reported using modern contraception. Commonly used contraceptives were: condoms (83.8%, 316) and emergency contraceptives (20.6%, 78), respectively. The mean knowledge and attitude scores on STI were 9.94 (range 2–20) and 12 (range 2–14), respectively. Good knowledge and attitude on STI were reported in 53.2% (683) and 70.1% (899) of participants.
Conclusion
Students reported average knowledge and a good attitude towards STI. Contraceptive use among university students was low. There is a need to strengthen health education on STIs in schools and universities. All forms of contraceptives especially condoms should be made easily available to sexually active people.
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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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Kruk ME, Lewis TP, Arsenault C, Bhutta ZA, Irimu G, Jeong J, Lassi ZS, Sawyer SM, Vaivada T, Waiswa P, Yousafzai AK. Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services. Lancet 2022; 399:1830-1844. [PMID: 35489361 PMCID: PMC9077444 DOI: 10.1016/s0140-6736(21)02532-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/10/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health and Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Grace Irimu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Waiswa
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Macharia P, Pérez-Navarro A, Sambai B, Inwani I, Kinuthia J, Nduati R, Carrion C. An Unstructured Supplementary Service Data–Based mHealth App Providing On-Demand Sexual Reproductive Health Information for Adolescents in Kibra, Kenya: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e31233. [PMID: 35436230 PMCID: PMC9055479 DOI: 10.2196/31233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/07/2021] [Accepted: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes, and values that empower them. Accessible, reliable, appropriate, and friendly information can be provided through mobile phone–based health interventions.
Objective
This study aims to investigate the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)–based app in increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually transmitted infections (STIs), abstinence, and perceived vulnerability, and helping adolescents make informed decisions about their SRH.
Methods
A randomized controlled trial (RCT) methodology was applied to investigate the potential of a USSD-based app for providing on-demand SRH information. To be eligible, adolescents aged 15 to 19 years residing in Kibra, Kenya, had to have access to a phone and be available for the 3-month follow-up visit. Participants were randomly assigned to the intervention (n=146) and control (n=154) groups using sequentially numbered, opaque, sealed envelopes. The primary outcome was improved SRH knowledge. The secondary outcome was improved decision-making on SRH. The outcomes were measured using validated tools on adolescent SRH and user perceptions during the follow-up visit. A paired sample t test was used to compare the changes in knowledge scores in both groups. The control group did not receive any SRH information.
Results
During the RCT, 54.9% (62/109) of adolescents used the USSD-based app at least once. The mean age by randomization group was 17.3 (SD 1.23) years for the control group and 17.3 (SD 1.12) years for the intervention group. There was a statistically significant difference in the total knowledge scores in the intervention group (mean 10.770, SD 2.012) compared with the control group (mean 10.170, SD 2.412) conditions (t179=2.197; P=.03). There was a significant difference in abstinence (P=.01) and contraceptive use (P=.06). Of the individuals who used the app, all participants felt the information received could improve decision-making regarding SRH. Information on STIs was of particular interest, with 27% (20/62) of the adolescents seeking information in this area, of whom 55% (11/20) were female. In relation to improved decision-making, 21.6% (29/134) of responses showed the adolescents were able to identify STIs and were likely to seek treatment; 51.7% (15/29) of these were female. Ease of use was the most important feature of the app for 28.3% (54/191) of the responses.
Conclusions
Adolescents require accurate and up-to-date SRH information to guide their decision-making and improve health outcomes. As adolescents already use mobile phones in their day-to-day lives, apps provide an ideal platform for this information. A USSD-based app could be an appropriate tool for increasing SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided because it helped them identify SRH topics on which they needed more information.
Trial Registration
Pan African Clinical Trial Registry PACTR202204774993198; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22623
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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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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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van Daalen KR, Dada S, Issa R, Chowdhury M, Jung L, Singh L, Stokes D, Orcutt M, Singh NS. A Scoping Review to Assess Sexual and Reproductive Health Outcomes, Challenges and Recommendations in the Context of Climate Migration. Front Glob Womens Health 2021; 2:757153. [PMID: 34816251 PMCID: PMC8594026 DOI: 10.3389/fgwh.2021.757153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: As growing numbers of people may be forced to migrate due to climate change and variability, it is important to consider the disparate impacts on health for vulnerable populations, including sexual and reproductive health (SRH). This scoping review aims to explore the relationship between climate migration and SRH. Methods: We searched PubMed/MEDLINE, CINAHL Plus, EMBASE, Web of Science, Scopus, Global Health and Google for peer-reviewed and gray literature published before 2nd July 2021 in English that reported on SRH in the context of climate migration. Data were extracted using a piloted extraction tool and findings are reported in a narrative synthesis. Results: We screened 1,607 documents. Ten full-text publications were included for analysis: five peer-reviewed articles and five gray literature documents. Reported SRH outcomes focused on maternal health, access to family planning and antiretroviral therapy, sexual and gender-based violence, transactional sex, and early/forced marriage. Recommendations to improve SRH in the context of climate migration called for gender-transformative health systems, education and behavior change programmes, and the involvement of local women in policy planning and programme implementation. Discussion: While the disparate impacts of climate change and migration are well-established, primary data on the scope of impact due to climate migration is limited. The SRH outcomes reported in the literature focus on a relatively narrow range of SRH domains, emphasizing women and girls, over men. Achieving holistic and equitable SRH in the context of climate migration requires engaging all genders across the range of SRH outcomes and migration contexts. This review highlights the need for further empirical evidence on the effect of climate migration on SRH, with research that is context-specific and engages communities in order to reflect the heterogeneity of outcomes and impact in the climate-migration-SRH nexus.
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Affiliation(s)
- Kim Robin van Daalen
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, United Kingdom
| | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rita Issa
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Laura Jung
- Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Lucy Singh
- EGA Institute for Women's Health, University College London, London, United Kingdom
| | | | - Miriam Orcutt
- Institute for Global Health, University College London, London, United Kingdom
| | - Neha S. Singh
- Health in Humanitarian Crises Centre, London School of Tropical Hygiene and Medicine, London, United Kingdom
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Fatusi A, Riley T, Kayembe PK, Mabika C. Unintended pregnancy, induced abortion and abortion care-seeking experiences among adolescents in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMJ Open 2021; 11:e044682. [PMID: 34475140 PMCID: PMC8413879 DOI: 10.1136/bmjopen-2020-044682] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022] Open
Abstract
OBJECTIVES To estimate age-specific abortion incidence and unintended pregnancy in Kinshasa, Democratic Republic of Congo and compare care experiences between adolescents (15-19 years) and older women (20-49 years). DESIGN We used the age-specific variant of the Abortion Incidence Complications Method to estimate abortion and unintended pregnancy, with data from three primary sources: Health Facility Survey (n=361) provided postabortion care (PAC) caseloads; Prospective Morbidity Survey (n=1031) provided the age distribution and characteristics of women presenting for PAC and Health Professional Survey (n=115) provided an estimate of the proportion of abortions resulting in facility-based treatment of complications. Bivariate (χ2, t-test) and multivariable (binary logistic regression, Cox proportional hazard) analyses were used to compare abortion care experiences. SETTING Health facilities proving PAC in Kinshasa. PARTICIPANTS Women who presented to PAC facilities with abortion complications and their care providers. PRIMARY AND SECONDARY OUTCOME MEASURES The primary measures were abortion incidence and proportion of pregnancies unintended. The secondary measures were the odd of reporting specific abortion care experiences. RESULTS Adolescents had an estimated 27 590 induced abortions, constituting 18.8% of abortions in Kinshasa in 2016. Adolescents had the lowest abortion rate among women less than 35 years (55.2/1000 women) but the highest rate among ever sexually active women (138.4/1000) and recently sexually active women (167.2/1000). Also, adolescents had the highest abortion ratio (82.4/100 live births), proportion of pregnancies unintended (80%) and proportion of unintended pregnancies ending in abortion (49%). Compared with older women, adolescents had higher odds of reporting pregnancy unintendedness (adjusted OR, AOR 1.36, 95% CI 1.75 to 2.24), seeking abortion at later than first trimester (AOR 1.34, 95% CI 1.09 to 1.63) and from non-medical professionals (AOR 1.68, 95% CI 1.31 to 2.14), and not using contraceptives before pregnancy (AOR 2.23, 95% CI 2.77 to 3.43) or postabortion (AOR 2.46, 95% CI 1.87 to 3.29). CONCLUSIONS Interventions are needed to reduce unintended pregnancy among adolescents in Kinshasa and improve their abortion care experiences.
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Affiliation(s)
- Adesegun Fatusi
- Guttmacher Institute, New York, New York, USA
- School of Public Health, University of Medical Sciences, Ondo, Nigeria
| | | | - Patrick K Kayembe
- Department of Epidemiology & Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Crispin Mabika
- Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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28
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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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29
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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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Ali A, Khaliq A, Lokeesan L, Meherali S, Lassi ZS. Prevalence and predictors of teenage pregnancy in Pakistan: a trend analysis from Pakistan Demographic and Health Survey datasets from 1990 to 2018. Int Health 2021; 14:176-182. [PMID: 34013327 PMCID: PMC8890806 DOI: 10.1093/inthealth/ihab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Teenage pregnancies carry an increased risk of adverse obstetric and health outcomes for mothers and children. Methods This study assessed the prevalence and predictors of teenage pregnancies over time in Pakistan using the Pakistan Demographic and Health Survey (PDHS). Data on 400 076 ever-married pregnant women aged 15–49 y from four PDHS datasets were used. Teenage pregnancy was the outcome variable, whereas a woman's and her partner's education, occupation, wealth quintile, region, place of residence and access to knowledge on family planning were the explanatory variables. Pooled prevalence was estimated and regression analysis was undertaken to produce an adjusted prevalence ratio with 95% CIs. Results Although the prevalence of teenage pregnancy decreased from 54.4% in 1990–1991 to 43.7% in 2017–2018, the pooled prevalence was 42.5% (95% CI 37.9 to 49.6%). The prevalence of teenage pregnancy was significantly associated with place of residence, wealth quintile, education and occupation. Conclusion Despite a growing focus on women's education, access to sexual and reproductive health (SRH) services and contraception in the last decade in Pakistan, the prevalence of teenage pregnancy is still high. There is a pressing need to develop appropriate strategies for increasing access to education, SRH services and use of contraception in Pakistan.
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Affiliation(s)
- Anna Ali
- Robinson Research Institute, The University of Adelaide, Frome Rd, Adelaide SA 5000, Australia
| | - Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, 2 George St, Brisbane City QLD 4000, Australia
| | - Laavanya Lokeesan
- Department of Nursing, Faculty of Health Sciences, Open University of Sri Lanka, Nawala, Nugegoda 11222, Sri Lanka
| | - Salima Meherali
- Faculty of Nursing, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, Frome Rd, Adelaide SA 5000, Australia
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Attitudes and Practices of Healthcare Professionals and Clinical Medical Students on Contraception: A Cross-Sectional Study in Cape Coast, Ghana. Int J Reprod Med 2021; 2021:6631790. [PMID: 33834058 PMCID: PMC8012129 DOI: 10.1155/2021/6631790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare providers play a major role in the implementation of family planning policies. In Ghana, there has been a conscious effort to improve the knowledge of preservice and practicing health professionals on family planning. However, there have been concerns about the appropriateness of the attitudes and practices of these health cadres and, hence, their propensity to become barriers to the uptake of contraception in the general population. This study is aimed at assessing the attitudes and practices of healthcare workers and clinical-year medical students in contraceptives use, advocacy, and service provision. Methods A cross-sectional survey was conducted among health workers and clinical-year medical students from January 1 to June 30, 2018. Variables assessed included sexual activity status, previous and current contraceptive use, and satisfaction with contraceptive use among others. Data from 400 self-administered, structured questionnaires comprising close- and open-ended questions was entered in SPSS version 22 and analysed using same. The variables assessed were presented as means, frequencies, and percentages. Results About 58% of the respondents were sexually active. Half of the participants (50.2%) had used a form of contraception before, with condoms and other barrier methods being the most preferred (67.7%). However, only 18% of respondents were on a form of contraceptive at the time of the survey. Four out of five (82.6%) of the users of these contraceptives were satisfied with their past use. A little over half of the participants had discussed contraception with their partners. Over four-fifths of participants thought family planning was beneficial and were willing to encourage others to use a method of family planning. Majority (63.7%) of the participants had had formal training in family planning, but only 72 (18%) were actively involved in the provision of family planning services. Conclusions Although the attitudes of the health workers and trainees toward family planning were excellent generally, only a few were using a method of contraception at the time of the survey despite the fact that most of them were sexually active. There is a need to intensify communication on behaviour change towards contraception among health professionals and clinical-year medical students in order to strengthen their role as change agents in an effort to improve community uptake.
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Sserwanja Q, Musaba MW, Mukunya D. Prevalence and factors associated with modern contraceptives utilization among female adolescents in Uganda. BMC WOMENS HEALTH 2021; 21:61. [PMID: 33568124 PMCID: PMC7877106 DOI: 10.1186/s12905-021-01206-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022]
Abstract
Background The sexual and reproductive health (SRH) needs of adolescents remain largely unmet. For instance, over 20 million female adolescents in need of, a modern contraceptive method are not using any. This study determined the factors associated with utilization of modern contraceptives among female adolescents in Uganda. Methods A cross sectional study was conducted using the Uganda Demographic and Health Survey (UDHS) 2016 data of 4, 264 adolescents aged 15 to 19 years. Multistage stratified sampling was used to select study participants. Multivariable logistic regression was used to determine the factors associated with modern contraceptive utilization. All our analyses were done using SPSS version 25. Results The prevalence of modern contraceptive utilization among female adolescents was 9.4% (401/4264: (95% CI: 8.6–10.3). The odds of contraceptive utilisation were 1.6 times (AOR = 1.60; 95% CI: 1.09–2.34) higher among married adolescents compared to unmarried adolescents. Adolescents whose age at first birth was less than 15 years (AOR = 2.01; 95% CI: 1.01–3.99) were twice more likely to utilize a modern contraceptive compared to those whose age at first birth was above 15 years. Women belonging to the Central region (AOR = 1.93; 95% CI: 1.01–3.69) and those in the middle wealth quintile (AOR = 1.91; 95% CI: 1.06–3.46) were 93% and 91% more likely to utilize a modern contraceptive compared to those in the Northern region and those in the poorest wealth index respectively. Conclusion The prevalence of modern contraceptive utilization was 9.4%. The findings show the need for designing targeted interventions due to differences in adolescents according to their wealth index, regions and marital status.
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Affiliation(s)
- Quraish Sserwanja
- Monitoring and Evaluation Department, Doctors With Africa, CUAMM, TM Lion Hotel, Juba, South Sudan.
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - David Mukunya
- Department of Public Health, Busitema University, Tororo, Uganda.,Sanyu Africa Research Institute, Mbale, Uganda
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Huda MM, O'Flaherty M, Finlay JE, Al Mamun A. Time trends and sociodemographic inequalities in the prevalence of adolescent motherhood in 74 low-income and middle-income countries: a population-based study. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 5:26-36. [PMID: 33245863 DOI: 10.1016/s2352-4642(20)30311-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Documenting trends and inequalities in the prevalence of adolescent motherhood across low-income and middle-income countries (LMICs) is important to support the adolescent sexual and reproductive health target in the UN Sustainable Development Goals (SDGs). We aimed to examine time trends and sociodemographic inequalities in the prevalence of adolescent motherhood in LMICs. METHODS We analysed data from 747 137 young women (aged 15-19 years) from 74 LMICs, using 254 nationally representative Demographic and Health Surveys done between 1990 and 2018. We estimated the population-weighted prevalence of adolescent motherhood among women aged aged 15-19 years (defined as having had a livebirth or being pregnant at the time of the survey). Trends in the prevalence were calculated at the national level using the average annual rate of change (AARC) in a subset of 61 countries with at least two surveys from different timepoints during the study period. Sociodemographic inequalities (eg, wealth quintile, level of education, and rural or urban residence) in adolescent motherhood were described using the normalised concentration index. FINDINGS The highest prevalence of adolescent motherhood was observed in sub-Saharan African countries, for example it was 36·00% (95% CI 33·98-38·08) in Mali (which had recent survey data; 2018). Examining AARC, countries such as Nigeria (AARC -1·35%; 1990-2018) and India (-4·62%; 1992-2015) experienced a steady decline in the prevalence of adolescent motherhood during the study period. However, several high-burden countries experienced little change in prevalence over time (-0·60%; Bangladesh, 1993-2014), and 16 countries, such as Cambodia (2·42%; 2000-14) and Philippines (1·59%; 1993-2017), had an increase in the prevalence of adolescent motherhood over time. Sociodemographic inequalities in the prevalence of adolescent motherhood persist in most countries in this study. INTERPRETATION Many of the countries in this study experienced either a slow rate of reduction or an increase in the prevalence of adolescent motherhood during the study period, and sociodemographic inequalities within countries persist. These results indicate that efforts to reduce adolescent motherhood and the associated health burden need to be improved within many LMICs. These findings can assist policy makers to target the rollout of interventions on the basis of observed geographic and sociodemographic inequalities to reduce adolescent motherhood among the disadvantaged, and accelerate progress towards adolescent sexual and reproductive health targets in the UN SDGs. FUNDING None.
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Affiliation(s)
- M Mamun Huda
- Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia; ARC Centre of Excellence for Children and Families over the Life Course, University of Queensland, Brisbane, QLD, Australia.
| | - Martin O'Flaherty
- Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia; ARC Centre of Excellence for Children and Families over the Life Course, University of Queensland, Brisbane, QLD, Australia
| | - Jocelyn E Finlay
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Abdullah Al Mamun
- Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia; ARC Centre of Excellence for Children and Families over the Life Course, University of Queensland, Brisbane, QLD, Australia
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Ahinkorah BO. Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys. Contracept Reprod Med 2020; 5:32. [PMID: 33292675 PMCID: PMC7678092 DOI: 10.1186/s40834-020-00138-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background The use of modern contraceptives among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remains an issue that needs urgent attention. This present study assesses the individual and contextual factors associated with modern contraceptive use among AGYW in SSA. Methods Data for this study was obtained from the latest Demographic and Health Surveys (DHS) conducted between January 2010 and December 2018 across 29 countries in SSA. Data were analysed with Stata version 14.2 by employing both Pearson’s chi-square test of independence and a multilevel binary logistic regression. The selection of variables for the multilevel models was based on their statistical significance at the chi-square test at a p < 0.05. Model fitness for the multilevel models was checked using the log likelihood ratios and Akaike’s Information Criterion (AIC) and the results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI). Results It was found that 24.7% of AGYW in SSA use modern contraceptives. In terms of the individual level factors, the study showed that AGYW aged 15–19 [aOR = 0.86, CI = 0.83–0.90], those who were married [aOR = 0.83, CI = 0.79–0.87], Muslims [aOR = 0.59, CI = 0.57–0.62], working [aOR = 0.92, CI = 0.89–0.95], those who had no child [aOR = 0.44, CI = 0.42–0.47], those who had no exposure to newspaper/magazine [aOR = 0.44, CI = 0.63–0.71] and radio [aOR = 0.82, CI = 0.78–0.86] had lower odds of using modern contraceptives. Conversely, the use of modern contraceptives was high among AGYW whose age at first sex was 15–19 years [aOR = 1.20, CI = 1.12–1.28]. With the contextual factors, the odds of using modern contraceptives was low among AGYW who lived in rural areas [aOR = 0.89, CI = 0.85–0.93] and in communities with low literacy level [aOR = 0.73, CI = 0.70–0.77] and low socio-economic status [aOR = 0.69, CI = 0.65–0.73]. Conclusion Several individual and contextual factors are associated with modern contraceptive use among AGYW in SSA. Therefore, Governments in the various countries considered in this study should intensify mass education on the use of modern contraceptives. This education should be more centered on AGYW who are in socio-economically disadvantaged communities, those who are not married, Muslims, those with high parity and high fertility preferences and those who are working.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
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Kungu W, Khasakhala A, Agwanda A. Use of long-acting reversible contraception among adolescents and young women in Kenya. PLoS One 2020; 15:e0241506. [PMID: 33170851 PMCID: PMC7654813 DOI: 10.1371/journal.pone.0241506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022] Open
Abstract
The Kenya Demographic and Health Survey (KDHS 2014) revealed changing patterns in the contraceptive use of young women aged 15-24, shifting from injectable methods to implants. Long-acting reversible contraception (LARC) is user friendly, long-term, and more effective than other modern methods. It could be a game-changer in dealing with unintended pregnancies and herald a new chapter in the reproductive health and rights of young women. This study determined the factors associated with LARC use among adolescent girls and young women to expand the evidence of its potential as the most effective method of reducing unwanted pregnancies among the cohort. This study analysed secondary data from KDHS 2014 using binary logistic regression. The findings showed a rise in LARC use (18%), with identified predictors of reduced odds being aged 15-19 [OR = 0.735, 95% CI = 0.549-0.984], residence (rural) [OR = 0.674, CI = 0.525-0.865], religion (Protestant/other Christian) [OR = 0.377, CI = 0.168-0.842], married, [OR = 0.746, CI = 0.592-0.940], and region (high contraception) [OR = 0.773, CI = 0.626-0.955], while the number of living children showed increased odds for 1-2 children [OR = 17.624, CI = 9.482-32.756] and 3+ children [OR = 23.531, CI = 11.751-47.119]. This study established the rising popularity of LARC and identified factors that can be addressed to promote it. Its increased uptake could help Kenya achieve the International Conference on Population and Development 25's first and second commitments on teenage pregnancies and maternal and new-born health, thus promoting the health, wellbeing, educational goals, and rights of this critical cohort. This study can guide the accelerated efforts needed in Kenya's march towards the five zeros of unmet need for contraception, teenage pregnancies, unsafe abortions, preventable maternal deaths, and preventable neonatal/infant deaths.
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Affiliation(s)
- Wambui Kungu
- Population Studies and Research Institute, University of Nairobi, Nairobi, Kenya
| | - Anne Khasakhala
- Population Studies and Research Institute, University of Nairobi, Nairobi, Kenya
| | - Alfred Agwanda
- Population Studies and Research Institute, University of Nairobi, Nairobi, Kenya
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Ahinkorah BO, Seidu AA, Appiah F, Budu E, Adu C, Aderoju YBG, Adoboi F, Ajayi AI. Individual and community-level factors associated with modern contraceptive use among adolescent girls and young women in Mali: a mixed effects multilevel analysis of the 2018 Mali demographic and health survey. Contracept Reprod Med 2020; 5:27. [PMID: 33062298 PMCID: PMC7547459 DOI: 10.1186/s40834-020-00132-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unintended pregnancy constitutes a significant public health challenge in sub-Saharan Africa and particularly among young people, who are more likely to closely space births and experience adverse obstetric outcomes. Studies on modern contraceptive use have mostly focused on women of reproductive age in general with limited attention to factors associated with modern contraceptive use among adolescents and young women (aged 15–24) in Mali. We examined the individual and community-level factors associated with modern contraceptive use among this age cohort using the 2018 Mali demographic and health survey data. Methods We analyzed data from 2639 adolescent girls and young women, and our outcome of interest was current use of modern contraceptives. We performed descriptive analysis using frequencies and percentages and inferential analysis using mixed-effects multilevel logistic regression. The results of the mixed-effects multilevel logistic regression were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Results The prevalence of modern contraceptive use among adolescent girls and young women in Mali was 17.1% [95% CI, 15–19%]. Adolescent girls and young women who were married [aOR = 0.20, CI = 0.09–0.41], had no formal education [aOR = 0.43, CI = 0.32–0.59], in the poorest wealth quintile [aOR = 0.38, CI = 0.19–0.79] and had no children [aOR = 0.38, CI = 0.27–0.53] were less likely to use modern contraceptives. Similarly, those who had low knowledge of modern contraception [aOR = 0.60, CI = 0.42–0.85] and whose ideal number of children was six or more [aOR = 0.66, CI = 0.43–0.99] were less likely to use modern contraceptives. However, those with four or more births were more likely to use modern contraceptives [aOR = 1.85, CI = 1.24–2.77]. Conclusion Modern contraceptive use among adolescent girls and young women in Mali has improved slightly relative to the prevalence of 2012, though the prevalence is still low, compared to the prevalence in other sub-Saharan African countries and the prevalence globally. Individual-level factors such as marital status, educational level, wealth quintile, parity, ethnicity and ideal number of children were associated with the use of modern contraceptive among adolescent girls and young women in Mali. Community knowledge of modern contraceptives was found as a community-level factor associated with modern contraceptive use among adolescent girls and young women. Therefore, Mali’s Ministry of Health and Public Hygiene's Health Promotion and Education unit should prioritise and intensify contraceptive education to increase coverage of modern contraceptive use and address disparities in the use of modern contraceptives. Such education should be done, taking into consideration factors at the individual and community-level of the target population.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Francis Appiah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaa Boahemaa Gyasi Aderoju
- Department of Adult Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, 00100 Kenya
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Errors in Abstract, Results, and Table. JAMA Netw Open 2020; 3:e202596. [PMID: 32163163 PMCID: PMC7068227 DOI: 10.1001/jamanetworkopen.2020.2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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