Effect of TV and radio family planning messages on the probability of modern contraception utilization in post-Soviet Central Asia

Spatial variation in the non-use of modern contraception and its predictors in Bangladesh

This study aimed to investigate spatial variations in the non-use of modern contraception in Bangladesh and identify associated individual, household, and community-level factors. The analysis utilized data from 16,135 women, extracted from the 2017/18 Bangladesh Demographic and Health Survey. The study's main outcome was the prevalence of non-use of modern contraception (yes or no), while the explanatory variables included factors at the individual, household, and community level. To assess geographical heterogeneity in non-use of modern contraception, Moran's I statistics were applied. Additionally, the Gettis-Ord Gi* was calculated to measure spatial autocorrelation differences across various study locations. The relationship between non-use of modern contraception and location was further explored using a geographically weighted regression model at the cluster level. The results indicated that 42.8% (95% CI 41.6-43.8) of respondents reported non-use of modern contraception in Bangladesh, with significant variation across geographical locations (p < 0.001). Hot spots of high non-use were predominantly identified in the Sylhet, Barishal, and some areas of the Chattogram divisions, while cold spots of low use were concentrated in the Rangpur, Mymensingh, and some areas Rajshahi divisions. Notably, the likelihood of non-use was highest among women and partners with low levels of education. The analysis of other risk factors, such as partner occupation, community-level illiteracy, and poverty, revealed varying effects on non-use of modern contraception across different locations (clusters) within the country. The study's findings underscore the importance of targeted, area-specific policies and programs aimed at promoting knowledge and uptake of modern contraception in Bangladesh.

Factors associated with reporting good maternal health-related knowledge among rural mothers of Yemen

Increasing women's knowledge about maternal health is an important step towards empowering them and making them aware of their rights and health status, allowing them to seek appropriate health care. In Yemen, the ongoing conflict has hampered the delivery of health information to women in public health facilities. This study examined rural women's knowledge of, and attitude towards, maternal and child health in Yemen and identified the factors associated with good maternal health knowledge. The study was conducted between August and November 2018. A sample of 400 women aged 15-49 years who had delivered in the 6 months prior to the survey were systematically selected from selected public health facilities in Abyan and Lahj. Women were interviewed using a structured questionnaire to gather data on their demographic and economic characteristics, obstetric history and responses to health knowledge and attitude questions. Women's knowledge level was assessed as poor or good using the mean score as a cut-off. Chi-squared test and multiple logistic regression analysis were used to identify statistically significant factors associated with good maternal health knowledge. The percentage of women who had good knowledge was 44.8% (95% CI: 39.8-49.8). Women's attitude towards maternal health was negative in the areas of early ANC attendance, managing dietary regime and weight during pregnancy, facility delivery, PNC visits, cord care and mother and child health management. Women with primary education, whose husbands had received no formal education, who had their first ANC visit from the second trimester of pregnancy and who had fewer than four ANC visits were more likely to have poor health knowledge. Conversely, those with higher household income and only one child were more likely to have good maternal health knowledge. Overall, women's knowledge on maternal and child health care in rural areas of Yemen was low. Strategies are needed to increase rural women's knowledge on maternal and child health in this conflict-affected setting.

Contraceptive use in South and South-East Asian region: assessment of sustainable development goal 3.7 through indicator 3.7.1

BACKGROUND

Sustainable Development Goal (SDG) 3.7 concerns modern contraception use among women of reproductive ages. This study evaluated the progress of indicator 3.7.1 in 11 selected countries in South and South-East Asia and assessed the contribution of women's education to modern contraceptive use.

METHODS

Generalized linear models for complex surveys were fitted to Demographic and Health Survey (DHS) data from 40 surveys conducted in Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor Leste between 1990 and 2017, followed by a meta-analysis through forest plots.

RESULTS

Modern contraceptive coverage in most of the selected countries climbed or remained stationary over the past decades. In four countries, <50% of women used contraception. In no country was contraception used by ≥80% women. Higher education was associated with 13% higher odds of modern contraceptive use (95% confidence interval: 1.07, 1.18) among women compared to primary level or no education.

DISCUSSION

Completion of primary education is insufficient to broaden the coverage of modern contraceptive use. Greater national level effort from the selected countries is needed to lift the education levels of women to meet SDG 3.7 by 2030.

Which communication technology is effective for promoting reproductive health? Television, radio, and mobile phones in sub-Saharan Africa

The use of radio and television as means to spread reproductive health awareness in Sub-Saharan Africa has been extensive, and its impacts significant. More recently, other means of communication, such as mobile phones, have received the attention of researchers and policy makers as health communication tools. However, evidence on which of the two types of communication (i.e. passive communication from TV/radio, or active communication through phones) is more effective in fostering better reproductive health choices is sparse. This study aims to identify the potential influence of TV or radio ownership as opposed to cell phone ownership on contraceptive use and access to maternal healthcare. Cross-sectional, individual analysis from eleven high-maternal mortality Sub-Saharan African countries is conducted. A total of 78,000 women in union are included in the analysis. Results indicate that ownership of TV or radio is more weakly correlated to better outcomes than mobile phone ownership is. Results are stronger for lower educated women and robust across all levels of wealth. Interestingly, the study also finds that decision-making power is a relevant mediator of cell phone ownership on contraceptive use, but not on maternal healthcare access. A key takeaway from the study is that, while the role of television and radio appears to have diminished in recent years, mobile phones have become a key tool for empowerment and behavioural change among Sub-Saharan African women. Health communication policies should be designed to take into account the now prominent role of mobile phones in affecting health behaviours.

Assessing changes in knowledge, attitudes, and intentions to use family planning after watching documentary and drama health education films: a qualitative study

Background

There is a paucity of literature on the effectiveness of drama or documentary films in changing knowledge, beliefs, attitudes, and behavior of people towards family planning. This study aimed to compare and assess the acceptability of health promotion films based on documentary or drama, and their effect on knowledge, attitudes, and intention to use family planning.

Methods

We developed short documentary and drama films about contraceptive implants, using the person-based approach. Their acceptability was assessed in focus group discussions with younger women below 23 years, women over 23 years, men of reproductive age, and health workers in four different areas of Uganda (Bwindi/Kanungu, Walukuba/Jinja, Kampala, and Mbarara). Transcripts of the focus group discussions were analyzed using thematic analysis, to generate themes and examine the key issues. We assessed changes in knowledge, attitudes, and intentions to use family planning after watching the films.

Results

Sixteen focus groups with 150 participants were carried out. Participants said that the documentary improved their knowledge and addressed their fears about side effects, myths, and implant insertion. The drama improved their attitudes towards the implant and encouraged them to discuss family planning with their partner. The final versions of the documentary and the drama films were equally liked.

Conclusions

Viewing a short documentary on the contraceptive implant led to positive changes in knowledge, while a short drama improved attitudes and intentions to discuss the implant with their partner. The drama and documentary have complementary features, and most participants wanted to see both.

Thousands of women and children in Uganda die every year due to problems related to pregnancy and childbirth. About 20% of these deaths are avoidable by better use of contraception. Many women are reluctant to begin contraception because of fears and myths about side-effects, and because they need the agreement of their husbands. The aim of this research was to study whether health education films could address these fears, and to compare a short documentary with a short drama film. We produced two health education films (a documentary and a drama) in two local languages with the involvement of local people. Films aimed to (1) dispel some myths on contraception, (2) encourage men to attend at least one antenatal clinic with their wives, and (3) discuss with a health worker whether they would like a method of family planning after the delivery. We showed these films to focus groups of local women, men and health workers in four contrasting areas of Uganda. The people taking part in the focus groups discussed their reactions to the films, whether they had learned anything from them, whether their attitudes towards family planning had changed as a result, and whether they intended to discuss this with their partner. Viewing a short documentary on the contraceptive implant improved knowledge, and short drama films improved attitudes and intentions to discuss the implant with their partner. The documentary and drama had different advantages, and most participants wanted to see both.

The Impact of Mass Media-Delivered Family Planning Campaigns in Low- and Middle-Income Countries: A Meta-Analysis of Advertising and Entertainment-Education Format Effects

Effective family planning methods are shown to save lives, contribute to gender equality, and boost economic development. Mass media communication campaigns in low- and middle-income countries have been effective in increasing contraceptive use, although the strategies that increase the likelihood of success are unclear. The present study uses meta-analyses to uncover the average effect of media campaigns on family planning behaviors in low- and middle-income countries and to examine the effectiveness of two communication strategies: entertainment-education and advertising/public service announcements. Results indicated that mass media-delivered family planning campaigns have a positive impact on family planning behaviors: d = 0.19, 95% CI [0.15, 0.24] for women (k = 64), d = 0.16, 95% CI [0.11, 0.21] for men (k = 27), and d = 0.20, 95% CI [0.17, 0.23] for an undifferentiated target group of men and women (k = 37). The use of an entertainment-education format, often in addition to campaign advertising messages, was associated with greater campaign success rates for women. Men, however, responded negatively to education-entertainment and positively to campaigns using only advertising and public service announcement formats. Recommendations for future family planning mass media campaigns and academic research opportunities are discussed.

Reversible Long Term Contraceptives Utilization among Married Women of Reproductive Age Group in Areka Town, Southern Ethiopia

Background

In low income countries, bearing many children is the main factor affecting maternal health. This study aimed to estimate the prevalence of reversible long term contraceptives utilization and identify factors associated with it among married women of child bearing age in Areka District in South Ethiopia.

Methods

We conducted a community-based cross-sectional survey involving systematically recruited 346 married women of reproductive age group. Data was collected using a structured interviewer-administered questionnaire on May 2019. We used SPSS version 25 for data entry and analyses. Bivariate logistic regression analysis was used to select exposure variables with crude association. Multivariate analysis was done to control for potential confounders and identify predictors of the outcome. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported, and statistical significance was declared at p<0.05.

Results

The prevalence of reversible long term contraceptives utilization among married women of reproductive age group was 134(38.7%). Utilization of Reversible Long Term Contraceptives (RLTCs) was positively associated with being protestant Christian religion follower, advanced educational status, history of abortion, and having a better attitude towards reversible long term contraceptives. In other words, being housewife, being daily laborer, having no radio in the household and making fertility decisions alone were negatively associated.

Conclusion

The prevalence of RLTCs in the study area was high. Women should be empowered educationally through other alternative opportunities to formal school. In addition to electronic media, different community events and community conversations should be used to convey messages on contraceptives particularly RLTCs. Behavioral change communications would benefit women in shaping their attitudes towards RLTCs.

Prevalence and Predictors of Contraceptive Use Among Women of Premenopausal Period in Ethiopia: A Retrospective Cross-Sectional Data Analysis

Background

Contraceptive use is internationally endorsed as a human right and an indicator of the highest standard of sexual and reproductive health life. But reports from countries including Ethiopia showed a lower and capricious rate due to wider factors. Thus, the current study aimed to determine the prevalence and the predictors of contraceptive use among women of the premenopausal period.

Methods

A retrospective cross-sectional data analysis was performed from Ethiopian Demographic and Health survey 2019 in January 2021. A total of 3260 premenopausal women were included by stratified sampling, and data were analyzed using SPSS version 25 software. Data were initially analyzed descriptively, and tests were done for variable multicollinearity, and model goodness of fit and predictive capacity. Subsequently, bivariate and multivariable logistic regression analyses were performed successively for the crude and adjusted odds ratio, and finally declared variables with a p-value of <0.05 as predictors of contraceptive use.

Results

The study included 3260 women with an average age of 41.66 (standard deviation ±3.9) years. The overall prevalence of contraceptive use was reported 17% and explained to vary by women’s age, place of residence, education level, wealth index, and current working statuses. However, only the age, education, and wealth index of women have predicted a statistical significance with contraceptive use. Accordingly, an increase in women’s age was found to increase contraceptive use more likely by 89% [AOR=0.89 (95% CI: 0.87, 0.92)]. Similarly, primary [AOR = 1.53, (95% CI: 1.20, 195)], secondary [AOR = 2.57, (95% CI: 1.70)] or higher [AOR = 2.64, (95% CI: 1.67, 4.20)] level educated women were about twice more likely to use contraceptive methods than uneducated women. Finally, women in poorer [AOR = 3.11 (95% CI: 2.17, 4.46)], middle [AOR = 3.03 (95% CI: 2.09, 4, 37)], rich [AOR = 3.70, (95% CI: 2.58, 5.31)] or richest [AOR = 3.42, (95% CI: 2.39, 4, 88)] wealth index were more than 3 times more likely use contraceptive methods when compared to women of the poorest wealth index.

Conclusion

The prevalence of contraceptive use among premenopausal women in Ethiopia is low and utmost related to age, education level, and wealth index of women.

Utilization of family planning methods among currently married women in Pakistan: Insight from Pakistan Demographic and Health Survey 2017-2018

In Pakistan, like other developing countries, utilization of family planning methods is a serious public health concern among married women. Researchers in the study focused on utilization of family planning methods among married women and their exposure to media messages. The researchers used retrospective analysis of secondary data of 3334 married women. Our research findings reveal that married women have a very limited access to media service messages promoting utilization of family planning methods. It is discussed that women with exposure to media messages about the utilization of family planning significantly utilized birth control behavior than women who had not heard and seen any media message. The authors concluded that married women in the country particularly in rural areas have a very limited access to media messages promoting family planning which causes non-utilization of family planning methods. It is recommended that different programs and awareness messages on media should be started to promote family planning and married women's access to media programs should be ensured.

The Effectiveness of an Educational Intervention on Knowledge, Attitudes and Reported Practices on Antibiotic Use in Humans and Pigs: A Quasi-Experimental Study in Twelve Villages in Shandong Province, China

Our aim was to evaluate the effectiveness of an intervention for residents in rural China on knowledge, attitudes and reported practices (KAP) on antibiotic use in humans and pigs. A quasi-experimental study was conducted in 12 villages in rural Shandong province, divided into intervention and control groups, covering a two-year period from July 2015 to June 2017. A package of health education-based interventions including training sessions, speakerphone messages, posters and handbooks for residents was developed and implemented over a one-year period to improve the use of antibiotics in humans and pigs. The intervention net effects were evaluated by Difference-in-Difference (DID) analysis based on responses to a questionnaire concerning KAP towards antibiotic use in humans and pigs. A total of 629 participants completed both baseline and post-trial questionnaires, including 127 participants with backyard pig farms. Significant improvements were found in KAP towards antibiotic use in humans, but changes related to antibiotic use for pigs were not significant. Participants who were in the intervention group (p < 0.001) were more likely to have improved their knowledge on antibiotic use in humans. Participants who had higher attitude scores were less likely to report self-medicating with stored antibiotics in the previous year (p < 0.001). Our results suggest that our health education-based intervention was effective in improving KAP on human antibiotic use, but it had little effect regarding antibiotic use for pigs.

Women's decision-making autonomy and utilization of antenatal, natal and post-natal healthcare services: Insights from Tajikistan's national surveys

BACKGROUND

The purpose of this article is to investigate the link between women's autonomy and their utilization of antenatal, natal and post-natal healthcare services in Tajikistan. Previous studies focused only on a single dimension of such services, for instance, utilization of antenatal care. By contrast, we explore antenatal, natal and post-natal healthcare services utilization using the number of indicator for each of the dimensions.

METHODS

Data come from two national surveys that were conducted in 2012 and 2017. The target population is women of reproductive age (16-49) who were married or cohabitating with a partner (N = 7540). Several regression models were estimated to quantify association between women's autonomy and the utilization.

RESULTS

Lack of women's autonomy is associated with a lower probability of: (a) having had at least four antenatal check-ups during pregnancy, (b) beginning first antenatal check-up early, (c) delivering in a healthcare facility, (d) having the skilled attendance during pregnancy, (e) having a mother post-delivery check-up, and (f) having a child post-delivery check-up. The size effect of women's autonomy is stronger than that of well-developed precursors of utilization such as poverty and mothers' education.

CONCLUSION

Women autonomy should be improved to achieve higher rates of child and maternal healthcare utilization. Studies of maternal and child healthcare utilization should control explicitly for women's autonomy.

Association Between Exposure to Mass Media Family Planning Messages and Utilization of Modern Contraceptive Among Urban and Rural Youth Women in Ethiopia

Background

Family planning helps to reduce poverty, increase gender equity, prevent the spread of sexually transmitted infections, and reduce maternal, infant, and childhood mortality. Hence, this study aimed to examine the association between exposure to mass media family planning messages and the utilization of modern contraceptives among urban and rural youth women in Ethiopia.

Methods

A comparative cross-sectional study using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set was applied. The data were analyzed with SPSS version 20. Multivariate logistic regression analysis was performed to assess the association between exposure to mass media family planning messages and the utilization of modern contraceptives by controlling confounders. An adjusted odds ratio with a 95% confidence interval was considered to declare a statistically significant association.

Results

The total sample was comprised of 6401 women (4061 from rural and 2340 from the urban area). There was no association between women exposed to mass media family planning messages and the utilization of modern contraceptives in rural areas. Surprisingly, this study showed that women exposed to mass media family planning messages in an urban area were less likely to use modern contraception by 62% (AOR: 0.38; 95% CI: 0.21, 0.68).

Conclusion

The present study revealed that there was no significant association between women exposed to mass media family planning messages and utilization of modern contraceptives in rural areas. But, women exposed to mass media family planning messages in urban areas were less likely to use modern contraception. The study showed the role of inequalities in modern contraceptive utilization as shaped by structural and intermediary factors including religion, location, household wealth, education, and the number of children. This implies that the use of modern contraceptive use may be more impactful if cultural, geographical, and socioeconomic barriers are addressed.

Reported evidence on the effectiveness of mass media interventions in increasing knowledge and use of family planning in low and middle-income countries: a systematic mixed methods review

BACKGROUND

An estimated 200 million women and girls in low and middle-income countries (LMICs) wish to delay, space or avoid becoming pregnant, yet are not using contraceptives. This study seeks to investigate the effectiveness of mass media interventions for increasing knowledge and use of contraceptives, and to identify barriers to program implementation.

METHODS

Using a mixed-methods systematic approach, we searched five electronic databases using pre-determined search strategies and hand-searching of articles of any study design published from 1994 to 2017 of mass media interventions for family planning education. Two reviewers independently applied clearly defined eligibility criteria to the search results, quality appraisal, data extraction from published reports, and data analysis (using meta-analysis and thematic analysis) following PRISMA guidelines.

RESULTS

We identified 59 eligible studies. Although the majority of studies suggest a positive association between media interventions and family planning outcomes, the pooled results are still consistent with possibly null intervention effects. The reported prevalence ratios (PR) for media interventions association with increased contraceptive knowledge range from 0.97 to 1.41, while the PRs for contraceptive use range from 0.54 to 3.23. The qualitative analysis indicates that there are barriers to contraceptive uptake at the level of individual knowledge (including demographic factors and preconceived notions), access (including issues relating to mobility and financing), and programming (including lack of participatory approaches).

CONCLUSIONS

There is a need for rigorous impact evaluation, including randomised controlled trials, of mass media interventions on knowledge and uptake of family planning in LMIC settings. Interventions should be better tailored to cultural and socio-demographic characteristics of the target populations, while access to resources should continue to remain a priority and be improved, where possible.