Role of community resource persons in improving use of modern family planning methods among women of reproductive age in a rural area in Ebonyi State, Nigeria

Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review

Background

Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population.

Methods

We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review.

Results

Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services.

Conclusion

The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.

Sustained impact of community-based interventions on contraceptive use among married adolescent girls in rural Niger: Results from a cluster randomized controlled trial

OBJECTIVE

To evaluate the sustained impact of community-based family planning (FP) interventions on current modern contraceptive and long-acting reversible contraceptive (LARC) use among married adolescent girls in rural Niger.

METHODS

We used a cluster randomized controlled trial design following married adolescent girls and their husbands over 3 years. Villages were randomized to one of four arms: household visits, small group discussions, combined intervention, or control. For 1.5 years, couples were exposed to one intervention activity per month and 1.5 years after implementation ended, we used a multi-level mixed effects logistic regression model to evaluate changes in key FP outcomes.

RESULTS

We analyzed survey data from 404 married adolescent girls with data at baseline and endline. Small group discussions (+35.6%; adjusted odds ratio [aOR] 7.94, P < 0.001) and the combined intervention (+17.9%: aOR 4.53, P = 0.005) led to statistically significant increases in the odds of using modern contraceptives at endline compared with the control. The combined intervention (+14.2%; aOR 7.98, P < 0.001) and home visits (+12.6%; aOR 8.09, P < 0.001) led to statistically significant increases in odds of using LARC methods at endline compared with the control. Increase in LARC use was driven by implant use across all intervention groups.

CONCLUSION

This study contributes to the empirical evidence base on the sustained impact of community-based interventions on increases in FP use among married adolescent girls in low- and middle-income countries.

Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy

BACKGROUND

Over the years, family planning uptake in Nigeria has remained low and this is as a result of the various challenges and barriers faced by women. The aim of this study was to systematically review studies on family planning services undertaken in Nigeria in order to understand the challenges to uptake of the services and the policy implications.

METHODS

A PubMed search was performed in June 2020 and studies that investigated challenges of family planning uptake in Nigeria published in English between 2006 and 2020 were sought. A combination of the search terms family planning, contraceptives, challenges, barriers, Nigeria was used. Review articles, case reports, and case studies were excluded. Studies that did not report barriers or challenges to family planning or contraceptives were excluded.

RESULT

Twenty seven studies carried out in Nigeria which provided sufficient information were identified and used for this review. The Uptake of family planning recorded in the reviewed studies ranges from 10.3 to 66.8%. Challenges that are client related include education, desire for more children, uncertainty about its need, partner disapproval, previous side effects, religious beliefs, culture disapproval, age, marital status, and wealth index, residence, ignorance, embarrassment, domestic violence and sexual factor. Health service related factors identified include cost, difficulty accessing services, and procurement difficulties. Recommendations for family planning propram and policy include targeting of health service delivery for improvement, focus on gender issues and male involvement, involvement of religious leaders, targeting of younger women for better education and counseling, and continuous awareness creation and counseling among others.

CONCLUSION

The review has shown that uptake of family planning remains low in Nigeria and challenges abound. We recommend that strategies that are multi-sectoral should be applied to address the multi-pronged challenges facing uptake of family planning services.

Perception, pattern of use, partner support and determinants of uptake of family planning methods among women in rural communities in Southeast Nigeria

BACKGROUND

Family planning is a cost-effective strategy for achieving population development. Family planning uptake is low in sub-Saharan Africa, including Nigeria. We assessed the perception, pattern of use, partner support and determinants of uptake of family planning methods among married women of reproductive age in rural communities of Ebonyi state.

METHODS

This is part of a baseline report of a quasi-experimental study. A total of 484 married women of reproductive age were recruited using multistage sampling method. Four focus group discussions (men and women) and pre-tested semi-structured interviewer-administered questionnaires were used to collect information from the participants. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 software and thematic analysis. Chi-square test and logistic regression were carried out at 5% significance level.

RESULTS

Only 26.2% of respondents were currently using any method of family planning. The most commonly used method was the natural method (57%). Amongst those who reported using artificial methods, 32.7% used condoms, 27.3% used implant while 23.64 and 16.4% used injectables and pills respectively. Predictors of current use of any family planning method were: older age (AOR = 1.7, 95%CI = 1.01-3.00), having more than five children (AOR = 1.7, 95%CI = 1.05-2.83), minimum of secondary level of education for respondent (AOR = 3.3, CI = 1.60-6.96) and their husband/partner (AOR = 2.0, 95%CI = 1.05-3.92). Qualitative findings showed that only few families were using a method of family planning and those who did not practice family planning perceived it to interfere with God's plan for fruitfulness and to be counter-productive to household income due to decreased manpower for agricultural activities. Poor partner involvement and support for family planning was also cited as a deterrent by both male and female participants.

CONCLUSIONS

Perception and use of family planning methods is poor in rural communities of Ebonyi state. Improving uptake of family planning methods in these rural communities will require proper demographic targeting as well as debunking fatalistic views, and cultural and religious myths around family planning.