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Qureshi MJ, Miller AP, Mugamba S, Kyasanku E, Nalugoda F, Bulamba RM, Kigozi G, Nakigozi G, Nkale J, Kato P, Nalwoga GK, Watya S, Wagman JA. Women's access to family planning and experiences of reproductive coercion during the COVID-19 lockdown in two districts of Uganda. Heliyon 2024; 10:e30216. [PMID: 38765155 PMCID: PMC11098776 DOI: 10.1016/j.heliyon.2024.e30216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024] Open
Abstract
Background In March 2020, Uganda enforced country-wide restrictions to control the spread of SARS-CoV-2, categorizing some health services, including family planning (FP), as non-essential. Globally, similar COVID-19 restrictions have been associated with increased vulnerability to reproductive coercion (RC) among women, due to changes in FP service availability and restricted access by partners. This study aims to investigate these dynamics in Uganda, specifically examining the impact of the COVID-19 lockdown on women's access to FP, their experiences of RC, and the relationship between RC and intimate partner violence (IPV). Methods We conducted a cross-sectional analysis of data from 960 women participating in the AMBSO Population Health Surveillance Study (APHS) between August 2020 and March 2021 across Wakiso (N = 164) and Hoima (N = 796) districts in Uganda. Our analysis focused on women who were sexually active in the past month, using bivariate analyses to explore the associations between RC and recent experiences of sexual, physical, and verbal IPV. Findings The most commonly reported FP methods were injectables (36.8 %) and implants (16 %). Despite the COVID-19 lockdown, less than one percent of participants reported an inability to access their preferred FP method. Notably, 3 % of the women experienced RC in the past 12 months. There was a significant association between RC and sexual IPV (p < 0.0001), as well as physical IPV (p < 0.0001). Instances of verbal IPV were observed to have tripled during the lockdown period. Interpretation An increase in verbal IPV was found among women during the COVID-19 lockdown. Additionally, a notable association emerged between other forms of IPV and an increased risk of RC. Despite the lockdown, access to FP remained high, which could be attributed to the prevalent use of long-acting FP methods.
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Affiliation(s)
- Mira J. Qureshi
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Amanda P. Miller
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Emmanuel Kyasanku
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Robert Malyabe Bulamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Gertrude Nakigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - James Nkale
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Phillip Kato
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Grace Kigozi Nalwoga
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Uysal J, Boyce SC, Undie CC, Liambila W, Wendoh S, Pearson E, Johns NE, Silverman JG. Effects of a clinic-based reproductive empowerment intervention on proximal outcomes of contraceptive use, self-efficacy, attitudes, and awareness and use of survivor services: a cluster-controlled trial in Nairobi, Kenya. Sex Reprod Health Matters 2023; 31:2227371. [PMID: 37594312 PMCID: PMC10443967 DOI: 10.1080/26410397.2023.2227371] [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] [Indexed: 08/19/2023] Open
Abstract
This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta -0.34, 95% CI -0.65, -0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs.Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women's reproductive health. While one intervention, ARCHES - Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women's proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.
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Affiliation(s)
- Jasmine Uysal
- Predoctoral fellow, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Sabrina C. Boyce
- Postdoctoral fellow, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Chi-Chi Undie
- Senior Associate, Population Council, Nairobi, Kenya
| | | | - Seri Wendoh
- Global Lead for Gender & Inclusion, International Planned Parenthood Federation, London, UK
| | - Erin Pearson
- Research Scientist, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Nicole E. Johns
- Data Analyst, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Jay G. Silverman
- Professor of Medicine and Global Public Health, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
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Wood SN, Thomas HL, Guiella G, Bazié F, Mosso R, Fassassi R, Akilimali PZ, Thiongo M, Gichangi P, Oumarou S, OlaOlorun FM, Omoluabi E, Khanna A, Kibira SPS, Makumbi F, Decker MR. Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence. Reprod Health 2023; 20:22. [PMID: 36707833 PMCID: PMC9881347 DOI: 10.1186/s12978-023-01568-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reproductive coercion (RC) is a type of abuse where a partner asserts control over a woman's reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC. METHODS This analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework. RESULTS Confirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d'Ivoire-0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59-10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23-0.67). Other assessed correlates differed by site. CONCLUSIONS Understanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women's immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.
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Affiliation(s)
- Shannon N. Wood
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Haley L. Thomas
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA
| | - Georges Guiella
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Fiacre Bazié
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Rosine Mosso
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Raimi Fassassi
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Pierre Z. Akilimali
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya ,grid.449703.d0000 0004 1762 6835Technical University of Mombasa, Mombasa, Kenya ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Funmilola M. OlaOlorun
- grid.9582.60000 0004 1794 5983College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoluabi
- grid.8974.20000 0001 2156 8226University of the Western Cape, Cape Town, South Africa
| | - Anoop Khanna
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Simon Peter Sebina Kibira
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Fredrick Makumbi
- grid.11194.3c0000 0004 0620 0548Makerere University School of Public Health, Kampala, Uganda
| | - Michele R. Decker
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA ,grid.21107.350000 0001 2171 9311Johns Hopkins School of Nursing, Baltimore, USA
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Wood SN, Kennedy SR, Akumu I, Tallam C, Asira B, Zimmerman LA, Glass N, Decker MR. Understanding the Link Between Reproductive Coercion and Covert Use of Contraception as a Safety Strategy for Women Experiencing Violence in Nairobi's Urban Informal Settlements. Violence Against Women 2022; 29:1343-1367. [PMID: 36000323 DOI: 10.1177/10778012221108422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed-methods study examined the relationship between reproductive coercion (RC) and covert contraceptive use among intimate partner violence survivors in Nairobi, Kenya. Quantitative analyses utilize baseline data from the myPlan Kenya trial (n = 321). Purposive in-depth interviews (IDIs) (n = 30) explored women's reproductive safety strategies. Multinomial analyses indicated increased covert use and decreased overt use compared to nonuse, for women experiencing RC; logistic models similarly report increased odds of covert use with RC experience. Qualitative data contextualize women's reasons for use and challenges faced. Integration of reproductive safety strategies into family planning and violence services can improve the safe use of contraception.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Irene Akumu
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | | | - Ben Asira
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Global Health, 15851Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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