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Amenu M, Tediso D, Feleke T, Fantahun S, Woldesemayat EM. Pregnancy and associated factors among teenage females in Hula District, Sidama region, Ethiopia: a community-based cross-sectional study. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1367436. [PMID: 39309616 PMCID: PMC11412938 DOI: 10.3389/frph.2024.1367436] [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: 01/08/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
Background Teenage pregnancy causes serious health, social, and economic consequences, with 95% occurring in developing countries. A significant number of girls start childbearing at an early age in Ethiopia, which contributes to high infant and maternal morbidity and mortality. However, the information on teenage pregnancy and related variables is limited in the study area. Objective To assess the prevalence of teenage pregnancy and its associated factors among teenage females in the Hula District, Sidama, Ethiopia. Methods A community-based cross-sectional study was employed among 518 teenagers, randomly selected between 15 February and 15 March 2023. An interviewer-administered questionnaire was used for data collection. Bivariate and multivariate logistic regression analyses were applied to assess the relationship under study. Results Living in rural areas compared to urban [adjusted odds ratio (AOR) = 3.90; 95% confidence interval (CI): 1.30-11.3], lack of awareness about family planning methods (AOR = 5.90; 95% CI: 1.60-22.24), unfamiliarity with the availability of family planning services (AOR = 3.20; 95% CI: 1.08-9.24), and inadequate communication about sexual issues with parents (AOR = 3.61; 95% CI: 1.14-11.56) were independently associated with teenage pregnancy. Conclusion The prevalence of teenage pregnancies in the Hula District was high. Factors such as residing in rural areas, limited access to information on family planning methods and services, as well as a lack of open discussions about sexual health were associated with teenage pregnancy.
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Affiliation(s)
- Mekdes Amenu
- Hula Woreda Health Office, Hula Woreda, Eastern Sidama Zone, Sidama Region, Ethiopia
| | - Dansamo Tediso
- Department of public Health, Hawassa College of Health Sciences, Hawassa, Sidama Region, Ethiopia
| | - Tihun Feleke
- Department of public Health, Hawassa College of Health Sciences, Hawassa, Sidama Region, Ethiopia
| | - Selam Fantahun
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Rocca CH, Muñoz I, Rao L, Levin S, Tzvieli O, Harper CC. Measuring a Critical Component of Contraceptive Decision Making: The Contraceptive Concerns and Beliefs Scale. Matern Child Health J 2024; 28:847-857. [PMID: 38194129 PMCID: PMC11001673 DOI: 10.1007/s10995-023-03856-5] [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] [Accepted: 12/10/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Concerns about safety and side effects from contraceptives are widespread and related to reluctance to use them. Measuring these concerns is an essential component of understanding contraceptive decision-making and guiding contraceptive and interpregnancy clinical care. METHODS We used qualitative research and item response theory to develop and test a psychometric instrument to measure contraceptive concerns and beliefs. We developed 55 candidate scale items and tested them among 572 adolescents and adults across nine California healthcare facilities in 2019-2020. We derived a 6-item scale and assessed differences by age and social determinants of health with multivariable regression. RESULTS In qualitative data, participants voiced both concerns and positive beliefs about contraception. Quantitative survey respondents were aged 21 years on average, and 24% were parous. Over half (54%) worried contraception has dangerous side effects, and 39% worried it is unnatural. The mean Contraceptive Concerns score, increasing with higher concerns, was 1.85 (SD: 1.00, range 0-4, α = 0.81). Items fit a partial credit item response model and met prespecified criteria for internal structure validity. Contraceptive use declined with increasing Concerns score (adjusted prevalence ratio [aPR] = 0.81 [0.72-0.92]). Scores were elevated among Black (mean: 2.06; aβ = 0.34 [0.09, 0.59]) and Multiracial or other race (2.11; aβ = 0.34 [0.02, 0.66]) respondents vs. White (1.66), but not Latinx respondents (1.81; aβ = 0.11 [- 0.11, 0.33]). Scores were also elevated among participants with lower maternal education (high school/Associate's 1.89 versus college 1.60; aβ = 0.28 [0.04, 0.53]). DISCUSSION The psychometrically robust Concerns instrument can be used in research to measure autonomous contraceptive decision-making and to design person-centered care.
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Affiliation(s)
- Corinne H Rocca
- Advancing Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, Oakland, CA, USA.
| | - Isabel Muñoz
- Advancing Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Lavanya Rao
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Levin
- Division of Public Health, Contra Costa Health, Martinez, CA, USA
| | - Ori Tzvieli
- Division of Public Health, Contra Costa Health, Martinez, CA, USA
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Gnimpieba Kassep CA, Sarpkaya Güder D. Knowledge, attitudes and practices of contraceptive methods among students in public and private high schools in Cameroon. Women Health 2024; 64:274-282. [PMID: 38356119 DOI: 10.1080/03630242.2024.2317272] [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: 06/12/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
The use of contraceptive methods is still a controversial subject in the societies of developing countries. This study aims to assess the knowledge, attitudes, and practices of contraceptive methods among students, aged 15 to 25 years, in public and private schools in the district of Bonaberi, Douala, Cameroon. This research was modeled on the pattern of descriptive study. The population in this study was composed of students (N = 1649) from the five public and private high schools of Bonaberi, Cameroon. The sample size of this study was 379 students. These data were collected in person by the researcher between 1 and 30, June 2022. The data collection tools are the student information form, the Knowledge and Practices of Contraceptive Methods Questionnaire, and the Contraceptive Attitude Scale (CAS). The data of this study were analyzed using descriptive statistics tests, Kruskal-Wallis Test, Pearson Chi-Square, Kolmogorov-Smirnoff, Student's T-Test, Mann-Whitney Test, and the One-way ANOVA. It was found that almost half (45.91 percent) of students were 19-22 years old, 59.1 percent of them were male, and almost half (49.3 percent) of them were sexually active. Currently, the male condom is the most commonly used and known method of contraception among students. It was determined that students take an average of 3.406 points from the total score of CAS. This result indicated a positive attitude toward contraceptive methods. There were no statistically significant differences in contraceptive attitudes according to gender, religion, or sexual activity. There was a statistically significant difference in contraceptive attitudes according to marital status and age. It is recommended to provide family planning counseling services in these schools in order to increase the use of effective methods and provide students with a reliable source of information on contraceptive methods.
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Affiliation(s)
| | - Dilek Sarpkaya Güder
- Obstetric and Women Health Nursing, Near East University, Nicosia, Northern Cyprus
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Castro CA, Monterrosa-Blanco A, Rodríguez LL, Castiblanco A, Bernal L, Ladino MJ, Pinilla D, Melo C, Baquero F. Knowledge and attitudes regarding contraceptive methods and sex education in students and parents of eight Colombian schools 2020-2021: a mixed methods study. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100678. [PMID: 38322782 PMCID: PMC10844851 DOI: 10.1016/j.lana.2024.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
Background In Colombia, the average age of first sexual intercourse is between 14 and 15, and it has one of the highest fertility rates among adolescents in Latin America, which reflects poor access to health services and a lack of knowledge about contraception. Some laws support comprehensive sex education as a learning process that families and schools should provide. The objective of this work was to assess the frequency of adequate knowledge and attitudes of acceptance towards contraception in students, their associated factors, sexual behaviours in sexually active students, and experiences with sex education. Methods Mixed methods study consisting of an analytical cross-sectional study and a qualitative hermeneutic phenomenological study. The former included students who completed a questionnaire with sociodemographic variables, surveys on knowledge and attitudes toward contraception, and questions about sexual behaviour. Focus groups were used in the qualitative study to evaluate students' and parents' sex education experiences. Findings 827 students were surveyed, of whom 52.3% had adequate knowledge about contraceptives and 80.1% had attitudes of acceptance. Talking with parents about sex education, receiving sex education, and being in the eleventh grade increased the likelihood of having adequate knowledge. Each year of age, being male, being a victim of forced displacement, and studying in a public school were associated with lower possibilities of attitudes of acceptance. Using condoms, compared to other contraceptives, was associated with less adequate knowledge and attitudes of acceptance (p < 0.05). Experiences with sex education, contraception, and sexual and reproductive rights were three emerging categories in the focus groups. Interpretation In a group of Colombian high school students, half of them had adequate knowledge, eight out of 10 had attitudes of acceptance about contraception, and both were associated with having received sex education. Nevertheless, different types of barriers to sexual education were identified at home and in schools. The results will allow the generation of educational policies that modify the educational model as well as new strategies by health professionals to raise awareness about responsible sexuality. Funding This project was financed by internal research of the Fundación Universitaria de Ciencias de la Salud-FUCS (DI-I-0392-20).
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Affiliation(s)
| | | | | | | | - Liliana Bernal
- Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - María José Ladino
- Nursing School, Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - Diana Pinilla
- School of Medicine, Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - Carlos Melo
- Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - Ferney Baquero
- Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
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Benavides-Torres RA, Meneses-Tirado MDLÁ, Ramírez-Calderón AJ, Onofre-Rodríguez DJ, Champion JD. Personal, Interpersonal, and Sociocultural Factors of Condom Use in Rural Indigenous Nahuas Adolescents in Mexico. CHILDREN (BASEL, SWITZERLAND) 2023; 10:921. [PMID: 37371153 DOI: 10.3390/children10060921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
The goal of this research was to determine the personal, interpersonal, and sociocultural predictors of condom use among rural Indigenous adolescents. Predictor variables were selected from Bandura's Social Cognitive Theory and Leininger's Transcultural Theory. The sample consisted of 419 Nahuas adolescents randomly selected from the total number of neighborhood blocks in a rural community in Puebla, Mexico. The instruments had acceptable psychometric characteristics (Cronbach alpha and validity scores). Multiple linear regression models were used. Results: 56.8% of participants were female, and 50.40% were students. Mean age was M = 17.5 (SD = 0.97), and the majority (63%) identified as Catholic. Age at menarche/first ejaculation (β = -1.2, p = 0.038), attitude toward condom use (β = 0.13, p < 0.001), ethnic identity (β = 0.21, p < 0.001), and ability to negotiate condom use (β = 0.13, p = 0.003) predicted (R2 = 22.3) condom use. This study provided a basis for integration of the cultural values of Indigenous adolescents within interventions for sexual health promotion.
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Affiliation(s)
- Raquel A Benavides-Torres
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, Ciudad Universitaria, San Nicolás de los Garza 66451, Mexico
| | | | - Alan Josué Ramírez-Calderón
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, Ciudad Universitaria, San Nicolás de los Garza 66451, Mexico
| | - Dora Julia Onofre-Rodríguez
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, Ciudad Universitaria, San Nicolás de los Garza 66451, Mexico
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Tierney S, Deng Y, Geauvreau A, Kearn N, Hodgson J, Othman M. Hormonal contraception and thrombosis: Identifying the gaps in knowledge among females in post-secondary education. Heliyon 2023; 9:e14867. [PMID: 37025893 PMCID: PMC10070904 DOI: 10.1016/j.heliyon.2023.e14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Objective To determine the current level of knowledge about hormonal contraception among young women so they may be better informed about the risks and various choices available to them regarding hormonal contraception (HC). Methods In an online survey-based study, data was analyzed from the anonymous responses of 675 female participants aged 18-30 years in various academic programs at two post-secondary institutions in Kingston, Ontario. Surveys explored demographics, use/type/duration of hormonal contraception, and knowledge of HC and thrombosis. Kruskal Wallis test and Spearman Correlation were used to determine differences in knowledge level about contraceptives across age groups, education levels, as well as use/type/duration of HC. Results 476 participants were users of HC (264 > 1 year) and 199 were non-HC users. 370 participants have a high school diploma. The knowledge level of HC risks was associated with duration of use and overall knowledge of thrombosis and HC. The knowledge level of thrombosis was correlated with duration of use, education level, and age. Participants with higher level of education or those that have been using HC for 5 years or longer had an increased knowledge surrounding thrombosis. Participants aged 24 and older had a higher knowledge of thrombosis than that of participants younger than 24. Overall, the data was used to generate a simple infographic to further educate women in this regard. Conclusion Misconceptions remain among young women concerning benefits and risks of HC which can be addressed by formal education.
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Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study. Contraception 2023; 118:109897. [PMID: 36240905 DOI: 10.1016/j.contraception.2022.09.135] [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: 01/18/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers. STUDY DESIGN We conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use. RESULTS At baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge. CONCLUSION Sexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it. IMPLICATIONS This study addressees gaps in knowledge about U.S. Latina adolescents' contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.
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Fahme SA, El Ayoubi LL, DeJong J, Sieverding M. Sexual and reproductive health knowledge among adolescent Syrian refugee girls displaced in Lebanon: The role of schooling and parental communication. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001437. [PMID: 36962850 PMCID: PMC10021785 DOI: 10.1371/journal.pgph.0001437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/10/2022] [Indexed: 01/11/2023]
Abstract
Adolescent Syrian refugee girls living in Lebanon are vulnerable to poor sexual and reproductive health (SRH). Sociocultural norms, stigmatization, and limited educational opportunities in the context of forced displacement may impact adolescent girls' SRH. Little is known about how and where girls in this population access SRH information and services. This study aimed to: (1) assess knowledge of SRH topics among a population of adolescent Syrian refugee girls displaced in Lebanon, and (2) determine the association of schooling versus maternal SRH communication with SRH knowledge. A total of 418 11-17-year-old Syrian refugee girls displaced in the Beqaa region of Lebanon were recruited to participate in a cross-sectional survey. Bivariate logistic regression and ordinary least squares regression models were used to examine the associations between schooling, maternal SRH communication, and other covariates with SRH knowledge outcomes. Significant predictors (p<0.2) were included in multivariate analyses. The mean age of girls was 13.4 years. Approximately two thirds of our sample was enrolled in school, with enrollment rates dropping considerably around age 15. In bivariate and multivariate models, older age and participation in SRH programs were predictive of puberty knowledge. One in five girls enrolled in school had learned about menstruation in school, which was associated with higher puberty knowledge in bivariate models. Older age, current school enrollment, and reaching the 8th-11th grade were strongly associated with HIV knowledge. Schooling is more strongly associated with SRH knowledge among adolescent girls than is maternal communication. School-based SRH curricula should be administered on the basis of age and not grade, given significant age-for-grade heterogeneity in this population. Forced displacement and poverty are major barriers to education retention and may have long-term impacts on girls' health.
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Affiliation(s)
- Sasha Abdallah Fahme
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - L'Emira Lama El Ayoubi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jocelyn DeJong
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maia Sieverding
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Swan LET, McDonald SE, Price SK. Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6487-e6499. [PMID: 36317755 PMCID: PMC10092462 DOI: 10.1111/hsc.14094] [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: 01/10/2022] [Revised: 07/19/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; Mage = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = -0.014, 95% confidence interval: -0.041, -0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities.
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Affiliation(s)
- Laura E. T. Swan
- Department of Population Health SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Shelby E. McDonald
- Virginia Commonwealth UniversityClark‐Hill Institute for Positive Youth DevelopmentRichmondVirginiaUSA
| | - Sarah K. Price
- Virginia Commonwealth UniversitySchool of Social WorkRichmondVirginiaUSA
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Khan A, Qureshi M, Daniyal M, Tawiah K. Impact of Sociocultural Factors on Contraceptive Use: A Case Study of Pakistan. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2939166. [PMID: 36158874 PMCID: PMC9492426 DOI: 10.1155/2022/2939166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022]
Abstract
Background The use of birth control methods is influenced by complex and competing socioeconomic and demographic factors. Regardless of the complexity of the behavioral approach of women, the utility of contraceptive methods in providing the opportunity of choice is well paired. This study examined the factors driving the usage of contraception and the impact of contraceptive practices on population growth in Pakistan. We also perused the quantification of sociocultural contraceptive use. Methodology. The Pakistan Demographic and Health Survey (PDHS, 2017-18) dataset collected by the National Institute of Population Study (NIPS) was used for all analyses. We applied the frequentist logistic regression model and multinomial logistic regression model in assessing factors impacting contraceptive practices. Bayesian logistic and multinomial regression models were also implemented to compare estimates. The regions and provinces in Pakistan were considered as different clusters, thereby introducing hierarchical structures in the regression model. Results The study revealed a distinctive highly significant negative effect on contraceptive use and women's age. The odds ratio (OR) for women aged 25-34, 35-44, and above 44 was 1.242, 1.155, and 0.638, respectively, which shows that the OR of contraceptive use decreases in women aged 25-44. Our study showed the superior performance of the Bayesian model in highlighting disparities among the various cultural streams existing in the country. Estimates of the Bayesian analysis of competing models indicated that the Bayesian models provide powerful estimates compared to the classical models. Conclusion Our results indicated that contraceptive use is almost relevant to sociodemographic factors (education, age, language, partner, work, etc.). Women with no formal education living in rural areas were not aware of the use of contraception, thereby not using it. Contraceptive use and methods are most probably influenced by the age and the number of children of women. We recommend that high-quality education, counseling, and widespread access to contraceptives should be prioritized in family planning healthcare in all areas of the country, especially rural areas.
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Affiliation(s)
- Arsalan Khan
- Department of Statistics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Moiz Qureshi
- Department of Statistics, Shaheed Benazir Bhutto University, Shaheed Benazirabad, Pakistan
| | - Muhammad Daniyal
- Department of Statistics, Islamia University of Bahawalpur, Pakistan
| | - Kassim Tawiah
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Cederbaum JA, Yoon Y, Lee JO, Desai M, Brown K, Clark L. AIM for Teen Moms: Social Support's Role in Contraception Use Among Young Mothers. J Adolesc Health 2022; 71:78-85. [PMID: 35300930 DOI: 10.1016/j.jadohealth.2022.01.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/03/2022] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Rapid repeat pregnancy is associated with negative outcomes for teen mothers and their offspring. Contraceptive use can reduce this risk. We explored the impact of AIM for Teen Moms, a future-oriented behavioral intervention, on emotional and tangible support and the influence of this support on the attitudes, intentions, and past 3-month contraceptive use behaviors. METHOD Participants were 295 first-time moms (ages 15-19) in Los Angeles County who participated in a randomized control trial intervention to reduce rapid repeat pregnancies. Participants completed surveys at baseline and 36-months. Hypotheses were tested using multivariate and interaction analysis. RESULTS Teen mothers in treatment group reported more emotional (β =.13, p < .05) and tangible support (β =.13, p < .05). Higher tangible support was positively associated with birth control attitudes (β =.13, p < .05), which, in turn, predicted intention to use birth control (β =.31, p < .001). Intention to use birth control also predicted higher past 3-month birth control use (β =.18, p < .01); there was also a direct path from attitude to 3-month birth control use (β =.35, p < .001). There was no association between emotional support and birth control attitudes, intentions, or behaviors. CONCLUSION AIM for Teen Mom's effects on contraception use at 36 months was mediated by social support, specifically tangible support, which, in turn, affected birth control attitudes, intentions, and reported birth control use. Interventionists must consider how intervention content can specifically address the building of target support to meet the needs of teen mothers.
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Affiliation(s)
- Julie A Cederbaum
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California.
| | - Yoewon Yoon
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Jungeun Olivia Lee
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Mona Desai
- Children's Hospital Los Angeles, Los Angeles, California
| | - Kayla Brown
- University of Southern California, Chan Division of Occupational Sciences and Occupational Therapy, Los Angeles, California
| | - Leslie Clark
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California
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Kirubarajan A, Li X, Yau M, Yu C, Got T, Li Q, Huszti E, Leung S, Thangavelu N, Sobel M. Awareness, knowledge, and misconceptions of adolescents and young people regarding long-acting reversible contraceptives: a systematic review and meta-analysis. Fertil Steril 2022; 118:168-179. [DOI: 10.1016/j.fertnstert.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/04/2022]
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Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
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Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
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Minnis AM, Browne EN, Chavez M, McGlone L, Raymond-Flesch M, Auerswald C. Early Sexual Debut and Neighborhood Social Environment in Latinx Youth. Pediatrics 2022; 149:184753. [PMID: 35137189 PMCID: PMC9150543 DOI: 10.1542/peds.2021-050861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To examine whether social aspects of the neighborhood environment are associated with early sexual initiation in a California agricultural community of predominantly Latinx adolescents. METHODS In a prospective cohort study of 599 eighth graders recruited from middle schools in Salinas, California (2015-2019), participants completed five interviews over 2 years. Social environment measures included neighborhood social dynamics (neighborhood disorder, social cohesion, and social network gang exposure); experiences of discrimination; and school connectedness. We estimated associations between baseline social environment and early sexual initiation (<15 years) using Poisson regression with robust standard errors. We compared contraceptive self-efficacy and attitudes by sexual initiation status using ANOVA. RESULTS Most youth were Latinx (94%) and age 13 (70%) at enrollment; 53% were female and 49% had a parent employed in agriculture. Additionally, 14% reported first vaginal sex before age 15. Neighborhood disorder (relative risk [RR], 1.13; 95% confidence interval [CI], 1.05-1.21), social network gang exposure (RR, 2.23; 95% CI, 1.49-3.33), and experiences of discrimination (RR, 1.67 [1-2 events versus none], 95% CI, 1.09-2.55; RR, 2.33 [3+ events versus none], 95% CI, 1.07-4.64) were associated with early sexual initiation. School connectedness was protective (RR, 0.44, 95% CI, 0.29-0.69). Youth who initiated sex before age 15 had more negative birth control attitudes and expressed lower motivation to use contraceptives. CONCLUSIONS Findings underscore opportunities to promote early adolescent sexual health through strengthening supportive and safe neighborhood environments with the promise of addressing disparities in unintended pregnancy and sexually transmitted infection rates in later adolescence.
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Affiliation(s)
- Alexandra M. Minnis
- Women’s Global Health Imperative, RTI International, Berkeley, California,School of Public Health, University of California, Berkeley, California,Address correspondence to Alexandra M. Minnis, PhD, MPH, Director and Senior Research Epidemiologist, Women’s Global Health Imperative, RTI International, 2150 Shattuck Ave, Ste 800; Berkeley, CA 94704. E-mail:
| | - Erica N. Browne
- Women’s Global Health Imperative, RTI International, Berkeley, California
| | - Marisol Chavez
- Women’s Global Health Imperative, RTI International, Berkeley, California,Children’s Hospital Los Angeles (CHLA), Los Angeles, California
| | - Linda McGlone
- Monterey County Health Department, Salinas, California
| | | | - Colette Auerswald
- School of Public Health, University of California, Berkeley, California
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15
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Flanagan EA, Erickson HC, Parchem SJ, Smith CV, Poland N, Nelson SC, Redman SD. Gender Differences in Attitudes and Behaviors Toward Condoms and Birth Control Among Chicago Adolescents. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Guzzo KB, Hayford SR. Adolescent reproductive attitudes and knowledge effects on early adult unintended and nonmarital fertility across gender. ADVANCES IN LIFE COURSE RESEARCH 2021; 50:100430. [PMID: 34992512 PMCID: PMC8726112 DOI: 10.1016/j.alcr.2021.100430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Theory and evidence suggest strong short-term effects of attitudes toward, and knowledge about, reproduction on women's fertility. Adolescent attitudes and knowledge may also have longer-term implications about the contexts women perceive as appropriate for childbearing and their capacity to manage their preferences. Although previous research on men's fertility is limited, theory would suggest the links between adolescent attitudes and knowledge and subsequent fertility would also exist for men (though perhaps in different ways given the gendered meanings of sex, contraception, and reproduction). We analyze the relationship between reproductive attitudes and knowledge in adolescence and unintended and nonmarital first and second births in early adulthood, using the National Longitudinal Study of Adolescent to Adult Health (N = 9,431). Adolescent reproductive attitudes, especially life course consequences of early childbearing, predict the intendedness and marital status of first and second births. Adolescent reproductive knowledge is more often linked to the context of second births than first births. These associations vary by gender, but the overall results suggest that fertility schemas developed during adolescence predict behavior into early adulthood.
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Affiliation(s)
- Karen Benjamin Guzzo
- Department of Sociology, Bowling Green State University, Bowling Green, OH, 43403-0222, United States.
| | - Sarah R Hayford
- Department of Sociology, The Ohio State University, 1885 Neil Avenue Mall, Columbus, OH, 43210, United States.
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17
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Guan M. Sexual and reproductive health knowledge, sexual attitudes, and sexual behaviour of university students: Findings of a Beijing-Based Survey in 2010-2011. Arch Public Health 2021; 79:215. [PMID: 34844649 PMCID: PMC8628385 DOI: 10.1186/s13690-021-00739-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although several studies have attempted investigating sex-related knowledge, attitudes, and practices among young people in China, deeper insights were still needed to further understand how this population could be supported to make healthy and safe sexual choices. Against this background, this study used a large set of secondary data to examine associations among sexual and reproductive health (SRH) knowledge, sexual attitudes, and sexual behaviour. METHODS A cross-sectional study was employed to explore the associations among SRH knowledge, sexual attitudes, and sexual behaviour with a publicly available survey data among the 1196 university students from freshmen to Ph.D. candidates. Descriptive analysis was used to describe the sociodemographic characteristics of the university students by gender. Associations of sociodemographic factors with sources and categories of SRH knowledge, categories of contraceptive knowledge, sexual attitudes, and sexual behavior were explored with Poisson regressions and logistic regressions, respectively. The mediating effects of sociodemographic factors on the associations between SRH knowledge and sexual behavior, observed sexual attitudes on the associations of SRH knowledge with sexual behavior, and latent sexual attitudes on the relationship between SRH knowledge and sexual behavior were analyzed in order. RESULTS Descriptive analysis showed that the sample was dominated by age group (18 to 24 years), undergraduates, females, limited contraceptive knowledge, unfavorable sexual attitudes, and insufficient knowledge sources. Regression analyses showed that sociodemographic factors had significant associations with SRH knowledge, sexual attitudes, and sexual behavior. Subsequently, the mediating effects of sociodemographic factors on the associations of SRH knowledge and sexual attitudes with sexual behavior were confirmed. Controlling for sociodemographic factors, the effects of sexual attitudes on the associations between SRH knowledge and sexual behaviour could be verified. Structural equation modeling indicated that the linear sequence of sources and categories of SRH knowledge → sexual attitudes → sexual behaviour model and the triangle mediating effects of sexual behaviour → sexual attitudes → SRH knowledge model existed. CONCLUSIONS Sociodemographic factors and observed sexual attitudes mediated the associations between SRH knowledge and sexual behaviour. The sequence relationship: sources and categories of SRH knowledge → sexual attitudes → sexual behavior and the mediating relationship: sexual behavior → sexual attitude → sources and categories of SRH knowledge & sexual behavior → sources and categories of SRH knowledge and sexual behavior → sexual attitude → categories of contraceptive knowledge & sexual behavior → categories of contraceptive knowledge were confirmed in the sample. This study also identified an urgent need for the university students to access to SRH comprehensive knowledge.
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Affiliation(s)
- Ming Guan
- International Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China.
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18
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Finigan-Carr NM, Craddock JB, Johnson T. Predictors of condom use among system-involved youth: The importance of Sex Ed. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106130. [PMID: 36090583 PMCID: PMC9457273 DOI: 10.1016/j.childyouth.2021.106130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual health education has been proven effective in improving adolescent sexual reproductive health outcomes. System-involved youth, including those in child welfare or juvenile justice systems, experience disproportionately poor outcomes as compared to youth in the general population, especially concerning STIs and early or unplanned pregnancies. Using logistic regression, this cross-sectional study examined the odds of condom use in a sample (n = 318; 61.3% males; 79.9% African American) of system-involved youth with multiple high-risk sexual behaviors. Specifically, it examined the impact of sexual health education, attitudes and beliefs about condoms, and the moderating effect of gender. The logistic regression models showed that youth were more likely to use a condom when exposed to comprehensive sexual health education (p < .05). Beliefs about condom effectiveness increased the odds of condom use in the second model (p < .01). Gender was not found to have a moderating effect. This study examined whether receiving comprehensive sexual health education and adolescent attitudes and beliefs towards condoms were associated with non-condom use using logistic regression in a sample of system-involved youth. Results suggest that comprehensive sexual health education could improve condom use in this vulnerable population.
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Affiliation(s)
| | - Jaih B. Craddock
- University of Maryland, Baltimore: School of Social Work, Baltimore, MD, USA
| | - Tonya Johnson
- Baltimore City Health Department, Baltimore, MD, USA
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19
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Kassa B, Belay H, Ayele A. Teenage pregnancy and its associated factors among teenage females in Farta Woreda, Northwest, Ethiopia, 2020: A community-based cross-sectional study. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/139190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Esposito CP. Intrauterine Device Initiation After Gonococcal and Chlamydial Infections: A Practice Workflow Initiative. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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21
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Coyle K, Anderson P, Laris BA, Barrett M, Unti T, Baumler E. A Group Randomized Trial Evaluating High School FLASH, a Comprehensive Sexual Health Curriculum. J Adolesc Health 2021; 68:686-695. [PMID: 33583683 DOI: 10.1016/j.jadohealth.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the effectiveness of a school-based comprehensive sexual health curriculum (FLASH) on high-school students' sexual behavior and related outcomes. METHODS A cohort of 1,597 9th and 10th grade students representing 20 schools from two regions in the U.S. (Midwest and South) were enrolled and completed the baseline survey. Following baseline, the 20 schools were randomly assigned to receive FLASH (n = 10 schools, five per region) or a knowledge-based sexual health curriculum (n = 10 schools, five per region). Follow-up surveys were administered at 3 months and 12 months after the instruction period. RESULTS There were no statistically significant differences between conditions for the overall sample on rates of vaginal sex in the past 3 months or the rates of vaginal sex without a condom or other birth control. In supplementary subgroup analyses of students who were not sexually experienced at baseline, FLASH showed a statistically significant protective impact at the 3-month follow-up on vaginal sex without a condom or birth control (p = .04). FLASH also showed statistically significant gains in psychosocial outcomes, such as refusal and condom use self-efficacy, attitudes toward birth control and condoms, and perceived norms. CONCLUSIONS FLASH demonstrated consistent short-term and long-term impacts on key behavioral determinants. It also showed a significant impact on vaginal sex without a condom or other birth control for the subgroup of students who were not sexually experienced at baseline. Behavioral impacts were not evident for the entire study population.
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Affiliation(s)
- Karin Coyle
- Education-Training-Research, Services Department, Scotts Valley, California.
| | - Pamela Anderson
- Education-Training-Research, Services Department, Scotts Valley, California
| | - B A Laris
- Education-Training-Research, Services Department, Scotts Valley, California
| | - Mia Barrett
- Education-Training-Research, Services Department, Scotts Valley, California
| | - Tracy Unti
- Education-Training-Research, Services Department, Scotts Valley, California
| | - Elizabeth Baumler
- Behavioral Health and Research Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, Texas
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22
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Manlove J, Ciaravino S, Welti K. Opportunities and Challenges in Implementing and Evaluating School-Based Sex Education Programs. J Adolesc Health 2021; 68:637-638. [PMID: 33781467 DOI: 10.1016/j.jadohealth.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jennifer Manlove
- Department of Reproductive Health and Family Formation, Child Trends, Bethesda, Maryland
| | - Samantha Ciaravino
- Department of Reproductive Health and Family Formation, Child Trends, Bethesda, Maryland
| | - Kate Welti
- Department of Reproductive Health and Family Formation, Child Trends, Bethesda, Maryland
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23
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Aziz MM, Elgibaly O, Mohammed HM. Family planning perspectives and practices of married adolescent girls in rural Upper Egypt. EUR J CONTRACEP REPR 2021; 26:214-220. [PMID: 33576289 DOI: 10.1080/13625187.2021.1879781] [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: 10/22/2022]
Abstract
OBJECTIVES The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception. METHODS The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire. RESULTS Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman's fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p < .001), older age (B = 0.42, p < .01), better reproductive health knowledge (B = 0.23, p < .05) and sharing in contraceptive decision making (B = 0.55, p < .05). CONCLUSION Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.
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Affiliation(s)
- Mirette M Aziz
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Omaima Elgibaly
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Heba M Mohammed
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
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24
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Cleland K, Marcantonio TL, Hunt ME, Jozkowski KN. "It prevents a fertilized egg from attaching…and causes a miscarriage of the baby": A qualitative assessment of how people understand the mechanism of action of emergency contraceptive pills. Contraception 2021; 103:408-413. [PMID: 33508253 DOI: 10.1016/j.contraception.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The mechanism of action (MOA) of emergency contraceptive pills (ECPs) is frequently mischaracterized. Our objective was to identify how members of the general public understand the mechanisms of ECPs. STUDY DESIGN We recruited a convenience sample from social media for a survey about reproductive health attitudes and analyzed spontaneous descriptions of how ECPs work. We inductively coded responses to create themes and subthemes, and collapsed subthemes into three MOA categories based on previous research. RESULTS Among 1443 respondents, 533 mentioned an MOA in their description of ECPs. While nearly half of these responses (49.5%) stated that ECPs prevent pregnancy before fertilization occurs (in accordance with most biomedical ECP research), over 60% described a mechanism related to preventing implantation of a fertilized egg. Nine percent of responses described a postimplantation mechanism that would be considered abortion by mainstream medical standards. Some respondents conveyed significant confusion about the biological processes involved with pregnancy and pregnancy prevention. CONCLUSION Confusion about how ECPs work was common among our sample. The largest group of responses described a mechanism-preventing implantation of a fertilized egg-listed on the Food and Drug Administration (FDA)-approved ECP labels that does not reflect most relevant biomedical research. Mischaracterizations of ECPs' mechanisms have been used to limit access to EC. These misunderstandings were common in our sample and may reflect poor quality sex education and public information, and confusion introduced by the FDA-approved labels. Additional research should identify whether public perception of ECPs' mechanisms influences policy, health care provision, and use of ECPs.
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Affiliation(s)
- Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville NJ, United States.
| | - Tiffany L Marcantonio
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville AR, United States
| | - Mary E Hunt
- Department of Health and Human Development, Western Washington University, Bellingham WA, United States
| | - Kristen N Jozkowski
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington IN, United States
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25
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Hylton-Kong T, Bailey A, Steiner MJ, Gallo MF. Contraceptive knowledge among women at risk of unintended pregnancy in Kingston, Jamaica. Women Health 2021; 61:294-302. [PMID: 33491609 DOI: 10.1080/03630242.2021.1876812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Low contraceptive knowledge may limit contraception initiation or continuation and, consequently, could represent an important, modifiable cause of unintended pregnancy. The objective of this analysis was to identify correlates of knowledge among women at risk of unintended pregnancy. We analyzed data from a study of 222 young women attending a public clinic in Kingston in November 2018 to March 2019. We measured contraceptive knowledge with seven questions on method reversibility, ability to use covertly, contraindications, and side effects. We used multivariable linear regression to evaluate the correlates of summary knowledge scores and report beta coefficients, which represent differences in mean summary knowledge scores. The mean knowledge score was low (2.7; range = 0-7). Only 30.2% of the participants correctly identified intrauterine devices as more effective than oral contraception, male condoms, and withdrawal. Women who reported that their provider discussed contraception scored higher (adjusted ß = 0.37, p = 0.05) than those not reporting this. Women who perceived implants as very/mostly safe scored higher (adjusted ß = 0.45, p = 0.01) than those perceiving the device as mostly/very unsafe. Finally, compared to contraception non-users, women using less-effective contraception had a lower score (adjusted ß = -0.40, p = 0.04) while those using effective contraception did not differ in scores (ß = -0.30, p = 0.18). Overall, we found poor contraceptive knowledge among young women in Kingston. Providers appeared to hold an important role in women's understanding of contraception.
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Affiliation(s)
- Tina Hylton-Kong
- Jamaica Ministry of Health, Epidemiology Research and Training Unit (ERTU), Kingston, Jamaica
| | - Althea Bailey
- Department of Community Health and Psychiatry, The University of the West Indies at Mona, Mona, Jamaica
| | - Markus J Steiner
- Contraceptive Technology Innovation Division, FHI 360, Durham, North Carolina, USA
| | - Maria F Gallo
- College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA
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26
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Guzzo KB, Lang VW, Hayford SR. Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships? J Adolesc Health 2021; 68:95-102. [PMID: 32646829 PMCID: PMC7755833 DOI: 10.1016/j.jadohealth.2020.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Adolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors. METHODS By following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender. RESULTS Men and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners. CONCLUSIONS Adolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.
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Affiliation(s)
| | | | - Sarah R Hayford
- Department of Sociology, The Ohio State University, Columbus, Ohio
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27
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MacLean L. A Literature Review of Health Literacy of Adolescents During Pregnancy. Nurs Womens Health 2020; 24:431-439. [PMID: 33157069 DOI: 10.1016/j.nwh.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/21/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
Adolescents who are pregnant are a vulnerable population at risk for poor health literacy. Health literacy is an important determinant of health, and poor health literacy among adolescents is correlated with high-risk health behaviors and adverse health outcomes into adulthood. A review of the literature showed a significant gap in research related to health literacy in pregnant adolescents. The limited findings indicate the need for additional research attention on health literacy in pregnant adolescents and upstream approaches to improve adolescent health literacy, such as incorporating health literacy education into secondary schools. To strengthen approaches that build health literacy capacity, it is imperative that future research focuses on pregnant adolescents' health literacy related to health behaviors, health outcomes, measurement instruments, health literacy frameworks, and targeted interventions.
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28
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Lowrey K, Altman C, Jungmeyer A. Targeted High-Risk Youth in Missouri PREP: Understanding Program Impacts on Youth Sexual Behavior Intentions. CHILD & YOUTH CARE FORUM 2020; 50:415-435. [PMID: 33994764 DOI: 10.1007/s10566-020-09580-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background Missouri Personal Responsibility Education Program (PREP) provides sexual health education programs to youth with goals of reducing unintended teen pregnancies. Theories of change provide that youth improve their sexual health knowledge, intentions, attitudes, and behaviors as a result of program implementation. Program evaluations are needed to assess the degree to which PREP programs are meeting their goals of improving youth outcomes. Objective The purpose of this study is to examine youth sexual intentions to use a condom, engage in sexual behavior, and abstain from sex as a result of Missouri PREP program implementation. We evaluate the effectiveness of the Missouri program in modifying youth intentions toward healthier planned behaviors. Methods All programs required youth to take pre- and post-program surveys. For this study, we evaluate a sample of 1,335 youth's pre- and post-survey intentions related to condom use, sex, and abstention. We utilize t-tests as well as a lagged logistic regression approach to account for youth's respective pre-intentions. Results Youth's scores on intentions, knowledge, and attitudes rise from pre- to post-survey. Knowledge gains are salient while attitudes remain relatively high and stable. Intentions to use condoms differ from those in intentions to have or abstain from sex. Program change in intentions to use a condom are highest among the three intention outcomes. Conclusions Missouri PREP saw improvements in knowledge, attitudes, and intentions as a result of program implementation. Findings suggest that the Missouri PREP program is effective at positively influencing youth intentions to engage in risky or sexual behavior.
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Esposito CP. Intrauterine Devices in the Context of Gonococcal Infection, Chlamydial Infection, and Pelvic Inflammatory Disease: Not Mutually Exclusive. J Midwifery Womens Health 2020; 65:562-566. [PMID: 32592523 DOI: 10.1111/jmwh.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 02/03/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Abstract
The use of long-acting reversible contraception, namely, intrauterine device (IUDs) and the subdermal implant, has been recommended to address the high rate of the unintended pregnancy in the United States. IUDs are a safe, highly effective contraceptive method, suitable for most women. The underutilization of IUDs arises in part from the lack of translation of best practices in the clinical setting as well as fears and misperceptions about this contraceptive method held by health care providers and women. This article reviews screening and management of Neisseria gonorrhoeae and Chlamydia trachomatis infection and pelvic inflammatory disease (PID) in women who are using or want to use an IUD. An IUD may be inserted without prior screening for N gonorrhoeae or C trachomatis in women who are at low risk for sexually transmitted infections and asymptomatic. An in situ IUD may remain in the uterus during and after treatment for gonococcal infection, chlamydial infection, or PID. The risk of PID with an IUD in situ is less than 1%. Following IUD best practices, including their use in the context of sexually transmitted infections, can increase the availability of this method for suitable candidates and decrease the unintended pregnancy rate.
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Perceptions and Behaviors Related to Contraceptive Use in the Postpartum Period Among Women With Pregestational Diabetes Mellitus. J Obstet Gynecol Neonatal Nurs 2020; 49:154-166. [PMID: 31951814 DOI: 10.1016/j.jogn.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe perceptions and behaviors related to contraception and preconception care and to test the association between these perceptions and contraceptive use in the postpartum period among women with pregestational diabetes mellitus. DESIGN Cross-sectional, descriptive survey. SETTING Three high-risk obstetric clinics in the Southeastern United States. PARTICIPANTS Fifty-five women who were 18 years or older with pregestational Type 1 or Type 2 diabetes mellitus. METHODS Between 4 and 8 weeks after birth, we used investigator-developed items and psychometrically validated scales to measure participants' perceptions and behaviors related to contraception and preconception care. We dichotomized use of contraception in the postpartum period as procedure/prescription or nonprescription/no method. We used multiple logistic regression to test the hypothesis that perceptions are associated with contraceptive use. RESULTS When data were collected 4 to 8 weeks after birth, almost half (49%, n = 27) of the participants had resumed sexual activity; however, most (95%, n = 52) did not want another pregnancy in the next 18 months. Fifty-six percent (n = 31) of participants used procedure/prescription contraception, and 44% (n = 24) used nonprescription/no method. Those who perceived contraception use and preconception care to be beneficial were more likely to use procedure/prescription contraception (adjusted odds ratio = 1.52; 95% confidence interval [1.07, 2.17]). CONCLUSION When caring for women in the postpartum period, providers should be mindful that women's perceptions of the benefits of contraception and preconception care may have implications for whether their use aligns with their reproductive goals and optimizes outcomes for future pregnancies.
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Esposito CP, LoGiudice J. Beliefs and Use of Intrauterine Devices (IUDs) Among Women’s Health Care Providers. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guzzo KB, Lang VW, Hayford SR. Teen Girls' Reproductive Attitudes and the Timing and Sequencing of Sexual Behaviors. J Adolesc Health 2019; 65:507-513. [PMID: 31326249 PMCID: PMC6755050 DOI: 10.1016/j.jadohealth.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Teen girls consider not only health outcomes, such as pregnancy or contracting a sexually transmitted infection (STI), but also social outcomes, such as guilt or embarrassment, when making decisions about sexual behaviors. METHODS Following a sample of female virgins aged 15-18 years from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (N = 2,376), we tested whether adolescent girls' attitudes toward sex, contraception, pregnancy, and STIs influence the timing of coital debut, using discrete time event history logistic regression, and whether oral sex precedes coital debut, using logistic regression. RESULTS Concerns about negative social consequences of sex were associated with later coital debut (adjusted odds ratio [AOR]=.79, p = .000), whereas perceived physical benefits of sex and positive attitudes toward contraception were associated with earlier coital debut (AOR = 1.09, p = .049 and AOR = 1.17, p = .002, respectively). Worries about pregnancy were not associated with the timing of coital debut but did predict having oral sex before vaginal sex (AOR = 1.33, p = .007). Favorable birth control attitudes and positive attitudes toward sex also increased the odds of oral sex before vaginal sex (AOR = 1.38, p = .008 and AOR = 1.47, p = .000, respectively). CONCLUSIONS Teen girls' worries about the emotional and social consequences of sex may be a more salient predictor of the timing of coital debut than concerns about the risk of pregnancy or STIs. Teen girls' fears coexist with positive views about sex and contraception, which are associated with earlier sex and sexual sequencing.
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Affiliation(s)
| | - Vanessa Wanner Lang
- Department of Sociology, Bowling Green State University, Bowling Green, Ohio
| | - Sarah R Hayford
- Department of Sociology, The Ohio State University, Columbus, Ohio
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Sámano R, Martínez-Rojano H, Chico-Barba G, Sánchez-Jiménez B, Sam-Soto S, Rodríguez-Ventura AL, Mejía-Luna L, Sclavo-Melo S. Sociodemographic Factors Associated with the Knowledge and Use of Birth Control Methods in Adolescents before and after Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061022. [PMID: 30897835 PMCID: PMC6465996 DOI: 10.3390/ijerph16061022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
Abstract
Adolescent pregnancy rates are high worldwide. However, insufficient information exists regarding the frequency of birth control methods used before the first pregnancy and postpartum. In the current study, we analyzed the association of sociodemographic factors with the knowledge of birth control methods and their use before and after pregnancy in a sample of adolescents in Mexico City. A cohort study was conducted on 600 pregnant adolescents in Mexico City, from 2013 to 2017, at a health care institution providing prenatal care. Participants were assessed during the second trimester and four months postpartum. The questionnaire explored the knowledge of birth control methods, their use, and other associated factors. Two logistic regression models were implemented to identify potential variables associated with the lack of birth control method use before and after pregnancy. The mean age of participants was 15.4 + 1 years, of which, 48% and 65.2% used a birth control method before pregnancy and postpartum, respectively. We found that the main factors associated with increased risk of not using any birth control method before pregnancy included being under the age of 15 years, school dropout, having an educational lag, initiation of sexual life before the age of 15, and having a mother who did not inform their child about contraceptives. By contrast, variables associated with a higher risk of not using any contraceptive methods after pregnancy included educational lag, lower level of education, and the fact that the adolescent had not used any birth control prior to the pregnancy.
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Affiliation(s)
- Reyna Sámano
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Montes Urales 800, Lomas de Virreyes, Mexico City C. P. 11000, Mexico.
| | - Hugo Martínez-Rojano
- Sección de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Casco de Santo Tomas, Mexico City C. P. 11340, Mexico.
- Coordinación de Medicina Laboral, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) "Dr. Manuel Martínez Báez", Secretaría de Salud, Francisco de P. Miranda 177, Lomas de Plateros, Mexico City C. P. 01480, Mexico.
| | - Gabriela Chico-Barba
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Montes Urales 800, Lomas de Virreyes, Mexico City C. P. 11000, Mexico.
| | - Bernarda Sánchez-Jiménez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Montes Urales 800, Lomas de Virreyes, Mexico City C. P. 11000, Mexico.
| | - Selene Sam-Soto
- Coordinación de Colposcopía. Instituto Nacional de Perinatología, Secretaría de Salud, Montes Urales 800 Lomas de Virreyes, Mexico City C. P. 11000, Mexico.
| | - Ana Lilia Rodríguez-Ventura
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Montes Urales 800, Lomas de Virreyes, Mexico City C. P. 11000, Mexico.
| | - Laura Mejía-Luna
- Coordinación de Nutrición, Universidad del Valle de México-Chapultepec, Avenida Observatorio 400, 16 de Septiembre, Mexico City C. P. 11810, Mexico.
| | - Sylvia Sclavo-Melo
- Departamento de Salud, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City C. P. 01219, Mexico.
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Xu SF, Wu JQ, Li YY, Yu CN, Zhao R, Zhou Y, Li YR, Zhang JG, Jin MH. Association between factors related to family planning/sexual and reproductive health and contraceptive use as well as consistent condom use among internal migrant population of reproductive ages in three cities in China, based on Heckprobit selection models. BMJ Open 2018; 8:e020351. [PMID: 30429141 PMCID: PMC6252756 DOI: 10.1136/bmjopen-2017-020351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE With the increased population mobility and the transition in population policy, scholars are quite concerned about family planning/sexual and reproductive health (SRH) and related factors among internal migrant population of reproductive age. Therefore, the proposed study was designed to explore the association between factors related to family planning/SRH and contraceptive use as well as consistent condom use among the above-described population in China. DESIGN Cross-sectional study. SETTING Three municipalities in China, namely Beijing, Shanghai and Chongqing. PARTICIPANTS Among the 6545 participants, 2099, 2414 and 2031 subjects came from Beijing, Shanghai and Chongqing, respectively. RESULTS A total of 6545 eligible participants were included as the full sample, 6188 of whom who had intercourse in the last 3 months were selected as the subsample. Among the subsample, 80.88% (5005/6188) adopted any form of contraceptive methods and 49.14% (3041/6188) consistently used condom in the last three sexual intercourses. Meanwhile, the involved participants had a better mastery of knowledge on SRH than on contraception (p<0.0001). The results of the Heckprobit models revealed that the factors associated with both contraceptive use and consistent condom use were relationship with the first intercourse partner, communication frequency with spouse/sexual partners on sex, actual number of children and knowledge on SRH, while knowledge on contraception and age at first intercourse were associated with contraceptive use and consistent condom use, respectively (p<0.05). CONCLUSIONS In the current study, we revealed a high-level contraceptive prevalence, a relatively low-level consistent condom use and a poor mastery of knowledge on contraception and SRH. The Heckprobit selection model specified the existence of selection bias, providing evidence on the association between the factors on family planning/SRH and contraceptive use as well as consistent condom use, respectively. Our findings indicated that health institutions should offer appropriate technology and high-quality family planning/SRH services for the internal migrant population in China.
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Affiliation(s)
- Shuang-Fei Xu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Jun-Qing Wu
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Yu-Yan Li
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Chuan-Ning Yu
- Longhua District Center for Chronic Disease Control (Mental Health Center), Shenzhen, China
| | - Rui Zhao
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Ying Zhou
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Yi-Ran Li
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Jun-Guo Zhang
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Meng-Hua Jin
- Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
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