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Towongo MF, Kelepile M. Prevalence, distribution and factors associated with modern contraceptive use among women of reproductive age in Uganda: evidence from UDHS 2016. Contracept Reprod Med 2024; 9:32. [PMID: 38937845 PMCID: PMC11212173 DOI: 10.1186/s40834-024-00288-6] [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: 03/23/2024] [Accepted: 05/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Unintended pregnancies pose significant health risks, particularly in sub-Saharan Africa, where millions of cases are recorded annually, disproportionately affecting adolescent women. Utilization of modern contraceptives is crucial in managing fertility and reducing unintended pregnancies, abortions, and associated health complications. This study aimed to assess the prevalence, distribution and factors associated with modern contraceptives utilization among women aged 15-49 in Uganda. METHODS The study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS). The study sample comprise of 9,235 women aged 15-49 who used any method to prevent pregnancy in the five years preceding 2016 UDHS survey. The outcome variable for this study is utilization of modern contraceptives. Univariate, bivariate, and multilevel binary logistic regression was used to examine the relationship between individual and contextual factors on the modern contraceptive use among women aged 15-49 in Uganda. Choropleth mapping and network analysis in ArcGIS 10.8.2 was used to visualize spatial distribution of modern contraceptive use and measure community access to health facilities respectively. RESULTS The prevalence of modern contraceptive use was 53.19% (n = 4,919) in Uganda, with significant spatial variation by district. Higher prevalence (23.18%) was observed among women aged 20-29 compared to adolescents (4.1%). Only 21.9% of married women reported using modern contraceptives. At the individual-level, the factors that positively influenced use of modern contraceptives included: women's marital status, wealth index and level of education while sex of the household head, ever terminated a pregnancy and religion negatively affected the use of modern contraceptives. At community-level, community access to health facilities was found to have negative influence on the use of modern contraceptives among women. In communities where women frequently visited health facilities in the 12 months preceding the survey, the use of modern contraceptives reduced by 3.9%. Accessibility analysis revealed challenges, with women in northeastern districts (rural districts) facing travel times exceeding four hours to reach health facilities. CONCLUSION Utilization of modern contraceptives are essential for promoting women's health and well-being, particularly concerning maternal healthcare. This study highlights disparities in modern contraceptive use across age groups and the districts, emphasizing the need for targeted interventions. Policymakers and stakeholders must prioritize strategies that promote utilization of modern contraceptives and maternal healthcare services to address these disparities effectively. Such efforts are crucial for improving reproductive health outcomes and reducing the burden of unintended pregnancies and related complications in Uganda.
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Affiliation(s)
- Moses Festo Towongo
- Department of Population Studies, University of Botswana, Gaborone, Botswana.
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Jean de Dieu H, Lambert M. Predictors of contraceptive discontinuation in Rwanda: evidence from demographic and health survey 2019-2020. Contracept Reprod Med 2024; 9:19. [PMID: 38664853 PMCID: PMC11044445 DOI: 10.1186/s40834-024-00282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite advancements, Rwanda continues to face challenges regarding contraceptive discontinuation. The 2019-2020 Rwanda Demographic and Health Survey (DHS) reported a 30% discontinuation rate among women within the first year of use. This study analyses predictors of discontinuation using this DHS data, with the goal of strengthening Rwanda's family planning programs. METHODS Data from the 2019-20 Rwanda DHS (14,634 women aged 15-49) was examined. A two-stage sampling design informed the survey. Life table methods and Cox proportional hazard models were used to analyze discontinuation rates, median usage duration across contraceptive methods, and the influence of demographic and other factors. RESULTS Results indicated a progressive rise in contraceptive discontinuation over different period: 16.69% at 6 months, 29.29% at 12 months, and 47.21% at 24 months. Pills and male condoms showed higher discontinuation probabilities early on. While injectables and LAM initially showed lower discontinuation, rates rose significantly by the 24th month. Health concerns and side effects were the primary reasons cited for discontinuation. The Cox proportional hazards analysis revealed significant factors influencing discontinuation: contraceptive method, desire for pregnancy, husband's disapproval, access/availability, and the desire for a more effective method. CONCLUSION This study highlights substantial contraceptive discontinuation rates in Rwanda, particularly for pills and injectables. Method type, health concerns, side effects, and method failure were associated with discontinuation. Interventions should focus on improving contraceptive continuation and investigating alternative methods with lower discontinuation tendencies.
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Essien SK, Chireh B, Essien JK. Knowledge about unintended pregnancy shortly after childbirth: An issue of ineffective counseling or adherence? WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241255655. [PMID: 38778791 PMCID: PMC11113048 DOI: 10.1177/17455057241255655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. OBJECTIVE This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. DESIGN A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. METHODS We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. RESULTS Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03-1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. CONCLUSION Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance.
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Affiliation(s)
- Samuel Kwaku Essien
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
- EPID@Work (Enhancing the Prevention of Injury & Disability @ Work) Research Institute, Lakehead University, Thunder Bay, ON, Canada
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Batholomew Chireh
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
- EPID@Work (Enhancing the Prevention of Injury & Disability @ Work) Research Institute, Lakehead University, Thunder Bay, ON, Canada
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Ejeta Chibsa S, Bayisa K, Adem Hussen M, Tefera Kefeni B. Determinant of Implanon discontinuation among women in southwest Ethiopia: unmatched case control study. Contracept Reprod Med 2023; 8:54. [PMID: 37919819 PMCID: PMC10623863 DOI: 10.1186/s40834-023-00253-9] [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: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Over 4.5 million women worldwide have used Implanon. It plays an important role in reducing unwanted conceptions, lowering maternal mortality, and enhancing child survival. As a result, the availability of family planning programmes encourages women to begin using contraception and encourages women who are already using family planning to continue using it. The purpose of this study was to investigate the factors that lead to implanon cessation among women in southwest, Ethiopia. METHODS A facility-based unmatched case-control study was conducted from February 01 to March 02, 2023. It included 348 participants, 174 cases, and 174 controls. The cases were selected consecutively, and the controls were selected using a systematic random sampling method. Data was collected through a structured, face-to-face interview and entered into Epi-data version 4.6 and SPSS version 25.0 for analysis. The confidence interval (CI) of 95 and the strength of the association were measured using an adjusted odds ratio. A p-value of less than 0.05 was considered statistically significant. RESULT Women whose husbands have formal education [AOR = 0.33, 95% CI (0.121-0.0944)], women who have been counseled individually [AOR = 3.403 (1.390-8.3.32)], women who have been counseled for less than 5 min [AOR = 3.143, 95% CI (1.303-8.046)], and women who discuss Implanon insertion with their partner [AOR = 0.289, 95% CI (0.143-0.585)] were significantly associated with Implanon discontinuation. CONCLUSION Implanon discontinuation was predicted by the husband's education, the number of women counselled alone, the length of counselling, a conversation with the spouse, satisfaction with the service, and implanon side effects. The health care provider should increase counselling services, especially the length of implanon pregnancy, in accordance with the national family planning recommendations, to reduce early implanon removal.
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Affiliation(s)
- Samuel Ejeta Chibsa
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia.
| | - Kenbon Bayisa
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | - Mustefa Adem Hussen
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
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Mohamed S, Chipeta MG, Kamninga T, Nthakomwa L, Chifungo C, Mzembe T, Vellemu R, Chikwapulo V, Peterson M, Abdullahi L, Musau K, Wazny K, Zulu E, Madise N. Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews. Syst Rev 2023; 12:198. [PMID: 37858208 PMCID: PMC10585784 DOI: 10.1186/s13643-023-02361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.
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Affiliation(s)
- Sahra Mohamed
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Michael G Chipeta
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi.
| | | | - Lomuthando Nthakomwa
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Chimwemwe Chifungo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Themba Mzembe
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Victor Chikwapulo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Leyla Abdullahi
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
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Sharif AB, Hasan MT, Naziat MH, Zerin T, Kundu S. Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017-2018 data. BMJ Open 2023; 13:e073469. [PMID: 37451714 PMCID: PMC10351289 DOI: 10.1136/bmjopen-2023-073469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES This study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged 15-49 years. DESIGN Cross-sectional study. SETTING We used data from Bangladesh Demographic Health Survey (BDHS) 2017-2018. PARTICIPANTS A total of 9669 Bangladeshi reproductive-aged women who gave information on contraception use were the study participants. A multilevel multinomial logistic regression model was employed where the SARC method was considered as the base category and the cluster was considered as level-2 factor. RESULTS Among the contraceptive users in Bangladeshi women, about 83.48% used the SARC method, while 11.34%, and 5.18% used permanent and LARC methods, respectively. Compared with SARC, women with no formal education and only primary education who were non-Muslims, and had parity of ≥3 had a higher likelihood of using both permanent and LARC methods. Women from the age group of 25-34 years (adjusted relative risk ratio (aRRR): 7.03, 95% CI: 4.17 to 11.85) and 35-49 years (aRRR: 12.53, 95% CI: 7.27 to 21.58) who were employed (aRRR: 1.19, 95% CI: 1.00 to 1.40), had media access (aRRR: 1.24, 95% CI: 1.03 to 1.49), gave birth in last 5 years (aRRR: 1.40, 95% CI: 1.11 to 1.76), whose contraception decision solely made by their husband (aRRR: 7.03, 95% CI: 5.15 to 9.60) and having high decision-making power (aRRR: 2.12, 95% CI: 1.62 to 2.77) were more likely to use permanent contraceptive methods. We observed that women from households with richer (aRRR: 0.65, 95% CI: 0.45 to 0.93) and richest (aRRR: 0.38, 95% CI: 0.23 to 0.63) wealth quintiles were less likely to use LARC methods. CONCLUSIONS This study identified that women with no/less education, non-Muslims, and having parity of ≥3 were more likely to use both permanent and LARC methods than SARC methods. Targeted interventions could be developed and implemented to promote personalised contraceptive use.
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Affiliation(s)
- Azaz Bin Sharif
- Global Health Institute, North South University, Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md Tamzid Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md Habib Naziat
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Tahmina Zerin
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Oral & Maxillofacial Surgery, Marks Medical College Hospital & Dental Unit, Dhaka, Bangladesh
| | - Satyajit Kundu
- Global Health Institute, North South University, Dhaka, Bangladesh
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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Liu JX, Vallin J, Chiu C, Cabrera FA, Hunter LA, Rao A, Njau P, McCoy SI. Designing for two: How enhancing human-centered design with behavioral nudges unlocked breakthroughs to promote young women's psychological safety and access to reproductive care in Tanzania. Soc Sci Med 2023; 320:115683. [PMID: 36709692 PMCID: PMC10798268 DOI: 10.1016/j.socscimed.2023.115683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/16/2023]
Abstract
Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face many barriers to accessing preventive sexual and reproductive health (SRH) services. We drew upon the strengths of two complementary approaches, human-centered design and behavioral economics, to craft a holistic, highly-tailored, and empathetic intervention to motivate AGYW to seek contraception and HIV self-test kits at community drug shops. To encourage engagement, we embedded "nudge" strategies at different opportunity points (uncovered during our design research) along the care-seeking and service delivery journey. Our Malkia Klabu intervention is a loyalty program designed to enhance drug shops' role as SRH providers through which AGYW earned punches for shop purchases redeemable for small prizes; free SRH products could be requested at any time. From our 4-month pilot in Shinyanga, Tanzania, we assess the extent to which different behavioral nudge strategies motivated behaviors as predicted by synthesizing findings from (1) in-depth interviews with AGYW and shopkeepers, (2) shop program records, (3) shop observations, and (4) customer exit surveys. Overall, we find that AGYW and shopkeepers were motivated by many intervention features as intended and consistent with hypothesized mechanisms. We found strong evidence of social norms for helping to spread awareness of Malkia Klabu among peers, prize incentives for drawing AGYW back to shops, and the opt-out default membership gift of an HIV self-test kit for encouraging testing uptake and exploration of contraceptives. Shopkeepers in both arms noted increased community status from distributing HIV self-testing kits (ego). Malkia Klabu shopkeepers experienced increased customer traffic and business revenues (incentives), which reduced shopkeepers' gatekeeping tendencies and earned them additional recognition as champions of AGYW well-being. Integrating human-centered design and behavioral economics was effective for developing an innovative and effective intervention that simultaneously met the different needs of economic actors in support of public health priorities.
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Affiliation(s)
- Jenny X Liu
- Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco, 490 Illinois St. 123J, San Francisco, CA 94158, USA.
| | - Janelli Vallin
- Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco, 490 Illinois St. 123J, San Francisco, CA 94158, USA.
| | - Calvin Chiu
- School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
| | - F Abigail Cabrera
- Center for Excellence in Primary Care; University of California, San Francisco; Zuckerberg San Francisco General Hospital; 995 Potrero Ave, Ward 83, San Francisco, CA, 94110, USA.
| | - Lauren A Hunter
- School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
| | - Aarthi Rao
- Behavioral Insights and Program Design; Cityblock Health; 86 Laws Brook Rd, Concord, MA 01742, USA.
| | - Prosper Njau
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children; Government City - Mtumba, Afya Road, P.O. Box 743, 40478 Dodoma, United Republic of Tanzania.
| | - Sandra I McCoy
- School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
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Chekole MS, Zikie DT, Wogie Fitie G, Taye BT, Kibiret DM, Silesh Zerihun M, Moltot Kitaw T, Ali MA, Legasu TD, Assefa KT, Lemma Demisse T. Determinants of Implanon discontinuation among women who use Implanon at Debre Berhan town public health institutions in Northeast Ethiopia: a case-control study. Front Glob Womens Health 2023; 4:961364. [PMID: 36875719 PMCID: PMC9977160 DOI: 10.3389/fgwh.2023.961364] [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: 06/04/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
Background Discontinuation of the most effective methods of contraception such as Implanon has now become a worldwide problem, which is significantly associated with mistimed and unwanted pregnancies and unsafe abortion, leading to an increased risk of maternal and child mortality and morbidity. However, studies on factors associated with Implanon discontinuation in Ethiopia, particularly in the area under this study, are limited. Therefore, this study aims to identify the determinants of Implanon discontinuation among women who used Implanon at Debre Berhan town public health institutions. Methods and materials A facility-based unmatched case-control study was conducted among 312 study participants (78 cases and 234 controls) from February 1, 2021, to April 30, 2021. The study participants were selected by using a systematic random sampling method for controls, and cases were selected consecutively until the required sample size was reached, during the data collection period. The data were collected by using a structured face-to-face interviewer-administered questionnaire and entered into Epidata version 4.6 and transferred to SPSS version 25 for analysis. Variables with a p-value of <0.25 in the bivariable analysis were entered into the multivariable logistic regression model. In the final model variables, a p-value of <0.05 was considered statistically significant at a 95% confidence interval (CI) and the strength of association was measured using an adjusted odds ratio (AOR). Results In this study, the determinants of Implanon discontinuation were the following: women who had no formal education (AOR: 3.57; 95% CI, 1.62-7.87), who had no children (AOR: 2.8; 95% CI, 1.50-5.17), who had no counseling about side effects (AOR: 2.43;95% CI, 1.30-4.55), who had no discussion with their partner (AOR: 2.7; 95% CI, 1.34-5.46), who had no follow-up appointment (AOR:2.81; 95% CI, 1.54-5.12), and who had side effects (AOR:1.91; 95% CI, 1.13-3.53). Conclusion and Recommendations Women's educational status, having no children during the insertion of Implanon, received no counseling about the side effects of insertion, no follow-up appointment, experiencing side effects, and no discussion with a partner were determinants of Implanon discontinuation. Hence, healthcare providers and other health sector stakeholders should provide and strengthen pre-insertion counseling, and follow-up appointments to increase the retention rates of Implanon.
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Affiliation(s)
- Moges Sisay Chekole
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Delelegn Tsegaye Zikie
- Department of Midwifery, College of Medicine and Health Science School of Nursing and Midwifery, Wollo University, Wollo, Ethiopia
| | - Girma Wogie Fitie
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Desta Mekete Kibiret
- Department of Midwifery, College of Medicine and Health Science, Metu University, Metu, Ethiopia
| | - Mulualem Silesh Zerihun
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tebabere Moltot Kitaw
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mohamed Ahmed Ali
- Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Temesegen Desalegn Legasu
- Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Kibir Temesgen Assefa
- Department of Midwifery, College of Medicine and Health Science School of Nursing and Midwifery, Wollo University, Wollo, Ethiopia
| | - Tesfanesh Lemma Demisse
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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Lee JK, Gutin SA, Getahun M, Okiring J, Neilands TB, Akullian A, Ssali S, Cohen CR, Maeri I, Eyul P, Kamya MR, Bukusi EA, Charlebois ED, Camlin CS. Condom, modern contraceptive, and dual method use are associated with HIV status and relationship concurrency in a context of high mobility: A cross-sectional study of women of reproductive age in rural Kenya and Uganda, 2016. Contraception 2023; 117:13-21. [PMID: 36115610 PMCID: PMC9984206 DOI: 10.1016/j.contraception.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Mobility (international/internal migration, and localized mobility) is a key driver of the HIV epidemic. While mobility is associated with higher-risk sexual behavior in women, a possible association with condom, modern contraceptive, and dual method use among women living with HIV (WLHIV), is unknown. In addition, HIV status and sexual behaviors such as relationship concurrency may also affect condom, modern contraceptive, and dual method use. STUDY DESIGN We surveyed sexually active women (N = 1067) aged 15 to 49 in 12 communities in Kenya and Uganda participating in a test-and-treat trial in 2015 to 2016. Generalized (unordered) multinomial logistic regression models accounting for community clustering examined associations between mobility (overnight travel away from home in past 6 months and any migration within past 2 years) and condom, modern contraceptive (i.e., oral contraceptive pills, injectables, intrauterine devices, implants, vasectomy, tubal ligation; excluding male/female condoms), and dual method use within past 6 months, adjusting for key covariates such as HIV status and relationship concurrency. RESULTS WLHIV relative to HIV-negative women (ratios of relative risk [RRR] = 3.76, 95% confidence interval [CI]: 2.40-5.89), and women in concurrent relative to monogamous relationships (RRR = 4.03, 95% CI 1.9-8.50) had higher odds of condom use alone. In contraceptive use models, WLHIV relative to HIV-negative women were less likely to use modern contraceptive methods alone (RRR = 0.51, 95% CI 0.36-0.73). Relationship concurrency (RRR = 4.51, 95% CI 2.10-9.67) and HIV status (RRR = 3.97, 95% CI 2.43-6.50) were associated with higher odds of dual method use while mobility was marginally associated with higher odds of dual method use (RRR = 1.65, 95% CI 0.99-2.77, p = 0.057). CONCLUSIONS Mobility had a potential impact on dual method use in Kenya and Uganda. In addition, our findings highlight that WLHIV were using condoms and dual methods more, but modern contraceptives less, than HIV-negative women. Those in concurrent relationships were also more likely to use condoms or dual methods. These findings suggest that in a context of high mobility, women may be appropriately assessing risks and taking measures to protect themselves and their partners from unintended pregnancies and acquisition and transmission of HIV. IMPLICATIONS Our findings point to a need to strengthen accessibility of sexual and reproductive health services for both mobile and residentially stable women in settings of high mobility and high HIV prevalence.
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Affiliation(s)
- Joi K. Lee
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA,Corresponding author: Joi Lee, , Advancing New Standards in Reproductive Health (ANSIRH) Program, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), 1330 Broadway, Suite 1100, Oakland, CA 94512
| | - Sarah A. Gutin
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Torsten B. Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
| | - Adam Akullian
- Institute for Disease Modeling (IDM), Seattle, Washington, USA
| | - Sarah Ssali
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda,School of Women and Gender Studies, Makerere University College of Health Sciences, Kampala, Uganda
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA,Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Edwin D. Charlebois
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA,Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
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Hunter LA, Rao A, Napierala S, Kalinjila A, Mnyippembe A, Hassan K, Bertozzi SM, Mfaume R, Njau P, Liu JX, McCoy SI. Reaching Adolescent Girls and Young Women With HIV Self-Testing and Contraception at Girl-Friendly Drug Shops: A Randomized Trial in Tanzania. J Adolesc Health 2023; 72:64-72. [PMID: 36241492 PMCID: PMC9893895 DOI: 10.1016/j.jadohealth.2022.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE We hypothesized that an intervention designed to create girl-friendly drug shops would increase access to sexual and reproductive health products and services among adolescent girls and young women (AGYW) (ages 15-24 years) in Tanzania. METHODS We conducted a four-month randomized trial at 20 drug shops in Shinyanga, Tanzania from August-December 2019 to determine if the Malkia Klabu ("Queen Club") intervention increased AGYW patronage and the provision of HIV self-testing (HIVST), contraception, and health facility referrals to AGYW (primary outcomes). Drug shops were randomized 1:1 to the intervention or comparison arm. All shops were provided with OraQuick HIVST kits to give to AGYW for free. Intervention shops implemented Malkia Klabu, a loyalty program for AGYW created using human-centered design through which AGYW could also access free contraception. We compared outcomes in intention-to-treat analyses using shop observations and shopkeeper records. RESULTS By endline, shops implementing Malkia Klabu had higher AGYW patronage than comparison shops (rate ratio: 4.4; 95% confidence interval: 2.0, 9.8). Intervention shops distributed more HIVST kits (median per shop: 130.5 vs. 58.5, P = .02) and contraceptives (325.5 vs. 7.0, P < .01) to AGYW and provided more referrals for HIV, family planning, or pregnancy services combined (3.5 vs. 0.5, P = .02) than comparison shops. DISCUSSION The Malkia Klabu intervention increased AGYW patronage and the provision of HIVST kits, contraception, and referrals to AGYW at drug shops, despite HIVST kits being freely available at all participating shops. Enhancing drug shops with girl-friendly services may be an effective strategy to reach AGYW with sexual and reproductive health services.
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Affiliation(s)
- Lauren A. Hunter
- School of Public Health; University of California, Berkeley; Berkeley, California, U.S
| | - Aarthi Rao
- Cityblock Health; Boston, Massachusetts, U.S
| | | | | | | | - Kassim Hassan
- Health for a Prosperous Nation; Dar es Salaam, Tanzania
| | - Stefano M. Bertozzi
- School of Public Health; University of California, Berkeley; Berkeley, California, U.S
| | - Rashid Mfaume
- Shinyanga Regional Medical Office; Shinyanga, Tanzania
| | - Prosper Njau
- Health for a Prosperous Nation; Dar es Salaam, Tanzania.,National AIDS Control Program; Ministry of Health, Community Development, Gender, Elderly, and Children; Dar es Salaam, Tanzania
| | - Jenny X. Liu
- Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco; San Francisco, California, U.S
| | - Sandra I. McCoy
- School of Public Health; University of California, Berkeley; Berkeley, California, U.S
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Stoner MCD, Browne EN, Etima J, Musara P, Hartmann M, Shapley-Quinn MK, Kemigisha D, Mutero P, Mgodi NM, Nakabiito C, Bhushan NL, Piper J, van der Straten A, Minnis AM. Couples' decision making regarding the use of multipurpose prevention technology (MPT) for pregnancy and HIV prevention. AIDS Behav 2023; 27:198-207. [PMID: 35776249 PMCID: PMC9805468 DOI: 10.1007/s10461-022-03756-9] [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: 06/11/2022] [Indexed: 01/24/2023]
Abstract
We conducted a secondary analysis of discrete choice experiment (DCE) data from 395 couples enrolled in the Microbicide Trials Network (MTN)-045/CUPID study in Uganda and Zimbabwe to understand couple decision making around choice of multipurpose prevention technologies (MPTs) to prevent both HIV and pregnancy. Members of couples completed the same DCE, first separately then jointly, choosing between two hypothetical MPTs in a series of nine questions. Most couples either had similar preferences at the outset or had equal decision-making around MPTs (62%). Couples with male influence (17%) were more likely to use contraceptive pills with a male partner's knowledge and couples with female influence (21%) were less likely to have shared decision making about family planning. Males influenced discussion around MPT duration, side effects, menstrual changes, and how the vagina feels during sex. Decision making was relatively shared, though decisions around certain attributes were more likely to be dominated by male partners.
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Affiliation(s)
| | | | - Juliane Etima
- Makerere University - Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Petina Musara
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Doreen Kemigisha
- Makerere University - Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Prisca Mutero
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Nyaradzo M Mgodi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Clemensia Nakabiito
- Makerere University - Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | | | - Jeanna Piper
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Maryland, USA
| | - Ariane van der Straten
- ASTRA Consulting, Kensington, CA,, USA
- Department of Medicine, University of California, San Francisco, USA
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12
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Tesfa D, Azanaw MM, Gebremariam AD, Engidaw MT, Tiruneh M, Zemene MA, Anley DT, Dessie AM. Women's independent decision-making power and determinants on not to use contraceptives among currently married women in Ethiopia using demographic and Health Survey data: Multilevel Analysis. BMC Womens Health 2022; 22:541. [PMID: 36550498 PMCID: PMC9773615 DOI: 10.1186/s12905-022-02051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence suggests that couples frequently dispute regarding the desirability of pregnancy, as well as whether or not to employ family planning measures. There are numerous unmet needs owing to partner or family objections, according to a scares study that illustrates women's independent decision-making capacity on whether or not to use a contraceptive. As a result, the purpose of this study was to analyze women's independent decision-making power and determinants of not using contraceptives. METHODS Reproductive age group women aged (15-49 years) currently married who are not pregnant and are currently not using family planning preceding five years the survey was included from the individual record (IR file) file using standard demographic and health survey datasets of Ethiopia. Using multilevel logistic regression models, we investigated the relationship between several independent factors and women's independent decision-making not to use contraception. The adjusted odds ratios were evaluated using 95% confidence intervals. RESULTS A total of 5,598 currently married women were included in this study. Individual level factors significantly associated with women independent decision making on not to use contraceptive were female-led households (AOR = 2.11; 95% CI = 1.60-2.78), being orthodox ( AOR = 1.84; 95% CI = 1.39-2.44 ) and protestant ( AOR = 1.62; 95% CI = 1.17-2.23), and belonging to more than one union (AOR = 1.48; 95% CI = 1.12-1.95). Whereas, low community education (AOR = 1.19; 95%= 1.00-1.49) and regions: in Tigray (AOR = 2.19; 95%CI = 1.51-3.16), Afar (AOR = 1.74; 95% CI = 1.14-2.64), Amhara (AOR = 2.45; 95% CI = 1.71-3.500), South Nations Nationality (AOR = 1.87; 95% CI = 1.32-2.65), Gambela (AOR = 2.58; 95% CI = 1.73-3.84), Hareri (AOR = 3.93; 95% CI = 2.62-5.88), and Dre DDewa (AOR = 1.66; 95% CI = 1.12-2.45) were community-level factors. CONCLUSION Women's independent decision-making power not to use contraceptives was low and greatly affected by both individual and community-level factors. Therefore, it is necessary to develop policies and create programs that promote women's empowerment by incorporating their partners in each region of the nation to encourage women's independent decision-making authority to use or not to use a contraceptive.
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Affiliation(s)
- Desalegn Tesfa
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Melaku Tadege Engidaw
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Jonas K, Lombard C, Chirinda W, Govindasamy D, Appollis TM, Kuo C, Gray G, Beauclair R, Cheyip M, Mathews C. Participation in an HIV prevention intervention and access to and use of contraceptives among young women: A cross sectional analysis in six South African districts. Contraception 2022; 116:51-58. [PMID: 35882358 PMCID: PMC9691588 DOI: 10.1016/j.contraception.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study investigated whether young women's participation in a combination HIV-prevention intervention was associated with accessing and using condoms and other contraceptives. STUDY DESIGN A cross-sectional household survey was conducted from 2017 to 2018 among a representative sample of young women aged 15-24 years old living in six South African districts in which the intervention was implemented. Cross-tabulations and multivariate regression analyses of weighted data were performed to examine access to and use of condoms and other contraceptives. RESULTS In total 4399 young women participated, representing a 60.6% response rate. Of participants, 61.0% (n = 2685) reported accessing condoms and other contraceptives in the past year. Among those who ever had sex (n = 3009), 51.0% used condoms and 37.4% other contraceptives at last sex. Among 15-19 year old, participation in the combination intervention was positively associated with reporting contraceptive use other than condoms at last sex (Prevalence Ratio (PR): 1.36; 95% CI: 1.21-1.53) and reporting use of both condoms and other contraceptives at last sex (PR: 1.45; 95% CI: 1.26-1.68). No associations were observed in the age group 20-24. CONCLUSION Our findings suggest that combination HIV prevention interventions may lead to increased access and use of condoms and other methods of contraception among adolescent women, but this needs to be confirmed in experimental studies. We need to test different or more intensive interventions to increase contraceptive use in young women aged 20-24. IMPLICATIONS Participating in combination HIV prevention interventions that are delivered via multiple approaches may promote access to, and use of condoms and other methods of contraceptives among adolescent women, and thereby help reduce unintended pregnancies.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Unit, Cape Town, South Africa; Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Glenda Gray
- South African Medical Research Unit, Cape Town, South Africa
| | - Roxanne Beauclair
- Department of Science and Innovation (DSI)-National Research Foundation (NRF) Center of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Mireille Cheyip
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ayalew HG, Liyew AM, Tessema ZT, Worku MG, Tesema GA, Alamneh TS, Teshale AB, Yeshaw Y, Alem AZ. Prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa, a multilevel analysis. BMC Womens Health 2022; 22:464. [PMID: 36404306 PMCID: PMC9677641 DOI: 10.1186/s12905-022-02048-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unintended pregnancy predisposes women to unsafe abortion, malnutrition, mental illness, and even death. Though adolescent girls and young women are at higher risk of unintended pregnancy, there is a paucity of evidence in its burden and associated factors in sub-Saharan Africa. Therefore, this study aimed to assess the prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa. METHOD This study was a secondary data analysis of 36 sub-Saharan African countries with a total weighted sample of 17,797 adolescent girls and young women. A multilevel logistic regression model was fitted and, the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported to assess the association between the independent variables and unintended pregnancy in Sub-Saharan Africa. RESULT The pooled prevalence of unintended pregnancy in sub-Saharan Africa was 30.01 with 95% CI (29.38-30.74). In multivariable multilevel logistic regression analysis, adolescent girls, and young women with higher education (AOR = 0.71 95%CI 0.52-0.97), those who know modern contraceptive methods (AOR = 0.86 95%CI 0.75-0.98), and traditional contraceptive methods (AOR = 0.90, 95%CI 0.59-0.95), married (AOR = 0.80, 95%CI 0.73-0.88), those from female-headed households (AOR = 0.86,95%CI 0.78-0.94), had lower odds of unintended pregnancy. Whereas adolescent girls and young women from Central Africa (AOR = 2.09,95%CI 1.23-3.55), southern Africa (AOR = 5.23, 95%CI 2.71-10.09), and Eastern Africa (AOR = 1.07,95%CI 1.07-2.66) had higher odds of unintended pregnancy. CONCLUSION Prevalence of unintended pregnancy in Sub-Saharan Africa is high. Therefore, educating adolescent girls and young women, and improving their knowledge about family planning services is vital. It is also better for the government of countries in sub-Saharan Africa and other global and local stakeholders to work hard to ensure universal access to sexual and reproductive healthcare services, including family planning, education, and the integration of reproductive health into national strategies and programs to reduce unintended pregnancy.
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Affiliation(s)
- Hiwotie Getaneh Ayalew
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
- Department of Human Physiology, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Childbearing intentions, fertility awareness knowledge and contraceptive use among female university students in Cameroon. PLoS One 2022; 17:e0276270. [PMID: 36251661 PMCID: PMC9576058 DOI: 10.1371/journal.pone.0276270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to examine the association between fertility awareness knowledge, and contraceptive use among sexually active female university students (FUS) in Cameroon. METHODS This study was designed as a secondary data analysis of a cross-sectional survey that was conducted between July and August 2018. We extracted and analyzed relevant data (i.e., socio-demographic characteristics, sexual behavior, fertility-related characteristics, and contraceptive use) using a modified Poisson regression with a robust variance estimator. Prevalence Ratios (PR) and 95% confidence intervals were estimated, and statistical significance was set at P≤0.05. RESULTS The median age of the sexually active FUS was 23 years (IQR = 21-25) and 99.3% indicated that they wanted to have children. Only 49.3% knew their fertile period and 62.5% of the sexually active FUS were current contraceptive users. We found a statistically significant association between fertility awareness knowledge and period abstinence (PR = 1.57;95%CI: 1.02-2.44, p = 0.049). In multivariate adjusted models, there was a statistically significant association between fertility awareness knowledge and male condom use (APR = 1.29; 95% CI:1.02-1.64, p-value = 0.032) and the withdrawal method (APR = 1.40;95% CI:1.02-1.93, p = 0.038). We found a statistically significant effect modification of "preferred timing to have children" on the association between fertility awareness knowledge and withdrawal method use. There was no association between fertility awareness knowledge and the use of oral contraceptive pills. CONCLUSION Most of the female students intend to have children in the future, but their fertility awareness knowledge was suboptimal. There was a statistically significant relationship between fertility awareness knowledge, and the use of male condoms and the withdrawal method. The study underscores the need for FUS to be targeted with interventions to help them gain knowledge of their menstrual cycle to better plan or avoid unwanted pregnancy.
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Muacevic A, Adler JR. Knowledge, Attitude and Practices of Postpartum Females Regarding the Acceptance of Immediate Postpartum Contraception: A Cross-Sectional Study From North India. Cureus 2022; 14:e29824. [PMID: 36337806 PMCID: PMC9624235 DOI: 10.7759/cureus.29824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/26/2022] Open
Abstract
The immediate postpartum period is a great time to encourage the acceptance of contraceptive methods; the time is influenced by both emotional and physical factors. At this stage, the administration of intrauterine contraceptives is relatively easier with lesser complications due to the prior obstetric event. A single-center cross-sectional study was conducted using a self-constructed questionnaire-based interview on 331 women in their immediate postpartum period who had delivered a healthy live-born infant. The majority (59.8%) of study participants had unplanned pregnancies. We conducted behavior change communication sessions for postpartum family planning which resulted in 89% of participants accepting the methods with the prime reasons for acceptance being temporary child spacing (41%) and a definitive desire for no more children (34%). The odds were higher in women with more than five pregnancies [adjusted odds ratio (AOR) = 1.951, 95% CI = 1.389-2.925] and women whose last pregnancy was planned [AOR = 1.248, 95% CI = 1.002-3.215].The hindrance to adopt and adhere to postpartum contraception stems from a variety of socio-economic factors which are unique to low-income countries. Individually tailored behavior change communication/counseling approaches may help overcome misconceptions and meet the heterogeneous needs for family planning in the immediate postpartum phase.
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Exposure to mass media family planning messages and associated factors among youth men in Ethiopia. Heliyon 2022; 8:e10544. [PMID: 36110239 PMCID: PMC9468396 DOI: 10.1016/j.heliyon.2022.e10544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/11/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Family planning programs usually focus information and messaging on women and girls. However, they may not be the primary decision-makers about their own contraceptive choice and utilization. Hence, this study aimed to assess youth men's exposure to family planning messages and associated factors in Ethiopia. Method The study used data for analysis from the 2016 Ethiopian demographic and health survey data set. A total of 7,639 youth men have been included in this analysis. Statistical package for social science version 20 has been used for data analysis. We have used multivariable logistic regression analysis to identify the association of independent variables with the outcome variable. Adjusted odds ratio with 95 % confidence interval was used to declare significant statistical association. Result The mean age of participants was 19.02 years with a standard deviation of ±2.83. The proportion of youths who have exposure to family planning messages was 34.7 % (33.7%, 35.7%). Owning mobile phone (AOR = 1.49, 95% CI: 1.12–1.97, using internet (AOR = 1.90, 95% CI: 1.33–2.73), knowing where to obtain family planning (AOR = 4.28, 95% CI:3.08–5.95), educational status of primary (AOR = 1.98, 95% CI:1.36–2.86) secondary (AOR = 3.01,95% CI:1.94–4.67) and higher (AOR = 6.01,95% CI:3.24–11.16) were the factors associated with the outcome variable. Also, the odds of exposure of youths who agree contraception is women's business was lower (AOR = 0.55, 95% CI: 0.35–0.85). Conclusion Only one-third of youths have exposure to family planning messages. Educational status, owning a mobile phone, knowing where to obtain family planning methods, use of the internet, and considering family planning as a women's business were the factors that have an association with the outcome variable. So it is important to improve the education level of youths, to inform youths about different outlets through which family planning messages will be transmitted, and avert youth's misconception towards contraception.
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Women’s Decision-Making Power on Modern Family Planning Use and Its Associated Factors in Northwest Ethiopia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9060809. [PMID: 35865670 PMCID: PMC9296305 DOI: 10.1155/2022/9060809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
Introduction Poor decision-making power on family planning among married women is a public health concern. Despite this, there is a scarcity of research done on decision-making power of family planning use as one of their basic human rights. The study is aimed at determining the magnitude of married women's decision-making power on family planning use and its associated factors. Methods This was a community-based cross-sectional study that was conducted on married women from May, 01-30/2021. A multistage systematic random sampling technique was applied to select 620 eligible study participants. The study used semi-interviewer questionnaires to collect data, and the collected data were entered into EpiInfo version 3.7.2 and then exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression analyses were used. The strength of associations of variables was described by using odds ratio, 95% confidence level, and P values less than 0.05. Results A total of 620 women were interviewed with 98% of the response rate. Overall, married women's decision-making power on family planning was 440 (71.0%). Odds of decision-making power on family planning use were higher among women who have primary education (AOR = 11.31, CI: 4.90-26.09) and secondary and above (AOR = 6.99, CI: 3.89-12.56) as compared with those who have no education. Husbands with secondary and above educational level (AOR = 3.27, CI: 1.58-6.78), having good knowledge about family planning use (AOR = 2.41, CI: 1.48-3.95) and having a good attitude towards family planning (AOR = 6.59, CI: 4.01-10.75), had higher odds of decision-making power on family planning. Conclusion Women's educational status, knowledge, and attitude increased the odds of decision-making power on family planning. Therefore, the authors recommend awareness creation on family planning considering lower educational level as a priority to improve women's decision-making power.
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Gertz AM, Soffi ASM, Mompe A, Sickboy O, Gaines AN, Ryan R, Mussa A, Bawn C, Gallop R, Morroni C, Crits-Christoph P. Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes. Front Glob Womens Health 2022; 3:815634. [PMID: 35663924 PMCID: PMC9157818 DOI: 10.3389/fgwh.2022.815634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction To develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians. Methods A list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice "best-worst scaling" approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined. Results For 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based "most-preferred" method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93. Conclusions A best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.
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Affiliation(s)
- Alida M. Gertz
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Atlang Mompe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Robert Gallop
- West Chester University, West Chester, PA, United States
| | - Chelsea Morroni
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Medical Research Council (MRC) University of Edinburgh Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Paul Crits-Christoph
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Demissie GD, Akalu Y, Gelagay AA, Alemnew W, Yeshaw Y. Factors associated with decision-making power of married women to use family planning in sub-Saharan Africa: a multilevel analysis of demographic health surveys. BMC Public Health 2022; 22:837. [PMID: 35473613 PMCID: PMC9044612 DOI: 10.1186/s12889-022-13251-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background In sub-Saharan Africa, there are several socio-economic and cultural factors which affect women’s ability to make decision regarding their own health including the use of contraceptives. Therefore, the main aim of this study was to determine factors associated with decision-making power of married women to use family planning service (contraceptives) in sub-Saharan Africa. Methods The appended, most recent demographic and health survey datasets of 35 sub-Saharan countries were used. A total weighted sample of 83,882 women were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of decision-making power of married women to use family planning service in sub-Saharan countries. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential variables included in the final model. Results Married women with primary education (AOR = 1.24; CI:1.16,1.32), secondary education (AOR = 1.31; CI:1.22,1.41), higher education (AOR = 1.36; CI:1.20,1.53), media exposure (AOR = 1.08; CI: 1.03, 1.13), currently working (AOR = 1.27; CI: 1.20, 1.33), 1–3 antenatal care visits (AOR = 1.12; CI:1.05,1.20), ≥ 4 ANC visits (AOR = 1.14;CI:1.07,1.21), informed about family planning (AOR = 1.09; CI: 1.04, 1.15), having less than 3 children (AOR = 1.12; CI: 1.02, 1.23) and 3–5 children (AOR = 1.08; CI: 1.01, 1.16) had higher odds of decision-making power to use family planning. Mothers who are 15–19 (AOR = 0.61; CI: 0.52, 0.72), 20–24 (AOR = 0.69; CI: 0.60, 0.79), 25–29 (AOR = 0.74; CI: 0.66, 0.84), and 30–34 years of age (AOR = 0.82; CI: 0.73, 0.92) had reduced odds off decision-making power to use family planning as compared to their counterparts. Conclusion Age, women’s level of education, occupation of women and their husbands, wealth index, media exposure, ANC visit, fertility preference, husband’s desire in terms of number of children, region and information about family planning were factors associated with decision-making power to use family planning among married women.
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Affiliation(s)
- Getu Debalkie Demissie
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box, 196, Gondar, Ethiopia.
| | - Yonas Akalu
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box, 196, Gondar, Ethiopia
| | - Abebaw Addis Gelagay
- Department of Reproductive health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box, 196, Gondar, Ethiopia
| | - Wallelign Alemnew
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box, 196, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box, 196, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box, 196, Gondar, Ethiopia
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Mambo SB, Sikakulya FK, Ssebuufu R, Mulumba Y, Wasswa H, Mbina SA, Rusatira JC, Bhondoekhan F, Kamyuka LK, Akib SO, Kirimuhuzya C, Nakawesi J, Kyamanywa P. Challenges in Access and Utilization of Sexual and Reproductive Health Services Among Youth During the COVID-19 Pandemic Lockdown in Uganda: An Online Cross-Sectional Survey. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:705609. [PMID: 36303975 PMCID: PMC9580707 DOI: 10.3389/frph.2021.705609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/24/2021] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Sexual and Reproductive Health access to Information services is still a pressing need for youth in Uganda even during the COVID-19 pandemic, which has disrupted health care access in many countries. The aim of this study was to explore the challenges in access and utilization of sexual and reproductive health services as faced by youth during the COVID-19 pandemic lockdown in Uganda. METHODS This was a cross-sectional study carried out from 28th April 2020 to 11th May 2020 in Uganda. An online questionnaire was disseminated to youth aged between 18 and 30 years over a period of 14 days. The snowball sampling method was used to recruit participants. STATA version 14.2 was used for statistical analysis. RESULTS Of 724 participants, 203 (28%) reported that they did not have access to information and/or education concerning sexual and reproductive health (SRH). More than a quarter of the participants (26.9%, n = 195) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown, and 27.2% could not obtain contraceptive supplies. Access to HIV/AIDS care services and menstrual supplies was also impaired. Lack of transportation was the commonest factor cited as limiting access to SRH services during the lockdown (68.7%), followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and the curfew (39.1%). Sexually transmitted infections were the commonest SRH problems related to SRH during the lockdown (40.4%) followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Marital, educational, and employment status were significantly correlated with the reported experiences of the participants. CONCLUSION Access to SRH information and services for Ugandan youth was restricted during the COVID-19 lockdown and leaving them vulnerable to various SRH risks and adverse outcomes. Lack of transportation, long distances to health facilities, and high cost of services were important limiting factors. The Government and other stakeholders should incorporate SRH among the priority services to be preserved during future outbreaks.
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Affiliation(s)
- Simon Binezero Mambo
- Department of Public Health, School of Allied Health Sciences, Kampala International University Western Campus, Kampala, Uganda
- Youth Alliance for Reproductive Health, Goma, Democratic Republic of the Congo
| | - Franck Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
| | - Yusuf Mulumba
- Biostatistics, Cancer Institute, Makerere University, Kampala, Uganda
| | | | - Solomon Adomi Mbina
- Department of Public Health, School of Allied Health Sciences, Kampala International University Western Campus, Kampala, Uganda
| | - Jean Christophe Rusatira
- Johns Hopkins Bloomberg School of Public Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, MD, United States
| | - Fiona Bhondoekhan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Louis K. Kamyuka
- Department of HIV/TB (CHAI Clinic), Kampala International University Teaching Hospital, Kampala, Uganda
| | - Surat Olabisi Akib
- Department of Pathology, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Kampala, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University Western Campus, Kampala, Uganda
| | - Jane Nakawesi
- Department of Paediatrics, Mildmay Uganda Hospital, Wakiso, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
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Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey. BMC Pregnancy Childbirth 2022; 22:17. [PMID: 34991501 PMCID: PMC8734335 DOI: 10.1186/s12884-021-04371-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. Methods The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. Results Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30–34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15–19 years (AOR = 0.55; 95% CI: 0.32–0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3–4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1–2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. Conclusion The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.
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Ahissou NCA, Benova L, Delvaux T, Gryseels C, Dossou JP, Goufodji S, Kanhonou L, Boyi C, Vigan A, Peeters K, Sato M, Matsui M. Modern contraceptive use among adolescent girls and young women in Benin: a mixed-methods study. BMJ Open 2022; 12:e054188. [PMID: 34983766 PMCID: PMC8728422 DOI: 10.1136/bmjopen-2021-054188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The study aimed to assess the determinants of modern contraceptive method use among young women in Benin. DESIGN A mixed-methods design. SETTING AND PARTICIPANTS We used the Benin 2017-2018 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals in Benin. The participants were purposively selected. OUTCOMES Contraceptive prevalence rate, unmet need for modern method and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilisation of modern methods were assessed in the qualitative part. RESULTS Overall, 8.5% (95% CI 7.7% to 9.5%) among young women ages 15-24 were using modern contraceptives and 13% (12.1% to 14.0%) among women ages 25 or more. Women 15-24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared with women ages 25 or more. 60.8% (56.9% to 64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women's fertility, spousal consent and the use of non-modern contraceptives. CONCLUSION Contraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by sociodemographic factors and social norms. Appropriate interventions might promote comprehensive sexuality education, increase community engagement, provide youth-friendly services and address gender inequalities.
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Affiliation(s)
- Noudéhouénou Crédo Adelphe Ahissou
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte Gryseels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sourou Goufodji
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Lydie Kanhonou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Christelle Boyi
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Armelle Vigan
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Koen Peeters
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Miho Sato
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
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Bhushan NL, Phanga T, Maseko B, Vansia D, Kamtsendero L, Gichane MW, Maman S, Pettifor AE, Rosenberg NE. Contraceptive Conversations among Adolescent Girls and Young Women and Their Partners, Peers, and Older Female Family Members in Lilongwe, Malawi: A QualitativeAnalysis. Stud Fam Plann 2021; 52:397-413. [PMID: 34585384 PMCID: PMC8664985 DOI: 10.1111/sifp.12174] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In sub-Saharan Africa, adolescent girls and young women (AGYW) have high levels of unmet need for contraception, particularly those who are unmarried or nulliparous. Conversations with partners, peers, and family members influence AGYW contraceptive decision-making yet little is known about conversation content and impact or how they vary by relationship status and parity. This paper draws on qualitative data from 60 AGYW (aged 15-24) participating in a sexual and reproductive health study in Malawi to examine contraceptive conversation patterns among participants and their social ties. AGYW's relationship status and parity influenced whether they talked about contraceptives, who they talked to about contraceptives, and the type of contraceptives that were endorsed during conversations. Unmarried and nulliparous AGYW were less likely to discuss contraceptives with all social ties and when conversations occurred, norms and misinformation regarding nonbarrier methods were reinforced, and condoms were largely prescribed. Conversations with intimate partners often provided permission for contraceptive use while conversations with peers and older women in the family provided information on contraceptive methods. Our results highlight the unique roles that social ties play in AGYW contraceptive decision-making and suggest that existing contraceptive conversation patterns might exclude unmarried, nulliparous AGYW from accurate and comprehensive contraceptive information and options.
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Affiliation(s)
- Nivedita L Bhushan
- RTI International, Center for Communication Science, Research Triangle Park, NC, United States
| | | | | | | | | | - Margaret W Gichane
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, CA, United States
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nora E Rosenberg
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Usso AA, Adem HA, Dessie Y, Tura AK. Utilization of Immediate Postpartum Long Acting Reversible Contraceptives among Women Who Gave Birth in Public Health Facilities in Eastern Ethiopia: A Cross-Sectional Study. Int J Reprod Med 2021; 2021:1307305. [PMID: 34805394 PMCID: PMC8598333 DOI: 10.1155/2021/1307305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Although importance of postpartum family planning is essential and immediate postpartum insertion of long acting and reversible contraceptives (LARC) is recommended, evidence on its uptake and associated factors is limited in Ethiopia. This study was conducted to assess utilization of immediate postpartum LARC among women who gave birth in selected public health facilities in eastern Ethiopia. METHOD An institution-based cross-sectional study was conducted among randomly selected women who gave birth in selected public health facilities in eastern Ethiopia from 10 March to 09 April 2020. At discharge, all eligible women who gave birth in the facilities were interviewed using a pretested structured questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with utilization of immediate postpartum LARC. Adjusted odds ratio (aOR) with 95% confidence interval was used to report association, and significance was declared at p value < 0.05. RESULTS From a total of 546 women invited to the study, 530 (97.1%) participated in the study and 98 (18.5%; 95% CI: 15.1%, 22.0%) reported starting long acting reversible contraceptives. Women who reported discussing about contraceptives with partners (aOR = 6.69, 95% CI: 3.54, 12.61) and receiving postpartum counselling on contraceptives (aOR = 5.37, 95% CI: 3.00, 9.63) were more likely to using contraception. However, women who live >30-minute walking distance from the nearest health facility (aOR = 0.47, 95% CI: 0.26, 0.85) and reported disrespect and abuse during childbirth (aOR = 0.22, 95% CI: 0.12, 0.40) were less likely to start LARC. CONCLUSIONS Almost one in five women delivering in public health facilities in eastern Ethiopia started using LARC. Provision of respectful maternity care including counselling on the importance of immediate postpartum family planning is essential for increasing its uptake.
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Affiliation(s)
- Ahmedin Aliyi Usso
- School of Nursing and Midwifery, College of Health and Medical Sciences, Jijjiga University, Jijjiga, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Boamah-Kaali EA, Mevissen FEF, Owusu-Agyei S, Enuameh Y, Asante KP, Ruiter RAC. A Qualitative Exploration of Factors Explaining Non-Uptake of Hormonal Contraceptives Among Adolescent Girls in Rural Ghana: The Adolescent Girls' Perspective. Open Access J Contracept 2021; 12:173-185. [PMID: 34764703 PMCID: PMC8577562 DOI: 10.2147/oajc.s320038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adolescent pregnancy remains a public health concern globally. The use of hormonal contraceptive methods are proven ways of preventing pregnancies and in turn unsafe abortions. However, research shows that use of hormonal contraceptive methods is rather low among African adolescent girls, of which Ghana is no exception. OBJECTIVE This manuscript uses the socio-ecological model to guide our understanding of the factors associated with non-use of hormonal contraceptives among adolescent girls in Ghana. METHODS An explorative study was done using qualitative data collection methods. Two focus group discussions and sixteen in-depth interviews were conducted among adolescent girls aged 15-19 years (N = 38) in the Kintampo area of Ghana to determine factors affecting uptake of hormonal contraceptives. RESULTS Adolescents showed a lack of in-depth knowledge related to the different hormonal contraceptive types. Negative attitudes towards adolescent hormonal contraceptive use, fear of real and perceived side effects of hormonal contraceptives, lack of self-efficacy to use contraceptives, fear of disclosure of use and fear of societal stigma related to sexual intercourse and its related issues among adolescents may explain why adolescent girls in this context do not use hormonal contraceptive methods. CONCLUSION To promote hormonal contraceptives among adolescent girls, a combination of multifaceted social-psychological, personal and community level interventions are needed.
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Affiliation(s)
- Ellen Abrafi Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Fraukje E F Mevissen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Municipal Public Health Service Rotterdam-Rijnmond, Department of Public Health, Rotterdam, the Netherlands
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
- Department of Epidemiology & Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
| | - Robbert A C Ruiter
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Factors Associated with Condom Knowledge, Attitude, and Use among Black Heterosexual Men in Ontario, Canada. ScientificWorldJournal 2021; 2021:8862534. [PMID: 34566521 PMCID: PMC8463252 DOI: 10.1155/2021/8862534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/03/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
African, Caribbean, and Black (ACB) men living in Canada share a heightened risk of HIV infection and the associated risk factors such as suboptimal use of family planning services such as condom use. In this study, we assessed the factors associated with knowledge, attitude, and condom use among ACB men in Ontario. Methods. This was a cross-sectional study that surveyed heterosexual ACB men regardless of their residency status living in Ontario (n = 430). This is a part of a larger mixed methods study informed by critical race theory, intersectionality, and community-based participatory research (CBPR). Outcome variables were knowledge of condom use, attitude towards condom use, and actual use of condom during the last 12 months. Results. Of 430 participants, 77.70% has good knowledge of condom use as a protection against HIV transmission, 31.77% had positive attitude towards condom use, and 62.43% reported using condom regularly with casual partners during the last 12 months. Men who were currently married had more positive attitude towards condom use compared with their unmarried counterparts (odds ratio = 1.46, 95% CI = 1.20, 1.78). Canadian residents were found to have higher odds of having correct knowledge of condom (odds ratio = 1.31, 95% CI = 1.11, 1.55), and positive attitude towards condom use (odds ratio = 1.44, 95%CI = 1.09, 1.92). Men who visited sexual health clinics showed a positive association with having correct knowledge of condom (odds ratio = 1.78, 95% CI = 1.30, 2.44) and reported experiences of difficulty in accessing sexual health. This showed a negative association towards condom use (odds ratio = 0.45, 95% CI = 0.21, 0.97]. Conclusion. A considerable percentage of heterosexual ACB men did not have correct knowledge regarding the protective effect of condom use against HIV and positive attitude towards the use of condom. Several sociodemographic and healthcare-related factors were significantly associated with knowledge, attitude, and use of condom.
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Bolarinwa OA, Nwagbara UI, Okyere J, Ahinkorah BO, Seidu AA, Ameyaw EK, Igharo V. Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries. Int Health 2021; 14:492-500. [PMID: 34405873 PMCID: PMC9450634 DOI: 10.1093/inthealth/ihab053] [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: 03/06/2021] [Revised: 06/10/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Long-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA). Methods Secondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15–49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05. Results The prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child. Conclusions The use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Ugochinyere Ijeoma Nwagbara
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast,PMB, Ghana
| | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast,PMB, Ghana.,College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Queensland, QLD4811, Australia.,Department of Estate Management, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana
| | | | - Victor Igharo
- John's Hopkins Centre for Communications Programs, 111 Market Place Suite 310 Baltimore, MD, USA
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Some SYM, Pu C, Huang SL. Empowerment and use of modern contraceptive methods among married women in Burkina Faso: a multilevel analysis. BMC Public Health 2021; 21:1498. [PMID: 34344339 PMCID: PMC8336087 DOI: 10.1186/s12889-021-11541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso. METHODS We analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors. RESULTS Overall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS. CONCLUSIONS Empowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights. TRIAL REGISTRATION No clinical trial has been performed in this study.
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Affiliation(s)
- Sylvain Y. M. Some
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Christy Pu
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Song-Lih Huang
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
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Muhoza P, Koffi AK, Anglewicz P, Gichangi P, Guiella G, OlaOlorun F, Omoluabi E, Sodani PR, Thiongo M, Akilimali P, Tsui A, Radloff S. Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption. Health Policy Plan 2021; 36:273-287. [PMID: 33454786 PMCID: PMC8058948 DOI: 10.1093/heapol/czaa197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception, oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.
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Affiliation(s)
- Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP) of the Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | | | | | | | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Pierre Akilimali
- Ecole de Santé Publique de l'Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Hunter LA, McCoy SI, Rao A, Mnyippembe A, Hassan K, Njau P, Mfaume R, Liu JX. Designing drug shops for young women in Tanzania: applying human-centred design to facilitate access to HIV self-testing and contraception. Health Policy Plan 2021; 36:1562-1573. [PMID: 34313728 PMCID: PMC8597958 DOI: 10.1093/heapol/czab084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022] Open
Abstract
Adolescent and young adult women in sub-Saharan Africa experience barriers to sexual and reproductive health (SRH) services that elevate their risk of human immunodeficiency virus (HIV) acquisition and unintended pregnancy. Community drug shops may be effective distribution points to connect young women with SRH products. Thus, we used human-centred design (HCD) to create drug shops where young women could access HIV self-testing and contraception in Shinyanga, Tanzania. Enhancing the HCD process with behavioural science, we collected diverse data (i.e. 18 in-depth interviews, 9 ‘shadowing’ interviews, 6 shop observations, 6 focus groups) to understand the latent needs and motivations of young women and drug shopkeepers, brainstormed creative solutions and iteratively refined and tested solutions for acceptability, feasibility and cultural fit. We found a widespread moral imperative to control young women’s behaviour via misinformation about SRH, community gossip and financial control. Young women often engaged in mundane shopping at the behest of others. At drug shops, few SRH products were deemed appropriate for unmarried women, and many reactively sought SRH products only after engaging in higher risk behaviours. In response to these insights, we designed the ‘Malkia Klabu’ (‘Queen Club’) loyalty programme through which young women could earn mystery prizes by shopping at drug shops and discreetly request free SRH products, including HIV self-test kits, by pointing at symbols on loyalty cards. Our HCD approach increases the likelihood that the intervention will address the specific needs and preferences of both drug shopkeepers and young women. We will evaluate its effectiveness in a randomized trial.
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Affiliation(s)
- Lauren A Hunter
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA
| | - Sandra I McCoy
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA
| | - Aarthi Rao
- Design and Innovation Lab, CVS Health, Boston, MA, USA
| | - Agatha Mnyippembe
- Health for a Prosperous Nation, PO Box 13560, Dar es Salaam, Tanzania
| | - Kassim Hassan
- Health for a Prosperous Nation, PO Box 13560, Dar es Salaam, Tanzania
| | - Prosper Njau
- Health for a Prosperous Nation, PO Box 13560, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Rashid Mfaume
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Jenny X Liu
- Institute for Health and Aging, Bixby Center for Global Reproductive Health, 490 Illinois Street, San Francisco, CA 94158, USA
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Pozuelo JR, Kilford EJ. Adolescent health series: Adolescent neurocognitive development in Western and Sub-Saharan African contexts. Trop Med Int Health 2021; 26:1333-1344. [PMID: 34270856 DOI: 10.1111/tmi.13656] [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: 11/29/2022]
Abstract
The transitional period of adolescence has long been associated with physical, social and behavioural change. During this time, adolescents start to develop their own self-identity, make important life decisions and acquire the necessary skills to successfully transition to adulthood. More recently, advances in brain imaging technology have enabled increased understanding of structural and functional changes in the human brain during this developmental period, and how they relate to social, emotional, motivational and cognitive development. The ability to integrate these developing cognitive processes in increasingly complex social contexts is a key aspect of mature decision-making, which has implications for adolescent health, educational, economic and social outcomes. Insights from the field of developmental cognitive neuroscience could increase our understanding of this influential stage of life and thus inform potential interventions to promote adolescent health, a critical goal for global health research. Many social changes occur during adolescence and the social environment shapes both brain and cognitive development and the decisions adolescents make. Thus, it is important to study adolescent neurocognitive development in socio-cultural context. Yet, despite evidence from Western studies that socio-cultural and economic factors impact on adolescent neurocognitive development, existing studies of adolescent neurocognitive development in sub-Saharan Africa are relatively scarce. We summarise research findings from Western and sub-Saharan African contexts and highlight areas where research is lacking. Longitudinal studies from more diverse global samples will be needed to build a comprehensive model of adolescent development, that characterises both commonalities in developmental trajectories, as well as the way these can meaningfully differ between both individuals and contexts.
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Affiliation(s)
- Julia R Pozuelo
- Department of Psychiatry, University of Oxford, Oxford, UK.,Centre for the Study of African Economies, Blavatnik School of Government and Economics Department, University of Oxford, Oxford, UK
| | - Emma J Kilford
- Institute of Cognitive Neuroscience, University College London, London, UK.,Department of Clinical, Educational & Health Psychology, University College London, London, UK
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Henry EG, Agula C, Agyei-Asabere C, Asuming PO, Bawah AA, Canning D, Shah I. Dynamics of Emergency Contraceptive Use in Accra, Ghana. Stud Fam Plann 2021; 52:105-123. [PMID: 34110017 DOI: 10.1111/sifp.12154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recent data suggest increasing rates of emergency contraception (EC) use in Ghana, particularly in urban areas. In 2018, we collected survey data from 3,703 sexually experienced women aged 16-44 years living in low-income settlements of Accra. We estimated the prevalence of lifetime and current EC use. Multivariate logistic regression was used to assess factors associated with current use of EC. Retrospective monthly calendar data on contraceptive use were analyzed to identify patterns of EC use, including repeat and continuous use, and uptake of other contraceptive methods in the months following EC use. Nearly 15 percent of women had ever used EC. About half of recent EC users (52 percent) used EC for at least four months cumulatively within a 12-month window. There was no evidence of adoption of other modern methods in the months after using EC. Our results suggest that EC is a common method for pregnancy prevention in Accra, particularly among young, unmarried, highly educated women. Counseling on effective EC use and strategies that promote equitable access should be prioritized.
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Unintended pregnancy resolution among parous women in twelve low- and middle-income countries. J Biosoc Sci 2021; 54:698-724. [PMID: 34024306 DOI: 10.1017/s0021932021000225] [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: 11/07/2022]
Abstract
Around 40% of pregnancies worldwide are unintended and a half of those are terminated. Yet, few international comparisons of unintended pregnancy resolution (choosing birth or abortion) exist. This study analysed how parous women's pregnancy intentions and abortion decisions are associated with their reproductive histories and country contexts using twelve Demographic and Health Surveys representing four context groups: post-Soviet/communist and Asian countries with liberal abortion legislation, and Asian and Latin American countries with restrictive abortion legislation. Similarities were found across contexts: preference to have children of both sexes, space births, stop childbearing after reaching desired family size and an increased likelihood of unintended pregnancy when using less-effective contraceptive methods versus none. Contextual factors most clearly associated with reports of unintended pregnancy resolution were type of abortion legislation and living in post-Soviet/communist contexts. Women's propensity to report abortions and unintended pregnancy varied by context and the decision-making processes for pregnancy versus fertility management were different.
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35
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Moges Mittiku Y, Tamiru AT, Rade BK. The significant influence of history of induced abortion on the utilisation of long-acting reversible contraceptive methods in the immediate post abortion period, Northern Ethiopia. EUR J CONTRACEP REPR 2021; 26:367-373. [PMID: 33860731 DOI: 10.1080/13625187.2021.1901878] [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: 10/21/2022]
Abstract
BACKGROUND Rapid population growth, untended pregnancy, and related consequences remain the concern of Sub-Saharan African countries, including Ethiopia. Despite this, long-acting reversible contraceptives methods are still underutilised and no studies have sought the factors in this study setting. Therefore, this study conducted to assess the prevalence and determining factors of long-acting reversible contraceptives utilisation following an abortion in Northern Ethiopia. METHOD Facility-based cross-sectional study design was employed. A total of340 post aborted women selected by a systematic sampling method from August 1 to October 30, 2018. Data were entered into Epi-Info version 7 software and exported to SPSS version 20 for analysis. Both bivariate and multivariate logistic regression models were used to identify factors associated with the outcome variable. RESULTS The overall post-abortion long-acting reversible contraceptives utilisation was 57(16.76%) with 47(82.46%) implantand 10 (17.54%) intrauterine devices. Age range 20-29 years (AOR = 0.09, 95% CI 0.02-0.37), employed (AOR = 5.22, 95% CI 1.99-13.67), had ≥2 alive children (AOR = 7.02, 95% CI 1.58-31.23), induced abortion (AOR = 8.41, 95% CI 3.28-21.59), surgical abortion (AOR = 5.99, 95% CI 2.25-15.94), previous awareness (AOR = 3.18, 95% CI 1.14-8.82) and history of prior utilisation (AOR = 3.59, 95% CI 1.08-11.97) were the factors significantly associated with utilisation of post-abortion long-acting reversible contraceptives. CONCLUSION Long-acting reversible contraceptive methods level of utilisation following an abortion in this study was low. Advocating and raising awareness should always consider on benefits and effectiveness of long-acting reversible contraceptives for all type of abortion and methods of termination as an integral part of reproductive health care services.
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Affiliation(s)
- Yohannes Moges Mittiku
- Department of Midwifery, Institute of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Animut Tagele Tamiru
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bayew Kelkay Rade
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abose A, Adhena G, Dessie Y. Assessment of Male Involvement in Long-Acting and Permanent Contraceptive Use of Their Partner in West Badewacho, Southern Ethiopia. Open Access J Contracept 2021; 12:63-72. [PMID: 33664602 PMCID: PMC7924250 DOI: 10.2147/oajc.s297267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Male involvement in family planning use particularly in long-acting and permanent contraceptive methods (LAPCM) is a key strategy to reduce fertility, and promote maternal and child health. Despite this, little is known about male involvement in LAPCM use of their partners in Africa, particularly in Ethiopia. This study aimed to assess male involvement in long-acting and permanent contraceptive method use in west Badewacho district, Southern Ethiopia. METHODS A community-based cross-sectional study was conducted among 564 participants from April 1 to 30/2019. A multi-stage sampling technique was used to select eligible participants. A pre-tested, structured, and interviewer-administered questionnaire was used. Binary and multivariable logistic regression analysis was done to identify associated factors. The adjusted odds ratio with 95% CI was estimated to show the direction and strength of the association. Variables with p<0.05 were considered statistically significant. RESULTS About 108 (19.9%, 95% CI: (16.8, 23.2)) participants were involved in LAPCM use. Being urban dweller [AOR=3.13; 95% CI: (1.58, 6.19)], discussion with wives about LAPCM [AOR=2.81; 95% CI: (1.64, 4.8)], having good knowledge about LAPCM [AOR=2.55; 95% CI: (1.42, 4.57)], and positive attitude towards LAPCM [AOR=2.16; 95% CI: (1.16, 4.02)] were significantly associated factors. CONCLUSION Overall, the male involvement in LAPCM use was low. Enhancing male involvement in family planning use through creating community awareness, encouraging inter-spousal communication to enhance decision making, and increasing positive attitude towards LAPCM in the community is crucial to decrease the problem.
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Affiliation(s)
- Abera Abose
- Department of Reproductive Health, West Badewacho, Ethiopia
| | - Girmay Adhena
- Department of Reproductive Health, Tigray Regional Health Bureau, Tigray, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Ontiri S, Mutea L, Naanyu V, Kabue M, Biesma R, Stekelenburg J. A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya. Reprod Health 2021; 18:33. [PMID: 33563304 PMCID: PMC7871615 DOI: 10.1186/s12978-021-01094-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. METHODS Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. RESULTS Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods. CONCLUSION This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.
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Affiliation(s)
- Susan Ontiri
- Jhpiego Corporation, Johns Hopkins University Affiliate, Nairobi, Kenya. .,Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.
| | | | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Mark Kabue
- Jhpiego Corporation, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Regien Biesma
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Otim J. Contraceptive nonuse among women in Uganda: a comparative assessment of predictors across regions. BMC Womens Health 2020; 20:275. [PMID: 33334342 PMCID: PMC7745472 DOI: 10.1186/s12905-020-01148-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contraceptive nonuse has diverse effects on women, such as unintended pregnancies and births that result in high fertility and poor maternal health outcomes. In Uganda, knowledge on contraceptive use is high, amidst undesirably high contraceptive nonuse and scarce literature on predictors of contraceptive nonuse across regions. This study assessed factors associated with contraceptive nonuse among women of reproductive age across regions in Uganda. METHOD This study used data from a cross-sectional 2016 Uganda demographic and heath survey that had 18,506 women of reproductive age. The relationship between contraceptive nonuse and socio-economic and demographic factors across regions were assessed using a binary multivariable logistic regression model. RESULTS In Uganda, contraceptive nonuse is estimated at 40%. Northern region (55%) had the highest prevalence of contraceptive nonuse compared to Central region (35%) with the lowest. Across regions, wealth index, number of living children, educational level, and children born in the last 5 years prior to the demographic survey differently predicted contraceptive nonuse. Conversely, age, religion, age at first marriage, sexual autonomy, age at first birth, desire for children, listening to radio, and employment status were only predictors of contraceptive nonuse in particular regions amidst variations. Residence, perception of distance to health facility, watching television, and reading newspapers or magazines did not predict contraceptive nonuse. CONCLUSIONS The study findings propose the need to appreciate regional-variations in effect of contraceptive nonuse predictors and therefore, efforts should be directed towards addressing regional-variations so as to attain high contraceptive usage across regions, and thus reduce on unwanted pregnancies and births.
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Affiliation(s)
- Jude Otim
- Department of Sociology and Social Administration, Kyambogo University, P.O. Box 1, Kyambogo, Kampala, Uganda.
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Khan MN, Harris ML, Loxton D. Assessing the effect of pregnancy intention at conception on the continuum of care in maternal healthcare services use in Bangladesh: Evidence from a nationally representative cross-sectional survey. PLoS One 2020; 15:e0242729. [PMID: 33216799 PMCID: PMC7678970 DOI: 10.1371/journal.pone.0242729] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background The Continuum of Care (CoC; defined as accessing the recommended healthcare services during pregnancy and the early postpartum period) is low in lower-middle-income countries (LMICs). This may be a major contributor to the high rates of pregnancy-related complications and deaths in LMICs, particularly among women who had an unintended pregnancy. With a lack of research on the subject in Bangladesh, we aimed to examine the effect of unintended pregnancy on CoC. Methods Data from 4,493 mother-newborn dyads who participated in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Women’s level of CoC was generated from responses to questions on the use and non-use of three recommended services during the course of pregnancy: four or more antenatal care (ANC) visits, skilled birth attendance (SBA) during delivery, and at least one postnatal care (PNC) visit within 24 hours of giving birth. Global recommendations of service use were used to classify CoC as high (used each of the recommended services), moderate (used at least two of the three recommended services), and low/none (no PNC, no SBA, and ≤3 ANC visits). Women’s pregnancy intention at the time of conception of their last pregnancy (ending with a live birth) was the major exposure variable, classified as wanted, mistimed, and unwanted. Unadjusted and adjusted (with individual-, household-, and community-level factors) multilevel multinomial logistic regression models were used to assess the association between unintended pregnancy and level of CoC. Results In Bangladesh, the highest level of CoC occurred in only 12% of pregnancies that ended with live births. This figure was reduced to 5.6% if the pregnancy was unwanted at conception. The antenatal period saw the greatest drop in CoC, with 65.13% of women receiving at least one ANC visit and 26.32% having four or more ANC visits. Following the adjustment of confounders, an unwanted pregnancy was found to be associated with 39% and 62% reduced odds of women receiving moderate and high levels of CoC, respectively, than those with a wanted pregnancy. Having a mistimed pregnancy was found to be associated with a 31% reduction in odds of women achieving a high CoC than women with a wanted pregnancy. Conclusion Almost nine in ten women did not achieve CoC in their last pregnancy, which was even higher when the pregnancy was unintended. Given that the ANC period has been identified as a critical time for intervention for these women, it is necessary for policies to scale up current maternal healthcare services that provide in-home maternal healthcare services and to monitor the continuity of ANC, with a particular focus on women who have an unintended pregnancy. Integration of maternal healthcare services with family planning services is also required to ensure CoC.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
- * E-mail: ,
| | - Melissa L. Harris
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Deborah Loxton
- Faculty of Health and Medicine, Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Yah CS, Ndlovu S, Kutywayo A, Naidoo N, Mahuma T, Mullick S. The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub: A systematic review and meta-analysis. Health Promot Perspect 2020; 10:325-337. [PMID: 33312928 PMCID: PMC7723002 DOI: 10.34172/hpp.2020.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. Methods: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. Results: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI:19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I=99.78%, P < 0.001), even within individual countries. Conclusion: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/STIs, as well as other risk strategies.
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Affiliation(s)
- Clarence S. Yah
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sithembiso Ndlovu
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Kutywayo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepo Mahuma
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mamecha Mesha, Akalewold Alemayehu, Deresse Daka. Prevalence and factors associated with early discontinuation rate of Implanon utilization among women who ever used Implanon in Kucha District Gamo Gofa Zone, Southern Ethiopia. BMC WOMENS HEALTH 2020; 20:239. [PMID: 33097056 PMCID: PMC7583223 DOI: 10.1186/s12905-020-01096-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/07/2020] [Indexed: 11/21/2022]
Abstract
Background The promotion of contraception in countries with high birth rates has the potential to reduce poverty, hunger, maternal, and childhood deaths. Every year in sub-Saharan Africa approximately 14 million unintended pregnancies occurred and a sizeable proportion was due to poor use of short-term hormonal methods. Contraceptive hormonal implants are highly effective and suitable for almost all women at any stage of their reproductive lives. On the other hand, early discontinuation of the Implanon contraceptive method utilization is one of the foremost problems amid the family planning program. Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation lingers the most significant anxiety for family planning programs. In unindustrialized countries, contraceptive discontinuation due to health concerns is generally higher; these complaints are often related to service quality. Hence, this study aimed to assess the prevalence and factors associated with early discontinuation of Implanon among women who ever used Implanon in Kucha district, Gamo Gofa Zone, Southern Ethiopia. Methods Implanon contraceptive device users were selected from the Kucha district using a cross-sectional community-based survey from January to March 2018. A total of 430 women were selected and data were collected through face-to-face interviews by using a pre-tested structured questionnaire. Data were cleaned, coded, and entered into Epi-Info version 7statistical software. Factors that showed association in a bivariate analysis that has a p value of less than 0.25 were entered into multiple logistic regression models for controlling confounding factors. The strength of statistical association was measured by adjusted odds ratio, at 95% confidence intervals, and p value < 0.05 were considered as statistically significant variables. Result The result of this study revealed that the overall discontinuation rate of Implanon in the study was 34%. Variables having statistically significant association with Implanon discontinuation were women who never use a contraceptive method other than Implanon (AOR = 2.96, 95% CI 1.53–5.74), women who didn’t make discussion with a partner (AOR = 3.32, 95% CI 1.57–7.04), poor counseling and follow up (AOR = 9.23, 95% CI 4.7–18.13), fear of side effects (AOR = 0.12, 95% CI 0.058- 0.24) and poor satisfaction of service (AOR = 5.2, 95% CI 2.77- 9.76) Conclusion The overall early discontinuation rate of Implanon in the study area was high. The main factors associated with early discontinuation of Implanon were contraceptive ever use, discussion with partner, poor follow-up of counseling, fear of side effects, and un-satisfaction by the services given during the insertion rate of Implanon.
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Affiliation(s)
- Mamecha Mesha
- College of Medicine and Health Sciences, Faculty of Health Science, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- College of Medicine and Health Sciences, Faculty of Health Science, Hawassa University, Hawassa, Ethiopia
| | - Deresse Daka
- College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia.
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Gashaye KT, Tsegaye AT, Abebe SM, Woldetsadik MA, Ayele TA, Gashaw ZM. Determinants of long acting reversible contraception utilization in Northwest Ethiopia: An institution-based case control study. PLoS One 2020; 15:e0240816. [PMID: 33079973 PMCID: PMC7575092 DOI: 10.1371/journal.pone.0240816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Though long-acting reversible contraceptives (LARCs) are highly effective, have minimal side effects, require minimal follow-up, and are low cost, only 10% of contraceptives used in Ethiopia are LARCs. The reason for this low uptake is not understood at the country or regional level. Therefore, this study identified determinants of LARC utilization in Northwest Ethiopia. METHODS A facility-based unmatched case control study, using LARC users as cases and short- acting reversible contraception (SARC) users as controls, had been conducted at fourteen public health institutions in Northwest Ethiopia. A systematic random sampling technique was used to select participants with a 1:2 case to control ratio (n = 1167). Binary logistic regression analysis was used to identify determinants of LARC utilization among family planning service users. RESULTS Wealth status [AOR:1.87, 95%CI (1.08, 3.24)], history of abortion [AOR:2.69, 95%CI (1.41, 5.12)], limiting family size [AOR: 2.38, 95%CI (1.01, 5.62)], good knowledge about LARCs [AOR: 2.52, 95%CI (1.17, 5.41)], method convenience [AOR: 0.23, 95%CI (0.16, 0.34)], good availability of method [AOR:0.10 (0.05, 0.19)], less frequent visits to health facility [AOR:2.95, 95% CI(1.89, 4.62)], health care providers advice [AOR:10.69, 95%CI (3.27, 34.87)], partner approval [AOR:0.66, 95%CI (0.45, 0.97)], and favorable attitude towards LARCs [AOR:13.0, 95%CI (8.60, 19.72)] were significantly associated with LARC utilization. CONCLUSION Professional support, favorable attitude towards LARC use, high economic status, history of abortion, advantage of less frequent visits, having good knowledge towards LARC and interest of limiting births were significantly associated with LARC Utilization. On the other hand, perceived method convenience, and contraception availability were inversely associated with it. Family planning education about the benefits of LARC should be done by health providers and media. Male involvement in the counselling and decision making about the advantage of using LARC may improve the negative influence of partners on LARC utilization. It is also recommended that, future qualitative research further explore perceptions of LARC use.
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Affiliation(s)
- Kiros Terefe Gashaye
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris Woldetsadik
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mengistu Gashaw
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
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Jeena PM, Asharam K, Mitku AA, Naidoo P, Naidoo RN. Maternal demographic and antenatal factors, low birth weight and preterm birth: findings from the mother and child in the environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth 2020; 20:628. [PMID: 33076865 PMCID: PMC7574237 DOI: 10.1186/s12884-020-03328-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birthweight (LBW) and preterm birth (PB) remain the leading cause of morbidity and mortality in neonates worldwide. The aim of this study was to identify maternal demographic and antenatal factors associated with PB and LBW among low socio-economic communities. METHODS Pregnant women (n = 1099) were recruited in the first trimester into the Mother and Child in the Environment (MACE) birth cohort in Durban, South Africa. Maternal factors such as demographic information, health status, residential area, occupational, personal and environmental smoking and biomass fuel use were obtained through standardised interviews, while clinical status was obtained in each trimester and antenatal information on HIV status and treatment, syphilis and conditions such as pregnancy induced hypertension, diabetes etc. was extracted from the antenatal assessments. Key outcomes of interest were preterm birth and low birthweight. The latter data was obtained from the clinical assessments performed by midwives at delivery. Logistic regression models identified factors associated with PB and LBW. RESULTS Of the 760 live births, 16.4 and 13.5% were preterm and LBW, respectively. Mothers who delivered by caesarean section had an increased odds of having LBW babies (Adjusted odds ratio (AOR): 1.7; 95% CI: 1.1-2.7) and PB (AOR: 1.7, 95% CI: 1.1-2.7) versus normal vaginal deliveries. Mothers > 30 years (AOR: 1.8, 95% CI: 1.1-2.9) and current smokers (AOR: 2.7, 95% CI: 1.3-5.8) had an increased odds of having PB babies. Compared to younger mothers and non-smokers respectively. An effect of PB and LBW was seen among mothers with high BMI (25.0-29.9 kg/m2) (PB: AOR: 0.5, 95% CI: 0.3-0.9 and LBW: AOR: 0.5, 0.5, CI: 0.3-0.8), and obese BMI (> 30 kg/m2) (PB: AOR: 0.5, 95% CI: 0.3-0.9 and LBW: AOR: 0.4, CI: 0.2-0.7). Maternal HIV (PB AOR: 1.4 and LBW AOR: 1.2) and history of sexually transmitted infections (PB AOR: 2.7 and LBW AOR: 4.2) were not statistically significant. CONCLUSION Maternal age, cigarette smoking and caesarean delivery were associated with LBW and PB. Findings highlight the need of maternal health interventions to improve new-born health outcomes.
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Affiliation(s)
- Prakash M. Jeena
- Discipline of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
| | - Aweke A. Mitku
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
| | - Pragalathan Naidoo
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
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Determinants of Implanon Discontinuation among Women Who Use Implanon at Bahir Dar Town Health Institutions, Northwest Ethiopia, 2019: A Case-Control Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:9048609. [PMID: 33029180 PMCID: PMC7532418 DOI: 10.1155/2020/9048609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022]
Abstract
Background Implanon is a long-acting reversible contraceptive method that is 99% effective in preventing unintended pregnancy. Despite its effectiveness, the rate of Implanon discontinuation is high. In Ethiopia, there is limited information about determinants of Implanon discontinuation. Therefore, this study aimed to identify the determinants of Implanon discontinuation among women who used Implanon at Bahir Dar town health institutions. Methods We employed an unmatched case-control study to find out the determinants of Implanon discontinuation at Bahir Dar town health institutions from March to June 2019 using the multistage stratified sampling technique to select study participants. Cases were women who had discontinued Implanon before completion of 3 years, and controls were women who had removed Implanon at the date of appointment (3 years). A pretested, structured questionnaire with face-to-face interviews was used. Binary logistic regression was performed to identify determinants of Implanon discontinuation. In the final model, variables with a p value of <0.05 were considered significant at 95% confidence interval and the strength of association was measured using odds ratio. Results Primary education (AOR = 0.104, 95% CI (0.02–0.48)), secondary education (AOR = 0.48, 95% CI (0.24–0.952)), women who have no child (AOR = 2.04, 95% CI (1.2–3.4)), women who had no discussion with their partner (AOR = 2.2, 95% CI (1.39–3.57)), mass counseling (AOR = 3.5, 95% CI (1.75–7.01)), women who had no counseling about side effects (AOR = 1.7, 95% CI (1.07–2.07)), women who experienced side effects (AOR = 2.2, 95% CI (1.4–3.4)), and purpose of family planning use (AOR = 2.5, 95% CI (1.14–4.8)) were determinants of Implanon discontinuation. Conclusion Implanon discontinuation is attributed by multifactorial involvement. Women's educational status, nulliparity, no counseling, not informed of side effects, and no partner discussion are significant factors. Health sector stakeholders need to tailor counseling services at individual level to bolster family planning utilization until the desired time.
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Ngure K, Velloza J, Patel RC, Mugo NR, Bukusi EA, Haberer JE, Odoyo J, Celum C, Baeten JM, Heffron R. Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships. Int J STD AIDS 2020; 31:1263-1271. [PMID: 32998640 DOI: 10.1177/0956462420951501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Women who have a prevention mindset may opt for concurrent use of oral pre-exposure prophylaxis (PrEP) and all forms of contraception; we therefore assessed how contraception may influence PrEP use or vice versa. We analyzed data from Kenyan and Ugandan HIV-uninfected non-pregnant women in sero-discordant partnerships who were participating in the Partners Demonstration Project. Using multivariable generalized estimating equation models, we estimated the associations between effective contraceptive use and 1) PrEP dispensation 2) high effective PrEP use. Among the 311 women (93.1% of all those followed in the Partners Demonstration Project) median age was 29 years (interquartile range [IQR] 24.0-35.0) and 115 (37.0%) reported using effective contraception at baseline. All the women initiated PrEP during the study and moderately high PrEP adherence was recorded at 73.1% of visits over an average 7.5 months following PrEP dispensation. Women (14.8%) consistently used an effective contraceptive throughout study follow-up. PrEP dispensation was more frequent among those concurrently using effective contraception, (adjusted relative risk [aRR] = 1.19; 95% confidence interval [CI] = 1.08-1.32) and contraceptive use was more common among those on PrEP (aRR = 1.63; 95% CI = 1.18-2.25). Among East African women at high risk of HIV infection, PrEP dispensation was more frequent among women using effective contraception, indicating that family planning outlets may be efficient locations to deliver PrEP.
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Affiliation(s)
- Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rena C Patel
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Apanga PA, Kumbeni MT, Ayamga EA, Ulanja MB, Akparibo R. Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study. BMJ Open 2020; 10:e041103. [PMID: 32978208 PMCID: PMC7520862 DOI: 10.1136/bmjopen-2020-041103] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the prevalence and factors associated with modern contraceptive (CP) use among women of the reproductive age. DESIGN Cross-sectional study. SETTING We used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018. PARTICIPANTS Data on 1 177 459 women aged 15-49 years old. METHODS Multivariable logistic regression was used to identify factors associated with modern CP use, while controlling simultaneously for independent variables, and accounting for clustering, stratification and sample weights from the complex sampling design. We used random effects meta-analysis to pool adjusted estimates across the 20 countries. RESULTS The overall prevalence of modern CP use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe. Overall, injectable (32%) was the most preferred method of CP, followed by oral pill (27%) and implants (16%). Women were more likely to use a modern CP if they: had a primary (adjusted prevalence odds ratios (aPORs): 1.68, 95% CI: 1.47 to 1.91)) or secondary/higher education (aPOR: 2.16, 95% CI: 1.80 to 2.59) compared with women with no formal education; had no delivery in the last 2 years (aPOR: 3.89, 95% CI: 2.76 to 5.47) compared with women who delivered in the last 2 years; were aged 25-34 years (aPOR: 1.33, 95% CI: 1.20 to 1.47) compared with women aged 15-24 years; were of middle-income status (aPOR: 1.25, 95% CI: 1.11 to 1.39) or rich (aPOR: 1.53, 95% CI: 1.27 to 1.84) compared with poor women and had two or more antenatal care visits compared with women without a visit. Perceived domestic violence was not associated with modern CP use (aPOR: 0.98, 95% CI: 0.92 to 1.05). CONCLUSION Our findings are relevant in a global context, particularly in the African region, and improve our understanding on relevant factors essential to increasing modern CP use.
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Affiliation(s)
| | - Maxwell Tii Kumbeni
- Nabdam District Health Directorate, Ghana Health Service, Nangodi, Upper East Region, Ghana
| | - Emmanuel Awine Ayamga
- Nabdam District Health Directorate, Ghana Health Service, Nangodi, Upper East Region, Ghana
| | - Mark B Ulanja
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Robert Akparibo
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Wondie KY, Badi MB, Tamiru AT. Rural-Urban Differentials of Long-Acting Contraceptive Method Utilization Among Reproductive-Age Women in Amhara Region, Ethiopia: Further Analysis of the 2016 EDHS. Open Access J Contracept 2020; 11:77-89. [PMID: 32821179 PMCID: PMC7417927 DOI: 10.2147/oajc.s255551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The sharp fertility drop-off in the Amhara region between 2000 and 2011 was due to an increase in modern contraceptive utilization of rural women. However, long-acting contraceptive method utilization was higher among urban than rural women. Therefore, this study aimed to assess rural-urban differentials of long-acting contraceptive method utilization and the contributing factors among reproductive-age women in the Amhara region: analysis of the 2016 EDHS. METHODS The 2016 EDHS data were used. A weighted sample of 2188 (1675 rural and 513 urban) fecund reproductive-age women was used, and a mixed-effects logistic regression model was fitted. Multivariable logistic regression analysis at a P-value <0.05 and adjusted odds ratio with a 95% confidence interval were used to declare significant associations. RESULTS The overall long-acting contraceptive method use was 13.3% (95% CI=11.6-15.8), and it was 14.8% (95% CI=12.4-17.2) among rural and 8.3% (95% CI=4.5-12.4) among urban women. Among urban women, the odds of long-acting contraceptive method use was higher for women living with a partner (AOR=6.83; 95% CI=1.23-37.84), married women (AOR=5.21; 95% CI=1.95-13.89), women living in a male-headed household (AOR=5.29; 95% CI=1.26-22.38), and women whose partner wanted fewer children (AOR=11; 95% CI=3.46-16.2). Among rural women, the odds of long-acting contraceptive use was higher for women in the richest wealth index (AOR=6.69; 95% CI=3.02-14.83), married women (AOR=30.26; 95% CI=8.81-42.9), women with good knowledge of LACMs (AOR=1.75; 95% CI=1.25-2.46), and women who had no correct knowledge of their ovulatory cycle (AOR=1.93; 95% CI=1.16-3.19). CONCLUSION Long-acting contraceptive method use was lower than the national target. LACM use was 8.3% (95% CI=4.5-12.4) among urban and 14.8% (95% CI=12.4-17.2) among rural women. Overall, marital status, educational level, the total number of children, knowledge of LACMs, and correct knowledge of the ovulatory cycle were significantly associated with LACM use.
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Affiliation(s)
- Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Marta Berta Badi
- Department of Women’s and Family Health, School of Midwifery, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Animut Tagele Tamiru
- Department of General Midwifery, School of Midwifery, University of Gondar, Gondar, Amhara Regional State, Ethiopia
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Kosugi H, Shibanuma A, Kiriya J, Ong KIC, Mucunguzi S, Muzoora C, Jimba M. Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145009. [PMID: 32664646 PMCID: PMC7400262 DOI: 10.3390/ijerph17145009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
Dual-method use is the most reliable form of protection against unintended pregnancies and human immunodeficiency virus/sexually transmitted infections (HIV/STIs). Although dual-method use remains uncommon among women in stable relationships, some women do practice it. In this study, we explored the barriers that make dual-method use rare and the behaviors of women who practice dual-method use using a positive deviance framework in Uganda. We screened 150 women using highly effective contraceptives at five health facilities. We identified nine women who practiced dual-method use and 141 women who did not. In a qualitative study, we conducted in-depth interviews with all nine women practicing dual-method use and 10 women randomly selected out of the 141 who did not. We performed a thematic analysis using the positive deviance framework. Regardless of practicing dual-method use or not, women faced perceived barriers against dual-method use, such as partner’s objection, distrust, shyness about introducing condoms into marital relationships, and limited access to condoms. However, women practicing dual-method use had higher levels of risk perception about unintended pregnancies and HIV/STIs. They also engaged in unique behaviors, such as influencing their partners’ condom use by initiating discussions, educating their partners on sexual risks and condom use, and obtaining condoms by themselves. These findings will be useful in developing effective community-led and peer-based interventions promoting dual-method use to reduce the dual burden of unintended pregnancies and HIV/STIs among women in Uganda.
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Affiliation(s)
- Hodaka Kosugi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.K.); (A.S.); (J.K.); (K.I.C.O.)
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.K.); (A.S.); (J.K.); (K.I.C.O.)
| | - Junko Kiriya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.K.); (A.S.); (J.K.); (K.I.C.O.)
| | - Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.K.); (A.S.); (J.K.); (K.I.C.O.)
| | | | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.K.); (A.S.); (J.K.); (K.I.C.O.)
- Correspondence: ; Tel.: +81-3-5841-3698
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Stats MA, Hill DR, Ndirias J. Knowledge and misconceptions surrounding family planning among Young Maasai women in Kenya. Glob Public Health 2020; 15:1847-1856. [PMID: 32623957 DOI: 10.1080/17441692.2020.1788112] [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: 10/23/2022]
Abstract
Adolescent fertility rates are high in Kenya and increase the likelihood of maternal and infant morbidity and mortality. Our objective was to explore the knowledge, perceptions, and barriers surrounding the use of family planning services among young Maasai women in Laikipia County, Central Kenya. Individual interviews with 50 participants were conducted in Laikipia County, Kenya during June and July of 2019. Qualitative data was visualised using JMP software and coded using the framework method for content analysis. Several overarching themes were identified. First, we identified a high rate of unintended pregnancy and a low rate of family planning use. Second, we found that many young Maasai women believe that only women that are married and have finished childbearing should utilise family planning services. Finally, we document highly prevalent myths among young women in the Maasai community that the use of family planning will lead to negative health consequences, such as infertility and cancer. We conclude that the Maasai community of Laikipia County, Kenya needs comprehensive family planning education that will improve knowledge and dispel myths in order to empower young Maasai women to make informed decisions surrounding family planning.
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Affiliation(s)
- Miriam A Stats
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - David R Hill
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, USA
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Hibstu DT, Alemayehu A. Long acting reversible contraceptives utilization and associated factors among women of reproductive age in Arsi Negele town, Southeastern Ethiopia. Contracept Reprod Med 2020; 5:6. [PMID: 32514372 PMCID: PMC7262748 DOI: 10.1186/s40834-020-00109-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Ethiopia is the second populous country in Africa with a total fertility rate of 4.6 and contraceptive prevalence of 35%, where implant and intrauterine contraceptive devices account for 8 and 2% respectively. The aim of this study was to determine the magnitude of long acting reversible contraceptives utilization and its associated factors among women of reproductive age in Arsi Negele town, Southeastern Ethiopia. Methods Facility-based cross-sectional study was conducted from April 01–May 30, 2017. A total of 361 women using modern contraceptives were selected by a systematic random sampling technique. Pre-tested and interviewer administered structured questionnaire was used to collect quantitative data. Bivariate and multivariate logistic regressions were performed using SPSS version 20.0 software. Result The magnitude of long acting reversible contraceptives (LARCs) utilization was 33.5% [95% CI, 28.5–38.8]. Husband with no formal education [AOR = 0.41, CI: 0.16, 0.78] and unemployed women [AOR = 0.35, CI: 0.42, 0.65] were negative predictors while having media exposure [AOR = 7.14, CI: 3.85, 13.25], women who desired only one child [AOR = 3.28, CI; 1.28, 8.39] and husband support [AOR = 7.33, CI: 3.48, 15.43] were positive predictors of LARCs utilization. Conclusion The overall utilization of LARCs is 33.5%. Creating employment opportunities, male involvement, advertisement and advocacy activities through mass media need to be considered to improve utilization of LARCs.
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Affiliation(s)
- Desalegn Tsegaw Hibstu
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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