Cross-sectional analysis of factors associated with prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan

Factors associated with reported modern contraceptive use among married men in Afghanistan

BACKGROUND

Afghanistan has high maternal and infant mortality which is in part driven by high fertility and low modern contraceptive use. Using modern contraceptive methods can reduce maternal and infant mortality, however there are several barriers to modern contraceptive use in Afghanistan. Married men have the potential to hinder or facilitate their wives' contraceptive use. Internally displaced persons (IDP), a growing population in Afghanistan, are rarely included in reproductive health research. We explored whether married men's, including IDPs', gender-related attitudes and other factors were associated with reported modern contraceptive use to inform programming to meet reproductive health needs of married couples.

METHODS

Cross-sectional study using data from 885 married men determined to have contraceptive need in seven Afghan provinces. We explored associations between sociodemographic factors, IDP status, wives' involvement in household decision-making and men's attitudes towards intimate partner violence (IPV) with reported modern contraceptive use using logistic regression analysis.

RESULTS

Most men (78%) had ≥2 children, 60% reported any formal education, and 30% reported being IDPs. Only 38% of married men and 24% of IDPs with contraceptive need reported using modern contraception with their wives. Most (80% overall, 63% of IDPs) reported their wives' involvement in some/all household decisions, while 47% overall and 57% of IDPs reported IPV was justified in one or more listed circumstances. In bivariate analysis, men responding that IPV was not justified in any listed circumstance were more likely and IDPs less likely to report modern contraceptive use. In multivariable analysis, involvement by wives in household decision-making (AOR 2.57; 95% CI: 1.51, 4.37), owning a radio and/or television (AOR 1.69; 95% CI: 1.10, 2.59), having more children, age, and province of interview were independently associated with reported modern contraceptive use, while IDP status was not.

CONCLUSIONS

Our findings reflect positive associations between wives' participation in household decisions and mass media exposure (television/radio ownership) with reported modern contraceptive use. Reproductive health initiatives engaging men to promote communication within couples and through mass media channels may further increase modern contraceptive use and advance Afghanistan's family planning goals. As fewer IDPs owned a radio/television, additional outreach methods should be tested for this group.

Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran

Refugee women are at high risk of experiencing high level of Intimate Partner Violence (IPV) and its negative impacts. We conducted a cross-sectional population-based household survey with refugees in a settlement in the city of Semnan, Iran, from 2016 to 2017. Afghan refugee women (n = 188) with ages between 15 and 49 years were recruited for the survey. Overall, about 79.8% of the participants reported to have experienced a form of IPV in the past 12 months. IPV exposure is associated with a negative reproductive health outcome. The high prevalence of IPV found among refugee women in the present research and its strong links with poor reproductive health outcomes, underline the urgent need for the development and testing of appropriate interventions in refugee settlements.

The family planning conundrum in Afghanistan

Introduction

In Afghanistan, despite the high awareness levels of contraceptive methods, the contraceptive prevalence is low and short birth spacing is common. The aim of this study was to understand the perception about family planning and contraceptive utilization among reproductive-aged married women, their husbands, their mothers-in-law, religious leaders and healthcare providers.

Methods

Focus group discussions and semi-structured interviews were conducted among married women of reproductive age (n = 482), their husbands (n = 133), their mothers-in-law (n = 194), their religious leaders (n = 16), and healthcare providers (n = 36) in rural and urban areas in five provinces.

Results

Bigger family size was generally considered as desirable for emotional, economic and social well-being. The majority endorsed contraception. However, some religious scholars and their followers argued that contraception is a sinful act in Islam by interpreting contraception as equivalent to infanticide and suppression of the increase of the Muslim population. Healthcare providers attempted to disseminate health benefits of modern contraception on a family basis. However, fear of various side effects and doubts about their effectiveness due to irregular supply were prevalent in communities.

Discussion

It is important to increase awareness on the health benefits of appropriate birth spacing at community level. Public health campaigns supported by Islamic religious scholars and a system that ensures appropriate counselling and a steady supply of contraceptives are likely to increase contraceptive utilization.

Factors Associated With Contraceptive Use Among Antenatal Care Clients With 3 or More Children at a Central Hospital in Burundi: A Cross-Sectional Study

BACKGROUND

The fertility rate in Burundi has remained consistently high since the 1980s, while the prevalence of contraceptive use in the country (22%) has been among the lowest in Africa. Reasons for low contraception uptake in Burundi have not been adequately clarified.This study aimed to identify factors associated with contraceptive use among pregnant women who had at least 3 healthy children and sought antenatal care services at an urban tertiary hospital in Burundi.

METHODS

Data were collected from antenatal clients with 3 or more children at Kamenge University Hospital. Data analysis included univariate and multivariate methods as well as multiple logistic regression analysis using SPSS, version 16.0.

RESULTS

We enrolled 255 women with a mean age of 32±4.5 years. The majority (n=232, 91.0%) of participants were urban residents with low incomes, and most (n=227, 89.0%) were educated to the primary school level or lower. The mean parity was 4.2±1.4, and most women had either 3 (n=120, 47.1%), 4 (n=66, 25.9%), or 5 (n=43, 16.9%) children; 26 (10%) participants had at least 6 children. Most (n=166, 65.1%) participants were part of couples who desired to have a final number of 4 to 6 children. About half (n=129, 50.6%) of the participants were able to name 1 or 2 benefits of contraception, and 105 (41.2%) participants mentioned 3 or 4 benefits of contraception. The most commonly reported benefit of contraceptive use was that it allows for improved maternal and child health. Low rates of contraceptive use were reported by participants with partners who worked as farmers, those citing fewer benefits of contraception, and those who relied on neighbours as their main source of information about contraception.

CONCLUSION

Knowledge of the benefits of contraception was among the strongest determinants of contraceptive use in this population. Farmers and traders were less likely to use contraceptives than participants who were engaged in other types of work. Medical personnel were the most relied upon source of information about contraception, and the strongest predictor of contraceptive use was the personal opinion that contraception is acceptable.

Utilization of contraceptives by persons living with HIV in Eastern Uganda: a cross sectional study

Background

In Uganda, there has been an increase in use of contraceptives by 6% from 2006 to 2011 among married women. During the same period HIV prevalence had gone up by 0.9%. Lack of use of contraceptives especially among persons living with HIV may escalate the spread of the virus. The purpose of the study was to determine the rate of contraceptive use and associated factors among persons receiving HIV care and treatment in Eastern Uganda.

Methods

A cross-sectional study was conducted in 4 public hospitals of Mbale, Kapchorwa, Atutur and Pallisa in Eastern Uganda. In total, 300 respondents comprising of women aged (15–49) and men (15–54) years were interviewed using interviewer administered questionnaires. However, data from 298 respondents were analyzed using multinomial logistic regression at α = 0.05 in STATA statistical software (Version 10).

Results

Approximately 62% (185/298) of persons living with HIV had used contraceptives within the three months preceding the study. Among the significant predictors, higher proportions of female respondents aged 36–49 years used injectables and male aged 50–54 years used condoms (p = 0.030 and p = 0.034, respectively). Furthermore, higher proportions of respondents with primary, secondary and tertiary education levels were more likely to use condoms (p = 0.004, p = 0.000 and p = 0.005, respectively) compared with those who never went to school. Besides, condoms were being used by Protestants (p = 0.000) compared to Catholics and Muslims. Also, more female respondents (p = 0.000) used condoms with their partners compared with the male counterparts. The main barrier to contraceptive use among non-users was desire for more children.

Conclusion

More efforts are needed to sensitize and provide contraceptives targeting the illiterate clients, youth, men and believers from different religious sects to increase utilization.

Knowledge, attitudes and practices of contraception among Afghan refugee women in Pakistan: a cross-sectional study

BACKGROUND

During the 1980s, approximately three million people migrated from Afghanistan to Pakistan and sought refuge in several cities including the city of Karachi. After the initial settlement of the refugees, the international organizations transitioned the health care of these refugees to the two local non-profit service agencies in Karachi. One of these agencies subsidized health care to the refugees under their care and the other agency encouraged the refugees under their care to utilize governmental and non-governmental private health resources at the disposal of general public. Our objective was to measure the effect of health subsidy on the uptake of contraception among Afghan refugee women and compare them to the group of Afghan women without such a subsidy.

METHODOLOGY/PRINCIPAL FINDINGS

A randomly selected group of 650 married Afghan women--325 women in each group--participated in a detailed survey regarding the knowledge, attitude and practices of family planning and contraceptive use. 90 percent of the women in the health subsidy group had had heard of family planning, compared to the 45 percent in the non-subsidized group. The use of contraceptives was greater than two-fold in the former versus the latter. Results of logistic regression analysis revealed that the refugee women who had had access to subsidized healthcare were significantly more likely to use the contraceptive methods with advancing age as compared to the women in the non-health subsidy group. The difference remained significant after adjusting for other variables.

CONCLUSIONS/SIGNIFICANCE

Refugee women who are provided subsidized healthcare are more inclined to use contraceptives. It is therefore important that Afghan refugee women living elsewhere in Pakistan be provided healthcare subsidy, whereby their reproductive health indicators could improve with reduced fertility. We strongly encourage facilities introducing such subsidies to refugees in resource poor settings to assess the impact through similar inquiry.

Contraceptive utilization and pregnancy termination among female sex workers in Afghanistan

BACKGROUND

To determine the prevalence and correlates of prior pregnancy termination and unmet need for contraception among female sex workers (FSWs) in Afghanistan.

METHODS

FSWs in Jalalabad, Kabul, and Mazar-i-Sharif were recruited between June 2006 and December 2007 through outreach programs. Participants completed an interviewer-administered survey describing demographics, behaviors associated with risk of sexually transmitted infections (STIs) and unplanned pregnancy, and medical history. Correlates of prior pregnancy termination and current unmet need for contraception were assessed with logistic regression analysis, controlling for site.

RESULTS

Of 520 FSWs, most (82.3%) had been pregnant at least once (mean 4.9 ± 2.7, range 1-17), among whom unplanned pregnancy (36.9%) and termination (33.2%) were common. Jalalabad participants were more likely to report both prior unplanned pregnancy (60.6% vs. 48.3% in Kabul or 20.7% in Mazar, p < 0.001) and prior termination (54.9% vs. 31.8% in Kabul or 26.8% in Mazar, p < 0.001). Most FSWs (90.0%) stated pregnancy was not currently desirable, and 85.2% were using contraception. Unmet need for contraception (14.7% of participants) was positively associated with having sold sex outside their city of residence (adjusted odds ratio [AOR] 1.88, 95% confidence interval [CI] 1.28-2.77) and inversely associated with illicit drug use (AOR 0.41, 95% CI 0.31-0.53).

CONCLUSIONS

Although FSWs in Afghanistan report high rates of contraceptive use, unplanned pregnancy is common. Reproductive health services should be included in programming for FSWs to reduce unplanned pregnancies and to reduce HIV/STI risks.

Current status of contraceptive use among rural married women in Anhui Province of China

OBJECTIVES

This study aims to explore the current status of married women in regard of their use of contraceptive methods (permanent methods versus non-permanent methods) and to find out factors that affect the use of contraceptive methods in rural areas of Anhui Province of China.

DESIGN

Survey.

SETTING

Anhui, China.

POPULATION

A total of 53,652 married women aged 18-49 years.

METHODS

A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18-49 years. All women were asked to provide detailed information by completing detailed questionnaires.

MAIN OUTCOME MEASURES

Contraceptive prevalence and influence factors.

RESULTS

The total birth control rate of the sample was 95.2%. Samples choosing the permanent and nonpermanent contraceptive methods have taken up 46.7 and 48.5% respectively. Female sterilisation was the first choice with a usage rate of 43.6%, followed by intrauterine device (IUD), which was used by 41.1% of samples. Single-variable analysis showed that the choice of contraceptive methods was associated with age, education level, parity, frequency of sex intercourses in a month, contraceptive knowledge, RTI symptom and the gender of the last child of rural married women.

CONCLUSIONS

A significant increase in contraceptive use of rural married women in Anhui Province of China. Female sterilisation and IUD still play the dominant role. Effective family planning methods should be advocated through adequate counselling on the correct use and proper management, with consideration of the background of custom and belief.