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Bolarinwa OA. Inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. BMC Womens Health 2024; 24:317. [PMID: 38824536 PMCID: PMC11143664 DOI: 10.1186/s12905-024-03167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/28/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Inequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. METHODS This study employed the World Health Organisation's Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF). RESULTS The study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20-49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018. CONCLUSION The inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health, York St John University, London, UK.
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa.
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Achola R, Atuyambe L, Nabiwemba E, Nyashanu M, Garimoi Orach C. Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study. PLoS One 2024; 19:e0278731. [PMID: 38427612 PMCID: PMC10906906 DOI: 10.1371/journal.pone.0278731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/22/2023] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathew Nyashanu
- Department of Health & Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Alemu MD, Workie SB, Kussa S, Gidey TT, Berheto TM. Trend and determinants of unmet need for family planning among married women in Ethiopia, evidence from Ethiopian demographic and health survey 2000-2016; multilevel analysis. PLoS One 2024; 19:e0296382. [PMID: 38166096 PMCID: PMC10760879 DOI: 10.1371/journal.pone.0296382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Unmet need refers to the gap between women's desires and contraception use to monitor their fertility level. According to the data, unplanned pregnancies are more likely to result in miscarriage and other obstetric difficulties, have poor maternal health care usage, and have a higher risk of having babies who are underweight. Information on the trend of unmet family planning needs in Ethiopia is scarce. The aim of this study was to examine the trend and determinants of unmet need for family planning among married or in union women in Ethiopia from 2000 to 2016. METHOD Cross-sectional study design from secondary data was performed. Data for the study was obtained from four consecutive Ethiopian Demographic Health Surveys 2000 to 2016. The survey employs a nationally representative sample of households using a multistage stratified sampling technique. A descriptive analysis was done to see the trend in unmet need. Multivariable, multilevel logistic regression was performed to assess individual and community-level determinants. An adjusted odds ratio (AOR) at a 95% confidence interval and a p-value of 0.05 were used to declare the level of significance. RESULT Unmet need declined by 40.2%, from 37.3% to 22.3%, from 2000 to 2016. Rural (AOR = 1.42; 95% CI: 1.27-1.59), number of living children > = 5 (AOR = 1.14 (1.04-1.24), age at first marriage > = 18 years (AOR = 1.15; 95% CI: 1.09-1.21), knowing at least one method of Family Planning (FP) (AOR = 1.57; 95% CI: 1.43-1.72), and no previous use of FP (1.27 (1.20-1.36) were associated with increased unmet need. While women between the ages of 20 and 24 (AOR = 0.71; 95% CI: 0.64-0.79), 25-29 (AOR = 0.62; 95% CI: 0.55-0.70), 40-44 (AOR = 0.43; 95% CI: 0.39-0.50), 45-49 (AOR = 0.21; 95% CI: 0.18-0.24), the richest wealth index (AOR = 0.88; 95% CI: 0.80-0.96. CONCLUSION The level of unmet need has decreased significantly in Ethiopia over the past 16 years. Age, educational level, media exposure, number of living children, age at first marriage, parity, previous use of FP, knowledge of FP, wealth index, regional setting, residence (rural), and survey year all have an association with an unmet need for family planning.
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Affiliation(s)
- Meseret Desalegn Alemu
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Shimelash Bitew Workie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Sintayehu Kussa
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tesfaye Tsegaye Gidey
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tezera Moshago Berheto
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Kristiansen D, Boyle EH, Svec J. The impact of local supply of popular contraceptives on women's use of family planning: findings from performance-monitoring-for-action in seven sub-Saharan African countries. Reprod Health 2023; 20:171. [PMID: 37990268 PMCID: PMC10664543 DOI: 10.1186/s12978-023-01708-7] [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] [Received: 03/23/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
Contraceptive use has substantial implications for women's reproductive health, motivating research on the most effective approaches to minimize inequalities in access. When women prefer to limit or delay fertility but are not using contraception, this potentially reflects demand for contraception that is not being satisfied. Current literature emphasizes a nuanced integration of supply and demand factors to better understand this gap. In this research, we examine the interconnectedness of supply and demand factors both conceptually and methodologically by augmenting existing measures of local supply with a demand-side factor-community-level preferences for contraceptive methods. Using novel data from Performance Monitoring for Action (PMA) in seven sub-Saharan African countries, we test whether the available supply of locally preferred methods at nearby service delivery points (SDP) explains variation in women's uptake of contraception beyond the more typical measure of contraceptive stockouts. Findings from logistic regression analyses (N = 32,282) suggest that demand and supply can be understood as tightly interconnected factors which are directly affected by local social preferences. The odds of women using modern contraception increase significantly when locally preferred methods are available, and this is true even after controlling for the availability of methods in general. The new measure tested in this research centers women and their specific desires in a manner consistent with the promotion of contraceptives as an important human right.
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Affiliation(s)
- Devon Kristiansen
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Joseph Svec
- Social Sciences Department, Saint Joseph's University, Patchogue, NY, USA.
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Rwabilimbo AG, Ahmed KY, Mshokela JB, Arora A, Ogbo FA. Trends and Drivers of Unmet Need for Family Planning in Currently Married Tanzanian Women between 1999 and 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2262. [PMID: 36767627 PMCID: PMC9915218 DOI: 10.3390/ijerph20032262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The current study investigated the trends and factors associated with the unmet need for family planning (FP) for limiting and spacing births among married Tanzanian women between 1999 and 2016. The study used Tanzania Demographic and Health Survey (TDHS) data for the years 1999 (N = 2653), 2004-2005 (N = 2950), 2010 (N = 6412), and 2015-2016 (N = 8210). Trends in the unmet need for FP were estimated over the study period. Multivariable multinomial logistic regression models were used to investigate the association between community-level, predisposing, enabling, and need factors with the unmet need for FP in Tanzania. The results showed no significant change in percentage of married women with an unmet need for birth spacing between 1999 and 2016. The proportion of married women with an unmet need for limiting births decreased from 9.5% (95% confidence interval (CI): 7.9%, 10.6%) in 1999 to 6.6% (95% CI: 5.9%, 7.3%) in 2016. Residing in a rural area, parity between 1-4 and 5+, visiting a health facility for any health services within twelve months, and planning to have more children (after two years and/or undecided) were factors positively associated with the unmet need for FP-spacing. Women with parity of 5+ were more likely to experience an unmet need for FP-limiting. Women's age between 25-34 and 35-49 years, women's employment status, watching television, women's autonomy of not being involved in household decisions, and planning to have more children were factors associated with lower odds of having an unmet need for FP-spacing. Women's age between 25-34 years, watching television, autonomy, and planning to have more children were factors with lower odds of having an unmet need for FP-limiting. Improving FP uptake among married Tanzanian women can reduce the unmet need for FP. Therefore, reducing unmet needs for FP is attainable if government policies and interventions can target women residing in rural areas and other modifiable risk factors, such as parity, health facility visits, planning to having more children, employment, watching television, and women's autonomy.
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Affiliation(s)
- Abdon Gregory Rwabilimbo
- Ifakara Health Institute, Dar Es Salaam 14112, Tanzania
- Medical Team International, 4th Floor Plot No.96. Mikocheni Light Industrial Area, New Bagamoyo Road, Dar Es Salaam 14112, Tanzania
- International Rescue Committee, Kasulu 47301, Tanzania
| | - Kedir Y. Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 1797, Australia
| | - Jackline Boniphace Mshokela
- Medical Team International, 4th Floor Plot No.96. Mikocheni Light Industrial Area, New Bagamoyo Road, Dar Es Salaam 14112, Tanzania
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 1797, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 1797, Australia
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, SA Health, Government of South Australia, Berri, SA 5343, Australia
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Zandam H, Mitra M, Mitra S. Awareness and access to mass media sources of information about modern family planning methods among women with disabilities in Nigeria: An analysis of 2018 demographic and health survey. Front Glob Womens Health 2022; 3:746569. [PMID: 36532957 PMCID: PMC9755848 DOI: 10.3389/fgwh.2022.746569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/31/2022] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Family planning is the foundation of sexual and reproductive health, and necessary for achieving the Sustainable Development Goals. Yet, the needs of women with disabilities and their access to these services have been neglected for decades, especially in Low and Middle-income Countries. To improve utilization of these services among women with disabilities, they have to be aware and informed about the services. This study was conducted to examine awareness and mass media sources of information on family planning between women with and without disabilities. METHODS This study used data from the 2018 Nigeria Demographic and Health Surveys (NDHS). Our analytic sample included 26,585 women between 15 and 49 years of age who answered the disability module. We compared demographics and socioeconomic characteristics of women with and without disabilities using the chi-square test for categorical variables. In addition, we conducted logistic regressions to estimate the unadjusted and adjusted odds ratio (with 95% confidence intervals) for level of awareness and mass media sources of information on modern contraceptive methods, using women without a disability as the reference group. RESULTS Finding showed that women with disabilities have poor awareness about family planning compared to women without disabilities even after adjusting for all covariates (AOR = 0.42, 95% CI: 0.23-0.76, P < 0.05). We also found that women with disabilities are less likely to receive information about family planning from any of the available mass media channels even after adjusting for covariates (AOR = 0.46, 95% CI: 0.22-0.98, P < 0.05). CONCLUSIONS The study revealed that women with disabilities Nigeria have poor awareness about modern family planning methods compared to non-disabled women. They are also less likely to receive information about modern family planning methods compared to non-disabled women. To effectively reach women with disabilities, information barriers must be eliminated, coupled with increased opportunities to access family planning information. Donors, government, and other relevant stakeholders should consider funding inclusive campaigns and explore other mechanisms for disseminating family planning information to women with disabilities.
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Affiliation(s)
- Hussaini Zandam
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Sophie Mitra
- Economics Department and Research Consortium on Disability, Fordham University, Bronx, NY, United States
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Ukoji VU, Anele PO, Imo CK. Assessing the relationship between knowledge and the actual use of contraceptives among childbearing women in South-South Nigeria: evidence from the 2018 Nigeria demographic and health survey. BMC Public Health 2022; 22:2225. [PMID: 36447222 PMCID: PMC9710025 DOI: 10.1186/s12889-022-14728-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: 08/25/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Nigeria has one of the world's highest fertility rates, which is detrimental to its public health and socioeconomic growth. Despite several efforts by the country and other development partners to reduce high fertility by increasing contraceptive use, the contraceptive prevalence rate among childbearing women remains low, particularly in the South-South compared to other Southern regions. This study, therefore, assessed the relationship between knowledge of and actual use of contraception among women in South-South Nigeria. METHODS The study employed a cross-sectional analysis of a nationally representative weighted sub-sample of 4,553 South-South childbearing women extracted from the 2018 National Demographic and Health Survey dataset. The dataset was weighted and examined for missing values that were excluded during the analyses at univariate, bivariate, and multivariate levels. The analyses involved a baseline descriptive analysis, a chi-square test, and logistic regression models using Stata software. The results of the explanatory variables were presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Eighty-two per cent of the respondents knew at least one form of contraception, while approximately 82% never used any contraceptive method. The likelihood of using any contraceptive method increased among those who knew about contraceptives (aOR: 1.40; CI: 0.93-2.11). Also, contraceptive use was significantly higher among women and their partners who had post-primary education (aOR: 1.34; CI: 1.25-2.43 and aOR: 1.74; CI: 1.25-2.43, respectively). Furthermore, the prevalence of contraceptive use among women significantly increased with an increase in the household wealth index. Similar results were recorded among women who had five or more living children, who were residents of Rivers State, were married or lived with their partners, were aged 35 years or older, and were currently working. CONCLUSIONS Contraceptive knowledge was high but did not translate into actual practice among childbearing women in South-South Nigeria. The use of any contraception was highly influenced by contraceptive knowledge, education, age, marital status, place of residence, and household wealth index, among others. Therefore, some policy issues relating to contraceptive knowledge and actual adoption must be addressed to improve the low rate of contraceptive use in Nigeria.
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Affiliation(s)
- Vitalis U. Ukoji
- Department of Sociology, Faculty of Social and Management Sciences, Nigeria Police Academy, Wudil, Kano State Nigeria
| | - Princewill O. Anele
- Department of Sociology, Faculty of Social and Management Sciences, Nigeria Police Academy, Wudil, Kano State Nigeria
| | - Chukwuechefulam K. Imo
- grid.442500.70000 0001 0591 1864Department of Sociology, Adekunle Ajasin University, Akoko-Akungba, Ondo State Nigeria
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Trends and predictors of change of unmet need for family planning among reproductive age women in Ethiopia, based on Ethiopian demographic and health surveys from 2005–2016: Multivariable decomposition analysis. PLoS One 2022; 17:e0272701. [PMID: 35980895 PMCID: PMC9387833 DOI: 10.1371/journal.pone.0272701] [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: 05/30/2021] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background By spacing births and preventing unintended pregnancies, family planning is a crucial technique strategy for controlling the fast expansion of the human population. It also improves maternal and child health. women who are thought to be sexually active but who do not use modern contraception methods, who either do not want to have any more children (Limiting) or who want to delay having children for at least two years are considered to have an unmet need for family planning (Spacing). Objective This study carried out to determine which socio-demographic factors are the key contributors to the discrepancies in the unmet need for family planning among women of reproductive age between surveys years 2005 and 2016. Methods The data for this study arrived from the Ethiopia Demographic Health Surveys in 2005, 2011, and 2016 to investigate trends and Predictors of change of unmet need for family planning among reproductive age women in Ethiopia. Pooled weighted sample of 26,230 (7761 in 2005, 9136 in 2011 and 9,333 in 2016 Ethiopian demographic health surveys) reproductive-age women were used for this study. For the overall trend (2005–2016) multivariable decomposition analysis for non-linear response outcome was calibrated to identify the factors that contributed to the change of unmet need for family planning. The Logit based multivariable decomposition analysis utilizes the output from the logistic regression model to assign the observed change in unmet need for family planning over time into two components. Stata version 16.0 was used to analyze the data. Result The percentage of Ethiopian women of reproductive age who still lack access (unmet need) for family planning declined from 39.6% in 2005 to 23.6 percent in 2016. The decomposition analysis revealed that the change of unmet need for family planning was due to change in characteristics and coefficients. The difference in coefficients accounted for around nine out of 10 variations in unmet family planning need. Education level, birth order, and desired number of children were all factors that changed over the course of the last 11 years in relation to the unmet need for family planning. Conclusion Between 2005 and 2016, there were remarkable changes in unmet need for family planning. Women with birth orders of five and up, women with secondary education, and women who wanted fewer children overall were the main causes of the change in unmet need for family planning.
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Unmet need for family planning among married women in Zambia: lessons from the 2018 Demographic and Health Survey. BMC Womens Health 2022; 22:137. [PMID: 35477361 PMCID: PMC9044710 DOI: 10.1186/s12905-022-01709-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need for family planning among married women is still a public health concern in sub-Saharan Africa. In Zambia, one in every five married women had an unmet need for family planning in 2018. Unmet need for family planning has the potential to increase the number of unintended pregnancies and unsafe abortions. These factors can increase the proportion of women of child bearing age, who are at high risk of birth complications. This study was therefore conducted to understand the determinants of unmet need for family planning among married women in Zambia based on recent cross-sectional data. METHODS The study analysed data extracted from the Zambia Demographic and Health Survey, which was a representative cross-sectional survey conducted in 2018. The analysis was done on a sample of 7598 currently married women aged 15-49 years. Multivariate logistic regression was used to examine determinants of unmet need for family planning in Zambia. The analyses was weighted to account for complex sample design. RESULTS Prevalence of unmet need for family planning is still high in Zambia at 20%. Women in the age groups 25-34 and 35-49 were less likely to have total unmet need for family planning (AOR = 0.61; 95% CI 0.47, 0.78) and (AOR = 0.63; 95% CI 0.45, 0.86) respectively, compared with those aged 15-24 years. Age of a woman, parity, household wealth and exposure to media-based family planning messages were found to be significantly associated with unmet need for family planning among married women. CONCLUSION There were significant differences in unmet need for family planning based on a woman's age, number of children ever born, wealth level, and exposure to media-based family planning messaging. Improving access to family planning messages and addressing underlying structural factors that improve the wealth status, particularly among young women, may help to reduce unmet need for family planning in Zambia.
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Ekholuenetale M, Olorunju S, Fowobaje KR, Onikan A, Tudeme G, Barrow A. When Do Nigerian Women of Reproductive Age Initiate and What Factors Influence Their Contraceptive Use? A Contextual Analysis. Open Access J Contracept 2021; 12:133-147. [PMID: 34285601 PMCID: PMC8286125 DOI: 10.2147/oajc.s316009] [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: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Contraceptive use initiation and continuation is one of the major interventions for reducing maternal deaths worldwide. Nigeria aimed to achieve a 27% prevalence rate of modern contraceptive uptake by 2020, however, this seems to have remained unachieved. The objective of this study was to investigate when Nigerian women initiate contraceptive use and its associated factors, using nationally representative data. Methods Data on 11,382 Nigerian women (aged 15–49 years) from the 2017 Performance Monitoring and Accountability 2020 (PMA2020) survey were used to determine the prevalence of lifetime contraceptive use. The Kaplan–Meier test was used to determine median time (years) to contraceptive uptake. In addition, the factors associated with contraceptive use were determined using multivariable logistic regression model. Statistical significance was determined at 5%. Results The prevalence of modern contraceptive use was 14.2%. There were disparities in the timing (years) of contraceptive use initiation across several women’s characteristics. Women from urban residence, highest household wealth index, nulliparous, unmarried, and highly educated women had the minimum median time (years) to contraceptive use initiation. The multivariable logistic model showed that rural women were 26% less likely to initiate contraceptive use, when compared with the urban dwellers (OR= 0.74; 95% CI: 0.65, 0.84). Furthermore, married women were 24% less likely to initiate contraceptive use, when compared with the unmarried (OR= 0.76; 95% CI: 0.63, 0.93). In addition, geographical region, wealth, television source, ever given birth, education, age, and religion were significantly associated with contraceptive use. Conclusion The prevalence of contraceptive use is low in Nigeria. There were differences in contraceptive use initiation among women of reproductive age in Nigeria. There is a need to adopt sustainable strategies to improve contraceptive uptake and to re-iterate the benefits of contraception, including providing enlightenment programs among key populations such as the rural dwellers and low income earners.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samson Olorunju
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kayode R Fowobaje
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeyinka Onikan
- Program Management Unit, Management Sciences for Health, Abuja, Nigeria
| | - Godson Tudeme
- School of Medicine, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia
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Factors Influencing Choice of Contraceptives among Women of Reproductive Age Attending Lagos State University Teaching Hospital, Nigeria. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2021. [DOI: 10.52547/jgbfnm.18.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Mahuro G, Kimani M. Inequities in unmet need for contraception among married women: Evidence from the PMA2020/ Kenya survey. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1943125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Gerald Mahuro
- University of Nairobi, College of Humanities and Social Sciences, Population Studies Research Institute, Nairobi, Kenya
- Kenya School of Government, Center for Research and Advisory Services, Nairobi, Kenya
| | - Murungaru Kimani
- University of Nairobi, College of Humanities and Social Sciences, Population Studies Research Institute, Nairobi, Kenya
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Salawu MM, Afolabi RF, Gbadebo BM, Salawu AT, Fagbamigbe AF, Adebowale AS. Preventable multiple high-risk birth behaviour and infant survival in Nigeria. BMC Pregnancy Childbirth 2021; 21:345. [PMID: 33933016 PMCID: PMC8088621 DOI: 10.1186/s12884-021-03792-8] [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: 10/08/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria. METHODS This cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child's birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05). RESULTS The mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33-2.06) compared to their counterparts with no HrBBs. CONCLUSION Multiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.
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Affiliation(s)
- Mobolaji Modinat Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Makinde Gbadebo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adetokunbo Taophic Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ahinkorah BO, Ameyaw EK, Seidu AA. Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys. Reprod Health 2020; 17:163. [PMID: 33097088 PMCID: PMC7585192 DOI: 10.1186/s12978-020-01018-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/15/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. Methods Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15–24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. Results The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82–29.921], ranging from 11.30% [95% CI: 5.1–17.49] in Zimbabwe to 46.7% [95% CI: 36.92–56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12–1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20–1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81–0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20–24 [aOR = 0.74; CI = 0.70–0.77, p < 0.001], compared with 15–19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28–1.43, p < 0.001]. Conclusion Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
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Vieira CS, Braga GC, Cruz Lugarinho PT, Stifani BM, Bettiol H, Barbieri MA, Cardoso VC, de Carvalho Cavalli R. Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study. Int J Gynaecol Obstet 2020; 151:237-243. [PMID: 32652559 DOI: 10.1002/ijgo.13305] [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] [Received: 01/13/2020] [Revised: 05/23/2020] [Accepted: 07/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. METHODS A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. RESULTS The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. CONCLUSION Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.
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Affiliation(s)
- Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Giordana Campos Braga
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Bianca Maria Stifani
- Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marco Antônio Barbieri
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Viviane Cunha Cardoso
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ricardo de Carvalho Cavalli
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Contraception Use among Women of Childbearing Age in Southern Israel: A Comparison Between Two Ethnic Populations. J Racial Ethn Health Disparities 2020; 8:630-637. [PMID: 32700259 DOI: 10.1007/s40615-020-00822-7] [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: 12/22/2019] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Two populations with different socio-demographic characteristics reside in southern Israel: the traditional Muslim Bedouin population and the Jewish population that leads a western lifestyle. The aim of the study was to assess the rate, pattern, and dynamics of the use of contraception in these two ethnic populations from 2006 to 2016 and to identify factors associated with the practice of effective and safe contraception. METHODS A retrospective study based on a computerized medical database. We recorded actual purchases of different forms of contraception by women of childbearing age (15-49 years) from the two populations in the southern Negev region of Israel. RESULTS Contraceptives were purchased by 7588 Bedouin women and 30,482 Jewish women. The rate of purchase ranged from 5.2 to 9.7% in the Bedouin sector and from 12.9 to 28.2% in the Jewish sector. Oral contraceptives were the most common type. In the Jewish sector, their use remained relatively stable over the years. In the Bedouin sector, in contrast, the rate increased. The only factor that was associated with the use of intrauterine devices was age (OR = 1.063, P < 0.001). Among women who used combined hormonal contraception, Jewish ethnicity (OR = 5.835, P < 0.001), age (OR = 0.926, P < 0.001), and comorbidity (OR = 0.87, P = 0.001) were associated with the use of newer, low-dose estrogen drugs. CONCLUSIONS Our findings, such as the lower rate of contraception practice in the Bedouin sector in general and the use of the new and safer hormonal contraceptives in particular, can help focus the efforts of medical teams in programs for women's health promotion.
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Abstract
Background Puerperal period is an important and thought-provoking period for puerperal mothers. Surprisingly, reports have indicated that there is increasing number of women resuming menstruation within six weeks of childbirth (puerperal menstruation). To the best of knowledge, there is no prior study on predictors of puerperal menstruation. Objective To determine frequency and predictors of puerperal menstruation. Methods This was a single tertiary health institution cross-sectional study at ESUT Teaching Hospital, Parklane, Enugu, Nigeria that included data from May 2015 to December 2018. Women were interviewed at the end of the first six weeks of their childbirth. Women with HIV positive or had uterine rupture or peripartum hysterectomy were excluded. Bivariate analysis was performed by the chi-squared test and conditional logistic regression analysis was used to determine variables associated with puerperal menstruation. Statistical significance was accepted when P- value is <0.05. Results A total of 371 women met the inclusion criteria. The return of menses within 6 weeks was present in 118(31.8%) women versus 253 (68.2%) women without puerperal menstruation, given a ratio of 1:3. Of the 371 women, 249 (67.1%) were on exclusive breastfeeding. The significant associated risk factors were age (p = 0.009), parity (p<0.001), early use of family planning (p = 0.001), socio-economic status (p<0.001) and manual removal of placenta (p = 0.007). At conditional logistic regression analysis, early use of family planning (p = 0.001), exclusive breastfeeding (p = 0.027) and manual removal of placenta (p = 0.012) were independently associated with puerperal menstruation. Induction/augmentation of labor, postpartum misoprostol use and mode of delivery were not statistically significant (p>0.05, for all) Conclusion One in 3 women resumes menstruation within 6 weeks of childbirth. The major predictor was early initiation of family planning, and exclusive breastfeeding with manual removal of placenta a major protective factor. These interesting issues require further investigation to better understand the mechanism of puerperal menstruation.
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Asresie MB, Fekadu GA, Dagnew GW. Contraceptive use among women with no fertility intention in Ethiopia. PLoS One 2020; 15:e0234474. [PMID: 32525935 PMCID: PMC7289351 DOI: 10.1371/journal.pone.0234474] [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: 12/01/2019] [Accepted: 05/26/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Ethiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children. Methods We used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance. Results Contraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0–55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use. Conclusion Contraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail: ,
| | - Gedefaw Abeje Fekadu
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Yalew M, Adane B, Kefale B, Damtie Y. Individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia; a multi-level analysis of 2016 Ethiopia Demographic and Health Survey. BMC Public Health 2020; 20:529. [PMID: 32306933 PMCID: PMC7168822 DOI: 10.1186/s12889-020-08653-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence on the unmet need for contraceptives among married reproductive-age women especially in developing countries like Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia. METHOD A secondary analysis was done on the 2016 Ethiopian Demographic and Health Survey (EDHS) dataset which were collected cross-sectional. A total of 9056 women who were fecund, married and/or sexually active were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA version 14.0 to identify individual and community-level factors. Adjusted odds ratio with 95% confidence interval was used to show the strength and direction of the association and statistical significance was declared at P value less than 0.05. RESULT Factors significantly associated with unmet need were; ages of women between 45 and 49 years [AOR = 2.25, 95% CI: (1.34, 3.79)], greater than or equal to three living children [AOR = 1.87, 95% CI: (1.40, 2.49)], belong to richer household [AOR = 0.73, 95% CI: (0.54, 0.97)], Muslim followers [AOR = 1.37, 95% CI: (1.02, 1.83)], married more than once [AOR = 1.31, 95% CI: (1.06, 1.62)]. From community level variables: belong to the Somali region [AOR = 0.34, 95% CI: (0.19, 0.61)] were significantly associated with unmet need. CONCLUSION Both individual and community-level factors were significant determinants of unmet need. From individual-level factors: advanced ages of women, many total numbers of living children, live in the richer wealth quintile, being Muslim follower and married more than once and from community-level variables: belong to the Somali region were significantly associated with unmet need for contraception. The findings suggested that health care providers should mainly focus on women nearly on menopauses, who live in the poorest household and who had many numbers of living children and married more than once to decrease the unmet need for contraceptives.
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Affiliation(s)
- Melaku Yalew
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Do M, Hutchinson P, Omoluabi E, Akinyemi A, Akano B. Partner Discussion as a Mediator of the Effects of Mass Media Exposure to FP on Contraceptive Use among Young Nigerians: Evidence from 3 Urban Cities. JOURNAL OF HEALTH COMMUNICATION 2020; 25:115-125. [PMID: 31964316 DOI: 10.1080/10810730.2020.1716279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Evidence suggests that despite high knowledge of family planning (FP), unwanted pregnancies and birth rates remain high among young Nigerians. There is a critical gap in understanding the nexus between exposure to FP information and contraception practices among this population. This study aimed to fill this gap and tested a pathway of the impact of media exposure to FP messages on modern contraceptive use. Data came from a 2018 cross-sectional baseline survey of young people aged 15-24 in three urban centers in Nigeria - Lagos, Kaduna, and Kano. This was part of an impact evaluation of a television-based drama designed to improve contraceptive use among young individuals. The study was limited to 777 young men and women who were sexually active. We found evidence of the mediation effect of media exposure to FP messages on partner discussion about FP, which in turn was associated with an increased likelihood of modern contraceptive use. Contraceptive self-efficacy also had positive associations with contraception. Our study elucidated a potential pathway through which media communication programs can significantly contribute to increased modern contraceptive use and underlined the importance of providing young people in Nigeria with opportunities to learn and practice obtaining and using contraception.
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Affiliation(s)
- Mai Do
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, USA
| | - Paul Hutchinson
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, USA
| | - Elizabeth Omoluabi
- Centre for Research, Evaluation Resources and Development (CRERD), Ile-Ife, Nigeria
| | - Akanni Akinyemi
- Centre for Research, Evaluation Resources and Development (CRERD), Ile-Ife, Nigeria
- Demography and Social Statistics Department, Obafemi Awolowo University, Ilesa, Nigeria
| | - Babatunde Akano
- Centre for Research, Evaluation Resources and Development (CRERD), Ile-Ife, Nigeria
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Solanke BL, Oyinlola FF, Oyeleye OJ, Ilesanmi BB. Maternal and community factors associated with unmet contraceptive need among childbearing women in Northern Nigeria. Contracept Reprod Med 2019; 4:11. [PMID: 31497311 PMCID: PMC6717978 DOI: 10.1186/s40834-019-0093-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/19/2019] [Indexed: 12/20/2022] Open
Abstract
Background Unmet need for modern contraceptive remains a critical reproductive health challenge in Nigeria. Numerous studies in Nigeria and other countries have investigated the patterns, prevalence and associated factors of unmet contraceptive need. In spite of these, the associated factors of unmet contraceptive need in Northern Nigeria have remained insufficiently explored. The few studies that focused on Northern Nigeria have mainly examined maternal individual factors leaving out higher level factors such as community-level factors that may be associated with unmet contraceptive need. This study examines the extent to which maternal and community factors are associated with unmet contraceptive need in Northern Nigeria. Method Data was pooled from 2008 to 2013 Nigeria Demographic and Health Surveys. A weighted sample size of 26,730 women was analysed. The outcome variable was unmet contraceptive need, dichotomised into no unmet need and unmet need. The explanatory variables were individual maternal characteristics such as age, education, number of living children, age at marriage, pregnancy termination experience, and death of a child, and selected community characteristics such as community socioeconomic status, community literacy level, community knowledge of modern contraceptive and geo-political zone. The Multilevel Logistic Regression Model (MLRM) was applied. Result Results showed a prevalence of 18% unmet contraceptive need among Northern women in Nigeria. Maternal age of 35 years or older (AOR = 0.873; p < 0.05, CI: 0.780–0.976), having five or more living children (AOR = 1.813; p < 0.001, CI: 1.663–1.977), higher maternal education (AOR = 0.787; p < 0.05, CI: 0.625–0.993), and never experience death of a child (AOR = 0.866; p < 0.001, CI: 0.805–0.933) are the maternal factors significantly associated with unmet contraceptive need, while high community literacy level (AOR = 1.230; p < 0.05, CI: 1.041–1.454), moderate (AOR = 0.862; p < 0.05, CI: 0.767–0.968) or high (AOR = 0.821; p < 0.05, CI: 0.726–0.929) community knowledge of modern contraceptive, and geo-political zone of residence are the community-level characteristics significantly associated with unmet contraceptive need among women in Northern Nigeria. Conclusion Maternal and community factors are significantly associated with unmet contraceptive need, but based on the ICC maternal factors have more significance in Northern Nigeria. The expansion of existing family planning delivery points to cover all communities including rural and remote areas in the region is imperative.
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Affiliation(s)
- Bola Lukman Solanke
- 1Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olaoye James Oyeleye
- 1Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.,Action Against Hunger, ACF-International, Damaturu, Yobe State Nigeria
| | - Benjamin Bukky Ilesanmi
- 1Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Oketch D, Kaguiri EC, Orinda JO, Mboya G, Ogutu P, Lando R, Juma C, Ndivo R, Ontieri DO, Madiega PA, Oloo F, Oruko J, Akello R, Wandera K, Odipo E, Greene E, Andrew P, Mudhune V, Akelo V. Emerging trends in contraceptive use, transitions and preferences among female sex workers screened for an HIV prevention clinical trial in Kisumu, Kenya: a cross-sectional study. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.13000.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Globally about 210 million women conceive annually and 38% of these pregnancies are unintended. Female sex workers (FSWs) are at increased risk of both unintended pregnancy and acquiring HIV, which could lead to adverse sexual and reproductive health (SRH) outcomes. We sought to assess contraceptive use or non-use, preferences and determinants among a cohort of FSWs screened for an HIV prevention clinical trial in Kisumu, Kenya. Methods: A cross sectional study of healthy FSWs referred for possible recruitment into the Antibody Mediated HIV Prevention (AMP) Study was conducted between December 2016 and September 2018. Potentially eligible participants were screened for HIV and data on social-demographic, contraceptive use and other SRH characteristics were collected. Those not on a method recorded their contraceptive preferences. Results: Data on 210 FSWs with a median age of 24.5 years (interquartile range, IQR 22-26) are presented. Of these, 187 (89.1%) had two children or fewer; only 56 (26.7%) had completed secondary or higher education. At the time of the interview, 18 (8.6%) were HIV-infected and 181 (86.2%) were using a modern contraceptive. Implants (48.6%) and depot injections (37.6%) were the most commonly used methods. Most (41.4%) of those not on family planning preferred oral pills. Respondents who had two or more children were three times more likely than their primiparous and nulliparous counterparts to report use of a contraceptive. Use of modern contraception methods did not differ by respondent’s ownership of a medical insurance cover or other occupation. Conclusion: There is high use of modern contraception among FSWs in Kisumu with the majority using subdermal implants. Reproductive health programs should implement targeted SRH interventions for specific populations and risk groups. Effective contraceptive counselling and interventions among FSWs should consider the client’s parity and level of education.
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Schatzkin E, Afolabi K, Adedeji O, Kongnyuy E, Shen J, Liu J. Lessons learned from a public sector community-based distribution program for scaling up DMPA-SC contraceptive services in Nigeria. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.13010.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: From August 2016 to December 2017, the United Nations Population Fund (UNFPA) in Nigeria, through three implementing partners, scaled up the public sector delivery of subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana Press) across 10 states. The public sector program featured a proactive community-based distribution (CBD) model, led by community health extension workers (CHEWs) and supported by community health volunteers (CHVs). Methods: We conducted monitoring and evaluation (M&E) alongside program implementation to understand the program’s reach, particularly in terms of clients served, and their proportions of new users of modern contraception and younger women. Key performance indicators (KPIs) were calculated from end-user data digitized from client registers. To evaluate performance trends over time and understand geographic variation, we analyzed quarterly data in Excel and Stata 15, and complemented these analyses with data from interviews conducted periodically with program staff and performance documentation submitted by implementing partners. Results: The program reached 144,505 clients, of whom 88% (n=127,315) were women. Among women reached, 92% (n=116,614) chose DMPA-SC. The program reached a high percentage of new users of modern contraception: 80% (n=93,075) of DMPA-SC clients were new users, as were 80% (n=111,350) of overall clients. However, only 26% (n=36,313) of clients were under 25. From performance reports and interviews with program staff, many involved credited the CBD model with reaching a client base largely comprised of new users of modern contraception. Conclusions: Our analysis of the Nigeria public sector DMPA-SC program suggests that the combination of DMPA-SC and proactive CBD may accelerate contraceptive uptake and reduce unmet need in Nigeria. While some strategies for increasing the cost-efficiency of the CBD emerged, future research on this delivery model should focus on key concerns about the modality’s sustainability.
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Tadele A, Abebaw D, Ali R. Predictors of unmet need for family planning among all women of reproductive age in Ethiopia. Contracept Reprod Med 2019; 4:6. [PMID: 31171978 PMCID: PMC6547515 DOI: 10.1186/s40834-019-0087-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Contraception is a good indicator of the extent to which couples have access to reproductive health services. Survey data on unmet need can provide overall direction by helping to pinpoint the obstacles in society and weaknesses in services that need to be overcome. This study is significant as it provides strong policy recommendations for the design and implementation of economic and non-economic interventions into family planning utilization by all eligible women. Objective To Identify Predictors of Unmet Need of Family Planning in Ethiopia. Methods A national level survey by performance monitoring and accountability (PMA 2020), which conducted between March and April 2016 among 7552 all women of 15–49 years were utilized. Stata® version13 were used for survey data for analysis using weighted frequency to give equal chances for enumeration areas represented. Binary and multivariate logistic regression employed. P-value < 0.05 were used to declare independent predictors of unmet need for family planning in Ethiopia. Result 7494 women responded to the interview giving response rate of 99.2%. Overall unmet need for family planning was 1, 214 (16.2%) of which 772 (10.3%) was for spacing and 450 (6.0%) for limiting. Overall unmet need was 540 (7.2%) in urban and 1431(19.1%) in rural areas of the Ethiopia. Statistically significant predictors with this were found to be women’s age 0.73 AOR [95% C.I 0.6–0.9], being lower wealth 0.22 AOR [95% C.I 0.07–0.6] as compared to lowest, parity 2.1 AOR [95% C.I 1.4–2.9], number of children at first use of contraceptive 1.1 AOR [95% C.I 1.03–1.19], having final say with provider 0.03 AOR [95% C.I 0.003–0.23] as compared with own decision making. Conclusion Unmet need of family planning in Ethiopia was generally high especially with significant disparity in residence and regional states. Socio-demographic factors (age and wealth status) and obstetric factor (parity) were found to be significant factor. Informed decision making for provision of contraceptives and enhancing women’s awareness starting their childbearing life with family planning were recommended.
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Affiliation(s)
- Afework Tadele
- 1Population and family health, Jimma University, Jimma, Ethiopia
| | | | - Rahma Ali
- 1Population and family health, Jimma University, Jimma, Ethiopia
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Persisting Regional Disparities in Modern Contraceptive Use and Unmet Need for Contraception among Nigerian Women. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9103928. [PMID: 30906784 PMCID: PMC6398053 DOI: 10.1155/2019/9103928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 11/17/2022]
Abstract
Background Evidence suggests that equitable provision of contraceptive services can help women achieve their reproductive goals and has significant impact on reducing the rates abortion and unintended pregnancy at large. However, regional disparities continue to persist on top of low family planning prevalence which is a critical public health challenge for fast growing populations like Nigeria. Objectives The present study aimed to explore the prevalence of (1) nonuse of modern contraceptives, (2) unmet need for contraception, and (3) regional disparities in these two. Methods The present study used cross-sectional data obtained from the Nigeria Demographic and Health Surveys conducted in 2003, 2008, and 2013. Participants were women of reproductive of age (15-49 years) regardless of marital status. Regional disparities of nonuse of modern contraceptives and unmet need were analysed by descriptive and multivariate regression methods. Results In the pooled sample of 79,656 participants during 2003, 2008, and 2013, 88.6% reported not using any modern methods, and 13.5% reported having unmet need for contraception. The prevalence rates of nonuse were, respectively, 91.8%, 90.6%, and 88.6% and those of unmet need were 14.2%, 16.6%, and 13.5% in the years 2003, 2008, and 2013. Significant differences were observed in the odds of reporting nonuse and unmet need for contraception across the geopolitical zones. Conclusions The rates of nonuse of contraception are remarkably high among women in Nigeria with significant disparities across the six geopolitical zones. Efforts should be made to address the regional disparities in order to achieve the goals of universal coverage of family planning services in the country.
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Worku SA, Ahmed SM, Mulushewa TF. Unmet need for family planning and its associated factor among women of reproductive age in Debre Berhan Town, Amhara, Ethiopia. BMC Res Notes 2019; 12:143. [PMID: 30876437 PMCID: PMC6419818 DOI: 10.1186/s13104-019-4180-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/11/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Unmet need refers to fecund women who either wish to postpone the next birth (spacers) or who wish to stop childbearing (limiters) but are not using a contraceptive method. The aim of this study was to assess the unmet needs of family planning and identify associated factors in Debre Berhan town among women in reproductive age. The community-based cross-sectional study design was used among 411 study participants (women with reproductive age) at Debre Berhan town. A systematic sampling technique was used to select the households. Bivariate and multivariable analyses were done to determine the association of each independent variable with the dependent variable. Results The overall unmet need for family planning among women in reproductive age groups was found to be 30.9%. Occupational status AOR = 13.992 (1.054–185.833), from whom the respondents got information about family planning AOR = 0.018 (0.002–0.170), having a discussion with husband AOR = 16.692 (2.911–95.713) and support from husband AOR = 0.005 (0.001–0.025) was significantly associated with the outcome variable. The level of unmet need for family planning in the study area is still high compared to the target set (10%) in the national family planning guide plan for Ethiopia.
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Affiliation(s)
- Solomon Adanew Worku
- Department of Midwifery, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Sindew Mahmud Ahmed
- Departments of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tizebt Fisseha Mulushewa
- Departments of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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Maju M, Sharma A, Beeram A, Ostrach B. A colonial legacy of HIV/AIDS, NTD, and STI super-syndemics: Eugenicist foreign aid and intertwined health burdens in Nigeria. Glob Public Health 2019; 14:1221-1240. [PMID: 30829113 DOI: 10.1080/17441692.2019.1582683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Syndemics theory has been applied to the structurally shaped, biologically facilitated co-occurrence of HIV/AIDS with Neglected Tropical Diseases (NTDs) and with sexually transmitted infections (STIs). The biological and social pathways of interaction between all three ailments have not yet been analysed together. The effects of these diseases are often exacerbated by structural factors including access to care and socioeconomic status. We explore the interrelated biological pathways and structural factors that have further heightened the risk for HIV/AIDS, NTDs, and STIs. Furthermore, we argue women in rural areas are at an increased risk for all three diseases due to biological and social factors including increased distance to quality care and lower reproductive autonomy. This paper integrates the established syndemics of HIV/NTDs and HIV/STIs within the historical and modern contexts of colonisation and neo-colonisation in Nigeria. We explore the effects of colonisation on women's health by evaluating the influence of foreign aid policies, structural programmes, and shifting gender norms. Applying a syndemic approach, juxtaposed by historical contextualisation, offers important implications for the prevention and treatment of HIV/AIDS, STIs, and NTDs. Our analysis suggests a perspective through which to view health of regions with a history of colonisation.
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Affiliation(s)
- Mehar Maju
- a Department of Community Health Sciences, UCLA Fielding School of Public Health , Los Angeles, CA , USA.,b Department of Anthropology , Boston University , Boston, MA , USA
| | - Andria Sharma
- c Department of Biology , Boston University , Boston, MA , USA.,d Rutgers New Jersey Medical School, School of Medicine, Newark , New Jersey , USA
| | - Archana Beeram
- c Department of Biology , Boston University , Boston, MA , USA.,e Imperial College London, School of Public Health , London , UK
| | - Bayla Ostrach
- f Family Medicine, and Affiliated Faculty, Medical Anthropology , Boston University School of Medicine , Boston, MA.,g Sociology and Anthropology , University of North Carolina Asheville , NC , USA
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Atchison CJ, Cresswell JA, Kapiga S, Nsanya MK, Crawford EE, Mussa M, Bottomley C, Hargreaves JR, Doyle AM. Sexuality, fertility and family planning characteristics of married women aged 15 to 19 years in Ethiopia, Nigeria and Tanzania: a comparative analysis of cross-sectional data. Reprod Health 2019; 16:6. [PMID: 30665470 PMCID: PMC6341518 DOI: 10.1186/s12978-019-0666-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents 360 (A360) is an initiative being rolled out across Ethiopia, Nigeria and Tanzania with the aim of increasing uptake of voluntary modern contraception among sexually active women aged 15 to 19 years. Using evaluation baseline survey data, we described key sexuality, fertility and contraceptive use characteristics of married women aged 15 to 19 years living in three sub-national settings. Methods Cross-sectional baseline surveys of married women aged 15 to 19 years were conducted in Oromia (Ethiopia), Nasarawa (Northern Nigeria), and Mwanza (Tanzania) between August 2017 and February 2018. We also interviewed the husbands of a sub-group of married respondents to measure spousal acceptance and support for adolescent women to use modern contraception. A clustered sampling design was used in all three countries. We produced descriptive statistics on the socio-demographic and sexual and reproductive health characteristics of married women aged 15 to 19 years by study setting. Results In Oromia, Nasarawa and Mwanza, 31.4% (327/1198), 27.4% (1321/4816) and 7.5% (15/201) of married women surveyed had no education, and 68.3, 81.3 and 83.1% had ever been pregnant, respectively. Unmet need for modern contraception was 20.5, 21.9 and 32.0% in married women in Oromia, Nasarawa and Mwanza, made up almost entirely of unmet need for spacing. The vast majority of married women surveyed in Oromia (89.1%) and Mwanza (90.1%) had seen or heard about contraception in the last 12 months, compared to 30.1% of those surveyed in Nasarawa. Modern contraceptive prevalence (mCPR) was highest in married women aged 15 to 19 years in Oromia (47.2%), followed by Mwanza (19.4%) and Nasarawa (8.7%). Of those using a modern method of contraception in Oromia, 93.4% were using injectables or long-acting methods, compared to 49.4% in Nasarawa and 69.6% in Mwanza. Conclusions Overall, unmet need for modern contraception is high among married women aged 15 to 19 years across the three settings. mCPR for married women aged 15 to 19 years is low in Nasarawa and Mwanza. Ultimately, no single intervention will suit all situations, but improving the quality, analyses and utilisation of subnational data can help decision-makers design more context specific interventions.
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Affiliation(s)
- Christina J Atchison
- London School of Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK.
| | - Jenny A Cresswell
- London School of Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK
| | - Saidi Kapiga
- London School of Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK.,Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | | | | | - Christian Bottomley
- London School of Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine, Department of Social and Environmental Health Research, London, UK
| | - Aoife M Doyle
- London School of Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK
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Oluwasanu MM, John-Akinola YO, Desmennu AT, Oladunni O, Adebowale AS. Access to Information on Family Planning and Use of Modern Contraceptives Among Married Igbo Women in Southeast, Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 39:233-243. [PMID: 30600774 DOI: 10.1177/0272684x18821300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was conducted among married Igbo women in Nigeria who have the lowest median birth interval coupled with a culture of sex preference and low use of modern contraceptives. We examined the relationship between access to information on family planning and sex preference on the use of modern contraceptive (MC). The 2013 Nigeria Demographic and Health Survey data were used. The data of 1,661 women of reproductive age were analyzed in this study. Access to information on family planning was low, and almost half (48.6%) of the women had a score of zero. Controlling for possible confounding variables, the data show that women who have good (odds ratio [ OR]= 3.92; CI [2.28, 6.75], p < .001) and poor ( OR = 2.56; CI [1.85, 3.56], p < .001) access to information on family planning were more likely to use MC than those with no access to information on family planning. Sex preference showed no relationship with the use of MC. Families where husbands want more children than their wives inhibit ( OR = 0.62, CI [0.42, 0.90], p < .05) the use of MC compared with those families where husbands and wives fertility desire is the same. Public health programs by government and donors should intensify interventions to increase access to family planning information to promote the use of MC among married Igbo women.
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Affiliation(s)
- Mojisola M Oluwasanu
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Yetunde O John-Akinola
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeyimika T Desmennu
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Opeyemi Oladunni
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayo S Adebowale
- 2 Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Solanke BL, Banjo OO, Oyinloye BO, Asa SS. Maternal grand multiparity and intention to use modern contraceptives in Nigeria. BMC Public Health 2018; 18:1207. [PMID: 30373559 PMCID: PMC6206733 DOI: 10.1186/s12889-018-6130-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Grand multiparity and low contraceptive prevalence are dominant among Nigerian women. These elevate the risk of unintended pregnancies, high-risk fertility and adverse maternal and child health outcomes among women in the country, particularly grand multiparous women. Studies have examined predictors of intention to use modern contraceptives among women of reproductive age. However, these studies did not ascertain the extent to which grand multiparity is associated with intention to use modern contraceptives. This study examined association between grand multiparity and intention to use modern contraceptives in Nigeria. METHODS The study pooled data from 2003 to 2013 Nigeria Demographic and Health Surveys. The weighted sample size analysed was 34,302 women. The outcome variable was intention to use contraceptive. The main explanatory variable was parity with specific attention to grand multiparity. Unadjusted multinomial logistic regression coefficients were used to examine association between specific explanatory or control variables and intention to use contraceptives while the adjusted multinomial logistic regression was applied to further examine associated factors of intention to use contraceptives relative to being uncertain about future contraceptive use. Four multinomial logistic regression models were fitted using Stata 14. RESULTS More than half of respondents do not intend to use contraceptives, while less than one-fifth of respondents intend to use contraceptives in the future. Across the four fitted models, the relative risks of intention to use compared with being uncertain about future contraceptive use were significantly lower among grand multiparous women. Results further revealed pregnancy termination, fertility planning status, exposure to mass media family planning messages, knowledge of modern contraceptives, ideal family size, remarriage, household power relations, and maternal education as other key factors influencing expected risk of intention to use contraceptives relative to being uncertain about future contraceptive use. CONCLUSION Maternal grand multiparity is significantly associated with intention to use contraceptives among women in Nigeria. The development of a specific population and health programme to target grand multiparous women is imperative in the country. Such programme could be integrated into existing national family planning programme through specific contraceptive education, counselling and information for high parous women.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Bosede Odunola Oyinloye
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Soladoye Sunday Asa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Edietah EE, Njotang PN, Ajong AB, Essi MJ, Yakum MN, Mbu ER. Contraceptive use and determinants of unmet need for family planning; a cross sectional survey in the North West Region, Cameroon. BMC WOMENS HEALTH 2018; 18:171. [PMID: 30342502 PMCID: PMC6195995 DOI: 10.1186/s12905-018-0660-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/10/2018] [Indexed: 11/23/2022]
Abstract
Background Reducing unmet need for family planning by increasing the rate of modern contraceptive use is indispensable if Cameroon must meet maternal mortality targets of the Sustainable Development Goals. The objective of this survey was to estimate the rate of contraceptive use and identify factors associated with unmet need for family planning in rural Cameroon. Methods It was conducted a community-based cross sectional survey from February to March 2016 targeting women in a union of the Wum Health District. Participants were included by cluster multistep sampling and data collected by trained surveyors using a pretested questionnaire. Data were analysed using Epi-Info version 3.5.4. The odds ratio was used as a measure of association between unmet need for family planning and selected covariates with the statistical significant threshold set at p ≤ 0.05. Results Among the 466 women included in the survey, 78.5% were legally married. The mean age of the participants was 28.7 ± 7.2 years with a mean number of years of cohabitation of 9.1 ± 7.4 years. A total of 438 women from the sample were evaluated for contraceptive use and unmet need for family planning. The rate of modern contraceptive use at the time of the survey was 13[10.1–16.6]% and about 5 in every 10 women had an unmet need for family planning (46.6[41.8–51.4]%) with 31.1% having an unmet need for spacing and 15.5% an unmet need for limiting births. The potential demand for contraception was estimated at 45.9% with only 39.8% of this demand met. When controlled for age, monthly revenue, occupation and partner’s level of education, discussion of family planning within the couple (OR = 0.66[0.44–0.97], p-value = 0.032), and partner’s approval of contraception (OR = 0.66[0.45–0.97], p-value = 0.035), were found to be significantly associated with decreasing unmet need for family planning. Conclusion With the very low rates of modern contraceptive use and potential demand for contraception in the Wum Health District, the rate of unmet need for family planning is still very high. Non discussion of family planning within the couple, and disapproval of contraception by the partner are significantly associated with high unmet need for family planning. More of couple-based family planning interventions should be encouraged. Electronic supplementary material The online version of this article (10.1186/s12905-018-0660-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esambe Emmanuel Edietah
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Philip Nana Njotang
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Obstetrics and Gynaecology unit, Yaoundé Central Hospital, Higher Institute of Health Technologies, Yaoundé, Cameroon
| | - Atem Bethel Ajong
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Marie José Essi
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Enow Robinson Mbu
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Directorate of Family Health, Ministry of Public Health, Yaoundé, Cameroon
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Adefalu AA, Ladipo OA, Akinyemi OO, Popoola OA, Latunji OO, Iyanda OF. Awareness and opinions regarding contraception by women of reproductive age in North-West Nigeria. Pan Afr Med J 2018; 30:65. [PMID: 30344849 PMCID: PMC6192713 DOI: 10.11604/pamj.2018.30.65.12975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 04/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction North-west Nigeria is a traditionally high fertility setting. Increasing attention is being channeled into scaling up the various interventions that can reduce high fertility, including enhancing contraceptive uptake among women of reproductive age. However, in order to improve demand for contraception, understanding the level of awareness, knowledge and perception of WRA to contraceptive use is essential. This study examines the level of knowledge and perception of WRA to contraceptive use. Methods A descriptive cross-sectional study was carried out in December 2016 in Kebbi and Sokoto states, North-west Nigeria. Semi-structured questionnaires were administered to 500 women between the ages of 15-49 years in 4 randomly selected local government areas across the states. Data analysis included descriptive and bi-variate statistics. Results Only 43.8% claimed to be currently using a modern form of contraception; 82.4% were aware of at least one form of contraception, while health personnel formed the major source of information. The most popular and least common modern contraceptive methods were the male condom (86.8%) and vasectomy (26.6%) respectively. A higher proportion of married respondents (88.8%) than those presently single (68.8%) had good knowledge of contraceptives. Perception of contraceptives was mixed, with majority believing that contraceptives should be made available to every woman, despite stating that it contradicted their religious beliefs. Conclusion These results underline the need for policy makers to focus on improving the knowledge of younger age groups on contraceptives and include other information channels such as peer-to-peer discussions to increase awareness.
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Dambo ND, Jeremiah I, Wallymahmed A. Determinants of contraceptive use by women in the central senatorial zone of Bayelsa State, Nigeria: A cross-sectional survey. Niger Med J 2017; 58:26-31. [PMID: 29238125 PMCID: PMC5715563 DOI: 10.4103/0300-1652.218409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Contraceptives are known to contribute to maternal health and well-being as well as improve child survival. Due to the multiethnic nature of Nigeria, it is known that the factors that influence contraceptive use may vary from one location to another and as such a blanket policy by the federal government on improving contraceptive use may not take into account the subtle differences in sociocultural practices that may influence contraceptive use. The aim of the study was to determine the contraceptive prevalence and explore factors that determine the use of contraceptives among women of Bayelsa Central Senatorial Zone. Materials and Methods: A cross-sectional survey of 210 women aged between 18 and 49 years who completed a close-ended questionnaire was carried out. Descriptive analysis was done for sociodemographic data, and tests of significance were done using SPSS version 20. Results: The prevalence of modern contraceptives in the Central Senatorial Zone of Bayelsa State was 36.8%. Condoms were the most common type of contraceptives used. Education, religious beliefs, and knowledge of fertile days were factors that significantly predicted contraceptive use. Age and number of children influenced the type of contraception a woman used. Conclusion: The contraceptive prevalence in this study is high. The factors that determine contraceptive use such as education and religion have been identified and can be leveraged upon to increase its use.
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Affiliation(s)
- Numonyo Duabo Dambo
- Department of Public Health, Directorate of Clinical Services, Hospitals Management Board, Yenagoa, Bayelsa State, United Kingdom
| | - Israel Jeremiah
- Department of Obstetrics and Gynaecology, Niger Delta University, Amassama, Bayelsa State, Nigeria, United Kingdom
| | - Akhtar Wallymahmed
- Department of Public Health, Faculty of Life Sciences, University of Liverpool, Liverpool, United Kingdom
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Akaba GO, Ekele BA. Maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital. Trop Doct 2017; 48:132-135. [PMID: 29108472 DOI: 10.1177/0049475517735474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Our study sought to determine the maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital as well as assess reasons for these referrals. We enrolled women referred or who presented themselves to the emergency obstetric unit for management of complications of pregnancy, labour, delivery or the puerperium. The majority presented late, their mean duration of stay at the referring facility being 22.25 h. Only nine (7.3%) were transported by ambulance. Severe pre-eclampsia and eclampsia (in 33, 26.8%) were the commonest obstetric indications for referral. Stillbirths occurred in 20/122(16.4%). There were eleven maternal deaths, giving an emergency referral fatality rate of 8.9%. Both maternal and fetal outcomes of these emergency obstetric referrals were poor owing mainly to late presentation, this being the result, among other factors, of an inefficient referral system.
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Affiliation(s)
- Godwin O Akaba
- 1 Lecturer/Consultant Obstetrician and Gynaecologist, College of Health Sciences, Department of Obstetrics and Gynecology, University of Abuja.,2 Professor/Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Bissallah A Ekele
- 1 Lecturer/Consultant Obstetrician and Gynaecologist, College of Health Sciences, Department of Obstetrics and Gynecology, University of Abuja.,2 Professor/Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
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Viswan SP, Ravindran TKS, Kandala NB, Petzold MG, Fonn S. Sexual autonomy and contraceptive use among women in Nigeria: findings from the Demographic and Health Survey data. Int J Womens Health 2017; 9:581-590. [PMID: 28883744 PMCID: PMC5574684 DOI: 10.2147/ijwh.s133760] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT The persistent low contraceptive use and high fertility in Nigeria despite improvements in educational achievements calls for an examination of the role of factors, which may moderate the use of modern contraception. This article explores the influence of sexual autonomy on the use of modern contraceptive methods among women and its relative importance compared with other, more traditional, indicators of women's autonomy such as education and occupation. DATA AND METHODS Data from two Demographic and Health Surveys (DHS), 2008 and 2013, were used in this study. An index of sexual autonomy was constructed by combining related DHS variables, and its association with current use of modern contraception was examined at each time point as well as over time using multivariate regression analysis. RESULTS The observed prevalence for use of modern contraception was 2.8 and 2.6 times higher among women who had high sexual autonomy in 2008 and 2013, respectively. The corresponding figures for women with secondary or higher education were 8.2 and 11.8 times higher, respectively, compared with women with no education. But after controlling for wealth index, religion, place of residence, autonomy and experience of intimate partner violence (IPV), the likelihood of use of modern contraception was lowered to about 2.5 (from 8.2) and 2.8 (from 11.8) times during 2008 and 2013, respectively, among women with secondary or higher education. The likelihood of use of modern contraception lowered only to 1.6 (from 2.8) and 1.8 (from 2.6) times among women with high sexual autonomy after controlling for other covariates, respectively, during the same period. CONCLUSION Sexual autonomy seems to play an important role in women's use of modern contraceptive methods independent of education and a number of other factors related to women's status. Sexual autonomy needs to be simultaneously promoted alongside increasing educational opportunities to enhance women's ability to use modern contraception.
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Affiliation(s)
- Saritha P Viswan
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - T K Sundari Ravindran
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ngianga-Bakwin Kandala
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - Max G Petzold
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sharon Fonn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Blackstone SR, Iwelunmor J. Determinants of contraceptive use among Nigerian couples: evidence from the 2013 Demographic and Health Survey. Contracept Reprod Med 2017; 2:9. [PMID: 29201414 PMCID: PMC5683226 DOI: 10.1186/s40834-017-0037-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria remains a focus for increasing contraceptive use, as it is one of the most populous countries in Sub-Saharan Africa. The objective of the current study was to investigate determinants of contraceptive use in Nigeria couples. Methods Using the 2013 Nigeria Demographic and Health Survey, we estimated the likelihood of contraceptive use based on concordance with male partner desire for family size, male and female fertility preferences, female decision making power, and male partner attitudes toward contraceptive use. Results Male partner perception that decisions regarding health should be made jointly or primarily by women was positively associated with use. Women were less likely to use contraceptives in couples in which male partners had greater earning power. Finally, men who viewed contraceptives as an enabler for promiscuity had female partners less likely to use contraceptives. Conclusions These findings highlight the importance of male partners in women’s contraceptive decision making.
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Affiliation(s)
- Sarah R Blackstone
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, 123 Huff Hall, 1206S. 4th St., Champaign, IL 61802 USA
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, 123 Huff Hall, 1206S. 4th St., Champaign, IL 61802 USA
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Wealth index, empowerment and modern contraceptive use among married women in Nigeria: are they interrelated? J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0738-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Determinants of unmet need for family planning among women in Urban Cameroon: a cross sectional survey in the Biyem-Assi Health District, Yaoundé. BMC WOMENS HEALTH 2016; 16:4. [PMID: 26791410 PMCID: PMC4721192 DOI: 10.1186/s12905-016-0283-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/15/2016] [Indexed: 11/10/2022]
Abstract
Background With the unacceptably high level of unmet need for family planning in Sub-Saharan Africa, reducing unmet need is paramount in the fight against the high levels of induced abortions, maternal and neonatal morbi-mortality. A clear understanding of the determinants of unmet need for family planning is indispensable in this light. The objective of this study was to determine the prevalence of unmet need for family planning in Urban Cameroon while identifying major determinants of unmet need among women in a union in Urban Cameroon. Methods A community based cross sectional study was conducted from March 2015 to April 2015 during which 370 women in a union were recruited using cluster multistep sampling in the Biyem-Assi Health District, Yaounde. Data were collected using a pretested and validated questionnaire. Proportions and their 95 % confidence intervals were calculated with the Westoff/DHS method used to estimate unmet need for family planning and the odds ratio used as measure of association with statistical significant threshold set at p-value ≤ 0.05. Results Of the 370 eligible women included, the mean age was 29.9 ± 6.8 years, and 61.1 % were married. The prevalence of unmet need for family planning was 20.4 (16.4-24.8)% with 14.2 (11.2-18.7)% having an unmet need for spacing and 6.2 (3.6-8.7)% an unmet need for limiting. Husband’s approval of contraception had a statistically significant protective association with unmet need (AOR = 0.52 [0.30-0.92], p = 0.023), and discussion about family planning within the couple had a highly statistically significant protective association with unmet need (AOR = 0.39 [0.21-0.69], p = 0.001). The major reason for non-use of contraception among women with unmet need was the fear of side effects. Conclusion The prevalence of unmet need of family planning among women in the Biyem-Assi Health District remains high. Husband’s approval of contraception and couples’ discussion about family planning are two major factors to be considered when planning interventions to reduce unmet need for family planning. Family planning activities focused on couples or including men could be useful in reducing the rate of unmet need in Cameroon.
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Fagbamigbe AF, Adebowale AS, Morhason-Bello I. Survival analysis of time to uptake of modern contraceptives among sexually active women of reproductive age in Nigeria. BMJ Open 2015; 5:e008371. [PMID: 26671948 PMCID: PMC4679946 DOI: 10.1136/bmjopen-2015-008371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess the timing of modern contraceptive uptake among married and never-married women in Nigeria. DESIGN A retrospective cross-sectional study. DATA AND METHOD We used nationally representative 2013 Demographic and Health Survey data in Nigeria. Modern contraceptive uptake time was measured as the period between first sexual intercourse and first use of a modern contraceptive. Non-users of modern contraceptives were censored on the date of the survey. Kaplan-Meier survival curves were used to determine the rate of uptake. A Cox proportional-hazards model was used to determine variables influencing the uptake at 5% significance level. PARTICIPANTS A total of 33,223 sexually active women of reproductive age. OUTCOME MEASURE Time of uptake of a modern contraceptive after first sexual intercourse. RESULTS The median modern contraceptive uptake time was 4 years in never-married and 14 years among ever-married women. Significant differences in modern contraceptive uptake existed in respondents' age, location, education and wealth status. Never-married women were about three times more likely to use a modern contraceptive than ever-married women (aHR=3.24 (95% CI 2.82 to 3.65)). Women with higher education were six times more likely to use a modern contraceptive than those without education (aHR=6.18 (95% CI 5.15 to 7.42)). CONCLUSIONS The rate of modern contraceptive uptake is low, and timing of contraceptive uptake during or after first sexual intercourse differed according to marital status. Age and number of children ever born influenced modern contraceptive uptake among the never-married women, but religion and place of residence were associated with the probability of modern contraceptive uptake among ever-married women.
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Affiliation(s)
- Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Faculty of Human and Social Sciences (HSS), School of Research and Postgraduate Studies (SoRPS), North West University, Mafikeng, South Africa
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - ImranOludare Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Austin A, Fapohunda B, Langer A, Orobaton N. Trends in delivery with no one present in Nigeria between 2003 and 2013. Int J Womens Health 2015; 7:345-56. [PMID: 25897265 PMCID: PMC4396652 DOI: 10.2147/ijwh.s79573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Skilled attendance at birth is a proven intervention to improve maternal and newborn health outcomes. Unfortunately, in Nigeria there are many women who give birth alone, with no one present (NOP). The purpose of this study was to document trends in women delivering with NOP between 2003 and 2013, and to identify the characteristics of women who are engaging in this risky practice. METHODS We utilized pooled data sets from the 2003, 2008, and 2013 Nigerian Demographic and Health Surveys. Married women, who had given birth in the 5 years before each survey were included, resulting in a sample size of 38,949 women. We used logistic regression to assess the unadjusted and adjusted odds of a woman delivering with NOP over time, by socio-demographic characteristics. RESULTS Prevalence of delivery with NOP in Nigeria declined by 30% between 2003 and 2013. The largest declines occurred in Sokoto State, where the number of women giving birth with NOP declined by almost 100% between 2003 and 2013. In the North West of the country, however, there was a 27% increase in the number of women giving birth alone over this time period. Older, poorer, less educated, higher parity, Muslim women residing in the Northern regions were significantly more likely to give birth with NOP. Women, who were involved in decisions surrounding their own health, and who had accessed antenatal care were significantly less likely to give birth with NOP. CONCLUSION Although there have been improvements in Nigeria's Maternal Mortality Ratio since 1990, recent estimates suggest a stagnation in this trend. One reason for this protracted decline may be lack of access to skilled delivery care. The 2013 national prevalence of Nigerian women giving birth with NOP was 14%, equivalent to over 1 million births in 2013. Nigeria must implement interventions to ensure every woman's timely access to, and use of skilled care to reduce preventable maternal mortality and morbidity.
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Affiliation(s)
- Anne Austin
- Maternal Health Task Force, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Bolaji Fapohunda
- John Snow, Inc., Boston, MA, USA
- USAID Targeted States High Impact Project, Washington, DC, USA
| | - Ana Langer
- Maternal Health Task Force, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nosakhare Orobaton
- John Snow, Inc., Boston, MA, USA
- USAID Targeted States High Impact Project, Washington, DC, USA
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