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Agyepong IA, Agblevor E, Odopey S, Addom S, Enyimayew Afun NE, Agyekum MP, Asante PY, Aye GE, Darko N, Diarra A, Fenny AP, Gladzah A, Ibrahim N, Kagambega A, Wallace LJ, Novignon J, Yaogo M, Borgès Da Sliva R, Ensor T, Mirzoev T. Interventions for adolescent mental, sexual and reproductive health in West Africa: A scoping review. PUBLIC HEALTH IN PRACTICE 2024; 8:100530. [PMID: 39105105 PMCID: PMC11298589 DOI: 10.1016/j.puhip.2024.100530] [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: 06/15/2024] [Accepted: 06/27/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives A quarter of West Africa's population are adolescents 10-19 years. Their mental, sexual, and reproductive health is inter-related. We therefore aimed to examine published evidence on effectiveness of interventions for adolescent mental, sexual and reproductive health in the Economic Community of West African States (ECOWAS) to inform development, implementation and de-implementation of policies and programs. Study design The study design was a scoping review. Methods We considered all qualitative and quantitative research designs that included adolescents 10-19 years in any type of intervention evaluation that included adolescent mental, sexual and reproductive health. Outcomes were as defined by the researchers. PubMed/Medline, APA PsycINFO, CAIRN, and Google Scholar databases were searched for papers published between January 2000 and November 9, 2023.1526 English and French language papers were identified. After eliminating duplicates, screening abstracts and then full texts, 27 papers from studies in ECOWAS were included. Results Interventions represented three categories: service access, quality, and utilization; knowledge and information access and intersectionality and social determinants of adolescent health. Most studies were small-scale intervention research projects and interventions focused on sexual and reproductive or mental health individually rather than synergistically. The most common evaluation designs were quasi-experimental (13/27) followed by observational studies (8/27); randomized, and cluster randomized controlled trials (5/27), and one realist evaluation. The studies that evaluated policies and programs being implemented at scale used observational designs. Conclusion Research with robust evaluation designs on synergistic approaches to adolescent mental, sexual and reproductive health policies, interventions, implementation and de-implementation is urgently needed to inform adolescent health policies and programs.
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Affiliation(s)
- Irene A. Agyepong
- Ghana College of Physicians and Surgeons. (GCPS), Accra, Ghana
- Dodowa Health Research Center, Ghana
| | - Emelia Agblevor
- Ghana College of Physicians and Surgeons. (GCPS), Accra, Ghana
| | - Selase Odopey
- Dodowa Health Research Center, Ghana
- School of Public Health, University of Ghana, Ghana
| | - Selasie Addom
- Ghana College of Physicians and Surgeons. (GCPS), Accra, Ghana
- Ghana Mental Health Authority, Accra, Ghana
| | | | | | | | - Grace Emmanuelle Aye
- Ghana College of Physicians and Surgeons. (GCPS), Accra, Ghana
- Dodowa Health Research Center, Ghana
| | | | - Aïssa Diarra
- Laboratoire d’études et Recherches sur les dynamiques Sociales et le développement local. (LASDEL), Niger
| | - Ama Pokuaa Fenny
- University of Ghana, Institute of Statistical, Social and Economic Research (ISSER UG), Ghana
| | | | - Nassirou Ibrahim
- Laboratoire d’études et Recherches sur les dynamiques Sociales et le développement local. (LASDEL), Niger
- Université de Montréal Quebec, Canada
| | - Aline Kagambega
- Institut National de Santé Publique, Observatoire National de Santé de la Population (IASP), Burkina Faso
| | | | - Jacob Novignon
- Kwame Nkrumah University of Science and Technology (KNUST) Department of Economics, College of Humanities and Social Sciences, Ghana
| | - Maurice Yaogo
- Institut National de Santé Publique, Observatoire National de Santé de la Population (IASP), Burkina Faso
| | | | | | - Tolib Mirzoev
- London School of Hygiene and Tropical Medicine, London UK Department of Global Health and Development London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Dougherty L, Kassegne S, Nagbe R, Babogou J, Peace P, Moussa F, Kirk K, Tokplo H, Ouro-Gnao D, Agbodjan SP, Loll D, Werwie TR, Silva M. A qualitative exploration of how a community engagement approach influences community and health worker perceptions related to family planning service delivery in Togo. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1389716. [PMID: 39021709 PMCID: PMC11251956 DOI: 10.3389/frph.2024.1389716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Background There is a growing body of evidence that asserts community engagement approaches can improve the quality of reproductive health services. Family planning (FP) programs in Togo are implementing such approaches, which aim to mobilize both health workers and communities to improve FP service quality and FP uptake. However, there is not enough known about the enabling factors and challenges associated with implementation, or the extent to which the programs improve outcomes leading to contraceptive uptake. Methods We qualitatively explored how a community engagement approach influenced health worker and community perceptions related to FP service delivery in and around the city of Lomé, Togo, within the context of the broader integration of social and behavior change and service delivery. We conducted 18 in-depth interviews with health workers and 9 focus group discussions with community members. Results We found the approach, which included community dialogues, site walkthrough visits and the development of community action plans, worked synergistically together to support collaborative action between communities and health workers to increase mutual understanding of their collective needs related to FP services. Community members cited improved reception at the health facilities by health workers and indicated that the site walkthrough visits created a greater sense of empathy towards the providers and the challenges faced in their work environment. Health workers acknowledged a greater understanding of barriers at the community level following community dialogues, particularly among community members that are not routinely encountered at the health facility for reproductive health services such as men and youth. We found limited implementation of health facility improvements included in community action plans because they were dependent on commitment from community leadership and the need to mobilize additional support or financial resources. Conclusion Community engagement approaches are a promising mechanism to support collaboration and enhance mutual understanding between health workers and communities to achieve improved FP service quality. Future programs should consider incorporating additional mechanisms to monitor community action plans and provide support to address structural challenges at the facility level particularly those that require financial resources.
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Affiliation(s)
- Leanne Dougherty
- Breakthrough RESEARCH, Population Council, Washington, DC, United States
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Finkle C, Martin K, Salas I, Mirano J, Mwaikambo L, Lokko K, Rimon J. A Platform for Sustainable Scale: The Challenge Initiative's Innovative Approach to Scaling Proven Interventions. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200167. [PMID: 38772722 PMCID: PMC11111104 DOI: 10.9745/ghsp-d-22-00167] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/30/2022] [Indexed: 05/23/2024]
Abstract
INTRODUCTION The global health community continues to face barriers in scaling up evidence-based interventions for widespread adoption. Although many effective interventions have been developed over the years, expanding their reach to benefit broader populations has happened slowly or not at all. OVERVIEW The Challenge Initiative (TCI) is a nontraditional development platform that supports local urban governments to rapidly scale up proven family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions for the urban poor. TCI prioritizes sustainability and local ownership and uses a health systems approach when planning for and managing scale. TCI strengthens urban health systems with seed funding, coaching, and technical assistance (TA), and TCI University houses "how-to" guidance and tools for implementing the interventions. In turn, local governments commit political will and financial and human resources while using TCI coaching to integrate interventions into routine practice and systems to achieve widespread and sustained impact at scale. RESULTS As of June 2021, TCI has supported 104 local governments across 11 countries in scaling up effective FP and AYSRH interventions, while also mobilizing about US$28 million from those local governments to facilitate their implementation. TCI has increased capacity and bolstered urban health systems, with 39 local governments "graduating" from TCI support and 2.02 million additional FP clients across 4 regional TA hubs. CONCLUSION TCI aims to change how local governments coordinate, finance, and implement proven interventions to improve access to quality FP information and services. With built-in incentives for local governments, partners, and donors to participate, TCI is generating significant learning on how local governments can realize sustainable scale and demonstrating how organizations like TCI that facilitate governments to scale up effective interventions can accelerate the scale-up of these interventions across multiple geographies.
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Affiliation(s)
| | - Kim Martin
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Ian Salas
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Mirano
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Mwaikambo
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Kojo Lokko
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jose Rimon
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Oladayo AM, Odukoya O, Sule V, Molobe I, Busch T, Akodu B, Adeyemo WL, Gowans LJJ, Eshete M, Alade A, Awotoye W, Adeyemo AA, Mossey PA, Prince AER, Murray JC, Butali A. Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research. BMC Public Health 2024; 24:507. [PMID: 38365612 PMCID: PMC10873930 DOI: 10.1186/s12889-024-17987-z] [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: 10/02/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort. METHODS Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis. RESULTS Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI. CONCLUSIONS Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.
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Affiliation(s)
- Abimbola M Oladayo
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Veronica Sule
- Department of Operative Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Ikenna Molobe
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tamara Busch
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Babatunde Akodu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Wasiu L Adeyemo
- Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - Lord J J Gowans
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mekonen Eshete
- School of Medicine, Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Azeez Alade
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Waheed Awotoye
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | | | - Peter A Mossey
- Department of Orthodontics, University of Dundee, Dundee, UK
| | | | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
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O'Brien ML, Zimmermann M, Eitmann L, Chao DL, Proctor JL. Contraceptive Adoption and Changes in Empowerment in Kenya, Nigeria, and Senegal. Stud Fam Plann 2023; 54:609-623. [PMID: 37531224 DOI: 10.1111/sifp.12250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Women's empowerment and contraceptive use are critical to achieving gender equality. The positive association between more empowered women and higher rates of contraceptive use has been well-established by cross-sectional research. However, there remains a gap in understanding the longitudinal relationship between contraceptive adoption and changes to women's empowerment. This study represents a novel approach to understanding the relationship between contraceptive adoption and women's empowerment longitudinally, at the individual level. To the authors' knowledge, this is the first attempt to measure the relationship between contraceptive adoption and women's empowerment using more than one wave of panel data. We leverage the longitudinal design of the Urban Reproductive Health Initiative data to code empowerment items by change over time (e.g., more empowered, no change, less empowered). We use sparse principal component analysis to establish empowerment change domains and calculate individual scores standardized by country-level averages. We estimate mixed effects models on these change domains, to investigate the link between contraceptive adoption and empowerment. We find common themes in empowerment across contexts-but contraceptive adoption has both positive and negative effects on those domains, and this varies across context. We discuss the need for cohort studies to examine this relationship.
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Nabhan A, Kabra R, Ashraf A, Elghamry F, Kiarie J. Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review. BMC Womens Health 2023; 23:574. [PMID: 37932747 PMCID: PMC10629088 DOI: 10.1186/s12905-023-02735-z] [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: 01/27/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Demand generation aims to increase clients' desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning. METHODS We searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings. RESULTS Forty-six studies (published 1990-2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services. CONCLUSIONS Demand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization. TRIAL REGISTRATION Systematic review registration: Center for Open Science, osf.io/286j5.
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Affiliation(s)
- Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Ramses Street, Cairo, Egypt.
| | - Rita Kabra
- Department of Sexual and Reproductive Health including UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Alyaa Ashraf
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - James Kiarie
- Department of Sexual and Reproductive Health including UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Ssanyu JN, Kananura RM, Birabwa C, Kizito F, Namutamba S, Akongo D, Namara E, Kyangwa M, Kaula H, Nakimuli D, Magunda A, Kakaire O, Waiswa P. How a co-design process led to more contextually relevant family planning interventions in emerging urban settings in Eastern Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002421. [PMID: 37773920 PMCID: PMC10540946 DOI: 10.1371/journal.pgph.0002421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023]
Abstract
Voluntary, rights-based family planning upholds women's right to determine freely the number and spacing of their children. However, low-resource settings like Uganda still face a high unmet need for family planning. And, while urban areas are often indicated to have better access to health services, emerging evidence is revealing intra-urban socio-economic differentials in family planning utilization. To address the barriers to contraceptive use in these settings, understanding community-specific challenges and involving them in tailored intervention design is crucial. This paper describes the use of co-design, a human-centred design tool, to develop context-specific interventions that promote voluntary family planning in urban settings in Eastern Uganda. A five-stage co-design approach was used: 1) Empathize: primary data was collected to understand the problem and people involved, 2) Define: findings were shared with 56 participants in a three-day in-person co-design workshop, including community members, family planning service providers and leaders, 3) Ideate: workshop participants generated potential solutions, 4) Prototype: participants prioritized prototypes, and 5) Testing: user feedback was sought about the prototypes. A package of ten interventions was developed. Five interventions targeted demand-side barriers to family planning uptake, four targeted supply-side barriers, and one addressed leadership and governance barriers. Involving a diverse group of co-creators provided varied experiences and expertise to develop the interventions. Participants expressed satisfaction with their involvement in finding solutions to challenges in their communities. However, power imbalances and language barriers were identified by the participants as potential barriers to positive group dynamics and discussion quality. To address them, participants were separated into groups, and medical terminologies were simplified during brainstorming sessions. These changes improved participation and maximized the contributions of all participants. It is therefore important to consider participant characteristics and their potential impact on the process, especially when engaging diverse participant groups, and implement measures to mitigate their effects.
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Affiliation(s)
- Jacquellyn Nambi Ssanyu
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
| | - Catherine Birabwa
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | | | - Henry Kaula
- Kampala Slum Maternal and Newborn Health Project, Kampala Capital City Authority, Kampala, Uganda
| | | | - Andrew Magunda
- Kampala Slum Maternal and Newborn Health Project, Kampala Capital City Authority, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere university College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
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Corley AG, Sprockett A, Montagu D, Chakraborty NM. Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116576. [PMID: 35682160 PMCID: PMC9180733 DOI: 10.3390/ijerph19116576] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.
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Speizer IS, Guilkey DK, Winston J, Calhoun LM. Does Provider Bias Affect Choice of a Facility for Family Planning Services by Women in Urban Senegal? Stud Fam Plann 2022; 53:133-151. [PMID: 35083745 PMCID: PMC9148548 DOI: 10.1111/sifp.12181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Few studies to date have determined the effect of provider bias based on age, parity, and marital status on women's method and facility choice. Using data from women using modern methods in six cities of Senegal and a facility survey that included a facility audit and provider interviews, we undertake conditional logit analyses to determine whether women's choice of a family planning facility is associated with provider bias at the facility, controlling for other facility characteristics (e.g., size, sector, and number of methods available). We find that women bypass facilities where there is greater provider bias to attain their current family planning method. Women also bypass facilities of lower quality. This is the first study to demonstrate the effects of provider bias on women's contraceptive seeking behaviors and suggests the importance of training providers to reduce age and parity bias that affect access to a full range of methods and facilities for all women.
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Affiliation(s)
- Ilene S Speizer
- is Research Professor, Department of Maternal and Child Health and Faculty Fellow, Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - David K Guilkey
- is Boshamer Distinguished Professor, Department of Economics and Faculty Fellow, Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - Jennifer Winston
- are Research Associates, Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - Lisa M Calhoun
- are Research Associates, Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
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Hellwig F, Coll CVN, Blumenberg C, Ewerling F, Kabiru CW, Barros AJD. Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries. Front Glob Womens Health 2021; 2:674227. [PMID: 34816227 PMCID: PMC8594043 DOI: 10.3389/fgwh.2021.674227] [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: 03/01/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries. Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage. Results: mDFPS among urban women ranged from 27% (95% CI: 23–31%) in Chad to 87% (95% CI: 84–89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3–15%) among the poorest and 52% (95% CI: 49–56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3–11%) among the poorest and 46% (95% CI: 41–51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7–18%) among the poorest and 47% (95% CI: 41–53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities. Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Fernanda Ewerling
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Caroline W Kabiru
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Duminy J, Cleland J, Harpham T, Montgomery MR, Parnell S, Speizer IS. Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review. Front Glob Womens Health 2021; 2:749636. [PMID: 34816250 PMCID: PMC8593933 DOI: 10.3389/fgwh.2021.749636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.
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Affiliation(s)
- James Duminy
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - John Cleland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Trudy Harpham
- School of Law and Social Sciences, London South Bank University, London, United Kingdom
| | - Mark R. Montgomery
- Department of Economics, Stony Brook University, Stony Brook, NY, United States
- Population Council, New York, NY, United States
| | - Susan Parnell
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - Ilene S. Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
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Ganle JK, Baatiema L, Ayamah P, Ofori CAE, Ameyaw EK, Seidu AA, Ankomah A. Family planning for urban slums in low- and middle-income countries: a scoping review of interventions/service delivery models and their impact. Int J Equity Health 2021; 20:186. [PMID: 34412647 PMCID: PMC8375135 DOI: 10.1186/s12939-021-01518-y] [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: 01/07/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. Methods We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. Results The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls’ club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. Conclusions This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01518-y.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13 Legon, Accra, Ghana.
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Grabert BK, Speizer IS, Domino ME, Frerichs L, Corneli A, Fried BJ. Couple communication and contraception use in urban Senegal. SAGE Open Med 2021; 9:20503121211023378. [PMID: 34158943 PMCID: PMC8182225 DOI: 10.1177/20503121211023378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: Couple communication about family planning has been shown to increase uptake
of contraception. However, couple communication is often measured based
solely on one partner’s report of communication. This research investigates
the influence of couple-reported communication about family planning on
current and future use of contraception using couple-level data. Methods: We used baseline data from the Measurement, Learning, and Evaluation (MLE)
project collected through household surveys in 2011 from a cross-sectional
representative sample of women and men in urban Senegal to conduct secondary
data analysis. We used multivariable logit models to estimate the average
marginal effects of couple communication about family planning on current
contraception use and future intention to use contraception. Results: Couple communication about family planning reported by both partners was
significantly associated with an increased likelihood of current use of
contraception and with future intention to use contraception among
non-contracepting couples. Couples where one partner reported discussing
family planning had a 25% point greater likelihood of current contraception
use than couples where neither partner reported discussing, while couples
where both partners reported discussing family planning had a 56% point
greater likelihood of current contraception use, representing more than
twice the effect size. Among couples not using contraception, couples where
one partner reported discussing family planning had a 15% point greater
likelihood of future intention to use contraception than couples where
neither partner reported discussing, while couples where both partners
reported discussing family planning had a 38% point greater likelihood of
future intention to use contraception. Conclusion: These findings underscore the importance of the inclusion of both partners in
family planning programs to increase communication about contraception and
highlight the need for future research using couple-level data, measures,
and analysis.
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Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene S Speizer
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bruce J Fried
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
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Krug C, Cavallaro FL, Wong KLM, Gasparrini A, Faye A, Lynch CA. Evaluation of Senegal supply chain intervention on contraceptive stockouts using routine stock data. PLoS One 2020; 15:e0236659. [PMID: 32745110 PMCID: PMC7398546 DOI: 10.1371/journal.pone.0236659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background Until 2011, stockouts of family planning commodities were common in Senegalese public health facilities. Recognizing the importance of addressing this problem, the Government of Senegal implemented the Informed Push Model (IPM) supply system, which involves logisticians to collect facility-level stock turnover data once a month and provide contraceptive supplies accordingly. The aims of this paper were to evaluate the impact of IPM on contraceptive availability and on stockout duration. Methods and findings To estimate the impact of the IPM on contraceptive availability, stock card data were obtained from health facilities selected through multistage sampling. A total number of 103 health facilities pertaining to 27 districts and nine regions across the country participated in this project. We compared the odds of contraceptive stockouts within the health facilities on the 23 months after the intervention with the 18 months before. The analysis was performed with a logistic model of the monthly time-series. The odds of stockout for any of the five contraceptive products decreased during the 23 months post-intervention compared to the 18 months pre-intervention (odds ratio, 95%CI: 0.34, 0.22–0.51). To evaluate the impact of the IPM on duration of stockouts, a mixed negative binomial zero-truncated regression analysis was performed. The IPM was not effective in reducing the duration of contraceptive stockouts (incidence rate ratio, 95%CI: 0.81, 0.24–2.7), except for the two long-acting contraceptives (intrauterine devices and implants). Our model predicted a decrease in stockout median duration from 23 pre- to 4 days post-intervention for intrauterine devices; and from 19 to 14 days for implants. Conclusions We conclude that the IPM has resulted in greater efficiency in contraceptive stock management, increasing the availability of contraceptive methods in health facilities in Senegal. The IPM also resulted in decreased duration of stockouts for intrauterine devices and implants, but not for any of the short-acting contraception (pills and injectables).
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Affiliation(s)
- Catarina Krug
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Francesca L. Cavallaro
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Kerry L. M. Wong
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adama Faye
- Institut Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
| | - Caroline A. Lynch
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ogundele OJ, Pavlova M, Groot W. Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps. Int J Equity Health 2020; 19:44. [PMID: 32220250 PMCID: PMC7099835 DOI: 10.1186/s12939-020-01167-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Family planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services. METHODS Using the Demographic Health Survey data from Burkina Faso, Niger, Nigeria, Ghana, and Senegal, we perform a decomposition analysis to quantify the contribution of socio-demographic characteristics to disparities in exposure to mass media information on family planning, use of modern contraceptives, adequate antenatal care visits, facility-based childbirth and C-section between low-wealth and high-wealth women. RESULTS Our study shows that differences in maternal characteristics between the wealth groups explain at least 40% of the gap in exposure to mass media family planning information, 30% in modern contraceptive use, 24% of adequate antenatal care visits, 47% of the difference in facility-based childbirths, and 62% in C-section. Lack of information on pregnancy complications, living in rural residence, religion, lack of autonomy in health facility seeking decision, need to pay, and distance explains the disparity in reproductive health care use across all countries. In countries with complete fee exemption policies for specific groups in the population, Ghana, Niger, and Senegal, the inequality gaps between wealth groups in having an adequate number of antenatal care visits and facility-based childbirth are smaller than in countries with partial or no exemption policies. But this is not the case for C-section. CONCLUSIONS There is evidence that current policies addressing the cost of maternal care services may increase the wealth-based inequality in maternal care use if socio-demographic differences are not addressed. Public health interventions are needed to target socio-demographic disparities and health facility seeking problems that disadvantage women in poor households.
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Affiliation(s)
- Oluwasegun Jko Ogundele
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences; Maastricht University, PO Box 616, 6200MD, Maastricht, the Netherlands.
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences; Maastricht University, PO Box 616, 6200MD, Maastricht, the Netherlands
| | - Wim Groot
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences; Maastricht University, PO Box 616, 6200MD, Maastricht, the Netherlands.,United Nations University-Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, The Netherlands
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Speizer IS, Escamilla V, Lance PM, Guilkey DK. Longitudinal examination of changing fertility intentions and behaviors over a four-year period in urban Senegal. Reprod Health 2020; 17:38. [PMID: 32183890 PMCID: PMC7077111 DOI: 10.1186/s12978-020-0893-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background Fertility intentions and contraceptive use are often used to demonstrate gaps in programs and policies to meet the contraceptive needs of women and couples. Prior work demonstrated that fertility intentions are fluid and change over a woman’s (or couple’s) life course with changing marital status, childbearing, and education/employment opportunities. This study uses longitudinal data to better examine the fluidity of women’s fertility intentions and disentangle the complex interrelationships between fertility and contraceptive use. Methods Using survey data from three time points and three urban sites in Senegal, this study examines how women’s fertility intentions and contraceptive use in an earlier period affect pregnancy experience and the intentionality of experienced pregnancies among a sample of 1050 women who were in union at all three time points. We apply correlated random effect longitudinal regression methods to predict a subsequent birth by fertility intentions and modern contraceptive use at an earlier period addressing endogeneity concerns of earlier analyses that only include two time periods. Results Descriptive results demonstrate some change in fertility desires over time such that 6–8% of women who reported their pregnancy as intended (i.e., wanted to get pregnant at time of pregnancy) reported earlier that they did not want any(more) children. Multivariate analyses demonstrate that women who want to delay or avoid a pregnancy and are using modern contraception are the least likely to get pregnant. Among women who became pregnant, the only factor differentiating whether the pregnancy is reported as intended or unintended (mistimed or unwanted) was prior fertility intention. Women who wanted to delay a pregnancy previously were more likely to report the pregnancy as unintended compared to women who wanted to get pregnant soon. Conclusions These results suggest some post-hoc rationalization among women who are getting pregnant. Women who say they do not want to get pregnant may be choosing not to use a contraceptive method in this urban Senegal context of high fertility. Programs seeking to reach these women need to consider their complex situations including their fertility intentions, family planning use, and the community norms within which they are reporting these intentions and behaviors.
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Affiliation(s)
- Ilene S Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA.
| | - Veronica Escamilla
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
| | - Peter M Lance
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
| | - David K Guilkey
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA.,Department of Economics, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Association of men's exposure to family planning programming and reported discussion with partner and family planning use: The case of urban Senegal. PLoS One 2018; 13:e0204049. [PMID: 30252875 PMCID: PMC6155530 DOI: 10.1371/journal.pone.0204049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
Background Family planning programs increasingly aim to encourage men to be involved in women’s reproductive health decision-making as well as support men to be active agents of change for their own and the couple’s reproductive health needs. This study contributes to this area of work by examining men’s exposure to family planning (FP) program activities in urban Senegal and determining whether exposure is associated with reported FP use and discussion of family planning with female partners. Methods This study uses data from two cross-sectional surveys of men in four urban sites of Senegal (Dakar, Pikine, Guédiawaye, Mbao). In 2011 and 2015, men ages 15–59 in a random sample of households from study clusters were approached and asked to participate in a survey about their fertility and family planning experiences. These data were used to determine the association between exposure to the Initiative Sénégalaise de Santé Urbaine (in English: Senegal Urban Reproductive Health Initiative) family planning program interventions with men’s reported modern family planning use and their reported discussion of FP with their partners. Since data come from the same study clusters at each time period, fixed effects methods at the cluster level allowed us to control for possible program targeting by geographic area. Results Multivariate models demonstrate that religious leaders speaking favorably about family planning, seeing FP messages on the television, hearing FP messages on the radio, and exposure to community outreach activities with a FP focus (e.g., house to house and community religious dialogues) are associated with reported modern family planning use and discussion of family planning with partners among men in the four urban sites of Senegal. Conclusions This study demonstrates that it is possible to reach men with FP program activities in urban Senegal and that these activities are positively associated with reported FP behaviors.
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Cronin CJ, Guilkey DK, Speizer IS. The effects of health facility access and quality on family planning decisions in urban Senegal. HEALTH ECONOMICS 2018; 27:576-591. [PMID: 29094775 PMCID: PMC5867202 DOI: 10.1002/hec.3615] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/14/2017] [Accepted: 09/29/2017] [Indexed: 05/29/2023]
Abstract
Research in developing countries is rarely focused on examining how supply side factors affect family planning decisions due to a lack of facility-level data. When these data exist, analyses tend to focus on rural environments. In this paper, we study the effects that health facility access and quality have on contraceptive use and desired number of children for women in urban Senegal. Unlike related studies focusing on rural environments, we find no evidence that greater access to health facilities and pharmacies increases contraceptive use among urban women. However, we do find that contraceptive use among urban women is higher with greater facility quality. For example, we find that increasing the proportion of pharmacies employing multiple pharmacists from 0% to 50% would increase contraceptive use by 6.0 percentage points, and increasing the proportion of facilities with family planning guidelines/protocols from 50% to 100% would increase use by 2.1 percentage points.
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Affiliation(s)
| | - David K. Guilkey
- Department of Economics and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Ilene S. Speizer
- Gillings School of Public Health, Department of Maternal and Child Health and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
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