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Thomas HL, Bell SO, Karp C, Omoluabi E, Kibira SP, Makumbi F, Galadanci H, Shiferaw S, Seme A, Moreau C, Wood SN. A qualitative exploration of reproductive coercion experiences and perceptions in four geo-culturally diverse sub-Saharan African settings. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100383. [PMID: 38911288 PMCID: PMC11190838 DOI: 10.1016/j.ssmqr.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/22/2023] [Accepted: 12/13/2023] [Indexed: 06/25/2024]
Abstract
Reproductive coercion (RC) is any intentional behavior that interferes with another's reproductive decision-making or pregnancy outcome. This study aims to qualitatively examine RC experiences and perceptions among women and men in Ethiopia, Nigeria (Kano and Anambra States), and Uganda. This is a secondary analysis utilizing qualitative data from the Women's and Girls' Empowerment in Sexual and Reproductive Health study. Across sites, focus group discussions (38 groups; n=320 participants) and in-depth interviews (n=120) were conducted, recorded, and transcribed. Transcripts were loaded into Atlas.ti, and quotes describing experiences of reproductive control or abuse were coded as "reproductive coercion." RC quotes were input into a matrix for thematic analysis. Emergent RC themes included indirect reproductive pressures, direct family planning interference, concurrent experiences of violence, and responses to RC. Indirect reproductive pressures included tactics to both promote and prevent pregnancy, while direct interference centered on pregnancy promotion. Women who were not compliant with their partners' reproductive demands were often subjected to violence from multiple actors (i.e., parents, in-laws, community members) in addition to their partners. Despite concurrent forms of violence, women across sites resisted RC by using contraceptives covertly, choosing to abort, or leaving their abusive partnerships. Women and men across sites indicated that men were highly influential in fertility. RC behaviors were a mechanism of control over desired reproductive outcomes, which were often rooted in perceptions of childbearing as social status. Findings indicate a need for more nuanced community interventions targeting social norms, as well as improved RC screening and response within health services.
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Affiliation(s)
- Haley L. Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Suzanne O. Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | - Hadiza Galadanci
- Center for Advanced Medical Research and Training, Bayero University Kano, Nigeria
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Ethiopia
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94800, Villejuif, France
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Qureshi MJ, Miller AP, Mugamba S, Kyasanku E, Nalugoda F, Bulamba RM, Kigozi G, Nakigozi G, Nkale J, Kato P, Nalwoga GK, Watya S, Wagman JA. Women's access to family planning and experiences of reproductive coercion during the COVID-19 lockdown in two districts of Uganda. Heliyon 2024; 10:e30216. [PMID: 38765155 PMCID: PMC11098776 DOI: 10.1016/j.heliyon.2024.e30216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024] Open
Abstract
Background In March 2020, Uganda enforced country-wide restrictions to control the spread of SARS-CoV-2, categorizing some health services, including family planning (FP), as non-essential. Globally, similar COVID-19 restrictions have been associated with increased vulnerability to reproductive coercion (RC) among women, due to changes in FP service availability and restricted access by partners. This study aims to investigate these dynamics in Uganda, specifically examining the impact of the COVID-19 lockdown on women's access to FP, their experiences of RC, and the relationship between RC and intimate partner violence (IPV). Methods We conducted a cross-sectional analysis of data from 960 women participating in the AMBSO Population Health Surveillance Study (APHS) between August 2020 and March 2021 across Wakiso (N = 164) and Hoima (N = 796) districts in Uganda. Our analysis focused on women who were sexually active in the past month, using bivariate analyses to explore the associations between RC and recent experiences of sexual, physical, and verbal IPV. Findings The most commonly reported FP methods were injectables (36.8 %) and implants (16 %). Despite the COVID-19 lockdown, less than one percent of participants reported an inability to access their preferred FP method. Notably, 3 % of the women experienced RC in the past 12 months. There was a significant association between RC and sexual IPV (p < 0.0001), as well as physical IPV (p < 0.0001). Instances of verbal IPV were observed to have tripled during the lockdown period. Interpretation An increase in verbal IPV was found among women during the COVID-19 lockdown. Additionally, a notable association emerged between other forms of IPV and an increased risk of RC. Despite the lockdown, access to FP remained high, which could be attributed to the prevalent use of long-acting FP methods.
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Affiliation(s)
- Mira J. Qureshi
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Amanda P. Miller
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Emmanuel Kyasanku
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Robert Malyabe Bulamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Gertrude Nakigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - James Nkale
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Phillip Kato
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Grace Kigozi Nalwoga
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Habte A, Hailegebreal S, Simegn AE. Predictors of maternal health services uptake in West African region: a multilevel multinomial regression analysis of demographic health survey reports. Reprod Health 2024; 21:45. [PMID: 38582831 PMCID: PMC10999082 DOI: 10.1186/s12978-024-01782-5] [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: 11/05/2023] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Pursuant to studies, receiving the three key maternal health services (Antenatal Care, Skilled Delivery Service, and Postnatal Care) in a continuum could prevent 71% of global maternal deaths. Despite the Western African region being known for its high maternal death and poor access to maternal health services, there is a dearth of studies that delve into the spectrum of maternal health services uptake. Hence, this study aimed to assess the level and predictors of partial and adequate utilization of health services in a single analytical model using the most recent Demographic and Health Survey (DHS) data (2013-2021). METHODS This study was based on the appended women's (IR) file of twelve West African countries. STATA software version 16 was used to analyze a weighted sample of 89,504 women aged 15-49 years. A composite index of maternal health service utilization has been created by combining three key health services and categorizing them into 'no', 'partial', or 'adequate' use. A multilevel multivariable multinomial logistic regression analysis was carried out to examine the effects of each predictor on the level of service utilization. The degree of association was reported using the adjusted relative risk ratio (aRRR) with a corresponding 95% confidence interval, and statistical significance was declared at p < 0.05. RESULTS 66.4% (95% CI: 64.9, 67.7) and 23.8% (95% CI: 23.3, 24.2) of women used maternal health services partially and adequately, respectively. Togo has the highest proportion of women getting adequate health care in the region, at 56.7%, while Nigeria has the lowest proportion, at 11%. Maternal education, residence, wealth index, parity, media exposure (to radio and television), enrolment in health insurance schemes, attitude towards wife beating, and autonomy in decision-making were identified as significant predictors of partial and adequate maternal health service uptake. CONCLUSION The uptake of adequate maternal health services in the region was found to be low. Stakeholders should plan for and implement interventions that increase women's autonomy. Program planners and healthcare providers should give due emphasis to those women with no formal education and from low-income families. The government and the private sectors need to collaborate to improve media access and increase public enrolment in health insurance schemes.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | - Samuel Hailegebreal
- College of Medicine and Health Sciences, School of Public Health, Department of Health Informatics, Wachemo University, Hosaena, Ethiopia
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Baritwa MS, Joho AA. Intimate partner violence influences modern family planning use among married women in Tanzania: cross-sectional study. BMC Public Health 2024; 24:421. [PMID: 38336740 PMCID: PMC10858459 DOI: 10.1186/s12889-024-17666-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: 01/07/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Married women who experience intimate partner violence (IPV) are less likely to negotiate with their partners on modern family planning (FP) use. This study aimed to determine the influence of intimate partner violence and sociodemographics on modern family planning use. METHODS A community-based cross-sectional study was conducted in the Mara region, Tanzania from April to July 2020. A total of 366 married women were interviewed. Data were collected using a structured interviewer-administered questionnaire. Analysis was done using SPSS version 25, and a binary logistic regression model was used to determine the predictors of modern FP use. The significance level was set at a p-value less than 0.05. RESULTS The overall prevalence of IPV was 73% with 54.1% physical, 36.3% psychological, and 25.4%, sexual violence. The prevalence of modern FP use was 62%, and the most (49.1%) common method practiced by married women was injection (Depo Provera). Physical violence (AOR = 0.32, p = 0.0056), and psychological violence (AOR = 0.22, p = 0.0022) had significantly reduced odds of modern FP use. Religion (AOR = 4.6, p = 0.0085), and availability of preferred modern FP methods (AOR = 9.27, p < 0.0001) had significantly increased odds of modern FP use. CONCLUSION In this study, there is a positive association between the use of modern FP methods and IPV. To prevent IPV and its negative health consequences, it is crucial to involve community leaders and primary healthcare workers. They can help in identifying the best strategies to prevent IPV and promote the use of modern FP methods. It is equally important to involve male partners in reproductive health decisions, including the use of modern FP methods. This approach will help reduce reproductive coercion.
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Affiliation(s)
- Mrimi S Baritwa
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Angelina A Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania.
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Omona K, Mahoro RM. Factors associated with men’s participation in postpartum family planning: a study of Kiswa Health Centre III, Kampala, Uganda. J OBSTET GYNAECOL 2023; 43. [DOI: https:/doi.org/10.1080/01443615.2022.2158321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/09/2022] [Indexed: 02/17/2024]
Affiliation(s)
- Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Rose Mary Mahoro
- Department of Communication and Policy, Marie Stopes Uganda, Kampala, Uganda
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Omona K, Mahoro RM. Factors associated with men's participation in postpartum family planning: a study of Kiswa Health Centre III, Kampala, Uganda. J OBSTET GYNAECOL 2023; 43:2158321. [PMID: 36606701 DOI: 10.1080/01443615.2022.2158321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning.IMPACT STATEMENTWhat is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning.What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning.What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement.
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Affiliation(s)
- Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Rose Mary Mahoro
- Department of Communication and Policy, Marie Stopes Uganda, Kampala, Uganda
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Uysal J, Boyce SC, Undie CC, Liambila W, Wendoh S, Pearson E, Johns NE, Silverman JG. Effects of a clinic-based reproductive empowerment intervention on proximal outcomes of contraceptive use, self-efficacy, attitudes, and awareness and use of survivor services: a cluster-controlled trial in Nairobi, Kenya. Sex Reprod Health Matters 2023; 31:2227371. [PMID: 37594312 PMCID: PMC10443967 DOI: 10.1080/26410397.2023.2227371] [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] [Indexed: 08/19/2023] Open
Abstract
This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta -0.34, 95% CI -0.65, -0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs.Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women's reproductive health. While one intervention, ARCHES - Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women's proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.
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Affiliation(s)
- Jasmine Uysal
- Predoctoral fellow, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Sabrina C. Boyce
- Postdoctoral fellow, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Chi-Chi Undie
- Senior Associate, Population Council, Nairobi, Kenya
| | | | - Seri Wendoh
- Global Lead for Gender & Inclusion, International Planned Parenthood Federation, London, UK
| | - Erin Pearson
- Research Scientist, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Nicole E. Johns
- Data Analyst, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Jay G. Silverman
- Professor of Medicine and Global Public Health, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
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Tekakwo A, Nabirye RC, Nantale R, Oguttu F, Nambozo B, Wani S, Musaba MW, Mukunya D, Epuitai J. Enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda: a qualitative study. Contracept Reprod Med 2023; 8:49. [PMID: 37845730 PMCID: PMC10577923 DOI: 10.1186/s40834-023-00251-x] [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: 08/05/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Male involvement plays a critical role in the utilization of various sexual and reproductive health services. We explored enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda. METHODS This was a qualitative study in Mbale, Eastern Uganda done between November and December 2022. We conducted three group discussions comprising of four participants each, with male partners and eight key informant interviews with midwives. We followed a group discussion guide during the group discussions and an interview guide during the key informant interviews to explore enablers and barriers of male involvement in the use of modern family planning methods. All the interviews and group discussions were audio-recorded with permission from the participants, transcribed verbatim, and analyzed following thematic content analysis approach. RESULTS Two sub-themes emerged from the analysis; perceived enablers and barriers. The perceived enablers included positive attitude, subjective norms, need to support the woman, mutual consent, limited resources and expected benefits of reducing gender-based violence and sexually transmitted infections. Lack of male partner consent, busy work engagement, social stigma, religious prohibition, desire for many children and gender roles incompatibility hindered male partner involvement in family planning. Fear of side effects and misconceptions, unconducive hospital environment in form of mistreatment, family planning considered a female's issue, and lack of consideration of male partner needs in family planning clinic were additional barriers to male involvement. CONCLUSION Male involvement in family planning was related to positive attitude and subjective norms towards family planning, mutual consent, and recognition for limited resources to support a large family size. Lack of male partner approval, fear of side effects and misconceptions, unconducive hospital environment and social, cultural and religious prohibitions discouraged male partner involvement in family planning. Community based approaches to family planning sensitization, such as community education campaigns, may be an important step toward reducing barriers to male involvement in the use of modern family planning methods.
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Affiliation(s)
- Atkinson Tekakwo
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Rose Chalo Nabirye
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda.
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda.
| | - Faith Oguttu
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
| | - Brendah Nambozo
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
| | - Solomon Wani
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Joshua Epuitai
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Hayes BE, Maher CA, Pinchevsky GM. Reproductive Coercion Among College Students: An Extension and Test of Routine Activity Theory. Violence Against Women 2023; 29:2486-2507. [PMID: 37488470 DOI: 10.1177/10778012231186813] [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] [Indexed: 07/26/2023]
Abstract
The current study is guided by routine activity theory to explore the risk of experiencing reproductive coercion among a sample of sexually active college students (N = 1,515). Findings indicate that being in an exclusive relationship was associated with lower odds of reproductive coercion, yet prior victimization, including emotional abuse and sexual violence, was associated with higher odds of reproductive coercion. This study supports other research that finds reproductive coercion does not occur in isolation from other victimization experiences, and multifaceted prevention strategies are needed. Implications relating to autonomous reproductive decision-making are discussed.
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Affiliation(s)
- Brittany E Hayes
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, USA
| | - Cooper A Maher
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, USA
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Wollum A, Bornstein M, Mopiwa G, Norris A, Gipson JD. Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi. Reprod Health 2023; 20:142. [PMID: 37736687 PMCID: PMC10515069 DOI: 10.1186/s12978-023-01688-8] [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: 09/14/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.
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Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), UCLA Bixby Center on Population and Reproductive Health, Los Angeles, USA.
| | - Marta Bornstein
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Gladson Mopiwa
- Adolescent Girls and Young Women Program-The Global Fund Grant ActionAid Malawi, Lilongwe City, Malawi
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jessica D Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), UCLA Bixby Center on Population and Reproductive Health, Los Angeles, USA
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Habte A, Tamene A, Bogale B. Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework. PLoS One 2023; 18:e0291110. [PMID: 37683011 PMCID: PMC10491392 DOI: 10.1371/journal.pone.0291110] [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: 04/24/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Low women empowerment, is a known contributing factor to unmet needs for contraception by limiting access to health services through negative cultural beliefs and practices. However, little is known about the association between unmet needs and domains of women empowerment in Sub-Saharan African (SSA) countries. Hence, this study aimed at assessing the influence of women empowerment domains on the unmet need for contraception in the region using the most recent Demographic and Health Survey (DHS) data (2016-2021). METHODS The data for the study was derived from the appended women's (IR) file of eighteen SSA countries. A weighted sample of 128,939 married women was analyzed by STATA version 16. The Harvard Institute's Gender Roles Framework, which comprised of influencer, resource, and decision-making domains was employed to identify and categorize the covariates across three levels. The effects of each predictor on the unmet need for spacing and limiting were examined using a multivariable multilevel mixed-effect multinomial logistic regression analysis. Adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. RESULTS The pooled prevalence of unmet needs for contraception was 26.36% (95% CI: 24.83-30.40) in the region, with unmet needs for spacing and limiting being 16.74% (95% CI: 16.55, 17.02) and 9.62% (95% CI: 9.45, 12.78), respectively. Among variables in the influencer domain, educational level, family size of more than five, parity, number of children, attitude towards wife beating, and media exposure were substantially linked with an unmet need for spacing and limiting. Being in the poorest wealth quintile and enrollment in health insurance schemes, on the other hand, were the two variables in the resource domain that had a significant influence on unmet needs. The overall decision-making capacity of women was found to be the sole significant predictor of unmet needs among the covariates in the decision-making domain. CONCLUSION Unmet needs for contraception in SSA countries were found to be high. Reproductive health program planners and contraceptive service providers should place due emphasis on women who lack formal education, are from low-income families, and have large family sizes. Governments should collaborate with insurance providers to increase health insurance coverage alongside incorporating family planning within the service package to minimize out-of-pocket costs. NGOs, government bodies, and program planners should collaborate across sectors to pool resources, advocate for policies, share best practices, and coordinate initiatives to maximize the capacity of women's decision-making autonomy.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Aiggan Tamene
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Biruk Bogale
- Department of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia
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Boyce SC, Minnis AM, Deardorff J, McCoy SI, Challa S, Johns N, Aliou S, Brooks M, Nouhou AM, Gochyyev P, Wilson M, Baker H, Silverman JG. Measuring social norms of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy: an item response modelling of the IPV-ASRA scale. Reprod Health 2023; 20:90. [PMID: 37316890 DOI: 10.1186/s12978-023-01632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The field of violence prevention research is unequivocal that interventions must target contextual factors, like social norms, to reduce gender-based violence. Limited research, however, on the social norms contributing to intimate partner violence or reproductive coercion exists. One of the driving factors is lack of measurement tools to accurately assess social norms. METHODS Using an item response modelling approach, this study psychometrically assesses the reliability and validity of a social norms measure of the acceptability of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy with data from a population-based sample of married adolescent girls (ages 13-18) and their husbands in rural Niger (n = 559 husband-wife dyads) collected in 2019. RESULTS A two-dimensional Partial Credit Model for polytomous items was fit, showing evidence of reliability and validity. Higher scores on the "challenging husband authority" dimension were statistically associated with husband perpetration of intimate partner violence. CONCLUSIONS This brief scale is a short (5 items), practical measure with strong reliability and validity evidence. This scale can help identify populations with high-need for social norms-focused IPV prevention and to help measure the impact of such efforts.
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Affiliation(s)
- Sabrina C Boyce
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Alexandra M Minnis
- Women's Global Health Imperative, RTI International, 2150 Shattuck Ave. Ste 800, Berkeley, CA, 94704, USA
| | - Julianna Deardorff
- Community Health Sciences, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Sneha Challa
- School of Nursing, University of San Francisco, 3333 California Street, San Francisco, CA, 94118, USA
| | - Nicole Johns
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Sani Aliou
- Niger Country Office, Pathfinder International, Niamey, Niger
| | - Mohamad Brooks
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA, 02472, USA
| | | | - Perman Gochyyev
- Graduate School of Education, University of California, 2121 Berkeley Way, Berkeley, CA, 94720-1670, USA
| | - Mark Wilson
- Graduate School of Education, University of California, 2121 Berkeley Way, Berkeley, CA, 94720-1670, USA
| | - Holly Baker
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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13
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Silverman JG, Brooks MI, Aliou S, Johns NE, Challa S, Nouhou AM, Tomar S, Baker H, Boyce SC, McDougal L, DeLong S, Raj A. Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger. Reprod Health 2023; 20:83. [PMID: 37277837 PMCID: PMC10243049 DOI: 10.1186/s12978-023-01609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. METHODS We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13-19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. RESULTS Baseline and 24-month follow-up data were collected April-June 2016 and April-June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41-8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68-5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18-0.88 for Arm 2; aIRR 0.46, 95% CI 0.21-1.01 for Arm 3). No Arm 1 effects were observed. CONCLUSIONS The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730.
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Affiliation(s)
- Jay G. Silverman
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Sani Aliou
- Pathfinder International, Watertown, USA
| | - Nicole E. Johns
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sneha Challa
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Shweta Tomar
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Holly Baker
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sabrina C. Boyce
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Lotus McDougal
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Stephanie DeLong
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
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14
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The role of male partners in modern contraceptive use by women in South Africa: Does space also matter? JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
AbstractThis paper examined the role of male partners in modern contraceptive use by women across clusters in South Africa. Its main objective was threefold. First, the present paper sought to test whether South African married women’s modern contraceptive use is related to the influence of their husbands or male partners. Second, it examined whether modern contraceptive use is similar within clusters. Third, it tested whether group effects are spatially dependent among neighbouring clusters. It used the recent Demographic and Health Survey for South Africa as the data source to carry out the empirical analysis. On the one hand, the results confirm a positive and significant relationship between South African married women’s modern contraceptive use with their partners’ secondary education level, irrespective of the cluster in which they reside. On the other hand, the hypothesis that spatial dependence of random effects is not confirmed, leading to the conclusion that space only matters when it comes to spatial heterogeneity or group effects.
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15
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Wood SN, Thomas HL, Thiongo M, Guiella G, Bazié F, Onadja Y, Mosso R, Fassassi R, Gichangi P, Decker MR. Intersection of reproductive coercion and intimate partner violence: cross-sectional influences on women's contraceptive use in Burkina Faso, Côte d'Ivoire and Kenya. BMJ Open 2023; 13:e065697. [PMID: 37164455 PMCID: PMC10173961 DOI: 10.1136/bmjopen-2022-065697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES Among nationally representative cross-sections of women in need of contraception from Burkina Faso, Côte d'Ivoire and Kenya, we aimed to: (1) examine the intersection of past-year physical/sexual intimate partner violence (IPV), emotional IPV and reproductive coercion (RC) and (2) assess the impact of physical/sexual IPV, emotional IPV and RC on women's contraceptive use outcomes, including current contraceptive use, method type and covert use. DESIGN The present analysis uses cross-sectional female data collected in Burkina Faso (December 2020-March 2021), Côte d'Ivoire (October-November 2021) and Kenya (November-December 2020). SETTINGS Burkina Faso, Côte d'Ivoire and Kenya PARTICIPANTS: Analytical samples were restricted to partnered women with contraceptive need who completed a violence module (Burkina Faso n=1863; Côte d'Ivoire n=1105; Kenya n=3390). PRIMARY AND SECONDARY OUTCOME MEASURES The exposures of interest-past-year emotional IPV, physical/sexual IPV and RC-were assessed using abridged versions of the Revised Conflict and Tactics Scale-2 and Reproductive Coercion Scale, respectively. Outcomes of interest included current contraceptive use, contraceptive method type (female controlled vs male compliant), and covert contraceptive use, and used standard assessments. RESULTS Across sites, 6.4% (Côte d'Ivoire) to 7.8% (Kenya) of women in need of contraception experienced RC; approximately one-third to one-half of women experiencing RC reported no other violence forms (31.7% in Burkina Faso to 45.8% in Côte d'Ivoire), whereas physical/sexual IPV largely occurred with emotional IPV. In multivariable models, RC was consistently associated with covert use (Burkina Faso: aOR 2.84 (95% CI 1.21 to 6.64); Côte d'Ivoire: aOR 4.45 (95% CI 1.76 to 11.25); Kenya: aOR 5.77 (95% CI 3.51 to 9.46)). Some IPV in some settings was also associated with covert use (emotional IPV, Burkina Faso: aOR 2.99 (95% CI 1.56 to 5.74); physical/sexual, Kenya: aOR 2.35 (95% CI 1.33 to 4.17)). CONCLUSIONS Across settings, covert use is a critical strategy for women experiencing RC. Country policies must recognise RC as a unique form of violence with profound implications for women's reproductive health.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Fiacre Bazié
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Rosine Mosso
- Ecole Nationale Superieure de Statistique et d'Economie Appliquee, Abidjan, Côte d'Ivoire
| | - Raimi Fassassi
- Ecole Nationale Superieure de Statistique et d'Economie Appliquee, Abidjan, Côte d'Ivoire
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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16
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Dixit A, Johns NE, Ghule M, Battala M, Begum S, Saggurti N, Silverman J, Reed E, Kiene SM, Benmarhnia T, Averbach S, Raj A. Association of traditional marital practices with contraceptive decision-making, couple communication, and method use among couples in rural Maharashtra, India. CULTURE, HEALTH & SEXUALITY 2023; 25:521-536. [PMID: 35465833 PMCID: PMC9588848 DOI: 10.1080/13691058.2022.2062052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
In India, traditional social practices around marriage, such as non-involvement of prospective brides in choice of partner and timing of marriage, child/early marriage, dowry and purdah, compromise women's agency at the time of marriage and may also affect contraceptive practices in marriage. This paper examines the associations between traditional marital practices and contraceptive behaviours, including women's control over contraceptive decision-making, couples' communication about contraception, and ever use of contraceptives, among married women aged 18-29 years (N = 1,200) and their husbands in rural Maharashtra, India. Multivariable logistic regression was used to examine the association between these marginalising social practices and family planning behavioural outcomes, adjusting for demographic and parity confounders. Wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (AOR 1.76, 95% CI 1.16-2.68), and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Women's involvement in marital choice may facilitate couples' engagement related to family planning, possibly via the establishment of better communication between partners.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, CA, USA
| | - Nicole E. Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Jay Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Elizabeth Reed
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Division of Health Promotion and Behavior, San Diego State University, San Diego, CA, USA
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
- Scripps Institution of Oceanography, University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA. USA
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Canning D, Karra M. Unwanted Family Planning: Prevalence Estimates for 56 Countries. Stud Fam Plann 2023; 54:75-93. [PMID: 36705943 DOI: 10.1111/sifp.12230] [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: 01/28/2023]
Abstract
While there is a large literature on the prevalence of unmet need for family planning, there is no matching quantitative evidence on the prevalence of unwanted family planning; all contraceptive use is assumed to represent a "met need." This lack of evidence raises concerns that some observed contraceptive use may be undesired and coercive. We provide estimates of unwanted family planning using Demographic and Health Survey data collected from 1,546,987 women in 56 low- and middle-income countries between 2011 and 2019. We estimate the prevalence of unwanted family planning, defined as the proportion of women who report wanting a child in the next nine months but who are using contraception. We find that 12.2 percent of women have an unmet need for family planning, while 2.1 percent have unwanted family planning, with estimated prevalence rates ranging from 0.4 percent in Gambia to 7.1 percent in Jordan. About half of unwanted family planning use can be attributed to condoms, withdrawal, and abstinence. Estimating the prevalence of unwanted family planning is difficult given current data collection efforts, which are not designed for this purpose. We recommend that future surveys probe the reasons for the use of family planning.
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Affiliation(s)
- David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Mahesh Karra
- Frederick S. Pardee School of Global Studies, Boston University, Boston, MA, 02215, USA
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18
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Sileo KM, Muhumuza C, Helal T, Olfers A, Lule H, Sekamatte S, Kershaw TS, Wanyenze RK, Kiene SM. Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown. Reprod Health 2023; 20:31. [PMID: 36759838 PMCID: PMC9910252 DOI: 10.1186/s12978-023-01566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen's Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19. METHODS Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis. RESULTS We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women's ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns. CONCLUSIONS This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women's autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | | | - Teddy Helal
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | - Allison Olfers
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
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19
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Wood SN, Thomas HL, Guiella G, Bazié F, Mosso R, Fassassi R, Akilimali PZ, Thiongo M, Gichangi P, Oumarou S, OlaOlorun FM, Omoluabi E, Khanna A, Kibira SPS, Makumbi F, Decker MR. Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence. Reprod Health 2023; 20:22. [PMID: 36707833 PMCID: PMC9881347 DOI: 10.1186/s12978-023-01568-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reproductive coercion (RC) is a type of abuse where a partner asserts control over a woman's reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC. METHODS This analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework. RESULTS Confirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d'Ivoire-0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59-10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23-0.67). Other assessed correlates differed by site. CONCLUSIONS Understanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women's immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.
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Affiliation(s)
- Shannon N. Wood
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Haley L. Thomas
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA
| | - Georges Guiella
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Fiacre Bazié
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Rosine Mosso
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Raimi Fassassi
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Pierre Z. Akilimali
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya ,grid.449703.d0000 0004 1762 6835Technical University of Mombasa, Mombasa, Kenya ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Funmilola M. OlaOlorun
- grid.9582.60000 0004 1794 5983College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoluabi
- grid.8974.20000 0001 2156 8226University of the Western Cape, Cape Town, South Africa
| | - Anoop Khanna
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Simon Peter Sebina Kibira
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Fredrick Makumbi
- grid.11194.3c0000 0004 0620 0548Makerere University School of Public Health, Kampala, Uganda
| | - Michele R. Decker
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA ,grid.21107.350000 0001 2171 9311Johns Hopkins School of Nursing, Baltimore, USA
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20
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Wood SN, Dozier JL, Karp C, Desta S, Decker MR, Shiferaw S, Seme A, Yirgu R, Zimmerman LA. Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women. Sex Reprod Health Matters 2022; 30:2139891. [PMID: 36469634 PMCID: PMC9728127 DOI: 10.1080/26410397.2022.2139891] [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] [Indexed: 12/12/2022] Open
Abstract
Partner-perpetrated pregnancy coercion inhibits women's reproductive autonomy. However, few studies have quantified pregnancy coercion and its effects on women's health within low- and middle-income countries. Among a national sample of Ethiopian women, this study aimed to: (1) assess the prevalence of past-year pregnancy coercion and explore regional differences; (2) identify correlates; (3) examine the relationship between pregnancy coercion and modern contraceptive use. Analyses utilise cross-sectional data from Performance Monitoring for Action (PMA)-Ethiopia, a nationally representative sample of females aged 15-49 conducted from October to November 2019. Past-year pregnancy coercion was assessed via five items and analysed dichotomously and categorically for severity. Among women in need of contraception, bivariate and multivariable logistic regression examined associations between variables of interest, per aim, accounting for sampling weights and clustering by enumeration area. Approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa. Increasing parity was associated with decreased odds of pregnancy coercion. Among women in need of contraception, experience of pregnancy coercion was associated with a 32% decrease in odds of modern contraceptive use (aOR = 0.68; 95% CI: 0.53-0.89); when disaggregated by severity, odds decreased for most severe pregnancy coercion (aOR = 0.59; 95% CI = 0.41-0.83). Results indicate that partner-perpetrated pregnancy coercion is prevalent across diverse regions of Ethiopia, and most severe forms could interrupt recent gains in contraceptive coverage and progress to sexual and reproductive health and rights. Providers must be aware of potential contraceptive interference and address coercive influences during contraceptive counselling.
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Affiliation(s)
- Shannon N Wood
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Correspondence:
| | - Jessica L Dozier
- PhD Student, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Celia Karp
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Selamawit Desta
- Director of Survey Operations, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Bloomberg Professor of American Health, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Women’s Health and Rights Program Director, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Joint Professor, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Solomon Shiferaw
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robel Yirgu
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Linnea A Zimmerman
- Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Dixit A, Ghule M, Rao N, Battala M, Begum S, Johns NE, Averbach S, Raj A. Qualitative Examination of the Role and Influence of Mothers-in-Law on Young Married Couples' Family Planning in Rural Maharashtra, India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200050. [PMID: 36316150 PMCID: PMC9622279 DOI: 10.9745/ghsp-d-22-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
Unmet need for family planning (FP) continues to be high in India, especially among young and newly married women. Mothers-in-law (MILs) often exert pressure on couples for fertility and control decision making and behaviors around fertility and FP, yet there is a paucity of literature to understand their perspectives. Ten focus group discussions (FGDs) were carried out with MILs of young married women (aged 18-29 years) participating in a couple-focused FP intervention as a part of a cluster-randomized intervention evaluation trial (the CHARM2 study) in rural Maharashtra, India. FGDs included questions on their roles, attitudes, and decision making around fertility and FP. Audio-recorded data were translated/transcribed into English and analyzed for key themes using a deductive coding method. MILs reported having social norms of early fertility and son preference. They understood that family size norms are lower among daughters-in-law and that spacing can be beneficial but were not supportive of short-term contraceptives, especially before the first child. They preferred female sterilization, opposed abortion, had apprehensions around side effects from contraceptive use, and had misconceptions about the intrauterine device, with particular concerns around its coercive insertion. MILs mostly believed that decision making should be done jointly by a husband and wife, but that as elders, they should be consulted and involved in the decision-making process. These findings highlight the need for engagement of MILs for FP promotion in rural India and the potential utility of social norms interventions.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Namratha Rao
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Nicole E Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA, USA
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22
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Maytan-Joneydi A, MacLachlan EW, Agali BI, Louis-Charles K, Chaibou S, Amadou Garba S, Moumouni AN, Speizer IS. Providers' views on hormonal family planning methods: a qualitative study from Dosso, Niger. Gates Open Res 2022; 6:75. [PMID: 36262978 PMCID: PMC9550940 DOI: 10.12688/gatesopenres.13674.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers' views on three hormonal FP methods and why they think women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including adolescents and married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant's discretion, effectiveness, long-acting nature, and simplicity of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is "invisible" to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.
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Affiliation(s)
- Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | | | | | - Kyria Louis-Charles
- Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA
| | | | | | | | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA,Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA,
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23
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Maytan-Joneydi A, MacLachlan EW, Agali BI, Louis-Charles K, Chaibou S, Amadou Garba S, Moumouni AN, Speizer IS. Providers' views on hormonal family planning methods for young women: a qualitative study from Dosso, Niger. Gates Open Res 2022; 6:75. [PMID: 36262978 PMCID: PMC9550940 DOI: 10.12688/gatesopenres.13674.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers' views on three hormonal FP methods and why they think young women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including unmarried adolescents and young married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant's discretion, effectiveness, long-acting nature, and ease of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is "invisible" to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.
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Affiliation(s)
- Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | | | | | - Kyria Louis-Charles
- Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA
| | | | | | | | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA,Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA,
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24
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Paul P, Mondal D. Association Between Intimate Partner Violence and Contraceptive Use in India: Exploring the Moderating Role of Husband's Controlling Behaviors. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP15405-NP15433. [PMID: 34000903 DOI: 10.1177/08862605211015212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Existing studies show a mixed relationship between intimate partner violence (IPV) and contraceptive use. This study assesses the association between women's exposure to IPV and contraceptive use in India. Furthermore, we aim to determine whether husband's controlling behaviors play a moderating role in the IPV-contraception link. We used nationally representative data from the recent round of the National Family Health Survey (NFHS-4), conducted in 2015-2016. In this study, the use of contraceptives is the outcome variable, categorized into three groups: no/traditional methods, modern methods, and female sterilization. Women's exposure to IPV in the past year is the key exposure of interest. Socio-economic and demographic variables were used as covariates. Multinomial logistic regression models were performed to examine the association between women's exposure to IPV and contraceptive use. Of the total participants (N = 58,891), approximately one in every four women (24.1%) experienced any form of IPV in the past year. Slightly over half (50.8%) reported using either traditional methods of contraception or no contraceptive at all. About 14% of the respondents were using modern methods of contraception and 34.9% had undergone sterilization. After controlling for confounding factors, women who experienced IPV were 8% (95% CI [.87, .99]) less likely to report using modern contraceptives than those who did not face any IPV. Conversely, women who faced IPV were 14% (95% CI [1.09, 1.20]) more likely to undergo sterilization. Furthermore, women who experienced any form of IPV and whose husbands endorse controlling attitudes were 12% (95% CI [.81, .95]) less likely to report using modern contraceptives and 11% (95% CI [1.04, 1.17]) more likely to undergo sterilization. Interventions should be made to prevent violence against women that would increase their ability to choose appropriate contraception methods to avoid unintended pregnancies.
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Affiliation(s)
- Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Dinabandhu Mondal
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
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25
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Wood SN, Sarnak DO, Kibira SP, Zimmerman LA, Karp C, Makumbi F, Moreau C. Who uses covertly and what is the impact on contraceptive dynamics? Evidence from a national cohort of women in Uganda. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13667.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Little is known regarding the specific role of covert use (i.e., use of contraception without partner knowledge) in contraceptive discontinuation and switching. Among a nationally representative cohort of women in Uganda, we sought to: 1) compare characteristics of covert, overt, and non-users of contraception at baseline; 2) assess the effect of using contraception covertly on switching and discontinuation over a one-year period. Methods: Analyses utilized PMA2020 Uganda Round 6 (April–May 2018), with longitudinal analyses incorporating data from a one-year follow-up survey (May–June 2019). Both cross-sectional (n=1,764) and longitudinal (n=616) samples included women in need of contraception. For cross-sectional analyses, multinomial regression compared risk of overt/covert use vs. non-use by user characteristics and logistic regression compared the odds of covert vs. overt use among contraceptive users. For longitudinal analyses, multinomial regression examined risk of contraceptive switching and discontinuation by baseline covert vs. overt use status. Results: Among contraceptive users, 14.1% reported using covertly. In cross-sectional analyses, higher wealth (aRRR=1.74; 95% CI=1.19-2.54), secondary or higher education (aRRR=2.52; 95% CI=1.42-4.49), and middle parity (aRRR=1.24; 95% CI=1.00, 2.28) were associated with an increased risk of overt use, and higher wealth (aRRR=2.08; 95% CI=1.09-3.98) and polygyny (aRRR=1.60; 95% CI=1.01-2.54) with covert use, compared to non-use. Among contraceptive users, women within polygynous unions had double the odds of using covertly compared to those with monogamous partners (aOR=1.97; 95% CI=1.28-3.03). Longitudinal analyses revealed large proportions of overt and covert users switched (30% overt, 26% covert) or discontinued methods (32% overt, 37% covert) at one-year follow-up, however, neither switching nor discontinuation was significantly related to overt/covert use status at baseline. Conclusions: Though significant differences by covert use status were not detected, approximately 33% of users discontinued over one year; these women represent important beneficiaries of family planning programming as they may remain at risk for unintended pregnancy.
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26
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Bhan N, Raj A, Thomas EE, Nanda P. Measuring women's agency in family planning: the conceptual and structural factors in the way. Sex Reprod Health Matters 2022; 30:2062161. [PMID: 35648047 PMCID: PMC9176667 DOI: 10.1080/26410397.2022.2062161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nandita Bhan
- Research Scientist, Center on Gender Equity and Health, University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Anita Raj
- Tata Chancellor Professor of Society and Health, Department of Medicine; Professor of Education Studies, Division of Social Sciences; Director, Center on Gender Equity and Health, University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Edwin E Thomas
- Research Coordinator, Center on Gender Equity and Health, University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Priya Nanda
- Senior Program Officer, India Country Office, Bill & Melinda Gates Foundation, Seattle, USA
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- Research Scientist, Center on Gender Equity and Health, University of California San Diego, School of Medicine, La Jolla, CA, USA
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27
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Hoyt J, Hamon JK, Krishnaratne S, Houndekon E, Curry D, Mbembe M, Marcus S, Kambanje M, Pryor S, Barbra AA, Muhumuza H, Spilotros N, Webster J. "It was my own decision": the transformational shift that influences a woman's decision to use contraceptives covertly. BMC Womens Health 2022; 22:144. [PMID: 35501811 PMCID: PMC9063140 DOI: 10.1186/s12905-022-01731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family planning (FP) is an important element of sexual and reproductive health and rights, but socio-cultural barriers and unbalanced gender relations often limit women's decision-making about contraceptive use. Covert contraceptive use (CCU) exemplifies the limits on women's decision-making and represents a way in which some women overcome constraints to achieve their reproductive goals. This study explores the decision-making process through which women choose to use contraceptives covertly. METHODS A qualitative synthesis was conducted using data from women, health providers, community members, health administrators, and intervention implementers (n = 400) to explore the decision-making process through which women choose to use contraceptives covertly. Interviews and focus group discussions were conducted at two time points as part of an evaluation of interventions integrating FP and childhood immunisation services at sites in Benin, Kenya, Malawi and Uganda. The sexual and reproductive health empowerment framework by Karp et al. (2020) was adapted and used to guide the analysis. RESULTS Women recognised that although they suffered the negative consequences of frequent pregnancies and of raising large families, they lacked overt decision-making power over their fertility. Women were confident to engage in CCU because they believed their husbands did not understand these consequences nor acknowledged their suffering, which justified not informing them. CCU was a difficult choice however, women felt comfortable voicing their reproductive preferences in settings where health providers were supportive. CONCLUSIONS Women chose to use contraceptives covertly when they questioned the unfairness of their situation and recognised their own power to act in accordance with their reproductive preferences. This represented an important shift in a woman's perception of who is entitled to make decisions about contraceptive use. Importantly, health providers can play a key role in supporting women's autonomous decision making about contraceptive use and should be careful not to undermine women's confidence.
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Affiliation(s)
- Jenna Hoyt
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessie K. Hamon
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Shari Krishnaratne
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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28
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Vishwakarma M, Shekhar C. Covert use of reversible contraceptive methods and its association with husband's egalitarian gender attitude in India. BMC Public Health 2022; 22:460. [PMID: 35255867 PMCID: PMC8903557 DOI: 10.1186/s12889-022-12882-x] [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] [Received: 04/13/2021] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background In a patriarchal society, women often keep their use of contraceptives secret in order to meet their reproductive goals and satisfy their reproductive preferences. Nevertheless, to our knowledge, women’s covert contraceptive use and its association with husband’s gender attitude have not been studied in the Indian settings. The present study estimates the extent of covert modern contraceptive use (CCU) among women and its linkage with husbands’ gender attitudes in India. Methods The study is based on fecund and monogamous couples using modern, reversible contraceptive methods. The numbers of such couples were 4,825 and 7,824 in the national family health surveys 2005–06 and 2015–16 respectively. The outcome variable in the study was CCU, while the independent variables were husband’s gender attitude, women’s education, freedom of mobility, freedom to spend money independently, surviving number of children, concordance regarding additional children, couple-level information such as age and educational gap between spouses, and some socioeconomic status (SES) variables. We used latent class analysis to measure the gender attitude and used bivariate descriptive analysis and multivariate binary logistic regression to assess the linkages between husband’s gender attitude and CCU. Results This study found that the prevalence of CCU increased from 15% in 2005–06 to 27% in 2015–16. In both the time periods, contraceptive pills were the most preferred covert method, followed by intrauterine device (IUD). The results of the multivariate logistic regression show that women with husbands of moderate and low egalitarian gender attitudes were, respectively, 50% and 40% more likely to hide their contraceptive use than those with husbands of a high gender attitude. Women’s education, wealth index, number of living children, and region of residence were also found to be significantly associated with CCU. Conclusion The study reveals that husband’s low egalitarian gender attitude can be a potential barrier between spouses, preventing them from opening up about their fertility preferences and contraceptive needs to each other. A couple-oriented approach to family planning is needed so that both members of a couple can satisfy their fertility desires and preferences eventually. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12882-x.
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Affiliation(s)
- Minakshi Vishwakarma
- Research Scholar, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India, 400088
| | - Chander Shekhar
- Professor, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India, 400088
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29
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Upadhyay AK, Kumar K, James KS, Mcdougal L, Raj A, Singh A. Association between Intimate Partner Violence and Contraceptive Use Discontinuation in India. Stud Fam Plann 2022; 53:5-21. [PMID: 35032028 PMCID: PMC8957512 DOI: 10.1111/sifp.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap using microdata collected from women aged 15-49 in the 2015-2016 National Family Health Survey (NFHS). Analyses used multivariable multinomial logistic regressions stratified by long-acting reversible contraceptive methods (LARC)/non-LARC and condom/pill to examine the association between experience of IPV and contraceptive use discontinuation while still in need (DWSIN). Experience of physical violence was associated with DWSIN among LARC/IUD users (RRR: 3.73, 95 percent CI [1.55-8.95]) Among condom users, DWSIN was higher among women who experienced emotional violence compared with women who did not experience any violence (RRR: 4.16, 95 percent CI [1.59-10.90]). Although we did not find an association between IPV and overall contraceptive use discontinuation, we did find compelling evidence of an association between IPV and IUD and condom use discontinuation in India. There is a need to understand women's experience of IPV as a part of a broader strategy to provide high-quality family planning services to all women while considering individual circumstances and reproductive aspirations to support the uninterrupted use of contraception in India.
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Affiliation(s)
- Ashish Kumar Upadhyay
- Research Coordinator, GENDER ProjectInternational Institute for Population SciencesMumbai400 088India
| | - Kaushalendra Kumar
- Assistant Professor, Department of Public Health & Mortality StudiesInternational Institute for Population SciencesMumbai400 088India
| | - K. S. James
- Director and Senior ProfessorInternational Institute for Population SciencesMumbai400 088India
| | - Lotus Mcdougal
- Associate Project Scientist, Center on Gender Equity and HealthUniversity of California San DiegoLa JollaCA92093USA
| | - Anita Raj
- Tata Chancellor Professor of Medicine and Director, Center on Gender Equity and HealthUniversity of California San DiegoLa JollaCA92093USA
| | - Abhishek Singh
- Professor, Department of Public Health & Mortality StudiesInternational Institute for Population SciencesMumbai400 088India
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Adedini SA, Adewole OG, Oyinlola FF, Fayehun O. Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey. AAS Open Res 2021. [DOI: 10.12688/aasopenres.13247.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods : The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49 49 (nested within 1,400 communities), who were sexually active and were not pregnant at the time of the survey. Results : Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion : The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.
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Goemans SL, Singh A, Yadav AK, McDougal L, Raj A, Averbach SH. The association between intimate partner violence and recent self-managed abortion in India. AJOG GLOBAL REPORTS 2021; 1. [PMID: 35291317 PMCID: PMC8920295 DOI: 10.1016/j.xagr.2021.100029] [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] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies have shown that women who experience intimate partner violence have higher rates of unintended pregnancy and abortion—but whether there are differences between the types of abortion care accessed is unknown. Understanding the predictors of self-managed abortion is important for providing risk-mitigating information and resources to those at highest risk for unintended pregnancy and intimate partner violence. With access to information and medication abortion drugs, it is possible that self-managed abortion can be performed safely, increasing reproductive autonomy for women. OBJECTIVE The purpose of this study is to evaluate the association between experiencing intimate partner violence and using self-managed abortion. STUDY DESIGN This is a cross-sectional analysis of responses of 57,090 married women to the National Family Health Survey-4 conducted across India from 2015 to 2016. The association between the type of intimate partner violence and self-managed abortion was analyzed using multivariable multinomial logistic regression. RESULTS Women who have ever experienced physical intimate partner violence were more likely to have any abortion (adjusted relative risk=1.5; 95% confidence interval, 1.2–2.0) and use self-managed abortion (adjusted relative risk=1.7; 95% confidence interval, 1.1–2.6) than women who have not experienced physical intimate partner violence. Women who have ever experienced sexual intimate partner violence may have been more likely to use self-managed abortion, though this association was not statistically significant (adjusted relative risk=2.7; 95% confidence interval, 0.7–10.4). CONCLUSION Women who have experienced physical intimate partner violence disproportionately use abortion care, both facility-based and self-managed. Women who have experienced sexual intimate partner violence may also be more likely to use self-managed abortion. Although abortion is legal, self-managed abortion is commonly occurring in India. Self-managed abortion represents an additional choice and enhances reproductive autonomy in settings where abortion is legal. The implementation of risk-mitigation resources and policies regarding self-managed abortion would provide protection and enhanced autonomy to susceptible groups across India.
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Cheng Y, Wilson EG, Botfield JR, Boerma CJ, Estoesta J, Peters LJ, McGeechan K. Outcomes of routine screening for reproductive coercion in a family planning service. Sex Health 2021; 18:349-357. [PMID: 34606741 DOI: 10.1071/sh21079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022]
Abstract
Background Reproductive coercion (RC) occurs when a person's autonomous decision-making regarding reproductive health is compromised by another. RC screening, that is, the use of routine, non-invasive screening questions asked of service users/clients, is one strategy that can be used to assess for RC. Routine screening for RC was implemented within Family Planning NSW clinical consultations in December 2018. A cross-sectional study was undertaken to review the outcomes of screening to better understand the situation of RC among women accessing family planning services. Methods A retrospective review of clinical consultation data of eligible women attending Family Planning NSW clinics in 2019 was undertaken. Descriptive analysis was conducted and modified Poisson regression was used to estimate prevalence ratios and assess associations between binary outcomes and client characteristics. Results Of 7943 women eligible for RC screening, 5497 were screened (69%) and 127 women (2.3%) disclosed RC. RC was more likely to be disclosed among clients who were unemployed, had a disability or had more than one visit within 1 year. Conclusions Sexual and reproductive health clinicians, in particular, are well placed to conduct RC screening. However, they must have adequate training and access to resources to implement screening and respond to women who disclose RC.
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Affiliation(s)
- Yan Cheng
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Eleanor G Wilson
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Jessica R Botfield
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Clare J Boerma
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Jane Estoesta
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Leslie James Peters
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia; and The University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia; and The University of Sydney, Sydney, NSW, Australia
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Hardee K, Jordan S. Advancing Rights-Based Family Planning from 2020 to 2030. Open Access J Contracept 2021; 12:157-171. [PMID: 34531690 PMCID: PMC8438348 DOI: 10.2147/oajc.s324678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction An assessment in 2019 by Family Planning 2020 of progress on rights-based family planning since 2012 highlighted the development of tools and guidelines that identify and explain rights in relation to family planning, promotion of rights-based approaches to programing, strengthened accountability, and measurement of rights-focused outcomes. The assessment was also forward-looking, asking what aspects of rights-based family planning still need attention moving from 2020 to 2030. Methods This paper draws on interviews with 23 key informants from governments, civil society, and youth focused organizations, implementing partners, and bi-lateral and multilateral organizations from Africa, Asia and the Pacific, Europe and North America, all working on family planning and engaged in various roles with the FP2020 partnership at global and national levels, along with documentation of FP2030 partnership plans. The interviews were conducted as part of the assessment and included questions to respondents for their recommendations on rights-based family planning moving towards 2030. Results Respondents agreed that rights should be at the center of the vision for family planning, with attention to rights literacy, accountability and equity, including adolescent and youth leadership. They noted the need for consistent political and financial support, and incorporating rights into result-based financing programming. While respondents noted the need for development and dissemination of practical tools and training materials, along with rights metrics and implementation research, they stressed the importance of focusing work on rights at the country level. Respondents also acknowledged that institutionalizing rights-based family planning will require enhanced commitment and funding from both donors and countries to ensure programming – and success – over the long term. Amplifying civil society and particularly adolescent and youth voices will be key to engaging governments to support both rights-based programming and provide funding. Review of initial planning under FP2030 related to each of the recommendations suggests that the new partnership is seeking to addressing each of them. Discussion As the family planning field looks beyond 2020 to 2030, this paper provides a roadmap for building on the gains made over the past decade to effectively tackle the challenges remaining to ensure that programming to achieve the vision of the FP2030 Partnership is rights-based.
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Affiliation(s)
- Karen Hardee
- Executive Office, What Works Association, Arlington, VA, USA
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Adedini SA, Adewole OG, Oyinlola FF, Fayehun O. Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey. AAS Open Res 2021. [DOI: 10.12688/aasopenres.13247.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods: The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49, who were sexually active and were not pregnant at the time of the survey. Results: Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion: The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.
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Akoth C, Oguta JO, Gatimu SM. Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study. BMC Public Health 2021; 21:1316. [PMID: 34225673 PMCID: PMC8256600 DOI: 10.1186/s12889-021-11375-7] [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: 07/22/2020] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya. Methods We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions. Results The prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95% CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR 0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–0.99) reduced the odds of CCU. Conclusion About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make independent choices.
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Affiliation(s)
- Catherine Akoth
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
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Identifying the Impact of Intimate Partner Violence in Humanitarian Settings: Using an Ecological Framework to Review 15 Years of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136963. [PMID: 34209746 PMCID: PMC8297014 DOI: 10.3390/ijerph18136963] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational impact of IPV in humanitarian settings. However, findings highlighted a glaring gap in evidence examining the non-health impact of IPV for survivors in humanitarian settings and across levels of the ecological framework. Without enhanced research of women and girls and the violence they experience, humanitarian responses will continue to underachieve, and the needs of women and girls will continue to be relegated as secondary interests. Investment should prioritize addressing the range of both health and non-health impacts of IPV among individuals, families, and communities, as well as consider how the humanitarian environment influences these linkages.
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Belaid L, Atim P, Ochola E, Omara B, Atim E, Ogwang M, Bayo P, Oola J, Okello IW, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Community views on short birth interval in Northern Uganda: a participatory grounded theory. Reprod Health 2021; 18:88. [PMID: 33910570 PMCID: PMC8080315 DOI: 10.1186/s12978-021-01144-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda. METHODS Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing. RESULTS Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands' consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives. CONCLUSIONS The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women's capacity to practice child spacing.
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Affiliation(s)
- Loubna Belaid
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Pamela Atim
- Department of Public Health, Gulu University, Laroo Division, Gulu Municipality 166, Gulu, Uganda
| | | | - Bruno Omara
- Gulu University, Gulu Municipality 166, Gulu, Uganda
| | | | - Martin Ogwang
- St Mary’s Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | - Pontius Bayo
- St Mary’s Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | | | | | - Ivan Sarmiento
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Laura Rojas-Rozo
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Kate Zinszer
- University of Montreal, 7101 Av du Parc, Montreal, QC H3N 1X9 Canada
| | | | - Neil Andersson
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Patel R, Gupte SS, Srivastava S, Kumar P, Chauhan S, Govindu MD, Dhillon P. Experience of gender-based violence and its effect on depressive symptoms among Indian adolescent girls: Evidence from UDAYA survey. PLoS One 2021; 16:e0248396. [PMID: 33765009 PMCID: PMC7993765 DOI: 10.1371/journal.pone.0248396] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/26/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Violence against women has been one of the most prominent issue and a major public health concern. It is a principle violation of basic human rights and has both physical and mental effect on the victim. This study focuses on married and unmarried girls aged 15 to 19 years, belonging to Uttar Pradesh and Bihar, India. This study attempts to examine depression level among married and unmarried girls who have faced violence against them. With the unprecedented growth in social networking, online digital platform and its accessibility, the study also brings out the pertinent aspect of internet based violence and its psychological outcome on adolescent girls. Hence, the study can be seen as an important and needed value addition to the existing pool of knowledge on the subject. METHODS The study uses Understanding the lives of adolescents and young adults (UDAYA) project data for Uttar Pradesh and Bihar. Depressive symptoms among adolescent girl is the outcome variable of the study. Descriptive statistic and bivariate analysis has been used to get to preliminary results. Chi-squared test is used to test the significant of variables. Further, multi-variate analysis (logistic regression) was used. RESULTS Almost 29, 23 and 26 percent of married adolescent girls had faced emotional, physical and sexual violence respectively. It was found that about five per cent of unmarried and eight per cent of married girls had high depressive symptoms. It was found that unmarried adolescent girls who had witnessed their father beating mother were 71 percent more likely to suffer from higher depressive symptoms [OR: 1.71, 1.09-2.69]. Adolescents who faced perpetrated bullying had 90 per cent [OR: 1.90, 1.32-2.72] and 86 per cent [OR: 1.86, 0.98-3.52] higher likelihood to suffer from higher depressive symptoms. CONCLUSION The study goes beyond intimate partner violence and includes various covariates to explain the association between violence and depressive symptoms among married and unmarried adolescents. Hence, more inclusive policies are needed to address the issue of violence against women as the spectrum of the violence is expanding with time.
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Affiliation(s)
- Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | | | - Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
- * E-mail:
| | - Mani Deep Govindu
- Karnataka Health Promotion Trust (KHPT), Bengaluru, Karnataka, India
| | - Preeti Dhillon
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
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Buckingham P, Moulton JE, Subasinghe AK, Amos N, Mazza D. Acceptability of immediate postpartum and post-abortion long-acting reversible contraception provision to adolescents: A systematic review. Acta Obstet Gynecol Scand 2021; 100:629-640. [PMID: 33608901 DOI: 10.1111/aogs.14129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC. MATERIAL AND METHODS In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. RESULTS We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. CONCLUSIONS Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy.
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Affiliation(s)
- Pip Buckingham
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica E Moulton
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Asvini K Subasinghe
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Natalie Amos
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Webster J, Krishnaratne S, Hoyt J, Demissie SD, Spilotros N, Landegger J, Kambanje M, Pryor S, Moseti E, Marcus S, Gnintoungbe M, Curry D, Hamon JK. Context-acceptability theories: example of family planning interventions in five African countries. Implement Sci 2021; 16:12. [PMID: 33435959 PMCID: PMC7805098 DOI: 10.1186/s13012-020-01074-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services. METHODS Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described. RESULTS Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors' certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others. CONCLUSIONS This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts.
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Affiliation(s)
- Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Shari Krishnaratne
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenna Hoyt
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Jessie K Hamon
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
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Sarnak DO, Wood SN, Zimmerman LA, Karp C, Makumbi F, Kibira SPS, Moreau C. The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women. PLoS One 2021; 16:e0238662. [PMID: 33434205 PMCID: PMC7802956 DOI: 10.1371/journal.pone.0238662] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Understanding contraceptive use dynamics is critical to addressing unmet need for contraception. Despite evidence that male partners may influence contraceptive decision-making, few studies have prospectively examined the supportive ways that men influence women's contraceptive use and continuation. OBJECTIVE This study sought to understand the predictive effect of partner influence, defined as partner's fertility intentions and support for contraception, and discussions about avoiding pregnancy prior to contraceptive use, on contraceptive use dynamics (continuation, discontinuation, switching, adoption) over a one-year period. METHODS This study uses nationally representative longitudinal data of Ugandan women aged 15-49 collected in 2018-2019 (n = 4,288 women baseline; n = 2,755 women one-year follow-up). Two analytic sub-samples of women in union and in need of contraception at baseline were used (n = 618 contraceptive users at baseline for discontinuation/switching analysis; n = 687 contraceptive non-users at baseline for adoption analysis). Primary dependent variables encompassed contraceptive use dynamics (continuation, discontinuation, switching, and adoption); three independent variables assessed partner influence. For each sub-sample, bivariate associations explored differences in sociodemographic and partner influences by contraceptive dynamics. Multinomial regression models were used to examine discontinuation and switching for contraceptive users at baseline; logistic regression identified predictors of contraceptive adoption among non-users at baseline. RESULTS Among users at baseline, 26.3% of women switched methods and 31.5% discontinued contraceptive use by follow-up. Multinomial logistic regression, adjusting for women's characteristics, indicated the relative risk of contraceptive discontinuation doubled when women did not discuss pregnancy avoidance with their partner prior to contraceptive use. Partner influence was not related to method switching. Among non-users at baseline, partner support for future contraceptive use was associated with nearly three-fold increased odds of contraceptive adoption. SIGNIFICANCE These results highlight the potentially supportive role of male partners in contraceptive adoption. Future research is encouraged to elucidate the complex pathways between couple-based decision-making and contraceptive dynamics through further prospective studies.
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Affiliation(s)
- Dana O Sarnak
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon N Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Linnea A Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
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From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment. PLoS One 2020; 15:e0242345. [PMID: 33206705 PMCID: PMC7673533 DOI: 10.1371/journal.pone.0242345] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. METHODS Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. RESULTS Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users. CONCLUSION By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals.
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Ahinkorah BO, Ameyaw EK, Seidu AA, Agbaglo E, Budu E, Mensah F, Adu C, Yaya S. Sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa: Evidence from demographic and health surveys. PLoS One 2020; 15:e0240556. [PMID: 33141830 PMCID: PMC7608905 DOI: 10.1371/journal.pone.0240556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Contraception plays a significant role in fertility regulation and determines the reproductive health rights of women. Studies in other parts of the world have found that sexual violence has negative effects on unmet need for contraception. There has not been any study on the association between these two phenomena in sub-Saharan Africa using current nationally-representative survey data. We investigated the association between sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa. MATERIALS AND METHODS This study was based on secondary datasets from 26 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A sample of 101,968 women in sexual unions (married and cohabiting) with complete information on sexual violence and all the variables of interest were included in the analyses. Both bivariate and multilevel logistic regression analyses were carried out to examine the association between sexual violence and unmet need for contraception. Other individual and contextual level socio-economic and demographic variables were considered as covariates. Crude odds ratios [cOR] and adjusted odds ratios [aOR] with their corresponding 95% confidence intervals [CI], signifying precision, were presented. Level of statistical significance was declared at p<0.05. RESULTS The overall prevalence of sexual violence and unmet need for contraception in the 26 sub-Saharan African countries were 8.7% and 28.7% respectively. Experience of sexual violence within the last 12 months resulted in 10% increase in unmet need for contraception [OR = 1.10, CI = 1.03-1.14] and 5% increase in unmet need for contraception after controlling for individual and contextual level factors [aOR = 1.05, CI = 1.01-1.11]. With the individual level factors, women with 4 or more births [aOR = 4.85, CI = 4.41-5.33], those cohabiting [aOR = 1.43, CI = 1.37-1.47], those in female headed households [aOR = 1.22, CI = 1.18-1.27] and those who watched television at least once a week [aOR = 1.12, CI = 1.07-1.16] had higher odds of unmet need for family planning. However, those aged 30-34 [aOR = 0.56, CI = 0.52-0.61], those with secondary/higher level of education [AOR = 0.80, CI = 0.77-0.84], those who read newspaper less than once a week [aOR = 0.75, CI = 0.71-0.79] and those who listened to radio at least once a week [aOR = 0.94, CI = 0.90-0.97] had lower odds of unmet need for contraception. In terms of the contextual factors, women in rural areas [aOR = 0.87, CI = 0.84-0.91] and those in the richest wealth quintile households [aOR = 0.80, CI = 0.75-0.85] had lower odds of unmet need for contraception. CONCLUSION Our study has shown an association between sexual violence and unmet need for contraception in sub-Saharan Africa. Experiencing sexual violence increases the likelihood of unmet need for contraception in sub-Saharan Africa. It is also worthy to note that having four or more children, cohabiting with a male partner, and living in female-headed households are some of the key variables associated with unmet need for contraception in sub-Saharan Africa. Our study recommends that, successful contraceptive initiatives should focus on reducing sexual violence, while taking into consideration other significant factors that increase unmet need for contraception. Meanwhile, in doing this, contextual factors ought to be prioritised.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, 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
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Felix Mensah
- Fr. Thomas Alan Rooney Memorial Hospital, Asankrangwa, Western Region, Ghana
| | - Collins Adu
- Department of Health Promotion, and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanni Yaya
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
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Tomar S, Dehingia N, Dey AK, Chandurkar D, Raj A, Silverman JG. Associations of intimate partner violence and reproductive coercion with contraceptive use in Uttar Pradesh, India: How associations differ across contraceptive methods. PLoS One 2020; 15:e0241008. [PMID: 33064775 PMCID: PMC7567561 DOI: 10.1371/journal.pone.0241008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Intimate partner violence (IPV) and reproductive coercion (RC)-largely in the form of pressuring pregnancy-appear to contribute to low use of contraceptives in India; however, little is known about the extent to which these experiences differentially affect use of specific contraceptive methods. The current study assessed the association of IPV and RC with specific contraceptive methods (Intrauterine Devices [IUDs], pills, condoms) among a large population-based sample of currently married women (15-49 years, n = 1424) living in Uttar Pradesh. Outcomes variables included past year modern contraceptive use and type of contraceptive used. Primary independent variables included lifetime experience of RC by current husband or in-laws, and lifetime experiences of physical IPV and sexual IPV by current husband. Multivariate logistic regression models were developed to determine the effect of each form of abuse on women's contraceptive use. Approximately 1 in 7 women (15.1%) reported experiencing RC from their current husband or in-laws ever in their lifetime, 37.4% reported experience of physical IPV and 8.3% reported experience of sexual IPV by their current husband ever in their lifetime. Women experiencing RC were less likely to use any modern contraceptive (AOR: 0.18; 95% CI: 0.9-0.36). Such women also less likely to report pill and condom use but were more likely to report IUD use. Neither form of IPV were associated with either overall or method specific contraceptive use. Study findings highlight that RC may influence contraceptive use differently based on type of contraceptive, with less detectable, female-controlled contraceptives such as IUD preferred in the context of women facing RC. Unfortunately, IUD uptake remains low in India. Increased access and support for use, particularly for women contending with RC, may be important for improving women's control over contraceptive use and reducing unintended pregnancy.
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Affiliation(s)
- Shweta Tomar
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
- * E-mail:
| | - Nabamallika Dehingia
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | - Arnab K. Dey
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | | | - Anita Raj
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Jay G. Silverman
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
- Corresponding author.
| | - Abigail Hatcher
- University of North Carolina, Chapel Hill, United States
- University of the Witwatersrand, South Africa
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McDougal L, Silverman JG, Singh A, Raj A. Exploring the relationship between spousal violence during pregnancy and subsequent postpartum spacing contraception among first-time mothers in India. EClinicalMedicine 2020; 23:100414. [PMID: 32639480 PMCID: PMC7329749 DOI: 10.1016/j.eclinm.2020.100414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is a growing body of research exploring how intimate partner violence affects contraceptive decision-making, recognizing that these decisions are reflective not only of access and acceptability, but also spousal power imbalances. Unfortunately, there is a dearth of knowledge regarding contraceptive choices following gender-based violence during pregnancy. There are an estimated 7·8 million in India affected by violence during pregnancy, and an ongoing, heavy reliance on female sterilization as the dominant form of contraception. This study examines the relationship between abuse during pregnancy and subsequent postpartum spacing contraception in India. METHODS This analysis used cross-sectional, nationally representative data from first-time mothers of children aged 6-48 months in India. Multinomial regression models assessed relationships between spousal physical violence during pregnancy and postpartum spacing contraception (none, female-controlled, male-controlled). FINDINGS Two percent of first-time mothers (2·4%) reported spousal physical violence while pregnant. Women who reported abuse during pregnancy were less likely to subsequently use male-controlled contraception than no contraception (adjusted relative risk ratio [aRRR]=0·3, 95% CI 0·1-0·8; p = 0·02) and more likely to use female-controlled vs. male-controlled spacing contraception (aRRR=7·5, 95% CI 2·1-25·4, p<0·01). INTERPRETATION Women who experience spousal abuse during pregnancy have different postpartum contraceptive use patterns. The unique needs of this population should be incorporated into antenatal and postpartum contraceptive counseling. Efforts to increase spacing contraception use in India must consider experiences of gender-based violence and coercion.
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Affiliation(s)
- Lotus McDougal
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
- Corresponding author.
| | - Jay G. Silverman
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Abhishek Singh
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai 400 088, India
| | - Anita Raj
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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