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Fente BM, Asgedom YS, Asmare ZA, Kebede TN, Damtew BS, Workneh TW, Beyene MA, Seifu BL. Knowledge of fertility period among reproductive age women in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey. Contracept Reprod Med 2024; 9:27. [PMID: 38790022 PMCID: PMC11127376 DOI: 10.1186/s40834-024-00287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya. METHODS The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. RESULTS The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women's age, women's education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period. CONCLUSION As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.
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Affiliation(s)
- Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tirusew Nigussie Kebede
- Department of Midwifery, School of Nursing and Midwifery Asrat Woldeyes Health Science campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Beyene Sisay Damtew
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Tadesu Wondu Workneh
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Adamu Beyene
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Semera, Ethiopia
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Zegeye AF, Tamir TT, Mekonen EG, Workneh BS, Negash WD, Mekonnen CK. Individual and community-level determinants of knowledge about fertile periods among adolescent girls and young women (10-24 years) in Sub-Saharan Africa: A multilevel mixed effect analysis of a recent demographic and health survey. Heliyon 2024; 10:e26756. [PMID: 38439862 PMCID: PMC10909698 DOI: 10.1016/j.heliyon.2024.e26756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Background Identifying fertility periods accurately will protect teenage girls and young women from unintended pregnancies and related complications. However, in Sub-Saharan Africa, knowledge of the fertile period among adolescent girls and young women is not well studied. Thus, the purpose of this study was to assess adolescents' and young women's knowledge regarding fertility periods and its determinants in Sub-Saharan Africa. Methods The most recent demographic and health surveys' data were used. The study had 140,064 participants in all. The data was analyzed using STATA/SE version 14. Using a multilevel logistic regression model, factors associated with knowledge of fertile periods have been determined. P-values <0.05 showed the significance of the factors associated with the outcome variable. The data were interpreted using the adjusted odds ratio and confidence interval. The best-fit model was determined to be the one with the highest logliklihood ratio and the lowest deviance. Results One in five (20%) women between the ages of 10 and 24 had accurate knowledge about the fertile period. Age (AOR = 1.44, 95% CI: 1.40, 1.49), educational level (AOR = 1.68, 95% CI: 1.60, 1.77), knowledge of family planning (AOR = 1.33, 95% CI: 1.27, 1.39), distance (AOR = 2.31, 95% CI: 2.02, 2.98), residence (AOR = 1.06, 95% CI: 1.02, 1.10), and low community poverty (AOR = 3.06, 95% CI: 3.01, 3.12) had higher odds of knowledge about fertile period. Conclusion This research finds that adolescents and young women in sub-Saharan Africa have low knowledge of the reproductive period. It was discovered that factors at the individual and communal levels influence women's knowledge of the fertile period. While developing policies and strategies, the health ministries of Sub-Saharan African countries had to take into consideration input from women whose experiences indicated that obtaining reproductive health services was hindered by distance.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bodin M, Plantin L, Schmidt L, Ziebe S, Elmerstig E. The pros and cons of fertility awareness and information: a generational, Swedish perspective. HUM FERTIL 2023; 26:216-225. [PMID: 34423731 DOI: 10.1080/14647273.2021.1968045] [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: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.
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Affiliation(s)
- Maja Bodin
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Lars Plantin
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, København, Denmark
| | - Søren Ziebe
- Fertility Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
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Bouchard T, Yong P, Doyle-Baker P. Establishing a Gold Standard for Quantitative Menstrual Cycle Monitoring. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1513. [PMID: 37763632 PMCID: PMC10533176 DOI: 10.3390/medicina59091513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The Quantum Menstrual Health Monitoring Study will measure four key reproductive hormones in the urine (follicle-stimulating hormone, FSH; estrone-3-glucuronide, E13G; luteinizing hormone, LH; and pregnanediol glucuronide, PDG) to characterize patterns that predict and confirm ovulation, referenced to serum hormones and the gold standard of the ultrasound day of ovulation in participants with regular cycles. These normal cycles will provide a reference for comparison to irregular cycles in subjects with polycystic ovarian syndrome (PCOS) and athletes. Materials and Methods: Participants will track their menstrual cycles for 3 months and be provided with an at-home urine hormone monitor (Mira monitor) to predict ovulation. The day of ovulation will be confirmed with serial ultrasounds completed in a community clinic. Urine results will be compared to serum hormone values. Other markers of menstrual health, such as bleeding patterns and temperature changes, will be determined using a customized app. Three groups will be recruited. Group 1 will include those with consistent regular cycle lengths (between 24-38 days), and will be compared to two groups with irregular cycle lengths (with increased cycle length variability and longer cycles). Group 2 will include those with polycystic ovarian syndrome (PCOS) with irregular cycles and Group 3 will include individuals participating in high levels of exercise with irregular cycles. Hypothesis: The Mira monitor quantitative urine hormone pattern will accurately correlate with serum hormonal levels and will predict (with LH) and confirm (with PDG) the ultrasound day of ovulation in those with regular cycles as well as those with irregular cycles. Rationale: Once the ultrasound validation is complete, tools like the Mira monitor with a customized app may become a new standard for at-home and remote clinical monitoring of the menstrual cycle without having to use labor-intensive follicular-tracking ultrasound or follow serum hormone changes. Conclusions: Precision monitoring of the menstrual cycle is expected to impact individuals who want to increase their menstrual health literacy and guide decisions about fertility.
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Affiliation(s)
- Thomas Bouchard
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC V6Z 2K8, Canada;
- Department of Family Medicine, University of Calgary, Calgary, AB T3H 0N9, Canada
| | - Paul Yong
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC V6Z 2K8, Canada;
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Mu Q, Fehring RJ, Bouchard T. Multisite Effectiveness Study of the Marquette Method of Natural Family Planning Program. Linacre Q 2022; 89:64-72. [PMID: 35321484 PMCID: PMC8935430 DOI: 10.1177/0024363920957515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Women of reproductive age need reliable and effective family planning methods to manage their fertility. Natural family planning (NFP) methods or fertility awareness-based methods (FABMs) have been increasingly used by women due to their health benefits. Nevertheless, effectiveness of these natural methods remains inconsistent, and these methods are difficult for healthcare providers to implement in their clinical practice. The purpose of this study is to evaluate the effectiveness of the Marquette Model NFP system to avoid pregnancy for women at multiple teaching sites using twelve months of retrospectively collected teaching data. Survival analysis (Kaplan-Meier) was used to determine typical unintended pregnancy rates for a total of 1,221 women. There were forty-two unintended pregnancies which provided a typical use unintended pregnancy rate of 6.7 per 100 women over twelve months of use. Eleven of the forty-two unintended pregnancies were associated with correct use of the method. The total unintended pregnancy rate over twelve months of use was 2.8 per 100 for women with regular cycles, 8.0 per 100 women for the postpartum and breastfeeding women, and 4.3 per 100 for women with irregular menstrual cycles. The Marquette Model system of NFP was effective when provided by health professionals who completed the Marquette Model NFP teacher training program. Summary This study involved determining whether healthcare professionals at ten sites across the United States and Canada trained to provide the Marquette Method NFP services can replicate the effectiveness demonstrated in previous studies of the method. We found a high level of effectiveness (i.e., very low pregnancy rates) in using the Marquette Method among women from various regions across North America with diverse reproductive backgrounds and in particular when using hormonal fertility marker. Healthcare providers who have been trained to teach NFP can successfully incorporate NFP services in their practice and assist their clients in choosing appropriate family planning methods.
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Affiliation(s)
- Qiyan Mu
- College of Nursing, Marquette University, Milwaukee, WI, USA,Qiyan Mu, PhD, RN, College of Nursing, Marquette University, PO Box 1881, Milwaukee, WI 53201, USA.
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Perez Capotosto M. An Integrative Review of Fertility Knowledge and Fertility-Awareness Practices Among Women Trying to Conceive. Nurs Womens Health 2021; 25:198-206. [PMID: 33961806 DOI: 10.1016/j.nwh.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/09/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To synthesize the literature on fertility knowledge and fertility-awareness among women seeking pregnancy. DATA SOURCES The search terms "fertility-awareness OR fertility knowledge AND women AND subfertile OR infertile OR seeking pregnancy OR trying to conceive OR pre-conception OR conception NOT contraception NOT birth control" were used via CINAHL, PubMed, and Web of Science. Primary research studies were considered in the search parameters. STUDY SELECTION Searches yielded 116 studies published between 1978 and 2020. After screening, 43 full-text studies were assessed for eligibility, 35 of which were omitted as not relevant. Nine quantitative studies using cross-sectional designs met this review's inclusion criteria. DATA EXTRACTION Studies were reviewed for information on the relationship between fertility knowledge/fertility-awareness and pregnancy intention. Studies examining the results of fertility-awareness based method (FABM) efficacy, FABMs for contraception, and provider knowledge regarding FABMs were omitted. DATA SYNTHESIS Analysis showed low knowledge regarding the identification of the fertile window in the menstrual cycle to optimize pregnancy. There was moderate general knowledge on fertility (e.g., infertility definition, age of fertility decline, etc.). Use of an FABM and education regarding FABMs were infrequent, yet participants recognized that it would be beneficial to use and learn when trying to conceive. CONCLUSION Women seeking pregnancy have low to moderate fertility knowledge. More research is necessary on the relationship between fertility knowledge/fertility-awareness and unexplained infertility. Nurses, nurse practitioners, and nurse-midwives should provide education on FABMs to women when they first report difficulty achieving pregnancy. Clinicians' approaches toward FABM education for women and how to implement FABM education into the preconception visit are important areas for future research.
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Hoffman JR, Delaney MA, Valdes CT, Herrera D, Washington SL, Aghajanova L, Smith JF, Herndon CN. Disparities in fertility knowledge among women from low and high resource settings presenting for fertility care in two United States metropolitan centers. FERTILITY RESEARCH AND PRACTICE 2020; 6:15. [PMID: 32821417 PMCID: PMC7429753 DOI: 10.1186/s40738-020-00084-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Background Few studies have examined health literacy and fertility knowledge among women from low income, socio-culturally diverse communities presenting for fertility care in the United States. Our study sought to examine demographic predictors of fertility-related knowledge among infertile women from low and high-resource communities in two major metropolitan centers in the United States. Methods Fertility Knowledge Assessments were administered to women presenting for fertility care at county medical centers serving low-resource, largely immigrant patients and to women from largely affluent populations presenting to comprehensive fertility centers in two cities. The influence of demographic predictors on fertility knowledge was examined through regression analysis. Results A total of 143 women were included in our analysis. In the county hospital/low resource clinic (LR, n = 70), the mean age was 32.8 ± 6.1 years vs 35.0 ± 5.0 years in the fee-for-service/high resource clinic (HR, n = 73). Among the LR patients, 74% were immigrants, 71% had an annual income <$25,000 and 52% had completed high school. Among HR patients, 36% were immigrants, 60% had an annual income >$100,000, and 95% had some college or above. On average, women from HR settings scored 3.0 points higher on the Fertility Knowledge Assessment than their LR counterparts (p < 0.001). Upon multivariate analysis, education level remained the sole independent factor associated with fertility knowledge assessment score (p < 0.001). Stratifying by resource level revealed that income was highly associated with fertility knowledge (p < 0.01) among high resource individuals even when adjusting for education level. Conclusions Women from low resource, largely immigrant communities, seeking fertility care have greater disparities in fertility knowledge and lower health literacy compared to women from high resource clinical settings. Further studies are needed to understand these barriers and to develop targeted inventions to lower disparities and improve care for these vulnerable populations.
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Affiliation(s)
- Jacquelyn R Hoffman
- University of Arizona College of Medicine-Tucson, 1501 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Meaghan A Delaney
- Department of Obstetrics & Gynecology, Baystate Medical Center, 759 Chestnut Street, Office S1661, Springfield, MA 01199 USA
| | - Cecilia T Valdes
- Department of Obstetrics & Gynecology, One Baylor Plaza, BCM 610, Houston, TX 77030 USA
| | - Diana Herrera
- Department of Obstetrics & Gynecology, The Houston Methodist Hospital, 1401 St. Joseph Pkwy. Susan K. Strake Building, 1st Floor SKS1106A, Houston, TX 77002 USA
| | - Samuel L Washington
- Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology & Infertility Services, Department of Obstetrics & Gynecology, Stanford University School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA 94087 USA
| | - James F Smith
- Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA.,UCSF Philip R. Lee Institute for Health Policy Studies, 3333 California St, San Francisco, CA 94118 USA
| | - Christopher N Herndon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356460, Seattle, WA 98195-6460 USA
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