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Abeje G, Zelalem M, Bogale F, Worku N. Effect of women empowerment on treatment seeking practice for sexually transmitted infections among women in Ethiopia. BMC Infect Dis 2024; 24:623. [PMID: 38910255 PMCID: PMC11194876 DOI: 10.1186/s12879-024-09535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/18/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Sexually transmitted infections (STI) are public health problems in Ethiopia. Women have a higher chance of acquiring STI. STI complications are more severe in women compared to men. Despite that, treatment seeking for STI among women is poor. Woman empowerment and gender related factors may be playing a role for treatment seeking practice for STI. However, there are no studies that assess the association between these factors and treatment seeking practice for STI among married reproductive age women in Ethiopia. Therefore, this analysis was designed to explore this association in Ethiopia. METHODS This analysis used the 2016 Ethiopian demographic and health survey (EDHS) data. The 2016 EDHS collected data about STI treatment seeking practice for STI among other variables. Data was analyzed using STATA 17.0. Sampling weights were applied to improve the representativeness of the samples. Descriptive statistics were computed to describe the characteristics of the women. Binary and multivariable logistic regression models were fitted to identify the association between treatment seeking practice for STI and predictor variables. Multicollinearity was checked using variance inflation factors before running the multivariable logistic regression. RESULTS In this study, about 28% (95%CI: 20.87, 36.77) married reproductive age women with STI or STI symptoms sought treatment from the formal sector. Women whose husband attended secondary and higher education (AOR, 8.52; 95%CI 1.42, 51.21), and women with higher women empowerment scores (AOR 1.38, 95%CI 1.06, 1.81) had higher odds of treatment seeking for STI or STI symptoms. On the other hand, women who believe wife beating is justified had lower odds (AOR 0.32; 95%CI 0.15, 0.68) of treatment seeking for STI or STI symptoms. CONCLUSIONS Treatment seeking practice for STI among married reproductive age women in Ethiopia is low. The Ministry of Health and development partners shall conduct further research to identify barriers for treatment seeking practice. Gender variables (women empowerment and belief that wife beating is justified) were significantly associated with STI treatment seeking practice among married reproductive age women. STI prevention and control strategies shall include women empowerment and gender issues as essential component in STI prevention, treatment, and control activities.
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Affiliation(s)
- Gedefaw Abeje
- College of Medicine and Health Sciences, School of public Health, Department of Reproductive Health and Population studies, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Meseret Zelalem
- Maternal and Child Health Directorate Director, Ministry of Health, Addis Ababa, Ethiopia
| | - Firmaye Bogale
- Knowledge and Technology transfer, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Netsanet Worku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Howlader S, Rahman MA, Rahman MM. Continuation of education after marriage and its associated factors among young adult women: findings from the Bangladesh Demographic and Health Survey 2017-2018. BMJ Open 2023; 13:e078892. [PMID: 37996222 PMCID: PMC10668136 DOI: 10.1136/bmjopen-2023-078892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To identify the individual and community-level variables associated with the continuation of education among currently married young adult women in Bangladesh. DESIGN Cross-sectional data extracted from the Bangladesh Demographic and Health Survey (BDHS), 2017-2018. The BDHS is a stratified cluster sample of households conducted in two and three stages in both rural and urban settings. A multilevel multinomial logistic regression analysis was employed to identify the associated factors. SETTING Bangladesh. PARTICIPANTS Currently married young adult women aged 15-29 years (n=4595). PRIMARY OUTCOME Continuation of education after marriage was measured in the BDHS by asking respondents, 'Did you continue your studies after marriage?' with the response options: no; yes, less than a year; yes, for 1-2 years; yes, for 3-4 years; and yes, for 5+ years. RESULTS Among young adult women, 28.2% continued education after marriage for different durations of years (<1 year to 5+ years). The odds of continuing education after marriage for <1 year (adjusted OR (aOR): 0.68; 95% CI 0.50 to 0.90), 1-2 years (aOR: 0.67; 95% CI 0.47 to 0.96) and ≥5 years (aOR: 0.38; 95% CI 0.17 to 0.85) were lower among women who justified wife beating compared with women who did justify it. Compared with the high-literate community, women from the low-literate community were less likely to continue education after marriage for <1 year (aOR: 0.53; 95% CI 0.42 to 0.66), 1-2 years (aOR: 0.47; 95% CI 0.36 to 0.61), 3-4 years (aOR: 0.32; 95% CI 0.22 to 0.46), and for ≥5 years (aOR: 0.29; 95% CI 0.17 to 0.48). Several other individual-level and community-level variables, such as age at marriage, first birth interval, partner educational status, household wealth index, community economic status and region, were found to be associated with the continuation of education after marriage for different durations. CONCLUSIONS The proportion of women continuing their education after marriage in this sample is low. This study provides insight into the individual-level and community-level barriers women encounter in continuing their education after marriage. The identification of these barriers helps policy-makers develop effective intervention programmes to promote women's educational attainment.
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Affiliation(s)
- Sihab Howlader
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Aminur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Oyedele OK. Disparities and barriers of health facility delivery following optimal and suboptimal pregnancy care in Nigeria: evidence of home births from cross-sectional surveys. BMC Womens Health 2023; 23:194. [PMID: 37098533 PMCID: PMC10131351 DOI: 10.1186/s12905-023-02364-6] [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: 03/08/2023] [Accepted: 04/16/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Despite uptake of antenatal care (ANC), 70% of global burden of maternal and child mortality is prevalent in sub-Saharan Africa, particularly Nigeria, due to persistent home delivery. Thus, this study investigated the disparity and barriers to health facility delivery and the predictors of home delivery following optimal and suboptimal uptake of ANC in Nigeria. METHODOLOGY A secondary analysis of 34882 data from 3 waves of cross-sectional surveys (2008-2018 NDHS). Home delivery is the outcome while explanatory variables were classified as socio-demographics, obstetrics, and autonomous factors. Descriptive statistics (bar chart) reported frequencies and percentages of categorical data, median (interquartile range) summarized the non-normal count data. Bivariate chi-square test assessed relationship at 10% cutoff point (p < 0.10) and median test examined differences in medians of the non-normal data in two groups. Multivariable logistic regression (Coeff plot) evaluated the likelihood and significance of the predictors at p < 0.05. RESULTS 46.2% of women had home delivery after ANC. Only 5.8% of women with suboptimal ANC compared to the 48.0% with optimal ANC had facility delivery and the disparity was significant (p < 0.001). Older maternal age, SBA use, joint health decision making and ANC in a health facility are associated with facility delivery. About 75% of health facility barriers are due to high cost, long distance, poor service, and misconceptions. Women with any form of obstacle utilizing health facility are less likely to receive ANC in a health facility. Problem getting permission to seek for medical help (aOR = 1.84, 95%CI = 1.20-2.59) and religion (aOR = 1.43, 95%CI = 1.05-1.93) positively influence home delivery after suboptimal ANC while undesired pregnancy (aOR = 1.27, 95%CI = 1.01-1.60) positively influence home delivery after optimal ANC. Delayed initiation of ANC (aOR = 1.19, 95%CI = 1.02-1.39) is associated with home delivery after any ANC. CONCLUSIONS About half of women had home delivery after ANC. Hence disparity exist between suboptimal and optimal ANC attendees in institutional delivery. Religion, unwanted pregnancy, and women autonomy problem raise the likelihood of home delivery. Four-fifth of health facility barriers can be eradicated by optimizing maternity package with health education and improved quality service that expand focus ANC to capture women with limited access to health facility.
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Affiliation(s)
- Oyewole K Oyedele
- International Research Center of Excellence, Institute of Human Virology, Nigeria (IHVN), Abuja (FCT), Nigeria.
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Tujuba TD, Chilo D, Abebe E, Zenu S. Self-Medication and Associated Factors Among Pregnant Women in Rural Ethiopia: The Importance of Husband Education in Ensuring a Safe Pregnancy. Drug Healthc Patient Saf 2023; 15:39-50. [PMID: 36814849 PMCID: PMC9939672 DOI: 10.2147/dhps.s394346] [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: 10/21/2022] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Background Self-medication is the use of drugs without a medical prescription to treat self-identified illnesses; it is also the continued use of drugs without a physician's order for recurring symptoms, either by sharing or purchasing them from unlicensed vendors. It entails substantial risk to pregnant women and fetuses. Magnitude of the problem and its factors among rural pregnant women is not studied in Ethiopia. Objective This study aimed to assess the prevalence of self-medication practice and identify its associated factors among pregnant women in rural Southwest Shewa, Ethiopia. Methods A cross-sectional study was conducted on 585 randomly selected pregnant women in selected rural public health institutions from May to July 2021. Data was collected by using an interviewer-administered pretested structured questionnaire. Multivariable logistic regression was used to identify factors associated with self-medication. Variables with p-value <0.05 for the 95% confidence interval of the adjusted odds ratio were considered statistically significant. Results A total of 585 pregnant women participated in the study with a response rate of 92.3%. The prevalence of self-medication among pregnant women was 19.8%. Primigravidity (AOR = 2.7, 95% CI: 1.2-6.1), lower educational status of husbands (AOR = 3.6, 95% CI: 1.02-12.9), living close to health facilities (AOR = 0.23, 95% CI: 0.09-0.6) and knowing one's own gestational age (AOR = 0.5,95% CI: 0.30-0.9) were significantly associated with self-medication practice. Conclusion and Recommendation One in five of the pregnant women practiced self-medication during the current pregnancy. Primigravidity and lower educational status of husbands were associated with a higher probability of self-medication. Knowing gestational age and living close to health facilities were associated with a lower likelihood of practicing self-medication. Rational drug use has to be promoted among pregnant women. Maternal and child health interventions should also target husbands. Health education has to be strengthened to help pregnant women have a safe pregnancy.
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Affiliation(s)
- Takele Deribu Tujuba
- Department of Public Health, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Desalegn Chilo
- Department of Pharmacy, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Endegena Abebe
- Department of Biomedical Sciences, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Sabit Zenu
- Department of Public Health, College of Health Science, Mattu University, Mettu, Ethiopia,Correspondence: Sabit Zenu, Mettu, Ethiopia, Tel +251917751066, Email
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Braverman-Bronstein A, Ortigoza AF, Vidaña-Pérez D, Barrientos-Gutiérrez T, Baldovino-Chiquillo L, Bilal U, Friche AADL, Diez-Canseco F, Maslowsky J, Vives V. A, Diez Roux AV. Gender inequality, women's empowerment, and adolescent birth rates in 363 Latin American cities. Soc Sci Med 2023; 317:115566. [PMID: 36446141 PMCID: PMC7613905 DOI: 10.1016/j.socscimed.2022.115566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries. METHODS We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics. RESULTS We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores. CONCLUSION Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health Cuernavaca, Mexico
| | | | | | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alejandra Vives V.
- Department of Public Health, School of Medicine / CEDEUS. Pontificia Universidad Católica de Chile. Santiago de Chile, Chile
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Han L, Xiong W, Li M, Li R, Wu J, Tang X, Ling L, Liu X. Couple-level determinants of syphilis infection among heterosexual married couples of reproductive age in Guangdong Province, China: A population-based cross-sectional study. Front Public Health 2022; 10:1004246. [PMID: 36324455 PMCID: PMC9620861 DOI: 10.3389/fpubh.2022.1004246] [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: 07/27/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background Syphilis remains a major public health problem worldwide, and its prevention requires knowledge of factors that go beyond the individual-level. However, most syphilis-related studies have focused on individual-level and regional-level factors, neglecting couple-level factors. Thus, this study aimed to explore couple-level determinants of syphilis infection among heterosexual married couples. Methods This population-based cross-sectional study used data from heterosexual married couples who participated in the National Free Preconception Health Examination Project in Guangdong Province, China during 2014-2019. The syphilis infection was tested by the rapid plasma reagin test. Couple-level data were obtained by combining information provided by the man and woman living in the same household. Multivariate logistic models were employed to explore the couple-level determinants of syphilis infection by gender after adjusting for potential confounders. Results A total of 1,755,156 couples were recruited in this analysis. The seroprevalence was 0.25% (95%CI: 0.24-0.25%) and 0.26% (95%CI: 0.25-0.27%) among men and women, respectively. The median age was 28.0 (interquartile range, IQR: 25.0-31.0) years, and the median duration of marriage was 0.2 (IQR: 0.0-2.5) years. After adjusting for individual and regional-level variables, duration of marriage was a protective factor for syphilis infection in men (adjusted odds ratios, AOR: 0.97; 95% CI: 0.96-0.98) and women (AOR: 0.95, 95% CI: 0.94-0.96). The age gap and the difference in education level between the husband and wife were associated with syphilis infection, but these associations were somewhat different between men and women. Condom use was negatively associated with syphilis infection in men (AOR: 0.77; 95% CI: 0.70-0.84) and women (AOR: 0.77, 95% CI: 0.71-0.84). Our results also showed that couple mobility and the number of children were not statistically significant determinants of syphilis infection among heterosexual married couples. Conclusion This study contributes to a more comprehensive understanding of syphilis outcomes in individuals in the context of marriage in China. Several couple-level factors are indeed associated with syphilis infection, but these associations differ between men and women. Couple-based strategies that engage both women and men and efforts to promote condom use among heterosexual married couples need to be developed and further evaluated for syphilis prevention.
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Affiliation(s)
- Lu Han
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China
| | - Wenxue Xiong
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Mingzhen Li
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China
| | - Rui Li
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiabao Wu
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China
| | - Xijia Tang
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China,Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Li Ling
| | - Xiaohua Liu
- National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China,*Correspondence: Xiaohua Liu
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Aychiluhm SB, Melaku MS, Mare KU, Tadesse AW, Mulaw GF. Geographical clustering and geographically weighted regression analysis of home delivery and its determinants in developing regions of Ethiopia: a spatial analysis. Emerg Themes Epidemiol 2022; 19:8. [PMID: 35986295 PMCID: PMC9392356 DOI: 10.1186/s12982-022-00117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Nearly three-fourths of pregnant women in Ethiopia give birth at home. However, the spatial pattern and spatial variables linked to home delivery in developing regions of Ethiopia have not yet been discovered. Thus, this study aimed to explore the geographical variation of home delivery and its determinants among women living in emerging (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of Ethiopia, using geographically weighted regression analysis. Methods Data were retrieved from the Demographic and Health Survey program's official database (http://dhsprogram.com). In this study, a sample of 441 reproductive-age women in Ethiopia's four emerging regions was used. Global and local statistical analyses and mapping were performed using ArcGIS version 10.6. A Bernoulli model was applied to analyze the purely spatial cluster discovery of home delivery. GWR version 4 was used to model spatial regression analysis. Results The prevalence of home delivery in the emerging regions of Ethiopia was 76.9% (95% CI: 72.7%, 80.6%) and the spatial distribution of home delivery was clustered with global Moran’s I = 0.245. Getis-Ord analysis detected high-home birth practice among women in western parts of the Benishangul Gumz region, the Eastern part of the Gambela region, and the Southern and Central parts of the Afar region. Non-attendance of antenatal care, living in a male-headed household, perception of distance to a health facility as a big problem, residing in a rural area, and having a husband with no education significantly influenced home delivery in geographically weighted regression analysis. Conclusions More than three-fourths of mothers in the developing regions of Ethiopia gave birth at home, where high-risk locations have been identified and the spatial distribution has been clustered. Thus, strengthening programs targeted to improve antenatal care service utilization and women’s empowerment is important in reducing home birth practice in the study area. Besides, supporting the existing health extension programs on community-based health education through home-to-home visits is also crucial in reaching women residing in rural settings.
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Ssetaala A, Ssempiira J, Wambuzi M, Nanyonjo G, Okech B, Chinyenze K, Bagaya B, Price MA, Kiwanuka N, Degomme O. Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221103993. [PMID: 35748585 PMCID: PMC9234847 DOI: 10.1177/17455057221103993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore whether community health worker household-based maternal health visits improve antenatal care and skilled birth attendance among hard-to-reach fishing villages on Lake Victoria, Uganda. METHODS This quasi-experimental 18-month prospective study involved 486 consenting women aged 15-49 years, who were pregnant or had a pregnancy outcome in the past 6 months, from 6 island fishing communities. The community health worker household-based intervention (community health workers' household visits to provide counseling, blood pressure measurement, anemia, and HIV testing) involved 243 women from three fishing communities. Random effects logistic regression was used to determine the association between the community health worker intervention and antenatal care and skilled birth attendance among women who had at least 5 months of pregnancy or childbirth at follow-up. RESULTS Almost all women accepted the community health worker intervention (90.9% (221/243)). Hypertension was at 12.5% (27/216) among those who accepted blood pressure measurements, a third (33.3% (9/27)) were pregnant. HIV prevalence was 23.5% (52/221). Over a third (34.2% (69/202)) of women tested had anemia (hemoglobin levels less than 11 g/dL). The community health worker intervention was associated with attendance of first antenatal care visit within 20 weeks of pregnancy (adjusted odd ratio = 2.1 (95% confidence interval 0.6-7.6)), attendance of at least four antenatal care visits (adjusted odd ratio = 0.9 (95% confidence interval 0.4-2.0)), and skilled birth attendance (adjusted odd ratio = 0.5 (95% confidence interval 0.1-1.5)), though not statistically significant. CONCLUSION Community health workers have a crucial role in improving early antenatal care attendance, early community-based diagnosis of anemia, hypertensive disorders, and HIV among women in these hard-to-reach fishing communities.
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Affiliation(s)
- Ali Ssetaala
- UVRI-IAVI HIV Vaccine Program, Entebbe,
Uganda
- Ghent University International Centre
for Reproductive Health, Ghent, Belgium
| | - Julius Ssempiira
- School of Public Health, Makerere
University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Bernard Bagaya
- School of Public Health, Makerere
University College of Health Sciences, Kampala, Uganda
| | - Matt A Price
- IAVI, New York, NY, USA
- Department of Epidemiology and
Biostatistics, University of California at San Francisco, San Francisco, CA,
USA
| | - Noah Kiwanuka
- School of Public Health, Makerere
University College of Health Sciences, Kampala, Uganda
| | - Olivier Degomme
- Ghent University International Centre
for Reproductive Health, Ghent, Belgium
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Kim C, Erim D, Natiq K, Salehi AS, Zeng W. Combination of Interventions Needed to Improve Maternal Healthcare Utilization: A Multinomial Analysis of the Inequity in Place of Childbirth in Afghanistan. Front Glob Womens Health 2021; 1:571055. [PMID: 34816155 PMCID: PMC8594015 DOI: 10.3389/fgwh.2020.571055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
Giving birth with a skilled birth attendant at a facility that provides emergency obstetric care services has better outcomes, but many women do not have access to these services in low- and middle-income countries. Individual, household, and societal factors influence women's decisions about place of birth. Factors influencing birthplace preference by type of provider and level of public facility are not well understood. Applying the Andersen Behavioral Model of healthcare services use, we explored the association between characteristics of women and their choice of childbirth location using a multinomial logistic regression, and conducted a scenario analysis to predict changes in the childbirth location by imposing various interventions. Most women gave birth at home (68.1%), while 15.1% gave birth at a public clinic, 12.1% at a public hospital, and 4.7% at a private facility. Women with higher levels of education, from households in the upper two wealth quintiles, and who had any antenatal care were more likely to give birth in public or private facilities than at home. A combination of multisector interventions had the strongest signals from the model for increasing the predicted probability of in-facility childbirths. This study enhances our understanding of factors associated with the use of public facilities and the private sector for childbirth in Afghanistan. Policymakers and healthcare providers should seek to improve equity in the delivery of health services. This study highlights the need for decisionmakers to consider a combination of multisector efforts (e.g., health, education, and social protection), to increase equitable use of maternal healthcare services.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Erim
- Health Economics and Outcomes Research (HEOR) Modeling and Advanced Analytics, Parexel International, Durham, NC, United States
| | - Kayhan Natiq
- Silk Route Training and Research Organization, Kabul, Afghanistan
| | - Ahmad Shah Salehi
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wu Zeng
- Department of International Health, School of Nursing & Health Studies, Georgetown University, Washington, DC, United States
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Prevalence and correlates of pregnancy self-testing among pregnant women attending antenatal care in western Kenya. PLoS One 2021; 16:e0258578. [PMID: 34767573 PMCID: PMC8589148 DOI: 10.1371/journal.pone.0258578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/30/2021] [Indexed: 11/21/2022] Open
Abstract
In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) initiation. Understanding the characteristics of women who use pregnancy self-tests can facilitate more targeted efforts to improve pregnancy testing experiences and entry into the ANC pathway. We conducted a cross-sectional survey among pregnant women enrolling in a pre-exposure prophylaxis (PrEP) implementation study to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall, in our study population, 17% of women obtained a pregnancy self-test from a pharmacy. Pregnancy test use was higher among employed women, women with secondary and college-level educated partners, and women who spent 30 minutes or less traveling to the maternal and child health (MCH) clinic. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing as well as developing community-based models to improve access to pregnancy testing and ANC.
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Mobility for maternal health among women in hard-to-reach fishing communities on Lake Victoria, Uganda; a community-based cross-sectional survey. BMC Health Serv Res 2021; 21:948. [PMID: 34503486 PMCID: PMC8431852 DOI: 10.1186/s12913-021-06973-5] [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: 05/26/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality is still a challenge in Uganda, at 336 deaths per 100,000 live births, especially in rural hard to reach communities. Distance to a health facility influences maternal deaths. We explored women's mobility for maternal health, distances travelled for antenatal care (ANC) and childbirth among hard-to-reach Lake Victoria islands fishing communities (FCs) of Kalangala district, Uganda. METHODS A cross sectional survey among 450 consenting women aged 15-49 years, with a prior childbirth was conducted in 6 islands FCs, during January-May 2018. Data was collected on socio-demographics, ANC, birth attendance, and distances travelled from residence to ANC or childbirth during the most recent childbirth. Regression modeling was used to determine factors associated with over 5 km travel distance and mobility for childbirth. RESULTS The majority of women were residing in communities with a government (public) health facility [84.2 %, (379/450)]. Most ANC was at facilities within 5 km distance [72 %, (157/218)], while most women had travelled outside their communities for childbirth [58.9 %, (265/450)]. The longest distance travelled was 257.5 km for ANC and 426 km for childbirth attendance. Travel of over 5 km for childbirth was associated with adolescent girls and young women (AGYW) [AOR = 1.9, 95 % CI (1.1-3.6)], up to five years residency duration [AOR = 1.8, 95 % CI (1.0-3.3)], and absence of a public health facility in the community [AOR = 6.1, 95 % CI (1.4-27.1)]. Women who had stayed in the communities for up to 5 years [AOR = 3.0, 95 % CI (1.3-6.7)], those whose partners had completed at least eight years of formal education [AOR = 2.2, 95 % CI (1.0-4.7)], and those with up to one lifetime birth [AOR = 6.0, 95 % CI (2.0-18.1)] were likely to have moved to away from their communities for childbirth. CONCLUSIONS Despite most women who attended ANC doing so within their communities, we observed that majority chose to give birth outside their communities. Longer travel distances were more likely among AGYW, among shorter term community residents and where public health facilities were absent. TRIAL REGISTRATION PACTR201903906459874 (Retrospectively registered). https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5977 .
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Forty J, Rakgoasi SD, Keetile M. Patterns and determinants of modern contraceptive use and intention to usecontraceptives among Malawian women of reproductive ages (15-49 years). Contracept Reprod Med 2021; 6:21. [PMID: 34193289 PMCID: PMC8247247 DOI: 10.1186/s40834-021-00163-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malawi is one of the countries in SSA with the highest TFR. This study aimed to explore factors associated with modern contraceptive use and intention to use contraceptives among women of reproductive ages (15-49 years) in Malawi. METHODS The study used secondary data from 2015 to 16 Malawi Demographic and Health Survey (MDHS) dataset. Logistic regression models were used to derive adjusted odd ratios as the measures of association between need, predisposing and enabling factors, and contraceptive use and the intention to use contraceptives among women. The sample constituted 24,562 women who were successfully interviewed during the MDHS. All comparisons are considered statistically significant at 5% level. RESULTS Overall 54.8% of women were currently using contraceptives, while 69.1% had the intention to use contraceptives. The odds of contraceptive use were significantly low among, women aged 15-19 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years and 40-44 years compared to women aged 45-49 years; women of Tonga ethnic group (OR = O.60, CI = 0.43 0.84) compared to women of Nyanga ethnic group; women from poor households (OR = 0.78, CI = 0.68-0.90) and middle income households (OR = 0.84, CI = 0.74-0.95) compared to women from rich household. Nonetheless, women with no past experience of terminated pregnancy (OR = 1.50, CI = 1.34-1.68) were more likely to use contraceptives compared to women with past experience of terminated pregnancy. Similarly, Women with primary education (OR = 1.56, CI = 1.16-2.09) and secondary education (OR = 1.39, CI = 1.04-1.85) were more likely to use contraceptives compared to women with higher education. While the odds of intending to use contraceptives were significantly high with age only thus among women aged 15-19 years, (OR = 15.18, CI = 5.94-38.77); 20-24 years (OR = 16.77, CI = 7.46-37.71); 25-29 years (OR = 6.75, CI = 3.16-14.45); 30-34 years (OR = 7.75, CI = 3.61-16.65) and 35-39 years (OR = 5.05, CI = 2.29-11.12) compared to women aged 45-49 years. CONCLUSION As direct policy measure; information, education and communication programmes on family planning among poor and middle income women, and all women in reproductive ages should be strengthened.
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Affiliation(s)
- James Forty
- Department of Population Studies, University of Botswana, Private Bag UB, 00705, Gaborone, Botswana.
| | - Serai Daniel Rakgoasi
- Department of Population Studies, University of Botswana, Private Bag UB, 00705, Gaborone, Botswana
| | - Mpho Keetile
- Department of Population Studies, University of Botswana, Private Bag UB, 00705, Gaborone, Botswana
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Zegeye B, Keetile M, Ahinkorah BO, Ameyaw EK, Seidu AA, Yaya S. Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis. Trop Med Health 2021; 49:53. [PMID: 34193313 PMCID: PMC8247116 DOI: 10.1186/s41182-021-00343-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. METHODS We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). RESULTS The pooled results showed that about 50.7% (95% CI 48.2-53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0-69.1%) and West Africa (24.3%, 95% CI 22.4-26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32-2.84), women with educated husbands (aOR=1.40, 95% CI 1.11-1.77), wealthier women (aOR=3.12, 95% CI 1.95-4.99), women exposed to media (aOR=1.46, 95% CI 1.18-1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24-1.83). CONCLUSIONS Enhancing women's education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Mpho Keetile
- Department of Population Studies, Faculty of Social Sciences, University of Botswana, Private Bag, UB 0022 Gaborone, Botswana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, PMB 0494 Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Tchakounté Tchuimi D, Kamga BF. The effect of women's bargaining power within couples on contraceptive use in Cameroon. Gates Open Res 2021; 4:20. [PMID: 39036780 PMCID: PMC11259594 DOI: 10.12688/gatesopenres.13100.2] [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: 04/27/2021] [Indexed: 07/23/2024] Open
Abstract
Background: The prevalence of contraception among married women, evaluated at 23%, is low in Cameroon. Maternal death rates, estimated at 782 deaths per 100,000 live births, are very worrying. The National Strategic Plan for Reproductive, Maternal, Newborn and Child Health (2015-2020) and the Health Sector Strategy (2016-2027) focuses on increasing modern contraceptive prevalence as a means to reduce maternal death. This paper identifies women's bargaining power as a factor that may stimulate contraceptive use. The objective of this study is to analyze the association between women's bargaining power within couples and modern contraceptive use. Methods: The data used come from the fifth Demographic and Health Survey (DHS) conducted in 2018. Women's bargaining power within couple is measured by a Woman Bargaining Power Composite Index (WBPCI) built through a multiple correspondence analysis. The logistic regression model was used to analyze the relationship between WBPCI and modern contraceptive use. Results: The results of the descriptive statistics show that women's bargaining power is higher among women who use contraception than for those who do not. The results of the logistic regression model show that an increase of WBPCI was significantly associated with higher chances of using a modern contraceptive method (OR = 1.352; 95% CI: 1.257, 1.454; p <0.01). The education of women is also a key determinant since educated women were at least two times more likely to use a modern contraceptive method than uneducated women. Conclusions: To reduce high maternal death rates in Cameroon, public health policies should not only focus on the health system itself, but should also focus on social policies to empower women in the household.
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Affiliation(s)
| | - Benjamin Fomba Kamga
- Faculty of Economics and Management, University of Yaounde II, Yaounde, Centre, Po. Box 1792, Cameroon
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Stepfather families and children's schooling in sub-Saharan Africa: A cross-national study. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.44.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Risk factors affecting maternal health outcomes in Rivers State of Nigeria: Towards the PRISMA model. Soc Sci Med 2020; 265:113520. [PMID: 33250317 DOI: 10.1016/j.socscimed.2020.113520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
Existing research suggests that Nigeria accounts for about 23% of the world's maternal mortality ratio, with negative impacts on women's wellbeing and the country's socio-economic development. The underlying risk factors can be categorized into political influences, poor access to healthcare, inadequate utilization of health facilities, poor family planning support and complex pregnancy-related illness. Yet, the complex interrelations amongst the factors makes it difficult to ascertain the riskiest ones that affect women's reproduction and child death, with the existing intervening strategies failing to address the problem. This study identifies maternal health risk factors and prioritizes their management in Rivers State of Nigeria, using the Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) model. Taking a quantitative turn, we applied exploratory factor analysis to analyze 174 returned questionnaires from healthcare professionals working in Rivers State and used the results to establish relationships between maternal health risk factors, prioritizing the riskiest factors. The outcomes indicate that the PRISMA model provides an effective framework for identifying and managing maternal mortality risks that can enable healthcare experts and managers to address the avoidable risk factors and mitigate the unavoidable patient-related risk factors in Nigeria. The implications for theory, practice and policy are discussed.
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Fatema K, Lariscy JT. Mass media exposure and maternal healthcare utilization in South Asia. SSM Popul Health 2020; 11:100614. [PMID: 32596437 PMCID: PMC7306581 DOI: 10.1016/j.ssmph.2020.100614] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 11/05/2022] Open
Abstract
Maternal mortality remains a major population health problem in the developing world due in part to inadequate healthcare before, during, and after childbirth. Mass media has the potential to disseminate information about maternal healthcare that can improve well-being for mothers and infants, particularly among women with limited educational attainment. This study examines the impact of mass media exposure (e.g., television, radio, and newspaper) and sociodemographic factors on maternal healthcare utilization in four South Asian countries: India, Bangladesh, Nepal, and Pakistan. Analyses use 2014–2017 Demographic and Health Surveys, which are nationally representative of women aged 15–49 years. Results show that maternal healthcare utilization is significantly higher among women exposed to mass media across countries, even after controlling for mother's, husband's, and household sociodemographic factors. Women exposed to mass media are 46–86% more likely to receive antenatal care, 24–53% more likely to deliver their babies by skilled birth attendants, and 36–94% more likely to receive postpartum check-ups across countries. Mother's educational attainment moderates the association between mass media exposure and some maternal healthcare services in three of the four countries. Governments and public health organizations can consider mass media as a key intervention in promoting maternal health in developing contexts. Maternal mortality is high in South Asia due in part to inadequate maternal healthcare. Mass media exposure is positively associated with maternal healthcare utilization. Mother's education moderates mass media-healthcare association in three of four South Asian countries. NGOs should consider using mass media to disseminate information on maternal health.
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Affiliation(s)
- Kaniz Fatema
- Department of Sociology and Criminology, University of Iowa, Iowa City, IA, USA
| | - Joseph T Lariscy
- Department of Sociology, University of Memphis, Memphis, TN, USA
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Yadav AK, Sahni B, Jena PK, Kumar D, Bala K. Trends, Differentials, and Social Determinants of Maternal Health Care Services Utilization in Rural India: An Analysis from Pooled Data. WOMEN'S HEALTH REPORTS 2020; 1:179-189. [PMID: 35982988 PMCID: PMC9380883 DOI: 10.1089/whr.2019.0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/12/2022]
Abstract
Background: Millennium development goal 5 aimed at reduction of maternal deaths by three-quarters from 1990 to 2015: a target India commendably achieved, but this milestone remains overshadowed by inequalities in utilization of health services that are driven by determinants both at community and at individual level. Materials and Methods: We studied the utilization trends using descriptive statistics and analyzed the relative contribution of various socioeconomic predictors on the use of maternal health care services in rural India using binary logistic regression analysis on pooled data from three rounds of National Family Health Survey. Outcome variables included four or more antenatal care visits, skilled birth attendance, and postnatal care. Results: Although utilization of maternal health care services showed an upward trend from 1998–1999 to 2015–2016, factors such as illiteracy, female age ≥40 years, having five and more children, belonging to scheduled tribes, rural residence, and not possessing a health card were associated with significantly low utilization of maternal health care services. However, partner's education, good economic status, women's autonomy, and infrastructure at village level were associated with better odds of availing these services. Conclusions: The study generates evidence on the role of various socioeconomic determinants in maternal health care utilization and identifies gaps that must be strategically addressed to reach sustainable developmental goal maternal mortality target of 70 deaths per 100,000 live births by 2030. It reemphasizes the need for ensuring convergence among different stakeholders while structuring maternal health policies so that health reforms can be accomplished effectively at all levels of health care.
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Affiliation(s)
- Arvind Kumar Yadav
- Department of Economics, Shri Mata Vaishno Devi University, Katra, J&K, India
| | - Bhavna Sahni
- Department of Community Medicine, Government Medical College, Jammu, India
| | - Pabitra Kumar Jena
- Department of Economics, Shri Mata Vaishno Devi University, Katra, J&K, India
| | - Dinesh Kumar
- Department of Community Medicine, Government Medical College, Jammu, India
| | - Kiran Bala
- Department of Community Medicine, Government Medical College, Jammu, India
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Ibarra-Nava I, Choudhry V, Agardh A. Desire to delay the first childbirth among young, married women in India: a cross-sectional study based on national survey data. BMC Public Health 2020; 20:350. [PMID: 32183765 PMCID: PMC7079505 DOI: 10.1186/s12889-020-8402-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Young women in India continue to face diverse challenges that threaten their health and wellbeing. The reproductive health and rights of newly married women, who are often expected to begin childbearing soon after marriage, are often neglected. The present study aims to understand some of the factors associated with the desire to delay the first childbirth in young, married women in India. METHODS The study utilised the data from the most recent National Family Health Survey 2015-16 in India. Our study sample was restricted to married women who were 15-24 years of age and who had never been pregnant at the time of the survey. Chi-squared tests, independent t-tests and multivariable logistic regression analyses were performed to measure associations between multiple independent factors and the reported preferred waiting time for the first childbirth. RESULTS Among never pregnant, married women aged 15-24, 21.49% reported a preferred waiting time for their first childbirth of 2 years or more. Belonging to an other backward class, or OBC, (ORadjusted 1.55, 95%CI 1.14-2.10), having completed higher education (ORadjusted 2.04, 95%CI 1.11-3.76), marrying after the age of 18 (ORadjusted 1.57, 95%CI 1.10-2.24), a husband's higher education level (ORadjusted 2.42, 95%CI 1.27-4.64), a younger husband (ORadjusted 0.75, 95%CI 0.66-0.84) and non-exposure to physical violence (ORadjusted 1.84, 95%CI 1.09-3.11) were significantly associated with a longer preferred waiting time for the first childbirth. CONCLUSION Intimate partner violence and partner characteristics play a role in the childbearing intentions of young women after marriage. Delaying the first childbirth could improve women's educational and economic opportunities, their health, and the health of their future and properly planned children. To achieve this, it is crucial to promote and respect women's right to decide who and when to marry, when to have children, and to promote relationships free of gender-based violence.
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Affiliation(s)
- Ismael Ibarra-Nava
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Vikas Choudhry
- Sambodhi Research and Communications Pvt. Ltd., C-126, C Block, Sector 2, Noida, Uttar Pradesh, 201301, India
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden.
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Tchakounté Tchuimi D, Kamga BF. The effect of women’s bargaining power within couples on contraceptive use in Cameroon. Gates Open Res 2020. [DOI: 10.12688/gatesopenres.13100.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The prevalence of contraception among married women, evaluated at 23%, is low in Cameroon. Maternal death rates, estimated at 782 deaths per 100,000 live births, are very worrying. The National Strategic Plan for Reproductive, Maternal, Newborn and Child Health (2015-2020) focuses on increasing contraceptive prevalence as a means to reduce maternal death. This paper identifies women’s bargaining power as a factor that may stimulate contraceptive use. The objective of this study is to measure the effect of women's bargaining power within couples on contraceptive use. Methods: The data used come from the Demographic and Health Survey and Multiple Indicators (DHS-MICS) conducted in 2011. Women’s bargaining power within couples is measured by a Woman Bargaining Power Composite Index (WBPCI) built through a multiple correspondence analysis. Descriptive statistics (frequency distribution, cross tabulation, chi-square test) and the probit model were used to analyze the relationship between WBPCI and contraceptive use. Additionally, since the target population for this study is couples in which women were not pregnant, a Heckman probit model was also estimated to address the potential selection bias. Results: The results of the descriptive statistics show that women's bargaining power is higher among women who use contraception than for those who do not. The results of the probit model show that women's bargaining power significantly increases the probability of contraceptive use by 3.4%. In addition, the probability of using contraception also increases with the education of women. The estimation of the Heckman probit model illustrates that the effect of women's bargaining power on the probability of contraceptive use remains virtually unchanged. Conclusions: To reduce high maternal death rates in Cameroon, public health policies should not only focus on the health system itself but should also focus on social policies to empower women in the household.
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Masiano SP, Green TL, Dahman B, Kimmel AD. The effects of community-based distribution of family planning services on contraceptive use: The case of a national scale-up in Malawi. Soc Sci Med 2019; 238:112490. [PMID: 31437769 DOI: 10.1016/j.socscimed.2019.112490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 07/17/2019] [Accepted: 08/10/2019] [Indexed: 11/19/2022]
Abstract
RATIONALE Although many sub-Saharan African countries have scaled-up pilot projects of community-based distribution (CBD) of family planning services, the effects of the scaled-up CBDs on contraceptive use remain unclear. OBJECTIVE We leveraged a national scale-up of Malawi's Learning and Innovation Population and Family Planning pilot to evaluate the effects of a scale-up of CBDs on contraceptive use. We also investigated whether education and income, two important determinants of contraceptive use behaviors, moderate the effects of the scaled-up CBDs. METHOD We used the 2000/2004 and 2010/2016 Malawi Demographic and Health Surveys (N = 57,978) and difference-in-differences analyses to estimate the effects of the 2005 national scale-up of CBDs on modern contraceptive use. We used rural and urban communities as the intervention and comparison groups because the national CBDs were implemented only in rural communities. Contraceptive use is defined as the current use of any modern contraceptive method (e.g., pills) and was modelled using multilevel logistic regression. RESULTS Prior to the implementation of the national scale CBDs (2000/2004), the probability of using contraceptives was 21.5% in rural communities and 26.3% in urban communities. After the scale-up (2010/2016), the probability of using contraceptives increased in both rural and urban communities but was greater in rural communities (44.9% vs. 42.9%). The effect attributable to the national scale CBDs was 6.8 percentage points (95% CI [3.3, 9.7]). The effects of the national CBDs were greater among uneducated and low-income women. CONCLUSIONS These findings suggest that national CBDs increase overall contraceptive use, particularly in rural communities, and that poor and uneducated women benefit more from family planning interventions that reduce communication and financial barriers.
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Affiliation(s)
- Steven P Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
| | - Tiffany L Green
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - April D Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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