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Sarnak DO, Gemmill A. Perceptions of Partners' Fertility Preferences and Women's Covert Contraceptive Use in Eight sub-Saharan African Countries. Stud Fam Plann 2022; 53:527-548. [PMID: 35767464 PMCID: PMC9545344 DOI: 10.1111/sifp.12206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Covert use of contraception is a common but underreported and understudied phenomenon where one partner uses contraception without the other's knowledge. We used Demographic and Health Survey couple data to examine the relationship between wives’ perceptions of husbands’ fertility preferences and type of contraceptive use (overt vs. covert) in Benin, Ethiopia, Kenya, Mali, Nigeria, Sierra Leone, Uganda, and Zambia using logistic regression. Wives who perceived that their husbands wanted more children than them had increased odds of using covertly, compared to those who perceived that husbands wanted the same number of children in all countries except Benin, and the strength of the relationships ranged from adjusted odds ratio (aOR) 2.89 (95 percent confidence interval (CI) 1.75–4.76) in Zambia to aOR 4.01 (95 percent CI 1.68–9.58) in Mali. Wives who reported not knowing their husbands’ fertility preferences had increased odds of using covertly compared to wives who perceived that their husbands wanted the same number of children in all countries except Zambia, ranging from aOR 2.02 (95 percent CI 1.11–3.69) in Ethiopia to aOR 3.82 (95 percent CI 2.29–6.37) in Kenya. Our findings indicate that efforts to increase partner engagement to align couple's fertility preferences may encourage overt use.
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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, USA
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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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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Lozano M, Obiol MA, Peiró J, Iftimi A, Ramada JM. Professional counseling in women with serious mental illness: achieving a shift toward a more effective contraceptive method. J Psychosom Obstet Gynaecol 2021; 42:221-227. [PMID: 32050830 DOI: 10.1080/0167482x.2020.1725463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Mental disorders in reproductive-aged women have significant implications for the risk of unintended pregnancies. The objective of this study is to assess the professional counseling in clinical practice based on motivational interview in women with serious mental illness (SMI) in order to achieve a change to a more effective contraceptive method. STUDY DESIGN A prospective observational cohort study (2012-2017) was conducted in a convenience sample of women with severe-moderate psychiatric disorders (n = 91). Information related to psychiatric health, contraceptive use, sexual and reproductive health and socio-demographics was collected. To assess the variation in the contraceptive method, follow-up visits were planned before and after medical counseling. All participants underwent an evidence-based individual motivational interview for contraception counseling. A multivariate logistic model was carried out to identify the factors involved in changing to a more effective contraceptive method. RESULTS After evidence-based counseling, 51.6% of participants changed their contraceptive method to a more effective one. This change was associated with gender violence (β coefficient = 1.58, p value = .006). The relation between changing to a more effective contraceptive method and both previous abortions and having children was also positive, although the coefficients did not reach statistical significance. CONCLUSIONS Evidence-based contraception counseling in clinical practice, based on an adapted protocol to patients with SMI, has shown, in this study, to be adequate to promote the shift to more effective contraceptive methods, avoiding the need of daily compliance in this population. Gender violence has been significantly associated with the shift to very high effectiveness methods as well as previous abortions and having children, not significantly.
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Affiliation(s)
- Manuel Lozano
- Departament de Medicina Preventiva i Salut Pública, Ciències de l'Alimentació, Toxicologia i Medicina Legal, Universitat de València, València, Spain
| | - María Antonia Obiol
- Centre de Salut Sexual i Reproductiva Font de Sant Lluís, Hospital Universitari Dr. Peset, València, Spain
| | - Juanjo Peiró
- Departament d'Estadística i Investigació Operativa, Universitat de València, València, Spain
| | - Adina Iftimi
- Departament d'Estadística i Investigació Operativa, Universitat de València, València, Spain
| | - José María Ramada
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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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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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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Tiruye TY, Harris ML, Chojenta C, Holliday E, Loxton D. Intimate partner violence against women in Ethiopia and its association with unintended pregnancy: a national cross-sectional survey. Int J Public Health 2020; 65:1657-1667. [PMID: 33048193 DOI: 10.1007/s00038-020-01510-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate the association between intimate partner violence (IPV) and unintended pregnancy among women in Ethiopia. METHODS A retrospective analysis of nationally representative data was conducted among 2969 married women of reproductive age (15-49 years). Logistic regression models were used to estimate the association of IPV with the outcome variable. RESULTS Unintended pregnancy was reported by 26.5% of women. About 36% of participants reported having ever experienced IPV (a composite measure of physical, sexual, and emotional abuse) and 56% had experienced at least one act of partner controlling behaviour. After controlling for potential confounders, a significant association was observed between IPV and unintended pregnancy (AOR 1.39, 95% CI 1.05, 1.85) and between multiple acts of partner controlling behaviours and unintended pregnancy (AOR 1.57, 95% CI 1.16, 2.14). CONCLUSIONS In Ethiopia, which has a high fertility rate (4.6 children per woman) and low use of contraception (36%), IPV including partner controlling behaviour further contributes to the problem of unintended pregnancy. Reproductive health programs should be sensitive to the relational aspects of fertility control and incorporate IPV interventions into reproductive health services.
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Affiliation(s)
- Tenaw Yimer Tiruye
- Public Health Department, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Melissa L Harris
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Catherine Chojenta
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
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Kibira SPS, Karp C, Wood SN, Desta S, Galadanci H, Makumbi FE, Omoluabi E, Shiferaw S, Seme A, Tsui A, Moreau C. Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges. BMC Public Health 2020; 20:865. [PMID: 32503485 PMCID: PMC7275340 DOI: 10.1186/s12889-020-08977-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The balance between increasing men's participation in family planning and rights-based initiatives favoring women's empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low- and middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women's decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women's choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries. METHODS Women aged 15-49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women's and girls' empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes. RESULTS Findings comprised three thematic areas: the practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure. CONCLUSIONS Results indicate that while covert use of contraception is common, continued covert use is challenging, especially when side effects manifest. Covert use may further suggest women taking independent action, symbolizing some level of empowerment. Results underscore the importance of disentangling unique reasons for covert use and the severity of repercussions of disclosure.
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Affiliation(s)
- Simon P S Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Selamawit Desta
- 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, Kano State, Nigeria
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Elizabeth Omoluabi
- Centre for Research Evaluation Resources and Development, Ile-Ife Osun State, Nigeria
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807, Le Kremlin-Bicêtre, France
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Willie TC, Keene DE, Stockman JK, Alexander KA, Calabrese SK, Kershaw TS. Intimate Partner Violence Influences Women's Engagement in the Early Stages of the HIV Pre-exposure Prophylaxis (PrEP) Care Continuum: Using Doubly Robust Estimation. AIDS Behav 2020; 24:560-567. [PMID: 30915581 DOI: 10.1007/s10461-019-02469-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Intimate partner violence (IPV) is associated with pre-exposure prophylaxis (PrEP) acceptability among US women, but whether IPV influences other steps along the PrEP care continuum remains unclear. This study estimated the causal effects of IPV on the early stages of the PrEP care continuum using doubly robust (DR) estimation (statistical method allowing causal inference in non-randomized studies). Data were collected (2017-2018) from a cohort study of 124 US women without and 94 women with IPV experiences in the past 6 months (N = 218). Of the 218 women, 12.4% were worried about getting HIV, 22.9% knew of PrEP, 32.1% intended to use PrEP, and 40.4% preferred an "invisible" PrEP modality. IPV predicts HIV-related worry (DR estimate = 0.139, SE = 0.049, p = 0.004). IPV causes women to be more concerned about contracting HIV. Women experiencing IPV are worried about HIV, but this population may need trauma-informed approaches to help facilitate their PrEP interest and intentions.
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Affiliation(s)
- Tiara C Willie
- Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Danya E Keene
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kamila A Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Rm 417, Baltimore, MD, 21205, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Trace S Kershaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
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Sebert Kuhlmann A, Shato T, Fu Q, Sierra M. Intimate partner violence, pregnancy intention and contraceptive use in Honduras. Contraception 2019; 100:137-141. [DOI: 10.1016/j.contraception.2019.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
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10
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El-Khoury M, Thornton R, Chatterji M, Kamhawi S, Sloane P, Halassa M. Counseling Women and Couples on Family Planning: A Randomized Study in Jordan. Stud Fam Plann 2018; 47:222-38. [PMID: 27611319 DOI: 10.1111/sifp.69] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article evaluates the effects of involving men in family planning counseling in Jordan using a randomized experiment. We randomly assigned a sample of 1,247 married women to receive women-only counseling, couples counseling, or no counseling. We measured the effects of each type of counseling on family planning use, knowledge, attitudes, and spousal communication about family planning. Compared to no counseling, couples counseling led to a 54 percent increase in uptake of modern methods. This effect is not significantly different from the 46 percent increase in modern method uptake as a result of women-only counseling. This outcome may be due, in part, to lower rates of compliance with the intervention among those assigned to couples counseling compared to women-only counseling. To realize the possible added benefits of involving men, more tailored approaches may be needed to increase men's participation.
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Affiliation(s)
| | | | - Minki Chatterji
- Abt Associates, 4550 Montgomery Ave. #800N, Bethesda, MD 20814
| | - Sarah Kamhawi
- Monitoring, Evaluation and ResearchOfficer,Abt Associates-led SHOPS project, Amman, Jordan
| | - Phoebe Sloane
- Abt Associates, 4550 Montgomery Ave. #800N, Bethesda, MD 20814
| | - Mays Halassa
- Technical Specialist, Abt Associates, Amman, Jordan
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Alvergne A, Stevens R, Gurmu E. Side effects and the need for secrecy: characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods. Contracept Reprod Med 2017; 2:24. [PMID: 29201429 PMCID: PMC5683325 DOI: 10.1186/s40834-017-0052-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Contraceptive discontinuation is a major barrier to reducing global unmet needs for family planning, but the reasons why women discontinue contraception are poorly understood. Here we use data from Ethiopia to investigate (i) the magnitude of contraceptive discontinuation in 2005-2011, (ii) how the risk of discontinuation varies with method type and education level and (iii) the barriers to continuation. Our main hypothesis is that contraceptive discontinuation is driven by the experience of physiological side-effects associated with the use of hormonal contraception, rather than a lack of formal education. METHODS We used a mixed methods explanatory sequential design to explain the quantitative results in more details through the qualitative data. First, we analysed quantitative data from the 2011 Ethiopian Demographic and Health Survey to study patterns of contraceptive discontinuation and method choice using multilevel multiprocess models. Second, we conducted semi-structured interviews and focus group discussions in the 3 most populated regions of Ethiopia with individuals of reproductive age and health professionals. RESULTS The analysis of EDHS data shows that the rate of discontinuation has not reduced in the period 2005-2011 and remains high. Discontinuation mainly takes the form of abandonment, and is a function of method type, age and wealth but not of educational level. Interviews with women and health professionals reveal that the experience of debilitating physiological side effects, the need for secrecy and poverty are important barriers to continuation. CONCLUSIONS Our findings together suggest that physiological and social side-effects of contraceptive use, not a lack of formal education, are the root causes of contraceptive abandonment in Ethiopia.
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Affiliation(s)
- Alexandra Alvergne
- School of Anthropology & Museum Ethnography, University of Oxford, 51/53 Banbury road, Oxford, OX2 6PE UK
| | - Rose Stevens
- School of Anthropology & Museum Ethnography, University of Oxford, 51/53 Banbury road, Oxford, OX2 6PE UK
| | - Eshetu Gurmu
- Center for Population Studies and Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
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Zimmerman MS. Reproductive health information needs and maternal literacy in the developing world. IFLA JOURNAL-INTERNATIONAL FEDERATION OF LIBRARY ASSOCIATIONS 2017. [DOI: 10.1177/0340035217713227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article provides an analysis of the relationship of literacy and education in the developing world as they intertwine with reproductive health, and explores the reproductive health-related informational needs of women from these regions. Every day more than 800 women die from causes relating to pregnancy, 99% of whom are in the developing world. In 2015 16,000 children under five died every day. This article first provides a systematized review of the extensive canon of literature that explores the relationship between maternal literacy and mother and child health. A content analysis is conducted with the aim of deciphering the reproductive health-related informational needs of women in the developing world. Following, there is a discussion of interventions that have demonstrated success at ameliorating these gaps. Some of these interventions have met information needs related to family planning, HIV/AIDS, sexually transmitted infections, violence against women, sexuality, pregnancy education, and emergency obstetric care.
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Maxwell L, Devries K, Zionts D, Alhusen JL, Campbell J. Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis. PLoS One 2015; 10:e0118234. [PMID: 25693056 PMCID: PMC4334227 DOI: 10.1371/journal.pone.0118234] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/09/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women's use of contraception. METHODS We searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women's use of contraception. RESULTS Of the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women's experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I2 = 92%; 95% CII2: 87%, 96%). Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%). CONCLUSIONS IPV is associated with a reduction in women's use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women's experiences of IPV.
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Affiliation(s)
- Lauren Maxwell
- Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montréal, Québec, Canada
| | - Karen Devries
- Social and Mathematical Epidemiology Group and Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Danielle Zionts
- Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montréal, Québec, Canada
| | - Jeanne L. Alhusen
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Jacquelyn Campbell
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
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Moya EM, Chávez-Baray S, Martinez O. Intimate partner violence and sexual health: voices and images of Latina immigrant survivors in southwestern United States. Health Promot Pract 2014; 15:881-93. [PMID: 24787021 DOI: 10.1177/1524839914532651] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intimate partner violence (IPV), which describes physical and/or sexual assault of a spouse or sexually intimate companion, is a common health care issue across the globe. However, existing health outcomes studies are limited. Additionally, no study to our knowledge has specifically focused on the relationship between IPV and sexual health among Latina immigrants in southwestern United States. Through the use of photovoice methodology and a community-based participatory research approach, we assessed these types of relationships drawing on data gathered from 22 Latina survivors of IPV and 20 community stakeholders in El Paso, Texas. Participants identified two major themes: the different expressions of domestic violence and the need for access to sexual and reproductive health services. Community stakeholders and participants identified practical and achievable recommendations and actions including the development of a promotora training program on IPV and sexual health. This assessment extends beyond HIV and STI risk behaviors and highlights disease prevention within a wellness and health promotion framework.
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Affiliation(s)
- Eva M Moya
- Department of Social Work, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, USA
| | - Silvia Chávez-Baray
- Department of Social Work, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, USA
| | - Omar Martinez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
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15
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Stephenson R, Jadhav A, Hindin M. Physical domestic violence and subsequent contraceptive adoption among women in rural India. JOURNAL OF INTERPERSONAL VIOLENCE 2013; 28:1020-1039. [PMID: 23008052 PMCID: PMC3582775 DOI: 10.1177/0886260512459379] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study examines the relationship between male to female physical domestic violence and contraceptive adoption among women in four economically and culturally distinct areas of India. Data from India's 1998-1999 National Family Health Survey-2 and a follow-up survey in 2002-2003 for which the same women in four states were reinterviewed are analyzed. The focus of the analysis is on how baseline exposure to physical domestic violence is associated with the intersurvey adoption of contraception. Women who experience physical violence from their husbands are significantly less likely to adopt contraception in the intersurvey period, although this relationship varies by State. This study builds upon previous work by using an indicator of physical domestic violence exposure that is measured before contraceptive adoption, thus allowing the identification of how exposure to violence shapes the adoption of contraception. The results demonstrate that for women living in Bihar and Jharkhand there is a clear negative relationship between physical domestic violence and a woman's adoption of contraception; this relationship was not found for women in Maharashtra and Tamil Nadu. The results point to the need to include domestic violence screening and referral services into family planning services.
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Shattuck D, Kerner B, Gilles K, Hartmann M, Ng'ombe T, Guest G. Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project. Am J Public Health 2011; 101:1089-95. [PMID: 21493931 PMCID: PMC3093271 DOI: 10.2105/ajph.2010.300091] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples' contraceptive uptake. We based the intervention design on the information-motivation-behavioral skills (IMB) model. METHODS In 2008 we recruited 400 men from Malawi's Mangochi province who reported not using any method of contraception. We randomized them into an intervention arm and a control arm, and administered surveys on contraceptive use at baseline and after the intervention. We also conducted in-depth interviews with a subset of intervention participants. RESULTS After the intervention, contraceptive use increased significantly within both arms (P < .01), and this increase was significantly greater in the intervention arm than it was in the control arm (P < .01). Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake (P < .01). CONCLUSIONS Our findings indicate that men facilitated contraceptive use for their partners. Although the IMB model does not fully explain our findings, our results show that the intervention's content and its training in communication skills are essential mechanisms for successfully enabling men to help couples use a contraceptive.
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Affiliation(s)
- Dominick Shattuck
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA.
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Trends and correlates of hormonal contraceptive use among HIV-infected women in Rakai, Uganda, 1994-2006. Contraception 2010; 83:549-55. [PMID: 21570553 DOI: 10.1016/j.contraception.2010.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 09/09/2010] [Accepted: 10/13/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about what factors correlate with hormonal contraceptive (HC) use in HIV-infected women in sub-Saharan Africa. METHODS We assessed the trends in HC use among HIV-infected women in Rakai, Uganda; determined factors associated with HC use and considered whether those factors changed over time. RESULTS HC use among HIV-infected women in Rakai increased from 5.7% in 1994 to 19.2% in 2006, but nearly half of all pregnancies in this population were unintended. Variables associated with increased HC use included higher education, socioeconomic status, parity, sexual frequency, being currently married or in a relationship, discussion of family planning with a partner and receipt of HIV results. Variables negatively associated with HC use included symptoms suggestive of opportunistic infections, having no sex partner in the past year, condom use, breastfeeding and older age. Most associations remained stable over time. CONCLUSION Although contraceptive use by HIV-infected women has increased three-fold in this rural population, unintended pregnancies persist, placing women and their children at risk of adverse consequences.
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18
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Higgins JA, Hirsch JS. The pleasure deficit: revisiting the "sexuality connection" in reproductive health. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2007; 39:240-247. [PMID: 18093041 DOI: 10.1363/3924007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Jenny A Higgins
- Office of Population Research, Princeton University, New Jersey, USA.
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McCarraher DR, Bailey PE, Martin SL. The Relationship Between Birth Predictedness and Violence During Pregnancy Among Women in La Paz and El Alto, Bolivia. Matern Child Health J 2005; 9:101-12. [PMID: 15880979 DOI: 10.1007/s10995-005-2453-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The main objectives were to estimate the prevalence of predicted and unpredicted last births using a prospective approach and to estimate the prevalence of violence during the last pregnancy. In addition, the relationship between birth predictedness and violence during pregnancy was examined. METHODS The target population for this study was women who had participated in the 1994 Demographic and Health Survey (DHS) and lived in El Alto and La Paz Bolivia (n = 1308). In 1997, 816 women were located and re-interviewed. During this three-year interval, 127/816 women had given birth to their last child. RESULTS Of the last births that occurred during the three-year interval, 82% were unpredicted (18% were to women who stated in 1994 that they wanted to postpone childbirth for more than three years and 64% were to women who stated they wanted to wanted to forego childbearing entirely). Twenty-eight percent of women reported that they had experienced violence during their last pregnancy. No statistically significant relationship was found between birth predictedness and violence during their pregnancy. CONCLUSIONS The majority of births that occurred in the three-year study interval were unpredicted. The prevalence of violence during pregnancy was alarmingly high among this sample of women. Further investigation on violence during pregnancy is needed and should be expanded to examine how violence during pregnancy impacts maternal and infant outcomes, which have remained poor in this country. In addition, the high rates of unpredicted births illustrate that work remains to be done in addressing women's ability to control their fertility.
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Affiliation(s)
- Donna R McCarraher
- Family Health International, 2224 E NC 54 Durham, North Carolina 27709, USA.
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