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Alam MB, Rana MS, Kabir MA, Khanam SJ, Khan MN. Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019. Disabil Health J 2024:101651. [PMID: 38866623 DOI: 10.1016/j.dhjo.2024.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/16/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Contraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being. OBJECTIVE The objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh. METHODS We analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding. RESULTS The prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65-0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47-0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities. CONCLUSIONS The study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.
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Affiliation(s)
- Md Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Shohel Rana
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Awal Kabir
- Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh.
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Khan MN, Khanam SJ, Billah MA, Khan MMA, Islam MM. Children's sex composition and modern contraceptive use among mothers in Bangladesh. PLoS One 2024; 19:e0297658. [PMID: 38820268 PMCID: PMC11142447 DOI: 10.1371/journal.pone.0297658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/09/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The stagnation and relatively low use of modern contraceptives are ongoing public health concerns in Bangladesh and other low- and middle-income countries. Although a cultural preference for sons may be linked to the current use of contraceptives, this linkage has not been adequately explored in the Bangladesh context. We investigated the effects of child sex composition on the current use of modern contraceptives. METHODS We extracted and analysed data from 17,333 women who participated in the 2017/18 Bangladesh Demographic and Health Survey. The outcome variable was the current use of modern contraceptive methods. The study factor was the parity and sex composition of the living children. We used multilevel logistic regressions to determine the association between the study factor and outcome variables, adjusting for potential covariates at the individual-, household-, and community-levels. RESULTS Women with relatively high parity had higher odds of currently using modern contraceptives. Among the individual parities, compared to women with no live sons, women with one or more live sons were more likely to report currently using modern contraceptives. However, this association is significant for women up to three children. When examining both parity and children's sex composition in a regression model, in each parity category, the likelihood of using modern contraceptives tend to rise with an increasing number of sons compared to women with just one daughter. CONCLUSION The findings of this study suggest that while the use of modern contraceptives by women increases with the increasing number of children and son preference is prevalent in Bangladesh, women also want to have a mixed composition of son and daughter. The study findings can be used in family planning programmes to customise contraceptive promotion and counselling messages.
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Affiliation(s)
- Md. Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Md Arif Billah
- Faculty of Business, Economic and Social Development, Universiti Malaysia Terengganu, Kuala Terengganu, Malaysia
| | | | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Australia
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Rana MS, Khanam SJ, Alam MB, Hassen MT, Kabir MI, Khan MN. Exploration of modern contraceptive methods using patterns among later reproductive-aged women in Bangladesh. PLoS One 2024; 19:e0291100. [PMID: 38557777 PMCID: PMC10984413 DOI: 10.1371/journal.pone.0291100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND With the rapid increase in the number of women in their later reproductive years (aged 35 and above) in the present decade, the concern surrounding their contraceptive considerations has reached a critical point of importance. This study aims to examine the trends and determinants of modern contraceptive uptake among later reproductive-aged women in Bangladesh. METHODS A total of 17,736 women aged 35 and above were included in the analysis, utilizing data from three consecutives Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017-18. The outcome variable was the uptake of modern contraceptive methods (yes or no). The explanatory variables encompassed survey years, individual characteristics of the women, as well as characteristics of their partners and the community. Multilevel logistic regression model was used to explore the association of the outcome variable with explanatory variables. RESULTS We found that approximately 54% of women aged 35 and more do not use modern contraceptive methods, and there have been no significant shifts in their usage observed over the survey years. Compared to women aged 35-39, women aged 40-45 (aOR = 0.53, 95% CI: 0.49-0.57) and 45-49 (aOR = 0.24, 0.22-0.26) reported lower likelihoods of modern contraceptive method uptake. Higher education correlated with increased uptake of modern contraceptive methods (112%-142%), while partner's education showed a negative association. Later reproductive-aged women in richer (aOR = 0.83, 95% CI: 0.74-0.94) and richest (aOR = 0.76, 95% CI: 0.66-0.88) quintiles reported lower uptake of modern contraceptive methods compared to their counterparts in the poorest quintile. Later reproductive-aged women in Dhaka (aOR = 1.22, 95% CI: 1.07-1.38) and Rajshahi (aOR = 1.37, 95% CI: 1.19-1.59) regions had higher uptake of modern contraception than those residing in the Barishal division. Modern contraceptive methods uptake was 1.22 times higher among women who reported exposure to mass media and 1.19 times higher among women who reported engagement in paid work compared to among women who reported no exposure to mass media and participation in no formal work, respectively. Modern contraceptive methods uptake was 43% higher (aOR = 1.43, 95% CI: 1.32-1.55) in women with more than 2 children compared to those with ≤2 children. CONCLUSION The study highlights no significant change in modern contraception uptake among later reproductive-aged women in Bangladesh. This raises concerns about the elevated risk of unintended pregnancies and shorter birth intervals, emphasizing the need for targeted interventions to address the specific needs and preferences of this demographic.
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Affiliation(s)
- Md. Shohel Rana
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md. Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md. Tahir Hassen
- Centre for Women’s Health Research, Faculty of Health and Medicine, The University of Newcastle, New South Wales, Australia
| | - Md. Iqbal Kabir
- Climate Change and Health Promotion Unit (CCHPU), Health Services Division, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- Department of Disaster Science and Climate Resilience, University of Dhaka, Dhaka, Bangladesh
| | - Md. Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
- Centre for Women’s Health Research, Faculty of Health and Medicine, The University of Newcastle, New South Wales, Australia
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Omisakin OA, Adedini SA. A Longitudinal Multilevel Analysis of the Effects of Contraceptive Failures on Unintended Pregnancies among Women in Urban Nigeria. J Urban Health 2024; 101:193-204. [PMID: 38286904 PMCID: PMC10897120 DOI: 10.1007/s11524-023-00819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
Unintended pregnancy is a global public health concern. However, the effect of contraceptive failure on unintended pregnancy remains unclear in Nigeria. We undertook a longitudinal analysis to examine the effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. We used panel data from the Nigerian Urban Reproductive Health Initiative. The Measurement, Learning and Evaluation program conducted the surveys among a cohort of women aged 15-49 who were first interviewed at baseline in 2010/2011 and followed up at endline in 2014/2015. Analytic sample was 4140 women aged 15-49 who ever used contraceptives. We fitted three-level multilevel binary logistic regression models estimated with GLLAMM. The study established evidence that there is a significant effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. The positive effect of between-person contraceptive failure indicates that respondents who experienced more contraceptive failure than the average in the sample had 5.26 times higher odds of unintended pregnancy (OR = 5.26; p-value < 0.001). Results also established a significant effect of within-person contraceptive failures among the respondents. Findings suggest there is evidence of a significant longitudinal effect of contraceptive failure on unintended pregnancy in urban Nigeria. Efforts to reduce unintended pregnancy must include interventions to address the problem of contraceptive failure among urban women in Nigeria.
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Affiliation(s)
- Olusola A Omisakin
- Center for Safe & Healthy Children, College of Health and Human Development, The Pennsylvania State University, 201 Henderson Building University Park, State College, PA, 16802, USA.
| | - Sunday A Adedini
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hossain S, Akter T, Mohsin M, Islam MM, Chowdhury PB, Khudri MM. Contraceptive uses among married women in Bangladesh: a systematic review and meta-analyses. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:10. [PMID: 38233954 PMCID: PMC10795415 DOI: 10.1186/s41043-024-00502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Although Bangladesh's economy has shown significant improvement over the past two decades, the high population growth rate has hindered development efforts. This study aimed to review the prevalence of different contraceptive methods used among women of reproductive age in Bangladesh, which could help control the population growth rate. METHODS We conducted an extensive literature review and meta-analysis of 82 articles, identifying 20 articles for analysis. The analyses included heterogeneity and publication bias in published papers. RESULTS The pooled prevalence of various contraceptive methods was as follows: condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices (IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage, while traditional methods constituted 8.79%. On average, only 1.95% of women opted for the implant method. The overall prevalence of contraceptive method usage was 59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically significant heterogeneity for all contraceptive methods used by women in Bangladesh. The funnel plot and Egger's test showed no publication bias for any of the contraceptive methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by women in rural areas also showed publication bias (Z = -3.04, P = 0.0024). CONCLUSION A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies to ensure adherence to and provision of the most appropriate contraceptive method for couples.
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Affiliation(s)
- Sorif Hossain
- Department of Statistics, Noakhali Science and Technology University, Noakhali, Bangladesh.
| | - Tahmina Akter
- Department of Statistics, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Md Mohsin
- Interdisciplinary Health Sciences, The University of Texas at El Paso, El Paso, USA
| | - Md Momin Islam
- Department of Meteorology, University of Dhaka, Dhaka, 1000, Bangladesh.
| | | | - Md Mohsan Khudri
- Department of Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, USA
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Khan MN, Harris ML. Spatial variation in the non-use of modern contraception and its predictors in Bangladesh. Sci Rep 2023; 13:13814. [PMID: 37620501 PMCID: PMC10449799 DOI: 10.1038/s41598-023-41049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023] Open
Abstract
This study aimed to investigate spatial variations in the non-use of modern contraception in Bangladesh and identify associated individual, household, and community-level factors. The analysis utilized data from 16,135 women, extracted from the 2017/18 Bangladesh Demographic and Health Survey. The study's main outcome was the prevalence of non-use of modern contraception (yes or no), while the explanatory variables included factors at the individual, household, and community level. To assess geographical heterogeneity in non-use of modern contraception, Moran's I statistics were applied. Additionally, the Gettis-Ord Gi* was calculated to measure spatial autocorrelation differences across various study locations. The relationship between non-use of modern contraception and location was further explored using a geographically weighted regression model at the cluster level. The results indicated that 42.8% (95% CI 41.6-43.8) of respondents reported non-use of modern contraception in Bangladesh, with significant variation across geographical locations (p < 0.001). Hot spots of high non-use were predominantly identified in the Sylhet, Barishal, and some areas of the Chattogram divisions, while cold spots of low use were concentrated in the Rangpur, Mymensingh, and some areas Rajshahi divisions. Notably, the likelihood of non-use was highest among women and partners with low levels of education. The analysis of other risk factors, such as partner occupation, community-level illiteracy, and poverty, revealed varying effects on non-use of modern contraception across different locations (clusters) within the country. The study's findings underscore the importance of targeted, area-specific policies and programs aimed at promoting knowledge and uptake of modern contraception in Bangladesh.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Nazrul Islam University, Trishal, Mymensingh, Bangladesh.
- Centre for Women's Health Research, University of Newcastle, Sydney, Australia.
| | - Melissa L Harris
- Centre for Women's Health Research, University of Newcastle, Sydney, Australia
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Khan MN, Akter S, Islam MM. Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data. BMC Health Serv Res 2022; 22:1180. [PMID: 36131314 PMCID: PMC9490900 DOI: 10.1186/s12913-022-08565-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh. Methods In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors. Results Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities. Conclusion The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, 2222, Bangladesh.
| | - Shahinoor Akter
- Gender and Women's Health, Centre for Health Equity School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, 3086, Australia
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Khan MN, Harris ML, Huda MN, Loxton D. A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh. Sci Rep 2022; 12:15165. [PMID: 36071170 PMCID: PMC9452522 DOI: 10.1038/s41598-022-19559-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women's homes, on the occurrence of unintended pregnancy that resulted in a live birth. We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5051 women of reproductive age, who had at least one live birth within 3 years of the survey. The outcome variable was women's intention to conceive at their most recent pregnancy that ended with a live birth. The major explanatory variables were the health facility level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables adjusting for individual, household, and community-level factors. Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancies that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women's homes.The availability of health facilities near women's homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and to increase the number of health facilities are recommended.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia.
| | - Melissa L Harris
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Md Nazmul Huda
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbeltown, NSW, 2560, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
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