Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan

Men's reproductive coercion of women: prevalence, experiences, and coping strategies-a mixed method study in urban health facilities in León, Nicaragua

BACKGROUND

Reproductive coercion (RC) is a common form of violence against women. It can take several expressions aiming at limiting women's reproductive autonomy. Thus, the frequency and how reproductive coercion can be resisted must be investigated. There is limited research regarding RC in Latin America. Therefore, this study aimed to measure RC prevalence and associated factors and to explore the women experiences and coping strategies for RC.

METHODS

A convergent mixed-methods study with parallel sampling was conducted in Nicaragua. A quantitative phase was applied with 390 women 18-35 years old attending three main urban primary health care facilities. Lifetime and 12 months of exposure to RC behaviors including pregnancy promotion (PP) and contraceptive sabotage (CS) were assessed. Poisson regression with a robust variance estimator was used to obtain adjusted prevalence rate ratios and 95% Confidence Intervals (CIs). In addition, seven in-depth interviews were collected and analyzed using qualitative content analysis.

RESULTS

Ever RC prevalence was 17.4% (95% CI, 13.8-21.6) with similar proportions reporting ever experiencing PP (12.6%, 95% CI 9.4-16.3) or ever experiencing CS (11.8%, 95% CI 8.7-15.4). The prevalence of last twelve months RC was slightly lower (12.3%, 95% CI, 9.2-16.0) than above. Twelve months PP (7.4%, 95% CI 5.0-10.5) and CS (8.7%, 95% CI 6.1-12.0) were also similar. Women's higher education was a protective factor against ever and 12 months of exposure to any RC behaviors by a current or former partner. Informants described a broad spectrum of coping strategies during and after exposure to RC. However, these rarely succeeded in preventing unintended pregnancies or regaining women's long-term fertility autonomy.

CONCLUSIONS

Our facility-based study showed that men's RC is a continuous phenomenon that can be enacted through explicit or subtle behaviors. Women in our study used different strategies to cope with RC but rarely succeeded in preventing unintended pregnancies or regaining their long-term fertility autonomy. Population-based studies are needed assess this phenomenon in a larger sample. The Nicaraguan health system should screen for RC and develop policies to protect women's reproductive autonomy.

Intimate partner violence as a factor in contraceptive discontinuation among sexually active married women in Nigeria

Background

In spite of the well-established associations between socioeconomic and demographic factors and the high rate of contraceptive discontinuation among sexually active married contraceptive users, little is known in Nigeria about the relationship between contraceptive discontinuation and sexually active married women who have experienced Intimate Partner Violence (IPV).

Methods

The 2013 Nigeria Demographic and Health Survey data on women’s reproductive calendars and domestic violence were used to investigate the relationship between IPV and contraceptive discontinuation in a year period. A weighted sample size of 1341 women in a union in the domestic violence module, who have experienced IPV, and are using any contraceptive and are not sterilized in the 12 months periods was analyzed using frequency tables and chart, Pearson’s chi-square test, and binary logistic regression model.

Results

The results showed that women who have experienced any type of IPV are 1.28 times more likely to have discontinued contraceptive use although they are still at risk of becoming pregnant (aOR = 1.28, CI: 1.15–1.91; p < 0.05) than those who have not experienced IPV. The tertiary level of education (aOR = 3.94, CI = 1.67–9.29; p < 0.05), unemployed status (aOR = 1.97, CI = 1.07–3.62; p < 0.05), and higher marital duration of 20 years and above (aOR = 4.89, CI = 2.26–10.57; p < 0.05) significantly influenced women who have experienced any types of IPV to discontinue contraceptives even though they are still at risk of becoming pregnant than those who have not experienced IPV.

Conclusion

The study revealed that women who have experienced any form of IPV were significantly influenced by their education, occupation, the number of living children, and marital duration to discontinue contraception while still at risk of becoming pregnant. Thus, the study concludes that intervention programmes aimed at increasing contraceptive prevalence rate should be mindful of IPV which may affect women’s use of contraceptives.

A 1-year comparison of TCu380Ag versus TCu380A intrauterine contraceptive devices in India

OBJECTIVE

To compare TCu380Ag and TCu380A intrauterine contraceptive devices after 1 year of use.

METHODS

A prospective randomized controlled trial was conducted among healthy married women aged 20-35 years who attended the family planning clinics of three tertiary centers in India between August 1, 2015, to March 31, 2018. The TCu380Ag group (n=300) received one of three sizes of this device depending on uterocervical length: maxi (8.0-9.0 cm), normal (7.0-8.5 cm), or mini (6.0-7.5 cm). The remaining 300 participants received TCu380A. Follow-up was conducted at 3-monthly intervals to assess continuation rate, acceptability, efficacy, adverse effects, and complications.

RESULTS

The TCu380Ag group had a higher continuation rate than the TCu380A group at 1 year (84.0% vs 75.8%; P=0.01), with an efficacy of 99.6% versus 100.0% (P>0.05). Overall estimated continuation rates were 94.5% (95% confidence interval [CI] 91.7%-96.4%) and 88.4% (95% CI 83.2%-91.5%), respectively (P=0.026). Use of TCu380Ag was associated with fewer adverse effects (heavy menstrual bleeding, abdominal pain, or expulsion) when compared with TCu380A (P>0.05 for all comparisons). Discontinuation rates owing to adverse effects were 6.59% for TCu380Ag versus 13.26% for TCu380A (P=0.01).

CONCLUSIONS

Varying sizes of TCu380Ag could provide an alternative to TCu380A.

A Systematic Review of Reproductive Coercion in International Settings

Reproductive coercion is behavior that interferes with a woman's autonomous reproductive decision-making. It may take the form of birth control sabotage, pregnancy coercion, or controlling the outcome of a pregnancy. Perpetrators may be partners, a partner's family, or the woman's family. This article reviews the literature on reproductive coercion in international settings. In this review of 10 research studies, findings are presented on prevalence and type of reproductive coercion, associated factors, specific tactics, relationship with intimate partner violence and domestic violence (in-laws particularly), and implications for women's reproductive health. Findings highlight reproductive coercion as a subset of intimate partner violence that is poorly understood, especially in international settings. More research is needed on protective factors, how interventions can capitalize on protective factors, and the strategies women use to resist reproductive coercion. Policy implications and recommendations are discussed with particular attention to issues related to diverse social and cultural environments.

Knowledge, non-use, use and source of information on contraceptive methods among women in various stages of reproductive age in rural Lagos, Southwest Nigeria

Background

Contraceptives are advocated to be used against unwanted pregnancy and sexually transmitted diseases as unsafe abortion contributes to high maternal mortality in Nigeria while unwanted pregnancies have terminated the educational development of many females.

Objective

This questionnaire-based survey aimed to describe the knowledge, nonuse, and use of various contraceptive methods among women in different child-bearing age groups in rural Lagos, Nigeria.

Materials and methods

Between 2012 and 2013, 816 females in rural communities within Lagos State were surveyed for their knowledge, source of information, and use of contraceptives. They were grouped into early, mid, and late reproductive age. Statistical analysis of data harvested from respondents was carried out using STATA 13 software.

Results

In all, 816 females in different stages of reproductive age were involved in the study, among whom 19% were single, 78% married, 3% divorced, and 0.5% widowed. About 6% had no formal education, while the majority (81%) were of the Yoruba ethnic group. Married respondents were approximately thrice more likely to know of contraceptives than single respondents (χ²=29.9, P=0.000, odds ratio =2.9, 95% confidence interval =1.9, 4.2). Condom use was the most widely known and used method of contraceptive regardless of marital status and reproductive age status. Information about contraceptives was mainly from health facilities among married and divorced women and from school or educational institution among singles. Overall prevalence of contraceptive use was 51.9%. Nonuse of contraceptives was 43% among married women and 67% among singles. Knowledge of contraceptive method was negatively associated with marital status (t=−2.24, P=0.025) but positively associated with source of information on contraceptives (t=20.00, P=0.000). Use of contraceptives was positively associated with stage of reproductive age (t=1.94, P=0.05) and source of information on contraceptives (t=11.22, P=0.000), but negatively associated with marital status (t=−2.79, P=0.005) and religious belief (t=−1.89, P=0.05).

Conclusion

Knowledge and use or nonuse of contraceptives could be pivotal in designing adequate prenatal care to prevent unwanted pregnancy and consequently illegal abortion or possible adverse pregnancy outcomes such as low birth weight, preterm birth, and conditions such as small for gestational age. Data from this study can also be used to design penetrating health education on making pregnancy safer or living a healthy female reproductive life.

Determinants of intrauterine contraceptive device discontinuation among Indian women

OBJECTIVE

To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012.

METHODS

387 women who had an intrauterine device (IUD) inserted during the last 1-5 years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation.

RESULTS

The incidence of IUD discontinuation in the first year following insertion was 16.79 %. Approximately 31 % of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 387 women, 56 % discontinued IUD use because of a desire to conceive, 27.7 % because of side effects, 15.36 % because of opposition from the woman's family, and 1.5 % because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use.

CONCLUSIONS

The crude cumulative rate of IUD discontinuation was 16.79 % during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36 months (45 %), thereby fulfilling its objective of spacing between children as laid down by the WHO (2 years spacing between pregnancies). About 31 % of the women continued using IUCD even after 5 years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.

Modelling geographical variations and determinants of use of modern family planning methods among women of reproductive age in Nigeria

Summary Understanding the level, trend, geographical variations and determinants of use of modern family planning (FP) plays a major role in designing effective interventions leading to increased usage. This study assessed these characteristics of FP use in Nigeria using data from the 2003, 2005 and 2007 National HIV/AIDS and Reproductive Health Survey, a national population-based household survey. A Bayesian geo-additive procedure was used, which provides flexible modelling of non-linear and spatial effects at a highly disaggregated level of states. The findings reveal considerable geographical variation in the use of modern FP in Nigeria, with a distinct north-south divide. Furthermore, a significant trend in the use of modern FP was evident, with an increase between 2003 and 2005 followed by a decline between 2005 and 2007. The effect of respondent's age was non-linear, and use of modern FP was found to differ significantly between never-married and currently/formerly married respondents. Awareness of FP methods and knowledge of where to get/buy FP services/methods were found to be significantly associated with usage. The findings provide policymakers with tools to prioritize the use of scarce resources for implementing FP and reproductive health interventions.