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Buser JM, Pebolo PF, August E, Rana GK, Gray R, Jacobson-Davies FE, Kumakech E, Endale T, Auma AG, Smith YR. Scoping review of qualitative studies on family planning in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003313. [PMID: 38959214 PMCID: PMC11221757 DOI: 10.1371/journal.pgph.0003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/11/2024] [Indexed: 07/05/2024]
Abstract
Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.
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Affiliation(s)
- Julie M. Buser
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Pebalo F. Pebolo
- Department Reproductive Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Ella August
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- PREPSS (Pre-Publication Support Service), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gurpreet K. Rana
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel Gray
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Faelan E. Jacobson-Davies
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Edward Kumakech
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Tamrat Endale
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna Grace Auma
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Yolanda R. Smith
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Okyere J, Aboagye RG, Ayebeng C, Dosoo AK, Salu S, Dickson KS. Hormonal contraceptive use among women living with hypertension in sub-Saharan Africa: insights from 12 countries. BMC Res Notes 2024; 17:167. [PMID: 38898484 PMCID: PMC11186193 DOI: 10.1186/s13104-024-06830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES Given the well-established link between hormonal contraceptives and hypertension risk, and the paucity of research on hormonal contraceptive use dynamics in this particular demographic, we hypothesize that there is a likelihood of low utilization of high-risk hormonal contraceptives among women living with hypertension in SSA. This study investigates the prevalence and factors associated with hormonal contraceptive use among women living with hypertension in the SSA. RESULTS Only 18.5% of women living with hypertension used hormonal contraceptives. Hormonal contraceptive use was high among women with a higher level of education (aOR = 2.33; 95%CI: 1.73-3.14), those currently working (aOR = 1.38; 95%CI: 1.20-1.59), those who have heard about family planning on the radio (aOR = 1.27, 95%CI: 1.09-1.47), listened to the radio at least once a week (aOR = 1.29, 95%CI: 1.10-1.51), and those residing in rural areas (aOR = 1.32; 95%CI: 1.14-1.54). Conversely, women aged 45-49 exhibited a substantial decrease in the odds of hormonal contraceptive use (aOR = 0.23, 95%CI: 0.14-0.38) compared to younger women (15-19 years). Likewise, the odds of HCU were low among cohabiting (aOR = 0.66; 95%CI: 0.48-0.89) and previously married women (aOR = 0.67; 95%CI: 0.50-0.91) than never married women.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abigail Kabukie Dosoo
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Human Resource Management, School of Business, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Salu
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Choo BV, Vostrcil LA, Plummer EL, Fairley CK, Bradshaw CS, McNamee K, Henzell H, Chen MY, Chow EPF, Phillips TR. Trends in different contraception methods among women attending the Melbourne Sexual Health Centre from 2011 to 2020. Public Health 2024; 233:130-136. [PMID: 38875732 DOI: 10.1016/j.puhe.2024.04.032] [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: 02/27/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. STUDY DESIGN Repeated cross-sectional study. METHODS Women aged 16-49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. RESULTS A total of 38,288 women were included with a median age of 25 (interquartile range: 22-29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%-56.1%; Ptrend <0.001) and oral contraception (27.2%-20.5%; Ptrend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%-6.0%; Ptrend = 0.002) and intrauterine device (2.8%-11.8%; Ptrend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (Ptrend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56-0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48-0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07-1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22-1.87) had higher odds of using moderate-high-efficacy contraception. CONCLUSIONS Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes.
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Affiliation(s)
- B V Choo
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - L A Vostrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - E L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - C S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - K McNamee
- Sexual Health Victoria, Melbourne 3000, Australia.
| | - H Henzell
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - M Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - E P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - T R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
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Rizkianti A, Kistiana S, Fajarningtiyas DN, Hutasoit EF, Baskoro AA, Maryani H, Titisari AS, Sari DP, Naibaho MMP, Melissa M, Muthmainnah M. Understanding the association between family planning and fertility reduction in Southeast Asia: a scoping review. BMJ Open 2024; 14:e083241. [PMID: 38858142 PMCID: PMC11168165 DOI: 10.1136/bmjopen-2023-083241] [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: 12/15/2023] [Accepted: 05/28/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES We aimed to explore and understand the extent and type of evidence on fertility reduction and its association with family planning (FP) in Southeast Asia. DESIGN Scoping review, following the methodological principles developed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines for reporting. DATA SOURCE We searched PubMed/MEDLINE, ProQuest, EBSCO, Scopus, Web of Science, Google Scholar and reference lists of relevant articles between 1 January 2012 and 31 December 2022. Only open-access articles in English were considered. STUDY SELECTION For inclusion, observational studies were selected for eligibility based on the original articles investigating the uptake of FP on women aged 15-49 years and its association with fertility decline in Southeast Asian (SEA) countries. DATA EXTRACTION AND ANALYSIS Two reviewers screened the records independently for eligibility and extracted all data. The specific details of the studies, including data on the authors, year of publication, setting, study design, aims/objectives of the study, specific intervention, outcomes and main findings, were reported. RESULTS We retrieved 615 articles and retained 12 articles included in the analysis. Of these, 11 were quantitative studies and 1 was qualitative study. The frequently reported strategy of FP was the use of contraception. FP not only allows women to control their birth by spacing and limiting their pregnancies but also delay their first childbirth by using contraceptive methods. CONCLUSION Our review suggests that the FP programmes aiming at reducing fertility should have a specific focus on improving the uptake and continuation of FP services.
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Affiliation(s)
- Anissa Rizkianti
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Sari Kistiana
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Desy Nuri Fajarningtiyas
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Evalina Franciska Hutasoit
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Andhika Ajie Baskoro
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Herti Maryani
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Anastasia Septya Titisari
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Diah Puspita Sari
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Margareth Maya P Naibaho
- Research Centre for Population, National Research and Innovation Agency (BRIN), South Jakarta, Jakarta, Indonesia
| | - Melissa Melissa
- Faculty of Psychology, Tarumanagara University, West Jakarta, Jakarta, Indonesia
| | - Muthmainnah Muthmainnah
- Department of Epidemiology, Biostatistics, Population, and Health Promotion, Airlangga University Faculty of Public Health, Surabaya, East Java, Indonesia
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Bortoli MMD, Kantymir S, Pacheco-Brousseau L, Dahl B, Hansen EH, Lewis KB, Zhang Q, Cole V, Westergren T, Stacey D. Decisional needs and interventions for young women considering contraceptive options: an umbrella review. BMC Womens Health 2024; 24:336. [PMID: 38851748 PMCID: PMC11162067 DOI: 10.1186/s12905-024-03172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/29/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Although women face a wide range of contraceptive options, globally, young women are at risk of unintended pregnancies. Our umbrella review aimed to determine the decisional needs of nulligravida women aged 11 to 30 considering contraceptive options and identify effective interventions to support their involvement in making decisions about contraceptive use. METHODS We followed Joanna Briggs Institute methods for umbrella reviews, theoretically guided by the Ottawa Decision Support Framework. We searched six electronic databases. Two reviewers independently screened citations, extracted data, and appraised quality using AMSTAR2. We analysed findings descriptively. RESULTS Of 124 citations, we identified 11 reviews of variable quality (critically low to moderate quality): Six reported decisional needs and 5 reported on interventions. Decisional needs of young women were: (a) information needs about contraceptive options (e.g., mechanism of actions, eligibility, administration, side effects); (b) unclear values (concerns about hormone use) and features of different options (based on their religious values); and (c) need for support and resources (support from society and need for privacy). Compared to controls, decision support interventions including patient decision aids and patient education material increased knowledge and improved discussion of options with their clinicians. CONCLUSION Young women making contraceptive decisions experience unmet decisional needs. Effective interventions such as patient decision aids and general patient education materials may address their decisional needs and enhance their level of participation in making contraception decisions. Implications and contribution to the field: Young women's decisional needs when considering contraceptive use are informational needs, unclear values (including religious influences), need for support and resources when facing this decision. Interventions, such as patient decision aid and patient education material can, address decisional needs by improving young women's knowledge about contraceptive options.
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Affiliation(s)
- Marit Müller De Bortoli
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South - Eastern Norway , Kjølnes ring 56, Porsgrunn, N3918, Norway.
| | | | | | - Bente Dahl
- University of South-Eastern Norway, Bakkenteigen, Norway
| | | | - Krystina B Lewis
- School of Nursing, University of Ottawa, University of Ottawa Heart Institute, Ottawa, Canada
| | - Qian Zhang
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Victoria Cole
- Research Librarian, University of Ottawa, Ottawa, Canada
| | - Thomas Westergren
- University of Agder & University of Stavanger , Kristiansand & Stavanger, Norway
| | - Dawn Stacey
- School of Nursing, Centre for Implementation Research Ottawa Hospital Research Institute, , Ottawa Hospital Research Institute, Ottawa, Canada
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Hollands GJ, South E, Shemilt I, Oliver S, Thomas J, Sowden AJ. Methods used to conceptualize dimensions of health equity impacts of public health interventions in systematic reviews. J Clin Epidemiol 2024; 169:111312. [PMID: 38432524 DOI: 10.1016/j.jclinepi.2024.111312] [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: 10/18/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Our aims were to, first, identify and summarize the use of methods, frameworks, and tools as a conceptual basis for investigating dimensions of equity impacts of public health interventions in systematic reviews including an equity focus. These include PROGRESS-Plus, which identifies key sociodemographic characteristics that determine health outcomes. Second, we aimed to document challenges and opportunities encountered in the application of such methods, as reported in systematic reviews. STUDY DESIGN AND SETTING We conducted a methodological study, comprising an overview of systematic reviews with a focus on, or that aimed to assess, the equity impacts of public health interventions. We used electronic searches of the Cochrane Database of Systematic Reviews, the Database of Promoting Health Effectiveness Reviews (DoPHER), and the Finding Accessible Inequalities Research in Public Health Database, supplemented with automated searches of the OpenAlex dataset. An active learning algorithm was used to prioritize title-abstract records for manual screening against eligibility criteria. We extracted and analyzed a core dataset from a purposively selected sample of reviews, to summarize key characteristics and approaches to conceptualizing investigations of equity. RESULTS We assessed 322 full-text reports for eligibility, from which we included 120 reports of systematic reviews. PROGRESS-Plus was the only formalized framework used to conceptualize dimensions of equity impacts. Most reviews were able to apply their intended methods to at least some degree. Where intended methods were unable to be applied fully, this was usually because primary research studies did not report the necessary information. A general rationale for focusing on equity impacts was often included, but few reviews explicitly justified their focus on (or exclusion of) specific dimensions. In addition to practical challenges such as data not being available, authors highlighted significant measurement and conceptual issues with applying these methods which may impair the ability to investigate and interpret differential impacts within and between studies. These issues included investigating constructs that lack standardized operationalization and measurement, and the complex nature of differential impacts, with dimensions that may interact with one another, as well as with particular temporal, personal, social or geographic contexts. CONCLUSION PROGRESS-Plus is the predominant framework used in systematic reviews to conceptualize differential impacts of public health interventions by dimensions of equity. It appears sufficiently broad to encompass dimensions of equity examined in most investigations of this kind. However, PROGRESS-Plus does not necessarily ensure or guide critical thinking about more complex pathways, including interactions between dimensions of equity, and with wider contextual factors, and important practical, measurement and conceptual challenges remain. The findings from investigations of equity impacts in systematic reviews could be made more useful through more explicitly rationalized and considered approaches to the design, conduct and reporting of both primary research and the reviews themselves.
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Affiliation(s)
- Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK.
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ian Shemilt
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Sandy Oliver
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - James Thomas
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Amanda J Sowden
- Centre for Reviews and Dissemination, University of York, York, UK
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J, Kilander H. Women's experiences of postpartum contraceptive services when elective caesarean section is the method of birth: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:107-113. [PMID: 38365455 DOI: 10.1136/bmjsrh-2023-202046] [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: 08/21/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but is not routinely practised in Sweden. To improve contraceptive services and facilitate the informed choice of IUD placement at the time of a caesarean section (CS), we performed this study to identify and describe women's experiences of contraceptive services before, during and after an elective CS. METHODS A qualitative design and methodology was used. We interviewed 20 women aged 28-42 years who underwent elective CS in Sweden. Interviews were analysed using reflexive thematic analysis. RESULTS The three main themes found were (1) receptivity to contraceptive counselling in the context of CS, (2) communication and decision-making about postpartum contraception before CS and (3) lack of support and guidance to receive contraceptive services before and after CS. The participants described readiness and interest regarding postpartum contraception. They prefered counselling from around 25 weeks of gestation. Despite this finding, antenatal communication and contraceptive decision-making seemed rare. Participants reported a lack of support and guidance which necessitated a need by women to navigate the contraceptive services themselves in order to receive information about contraception before CS and to receive postpartum support. CONCLUSIONS Antenatal contraceptive counselling including information about IUD placement during CS was appreciated and welcomed by women with elective CS as their birth method. Most of the women whom we interviewed would prefer to receive contraception counselling on postpartum use during the second half of their pregnancy.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology, Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, School of Medical Sciences, Faculty of Health and Medicine, Örebro University, Örebro, Sweden
| | - Helena Kilander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Women's and Children's Health, Karolinska Institute and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
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O'Hara CA, Shan TW, Yau JNS. Knowledge of non-contraceptive benefits of and willingness to consider taking oral contraceptive pills among a low-risk female population: a cross-sectional study. EUR J CONTRACEP REPR 2024; 29:53-60. [PMID: 38284986 DOI: 10.1080/13625187.2023.2300944] [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: 10/17/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND In addition to its widely-appreciated contraceptive applications, the oral contraceptive pill (OCP) conveys both oncological and non-oncological benefits. Oncological benefits include a decreased risk of endometrial, ovarian, and colorectal cancer. Non-oncological benefits include reducing androgenic effects and alleviating menstruation-related problems. This study aimed to ascertain knowledge levels of non-contraceptive benefits and risks of OCP use among participants without contraindications to OCPs. This study also assessed factors associated with participants being more likely to consider taking OCPs. METHODS 263 women aged 21 to 40 years old with no contraindications for OCP usage participated in this study. An anonymous questionnaire collected sociodemographic information and assessed participants' knowledge of the non-contraceptive benefits and risks associated with OCP use. Multivariate linear regression was used to assess factors associated with knowledge levels. Multivariate logistic regression was used to investigate factors associated with being more likely to consider taking OCPs among women who did not presently take them. RESULTS Multivariate logistic regression revealed that participants who were more knowledgeable overall about the non-contraceptive benefits of OCPs were more likely to consider taking OCPs (coefficient = 0.184, p-value = 0.00). Knowledge of both oncological and non-oncological benefits of OCP use was relatively poor, especially among older women. Current OCP users were found to be more knowledgeable about their benefits. CONCLUSIONS As women with greater knowledge of non-contraceptive benefits of OCPs are more likely to consider taking them, knowledge gaps regarding OCPs should be filled, so that more women may reap the non-contraceptive benefits of OCPs.
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Affiliation(s)
| | - Teoh Wei Shan
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - Joseph Ng Soon Yau
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
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Lopes da Silva Filho A, Luis Pereira Bueno R, Ramires Y, Lino LMC. Etonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare system. PLoS One 2024; 19:e0301207. [PMID: 38547099 PMCID: PMC10977723 DOI: 10.1371/journal.pone.0301207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women's reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.
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Affiliation(s)
- Agnaldo Lopes da Silva Filho
- Medicine Faculty, Gynecology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Luis Pereira Bueno
- Business Graduate Program of University 9 of July (PPGA-UNINOVE), São Paulo, Brazil
- Organon & Co., São Paulo, Brazil
| | - Yohanna Ramires
- Organon & Co., São Paulo, Brazil
- Postgraduate Program in Pharmaceutical Science, Federal University of Paraná, Curiba, Paraná, Brazil
| | - Lara Marina Cruz Lino
- Organon & Co., São Paulo, Brazil
- Master’s Business Administration in Health Program, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Robbers GML, Cousins N, Lim YL, Estoesta J, Botfield JR. Views and experiences of young women from a migrant or refugee background regarding the contraceptive implant in Australia. CULTURE, HEALTH & SEXUALITY 2024:1-18. [PMID: 38497422 DOI: 10.1080/13691058.2024.2328223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Young people comprise a significant proportion of migrants and refugees in Australia. Many encounter challenges in accessing contraception information and services. This study explored the views and experiences of young women from migrant and/or refugee backgrounds regarding the contraceptive implant and related decision-making. Interviews were conducted with 33 women, aged 15-24, living in New South Wales, Australia, who spoke a language other than English and had some experience of the implant. Three themes were developed from the data as follows: 'Finding your own path': contraception decision-making (in which participants described sex and contraception as being taboo in their community, yet still made independent contraceptive choices); Accessing 'trustworthy' contraception information and navigating services (in which participants consulted online resources and social media for contraception information, and preferred discussions with healthcare providers from outside their community); and Views and experiences of the contraceptive implant (while the implant was described as a 'Western' method, most participants regarded it as an acceptable, convenient, cost-effective, and confidential means of contraception). Decision-making regarding the implant is influenced by many factors which must be considered in health promotion efforts and when providing clinical care. Consideration of more informative health promotion resources, peer education strategies, and healthcare provider training is warranted to support contraception decision-making and choice.
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Affiliation(s)
| | | | - Yen Li Lim
- Family Planning Australia, Newington, NSW, Australia
| | - Jane Estoesta
- Family Planning Australia, Newington, NSW, Australia
| | - Jessica R Botfield
- Family Planning Australia, Newington, NSW, Australia
- Monash University, Clayton, VIC, Australia
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Achola R, Atuyambe L, Nabiwemba E, Fredrick M, Orach CG. Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study. BMC Public Health 2024; 24:754. [PMID: 38468212 DOI: 10.1186/s12889-024-18103-x] [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: 11/24/2022] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Uganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda. METHODS A comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed. RESULTS We found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27-2.16], acquired skills [AOR = 2.28, 95% CI: 2.11-2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3-5 years [AOR = 2.24, 95% CI: 1.46-3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods. CONCLUSION Our findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Makumbi Fredrick
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Loi UR, Sorhaindo A, Embo M, Kabra R, Kiarie J, Ganatra B. Description of the methodology for developing and validating the WHO's family planning and comprehensive abortion care competencies for the primary health care workforce. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100945. [PMID: 38237452 PMCID: PMC10951617 DOI: 10.1016/j.srhc.2023.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Abstract
A qualified health workforce is essential to receiving effective, timely, affordable, equitable and respectful family planning and comprehensive abortion care. However, in many countries, health workers lack the competencies required to deliver quality family planning and comprehensive abortion care services. Competency-based education and learning aims to train and assess competencies. The theory-supported approach focuses on outcomes, emphasizes the learner's ability to perform, promotes learner-centeredness and links the health needs of the population to the competencies required of health workers. In 2011, the World Health Organization published a guidance document, Sexual and reproductive health - Core competencies in primary care, defining the competencies that primary care providers need to safely deliver sexual and reproductive health services at the community level and included family planning and comprehensive abortion care. In this article, we describe the methodology and process undertaken in 2020, by the World Health Organization to produce the family planning and comprehensive abortion care competencies guidance, filling gaps identified in the previous guidance document. The World Health Organization's Family Planning and Comprehensive Abortion Care toolkit for the primary health care workforce was published in 2022 and defines the key competencies for health workers in primary health care providing quality family planning and comprehensive abortion care services, as well as support for developing programmes and curricula for education and lifelong learning. The Toolkit is useful for practitioners, managers/supervisors and employers, educators, regulatory bodies, and policymakers. It is an important advance toward strengthening family planning and comprehensive abortion care services in primary health care.
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Affiliation(s)
- Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
| | - Annik Sorhaindo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Mieke Embo
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Rita Kabra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Sikaluzwe M, Phiri M, Lemba M, Shasha L, Muhanga M. Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001-2018). BMC Pregnancy Childbirth 2024; 24:148. [PMID: 38383354 PMCID: PMC10880343 DOI: 10.1186/s12884-024-06311-7] [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: 09/07/2022] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. METHODS This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15-49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. RESULTS Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25-29 years and 30-34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. CONCLUSIONS The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women's age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.
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Affiliation(s)
- Milika Sikaluzwe
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
| | - Million Phiri
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Musonda Lemba
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Liness Shasha
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Mikidadi Muhanga
- Department of the Development and Strategic Studies, College of Social Sciences and Humanities, Sokoine University of Agriculture, Morogoro, Tanzania
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Wahdi AE, Sutanto E, Setyawan A, Astrini YP, Adani N, Mardani H, Maulana N, Pattnaik A, Trihono T, Wilopo SA. National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis. Gates Open Res 2024; 7:105. [PMID: 38605912 PMCID: PMC11006955 DOI: 10.12688/gatesopenres.14642.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 04/13/2024] Open
Abstract
Background Launched in 2014, Indonesia's national health insurance system (JKN) aimed to provide universal health coverage, including contraceptive services, to its population. We aim to evaluate the contribution of JKN to the overall spending for the family planning program in Indonesia. Methods Data from the Indonesian Demographic Health Survey, Survey on Financial Flows for Family Planning, Indonesia Motion Tracker Matrix, World Population Prospect, and Indonesian ministries' budget accountability reports were entered into the CastCost Contraceptive Projection Tool to define budgetary allocation and spending for the family planning program at the national level in 2019. Results Indonesia's family planning program in 2019 was financed mostly by the national budget (64.0%) and out-of-pocket payments (34.6%). There were three main ministries responsible for family planning financing: the National Population and Family Planning Board (BKKBN) (35.8%), the Ministry of Finance (26.2%), and the Ministry of Health (2.0%). Overall, JKN contributed less than 0.4% of the funding for family planning services in Indonesia in 2019. The majority of family planning spending was by public facilities (57.3%) as opposed to private facilities (28.6%). Conclusion JKN's contribution to funding Indonesia's family planning programs in 2019 was low and highlights a huge opportunity to expand these contributions. A coordinated effort should be conducted to identify possible opportunities to realign BKKBN and JKN roles in the family planning programs and lift barriers to accessing family planning services in public and private facilities. This includes a concerted effort to improve integration of private family planning providers into the JKN program.
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Affiliation(s)
- Amirah Ellyza Wahdi
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Edward Sutanto
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Althaf Setyawan
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Yufan Putri Astrini
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Nadhila Adani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Halimah Mardani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Nirwan Maulana
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Anooj Pattnaik
- ThinkWell, 1519 York Road, Lutherville, Maryland, 21093, USA
| | - Trihono Trihono
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Siswanto Agus Wilopo
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
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Awang Dahlan S, Idris IB, Mohammed Nawi A, Abd Rahman R. Family planning behaviours among women with diabetes mellitus: a scoping review. Eur J Med Res 2024; 29:41. [PMID: 38212858 PMCID: PMC10782608 DOI: 10.1186/s40001-023-01626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/26/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Diabetes mellitus in pregnancies is associated with adverse outcomes both for the mothers and babies. Postponing pregnancy in unoptimized conditions and stabilisation of glucose should be prioritized. This scoping review is aimed to determine the scope and at the same time map the types of evidence available that is related to family planning behaviours among women with diabetes mellitus, with a particular focus on their factors which influence family planning usage and subsequently enable the identification of knowledge gaps in preventing unintended pregnancies among this high-risk population. METHODS This scoping review is guided by the methodological framework by Arksey and O'Malley's and Prisma-ScR checklist. PubMed, EBSCO and OVID were searched for empirical studies between 2000 and February 2022 using the search terms "family planning", "contraceptive" and "diabetes mellitus". Data were summarized according to the study characteristics and levels of factors influencing family planning behaviours. RESULTS Thirty-five articles that met the eligibility criteria included 33 quantitative studies, one qualitative study and one mixed-methods study. The prevalence of family planning methods used by women with diabetes mellitus varied ranging from 4.8 to 89.8% among the studied population. Women with diabetes mellitus were reported to be less likely to utilise any family planning methods compared to women without diabetes mellitus. CONCLUSIONS Most of the evidence to date on family planning behaviours among women with diabetes mellitus focuses on the role of individual level sociodemographic factors. Few studies focused on exploring determinants at multiple levels. In this review we found that there is limited evidence on disease control and pregnancy intention in relation to their family planning practices. Future studies with more clinical and contextual factors are needed to guide the strengthening of family planning services for high-risk group women specifically for women with diabetes mellitus.
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Affiliation(s)
- Sarah Awang Dahlan
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
- Family Health Development Division, Ministry of Health, Complex E, 62590, Putrajaya, Malaysia
| | - Idayu Badilla Idris
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Azmawati Mohammed Nawi
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
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Alomair N, Alageel S, Davies N, Bailey JV. Muslim women's views and experiences of family planning in Saudi Arabia: a qualitative study. BMC Womens Health 2023; 23:625. [PMID: 38007464 PMCID: PMC10675866 DOI: 10.1186/s12905-023-02786-2] [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: 05/05/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Islamic beliefs are associated with decreased contraceptive use compared to other religions, and Muslim women's contraceptive needs are often unmet. Research is needed to provide an in-depth understanding of the complex set of barriers to Muslim women's contraceptive use. Therefore, we aimed to explore Muslim women's awareness and experiences with family planning in Saudi Arabia and investigate barriers to contraceptive use and access to family planning. METHODS A qualitative study using semi-structured interviews with women in a public hospital, in Riyadh, Saudi Arabia, between January and June 2019. Data was analysed using reflexive thematic analysis. RESULTS Twenty-eight women participated in the study. Women's contraceptive awareness was limited to two methods. Women expressed positive attitudes towards family planning and did not believe it is forbidden in Islam. Barriers to contraception use included lack of knowledge, misconceptions, fear of side effects, family and community and social norms. Many women expressed that they have the right to use contraception, even if their husbands disapprove. Our findings show that healthcare providers rarely offered contraceptive advice, even when requested. Healthcare providers often prescribe oral contraceptives without offering information on other methods available. CONCLUSION Our findings suggest that education plays a fundamental role in reproductive autonomy. Men's role in family planning should be encouraged through sharing reproductive responsibility and supporting women's contraceptive choices. Efforts should be directed towards improving women's awareness of different methods of contraception.
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Affiliation(s)
- Noura Alomair
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Samah Alageel
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
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Perelló-Capo J, Quílez-Conde JC, Gutiérrez-Alés J, Lobo-Abascal P, Parra-Ribes I, Cristóbal-García I, Andeyro-García M, Herrero-Conde M, Rius-Tarruella J, Calaf-Alsina J. Use of Contraceptive Methods Among Women in the General Population and Female Gynecologists in Spain: the ELEGIAN Survey. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:478-486. [PMID: 37818182 PMCID: PMC10561741 DOI: 10.1089/whr.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/12/2023]
Abstract
Background The contraceptive preferences of obstetricians and gynecologists (OB/GYNs) are thought to influence the contraceptive counseling they provide. The purpose of this study was to assess contraceptive preferences of OB/GYNs and women in the general population (WGP) in the current Spanish contraceptive scenario. Materials and Methods Anonymous online survey of 100 OB/GYNs and 1,217 WGP aged 23-49 years. Results WGP were younger (35.3 ± 7.3 vs. 37.9 ± 6.2 years, respectively) and less likely to have stable partners (64.7% vs. 84.0%) and children (49.1% vs. 62.0%) (all p < 0.05 vs. OB/GYNs). Seventy-nine percent versus 82%, respectively, used contraceptive methods, with condoms used most frequently by WGP (37% vs. 22% by OB/GYNs; p < 0.05) and pills by OB/GYNs (26% vs. 21% by WGP; p > 0.05). Intrauterine devices (IUDs) were more frequently used by OB/GYNs (20% vs. 5%; p < 0.05), especially the levonorgestrel-releasing intrauterine devices (LNG-IUDs) (18% vs. 2.6%; p < 0.05). The highest-rated methods were condoms among WGP and LNG-IUDs among OB/GYNs. Effectiveness was the most valued attribute of contraceptive methods for both. Reasons related to convenience were the main reason for choosing IUDs. OB/GYNs prescribed the contraceptive method in 40% of cases. Conclusions Our study reveals differences between female OB/GYNs and WGP in contraceptive methods use and rating. The use of LNG-IUDs was much higher among OB/GYNs.
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Affiliation(s)
- Josep Perelló-Capo
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José C. Quílez-Conde
- Department of Obstetrics and Gynecology, Hospital Universitario Basurto, Bilbao, Spain
| | - José Gutiérrez-Alés
- Contraception and Sexual and Reproductive Health, Universidad de Alcalá (UAH), Madrid, Spain
| | - Paloma Lobo-Abascal
- Department of Obstetrics and Gynecology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
- Biomedical and Health Sciences, Obstetrics and Gynecology, Universidad Europea, Madrid, Spain
| | - Inmaculada Parra-Ribes
- Sueca Sexual and Reproductive Health Unit, La Ribera Department of Obstetrics and Gynecology, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
| | - Ignacio Cristóbal-García
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Universidad Francisco de Vitoria, Madrid, Spain
| | - Mercedes Andeyro-García
- Department of Obstetrics and Gynecology, Hospital General de Villalba, Madrid, Spain
- Obstetrics and Gynecology Department, Faculty of Medicine, Universidad Alfonso X, Madrid, España
| | | | | | - Joaquim Calaf-Alsina
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
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Demisse TL, Silesh M, Taye BT, Moltot T, Chekole MS, Ayalew M. Utilization of family planning and associated factors among women with disabilities in ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0291189. [PMID: 37683008 PMCID: PMC10490906 DOI: 10.1371/journal.pone.0291189] [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: 12/27/2022] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Persons with disabilities have a right to make their own choices about their bodies, health, and lives, especially regarding their sexual and reproductive health. But they may experience more challenges than women without disabilities in having their reproductive health needs met. So there is an urgent need to scale up disability inclusion in all levels of the health system including family planning. Therefore, the objective of this study was to estimate the pooled prevalence of Family Planning Utilization and Associated Factors among Women with Disabilities in Ethiopia. METHODOLOGY Studies were gathered from Pub Med/MEDLINE (681), Google Scholar (426), African Journal of Online (AJOL) (36), CINAHL (211), HINARI (191), Scopus (86), Science Direct (62), Excerpta Medica database (EMBA, SE) (113), DOAJ (38), Web of Science (26), Google (271), and other organization's websites (2) using a combination of search terms and Boolean operators. The modified Newcastle Ottawa Scale (NOS) for cross-sectional research was used by three authors to independently assess the quality of each study. For statistical analysis, STATATM Version 11 software was employed. For the meta-analysis, the random-effects (Der Simonian and Laird) technique was applied. The heterogeneity test was performed using I-squared (I2) statistics. A one-out sensitivity analysis was performed. RESULT A total of 7 articles with 2787 participants were included in this systematic review and meta-analysis. The pooled prevalence of family planning utilization among Women with Disabilities was 29.6% (95% CI: 22.3, 36.8); I2 = 94.6%). Women who were in marital union (p<0.001) and who had a discussion with their husbands (p = 0.007) were factors significantly associated with the utilization of family planning among women with disabilities. CONCLUSION The finding of this study showed that utilization of family planning among women with disability is relatively lower than the Ethiopian Demographic Health Survey 2019. Therefore, the discussions with the partner and their engagement in decisions to use family planning are critical to increase its use.
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Affiliation(s)
- Tesfanesh Lemma Demisse
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mulualem Silesh
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tebabere Moltot
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Moges Sisay Chekole
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Maritu Ayalew
- Department of Midwifery, Teda Health Science College, Gondar, Ethiopia
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Rehnström Loi U, Sorhaindo A, Embo M, Kabra R, Kiarie J, Ganatra B. Aligning health worker education and learning approaches with population health needs: WHO's Family Planning and Comprehensive Abortion Care Toolkit for the primary healthcare workforce. BMJ Glob Health 2023; 8:e013256. [PMID: 37666579 PMCID: PMC10481714 DOI: 10.1136/bmjgh-2023-013256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Annik Sorhaindo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Mieke Embo
- Department of Educational Studies, Ghent University, Gent, Belgium
| | - Rita Kabra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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20
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Teshale AB, Wang VQ, Biney GK, Ameyaw EK, Adjei NK, Yaya S. Contraceptive use pattern based on the number and composition of children among married women in sub-Saharan Africa: a multilevel analysis. Contracept Reprod Med 2023; 8:39. [PMID: 37488658 PMCID: PMC10364431 DOI: 10.1186/s40834-023-00240-0] [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: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The relationship between composition of children and contraception use has received limited scholarly attention in sub-Saharan Africa. In this study, we examined the relationship between contraceptive methods, the number and composition of children in SSA. METHODS Data on 21 countries in sub-Saharan Africa (SSA) countries that had a Demographic and Health Survey on or before 2015 were analysed. We applied a multilevel multinomial logistic regression model to assess the influence of family composition on contraceptive use. Adjusted relative risk ratio (aRRR) and 95% CI were estimated. The significant level was set at p < 0.05. All the analyses were conducted using weighted data. RESULTS Women who had one son and two daughters (aRRR = 0.85, CI = 0.75, 0.95), two sons and one daughter (aRRR = 0.81 CI = 0.72, 0.92), one son and three daughters (aRRR = 0.66, CI = 0.54, 0.80), two sons and two daughters (aRRR = 0.59, CI = 0.50, 0.69), and three or more sons (aRRR = 0.75, CI = 0.63, 0.91) were less likely to use temporary modern contraceptive methods. Those with two sons and two daughters were less likely to use traditional methods (aRRR = 0.52, CI = 0.35, 0.78). Women in the older age group (35-49 years) were less likely to use temporary modern methods (aRRR = 0.60; 95%CI; 0.57, 0.63). However, this group of women were more likely to use permanent (sterilization) (aRRR = 1.71; 95%CI; 1.50, 1.91) and traditional methods (aRRR = 1.28; 95%CI; 1.14, 1.43). CONCLUSION These findings suggest that contraception needs of women vary based on the composition of their children, hence a common approach or intervention will not fit. As a result, contraception interventions ought to be streamlined to meet the needs of different categories of women. The findings can inform policymakers and public health professionals in developing effective strategies to improve contraceptive use in SSA.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Vicky Qi Wang
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Godness Kye Biney
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Ghana
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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21
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Johansson L, Vesström J, Alehagen S, Kilander H. Women's experiences of dealing with fertility and side effects in contraceptive decision making: a qualitative study based on women's blog posts. Reprod Health 2023; 20:98. [PMID: 37381022 DOI: 10.1186/s12978-023-01642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Worldwide, there is limited knowledge regarding women's views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women's experiences of contraceptive methods based on data gathered from individual blog posts. METHODS Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis. RESULTS Two themes were identified. Theme 1, 'Seeking control over reproduction and optimise fertility' including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women's sexuality, A wish to understand the body's normal fertility function and Limited knowledge-sharing information about the menstrual cycle during counselling and Theme 2, 'Making the complex decision on their own' including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods. CONCLUSIONS During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.
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Affiliation(s)
- Lydia Johansson
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Julia Vesström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Siw Alehagen
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helena Kilander
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, P.O. Box 1026, 551 11, Jönköping, Sweden.
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
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22
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Srivastava S, Mohanty P, Muhammad T, Kumar M. Socio-economic inequalities in non-use of modern contraceptives among young and non-young married women in India. BMC Public Health 2023; 23:797. [PMID: 37127678 PMCID: PMC10150497 DOI: 10.1186/s12889-023-15669-w] [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: 05/18/2022] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities. METHODS The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study. RESULTS The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p < 0.001). Women from non-young age group had 39% significantly lower odds of non-use of modern contraceptive use than women from young age group (15-24 years) [AOR: 0.23; CI: 0.23, 0.23]. The value of concentration quintile was -0.022 for young and -0.058 for non-young age groups which also confirms that the non-use of modern contraceptives was more concentrated among women from poor socio-economic group and the inequality is higher among non-young women compared to young women. About 87.8 and 55.5% of the socio-economic inequality was explained by wealth quintile for modern contraceptive use in young and non-young women. A higher percent contribution of educational status (56.8%) in socio-economic inequality in non-use of modern contraceptive use was observed in non-young women compared to only -6.4% in young women. Further, the exposure to mass media was a major contributor to socio-economic inequality in young (35.8%) and non-young (43.2%) women. CONCLUSION Adverse socioeconomic and cultural factors like low levels of education, no exposure to mass media, lack of or limited knowledge about family planning, poor household wealth status, religion, and ethnicity remain impediments to the use of modern contraceptives. Thus, the current findings provide evidence to promote and enhance the use of modern contraceptives by reducing socioeconomic inequality.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Parimala Mohanty
- Institute of Medical Sciences & Sum Hospital, Siksha "O" Anusandhan Deemed to Be University, Bhubaneswar, Odisha, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Manish Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
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23
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Freeman-Spratt GJ, Botfield JR, Lee GS, Rajiv P, Black KI. Understanding women's views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:129-141. [PMID: 36635069 DOI: 10.1136/bmjsrh-2022-201718] [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: 10/05/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Nearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women's views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision. METHODS Five databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries. RESULTS Of 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement. CONCLUSIONS Most women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.
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24
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D'Souza P, Phagdol T, D'Souza SRB, D S A, Nayak BS, Velayudhan B, Bailey JV, Stephenson J, Oliver S. Interventions to support contraceptive choice and use: a global systematic map of systematic reviews. EUR J CONTRACEP REPR 2023; 28:83-91. [PMID: 36802955 DOI: 10.1080/13625187.2022.2162337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.
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Affiliation(s)
- Preethy D'Souza
- UCL Social Research Institute, University College London, London, UK
| | - Tenzin Phagdol
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D'Souza
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anupama D S
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | | | - Sandy Oliver
- UCL Social Research Institute, University College London, London, UK.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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Burgin J, Bailey JV. Factors affecting contraceptive choice in women over 40: a qualitative study. BMJ Open 2022; 12:e064987. [PMID: 36414297 PMCID: PMC9685181 DOI: 10.1136/bmjopen-2022-064987] [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] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the views of women over 40 years in choosing and using contraception, and to inform how contraceptive counselling for this age group could be improved. DESIGN, SETTING AND PARTICIPANTS Fourteen women aged 40-52 years were recruited through social media platforms to take part in online, semistructured, in-depth interviews. Transcripts were analysed using a qualitative thematic approach. RESULTS (1) Participants were anxious about unplanned pregnancy, and still highly motivated to avoid this. (2) Changes of contraceptive method over the lifecourse were occasionally precipitated by emergent health conditions, but healthcare providers often recommended a change in method on the basis of age alone. (3) Participants were experiencing perimenopausal symptoms but were largely unaware of how hormonal contraception could be used to treat these symptoms. (4) Prior negative experiences with contraceptive methods, coercive experiences with healthcare providers, and traumatic life events all contributed to a narrowing of contraceptive preference in later life. CONCLUSION Women over 40 years may be highly motivated to avoid pregnancy. This age group may have complex contraceptive histories with emerging perimenopausal symptoms. Women over 40 years may have accumulated adverse experiences which impact their contraceptive choices. These factors need to be explored by clinicians, to facilitate shared decision-making.
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Affiliation(s)
- Jo Burgin
- Centre for Academic Primary Care, Bristol Medical School, Bristol, UK
| | - Julia V Bailey
- eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK
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26
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Mazza D, Botfield JR. Opportunities for Increasing Access to Effective Contraception in Australia. Semin Reprod Med 2022; 40:240-245. [PMID: 36478566 DOI: 10.1055/s-0042-1759554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.
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Affiliation(s)
- Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
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