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Wondimagegene YA, Debelew GT, Koricha ZB. Effectiveness of peer-led education interventions on contraceptive use, unmet need, and demand among adolescent girls in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial. Glob Health Action 2023; 16:2160543. [PMID: 36695098 PMCID: PMC9879192 DOI: 10.1080/16549716.2022.2160543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. OBJECTIVE The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. METHODS A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. RESULT After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. CONCLUSIONS School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.
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Affiliation(s)
- Yohannes Addisu Wondimagegene
- College of Health Sciences and Medicine, Department of Health, Behavior, and Society, Dilla University, Dilla, Ethiopia,CONTACT Yohannes Addisu Wondimagegene College of Health Sciences and Medicine, Department of Health, Behavior, and Society, Dilla University, Ethiopia
| | - Gurmesa Tura Debelew
- Institute of Health, Faculty of Public Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu Koricha
- Institute of Health, Faculty of Public Health, Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
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Kneale D, Kjaersgaard A, de Melo M, Joaquim Picardo J, Griffin S, French RS, Burchett HED. Can cash transfer interventions increase contraceptive use and reduce adolescent birth and pregnancy in low and middle income countries? A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001631. [PMID: 37943721 PMCID: PMC10635429 DOI: 10.1371/journal.pgph.0001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/22/2023] [Indexed: 11/12/2023]
Abstract
Becoming pregnant and giving birth under the age of 20 is associated with a range of adverse social, socioeconomic and health outcomes for adolescent girls and their children in Low and middle income countries. Cash transfers are an example of a structural intervention that can change the local social and economic environment, and have been linked with positive health and social outcomes across several domains. As part of a wider review of structural adolescent contraception interventions, we conducted a systematic review on the impact of cash transfers on adolescent contraception and fertility. Fifteen studies were included in the review with eleven studies providing evidence for meta-analyses on contraception use, pregnancy and childbearing. The evidence suggests that cash transfer interventions are generally ineffective in raising levels of contraceptive use. However, cash transfer interventions did reduce levels of early pregnancy (OR 0.90, 95% CI 0.81 to 1.00). There was suggestive evidence that conditional, but not unconditional, cash transfers reduce levels of early childbearing. Given that much of the evidence is drawn from interventions providing cash transfers conditional on school attendance, supporting school attendance may enable adolescent girls and young women to make life choices that do not involve early pregnancy.
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Affiliation(s)
- Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Abel Kjaersgaard
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Malica de Melo
- International Centre for Reproductive Health Mozambique (ICRH-M), Maputo, Mozambique
| | | | - Sally Griffin
- International Centre for Reproductive Health Mozambique (ICRH-M), Maputo, Mozambique
| | - Rebecca S. French
- Department of Public Health, Environments and Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen E. D. Burchett
- Department of Public Health, Environments and Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Montt-Maray E, Adamjee L, Horanieh N, Witt A, González-Capella T, Zinke-Allmang A, Cislaghi B. Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2023; 4:1149632. [PMID: 37674903 PMCID: PMC10478786 DOI: 10.3389/fgwh.2023.1149632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.
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Affiliation(s)
- Eloisa Montt-Maray
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lamiah Adamjee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nour Horanieh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alice Witt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thaïs González-Capella
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Masonbrink AR, Hurley EA, Schuetz N, Rodean J, Rupe E, Lewis K, Boncoeur MD, Miller MK. Sexual behaviors, contraception use and barriers among adolescents and young adults in rural Haiti. BMC Womens Health 2023; 23:137. [PMID: 36973773 PMCID: PMC10045756 DOI: 10.1186/s12905-023-02268-5] [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: 09/06/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) in Haiti experience a high unintended pregnancy rate, in part due to unmet contraception needs. Little is known about AYA opinions of and experiences with contraception that may explain remaining gaps in coverage. We aimed to describe barriers and facilitators to contraception use among AYAs in Haiti. METHODS We conducted a cross-sectional survey and semi-structured qualitative interviews with a convenience sample of AYA females aged 14-24 in two rural communities in Haiti. The survey and semi-structured interviews assessed demographics, sexual health and pregnancy prevention behaviors and explored contraception opinions and experiences according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control. We used descriptive statistics to report means and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through inductive coding and team debriefing. RESULTS Among 200 survey respondents, 94% reported any past vaginal sexual activity, and 43% reported ever being pregnant. A large majority were trying to avoid pregnancy (75%). At last sexual activity, 127 (64%) reported use of any contraceptive method; Among them, condoms were the most common method (80%). Among those with previous condom use, most reported use less than half the time (55%). AYAs were concerned about parental approval of birth control use (42%) and that their friends might think they are looking for sex (29%). About one-third felt uncomfortable going to a clinic to ask for birth control. In interviews, AYAs desired pregnancy prevention but frequently noted concerns about privacy and parental, community and healthcare provider judgement for seeking care for reproductive health needs. AYAs also noted a lack of contraception knowledge, evident by frequent misconceptions and associated fears. CONCLUSION Among AYAs in rural Haiti, a large majority were sexually active and desire pregnancy avoidance, but few were using effective contraception due to numerous concerns, including privacy and fear of judgement. Future efforts should address these identified concerns to prevent unintended pregnancy and improve maternal and reproductive health outcomes in this population.
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Affiliation(s)
- Abbey R Masonbrink
- Children's Mercy Hospital, Kansas City, MO, US.
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, US.
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gilham Rd, Kansas City, MO, 64108, US.
| | - Emily A Hurley
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, US
- Division of Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, US
- Department of Population Health, University of Kansas Medical Center, Kansas City, MO, US
| | - Nikolaus Schuetz
- Division of Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, US
| | | | - Emily Rupe
- University of Kansas School of Medicine, Wichita, KS, US
| | - Kemi Lewis
- Children's Mercy Hospital, Kansas City, MO, US
| | | | - Melissa K Miller
- Children's Mercy Hospital, Kansas City, MO, US
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, US
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5
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Bertrand JT, Ross JA, Sauter SR. Trends in contraceptive method mix among adolescents and youth aged 15-24 in low- and middle-income countries. Front Glob Womens Health 2023; 3:1061648. [PMID: 36713979 PMCID: PMC9875564 DOI: 10.3389/fgwh.2022.1061648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
Background Method mix - the percent distribution of contraceptive use by method among contraceptive users - reflects both client choice of method and method availability. In a country where clients have access to a wide range of methods at an affordable price, method mix is a strong proxy for method choice. In contrast, where access is limited by numerous factors - method availability, cost, or provider attitudes - method mix may not capture method choice well. Given that method mix can be measured reliably from population-based surveys, it is useful in exploring method choice. While the method mix for all women of reproductive age (15-49 years) has been described previously, the method mix for adolescents and young women aged 15-24 remains unexplored despite this population's high risk for unintended pregnancy. Objectives This study investigates the contraceptive method mix for women aged 15-24 in low- and middle-income countries (LMICs) with national survey data and describes how the method mix differs by age group, geographic region, and marital status for women. Methods Using data from the Demographic and Health (DHS) Surveys, the contraceptive method mix among women aged 15-24 across 64 LMICs is analyzed by age, marital status, and region, with measures of skew and average deviation. Three case studies are presented in which the trend over time in the method mix is examined. Results There are large variations in method mixes across regions, which reflect their differences in various supply and demand constraints. However, there is consistently high usage of short-acting methods among both age groups, 15-19 and 20-24, compared to the full population of all women of reproductive age. Male condoms overwhelmingly predominate as the method used by women 15-24 in all regions. Conclusion The marked differences found by marital status, region, and age show the need for programs to be tailored to local circumstances. Additionally, the large unmet need for contraception signals the ongoing urgency for strengthened programmatic efforts, and for a wider offering of methods to enlarge the choices available to young women. Unmarried women in particular deserve attention, as well as young married women who wish to postpone a pregnancy.
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Affiliation(s)
- Jane T. Bertrand
- Tulane University School of Public Health and Tropical Medicine, Department of International Health and Sustainable Development, New Orleans, LA, United States
| | - John A. Ross
- Independent Demographic Consultant, New Paltz, New York, United States
| | - Sydney R. Sauter
- Tulane University School of Public Health and Tropical Medicine, Department of International Health and Sustainable Development, New Orleans, LA, United States
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Burchett HED, Griffin S, de Melo M, Picardo JJ, Kneale D, French RS. Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14414. [PMID: 36361287 PMCID: PMC9658296 DOI: 10.3390/ijerph192114414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Sally Griffin
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | | | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Braverman-Bronstein A, Vidaña-Pérez D, Ortigoza AF, Baldovino-Chiquillo L, Diez-Canseco F, Maslowsky J, Sánchez BN, Barrientos-Gutiérrez T, Diez Roux AV. Adolescent birth rates and the urban social environment in 363 Latin American cities. BMJ Glob Health 2022; 7:bmjgh-2022-009737. [PMID: 36253017 PMCID: PMC9577896 DOI: 10.1136/bmjgh-2022-009737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/06/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR. Methods We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15–19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries). Results The median subcity ABR was 58.5 per 1000 women 15–19 (IQR 43.0–75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively). Conclusions The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brisa N. Sánchez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Tiendrebeogo CO, Joseph V, Bicaba F, Bila A, Bicaba A, Druetz T. Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso. J Glob Health 2022; 12:04086. [PMID: 36227754 PMCID: PMC9559360 DOI: 10.7189/jogh.12.04086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Unmet needs for contraception constitute a major public health problem in sub-Saharan Africa. Several mechanisms have been tested to reduce the financial barrier and facilitate access to family planning services, with inconclusive results. Based on the positive impacts following the introduction of free health care for pregnant women, Burkina Faso decided to extend its national policy and abolished direct payment for family planning services. This study aims to evaluate the impact of this policy on contraceptive use and unmet needs for contraception among women of reproductive age (WRA) in Burkina Faso. Methods This study uses two different study designs to examine the impact of a user fee removal policy on contraceptive use across a panel of 1400 households randomly selected across eight health districts. Data were collected using a standardized socio-demographic questionnaire at three different time points during the pilot and scale-up phases of the fee abolition program. The questionnaire was administered six months after the launch of the pilot fee abolition program in four health districts. For the remaining four health districts, the survey was conducted one year prior to and six months after the implementation of the program in those areas. All WRA in the households were eligible to participate. A cross-sectional study design was used to determine the association between knowledge of the fee abolition policy among WRA and actual use of contraceptives by WRA six months after the policy's implementation and across all eight districts. Additionally, a pre-post study with a non-randomized, reflexive control group was designed using repeated surveys in four health districts. Hierarchical logistic mixed effects models were adjusted for a set of time-variant individual variables; the impact was assessed by a difference-in-differences approach that compared pre-post changes in contraception use in women who knew about the new policy and those who did not. Results Of the 1471 WRA surveyed six months after the removal of user fees for family planning services, 56% were aware of the policy's existence. Knowledge of the fee abolition policy was associated with a 46% increase probability of contraceptive use among WRA six months after the policy's implementation. Among the subset of the participants who were surveyed twice (n = 507), 65% knew about the fee removal policy six months after its introduction and constitute the intervention group. Pre-post changes in contraceptive use differed significantly between the intervention (n = 327) and control groups (n = 180). Removing user fees for family planning led to an 86% (95% confidence interval (CI) = 0.49, 1.31) increase in the likelihood of using contraception. In the study area, the policy reduced the prevalence of unmet needs for contraception by 13 percentage points. Conclusions Removing user fees for family planning services is a promising strategy to increase access to, and reduce unmet needs for, contraception. A broader dissemination of the policy's existence will likely increase its impact on the overall population.
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Affiliation(s)
- Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Vena Joseph
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Frank Bicaba
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
- Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Alice Bila
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Burchett HED, Kneale D, Griffin S, de Melo M, Picardo JJ, French RS. Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11715. [PMID: 36141987 PMCID: PMC9517431 DOI: 10.3390/ijerph191811715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Sally Griffin
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | | | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Khan MN, Harris ML, Huda MN, Loxton D. A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh. Sci Rep 2022; 12:15165. [PMID: 36071170 PMCID: PMC9452522 DOI: 10.1038/s41598-022-19559-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women's homes, on the occurrence of unintended pregnancy that resulted in a live birth. We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5051 women of reproductive age, who had at least one live birth within 3 years of the survey. The outcome variable was women's intention to conceive at their most recent pregnancy that ended with a live birth. The major explanatory variables were the health facility level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables adjusting for individual, household, and community-level factors. Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancies that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women's homes.The availability of health facilities near women's homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and to increase the number of health facilities are recommended.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia.
| | - Melissa L Harris
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Md Nazmul Huda
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbeltown, NSW, 2560, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
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Knowledge and attitude on sexually transmitted infections and contraceptive use among university students in Bhutan. PLoS One 2022; 17:e0272507. [PMID: 35921369 PMCID: PMC9348698 DOI: 10.1371/journal.pone.0272507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
The unmet needs of contraception can lead to unintended pregnancy and transmission of sexually transmitted infections (STI). Therefore, this study aimed to evaluate the contraception use, knowledge, and attitude on STI among students under Royan University of Bhutan (RUB).
Methods
This was a cross-sectional study using an online questionnaire. The questionnaire was developed in Google forms and the link was shared through the college WeChat groups. The questionnaire consisted of four parts on socio-demographic, sexual behaviour and contraceptive use, knowledge, and attitude on STIs. All the students under RUB were invited to participate voluntarily in this study. The socio-demography was presented in frequency and proportion.
Result
A total of 1,283 students participated in this survey and 55.0% (701) were females. Of this, 29.4% (377) were sexually active and 94.4% reported using modern contraception. Commonly used contraceptives were: condoms (83.8%, 316) and emergency contraceptives (20.6%, 78), respectively. The mean knowledge and attitude scores on STI were 9.94 (range 2–20) and 12 (range 2–14), respectively. Good knowledge and attitude on STI were reported in 53.2% (683) and 70.1% (899) of participants.
Conclusion
Students reported average knowledge and a good attitude towards STI. Contraceptive use among university students was low. There is a need to strengthen health education on STIs in schools and universities. All forms of contraceptives especially condoms should be made easily available to sexually active people.
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12
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Inthavong S, Pantasri T, Morakote N, Muangmool T, Piyamongkol W, Pongsatha S, Chaovisitseree S. Change of contraceptive preference after the free-LARC program for Thai teenagers. BMC Womens Health 2022; 22:211. [PMID: 35672692 PMCID: PMC9172104 DOI: 10.1186/s12905-022-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background In 2014, the Thai government launched a free-of-charge long-acting reversible contraception (LARC) program for Thai female adolescents. However, its acceptance had not been reported. Therefore, this study aimed to describe contraceptive use among women of reproductive age before and after the program was implemented. Methods This retrospective cross-sectional study was carried out from the medical records of 9000 women of reproductive age, who attended the Family Planning Clinic at Maharaj Nakorn Chiang Mai Hospital between 2009 and 2018. The Chi-square test was used to compare the contraceptive methods administered before and after the program was implemented, and binary logistic regression was used to find the factors associated with implant use after completion of the program. Results Depot medroxy progesterone acetate (DMPA) injection was the most popular contraceptive method used among 40.9% of the women. The rates of subdermal implant use were increased significantly after the program was implemented (2.3–9.3%, p < 0.001). Implant use for adolescents aged less than 20 years increased from 2.6% to 56.4%, while DMPA was the most popular method used among adult women at 36.4%. Factors associated significantly with implant use after implement of the program included age of less than 20 years (aOR = 4.17 (CI: 1.84–9.44); p = 0.001) and nulliparity (aOR = 8.55 (CI: 3.77–19.39); p < 0.001). Conclusion This study showed a significant increase in contraceptive implant use after the free-LARC program for adolescents had been applied. Statement of implications Contraceptive implant is the most effective hormonal reversible contraception. Its use rate is low among all age groups, but increased clearly after the free-of-charge program was applied for adolescents.
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Affiliation(s)
- Sathaphone Inthavong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tawiwan Pantasri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Nuntana Morakote
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wirawit Piyamongkol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somsak Chaovisitseree
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Rahaman M, Rana MJ, Roy A, Chouhan P. Spatial heterogeneity and socio-economic correlates of unmet need for spacing contraception in India: Evidences from National Family Health Survey, 2015-16. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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From science to sustainable systems: Evidence based-decision making for adolescent fertility in Zambia. HEALTH POLICY OPEN 2021. [DOI: 10.1016/j.hpopen.2021.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Ti A, Soin K, Rahman T, Dam A, Yeh PT. Contraceptive values and preferences of adolescents and young adults: A systematic review. Contraception 2021; 111:22-31. [PMID: 34077748 DOI: 10.1016/j.contraception.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally. STUDY DESIGN We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding end-users' values and preferences for contraception. We included studies that report specifically on people up to 25 years old. RESULTS Fifty-five studies out of 7,846 met our inclusion criteria. These studies included participants aged 10-25 years and were conducted in 16 countries. Through open coding, we identified 18 content areas. The five most commonly discussed content areas were: (1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice. Privacy and autonomy were important overarching themes, along with safety of the method. These considerations affected participants' access to and use of contraception. CONCLUSION Various social, cultural, and method-specific factors influence a young person's values and preferences around contraceptive methods. Understanding their values and preferences can help providers and programs improve contraceptive care for young people.
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Affiliation(s)
- Angeline Ti
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA United States.
| | - Komal Soin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Family Medicine and Community Health, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States
| | - Tasfia Rahman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anita Dam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ping T Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Gahungu J, Vahdaninia M, Regmi PR. The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature. Reprod Health 2021; 18:35. [PMID: 33568180 PMCID: PMC7877117 DOI: 10.1186/s12978-021-01089-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa has the highest fertility rate in the world, with the highest unmet need for family planning (FP). Yet, there is a lack of knowledge about the determinants for non-utilisation of modern contraceptive methods among women of reproductive age. This systematic review of literature assessed factors affecting the unmet need and reasons for non-utilisation of modern contraceptive methods during the postpartum period in Sub-Saharan African women. METHODS An online literature search was conducted in several databases: MEDLINE, Cochrane Review, PubMed, Elsevier's Science Direct and Web of Science. The search was completed by hand searching. Data were extracted and summarised using the Arksey and O'Malley methodology. RESULTS In total, 19 studies were included; one qualitative study, seventeen quantitative, and one used a mixed-methods approach. Studies were conducted in Ethiopia (n = 11), Nigeria (n = 3), Kenya (n = 2), Malawi (n = 2) and Uganda (n = 1). Factors affecting the unmet need for modern contraceptive methods were described at three levels: (a) individual; (b) household; and (c) healthcare facility level. Reasons for non-use of FP included: fear of side effects; husband's disapproval; the absence of menses; abstinence; and low perception of risk of pregnancy. CONCLUSION Unmet needs in postpartum FP in women from Sub-Saharan Africa were associated with health-system and socio-demographic determinants. We suggest that there is a need to improve the awareness of modern contraceptive methods through effective interventions. Further research is needed for under-studied countries in this continent.
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Affiliation(s)
| | - Mariam Vahdaninia
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Pramod R Regmi
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, 10 St Paul's Ln, BH8 8AJ, Bournemouth, UK
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Sothornwit J, Wattanakamolchai P, Werawatakul Y, Eamudomkarn N, Somboonporn W. Patterns of contraceptive use among Thai women aged ≥40 and at risk of pregnancy. EUR J CONTRACEP REPR 2020; 25:345-349. [PMID: 32567985 DOI: 10.1080/13625187.2020.1783653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aims of the study were to identify the patterns of contraceptive use among Thai women aged ≥40 years and the reasons for not using contraception. METHODS This cross-sectional study included sexually active women aged 40-49 years in Khon Kaen, Thailand. Information on contraceptive practice and reasons for not using contraception was collected through a self-reported questionnaire. The unmet need for a modern method of contraception and the unmet need for any method of contraception were calculated based on the percentage of participants who were not using contraception but who wanted to postpone or prevent pregnancy. RESULTS Of 400 women, 75.5% were currently using some form of contraception, with female sterilisation being the most used (35%). The main reasons for not using contraception included perceived low risk of pregnancy, health concerns, infrequent sexual intercourse and wish to become pregnant. The unmet need for a modern method of contraception was 23.3% (95% confidence interval [CI] 0.20%, 0.29%). Having children was a significant protective factor (adjusted odds ratio [OR] 0.18; 95% CI 0.08, 0.37; p = 0.000). The unmet need for any method of contraception was 12% (95% CI 0.09%, 0.16%). Previous abortion was a significant risk factor for not using any contraception (adjusted OR 2.23; 95% CI 1.12, 4.44; p = 0.022). CONCLUSION Although the use of contraception was common, some participants displayed a lack of knowledge and/or did not practise family planning. Our findings address the importance of improving knowledge about the risks of pregnancy and the need for effective contraception in this population.
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Affiliation(s)
- Jen Sothornwit
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panicha Wattanakamolchai
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yuthapong Werawatakul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nuntasiri Eamudomkarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Woraluk Somboonporn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Marra E, Meijer S, de Graaf H. Changes in young women’s contraceptive use in the Netherlands: findings from three sex under the age of 25 surveys. GENUS 2020. [DOI: 10.1186/s41118-020-00078-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractPrevention of unintended pregnancy among adolescents and young adults under 25 years is pivotal from an individual as well as societal perspective. In the USA, the use of long-acting reversible contraceptive (LARC) has been shown to increase, with no or little change in the use of short-acting reversible contraceptive (SARC). We assessed trends in no contraceptive, SARC, and LARC use by young women, aged between 12 and 25 years, and differences in trends within demographic groups (age, religion, ethnic background, and educational level) among these young women in the Netherlands. Data of sexually active young women aged 12–25 years from three cross-sectional representative surveys, 2005, 2012, and 2017, were used for this study. In total, 11,229 Dutch young women were included with a median age of 20 years (interquartile range 18–23 years). Overall, the proportion of young women using SARC decreased significantly between 2005 and 2017 from 88 to 76%. LARC use increased significantly between 2005 and 2017 from 3 to 16%. These trends varied by religious groups and educational level, emphasizing potential for tailored preventative measures for these groups. A shift towards LARC use might eventually lead to a further decrease in unwanted pregnancy and potentially abortion because of the lower risk of user errors.
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Keats EC, Jain RP, Bhutta ZA. Indirect health sector actions and supportive strategies to prevent malnutrition. Curr Opin Clin Nutr Metab Care 2020; 23:190-195. [PMID: 32167985 DOI: 10.1097/mco.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Malnutrition is a pervasive problem that causes negative acute, long-term, and intergenerational consequences. As we have begun to move from efficacy to effectiveness trials of nutrition interventions, and further still to more holistic case study approaches to understanding how and why nutrition outcomes change over time, it has become clear that more emphasis on the 'nutrition-sensitive' interventions is required. RECENT FINDINGS In this article, we propose recategorizing the nutrition-specific and sensitive terminology into a new framework that includes direct and indirect health sector actions and supportive strategies that exist outside the health sector; an adjustment that will improve sector-specific planning and accountability. We outline indirect health sector nutrition interventions, with a focus on family planning and the evidence to support its positive link with nutrition outcomes. In addition, we discuss supportive strategies for nutrition, with emphasis on agriculture and food security, water, sanitation, and hygiene, and poverty alleviation and highlight some of the recent evidence that has contributed to these fields. SUMMARY Indirect health sector nutrition interventions and supportive strategies for nutrition will be critical, alongside direct health sector nutrition interventions, to reach global targets. Investments should be made both inside and outside the health sector.
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Affiliation(s)
- Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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