1
|
Factors influencing the uptake of short-term contraceptives among women in Afghanistan. Sci Rep 2022; 12:6632. [PMID: 35459773 PMCID: PMC9033810 DOI: 10.1038/s41598-022-10535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 04/05/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to assess factors that influence the uptake of short-term contraceptives among married women aged between 15 and 49 years in Afghanistan. The cross-sectional Afghanistan 2015 Demographic and Health Survey provided the dataset for this analysis. We included 22,974 women and applied multivariable logistic regression to investigate the influencing factors for the uptake of short-term contraceptives. 92% of Afghan women knew at least one type of short-term contraception but only 17% were using short term contraceptives. Short term contraceptive use was most prevalent among women in the age group between 30 and 40 who were educated, employed, and rich. Most of the users were living in the western parts of Afghanistan and women from the Balooch and Pashtun ethnic groups were most likely to use short-term contraceptives. Media exposure and women empowerment were also positively associated with the use of short-term contraceptives. We did not find an association with living in urban or rural settings. Contraception promotion in Afghanistan requires multisectoral efforts, tailored to the needs of women from low and middle socioeconomic strata. Health promotion activities, empowering women, strengthening education, and training of service providers on effective counseling are options that should be considered to improve the current situation.
Collapse
|
2
|
Al-Sheyab NA, Al Nsour M, Khader YS, Yousif H, Alyahya MS, Taha H, Bardus M, Al Kattan M, Amiri M. Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics. Heliyon 2021; 7:e07810. [PMID: 34458635 PMCID: PMC8379452 DOI: 10.1016/j.heliyon.2021.e07810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/02/2021] [Accepted: 08/12/2021] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES This study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan. METHODS Explorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis. RESULTS Two themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality. CONCLUSIONS This study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.
Collapse
Affiliation(s)
- Nihaya A. Al-Sheyab
- Allied Medical Sciences, Department/Faculty of Applied Medical Sciences, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan
| | - Mohannad Al Nsour
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Yousef S. Khader
- Department of Community Medicine, Public Health and Family Medicine/ Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Hind Yousif
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Mohammad S. Alyahya
- Faculty of Medicine, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan
| | - Hana Taha
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Marco Bardus
- Department of Health Promotion & Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, P.O. Box (11-0236), Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Malika Al Kattan
- Department of Health Promotion & Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, P.O. Box (11-0236), Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mirwais Amiri
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| |
Collapse
|
3
|
Wasswa R, Kabagenyi A, Ariho P. Multilevel mixed effects analysis of individual and community level factors associated with modern contraceptive use among married women in Uganda. BMC Public Health 2021; 21:1457. [PMID: 34315436 PMCID: PMC8314485 DOI: 10.1186/s12889-021-11069-0] [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: 06/02/2020] [Accepted: 05/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background In spite of the universal right for women to decide freely for themselves when, and how many children they want to have in life, married women in Uganda are less likely to use modern contraceptives as compared to other marital categories. This study examines the individual and community factors associated with modern contraceptive use among married women in Uganda. Methods The study used data from the 2016 Uganda Demographic and Health Survey which comprised of 8671 married women aged 15–49 years who were fecund and non-pregnant at the time of the survey. Analysis was done using a multilevel mixed-effects logistic regression model. Results Findings showed that married women who were; Muslims (AOR = 0.78, CI = 0.66–0.91), had more than five children (AOR = 0.76, CI = 0.61–0.98), staying in communities with high poverty (AOR = 0.78, CI = 0.65–0.93), with older age at first birth (AOR = 0.94, CI = 0.92–0.96) as well as having spousal age difference of more than 9 years (AOR = 0.86, CI = 0.76–0.98) were associated with low modern contraceptive use. Women living in communities with higher age at first marriage (AOR = 0.93, CI = 0.88–0.98) or higher sexual debut (AOR = 0.91, CI = 0.85–0.98) were also associated with reduced odds of modern contraception. In addition, older women (AOR = 1.03, CI = 1.01–1.04), having secondary/higher education (AOR = 1.93, CI = 1.58–2.37), living in a rich household (AOR = 1.32, CI = 1.14–1.53), short distance to health facility (AOR = 1.18, CI = 1.06–1.31), high community education (AOR = 1.38, CI = 1.17–1.62), high community exposure to family planning messages (AOR = 1.24, CI = 1.08–1.42), and communities with high proportion of women working (AOR = 1.22, CI = 1.06–1.39) were more likely to use modern contraceptives. Conclusion The study revealed that both individual and community factors were important in explaining the factors associated with modern contraceptive use among married women in Uganda. Therefore, there is need to invest in community based programs like: family planning outreach services, mass media campaigns and community mobilization activities to help in dissemination of family planning information, increase awareness and promotion in use of modern contraceptives. Also, expansion of higher education and the need to make family planning services available and accessible to areas with limited physical access to health facilities will lead to sustained increase in uptake of modern contraceptives.
Collapse
Affiliation(s)
- Ronald Wasswa
- Department of Statistical Methods and Actuarial Science, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Allen Kabagenyi
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Paulino Ariho
- Department of Sociology and Social Administration, Kyambogo University, P.O. Box 1, Kampala, Uganda
| |
Collapse
|
4
|
Packer CA, Rastagar SH, Chen M, Bernholc A, Hemat S, Seddiqi S, McIntosh R, Costenbader E, Todd CS. Factors associated with reported modern contraceptive use among married men in Afghanistan. Reprod Health 2020; 17:64. [PMID: 32398075 PMCID: PMC7218614 DOI: 10.1186/s12978-020-0908-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan has high maternal and infant mortality which is in part driven by high fertility and low modern contraceptive use. Using modern contraceptive methods can reduce maternal and infant mortality, however there are several barriers to modern contraceptive use in Afghanistan. Married men have the potential to hinder or facilitate their wives' contraceptive use. Internally displaced persons (IDP), a growing population in Afghanistan, are rarely included in reproductive health research. We explored whether married men's, including IDPs', gender-related attitudes and other factors were associated with reported modern contraceptive use to inform programming to meet reproductive health needs of married couples. METHODS Cross-sectional study using data from 885 married men determined to have contraceptive need in seven Afghan provinces. We explored associations between sociodemographic factors, IDP status, wives' involvement in household decision-making and men's attitudes towards intimate partner violence (IPV) with reported modern contraceptive use using logistic regression analysis. RESULTS Most men (78%) had ≥2 children, 60% reported any formal education, and 30% reported being IDPs. Only 38% of married men and 24% of IDPs with contraceptive need reported using modern contraception with their wives. Most (80% overall, 63% of IDPs) reported their wives' involvement in some/all household decisions, while 47% overall and 57% of IDPs reported IPV was justified in one or more listed circumstances. In bivariate analysis, men responding that IPV was not justified in any listed circumstance were more likely and IDPs less likely to report modern contraceptive use. In multivariable analysis, involvement by wives in household decision-making (AOR 2.57; 95% CI: 1.51, 4.37), owning a radio and/or television (AOR 1.69; 95% CI: 1.10, 2.59), having more children, age, and province of interview were independently associated with reported modern contraceptive use, while IDP status was not. CONCLUSIONS Our findings reflect positive associations between wives' participation in household decisions and mass media exposure (television/radio ownership) with reported modern contraceptive use. Reproductive health initiatives engaging men to promote communication within couples and through mass media channels may further increase modern contraceptive use and advance Afghanistan's family planning goals. As fewer IDPs owned a radio/television, additional outreach methods should be tested for this group.
Collapse
Affiliation(s)
- Catherine A Packer
- Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, US.
| | | | - Mario Chen
- Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, US
| | - Alissa Bernholc
- Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, US
| | - Shafiqullah Hemat
- Department of Health Promotion, Ministry of Public Health, Islamic Republic of Afghanistan, Masoud Circle, Wazir Akbar Khan, Kabul, Afghanistan
| | - Sediq Seddiqi
- Assess, Transform, & Reach (ATR) Consulting, Taimani, Kabul, Afghanistan
| | - Ross McIntosh
- Assess, Transform, & Reach (ATR) Consulting, Taimani, Kabul, Afghanistan
| | - Elizabeth Costenbader
- Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, US
| | - Catherine S Todd
- Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, US
| |
Collapse
|