Free Access to a Broad Contraceptive Method Mix and Women's Contraceptive Choice: Evidence from Sub-Saharan Africa

Modern Contraceptive Use of National Health Insurance Participants before and during the COVID-19 Pandemic in South Kalimantan, Indonesia: Using Data from the Official Website of the National Population and Family Planning Agency

Objective

This study aims to explore and analyze the modern contraceptive use of National Health Insurance (NHI) participants before and during the COVID-19 pandemic in South Kalimantan, Indonesia.

Methods

This research is an ecological study using aggregated data from 13 Districts/Cities in South Kalimantan. This study used secondary data in 2018-2020 from the official website of the National Population and Family Planning Agency. Spatial analysis and paired T-test were used.

Results

There were 30.7% of Districts/Cities in stagnation and 30.7% in the decline of modern contraception use during the pandemic (2019-2020). In addition, the study showed that there were differences in the use of modern contraception before (2019) and during the COVID-19 pandemic (2020) among active family planning acceptors of NHI participants (p=0.048).

Conclusion

The existence of NHI, especially recipients of contribution assistance, can increase the use of modern contraception in South Kalimantan. There are differences in the use of modern contraception before and during the COVID-19 pandemic among NHI participants.

Choice and factors associated to the use of contraceptive methods among postpartum women: A prospective cohort study

OBJECTIVES

To assess women's contraceptive preferences in the immediate postpartum period and identify factors associated with use of their desired contraceptive method six months later.

MATERIAL AND METHODS

This prospective cohort study included women ≤48 h after delivery at a single public Brazilian hospital. The women's interview took place in two different momentsbefore hospital discharge (in-person interview) and six months after delivery (by telephone contact). For data collection and management, we used the REDCap electronic tool. Univariate and multivariate analyses (unadjusted and adjusted Odds Ratio and 95 % confidence intervals) were used to identify factors associated with higher use of their desired contraceptive method six months after delivery.

RESULTS

A total of 294 women (166 adolescents) were included. Initial contraceptive preferences were especially intrauterine devices (IUDs) (39.1 %), implants (33.0 %) and injectable hormonal contraceptives (17.0 %). Six months later, 42.5 % (n = 125) were using their desired contraceptive method. Younger age, white race and contraceptive initiation prior to hospital discharge were associated with use of their desired contraceptive at six months.

CONCLUSION

Long-acting reversible contraception (LARC) methods were the most desired contraceptives among women after delivery. Providing and initiating free contraception prior to discharge from a birthing unit is important with regard to use of their desired method.

Preferences and feasibility of long-acting technologies for treatment of hepatitis C virus in low- and middle-income countries: A survey of providers and policymakers

Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among providers, 93% (113/122) expressed willingness to prescribe LAT and 72% (88/120) of providers preferred LAT if provided at comparable efficacy, safety and cost as current oral treatments. Of providers preferring HCV LAT to daily oral medication, 67% (59/88) preferred injection, 24% (21/88) preferred patch and 9% (8/88) preferred implant. Only 20% (24/122) would prescribe LAT if it were more costly than oral treatment. In regression analysis, no provider characteristics were associated with preference for LAT over oral treatment. Policymakers reported high likelihood that LAT would be included in treatment guidelines (42/50; 84%) and national drug formularies (39/50; 78%) if efficacy, safety and cost were similar to oral treatment. HCV LATs could advance progress to HCV elimination in LMICs by diversifying treatment options to improve treatment coverage and outcomes. Provider preferences from LMICs are a critical consideration in the development of HCV LATs to ensure its early and equitable availability in LMICs.

A cross-sectional study of women's autonomy and modern contraception use in Zambia

BACKGROUND

Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women's autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women's autonomy and modern contraception use among partnered women in Zambia.

METHODS

This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women's autonomy using three indices: women's participation in decision-making, women's attitude towards wife-beating and women's household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR).

RESULTS

The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women's autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048-1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013-1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091-1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105-1.766) and age, 15-24 (AOR = 1.266, P value = 0.007, 95% CI 1.182-2.113,) and 25-34 (AOR = 1.163, P value = 0.002, 95% CI 1.052-1.273).

CONCLUSION

This study argues that increasing women's assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women's autonomy, which in turn would support gender equality and reproductive health.

Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso

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.