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Senderowicz L, Bullington BW, Sawadogo N, Tumlinson K. Asymmetry in contraceptive information at two sites in Burkina Faso. AJOG GLOBAL REPORTS 2024; 4:100376. [PMID: 39296602 PMCID: PMC11409022 DOI: 10.1016/j.xagr.2024.100376] [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] [Indexed: 09/21/2024] Open
Abstract
Background Family planning programs are foundationally important to public health, but like any medical intervention, contraception has drawbacks in addition to its benefits. Knowledge of these drawbacks in addition to benefits is essential for informed choice. Despite a general consensus among family planning researchers and providers that contraceptive counseling should be unbiased, little quantitative research has assessed the extent of bias in contraceptive counseling, and in people's contraceptive knowledge more broadly. Objective To understand the extent to which women report being told more about the advantages of contraception than the disadvantages-a concept we call "asymmetry" in contraceptive counseling, at two research sites in Burkina Faso. Methods We use data from a cross-sectional population-based survey of 3,929 women residing in the catchment areas of the Ouagadougou (urban) and the Nouna (rural) Health and Demographic Surveillance Systems in Burkina Faso. We use descriptive statistics to explore asymmetry in knowledge of the benefits/advantages and risks/disadvantages of contraceptive use overall, as well as method-specific asymmetry among current method users regarding their counseling experience. Findings Results show substantial asymmetry in knowledge of advantages/benefits of contraception compared to disadvantages/risks. 86% of respondents said they could name any advantage of family planning, while half of that proportion (43%) could name any disadvantage. We find a similarly stark asymmetry in method-specific results among contraceptive users, especially for hormonal/biomedical methods. We also find substantial variation between research sites, with urban respondents much less likely to self-report complete family planning knowledge than their rural counterparts. Conclusion Our results suggest that family planning messaging in Burkina Faso may place an emphasis on the advantages without a commensurate focus on disadvantages. Family planning programs worldwide must ensure that people can make informed choices based on balanced, accurate information about both the benefits and the disadvantages of contraception.
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Affiliation(s)
- Leigh Senderowicz
- Department of Obstetrics and Gynecology, Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI (Senderowicz)
| | - Brooke W Bullington
- Department of Epidemiology, Carolina Population Center, University of North Carolina Gillings School of Global Health, Chapel Hill, NC (Bullington)
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph KI-ZERBO, Burkina Faso, Centre, OU (Sawadogo)
| | - Katherine Tumlinson
- Department of Health Policy and Management, Carolina Population Center, University of North Carolina Gillings School of Global Health, Chapel Hill, NC (Tumlinson)
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Araújo FG, Velasquez-Melendez G, Felisbino-Mendes MS. Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity. Heliyon 2024; 10:e34833. [PMID: 39148974 PMCID: PMC11325839 DOI: 10.1016/j.heliyon.2024.e34833] [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: 05/10/2023] [Revised: 06/02/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024] Open
Abstract
Objective To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity. Methods Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units. Results Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women. Conclusions The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies. Implications for practice The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.
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Affiliation(s)
- Fernanda Gontijo Araújo
- Graduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, School of Nursing at the Universidade Federal de Minas Gerais, Belo Horizonte, state of Minas Gerais, Brazil
| | - Gustavo Velasquez-Melendez
- Graduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, School of Nursing at the Universidade Federal de Minas Gerais, Belo Horizonte, state of Minas Gerais, Brazil
| | - Mariana Santos Felisbino-Mendes
- Graduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, School of Nursing at the Universidade Federal de Minas Gerais, Belo Horizonte, state of Minas Gerais, Brazil
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Pinchoff J, Pike I, Austrian K, Grace K, Kabiru C. How migration shapes modern contraceptive use among urban young women: Evidence from six African countries. PLoS One 2024; 19:e0307141. [PMID: 39042650 PMCID: PMC11265688 DOI: 10.1371/journal.pone.0307141] [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: 02/27/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Internal migration is an important part of the transition to adulthood for many young people in sub-Saharan Africa. This study examines how migration, in relation to marriage and parenthood, impacts modern contraceptive use and health facility visits amongst young urban women. METHODS We draw on Performance Monitoring for Action (PMA) surveys conducted in Burkina Faso, Côte d'Ivoire, Democratic Republic of Congo, Kenya, Nigeria, and Uganda (2019-2022). Our analysis is unique in being able to adjust for whether women wanted to get pregnant soon. Our sample includes women ages 15-24 years currently residing in urban areas (n = 6,225). We conducted logistic regression models clustered by village level identifier to explore the sequence of life events and the timing of migration in relation to current modern contraceptive use and recent health facility visit, a proxy for engagement with formal health services. RESULTS The timing of migration matters more than the sequence of these life events. Young urban women who experienced both migration and a birth, regardless of the order, had increased contraceptive use and recent health facility visit, compared to women who had only experienced one event or neither. Young women who migrated in the past year had 24% lower odds of using a modern method (Odds Ratio = 0.76; 95% confidence interval 0.63, 0.91), adjusting for demographic factors and adjusting for fertility preference (Wanting to get pregnant soon). Having had a birth was highly significant for health facility visit and among women who had had a birth, those who migrated in the last year had lower odds of a recent visit (OR = 0.68, 95% CI 0.41, 0.89). Results suggest an initially disruptive effect of migration. DISCUSSION Our results suggest young women who recently migrated to urban areas may need additional support in accessing contraception and formal health services for themselves or their children.
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Affiliation(s)
| | | | | | - Kathryn Grace
- University of Minnesota, Minneapolis, MN, United States of America
| | - Caroline Kabiru
- African Population and Health Research Center, Nairobi, Kenya
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Harrington EK, Hauber B, Ouma DC, Kimanthi S, Dollah A, Onono M, Bukusi EA. Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1360390. [PMID: 38774834 PMCID: PMC11107089 DOI: 10.3389/frph.2024.1360390] [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] [Received: 12/22/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Despite increasing global commitment to meeting the family planning needs of adolescent girls and young women (AGYW), there is limited research on how they prioritize contraceptive method and service delivery characteristics. In this qualitative study, we examine the specific elements that drive the contraceptive choices of Kenyan AGYW, and apply our findings to the development of attributes and levels for a discrete choice experiment (DCE). Methods Our four-stage approach included data collection, data reduction, removing inappropriate attributes, and optimizing wording. Between June-October 2021, we conducted in-depth interviews with 30 sexually-active 15-24 year-old AGYW in Kisumu county, Kenya who were non-pregnant and desired to delay pregnancy. Interviews focused on priorities for contraceptive attributes, how AGYW make trade-offs between among these attributes, and the influences of preferences on contraceptive choice. Translated transcripts were qualitatively coded and analyzed with a constant comparative approach to identify key concepts. We developed and iteratively revised a list of attributes and levels, and pre-tested draft DCE choice tasks using cognitive interviews with an additional 15 AGYW to optimize comprehension and relevance. Results In-depth interview participants' median age was 18, 70% were current students, and 93% had a primary sexual partner. AGYW named a variety of priorities and preferences related to choosing and accessing contraceptive methods, which we distilled into six key themes: side effects; effectiveness; user control; privacy; source of services; and cost. Bleeding pattern was top of mind for participants; amenorrhea was generally considered an intolerable side effect. Many participants felt more strongly about privacy than effectiveness, though some prioritized duration of use and minimizing chance of pregnancy above other contraceptive characteristics. Most AGYW preferred a clinic setting for access, as they desired contraceptive counseling from a provider, but pharmacies were considered preferable for reasons of privacy. We selected, refined, and pre-tested 7 DCE attributes, each with 2-4 levels. Conclusions Identifying AGYW preferences for contraceptive method and service delivery characteristics is essential to developing innovative strategies to meet their unique SRH needs. DCE methods may provide valuable quantitative perspectives to guide and tailor contraceptive counseling and service delivery interventions for AGYW who want to use contraception.
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Affiliation(s)
- Elizabeth K. Harrington
- Department of OB/GYN, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Brett Hauber
- School of Pharmacy, Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
- Pfizer, Inc., New York, NY, United States
| | - Dismas Congo Ouma
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Syovata Kimanthi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A. Bukusi
- Department of OB/GYN, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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Wollum A, Moucheraud C, Gipson JD, Friedman W, Shah M, Wagner Z. Characterizing provider bias in contraceptive care in Tanzania and Burkina Faso: A mixed-methods study. Soc Sci Med 2024; 348:116826. [PMID: 38581812 DOI: 10.1016/j.socscimed.2024.116826] [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: 12/08/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
Provider bias based on age, marital status, and parity may be a barrier to quality contraceptive care. However, the extent to which bias leads to disparities in care quality is not well understood. In this mixed-methods study, we used four different data sources from the same facilities to assess the extent of bias and how much it affects contraceptive care. First, we surveyed providers in Tanzania and Burkina Faso (N = 295) to assess provider attitudes about young, unmarried, and nulliparous clients. Second, mystery clients anonymously visited providers for contraceptive care and we randomly assigned the reported age, marital status, and parity of each visit (N = 306). We used data from these visits to investigate contraceptive care disparities across 3 domains: information provision and counseling quality, contraceptive method provision, and perceived treatment. Third, we complemented mystery client data with client exit surveys (N = 31,023) and client in-depth interviews (N = 36). In surveys, providers reported biased attitudes against young, unmarried, and nulliparous clients seeking contraceptives. Similarly, we found disparities according to these characteristics in the reporting of contraceptive care quality; however, we found that each characteristic affected a different quality of care domain. Among mystery clients we found age-related disparities in the provision of methods; 16/17-year-old clients were 18 and 11 percentage points less likely to perceive they could take a contraceptive method relative to 24-year-old clients in Tanzania and Burkina Faso, respectively. Unmarried mystery clients perceived worse treatment from providers compared to married clients. Nulliparous mystery clients reported lower quality contraceptive counseling than their parous counterparts. These results suggest that clients of different characteristics likely experience bias across different elements of care. Improving care quality and reducing disparities will require attention to which elements of care are deficient for different types of clients.
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Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, University of California, Los Angeles, USA.
| | - Corrina Moucheraud
- Department of Public Health Policy & Management, New York University, USA
| | - Jessica D Gipson
- Department of Community Health Sciences, University of California, Los Angeles, USA
| | | | - Manisha Shah
- Goldman School of Public Policy, University of California, Berkeley, USA
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Bullington BW, Sawadogo N, Tumlinson K, Langer A, Soura A, Zabre P, Sié A, Senderowicz L. Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200470. [PMID: 37348946 PMCID: PMC10285731 DOI: 10.9745/ghsp-d-22-00470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways providers restrict access to contraception. Here, we propose a distinction between the classical "downward" provider bias that discourages contraceptive use and a new conception of "upward" provider bias that occurs when providers pressure or encourage clients to adopt contraception. METHODS Using cross-sectional data from reproductive-aged women in Burkina Faso, we describe lifetime prevalence of experiencing provider encouragement to use contraception due to provider perceptions of high parity (a type of upward provider bias) and provider discouragement from using contraception due to provider perceptions of low parity (a type of downward provider bias). We also examine associations between sociodemographic characteristics and experiences of provider encouragement to use contraception due to perceptions of high parity. RESULTS Sixteen percent of participants reported that a provider had encouraged them to use contraception due to provider perceptions of high parity, and 1% of participants reported that a provider had discouraged them from using contraception because of provider perceptions of low parity. Being married, being from the rural site, having higher parity, and having attended the 45th-day postpartum check-up were associated with increased odds of being encouraged to use contraception due to provider perceptions of high parity. CONCLUSION We find that experiences of upward provider bias linked to provider perceptions of high parity were considerably more common in this setting than downward provider bias linked to perceptions of low parity. Research into the mechanisms through which upward provider bias operates and how it may be mitigated is imperative to promote contraceptive autonomy.
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Affiliation(s)
- Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougo, Burkina Faso
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougo, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Leigh Senderowicz
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
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Castle S, Bazie F, Maytan-Joneydi A, Boukary K, Calhoun LM, Onadja Y, Guiella G, Speizer IS. "You could find a good or a bad provider, I would say you just have to go and see": A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001780. [PMID: 37000785 PMCID: PMC10065260 DOI: 10.1371/journal.pgph.0001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women's motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15-19 and 20-24 and ever married women ages 15-24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women's demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women's (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence.
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Affiliation(s)
| | - Fiacre Bazie
- Institut Supérieur des Sciences de la Population (ISSP) at the Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Amelia Maytan-Joneydi
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kindo Boukary
- Institut Supérieur des Sciences de la Population (ISSP) at the Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Lisa M. Calhoun
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Yentema Onadja
- Institut Supérieur des Sciences de la Population (ISSP) at the Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP) at the Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ilene S. Speizer
- Institut Supérieur des Sciences de la Population (ISSP) at the Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Karp C, OlaOlorun FM, Guiella G, Gichangi P, Choi Y, Anglewicz P, Holt K. Validation and Predictive Utility of a Person-Centered Quality of Contraceptive Counseling (QCC-10) Scale in Sub-Saharan Africa: A Multicountry Study of Family Planning Clients and a New Indicator for Measuring High-Quality, Rights-Based Care. Stud Fam Plann 2023; 54:119-143. [PMID: 36787283 PMCID: PMC11152181 DOI: 10.1111/sifp.12229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The lack of validated, cross-cultural measures for examining quality of contraceptive counseling compromises progress toward improved services. We tested the validity and reliability of the 10-item Quality of Contraceptive Counseling scale (QCC-10) and its association with continued protection from unintended pregnancy and person-centered outcomes using longitudinal data from women aged 15-49 in Burkina Faso, Kenya, and Nigeria. Psychometric analysis showed moderate-to-strong reliability (alphas: 0.73-0.91) and high convergent validity with greatest service satisfaction. At follow-up, QCC-10 scores were not associated with continued pregnancy protection but were linked to contraceptive informational needs being met among Burkinabe and Kenyan women; the reverse was true in Kano. Higher QCC-10 scores were also associated with care-seeking among Kenyan women experiencing side effects. The QCC-10 is a validated scale for assessing quality of contraceptive counseling across diverse contexts. Future work is needed to improve understanding of how the QCC-10 relates to person-centered measures of reproductive health.
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Affiliation(s)
- Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Funmilola M OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP/University Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | | | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Kelsey Holt
- Department of Family & Community Medicine, University of California, San Francisco, CA, 94110, USA
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Corley AG, Sprockett A, Montagu D, Chakraborty NM. Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116576. [PMID: 35682160 PMCID: PMC9180733 DOI: 10.3390/ijerph19116576] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.
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