Modern contraceptive use among sexually active women aged 15-19 years in North-Western Tanzania: results from the Adolescent 360 (A360) baseline survey

Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of 'Zvatinoda!' (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework

BACKGROUND

Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services.

OBJECTIVE

The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe.

METHODS

The intervention utilized mobile phone-based discussion groups, complemented by "ask the expert" sessions. Peer facilitators, supported by an "Auntie," led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators' debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance.

RESULTS

Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable "Auntie," and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance).

CONCLUSIONS

The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people's knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers.

Examining the decline in modern contraception usage among married women in Bangladesh: Applying Blinder-Oaxaca decomposition analysis

OBJECTIVES

Controlling population expansion and reducing unintended pregnancies through the use of modern contraceptives is a cost-effective strategy. In recent years, the rate of modern contraceptive use in Bangladesh has been declining. So, this study aimed to investigate the associated factors of the deterioration in modern contraceptive usage.

METHODS

This study used data from two successive Bangladesh Demographic and Health Surveys (2014 and 2017-18) and applied the Blinder-Oaxaca decomposition analysis to understand the drivers. A popular binary logistic regression model is fitted to determine the factors that influence the use of modern contraceptive methods over the years.

RESULTS

This study revealed that highly educated women were more likely to use modern contraception methods, and their use increased by 3 percent over the years. Factors such as women's working status, husband's education, number of living children, and fertility preference were found significantly associated with decreased usage of modern contraception methods over years. The result of the Blinder-Oaxaca (BO) decomposition analysis found a significant decrease between 2014 and 2018. Respondent's age, working status, husband's age, opinion on decision making, region, and media exposure were the most significant contributors to explaining the shift between 2014 and 2018. The two factors that contributed most to narrowing the difference between the two surveys were women's decision on own health (26%), and employment status (35%).

CONCLUSIONS

The factors that influence modern contraceptive prevalence are important to know for policy implication purposes in Bangladesh. The findings indicate the need for further improvement of factors for balancing the usage of modern contraception methods.

Engaging Community Health Workers to Enhance Modern Contraceptive Uptake Among Young First-Time Parents in Five Cities of Uttar Pradesh

INTRODUCTION

Young newly married women and first-time parents (FTPs), particularly those living in slum settlements, have a high unmet need for modern contraceptive methods to limit and space births. We describe an intervention in which adolescents and youth sexual and reproductive health (AYSRH) services tailored to FTPs were incorporated into the government's existing family planning (FP) program in 5 cities of Uttar Pradesh. We examined the effect of this intervention on modern contraceptive use among FTPs aged 15-24 years.

METHODS

To assess the effect of this pilot, in 2019, 1 year after the implementation of the program, we analyzed community-based output tracking survey data on 549 married women who are FTPs in the pilot cities. These FTPs were compared with 253 women who were FTPs from other cities where the program was implemented without a specific focus on FTPs. Descriptive statistics and multivariate logistic regression analysis were applied to understand the association between exposure to FP information, either through accredited social health activists or through service delivery points, and use of modern contraceptives.

RESULTS

Use of modern contraceptives was higher among FTPs in the 5 pilot cities than non-pilot cities (39% vs. 32%; P<.05). The interaction effect of city type and exposure to the information showed a positive association between modern contraceptive use and program exposure, greater in pilot cities than non-pilot cities.

CONCLUSIONS

Higher uptake of modern contraceptives among young women may be achieved when an FTP-focused intervention is layered on the government's existing FP programs. Future studies with a longer duration of implementation, in a wider geography, and with longitudinal design are recommended to provide more robust measures of high impact intervention/practices in urban areas.

Individual and community level factors associated with modern contraceptive utilization among women in Ethiopia: Multilevel modeling analysis

BACKGROUND

Modern contraceptive utilization is the most effective intervention to tackle unintended pregnancy and thereby reduce abortion and improve maternal, child, and newborn health. However, multilevel factors related to low modern contraceptive utilization and the robust analysis required for decision-making were scarce in Ethiopia.

OBJECTIVE

To investigate the individual and community-level predictors of modern contraceptive utilization among reproductive-age women in Ethiopia.

METHODS

We utilized data from a cross-sectional 2019 Performance Monitoring for Action Ethiopia survey. The survey employed a stratified two-stage cluster sampling method to select households for inclusion. In Stata version 16.0, the data underwent cleaning, aggregation, and survey weighting, following which a descriptive analysis was performed utilizing the "svy" command. Subsequently, the primary analysis was executed using R software version 4.1.3. We fitted a two-level mixed effects logistic regression model on 6,117 reproductive-age women nested within 265 enumeration areas (clusters). The fixed effect models were fitted. The measures of variation were explained by intra-cluster correlation, median odds ratio, and proportional change in variance. The shrinkage factor was calculated to estimate the effects of cluster variables using the Interval odds ratio and proportion opposed odds ratio. Finally, the independent variables with a significance level of (P<0.05) and their corresponding Adjusted Odds ratios and 95% confidence intervals were described for the explanatory factors in the final model.

RESULTS

In Ethiopia, the prevalence of modern contraceptive utilization was only 37.% (34.3 to 39.8). Women who attained primary, secondary, and above secondary levels of education were more likely to report modern contraceptive utilization with AOR of 1.47, 1.73, and 1.58, respectively. Divorced/widowed women were less likely to report modern contraceptive utilization (AOR:0.18, 95% CI 0.13,0.23) compared to never-married women. Discussions between women and healthcare providers at the health facility about family planning were positively associated with modern contraceptive utilization (AOR:1.84, 95% CI: 1.52, 2.23). Community-level factors have a significant influence on modern contraceptive utilization, which is attributed to 21.9% of the total variance in the odds of using modern contraceptives (ICC = 0.219). Clusters with a higher proportion of agrarian (AOR: 2.27, 95% CI 1.5, 3.44), clusters with higher literacy (AOR: 1.46, 95% CI 1.09, 1.94), clusters with empowered women and girls about FP (AOR: 1.47, 95% CI 1.11, 1.93) and clusters with high supportive attitudes and norms toward FP (AOR: 1.37, 95% CI 1.04, 1.81) had better modern contraceptive utilization than their counterparts.

CONCLUSION

In Ethiopia, understanding the factors related to modern contraceptive use among women of reproductive age requires consideration of both individual and community characteristics. Hence, to enhance family planning intervention programs, it is essential to focus on the empowerment of women and girls, foster supportive attitudes towards family planning within communities, collaborate with education authorities to enhance overall community literacy, pay special attention to pastoralist communities, and ensure that reproductive-age women as a whole are targeted rather than solely focusing on married women.

Prevalence and predictors associated with modern contraceptive method utilization among women in the nomadic community of Ethiopia: a cross-sectional study

BACKGROUND

Ethiopia is one of the countries in sub-Saharan Africa with the lowest prevalence of the use of modern contraceptive methods. On the frequency and determinants of modern contraceptive method in the Ethiopian women who live a nomadic lifestyle, there is, however, scant research. Therefore, the purpose of this study was to evaluate the factors that influence how often women in Ethiopia's nomadic tribes use modern contraceptive method.

METHODS

In the nomadic community of Ethiopia, a community-based retrospective cross-sectional study was carried out between January 18 and June 27, 2016. From the 15,683 nationally representative datasets on the 2016 Ethiopian Demography and Health Survey, a sample of 3,415 women from nomadic communities was chosen. To determine factors linked to modern contraceptive method usage within the nomadic group, a multivariable logistic regression model analysis was considered.

RESULT

In the nomadic population of Ethiopia, 10% (95% CI (9.10, 11.1)) of respondents reported using modern contraceptive method overall. The most popular way to use modern contraceptive method was through injection (73.5%). In the multivariable logistic regression model analysis, secondary and above-educated husbands (AOR = 1.6, 95% CI (1.01, 2.24)) and primarily educated husbands (AOR = 1.4, 95% CI (1.027, 2.0)), rich (AOR = 1.6, 95% CI (1.03, 2.74)) and middle wealth index (AOR = 1.58, 95% CI (1.25, 2.38)), public health place of delivery (AOR = 2.5, 95% CI (1.55, 3.0)), being a working husband (AOR = 3.8, 95% CI (1.96, 4.22)), and respondents working (AOR = 1.5, 95% CI (1.04, 1.79)) were positively critical risk predictors associated with modern contraceptive method usages. Compared to the Somali region, women living in the Afar (AOR = 2.58, 95% CI (1.68, 3.95)) and Benshangul-Gumuz (AOR = 3.40, 95% CI (2.22, 5.21)) regions had higher use of modern contraceptive method.

CONCLUSION

In Ethiopia, modern contraceptive method usage is still quite uncommon among women who live in nomadic communities. Therefore, in order to increase modern contraceptive method service utilization and improve the wealth index of households, two key strategies, government professionals and concerned body service providers should pay special attention to educational opportunities for husbands and give valuable and effective counseling information during child delivery for women.

Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries

INTRODUCTION

Various countries in sub-Saharan Africa have taken divergent steps toward achieving the Sustainable Development Goal's target of universal access to sexual and reproductive health-care services by 2030, particularly among sexually active adolescent girls who are at risk of unplanned pregnancies and sexually transmitted infections. However, because contraceptive use among sexually active adolescents remains unexplored in sub-Saharan Africa, the researchers intended to examine the prevalence and factors associated with contraceptive use among adolescent girls who had been sexually active in the previous four weeks.

MATERIALS AND METHODS

Cross-sectional data from the most recent demographic and health surveys of 25 sub-Saharan African countries on 16,442 sexually active adolescent girls were analyzed. In the analyses, descriptive statistics and multivariate binary logistic regression were used. Analyses were statistically significant at p<0.05.

RESULTS

The overall prevalence of contraceptive use was 25.4%. Chad had the lowest prevalence (4%), while Namibia had the highest (60.5%). Over 90% of the countries studied had less than 50% contraceptive use among sexually active adolescent girls. Adolescent girls withhigher education were eight times more likely than those with no formal education to use contraception (aOR = 7.97, 95% Cl = 6.26-9.45). When compared to single adolescent girls, married adolescent girls were 66% less likely to use contraceptives (aOR = 0.34, 95% Cl = 0.31-0.36). Adolescent girls with two or more children were seven times more likely than those without a child to use contraceptives (aOR = 6.91, 95% Cl = 5.58-8.56).

CONCLUSION

It is established that there exists a low prevalence of contraceptive use among adolescent girls in sub-Saharan Africa. As countries in the sub-region strive for universal access to reproductive health services, it is critical for the governments and civil societies in countries with low contraceptive use to strengthen mass education on the use of contraception among sexually active adolescents, with special emphasis on the less educated, married, and adolescent girls from poor households.

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

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.

Individual and community level factors associated with modern contraceptive utilization among married women in the emerging region of Ethiopia: a multilevel mixed effects analysis of the 2019 Ethiopia Mini-Demographic and health survey

BACKGROUND

A demonstrated technique to enhance reproductive health and economic progress is through ensuring that family planning services are accessible universally. Those studies that used Ethiopia Demographic and Health Survey (EDHS) data did not assess individual and community-level factors in contraceptive utilization. Thus, the study employs a multilevel mixed effects analysis approach, which allows for the examination of individual and community-level factors that influence contraceptive utilization.

METHODS

This study analyzed the 2019 Ethiopia Min Demographic and Health Survey datasets. A total of 1916 married women in the 2019 surveys were included in the analysis. The data were analyzed using Stata version 17.0. The data were analyzed using Multi-level mixed-effect logistic regression to identify the individual and community-level factors associated with modern contraceptive utilization. An adjusted odds ratio with a 95% confidence interval was used to. Show the strength and direction of the association and statistical significance was declared at a P value less than 0.05.

RESULTS

Factors significantly associated with modern contraceptive utilization were; Muslim and protestant followers [AOR = 0.31, 95% CI: (0.134, 0.714)] and [AOR = 0.35, 95% CI: (0.173, 0.691)] respectively, women with no education (OR = 0.46; 95% CI: 0.293, 0.710), those women who belong to the poor and middle wealth of household [AOR = 0.35, 95% CI: (0.237, 0.527)] and [AOR = 0.56, 95% CI: (0.347, 0.919)] respectively, women who had one to five and greater than or equal to six living children [AOR = 11.36, 95% CI:(2.119, 60.918)] and [AOR = 7.44, 95% CI:(1.437, 38.547)]respectively, Women in clusters poor wealth status [AOR = 0.40, 95% CI: (0.183, 0.875)] and women who belong to the Somali region [AOR = 0.20, 95% CI: (0.0.070, 0.506)].

CONCLUSION

The study revealed that both individual and community-level factors determined modern contraceptive utilization. At the individual level, the religion of women, educational status, the wealth of the household, and the total number of living children were significantly associated with modern contraceptive utilization. At community-level factors, community wealth status and belonging to the Somali region were significantly associated with modern contraceptive utilization. The findings suggest that interventions aimed at increasing modern contraceptive utilization should target women with lower levels of education, those living in households with lower wealth, and those with larger families. Additionally, efforts should be made to improve access to modern contraceptives in communities with lower wealth status and in regions where traditional beliefs may hinder their use.

Individual and community level factors for modern contraceptives utilization among reproductive aged women in Amhara region, Mixed effect multi-level modeling, Data from Mini-EDHS, 2019

BACKGROUND

Modern contraceptive has been identified as a key strategy to control unintended pregnancy, protect the health of the mother and child, and promote women wellbeing. Despite this and increasingly wider availability of modern contraceptives, however, there are still high levels of unmet need for birth interspacing and contraceptive use in Amhara regions. This study aimed to identify factors associated with the enhancing of modern contraceptives utilization among reproductive aged women in Amhara region, using a mixed effects multilevel modeling data from mini-EDHS 2019.

METHODS

A community-based cross-sectional study was conducted among 711(wt = 100%) samples of reproductive-aged women. The data were interviewed by trained data collectors using a semi-structured questionnaire for the final mini-EDHS 2019 data set. A multilevel binary logistic regression model was fitted to identify the enhancing factors for modern contraceptive utilization Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was used to identify factors associated with utilization.

RESULT

The median age of the participants was 31 with (IQR ± 13) years. The overall modern contraceptive utilization was 42.3% (95%CI: 38.7; 46.1). Individual and community factors accounted for 21.4% of the variation in modern contraceptive utilization at the cluster level. Being age 25 years (AOR = 12.99; 95%CI: 4.5-37.2), 26-35 years (AOR = 8.8, 95%CI: 3.25- 24), 36-45 years (AOR = 5.6, 95%CI: 2.2-16.2), being married (AOR = 4.2, 95%CI: 2.21-6.97), educated women (AOR = 11.6, 95%CI: 3.22-40.4), and being middle-economic class (AOR = 3.03; 95%CI: 1.87-4.91) were identified as individual enhancing factors. Whereas, being urban resident (AOR = 5.19; 95%CI: 5.19: 41.7) and having media exposure (AOR = 1.5; 95%CI: 1.58-3.7) were community-level enhancing factors for modern contraceptive utilization.

CONCLUSION

Compared to earlier studies, in Amhara region, a lower prevalence rate of modern contraceptive utilization was reported. The variation in utilization at the cluster level, 21.4%, was attributed to individual and community-level factors. Healthcare providers should prioritize raising awareness about contraceptive side effects to encourage new users and decrease the number of individuals who discontinue contraceptive methods.

Prevalence and predictors of post-abortion modern contraceptive utilization among reproductive age women in Ethiopia

The development of a post-abortion family plan is an integral part of comprehensive abortion care. In spite of this, it received insufficient attention as a means of breaking the cycle of repeated abortions, unintended pregnancies, and maternal deaths resulting from abortion. Therefore, this study examined post abortion modern contraceptive utilization among Ethiopian women as well as associated factors. The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of post abortion contraceptive use. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. Overall prevalence of post abortion contraceptive use was observed to be 25.6% (95% CI: 23.24, 28.12). Women's age 15-24 (AOR = 2.34; 95% CI: 1.11, 4.93), and 25-34 (AOR = 1.94; 95% CI: 1.27, 2.98), married women (AOR = 2.6; 95% CI: 1.43, 4.96), women who had 1-4 (AOR = 4.13; 95% CI: 1.79, 9.57) and ≥ 5 number of children (AOR = 8.80; 95% CI: 3.30, 13.49), Being in metropolitan region (AOR = 9.14; 95% CI: 1.79, 12.48), women being in urban area (AOR = 1.85; 95% CI: 1.32, 2.24), and community media exposure (AOR = 1.75; 95% CI: 1.11, 3.56) were associated with post abortion modern contraceptive use. Post abortion modern contraceptive use in this study was low. Women age, current marital status, number of living children, residency, community media exposure, and region were significantly associated with post abortion modern contraceptive utilization. Therefore, it is better to provide ongoing health information about post-abortion family planning and its benefits, especially for people who live in rural and small peripheral regions, and public health policymakers should take both individual and community level factors into account when designing family planning programmes.

Social-psychological determinants of hormonal contraceptive use intentions among adolescent girls in the Bono East Region of Ghana

Introduction

The correct and consistent use of hormonal contraceptive (HC) methods by sexually active adolescent girls can prevent pregnancy and avert the health and social consequences of unwanted pregnancy for both the mother and her child. Despite these benefits, research shows that HC use is rather low among adolescent girls globally and especially among those in low and middle-income countries. This study was carried out to assess the social-psychological determinants of HC use intentions among adolescent girls and young women.

Methods

A cross-sectional survey was conducted among 1,203 young women aged 15-24 years from 70 communities within the Kintampo North Municipality and Kintampo South District in the Bono-East Region of Ghana from April 2021 to September 2021. Multiple linear regression analysis was used to identify factors associated with the intention to use HC among the entire sample of 1,203 respondents and among two sub-samples of young women based on HC use experience.

Results

Attitude toward personal HC use (β = 0.268; p < 0.001), self-efficacy toward access and use of HC (β = 0.341; p < 0.001), and HC use experience (β = 0.647; p < 0.001) were found to be significant and unique correlates of HC use intention among the entire sample of adolescent girls. Attitude toward personal HC use and self-efficacy toward access and use of HC were also associated with HC use intention in the two sub samples significantly (p's < 0.001). In addition, among participants with no HC experience, being a Christian as opposed to participants that affiliate themselves with Islam, Traditional religion or being non-religious positively predicts future HC use (β = 0.230; p < 0.01).

Conclusion

Our results demonstrate that different groups of adolescent girls need different interventions, focusing on different determinants for the motivation to use HC. Comprehensive sexuality education, informing all adolescent girls about the personal benefits of HC use and enhancing their skills in accessing and using HCs, can support their HC use intentions to promote their reproductive health and general wellbeing.

Uptake of modern contraceptive methods among women of reproductive age in Chake District-Pemba Tanzania: a descriptive crossectional study

BACKGROUND

The uptake of the modern contraceptive method provides chances for women and couples to reach optimal child spacing, achieve the desired family size and prevent unsafe abortions and maternal deaths. Despite the efforts in the health sector still, the contraceptive prevalence rate in Zanzibar remains low (9.1%). In Pemba, few studies have been done on modern contraceptive uptake and little is known about factors that hinder the uptake of modern contraceptives among women of reproductive age. This study investigated the uptake of modern contraceptive methods among women of reproductive age (18-45 years) and its associated factors.

METHODS

This was a quantitative cross-sectional study conducted in Chake District Hospital, Pemba Tanzania. A stratified random sampling technique was used to recruit 214 eligible participants for the study. After we informed the participants, data were collected using a structured English questionnaire. The collected data was analyzed using SPSS version 25, descriptive analysis was done to determine frequencies. A chi-square test was done to determine the association between the study variables and multivariate logistic regression to check the nature and strength of the association. The p<0.05 was considered statistically significant.

RESULTS

This study included 214 women of with majority 79(36.9%) at the age group of 21-30 years, 100(46.7%) had secondary education and 187(87.4%) married. Most of the participants 212(99.1%) have heard about modern contraceptives, with health facilities being the common source of information191(45.3). More than half 120(56.1%) of the participants were not using any modern contraceptive method and injectable 38(40.4%) was the commonly reported method among users. Among the users of modern contraceptives, lack of power to decide 180(84.1%), fear of divorce 141(65.9%), and social perception of users as the cause of reduced workforce in the future 161(75.2%) were common barriers. Participants provided suggestions to improve modern contraceptive uptake including male involvement 203(94.9%) and community awareness 182(85%). Further analysis revealed women with college/university education were 2 times more likely to use modern contraceptives method compared to those with primary or not attended school(p=0.023, OR=2.437, 95% CI: 1.129-5.259). Moreover employed women were 2 times more likely to use modern contraceptives compared to unemployed/housewives (p=0.028, OR=1.844, CI=1.068-3.185).

CONCLUSION

This study assesses the uptake of modern contraceptives among women of reproductive age. Results showed a low uptake of modern contraceptives in this population. Although the observation in this study is similar to those reported in other countries, the updated information is still important to the policymakers and the Ministry of Health in the studied district.

Barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia: a formative qualitative study

OBJECTIVE

To assess barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia, in 2021.

DESIGN

A grounded theory approach to the qualitative study was conducted between December 2020 and April 2021 in Gedeo zone, South Ethiopia.

SETTING

The study was conducted in two urban and four rural schools, in Gedeo zone; Gedeo zone is one of the 14 zones in the Southern Nations, Nationalities, and Peoples' Region of Ethiopia.

PARTICIPANTS

The study involved 24 in-depth interviews with secondary school adolescents and 28 key informants. The interviews were conducted with students, school counsellors, Kebele youth association coordinators, zonal child, adolescent, and youth officers, health workers, and non-governmental organisation workers.

RESULTS

The findings were organised into four major themes that influence contraceptive use; these include; (1) Individual-related barriers such as knowledge, fear and psychosocial development. (2) Community-related barriers encompass fear of rumours, family pressure, social and cultural norms, economic vulnerability, and religious beliefs. (3) Health service-related barriers include the lack of adolescent-responsive health services, health workers' behaviour, and fear of health workers. Furthermore, (4) The school and service integration barrier was identified.

CONCLUSIONS

Adolescents' contraceptive use was affected by various barriers ranging from individual to multisectorial levels. Adolescents note various barriers to using contraception and that, without contraception, sexual activity can lead to an increased risk for unintended pregnancy and its associated health risks.

Modern contraceptive utilisation and its associated factors among reproductive age women in high fertility regions of Ethiopia: a multilevel analysis of Ethiopia Demographic and Health Survey

OBJECTIVE

This study is aimed to assess the magnitude of modern contraceptives utilisation and associated factors among reproductive age women in high fertility regions of Ethiopia.

DESIGN

Cross-sectional study.

SETTING

High fertility regions of Ethiopian.

PARTICIPANTS

A total weighted sample of 3822 married reproductive age women.

METHODS

In this study, data were obtained from the recent Ethiopian Demographic and Health Surveys. A total weighted sample of 3822 women of reproductive age was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of modern contraceptive utilisation. Statistical significance was determined using adjusted OR (AOR) with 95% CI.

RESULTS

The overall modern contraceptive utilisation was 29.75% (95% CI 28.2% to 31.2%). Among the factors associated with utilisation were women's age 25-34 years (AOR 1.3; 95% CI 1.01 to 1.66) and ≥35 (AOR 1.71; 95% CI 1.37 to 2.70), husband's occupation (AOR 1.49; 95% CI 1.03 to 1.99), number of alive children: 1-4 (AOR 2.20; 95% CI 1.47 to 3.30), 5-8 (AOR 1.74; 95% CI 1.09 to 2.77), husband's desired number of children (AOR 0.77; 95% CI 0.61 to 0 .96), residency (AOR 2.37; 95% CI 1.20 to 4.67), community media exposure (AOR 1.77; 95% CI 1.01 to 3.08), region (AOR 0.13; 95% CI 0.03 to 0.52) and religion (AOR 0.49; 95% CI 0.36 to 0.66) were significantly associated with modern contraceptive utilisation.

CONCLUSION

Modern contraceptives utilisation in high fertility regions of Ethiopia was low. Women age, husband occupation, number of living children, husband's desired number of children, residency, community media exposure, region and religion were significantly associated with modern contraceptive utilisation. Therefore, to improve the utilisation of modern contraceptives, public health policy makers should consider creating awareness through mass media, male involvement in family planning, as well as family planning programmes, should be encouraged in rural areas.

Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey

Background

Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone.

Methods

This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25.

Results

Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization.

Conclusion

In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01974-w.

Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study

Background

Modern contraceptive use has been shown to influence population growth, protect women’s health and rights, as well as prevent sexually transmitted infections (STIs) for barrier contraceptive methods such as condoms. The present study aimed at assessing the level of utilization and factors associated with modern contraceptive use among sexually active adolescent girls in Rwanda.

Methods

We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 data of 539 sexually active adolescent girls (aged 15 to 19 years). Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to assess the association between various socio-demographics and modern contraceptive use using SPSS version 25. Modern contraception included the use of products or medical procedures that interfere with reproduction from acts of sexual intercourse.

Results

Of the 539 sexually active girls, only 94 (17.4%, 95% CI: 13.8–20.1) were using modern contraceptives. Implants (69.1%) and male condoms (12.8%) were the most used options. Modern contraceptive use was positively associated with older age (AOR = 10.28, 95% CI: 1.34–78.70), higher educational level (AOR = 6.98, 95% CI: 1.08–45.07), history of having a sexually transmitted infection (AOR = 8.27, 95% CI: 2.54–26.99), working status (AOR = 1.72, 95% CI: 1.03–2.88) and being from a female-headed household (AOR = 1.96, 95% CI: 1.12–3.43). However, not being in a union (AOR = 0.18, 95% CI: 0.10–0.35) and region (AOR = 0.28, 95% CI: 0.10–0.80) had negative associations.

Conclusions

To promote utilisation of modern contraceptives, family planning campaigns need to place more emphasis on the younger, unmarried adolescents, as well as those with lower educational levels. Consideration of household and regional dynamics is also highlighted.

Determinants of adolescents' contraceptive uptake in Ethiopia: a systematic review of literature

Introduction

Various studies have identified different factors that affect adolescent contraceptive uptake in different parts of Ethiopia. However, varying results were reported across primary studies and those results need to be systematically collated to inform policies. Therefore, this systematic review aimed to synthesize the findings of those primary studies to obtain more robust and representative evidence about adolescent contraceptive uptake in Ethiopia.

Methods

Five databases (MEDLINE via PubMed, Google Scholar, Scopus, Science Direct and CINAHL) were searched for papers published from January 2000 up to June 2021 in English. We limited our search to start on January 2000 as the health of adolescents have been given more attention after this period and to avoid time-lapsed biases. Seven studies were included in this systematic review. We used the Newcastle-Ottawa Scale and the Mixed Methods Appraisal Tool for quality assessment of the selected studies.

Results

Determinants of adolescent contraceptive utilization were focused on four levels: individual, socio-cultural, healthcare service and knowledge related factors. Individual-related factors that influence adolescents’ contraceptive uptake include; being in the age group of 10–15 years, not currently enrolled in school and being from low-income families, while socio-cultural factors include: lack of discussion with family members, arranged marriage, pressure from a partner, harmful traditional practices, discussion with peer groups and sexual partners. Healthcare service-related factors include; lack of information about contraceptives during health facility visits, lack of privacy during service provision and inconvenient service hours at health facilities, and not visiting health facilities, whereas, knowledge related factors include; having knowledge of contraceptive methods and being heard about contraceptives from media. Also, the proportion of adolescent contraceptive uptake ranged from 12 to 79%.

Conclusions

In this systematic, individual, socio-cultural, health-care-related, and knowledge-related characteristics have all been identified as influencing adolescents’ contraceptive uptake in Ethiopia. Hence, integrated interventions aimed at overcoming barriers to adolescent contraceptive uptake would be beneficial to improving adolescent contraceptive utilization in Ethiopia.

Analysis of Unmarried Adolescents and Modern Contraceptives Initiation in Nigeria: Evidence from 2018 NDHS

Nigeria is one of Africa’s most populous countries. Nigeria’s population is expected to exceed 400 million by 2050, putting it among the top five most populous countries in the world. High birth rates, limited contraception use, and early marriage are the main causes of this rapid increase. In Nigeria, adolescents play a substantial role in these issues, with 117 births per 1000 girls aged 15–19 years. Data for this article comes from the 2018 Nigerian Demographic and Health Survey (NDHS). Our sample consisted of 1014 sexually active unmarried adolescents aged 15–19 years. Kaplan Meier’s curve, Log Rank Test, and Cox proportional hazards model were modeled to estimate the parameters at p > 0.05. Findings show that the average time to the first use of modern contraceptives after sexual initiation is two years. Initiating sex at age 15 or later, belonging to the richest household wealth quintile, and use of the internet is associated with the early initiation of modern contraceptive methods, while residing in the northwest region and being older are associated with a low incidence of modern contraceptive use. Results indicate a deferred initiation of modern contraceptives after first sexual encounter. It has become imperative for tailored interventions to improve the time of initiation of contraceptives, so as to reduce the associated burdens and consequences.

Contraceptive discontinuation among women of reproductive age in Papua New Guinea

Background

Papua New Guinea has one of the lowest contraceptive prevalence rates among women of reproductive age in the Western Pacific Region and this makes contraceptive discontinuation in this country a critical public health issue worth studying. This study sought to assess the factors associated with contraceptive discontinuation among women of reproductive age in Papua New Guinea.

Methods

The data used for the analysis were obtained from the Papua New Guinea Demographic and Health Survey which was conducted in 2016–2018. The outcome variable for this study was contraceptive discontinuation among women of reproductive age. Crude odds ratios and adjusted odds ratios with 95% confidence intervals were estimated using binary logistic regression.

Results

About 33.26% of the women discontinued injectables, 19.15% discontinued pills and 3.77% discontinued other contraception methods. Women aged 20–24 [aOR = 2.12, CI = [= [1.04,4.31] through to those aged 30–34 [aOR = 1.98, CI = 1.03,3.79] had higher odds to discontinue contraceptive usage compared to those aged 45–49. Women with no information on choice of contraception [aOR = 2.85, CI = 2.31,3.51], those with two or more births in the last five years [aOR = 2.35, CI = 1.65,3.35] and those living in the Highland region [aOR = 1.71, CI = 1.28,2.29] were more likely to discontinue contraceptive usage compared with those with information on contraceptive choices, those with no births and those living in the Island region respectively. However, women in the rural areas [aOR = 0.78, CI = 0.61,0.99], women using LARC [aOR = 0.10, CI = 0.06,0.15], injectables [aOR = 0.43, CI = 0.30,0.63] and other modern contraception methods including condom [aOR = 0.22, CI = 0.15,0.34] were less likely to discontinue contraceptive usage.

Conclusion

A nationwide mass education on the benefits of contraception is recommended for the Papua New Guinea National Department of Health to tackle the key findings of this study which were high contraceptive discontinuation prevalence with lack of information on choice, disproportionately high contraceptive discontinuation rate in the Highland Region and the desire to give birth to more than two children as some factors associated with contraceptive discontinuation in Papua New Guinea.

Barrier to contraceptive use among childbearing age women in rural Indonesia

INTRODUCTION

The contraceptive prevalence rate in Indonesia has not experienced much improvement, which has led to an increase in the number of pregnancies. This study aimed to analyse the barriers to contraception use among women of childbearing age in rural Indonesia.

METHODS

This study used a cross-sectional design with data from the Indonesian Demographic and Health Survey (IDHS) of 2017. The independent variables were age, employment status, education, marital status, wealth status, health insurance and parity. The dependent variable was the use of contraception. The statistical significance was set at p <0.05 using bivariate analysis and binary logistic regression.

RESULTS

The study showed that the age group of 45-49 years (OR 0.199; 95% CI 0.149-0.266), secondary education (OR 2.227; 95% CI 2.060-2.514), women married/living with their partner (OR 43.752; 95% CI: 35.484-53.946), wealth status: middle (OR 1.492; 95% CI 1.400-1.589) and multipara (OR 2.524; 95% CI: 2.328-2.737) exhibited the increased use of contraception among women of childbearing age in rural Indonesia.

CONCLUSION

The variables proven to represent obstacles to contraceptive use among women of childbearing age in rural Indonesia include old age, no education, no husband/partner, poverty and already having one child.

Perceived norms, personal agency, and postpartum family planning intentions among first-time mothers age 15-24 years in Kinshasa: A cross-sectional analysis

Unintended pregnancy is an important global health problem and frequently occurs during the immediate postpartum period. However, few studies have examined postpartum family planning (PPFP) intentions among adolescent girls and young women. This study assessed whether perceived norms and personal agency predicted PPFP intentions among first-time mothers age 15–24 in Kinshasa, the Democratic Republic of Congo. Data were derived from the 2018 Momentum Project baseline survey. Analysis was based on 2,418 nulliparous pregnant women age 15–24 who were approximately six months pregnant with their first child in six health zones of Kinshasa. Overall PPFP intentions were low and ten to thirteen percent of women stated they were very likely to discuss PPFP next month with (a) their husband/male partner and (b) a health worker, and to (c) obtain and (d) use a contraceptive method during the first six weeks following childbirth. The results of multivariable linear regression models indicated that the PPFP intention index was predicted by description norms, perceptions of the larger community’s approval of PPFP, normative expectations, perceived behavioral control, self-efficacy, and autonomy. Rejection of family planning myths and misconceptions was also a significant predictor. Interaction terms suggested that the association of normative expectations with PPFP intentions varied across ethnic groups and that the positive association of injunctive norms with PPFP intentions was significantly increased when the larger community was perceived to disapprove of PPFP use. Normative expectations and PPFP-related self-efficacy accounted for two-thirds of the variance in PPFP intentions. The results suggested that understanding different normative influences may be important to motivate women to use contraception in the immediate postpartum period. In addition to addressing institutional, individual, and social determinants of PPFP, programs should consider integrating norm-based and empowerment strategies.

Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

Background

The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys.

Methods

We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status.

Results

Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique.

Conclusion

Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

Predictors of modern contraceptive usage among sexually active rural women in Ethiopia: A multi-level analysis

BACKGROUND

Ethiopia is one of the Sub-Saharan Africa countries with the lowest modern contraceptive prevalence rate and the highest fertility rate. This study aimed to assess individual and community-level predictors of modern contraceptive use among sexually active rural women in Ethiopia.

DATA AND METHODS

A sample of 9450 sexual active rural women aged 15-49 was extracted from the 15, 683 nationally representative samples of 2016 Ethiopian Demographic and Health Survey (EDHS). Multi-level logistic regression model was considered to identify determinant factors of modern contraceptive use among sexually active rural women in Ethiopia.

RESULT

The prevalence of modern contraceptive use among respondents was 20% in rural Ethiopia. Injection (66.35%) was the most common type of modern contraceptive use. In the last full model of the multilevel analysis, individual and community-level factors accounted for 86.69% of the variation in the use of modern contraceptive methods. Secondary and above-educated women (AOR = 1.39, 95%CI: 1.06, 2.81), having 1-4 living children (AOR = 2.70, 95%CI: 2.07, 3.53), rich wealth status (AOR = 2.26, 95%CI: 1.96, 2.60), married women (AOR = 17.31, 95%CI: 10.72, 27.94), having primary educated husband (AOR = 1.45, 95%CI: 1.27, 1.67) and being working husband (AOR = 2.26, 95%CI: 1.96, 2.60) were significantly positively associated with individual-level factors of the use of modern contraceptive methods. Besides, modern contraceptive use was negatively associated with Muslim women (AOR = 0.29, 95%CI: 0.25, 0.33). Compared to the Tigray region, women living in the Afar, Somali, Harari, and Dire Dawa regions had lower use of modern contraceptive methods. Women who had access to mass media (AOR = 1.35, 95%CI: 1.16, 1.57) were more likely to use contraceptives than their counterparts.

CONCLUSION

The prevalence of modern contraceptive use among rural women has very low. Both individual and community-level factors were significant predictors of modern contraceptive use. Consequently, the government and other stakeholders need to address educational opportunities; creating awareness about modern contraception and valuable counseling would increase modern contraceptive methods utilization.

Social and provider networks and women's contraceptive use: Evidence from Madagascar

OBJECTIVES

Women may differ by whether they rely on health providers and/or social ties for seeking information and advice about family planning. It is unknown whether these differences matter for contraceptive outcomes. This study assessed the association between women's family planning (FP) network (social and/or provider ties) and contraceptive use.

STUDY DESIGN

This cross-sectional, egocentric network study was conducted among reproductive-age women (n = 193) in rural Madagascar. Data included socio-demographics and contraceptive use. Respondents listed who they relied on for contraceptive information, advice or guidance and provided ties' gender, age, relationship, and perceived support of contraceptive use. The primary outcome was current contraceptive use. Predictors included having a FP network (0/1) and FP network composition (no network, social ties only, provider ties only, both provider and social ties), respectively. Analyses were conducted using a generalized linear model specifying a Poisson distribution, with covariate adjustment and cluster robust standard errors.

RESULTS

Having a network of individuals to turn to for contraceptive information compared to having no FP network was positively associated with contraceptive use (adjusted relative risk [aRR] 4.4, 95% confidence interval [CI] 2.00-9.87). Having a social network, a provider network, or a combination of social and provider network were all positively associated with contraceptive use (aRR 4.30 [CI 1.92-9.66], aRR 4.46 [CI 2.04-9.75], aRR 4.72 [CI 1.93-11.50], respectively), compared to having no FP network.

CONCLUSIONS

Contraceptive use was higher among women who relied on social ties, provider ties or both for contraceptive information and advice, compared to women with no FP network. These findings suggest that FP interventions should use a multicomponent approach taking into account both social and provider networks.

IMPLICATIONS

It is unknown whether differences in whether women rely on social ties (friends, partner, family members) vs. providers for contraceptive information and advice affect contraceptive outcomes. Women are just as likely to use contraception whether they rely on social ties, provider ties, or both for contraceptive information and advice.

Contraceptive Method Utilization and Determinant Factors among Young Women (15-24) in Ethiopia: A Mixed-Effects Multilevel Logistic Regression Analysis of the Performance Monitoring for Action 2018 Household Survey

Despite highly effective modern contraceptive methods (both short and long acting) are made widely available and accessible globally, their utilization remains low among young women in low- and middle-income countries, including Ethiopia. Hence, this study is aimed at determining its status and identifying the determinant factors by using nationally representative data. A multilevel analysis of the nationwide Performance Monitoring for Action 2018 of Ethiopia round 6 data, collected from June to July, 2018, was conducted. A total of 982 both married and unmarried young women (15-24) were included in the analysis. Descriptive statistics was used to describe the status of contraceptive method utilization and unmet need across regions. A mixed-effects multilevel logistic regression model was used to identify the determinants of the contraceptive method utilization. Adjusted odds ratios with corresponding 95% confidence intervals were used to show the significance of the associations at p < 0.05. The status of contraceptive method utilization was 54.8% (95% CI: 51.7%, 57.9%), and 18.6% (95% CI: 16.3%, 21.2%) had unmet need. Afar (12.3%), Harari (12.5%), and Ethiopian Somali (20.0%) regions had the lowest contraceptive method utilization. Wealth quintiles and religion were the higher level variables affecting contraceptive method utilization among the young women. Age, marital status, parity, future birth intention, and knowledge of contraceptive methods were the individual level factors identified as determinants of contraceptive method use among the young women. In conclusion, the status of contraceptive method utilization among the young women in Ethiopia is promising as compared to the national target of 55% for 2020; however, still high unmet need exists. The factors also exist both at the contextual and at individual levels. Hence, multilevel interventions need to be in place giving special emphasis to the low performing regions. Besides, region-specific behavioral interventions and family planning services that will be able to reach the young women need to be designed.

Modern contraceptive use among unmarried girls aged 15-19 years in South Western Nigeria: results from a cross-sectional baseline survey for the Adolescent 360 (A360) impact evaluation

PURPOSE

Adolescents 360 (A360) is an initiative being rolled out across Nigeria with the aim of increasing voluntary modern contraception use among women aged 15 to 19 years. Using evaluation study baseline data, we identified sexuality, fertility and contraceptive use characteristics of young unmarried girls in South Western Nigeria.

METHODS

A cross-sectional baseline survey of unmarried girls aged 15 to 19 years was conducted in Ogun state, Nigeria in August 2017. A clustered sampling design was used. We identified determinants of modern contraceptive use in this subpopulation using logistic regression.

RESULTS

Of 12,024 women interviewed, 15.3% reported sexual intercourse in the past year. The majority of respondents (79.6%, 9525/11,967) had heard of contraception. 45.3% of sexually active respondents were using a modern contraceptive method. Of those using any method of contraception, male condoms (50.3%) were the most widely used modern method followed by the emergency contraceptive pill (16.7%). Following adjustment for socio-demographic characteristics, there was evidence that the use of modern contraception was positively associated with having never given birth, living in an urban area, current enrolment in education, high level of education, high socioeconomic status, exposure to information about contraception, perceived social support for contraception, and self-efficacy for contraception.

CONCLUSIONS

In South Western Nigeria, unmarried sexually active adolescent girls have relatively low levels of modern contraceptive use. Programmes should aim to increase access to modern contraception and to increase social support and acceptability of contraceptive use.

Factors associated with modern contraceptive use: a comparative analysis between younger and older women in Umlazi Township, KwaZulu-Natal, South Africa

INTRODUCTION

Unplanned pregnancy continues to be a global reproductive and public health concern among women. This study aimed to investigate whether factors associated with modern contraceptive use differ by age-group among young and older women of reproductive age.

METHODS

This was a cross-sectional study conducted among 433 women of reproductive age, with the median age of 25 years (interquartile range: 21-28), and aged between 18 and 49. Data were collected from 10 public health care clinics in Umlazi Township, KwaZulu-Natal, using a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson's chi-square test and logistic regression models were employed to assess the level of the association between the predictor and outcome variables, and the p-value of 0.05 or lower was considered statistically significant.

RESULTS

Most women in the sample (n = 351, 81%) had obtained a secondary level of education, while 53% (n = 230) were unemployed and 89% (n = 387) were single. We found that women with secondary level of education (AOR: 2.89, 95% CI: 0.99-5.38) or a tertiary level of education (AOR 3.80, 95% CI: 1.07-3.53) were more likely to use contraceptive methods compared to women with lower education. Women who experienced unplanned pregnancy (AOR 0.51, 95% CI: 0.22-3.79) were more likely to use contraceptives. Women aged 25-49 years who experienced pregnancy, whether planned (AOR 3.87, 95% CI: 1.08-3.89) or unplanned (AOR 3.60, 95% CI: 2.15-4.19), were more likely to use a contraceptive method. Results showed that the level of education (p = 0.942) and whether one experienced unplanned pregnancy (p = 0.913) were not significant predictors of contraceptive use among women aged 18-24 years.

CONCLUSION

Concerted educational efforts to addressing existing barriers deterring women from accessing contraception among young women are necessary. Different groups of women should be targeted with family planning interventions specific to their needs.

Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys

Background

The use of modern contraceptives among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remains an issue that needs urgent attention. This present study assesses the individual and contextual factors associated with modern contraceptive use among AGYW in SSA.

Methods

Data for this study was obtained from the latest Demographic and Health Surveys (DHS) conducted between January 2010 and December 2018 across 29 countries in SSA. Data were analysed with Stata version 14.2 by employing both Pearson’s chi-square test of independence and a multilevel binary logistic regression. The selection of variables for the multilevel models was based on their statistical significance at the chi-square test at a p < 0.05. Model fitness for the multilevel models was checked using the log likelihood ratios and Akaike’s Information Criterion (AIC) and the results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI).

Results

It was found that 24.7% of AGYW in SSA use modern contraceptives. In terms of the individual level factors, the study showed that AGYW aged 15–19 [aOR = 0.86, CI = 0.83–0.90], those who were married [aOR = 0.83, CI = 0.79–0.87], Muslims [aOR = 0.59, CI = 0.57–0.62], working [aOR = 0.92, CI = 0.89–0.95], those who had no child [aOR = 0.44, CI = 0.42–0.47], those who had no exposure to newspaper/magazine [aOR = 0.44, CI = 0.63–0.71] and radio [aOR = 0.82, CI = 0.78–0.86] had lower odds of using modern contraceptives. Conversely, the use of modern contraceptives was high among AGYW whose age at first sex was 15–19 years [aOR = 1.20, CI = 1.12–1.28]. With the contextual factors, the odds of using modern contraceptives was low among AGYW who lived in rural areas [aOR = 0.89, CI = 0.85–0.93] and in communities with low literacy level [aOR = 0.73, CI = 0.70–0.77] and low socio-economic status [aOR = 0.69, CI = 0.65–0.73].

Conclusion

Several individual and contextual factors are associated with modern contraceptive use among AGYW in SSA. Therefore, Governments in the various countries considered in this study should intensify mass education on the use of modern contraceptives. This education should be more centered on AGYW who are in socio-economically disadvantaged communities, those who are not married, Muslims, those with high parity and high fertility preferences and those who are working.

Factors associated with the awareness of contraceptive methods, understanding the prevention of HIV/AIDS and the perception of HIV/AIDS risk among secondary school students in Dar es Salaam, Tanzania

Objective: To assess the awareness of contraceptive methods, understanding of HIV/AIDS prevention and the perception of HIV/AIDS risks among secondary school students in Tanzania.

Methods: An anonymous self-administered questionnaire survey was conducted among secondary school students in Tanzania. The questionnaire included sociodemographic characteristics, awareness of contraceptive methods, an understanding of HIV/AIDS prevention, and the perception of HIV/AIDS risks. Three secondary schools were selected by considering the gender balance and location, which included the urban and surrounding areas. The research objectives, methods, and ethical considerations were explained, and the students voluntarily completed the questionnaire.

Results: A total of 233 responses were collected, and 204 responses were considered valid for the analysis. The mean and standard deviation of age were 18.5 ± 1.0. Regardless of the gender, age, religion, and major course of study, the maternal educational status (adjusted odds ratio [AOR]: 3.129; 95% confidence interval [CI]: 1.324, 7.398; P=0.009) and the number of information sources (AOR: 7.023, 95% CI: 3.166, 15.579, P<0.001) demonstrated associations with the awareness of contraceptive methods. Respondents who lived outside a dormitory (AOR: 3.782; 95% CI: 1.650, 8.671; P=0.002) and who currently had a partner (AOR: 3.616; 95% CI: 1.486, 8.800; P=0.005) were associated with a high level of understanding of HIV/AIDS prevention regardless of gender, age, religion, and major course of study. Respondents with few information sources were associated with a high level of perception of HIV/AIDS risks (AOR: 0.293; 95% CI: 0.115, 0.747; P=0.010), regardless of gender, age, religion, and major course of study.

Conclusion: Factors associated with the awareness of contraceptive methods, the understanding of HIV/AIDS prevention, and perception of HIV/AIDS risks were not consistent. To ensure the improvement of these factors among secondary school students, sexual health education should be integrated into educational programs and provided holistically.

Individual and community-level factors associated with modern contraceptive use among adolescent girls and young women in Mali: a mixed effects multilevel analysis of the 2018 Mali demographic and health survey

Background

Unintended pregnancy constitutes a significant public health challenge in sub-Saharan Africa and particularly among young people, who are more likely to closely space births and experience adverse obstetric outcomes. Studies on modern contraceptive use have mostly focused on women of reproductive age in general with limited attention to factors associated with modern contraceptive use among adolescents and young women (aged 15–24) in Mali. We examined the individual and community-level factors associated with modern contraceptive use among this age cohort using the 2018 Mali demographic and health survey data.

Methods

We analyzed data from 2639 adolescent girls and young women, and our outcome of interest was current use of modern contraceptives. We performed descriptive analysis using frequencies and percentages and inferential analysis using mixed-effects multilevel logistic regression. The results of the mixed-effects multilevel logistic regression were presented as adjusted odds ratios with their corresponding 95% confidence intervals.

Results

The prevalence of modern contraceptive use among adolescent girls and young women in Mali was 17.1% [95% CI, 15–19%]. Adolescent girls and young women who were married [aOR = 0.20, CI = 0.09–0.41], had no formal education [aOR = 0.43, CI = 0.32–0.59], in the poorest wealth quintile [aOR = 0.38, CI = 0.19–0.79] and had no children [aOR = 0.38, CI = 0.27–0.53] were less likely to use modern contraceptives. Similarly, those who had low knowledge of modern contraception [aOR = 0.60, CI = 0.42–0.85] and whose ideal number of children was six or more [aOR = 0.66, CI = 0.43–0.99] were less likely to use modern contraceptives. However, those with four or more births were more likely to use modern contraceptives [aOR = 1.85, CI = 1.24–2.77].

Conclusion

Modern contraceptive use among adolescent girls and young women in Mali has improved slightly relative to the prevalence of 2012, though the prevalence is still low, compared to the prevalence in other sub-Saharan African countries and the prevalence globally. Individual-level factors such as marital status, educational level, wealth quintile, parity, ethnicity and ideal number of children were associated with the use of modern contraceptive among adolescent girls and young women in Mali. Community knowledge of modern contraceptives was found as a community-level factor associated with modern contraceptive use among adolescent girls and young women. Therefore, Mali’s Ministry of Health and Public Hygiene's Health Promotion and Education unit should prioritise and intensify contraceptive education to increase coverage of modern contraceptive use and address disparities in the use of modern contraceptives. Such education should be done, taking into consideration factors at the individual and community-level of the target population.

Female adolescents' reproductive health decision-making capacity and contraceptive use in sub-Saharan Africa: What does the future hold?

INTRODUCTION

Given the social, economic, and health consequences of early parenthood, unintended pregnancy, and the risks of HIV infection and subsequent transmission, there is an urgent need to understand how adolescents make sexual and reproductive decisions regarding contraceptive use. This study sought to assess the association between female adolescents' reproductive health decision-making capacity and their contraceptive usage.

MATERIALS AND METHODS

Data was obtained from pooled current Demographic and Health Surveys (DHS) conducted in 32 countries in sub-Saharan Africa (SSA). The unit of analysis for this study was adolescents in sexual unions [n = 15,858]. Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. All analyses were performed using STATA version 14.2. Results were presented using Odds Ratios [OR] and adjusted Odds Ratios [AOR]. Statistical significance was set at p<0.05.

RESULTS

The results showed that 68.66% of adolescents in SSA had the capacity to make reproductive health decisions. The overall prevalence of contraceptive use was 18.87%, ranging from 1.84% in Chad to 45.75% in Zimbabwe. Adolescents who had the capacity to take reproductive health decisions had higher odds of using contraceptives [AOR = 1.47; CI = 1.31-1.65, p < 0.001]. The odds of contraceptive use among female adolescents increased with age, with those aged 19 years having the highest likelihood of using contraceptives [AOR = 3.12; CI = 2.27-34.29, p < 0.001]. Further, the higher the level of education, the more likely female adolescents will use contraceptives, and this was more predominant among those with secondary/higher education [AOR = 2.50; CI = 2.11-2.96, p < 0.001]. Female adolescents who were cohabiting had higher odds of using contraceptives, compared to those who were married [AOR = 1.69; CI = 1.47-1.95, p < 0.001]. The odds of contraceptive use was highest among female adolescents from the richest wealth quintile, compared to those from the poorest wealth quintile [AOR = 1.65; CI = 1.35-2.01, p<0.001]. Conversely, female adolescents in rural areas were less likely to use contraceptives, compared to those in urban areas [AOR = 0.78; CI = 0.69-0.89, p < 0.001].

CONCLUSION

The use of general and modern contraceptives among adolescents in SSA remains low. Therefore, there is a need to strengthen existing efforts on contraceptives usage among adolescents in SSA. This goal can be achieved by empowering these young females, particularly those in the rural areas where the level of literacy is very low to take positive reproductive health decisions to prevent unintended teenage pregnancy, HIV/AIDs and other sexually transmitted infections. This approach would help reduce maternal mortality and early childbirth in studied SSA countries.

Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

BACKGROUND

Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided.

METHODS

We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar.

RESULTS

Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members.

CONCLUSIONS

Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.

Use of modern contraceptives among advanced-level secondary school girls in the Rukwa Region, Tanzania, 2018

OBJECTIVES

To determine contraceptive uptake, reasons for non-use and predictors of use.

METHODS

We conducted a cross-sectional study among girls in advanced-level secondary schools in the Rukwa region of Tanzania. Using probability proportional to size (PPS), we recruited a random sample of 660 girls out of 1447-targeted participants. A tool for data collection was a questionnaire. Data analyses included univariate analysis to describe study participants and Poisson regression analysis to assess the effect of independent factors to the dependent variable. A 5%-level of significance was used in multivariate analysis.

RESULTS

More than 40% of the girls report being sexually active and only 25% reported current use of modern contraceptives. The main reported main method being use of male condoms (93%). Barriers for non-use of contraceptives included fear of side effects, fear of being perceived or labeled as promiscuous, inadequate knowledge about contraceptives and for religious reasons. The predictor for using modern contraceptives was attending class sessions about modern contraceptives.

CONCLUSIONS

Although girls in advanced-level secondary schools are sexually active, the use of modern contraceptives is still low. Girls report several barriers frustrating their intention to use contraceptives, mainly based on misconceptions and lack of knowledge.

Determinants of modern contraceptive use among sexually active men in Ethiopia; using EDHS 2016 national survey

BACKGROUND

Recently, the focus of family planning programs has changed from female oriented to men oriented, or both partner oriented to have effective outcomes. Although, contraceptive use among sexually active women was exhaustively researched; there is still a huge gap on modern contraceptive use and its determinants among sexually active men in Ethiopia.

OBJECTIVES

We assessed the determinants of contraceptive use among sexually active men in Ethiopia using national survey data.

METHOD

The data source for this study was the 2016's Ethiopian Demographic and Health Survey of men aged above 15-59 years. We analyzed data of 12, 688 sexually active men in the past 12 months prior to the survey using STATA version 14.1. Bivariate and multivariable multinomial logistic regression analysis was conducted and statistical significance was set at p value < 0.05.

RESULT

From a total of 12, 688 sexually active men in Ethiopia, 9378 (73.9%) didn't use any modern contraception or use traditional methods, 2394 (18.9%) use partner methods for those who reported using a method through their partner (such as pill, IUD, injections, female sterilization and Norplant) and the rest 916 (7.2%) used male methods for those who reported using male only methods (such as condoms and male sterilization). In the adjusted multinomial logistic regression model, men's age categories 25-34 years (AOR:2.0; 95%CI = 1.5-2.5), 35-44 (AOR: 2.8; 95%CI = (2.0-3.8), and 45+ years (AOR: 1.5; 95%CI = 1.0-2.6), being rural resident (AOR: 1.60; (95%CI = 1.3-2.2), married and living with partner (AOR: 0.03; (95%CI = 0.01-0.06), who attended secondary (AOR:1.2; (95%CI = 0.8-1.9) and higher (AOR: 1.4; (95%CI = 1.2-2.5) education, whose partner was working (AOR: 1.6; (95%CI = 1.3-2.2), having three and above children (AOR: 0.5; (95%CI = 0.3-0.8), reading newspaper/magazines at least once a week or less than once a week, listening to radio at least once a week, watching television at least once a week and watching television less than once a week were significantly associated with use of male method than traditional/no method as compared to their respective references.

CONCLUSION

Modern contraceptive use among sexually active men in Ethiopia is low and multiple factors determined it. Close monitoring and supporting of sexually active men with age above 25 years, rural background, higher educational level, whose partner was working, having three and more children and little exposure to media may increase men's use of modern contraceptives.