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Achola R, Orach CG, Nabiwemba E, Atuyambe LM. Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study. BMC Womens Health 2024; 24:427. [PMID: 39061042 PMCID: PMC11282639 DOI: 10.1186/s12905-024-03272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Contraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake. METHODS A qualitative exploratory study was conducted among women of reproductive age (15-49 years) and men (15-60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14. RESULTS We found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out. CONCLUSIONS This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees. TRIAL REGISTRATION This study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number-SS809ES.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Lynn M Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Kareem YO, Adelekan B, Bungudu K, Goldson E, Dasogot A, Hajjar JM, Yaya S. Assessment of the Trends and Factors Associated With Unintended Pregnancy Among Women of Reproductive Age: An Analysis of the Nigerian Demographic Health Survey Between 2008 to 2018. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:302-316. [PMID: 39148920 PMCID: PMC11323857 DOI: 10.1080/19317611.2024.2346144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 08/17/2024]
Abstract
Background Unintended pregnancy is a global public health issue with significant adverse effects which include health and economic consequences. Globally, there were 121 million unintended pregnancies annually between 2015 and 2019 among women of reproductive age between 15 and 49 mainly due to the non-uptake of modern contraceptives, harmful norms, stigma and lack of sexual and reproductive health care and information. Methods We extracted information from the Nigeria Demographic Health Survey conducted in 2008, 2013, and 2018 to assess the trends and factors associated with unintended pregnancies among women of reproductive-aged 15-49. The descriptive summaries were presented using percentages and binomial logistic regressions for the inferential analysis. All analyses were computed using Stata 15.0 at a 5% level of significance and accounted for the complex survey nature as well as the population size. Results The study included a total of 63,040 women of reproductive age. The prevalence of unintended pregnancy was highest among adolescents aged 15-19 years (15.1%, 95% CI: 13.9-16.5) and decreased with increasing age. The pooled adjusted model revealed that women had 11% lower odds of reporting unintended pregnancies in 2013 compared to 2008. Adolescent girls (aOR 2.48; 95%CI: 2.14-2.89) and young adults (aOR 1.86; 95%CI: 1.69-2.04) have higher odds of reporting unintended pregnancies compared to older women. Also, unmarried women had 9.8 times higher odds of reporting unintended pregnancies compared to ever-married women. Conclusions The findings from this study highlight the need for further family planning educational programs and initiatives that support the uptake of effective contraceptive methods to reduce the likelihood of unintended pregnancy and improve women's sexual and reproductive health while considering regional variations within the country to ensure tailored interventions that address specific needs within each region.
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Affiliation(s)
| | | | - Karima Bungudu
- United Nations Population Fund, Nigeria Country Office, Abuja, Nigeria
| | - Erika Goldson
- United Nations Population Fund, Nigeria Country Office, Abuja, Nigeria
| | - Andat Dasogot
- United Nations Population Fund, Nigeria Country Office, Abuja, Nigeria
| | - Julia Marie Hajjar
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Hossain S, Hasan MA, Faruk MO, Salam MA. Association between the salinity level with miscarriage and unintended pregnancy in Bangladesh: Impact of salinity level on miscarriage and unintended pregnancy in Bangladesh. Heliyon 2024; 10:e23858. [PMID: 38192867 PMCID: PMC10772722 DOI: 10.1016/j.heliyon.2023.e23858] [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: 03/01/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
Miscarriage is a significant public health concern worldwide, particularly in developing nations like Bangladesh. Moreover, people in coastal areas are more affected by miscarriage as compared to other areas. Increasing sea levels and salinity is the main reason for this discrepancy. This study aimed to investigate the association between different salinity levels (S1, S2, S3, S4, and S5) and miscarriage and unintended pregnancy. The outcome variables are pregnancy-related outcomes (miscarriage, unintended pregnancy), and the independent variables are different salinity levels. A frequency table and correlation analysis were done to find the descriptive scenarios of miscarriage, unintended pregnancy, and salinity levels. We found 621 miscarriage patients and 2271 unintended pregnant patients in our study. Furthermore, the Poisson regression model was used to observe the incidence of miscarriage and unintended pregnancy for different salinity levels. A higher amount of miscarriage and unintended pregnancy rate was found in Dhaka and Khulna, while these rates were lower in Barisal and Chittagong. However, the salinity levels were highest in Barisal and Khulna. Both miscarriage and unintended pregnancy are highly and negatively correlated with salinity levels. The Poisson regression model shows that the salinity levels s1-s5 are strongly associated with miscarriage. Lower and moderate levels of salinity are strongly associated with miscarriage than higher levels of salinity. Again, the average number of miscarriages decreases with the salinity levels. Likewise, unintended pregnancy was also negatively associated with salinity levels. However, it only reported a significant association with lower and moderate salinity levels, and higher salinity levels did not affect unintended pregnancy. Taking initiatives for raising awareness from government and non-government organizations, setting up deep tube water pumps extensively, and properly treating coastal areas women during pregnancy would be the ideal next step to reduce the miscarriage and unintended pregnancy rate in coastal zones in Bangladesh.
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Affiliation(s)
- Sorif Hossain
- Department of Statistics, Noakhali Science and Technology University, Noakhali- 3814, Bangladesh
| | - Md Abid Hasan
- Department of Oceanography, Noakhali Science and Technology University, Noakhali-3814, Bangladesh
| | - Mohammad Omar Faruk
- Department of Statistics, Noakhali Science and Technology University, Noakhali- 3814, Bangladesh
| | - Muhammad Abdus Salam
- Department of Management Information Systems, Noakhali Science and Technology University, Noakhali-3814, Bangladesh
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Gelaw KA, Atalay YA, Gebeyehu NA. Unintended pregnancy and contraceptive use among women in low- and middle-income countries: systematic review and meta-analysis. Contracept Reprod Med 2023; 8:55. [PMID: 37993927 PMCID: PMC10666441 DOI: 10.1186/s40834-023-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Unintended pregnancy is a leading cause of maternal mortality associated with abortion, inadequate contraceptive use, contraceptive failure, and contraceptive discontinuation in low- and middle-income countries. Most unintended pregnancies occur in regions with limited availability of maternal health services, resulting in a significant number of maternal deaths. Therefore, this review aimed to assess the overall prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries. METHOD PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University Online Library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked using forest plot, Begg rank test, and Egger regression test. To check for heterogeneity, I2 was calculated and an overall estimation analysis was performed. Subgroup analysis was conducted by study setting, study design, and publication. The Joanna Briggs Institute quality assessment tool was used to assess the quality of each study. We performed a one-time sensitivity analysis. RESULTS Of the 1304 articles retrieved, 23 studies (involving 40,338 subjects) met the eligibility criteria and were included in this study. The pooled prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries was 44.68% (95% CI: 35.16-54.20; I2 = 99.7%, P < 0.001). Based on subgroup analysis, the pooled prevalence of unintended events was 43.58% (CI: 32.99, 54.173) and 49.93% (CI: 28.298, 71.555) for cross-sectional and cohort studies, respectively. Based on the study design, it was 34.47% (CI: 27.012, 41.933) for community studies and 55.85% (CI: 33.364, 78.339) for institutional studies. CONCLUSION The overall prevalence of unintended pregnancy was high among women using contraceptives in low- and middle-income countries. Therefore, it is better to pay attention to prevention strategies for unintended pregnancy, such as information and education accessibility and contraceptive utilization.
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Affiliation(s)
- Kelemu Abebe Gelaw
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Tareke AA, Enyew EB, Dubale AT, Shimie AW, Kasaye MD, Eshetu HB. Determinants of change in unintended pregnancy in Ethiopia using the 2005 and 2016 EDHS: non-linear multivariable decomposition analysis. Arch Public Health 2022; 80:232. [DOI: 10.1186/s13690-022-00984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Unintended pregnancy is a pregnancy either mistimed or unwanted. The main consequence of unintended pregnancy is inducing abortion. In Ethiopia, more than half of unintended pregnancies end up in abortion.
Objective
This study aims to measure the change in unintended pregnancy among women of reproductive age between survey years 2005 and 2016 and to identify the socio-demographic factors that most significantly contributed to the change.
Methods
Data from the two most recent Ethiopian Demographic and Health Surveys (EDHS) were analyzed. We quantified the contribution of socio-demographic factors in the change of unintended pregnancy, using Oaxaca-Blinder decomposition for non-linear regression models by applying the STATA command ‘mvdcmp’.
Result
Unintended pregnancy decreased from 37% in 2005 to 27% in 2016 in Ethiopia. Both changes in population characteristics and coefficient were the contributing elements to the observed change in unintended pregnancy. Among population characteristics factors, being a partial decision-maker and being a slum in the Somali region contributed 10 and 14% to the change of unintended pregnancy between the 2005 and 2016. Of the coefficient factors, knowledge of modern family planning, being a partial decision-maker, media exposure, distance to health facilities, and health facility visits contributed to the change by 93, 43, 17, and 10% respectively.
Conclusion
The majority of the change in unintended pregnancy from 2005 to 2016 survey was due to differences in coefficients (85%). The principal contributing factors to the change of unintended pregnancy were FP knowledge, decision making, media exposure and health facility visits. Therefore, an interventional plan will be efficient, better, and more effective if focused on the larger contributing factors.
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Molla W, Hailemariam S, Mengistu N, Madoro D, Bayisa Y, Tilahun R, Wudneh A, Ayele GM. Unintended pregnancy and associated factors during COVID-19 pandemic in Ethiopia: Community-based cross-sectional study. WOMEN'S HEALTH 2022; 18:17455057221118170. [PMID: 35972047 PMCID: PMC9382576 DOI: 10.1177/17455057221118170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: The term ‘unintended pregnancy’ refers to a pregnancy that occurred when no children were desired or occurred earlier than desired. Unintended births account for one out of every three births in Ethiopia, and they are the leading cause of maternal morbidity and mortality. During the coronavirus disease (COVID-19) pandemic, this could be useful. COVID-19 has a significant impact on maternal health care utilization, including family planning services. As a result, this study aimed to assess unintended pregnancy and associated factors in Ethiopia during the COVID-19 pandemic. Method: A community-based cross-sectional study was conducted in Gedeo zone, Ethiopia, from April 1 to May 30, 2021. A simple random sampling technique was utilized to get 383 pregnant women from their respective kebeles. A structured questionnaire was used to collect data during a face-to-face interview. The data were coded, cleaned, and entered into Epidemiological Data Version 3.1 before being exported to the Statistical Package for Social Science Version 23.0 for analysis. A bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio, with a 95% confidence interval and a P value of 0.05%, was considered statistically significant. Result: A total of 383 pregnant women participated in the study, giving a response rate of 90.8%. During the COVID-19 pandemic, 140 (36.6%) participants stated that their current pregnancy was unintended. Unintended pregnancy was significantly associated with respondents’ age (adjusted odds ratio (AOR) = 5.214 (1.449–18.762)), primary decision maker for family planning services (AOR = 9.510 (5.057–17.887)), and fear of COVID-19 to visit a health care facility (AOR = 7.061 (2.665–18.710)). Conclusion: During the COVID-19 era, more than one-third of women had unintended pregnancies. Unintended pregnancy was significantly associated with respondents’ age, autonomy to use contraceptive methods, and fear of COVID-19, which required them to attend a health care institution.
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Affiliation(s)
| | | | | | - Derebe Madoro
- Department of Psychiatry, Dilla University, Dilla, Ethiopia
| | | | - Ruth Tilahun
- Department of Midwifery, Dilla University, Dilla, Ethiopia
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