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Rwebazibwa J, Migisha R, Munaru G, Byamukama O, Abesiga L, Mugyenyi GR, Kalyebara PK, Tibaijuka L, Ngonzi J, Kajabwangu R, Turanzomwe S, Mohammed F, Muhumuza J, Collins AD, Fajardo YT, Ssalongo WGM, Kayondo M, Kanyesigye H. Early contraceptive implant removal and associated factors among women attending public family planning clinics, Mbarara City, Southwestern Uganda: a cross-sectional study. Contracept Reprod Med 2024; 9:38. [PMID: 39080713 PMCID: PMC11289939 DOI: 10.1186/s40834-024-00299-3] [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: 04/27/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Early implant removal not only results in method wastage and strains healthcare resources but also exposes women to the risk of unplanned pregnancies and associated complications if an alternative contraceptive is not promptly adopted. Studies have demonstrated that prevalence and factors associated with contraceptive use vary across different cultures and regions even within Uganda. We determined the prevalence and associated factors of early implant removal, among women attending public family planning clinics in Mbarara City, southwestern Uganda. METHODS We conducted a cross-sectional study from April to July 2023 at four public family planning clinics in Mbarara City. We consecutively enrolled women and administered a questionnaire to obtain data on demographic, and medical characteristics. We defined early removal as implant discontinuation within a period < 2 years. We excluded women who did not have a written record of the date of insertion of the contraceptive implants. We used modified Poisson regression analysis to determine factors associated with early implant removal. RESULTS We enrolled 406 women, with a mean age of 29 ± 6 years. The prevalence of early contraceptive implant removal was 53% (n = 210; 95%, CI: 48-58%). Factors associated with early implant removal were experiencing side effects (adjusted prevalence ratio [aPR] = 1.63, 95% CI: 1.20-2.21), inserting an implant to achieve career goals (aPR = 1.88, 95% CI: 1.26-2.81) and intending to use the implant for < 24 months (aPR = 1.36, 95% CI: 1.11-1.66). CONCLUSION Approximately half of the surveyed women removed their contraceptive implant early. Women who experienced side effects, chose an implant due to career obligations and those whose intended implant use was < 2 years were more likely to have an early contraceptive implant removal compared to their counterparts. We recommend strengthening of pre- and post- insertion counselling to address concerns among those who may experience side-effects. Women who intend to use implants for < 2 years and those who have career obligations should be encouraged to use short-acting methods as an option.
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Affiliation(s)
- Joseph Rwebazibwa
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Richard Migisha
- Department of Physiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gideon Munaru
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Onesmus Byamukama
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Lenard Abesiga
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Godfrey R Mugyenyi
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Kato Kalyebara
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rogers Kajabwangu
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Stuart Turanzomwe
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fadumo Mohammed
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Agaba David Collins
- Department of Physiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Tornes Fajardo
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Wasswa G M Ssalongo
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hamson Kanyesigye
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Klu D, Odame ML, Asante PY, Dansu CA. Determinants of men's perspectives on women contraceptive use in Ghana: an analysis of the 2022 Ghana demographic and health survey. Contracept Reprod Med 2024; 9:35. [PMID: 39049061 PMCID: PMC11271215 DOI: 10.1186/s40834-024-00300-z] [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: 04/26/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Male dominance in reproductive health decision-making, specifically regarding family planning and contraceptive use among women, has been argued to have a significant influence on Africa's fertility transition. However, there is a paucity of research evidence on the extent to which men influence contraceptive adoption and the factors shaping their perspectives on contraceptive use among women in Ghana. This study aims to examine the factors influencing men's perspectives on women's contraceptive use in Ghana. METHODS Data for this study was obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 7,044 men aged 15-59 was extracted from the men's data file. Data was analyzed with SPSS version 27, employing both descriptive and binary logistics regression modeling. Statistical significance was set at p < 0.05. RESULTS The results indicate that 63% of men disagreed with the opinion that contraception is solely a woman's concern, while 59% agreed with the view that contraceptive use encourages promiscuity among women. With factors that significantly influence men's opinion on contraception being solely a woman's concern, men with secondary (aOR = 0.69; C.I: 0.57-0.82) and higher education, residing in urban areas, belonging to other Christian faiths, Ga/Dangme, Ewe, and Mole-Dagbani men were less likely to agree with such opinions. Conversely, men dwelling in the Coastal zones were more likely to agree with that view. Men exposure to FP messages on radio and during community durbars had higher odds of agreeing with that opinion. Regarding the factors influencing men's perspective on the perception that contraceptive use by women encourages promiscuity, men who are 20-24 (aOR = 1.51; C.I:1.12-2.03) and 35-39 years in Coastal and Middle Belt zones, cohabiting and formerly married men were more likely to agree with such opinions. Conversely, men with higher educational levels, in urban areas and unemployed had lower odds to agreeing with such perception. CONCLUSIONS The study underscores the importance of men's socio-demographic characteristics and their exposure to FP messages in shaping their perspectives on women's contraceptive use. Policy implications highlight the need to involve men in promoting safe sexual and reproductive health practices.
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Affiliation(s)
- Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | - Michael Larbi Odame
- Department of Sustainable Development and Policy, University of Environment and Sustainable Development, Somanya, Ghana
| | - Paapa Yaw Asante
- Mental Health Unit, Family and Community Health Department, University of Health and Allied Sciences, Ho, Ghana
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Buser JM, Pebolo PF, August E, Rana GK, Gray R, Jacobson-Davies FE, Kumakech E, Endale T, Auma AG, Smith YR. Scoping review of qualitative studies on family planning in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003313. [PMID: 38959214 PMCID: PMC11221757 DOI: 10.1371/journal.pgph.0003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/11/2024] [Indexed: 07/05/2024]
Abstract
Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.
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Affiliation(s)
- Julie M. Buser
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Pebalo F. Pebolo
- Department Reproductive Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Ella August
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- PREPSS (Pre-Publication Support Service), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gurpreet K. Rana
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel Gray
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Faelan E. Jacobson-Davies
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Edward Kumakech
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Tamrat Endale
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna Grace Auma
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Yolanda R. Smith
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Badri D, Krumeich A, van den Borne HW. Fertility intentions and family size among married men in Khartoum, Sudan. CULTURE, HEALTH & SEXUALITY 2024; 26:968-977. [PMID: 37772610 DOI: 10.1080/13691058.2023.2260453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
Numerous factors contribute to high fertility within a specific context some of which are related to women's fertility practices. What has been less frequently examined, however, is how men's preferences and behaviours contribute to high fertility rates. This is imperative in a country such as Sudan which has reported continuously high fertility rates. This study aimed to analyse the socio-cultural factors affecting husbands' preferences and behaviours contributing to high fertility in Sudan. Participants were recruited from the Fertility and Reproductive Health Services Centre in Khartoum and Ahfad Family Health Centre in Omdurman city. Qualitative interviews were used to examine men's fertility preferences and behaviours. The main study findings suggest that husband's fertility preferences and the desire for a large family were prominent, being determined by local socio-cultural factors and religious norms. The data presented offers insight into key factors sustaining high fertility.
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Affiliation(s)
- Dina Badri
- Department of Organisational Management, Ahfad University for Women, Omdurman, Sudan
| | - Anja Krumeich
- Department of Health, Ethics and Society, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - H W van den Borne
- Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Bukuluki P, Okwii M, Hoffmann K, Pavin M. Using Vignettes to Gain Insights Into Social Norms Related to Voluntary Family Planning and Gender-Based Violence in South Sudan. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300489. [PMID: 38906554 PMCID: PMC11216705 DOI: 10.9745/ghsp-d-23-00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/14/2024] [Indexed: 06/23/2024]
Abstract
Social norms are the shared expectations about behaviors that are held within collective groups. These differ from attitudes and beliefs, which are individually held. In South Sudan, social norms can affect the use of voluntary family planning and reproductive health (FP/RH); some of these norms even present risks for women seeking FP/RH care and their FP/RH providers. This cross-sectional, descriptive study conducted in 5 counties in South Sudan used vignettes as a qualitative method to explore social norms related to FP/RH and decisions related to contraceptive use and gender-based violence. Participants were asked to respond to vignettes about a fictional couple during various life stages of care-seeking. Vignettes allow respondents to share their opinions and feelings without directly speaking about their own experiences. Respondents included community members, FP/RH providers, and key influencers (e.g., religious leaders, traditional leaders, elders). The study identified restrictive social norms related to FP/RH, including entrenched, dominant gender roles (i.e., requiring male consent to use contraceptives) and risk for the woman and her provider if she accesses FP/RH services. Of note, supportive social norms are gaining acceptance regarding women's voice and agency; it was found that some women can negotiate their reproductive choice with their partners and participate in planning their families, which has not always been a widely accepted norm. The use of vignettes can lead to a better understanding of the challenges and provide insights on effective implementation approaches. It is essential for programs working to promote the use of FP/RH services in South Sudan to consider the challenges presented by social norms. Findings from this study were shared with stakeholders and communities to codesign interventions aimed at increasing the use of FP/RH services. Additionally, the dialogue stimulated by this study should lead to an organic transformation toward supportive social norms through collective agency.
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Affiliation(s)
| | | | - Kamden Hoffmann
- MOMENTUM Integrated Health Resilience, IMA World Health, Washington, DC, USA
| | - Melinda Pavin
- MOMENTUM Integrated Health Resilience, John Snow, Inc., Washington, DC, USA.
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Sileo KM, Muhumuza C, Tuhebwe D, Muñoz S, Wanyenze RK, Kershaw TS, Sekamatte S, Lule H, Kiene SM. "The burden is upon your shoulders to feed and take care of your children, not religion or culture": qualitative evaluation of participatory community dialogues to promote family planning's holistic benefits and reshape community norms on family success in rural Uganda. Contracept Reprod Med 2024; 9:28. [PMID: 38835058 PMCID: PMC11149320 DOI: 10.1186/s40834-024-00290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Family planning has significant health and social benefits, but in settings like Uganda, is underutilized due to prevalent community and religious norms promoting large family size and gender inequity. Family Health = Family Wealth (FH = FW) is a multi-level, community-based intervention that used community dialogues grounded in Campbell and Cornish's social psychological theory of transformative communication to reshape individual endorsement of community norms that negatively affect gender equitable reproductive decision-making among couples in rural Uganda. METHODS This study aimed to qualitatively evaluate the effect of FH = FW's community dialogue approach on participants' personal endorsement of community norms counter to family planning acceptance and gender equity. A pilot quasi-experimental controlled trial was implemented in 2021. This paper uses qualitative, post-intervention data collected from intervention arm participants (N = 70) at two time points: 3 weeks post-intervention (in-depth interviews, n = 64) and after 10-months follow-up (focus group discussions [n = 39] or semi-structured interviews [n = 27]). Data were analyzed through thematic analysis. RESULTS The community dialogue approach helped couples to reassess community beliefs that reinforce gender inequity and disapproval of family planning. FH = FW's inclusion of economic and relationship content served as key entry points for couples to discuss family planning. Results are presented in five central themes: (1) Community family size expectations were reconsidered through discussions on economic factors; (2) Showcasing how relationship health and gender equity are central to economic health influenced men's acceptance of gender equity; (3) Linking relationship health and family planning helped increase positive attitudes towards family planning and the perceived importance of shared household decision-making to family wellness; (4) Program elements to strengthen relationship skills helped to translate gender equitable attitudes into changes in relationship dynamics and to facilitate equitable family planning communication; (5) FH = FW participation increased couples' collective family planning (and overall health) decision-making and uptake of contraceptive methods. CONCLUSION Community dialogues may be an effective intervention approach to change individual endorsement of widespread community norms that reduce family planning acceptance. Future work should continue to explore innovative ways to use this approach to increase gender equitable reproductive decision-making among couples in settings where gender, religious, and community norms limit reproductive autonomy. Future evaluations of this work should aim to examine change in norms at the community-level. TRIAL REGISTRATION Clinicaltrials.gov (NCT04262882).
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, 30A Plot, 30A York Terrace, Kampala, Uganda
| | - Doreen Tuhebwe
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Health Policy Planning and Management, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Rhoda K Wanyenze
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavioral Science, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Samuel Sekamatte
- Butambala District Health Department, Gombe Hospital, Gombe, Uganda
| | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
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Wambete SN, Serwaa D, Dzantor EK, Baru A, Poku-Agyemang E, Kukeba MW, Bashiru Y, Olayemi OO. Determinants for male involvement in family planning and contraception in Nakawa Division, Kampala, Uganda; An urban slum qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003207. [PMID: 38820444 PMCID: PMC11142587 DOI: 10.1371/journal.pgph.0003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/15/2024] [Indexed: 06/02/2024]
Abstract
Current evidence shows that male involvement in family planning (FP) is crucial to women's contraceptive use decisions. This study explored the reasons for male involvement in FP and contraception in slum areas in Nakawa Division, Kampala, Uganda. A qualitative study was conducted among sexually active males in a slum area in Nakawa Division, Kampala. A purposive sampling technique was utilised to recruit 40 men for a Focus Group Discussion (FGDs), and 2 key informants (KI) for critical perspective interviews. A semi-structured FGDs and interview guides were used to collect the data. The FGDs were conducted in both English and the local language, Luganda. All interviews were recorded and transcribed verbatim. Transcripts for both FGDs and KI interviews were imported into the NVivo Qualitative Data Analysis Software version 10 application, and thematic data analysis was conducted. The findings show that males' involvement in FP and its decisions were minimal. The findings also show that several factors emerged as contributing to male's participation in FP and utilisation of contraceptives. Inadequate understanding of FP and contraceptives, lack of clarity on males' role in FP, unfriendly healthcare environment and community members' perceptions of male involvement in FP were reported as reasons contributing to male participation in FP and contraction. There is limited involvement of males in FP. There is a need for renewed efforts that will positively alter the factors that impact male involvement favourably. Promotion and education about FP for males will significantly address issues of limited understanding and clarity of males' role in FP services.
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Affiliation(s)
- Sarah Namee Wambete
- Faculty of Public Health, Department of Public Health, Nursing and Midwifery, Save The Mothers East Africa, Uganda Christian University, Mukono, Uganda
- Slum and Rural Health Initiative Network/Uganda, Kampala, Uganda
| | - Dorcas Serwaa
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
| | - Edem Kojo Dzantor
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Research and Innovation Unit, College of Nursing and Midwifery, Nalerigu, North-East Region, Ghana
| | - Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
- Slum and Rural Health Initiative Network/Ethiopia, Addis Ababa, Ethiopia
| | - Evelyn Poku-Agyemang
- Department of Nursing and Midwifery, Methodist Health Training Institute, Afosu, Eastern Region, Ghana
| | - Margaret Wekem Kukeba
- Department of Nursing, School of Nursing and Midwifery, CKT-University of Technology and Applied Sciences, Navrongo, Upper-East Region, Ghana
| | - Yussif Bashiru
- Department of Nursing and Midwifery, Methodist Health Training Institute, Afosu, Eastern Region, Ghana
| | - Oladapo O. Olayemi
- Faculty of Clinical Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Bwire A, Sama DJ, Mirano J, Nyachae P, Owino K, Nabukeera J, Tumuhairwe J, Malik M, Salas I, Mitchell V, Bose K. Boosting Contraceptive Uptake in Urban Uganda: Older Women Benefit When Layering Adolescent and Youth Interventions Onto Existing Family Planning Programming. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200308. [PMID: 38641402 PMCID: PMC11111102 DOI: 10.9745/ghsp-d-22-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Uganda has a large young population with a high unmet need for family planning (FP). Although there have been many efforts to improve access to and uptake of contraception, improvements have been slow. The Ministry of Health Uganda partnered with The Challenge Initiative (TCI) to implement a novel multipronged approach layering adolescent and youth sexual reproductive health (AYSRH) onto a functioning general FP program for women of reproductive age in 3 local governments of Buikwe, Mukono, and Iganga. We describe the approach and aim to determine whether layering AYSRH interventions onto an existing program resulted in increased contraceptive uptake among adolescents and youth aged 10-24 years and among women aged 25-49 years. METHODS We analyzed service statistics from the Uganda Health Management Information System to assess contraceptive uptake for adolescents and youth (aged 10-24 years) and older women (aged 25-49 years) before and after the implementation of the AYSRH approach in 3 areas (Buikwe, Iganga, and Mukono) compared to 11 areas where only the general FP program was implemented and the Uganda country total. RESULTS This analysis showed that before the start of TCI's support, levels of contraceptive uptake were similar in all local governments. However, after implementation, there was an increase in uptake for general FP program only areas (1.7-point advantage over country total) and an even greater increase in general FP+AYSRH areas (2.4-point advantage over FP only programming). This was observed in both adolescents and youth aged 10-24 years and among women aged 25-49 years. CONCLUSION The layering of TCI's AYSRH interventions onto a well-functioning FP platform not only increased contraceptive uptake among adolescents and youth aged 10-24 years but also boosted uptake among women older than age 25 years.
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Affiliation(s)
| | | | - Jessica Mirano
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | | | | | | | | | - Maheen Malik
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Ian Salas
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Vanessa Mitchell
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Krishna Bose
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
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Kananura RM, Birabwa C, Ssanyu JN, Kizito F, Kagaha A, Namutanba S, Kyangwa M, Kakaire O, Waiswa P. Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol. PLoS One 2024; 19:e0293351. [PMID: 38728317 PMCID: PMC11086862 DOI: 10.1371/journal.pone.0293351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/26/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?" METHODS We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why. DISCUSSION Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context. REGISTRATION This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).
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Affiliation(s)
- Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Birabwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Jacquellyn Nambi Ssanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Alexander Kagaha
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- Busoga Health Forum, Jinja, Uganda
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10
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Opiro K, Opee J, Sikoti M, Pebalo PF, Ayikoru JH, Akello H, Manano P, Bongomin F. Utilization of modern contraceptives among female health care workers at Gulu university teaching hospitals in Northern Uganda. Contracept Reprod Med 2024; 9:13. [PMID: 38582918 PMCID: PMC10998388 DOI: 10.1186/s40834-024-00274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND The global high rate of unintended pregnancy is a direct result of underutilization of contraceptives methods. Healthcare workers (HCWs) play a pivotal role in promoting and facilitating access to modern family planning services. By examining the extent to which healthcare providers practice what they preach, this research aimed to shed light on the prevalence and factors associated with modern contraceptive use among female HCW at two university teaching hospitals in northern Uganda. METHODS A cross-sectional survey was conducted among qualified female healthcare workers (FHCWs) at Gulu Regional Referral Hospital (GRRH) and St. Mary's Hospital-Lacor in Gulu, Uganda. Convenient consecutive sampling was used to enroll study participants. Linear regression analysis was employed to determine factors independently associated with modern contraceptive use. P < 0.005 was considered statistically significant. RESULTS We enrolled 201 female HCWs, with a median age 31 (interquartile range: 27-38) years. Overall, 15 (7.5%, 95% Confidence Interval [CI]: 4.4 -11.1) participants utilized modern methods of family planning in the last 3 months while lifetime use was at 73.6% (n = 148, 95%CI: 67.3 - 79.4%). Most common method utilized was intra-uterine devices [IUDs] (51%, n = 76), followed by sub-dermal implants (15.4%, n = 23). Eighty-five (42.3%, n = 85) participants had desire to get pregnant. Factors independently associated with utilization of modern methods contraceptives were working at GRRH (adjusted odds ratio (aOR): 5.0, 95% CI: 1.59 - 10.0, p = 0.003), and being single (aOR: 3.3, 9%CI: 1.02 -10.57, p = 0.046). CONCLUSIONS Utilization of modern methods of contraceptive among female HCWs in this study is lower than the Uganda national estimates for the general female population. Most utilized method is IUDs followed by sub-dermal implants. More studies are recommended to see if this finding is similar among FHCWs in other regions of Uganda and the rest of Africa while also considering Male Healthcare Workers.
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Affiliation(s)
| | - Jimmy Opee
- Gulu University, Gulu, P. O. Box 166, Uganda
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11
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Memon Z, Mian A, Ahmed W, Jawwad M, Muhammad S, Noorani AQ, Bhutta Z, Soltani H. Predictors of voluntary uptake of modern contraceptive methods in rural Sindh, Pakistan. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002419. [PMID: 38574040 PMCID: PMC10994370 DOI: 10.1371/journal.pgph.0002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
The use of modern contraceptive methods (MCMs) has been stagnant for the last decade in Pakistan. The second most populous province, Sindh reports 25% of MCMs use. Various factors including demographics and health services utilization are associated with the uptake of family planning services. This research aimed to identify and assess specific predictors of MCMs among women aged 15-49 in two districts of Sindh-Matiari and Badin. A cross-sectional household survey was conducted from October 2020- December 2020. In total, 1684 Married Women of Reproductive Age (MWRA) 15-49 years were interviewed. For the selection of eligible respondents, a two-stage stratified cluster sampling strategy was used. Univariate and multivariable logistic regression was used to determine the predictors for the use of MCM. Use of modern methods of contraceptive was 26.1% (n = 441). Statistically significant socio demographic predictors of MCM included: number of children 4 or more (AOR: 5.23; 95%CI: 2.78-9.84), mother having primary education (AOR: 1.73; 95% CI: 1.26-2.36), and husband having middle education (AOR: 1.69; 95% CI: 1.03-2.76). Maternal health services indicators included: postnatal care of mother (AOR: 1.46; 95% CI: 1.09-2.05); women who were visited by Lady Health Workers in their postnatal period and were counselled on family planning (AOR: 1.83; 95% CI: 1.38-2.42). Since the primary purpose of using modern contraceptive methods is for limiting pregnancies, there is a potential to promote awareness about the benefits of birth spacing as part of implementing a more integrated approach to family planning. The integration of family planning services within maternal and newborn child healthcare services effectively promote the voluntary adoption of modern contraceptive methods. The role of Lady Health Workers in family planning counseling and service provision and uptake is important in the context of Sindh and should be fostered further by opportunities for capacity building and their empowerment.
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Affiliation(s)
| | | | | | | | | | | | | | - Hora Soltani
- Sheffield Hallam University, Sheffield, England, United Kingdom
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12
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Namuhani N, Wanyenze RK, Kiwanuka SN, Matovu JKB, Makumbi FE. Equity in family planning policies and programs in Uganda: conceptualization, dimensions and implementation constraints. Int J Equity Health 2024; 23:50. [PMID: 38468272 DOI: 10.1186/s12939-024-02143-1] [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: 07/02/2022] [Accepted: 03/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Equity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper aims to document the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda. METHODS A review of Ugandan literature and key informant interviews with 25 key stakeholders on equity in FP was undertaken between April and July 2020. We searched Google, Google Scholar and PubMed for published and grey literature from Uganda on equity in FP. A total of 112 documents were identified, 25 met the inclusion criteria and were reviewed. Data from the selected documents were extracted into a Google master matrix in MS Excel. Data analysis was done across the thematic areas by collating similar information. Data were analyzed using thematic content analysis approach. RESULTS A limited number of documents had an explicit definition of equity, which varied across documents and stakeholders. The definitions revolved around universal access to FP information and services. There was a limited focus on equity in FP programs in Uganda. The dimensions most commonly used to assess equity were either geographical location, or socio-demographics, or wealth quintile. Almost all the key informants noted that equity is a very important element, which needs to be part of FP programming. However, implementation constraints (e.g. lack of quality comprehensive FP services, duplicated FP programs and a generic design of FP programs with limited targeting of the underserved populations) continue to hinder effective implementation of equitable FP programs in Uganda. Clients' constraints (e.g. limited contraceptive information) and policy constraints (inadequate focus on equity in policy documents) also remain key challenges. CONCLUSIONS There is lack of a common understanding and definition of equity in FP programs in Uganda. There is need to build consensus on the definitions and measurements of equity with a multidimensional lens to inform clear policy and programming focus on equity in FP programs and outcomes. To improve equitable access to and use of FP services, attention must be paid to addressing implementation, client and policy constraints.
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Affiliation(s)
- Noel Namuhani
- Department of Health Policy Planning and Management , Makerere University School of Public Health, P. BOX 7072, Kampala, Uganda.
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy Planning and Management , Makerere University School of Public Health, P. BOX 7072, Kampala, Uganda
| | - Joseph K B Matovu
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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Kabagenyi A, Wasswa R, Kayemba V. Multilevel mixed effects analysis of individual and community factors associated with unmet need for contraception among married women in four East African countries. SSM Popul Health 2024; 25:101602. [PMID: 38375320 PMCID: PMC10875291 DOI: 10.1016/j.ssmph.2024.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
Background Despite the use of contraceptives being an expression of a woman's reproductive control, the prevalence of unmet need remains high and a public concern among married women in East Africa. However, limited literature has explored the associated factors in the region. We live in age of leaving no one behind unfortunately many women still have unmet for family planning todate. This study therefore intends to examine the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda. Methods The study utilizes data from the four recent demographic and health surveys for Burundi, Rwanda, Tanzania and Uganda. Analyses were conducted using multilevel mixed effects logistic regressions with random community and country level effects. Results are reported using predictive probabilities and margins. Results This study revealed that: 20%, 22%, 28% and 33% of the married women in Tanzania, Uganda, Rwanda and Burundi respectively had unmet need for contraception. Younger women, and those: without formal education, from the poorest households, had ever experienced child loss, whose husbands desire more children than them, and have no access to family planning messages faced a higher probability of unmet need for contraception. This was also true for women living in communities with low usage of modern contraception and those in communities where there is an increasing number of children per woman. Conclusions The findings reiterate the need for family planning efforts to focus on younger women. Additionally, improved education, economic empowerment, calls for spousal involvement in family planning matters, support for those with child loss, and comprehensive awareness initiatives remain vital to tackling unmet need for contraception.
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Affiliation(s)
- Allen Kabagenyi
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - Ronald Wasswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
- Center of Excellence for Maternal and Newborn Health, Makerere University School of Public Health, New Mulago Complex, Makerere University, Kampala, Uganda
| | - Vincent Kayemba
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Bapolisi WA, Makelele J, Ferrari G, Kono-Tange L, Bisimwa G, Schindler C, Merten S. Engaging men in women's empowerment: impact of a complex gender transformative intervention on household socio-economic and health outcomes in the eastern democratic republic of the Congo using a longitudinal survey. BMC Public Health 2024; 24:443. [PMID: 38347559 PMCID: PMC10863082 DOI: 10.1186/s12889-024-17717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men's sensitization on gender equity and women's empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level. OBJECTIVE This study assessed how involving men in gender equity affects women's health and socio-economic outcomes, including food security. METHODS A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run. RESULTS Results showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women's participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple's cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area. CONCLUSION Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women's participation in decision-making and social cohesion.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Université Catholique de Bukavu, Democratic Republic of the Congo, Bukavu, Sud-Kivu, Democratic Republic of the Congo.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Jean Makelele
- CARE International, Goma, Democratic Republic of the Congo
| | - Giovanfrancesco Ferrari
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ghislain Bisimwa
- Université Catholique de Bukavu, Democratic Republic of the Congo, Bukavu, Sud-Kivu, Democratic Republic of the Congo
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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15
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Abdi B, Okal J, Serour G, Were V, Temmerman M, Gichangi P. Pattern and determinants of contraceptive use among the muslim women in Wajir and Lamu counties in Kenya: a cross-sectional study. BMC Womens Health 2024; 24:53. [PMID: 38238713 PMCID: PMC10795387 DOI: 10.1186/s12905-024-02892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Improving access to family planning (FP) is associated with positive health benefits that includes averting nearly a third of all maternal deaths and 10% of childhood deaths. Kenya has made great strides in improving access to family planning services. However, amid this considerable progress, regional variation has been noted which begs the need for a clearer understanding of the the patterns and determinants that drive these inconsistencies. METHODS We conducted a cross-sectional study that involved 663 Muslim women of reproductive age (15-49 years) from Wajir and Lamu counties in Kenya between March and October 2018.The objective of this study was to understand patterns and determinants of contraceptive use in two predominantly Muslim settings of Lamu and Wajir counties that have varying contraceptive uptake. Eligible women were interviewed using a semi-structured questionnaire containing socio-demographic information and history of family planning use. Simple and multiple logistic regression were used to identify determinants of family planning use. The results were presented as Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) ratios at 95% confidence interval. A p-value of 0.05 was considered statistically significant. RESULTS Of the 663 Muslim women of reproductive age consenting to participate in the study, 51.5%, n = 342 and 48.5%, n = 321 were from Lamu and Wajir County, respectively. The prevalence of women currently using contraceptive was 18.6% (n = 123). In Lamu, the prevalence was 32.8%, while in Wajir, it was 3.4%. The determinants of current contraceptive use in Lamu include; marital status, age at marriage, employment status, discussion with a partner on FP, acceptability of FP in culture, and willingness to obtain information on FP. While in Wajir, determinants of current contraceptive use were education, and the belief that family planning is allowed in Islam. CONCLUSIONS Our study found moderately high use of contraceptives among Muslim women of reproductive age in Lamu county and very low contraceptive use among women in Wajir. Given the role of men in decision making, it is critical to design male involvement strategy particularly in Wajir where the male influence is very prominent. It is critical for the government to invest in women and girls' education to enhance their ability to make informed decisions; particularly in Wajir where FP uptake is low with low education attainment. Further, our findings highlight the need for culturally appropriate messages and involvement of religious leaders to demystify the myths and misconception around family planning and Islam particularly in Wajir.
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Affiliation(s)
- Batula Abdi
- United Nations Population Fund, Uganda Country Office, Kampala, Uganda.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Gamal Serour
- International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt
| | - Vincent Were
- Data Synergy and Evaluation unit, African Population and Health Research Center Nairobi, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Hylkema R, Ilozumba O. Male engagement in family planning: the role of faith leaders in urban West Africa. J Public Health (Oxf) 2023; 45:1056-1059. [PMID: 37460406 PMCID: PMC10687861 DOI: 10.1093/pubmed/fdad112] [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: 07/26/2022] [Revised: 05/31/2023] [Accepted: 06/23/2023] [Indexed: 12/02/2023] Open
Abstract
Sustainable Development Goal 3 aims to improve access to modern contraceptives and inform and educate people on family planning (FP). However, contraceptive use among women of reproductive age in West Africa is low at approximately 20%. One related factor is the limited engagement of males in FP decision-making. Addressing this issue requires a multiplicity of approaches, including the engagement of faith leaders. Faith leaders are often trusted by their congregants and could be an avenue to promoting male involvement in FP. In this report, we discuss the role of faith leaders in two West African countries, Nigeria and Ghana. We conducted 11 in-depth interviews with faith leaders in Nigeria and Ghana. Our exploratory findings indicate that faith leaders seem to have adequate knowledge and a positive perspective on male engagement and FP. In addition, the relationship of trust faith leaders maintain with their congregants is valuable in educating or counselling congregants on male engagement and FP.
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Affiliation(s)
- Renske Hylkema
- Athena Institute, Vrije Universiteit, Amsterdam, 1081 HV, the Netherlands
| | - Onaedo Ilozumba
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Muhumuza C, Sileo KM, Wanyenze RK, Kershaw TS, Lule H, Sekamatte S, Kiene SM. Development of a multi-level family planning intervention for couples in rural Uganda: key findings & adaptations made from community engaged research methods. BMC Womens Health 2023; 23:545. [PMID: 37865746 PMCID: PMC10590522 DOI: 10.1186/s12905-023-02667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/21/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Uganda has among the highest fertility rates in the world and multi-level barriers contribute to the low contraceptive use. OBJECTIVE The objective of this study was to develop a culturally and socially relevant, community-based intervention to increase contraceptive use among couples in rural Uganda through community-engaged research methods. This study reports on the community-engaged research that informed the intervention's content and structure and the final content of the intervention; the evaluation of the pilot intervention will be reported upon completion. METHODS An intervention steering committee of community stakeholders reviewed the initially proposed intervention content and approach. Four (4) gender-segregated focus groups were conducted with twenty-six (26) men and women who had an unmet need for family planning. Fifteen key-informant interviews were conducted with community leaders and family planning stakeholders. Finally, the 4-session intervention was pilot tested with a cohort of couples (N = 7) similar in demographics to the target sample of the future pilot intervention trial. Qualitative data were analyzed thematically. RESULTS Findings included the identification of community beliefs to reshape in order to increase family planning acceptance, as well as strategies to engage men, acceptable approaches for community leader involvement in the intervention to endorse family planning, and methods for managing gender dynamics and minimizing risk of unintended negative consequences of participation. The findings were used to inform the ideal structure and format of the intervention, including the distribution of contraceptives directly during group sessions, and identified the need to strengthen health worker capacity to provide Long-Acting Reversable Contraceptives (LARCs) as part of the intervention. CONCLUSIONS These findings were used to refine an intervention before a larger scale pilot test of its feasibility, acceptability, and potential efficacy. They can inform other multi-level family planning interventions in similar settings and the methods can be adopted by others to increase the feasibility, acceptability, and cultural relevance of interventions.
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Affiliation(s)
- Christine Muhumuza
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
| | - Katelyn M Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Haruna Lule
- Gombe Hospital, Butambala Local Government, Kayenje, Uganda
| | | | - Susan M Kiene
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
- School of Public Health, San Diego State University, San Diego, USA
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Mare KU, Sabo KG, Mohammed AA, Leyto SM, Mulaw GF, Tebeje TM, Aychiluhm SB, Ebrahim OA, Wuneh AG, Seifu BL. Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression. Reprod Health 2023; 20:132. [PMID: 37667285 PMCID: PMC10476311 DOI: 10.1186/s12978-023-01678-w] [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: 04/23/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Despite the availability of exempted family planning services, a significant proportion of women in African countries continue to experience inadequately spaced pregnancies. To the authors' knowledge, evidence of suboptimal birth intervals at the SSA level is lacking and previous studies have been limited to specific geographic area. Therefore, this analysis was aimed to estimate the pooled prevalence of suboptimal birth spacing and its predictors among childbearing women in SSA. METHODS Pooled DHS data from 35 SSA countries were used and a weighted sample of 221,098 reproductive-age women was considered in the analysis. The survey across all countries employed a cross-sectional study design and collected data on basic sociodemographic characteristics and different health indicators. Forest plot was used to present the overall and country-level prevalence of suboptimal birth spacing. Multilevel mixed-effects models with robust Poisson regression were fitted to identify the predictors of suboptimal birth spacing. Akaike's and Bayesian information criteria and deviance were used to compare the models. In a multivariable regression model, a p-value less than 0.05 and an adjusted prevalence ratio with the corresponding 95% CI were used to assess the statistical significance of the explanatory variables. RESULTS The pooled prevalence of suboptimal birth spacing among women in SSA was 43.91% (43.71%-44.11%), with South Africa having the lowest prevalence (23.25%) and Chad having the highest (59.28%). It was also found that 14 of the 35 countries had a prevalence above the average for SSA. Rural residence [APR (95% CI) = 1.10 (1.12-1.15)], non-exposure to media [APR (95% CI) = 1.08 (1.07-1.11)], younger maternal age [APR (95% CI) = 2.05 (2.01-2.09)], non-use of contraception [APR (95% CI) = 1.18 (1.16-1.20)], unmet need for family planning [APR (95% CI) = 1.04 (1.03-1.06)], higher birth order [APR (95% CI) = 1.31 (1.28-1.34)], and desire to have at least six children [APR (95% CI) = 1.14 (1.13-1.16)] were the predictors of suboptimal birth spacing practice. CONCLUSION More than four out of ten reproductive-age women in SSA countries gave birth to a subsequent child earlier than the recommended birth spacing, with considerable variations across the countries. Thus, interventions designed at enhancing optimal birth spacing should pay particular attention to young and socioeconomically disadvantaged women and those residing in rural regions. Strengthening community health programs and improving accessibility and availabilities of fertility control methods that ultimately impacts optimal reproductive behaviors is crucial to address contraceptive utilization and unmet need.
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Affiliation(s)
- Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia.
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Ahmed Adem Mohammed
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Simeon Meskele Leyto
- Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Getahun Fentaw Mulaw
- School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Setognal Birara Aychiluhm
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Oumer Abdulkadir Ebrahim
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Abel Gebre Wuneh
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Fortin G, Gagnon-Dufresne MC, Bunkeddeko K, Muwereza J, Zinszer K. Barriers to family planning through structural health vulnerabilities: findings from case studies from rural Uganda. CULTURE, HEALTH & SEXUALITY 2023; 25:1070-1083. [PMID: 36153729 DOI: 10.1080/13691058.2022.2122571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
The burden of maternal mortality in sub-Saharan Africa is the highest in the world. As high fertility rates present an increased risk to women's health, programmes and services have been put in place to increase access to family planning. Several studies have identified sociocultural factors as limiting access to family planning, including male resistance and women's low decision-making power. However, these studies have often used a behavioural approach that anchors barriers to access in women's attitudes or motivations. In 2019, a qualitative evaluation of a family planning programme using a behavioural approach was conducted in rural Uganda, focusing on women's attitudes and unmet needs. With hindsight, we realised that our evaluation was insufficient to adequately capture barriers that extend beyond women's motivations. This paper shares three case studies that we analysed using a structural health vulnerabilities approach. Our analysis highlights political, economic, social and cultural structures that can impede access to family planning. Using a structural health vulnerabilities approach, we identify structural barriers which have their roots in the local realities women face and propose context-specific structural recommendations. Finally, we contrast our initial results with findings the case studies presented to highlight the relevance of taking structural vulnerabilities into account in future family planning programme evaluation and women's sexual and reproductive health studies.
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Affiliation(s)
- Geneviève Fortin
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
| | - Marie-Catherine Gagnon-Dufresne
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
| | | | | | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
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Muluneh MD, Francis L, Agho K, Stulz V. The association of intimate partner violence and contraceptive use: a multi-country analysis of demographic and health surveys. Int J Equity Health 2023; 22:75. [PMID: 37101283 PMCID: PMC10134549 DOI: 10.1186/s12939-023-01884-9] [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: 03/17/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause of poor health, disability, and death among women of reproductive age. However, the existing studies about the association between IPV and contraceptive use have been found to be conflicting and relatively less studied, particularly in low and middle income countries, including Eastern Sub Saharan Africa (SSA). This study examines the relationship between IPV and contraceptive use in Eastern SSA countries. METHODS The Demographic and Health Surveys (DHS) from 2014 to 2017 were a multi-stage cluster sample survey of 30,715 ever married (or cohabitating) women of reproductive age from six countries. The six Eastern SSA datasets were pooled and multivariable logistic regression using a hierarchical approach was performed to examine the association between IPV and contraceptive use after adjusting for women, partners, and household and health facility factors. RESULT Two thirds of women 67% [66.55, 67.88] were not using any modern contraceptive methods and almost half (48%) of the women had experienced at least one form of IPV from their partners. Our analysis showed a strong association with decreased odds of physical violence [adjusted odds ratios (aOR) = 0.72, 95%CI: 0.67, 0 0.78] among women not using any contraceptive methods. Other factors associated with women not using any contraceptive methods were older women (35-49 years), illiterate couples and women from poorest households. Women who had no access to any form of communication [aOR = 1.12, 95%CI: 1.08, 1.36], unemployed partner [aOR = 1.55, 95%CI: 1.23, 1.95] and women who travelled long distances to access health services [aOR = 1.16, 95%CI: 1.06, 1.26] significantly reported increased odds of not using any contraceptive methods. CONCLUSION Our study indicated that physical violence was negatively associated with not using any contraceptive method among married women in Eastern SSA countries. Tailored intervention messages to reduce IPV including physical violence among women not using contraceptive methods in East Africa should target those from low-socioeconomic groups especially, older women with no access to any form of communication, unemployed partners, and illiterate couples.
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Affiliation(s)
- Muluken Dessalegn Muluneh
- Amref Health Africa in Ethiopia, Addis Ababa 17022, Bole Sub, Ethiopia.
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, 2751, Australia.
| | - Lyn Francis
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, 2751, Australia
| | - Kingsley Agho
- School of Health Sciences, Western Sydney University, Locked Bag1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Virginia Stulz
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Jalinga Vuamaiku G, Epuitai J, Andru M, Aleni M. “I Don’t Support It for My Children”: Perceptions of Parents and Guardians regarding the Use of Modern Contraceptives by Adolescents in Arua City, Uganda. Int J Reprod Med 2023; 2023:6289886. [PMID: 37051291 PMCID: PMC10085655 DOI: 10.1155/2023/6289886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
Despite the high rates of adolescent pregnancies, the utilization of modern contraceptives is still low among adolescents in Uganda which highlights a missed opportunity for the prevention of unwanted pregnancies among adolescents. We explored the perception of parents and guardians regarding the use of modern contraceptives by adolescents and the roles parents and guardians play in the use of modern contraceptives by the adolescents. A descriptive qualitative study was conducted in one of the suburbs of Arua city in the West Nile subregion in Uganda. Fifteen (15) in-depth interviews were conducted with parents and or guardians to explore their perceptions and roles regarding the use of modern contraceptives by adolescents. Thematic analysis was used in qualitative data analysis. Parents did not support adolescents’ use of modern contraceptives. Lack of parental support was related to perceptions that modern contraceptives promote sexual promiscuity, fear that it causes infertility and that it is incompatible with cultural, religious, and moral norms. Parents and guardians opted to emphasize the importance of abstinence, conformity with cultural and religious norms, and the need to focus on completing school instead of encouraging the use of modern contraceptives. Few parents and guardians supported the use of modern contraceptives, specifically condoms, to prevent unwanted pregnancy by the adolescents and parents/guardians, sexually transmitted infections, and early school dropouts. Parents and guardians expressed feelings of inadequacy related to discussions on contraception use with their adolescent children and therefore avoided talking about it. Our study reveals a lack of parental support regarding the use of modern contraceptives among adolescents. Public health interventions which promote intergenerational, socioculturally, and religiously appropriate communication should be instituted in the communities in order to promote sustainable adoption of modern contraceptive use among adolescents.
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Affiliation(s)
| | - Joshua Epuitai
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Monicah Andru
- Department of Nursing and Midwifery, Faculty of Health Sciences, Muni University, Arua, Uganda
| | - Mary Aleni
- Department of Nursing and Midwifery, Faculty of Health Sciences, Muni University, Arua, Uganda
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Muhumuza CM, Sileo KSM, Wanyenze RW, Kershaw TKS, Lule HL, Sekamatte SS, Kiene SK. Development of a Multi-Level Family Planning Intervention for Couples in Rural Uganda: Key Findings & Adaptations Made from Community Engaged Research Methods. RESEARCH SQUARE 2023:rs.3.rs-2682031. [PMID: 37034818 PMCID: PMC10081372 DOI: 10.21203/rs.3.rs-2682031/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background Uganda has among the highest fertility rates in the world and multi-level barriers contribute to the low contraceptive use. Objective The objective of this study was to develop a culturally and socially relevant, community-based intervention to increase contraceptive use among couples in rural Uganda through community-engaged research methods. This study reports on the community-engaged research that informed the intervention's content and structure and the final content of the intervention; the evaluation of the pilot intervention will be reported upon completion. Methods An intervention steering committee of community stakeholders reviewed the initially proposed intervention content and approach. Focus groups were conducted with men and women separately (N=26) who had unmet need for family planning. Fifteen key-informant interviews were conducted with community leaders and family planning stakeholders. Finally, the 4-session intervention was pilot tested with a cohort of couples (N=7) similar in demographics to the target sample of the future pilot intervention trial. Qualitative data were analyzed thematically. Results Findings included the identification of community beliefs to reshape to increase family planning acceptance, as well as strategies to engage men, acceptable approaches for community leader involvement in the intervention to endorse family planning, and methods for managing gender dynamics and minimizing risk of unintended negative consequences of participation. The findings were used to shape the ideal structure and format of the intervention, including the distribution of contraceptives directly during group sessions, and identified the need to strengthen health worker capacity to provide Long-Acting Reversable Contraceptives (LARCs) as part of the intervention. Conclusions These findings were used to refine an intervention before a larger scale pilot test of its feasibility, acceptability, and potential efficacy. They can inform other multi-level family planning interventions in similar settings and the methods can be adopted by others to increase the feasibility, acceptability, and cultural relevance of interventions.
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Bapolisi WA, Bisimwa G, Merten S. Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey. BMJ Open 2023; 13:e061564. [PMID: 36764708 PMCID: PMC9923293 DOI: 10.1136/bmjopen-2022-061564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. DESIGN Longitudinal study. SETTING A community-based approach was used to investigate FP use in the North and South-Kivu regions. PARTICIPANTS Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. PRIMARY AND SECONDARY OUTCOMES FP use and intention to use FP. RESULTS The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052). CONCLUSION TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Epidemiology, University of Basel Faculty of Science, Basel, Switzerland
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Catholic University of Bukavu, Bukavu, South-Kivu, Congo (the Democratic Republic of the)
| | - Sonja Merten
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Asrese ET, Adem YF. Contraceptive utilization and associated factors among polygamous and monogamous women in Worebabo Woreda, South Wollo Zone, Ethiopia: a comparative cross sectional study. BMC Womens Health 2023; 23:39. [PMID: 36710331 PMCID: PMC9885600 DOI: 10.1186/s12905-023-02180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In Ethiopia high population growth and unintended pregnancies are posing pressures where the economy is incapable of holding overpopulation. Despite this problem, utilization of modern contraception is low in rural areas of the country, especially in the areas where polygamy is common. Therefore, this study was conducted to assess contraceptive utilization and associated factors among polygamous and monogamous women in, Ethiopia. METHOD A community-based comparative cross-sectional and phenomenological study design was employed from July 1 to September 30, 2021, on the total sample size of 774 selected married women of the reproductive age group by using a multistage sampling method and a purposive sampling method were used for the qualitative part of the study. A pre-tested interview with a structured questionnaire was used to collect data and key informants were interviewed using semi-structured questionnaire. Associated factors were analyzed by using bivariable and multivariable binary logistic regression models. The odds ratio, with a 95% confidence level, was used to declare a statistically significant association. RESULT A total of 703 married women of the reproductive age groups were interviewed, yielding a 90.89% response rate; among these married women, 352 and 351 were in monogamous and polygamous relationships. The proportion of women who use modern contraceptives was 161 (45.7%) in monogamous relationship, and 151 (43.0%) in polygamous relationships. Overall, utilization of modern contraceptives was significantly associated with educational status (AOR = 2.143, CI:1.428-3.216), religion (AOR = 1.704, CI: 1.144-2.539), undesired fertility (AOR = 3.17,CI:1.939-5.183), who decides on the number of children (AOR = 3.054, CI:1.93-4.832), getting clear information by Health care provider (AOR = 4.624, CI:3.132-6.828), family pressure (AOR = 1.855, CI:1.351-2.75), fear of social stigma (AOR = 2.482, CI:1.666-3.699), and accepts myths about contraceptives (AOR = 1.878, CI:1.278-2.761). CONCLUSION This study identified that utilization of modern contraception was low in the study area. The district health office and concerned stakeholders should implement interventions that scale up contraceptive use, need family involvement in decision making, addressing myths around contraceptives, helping women to get education, and training of health care providers.
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Affiliation(s)
- Eueail Teferi Asrese
- Department of Public Health, Dessie College of Health Sciences, P.O.Box: 1212, Dessie, Ethiopia
| | - Yonas Fissha Adem
- Department of Public Health, Dessie College of Health Sciences, P.O.Box: 1212, Dessie, Ethiopia
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Sileo KM, Muhumuza C, Sekamatte S, Lule H, Wanyenze RK, Kershaw TS, Kiene SM. The "Family Health = Family Wealth" intervention: study protocol for a pilot quasi-experimental controlled trial of a multi-level, community-based family planning intervention for couples in rural Uganda. Pilot Feasibility Stud 2022; 8:265. [PMID: 36564852 PMCID: PMC9789630 DOI: 10.1186/s40814-022-01226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Uganda has one of the highest fertility rates globally, but only 30% of women report using an effective method of contraception. Community-based, multi-level interventions are needed to help couples in rural Uganda overcome barriers to contraceptive use. METHODS This study will pilot test the Family Health = Family Wealth intervention, a multi-level, community-based intervention employing transformative community dialogues, which use facilitated discussion to reshape community norms that influence family planning acceptance, to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4 sessions (two gender-segregated and two gender-mixed). Sessions simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. At the health system level, a refresher training will be conducted with health workers in the intervention community's health center to address gaps in contraceptive knowledge and skills as identified from a needs assessment. The intervention will be evaluated through a pilot quasi-experimental trial paired with a mixed methods process evaluation. Participants include 70 couples (N=140) randomized by community to the Family Health = Family Wealth intervention (n=35 couples) or to an attention-matched water, sanitation, and hygiene (WASH) intervention (n=35 couples). Participants include sexually active, married couples who are age 18 (or an emancipated minor) to 40 for women and age 18 (or an emancipated minor) to 50 for men, not pregnant, at least one person in the couple reports wanting to avoid pregnancy for at least a year, and not currently using a method of contraception or using a low-efficacy or ineffective method of contraception. The primary aims of the study are to (1) assess the feasibility of the intervention trial procedures, (2) the acceptability and feasibility of the intervention content and structure, and (3) explore the intervention's preliminary effectiveness at increasing contraceptive use and affecting related outcomes among couples. DISCUSSION Filling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel, multi-level, community-based intervention to increase contraceptive use among couples with an unmet need for family planning in rural Uganda. We aim to use the findings of this pilot study to refine the trial procedures and intervention content for a future, larger cluster randomized controlled trial to establish the intervention's efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT04262882; registered on February 10, 2020.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
- United States Agency for International Development (USAID), Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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Githinji F, Maru SM, Karimi PN, Rutungwa E, Kayitare E. Factors affecting provision of female family planning commodities in public health facilities in Kajiado county, Kenya. J Pharm Policy Pract 2022; 15:91. [PMID: 36434712 PMCID: PMC9694591 DOI: 10.1186/s40545-022-00488-y] [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: 08/23/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Family planning involves the use of traditional or modern methods to prevent maternal and infant mortality associated with unintended pregnancies and negative economic outcomes. In sub-Saharan Africa, the unmet need for modern family planning is approximately 66%. However, information on factors affecting utilization of female family planning commodities is limited. Therefore, this research was conducted to bridge this gap. METHODS Health facility-based descriptive cross-sectional research design was conducted and involved the public health facilities offering family planning, targeting respondents who handle the commodities and service providers themselves. A semi-structured questionnaire was used to collect data about availability of the commodities, knowledge of service providers and barriers affecting provision of the service. Data were coded and analyzed via Microsoft Excel 2019 and SPSS version 20. RESULTS The study showed that shorter term methods were more readily available, 60-75% than the long-term methods, 20-60%. Approximately 60% of the service providers did not comprehensively utilize the recommended World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision. Stock outs, myths and misconceptions, male interference and culture were the major barriers identified. CONCLUSION Provision of family planning commodities in public health facilities in Kajiado county is affected by stock levels at the national program, and provider knowledge on WHO MEC. The key factors affecting provision of family planning were stock outs, myths and misconceptions on the contraceptives, inadequate male involvement and inadequate community engagement on potential benefits of the service. These challenges need to be part of the solutions to bridging the gap identified.
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Affiliation(s)
- Fredrick Githinji
- grid.10818.300000 0004 0620 2260EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Shital M. Maru
- grid.10604.330000 0001 2019 0495Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Peter N. Karimi
- grid.10604.330000 0001 2019 0495Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Eugene Rutungwa
- grid.10818.300000 0004 0620 2260EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.10818.300000 0004 0620 2260School of Business, College of Business and Economics, University of Rwanda, Kigali, Rwanda
| | - Egide Kayitare
- grid.10818.300000 0004 0620 2260School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Idris IB, Syed Soffian SS, Baharom M, Baharuddin UM, Hashim S, Nawi AM. Influence of sociocultural beliefs and practices on contraception: a systematic review. Women Health 2022; 62:688-699. [DOI: 10.1080/03630242.2022.2117764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Idayu Badilla Idris
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Mazni Baharom
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ummi Mirza Baharuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Syahirah Hashim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Amuzie CI, Nwamoh UN, Ukegbu A, Umeokonkwo CD, Azuogu BN, Agbo UO, Balogun MS. Determinants of male involvement in family planning services in Abia State, Southeast Nigeria. Contracept Reprod Med 2022; 7:15. [PMID: 35982494 PMCID: PMC9386938 DOI: 10.1186/s40834-022-00182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Male involvement in family planning (FP) remains low in male-dominant communities. Family planning contributes to the regulation of fertility and population growth in Nigeria. Increasing male involvement in family planning services is crucial in reducing maternal morbidity and mortality in patriarchal societies such as Nigeria. This study identified the determinants of male involvement in family planning services in Abia State, Nigeria. Methods This was a cross-sectional study conducted in twelve communities of Abia State, Nigeria. A total of 588 married men who met the eligibility criteria were recruited using a multistage sampling technique. An interviewer-administered semi-structured questionnaire was used to collect data on the variables. Univariate, bivariate and multivariate analysis was done. The level of significance was set at 5%. Results The overall level of active male involvement in family planning services was 55.1% (95% CI:51.0–59.2%). The mean age of the respondents was 42.4 ± 8.0 years. Access to television (aOR = 1.58, 95% CI: 1.05–2.39), spouse employment status (aOR = 2.02, 95% CI: 1.33–2.06), joint decision-making (aOR = 1.66, 95% CI: 1.05–2.62), and accompanying spouse to the FP clinic (aOR = 3.15, 95% CI: 2.16–4.62) were determinants of active male involvement. Conclusion At least, one out of every two men was actively involved in family planning services. This was determined by access to television, employment status of spouse, joint decision-making, and accompanying spouse to the FP clinic. There is a need to focus on the identified factors in order to further improve the active involvement of men in FP services. Supplementary Information The online version contains supplementary material available at 10.1186/s40834-022-00182-z.
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Affiliation(s)
- Chidinma Ihuoma Amuzie
- Nigeria Field Epidemiology Training Program, Abuja, Nigeria. .,Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria.
| | - Uche Ngozi Nwamoh
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Andrew Ukegbu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Chukwuma David Umeokonkwo
- Nigeria Field Epidemiology Training Program, Abuja, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Benedict Ndubueze Azuogu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Fadeyibi O, Alade M, Adebayo S, Erinfolami T, Mustapha F, Yaradua S. Household Structure and Contraceptive Use in Nigeria. Front Glob Womens Health 2022; 3:821178. [PMID: 35620301 PMCID: PMC9128017 DOI: 10.3389/fgwh.2022.821178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Contraceptive use in Nigeria has been consistently low despite its many benefits and several efforts by government and development partners to increase its uptake. According to the Nigeria Demographic and Health Survey, the use of any modern method staggeringly increased from 4 to 12% over 28 years (1990-2018). Studies have identified factors at the individual, household, and societal levels that affect contraceptive use. While studies have also shown that decisions such as contraceptive behavior and acquisition of family skills may vary according to the individual or societal factors, there is a dearth of knowledge on how household structure and composition influence contraceptive use in Nigeria. This article seeks to contribute to the body of knowledge by exploring contraceptive use within the household context. Method We used data from the 2018 Nigeria Demographic and Health Survey to examine the relationship between household structure and contraceptive use. We excluded pregnant and non-married women at the time of the survey from the sample and used multinomial regression analysis to examine the likelihood of using traditional or modern methods of contraception. Results Results show that having a large household size, and the presence of multiple wives in the household significantly reduces the likelihood of using any method of contraceptive. The result further shows a significant association between household wealth index and contraceptive use as the use of any method increases with household wealth index, with those from richest households being twice as likely as their counterparts in the poorest households to use traditional methods (OR:2.02, p < 0.05). Also, women living in households headed by older men (25 and above), households with under 5 children, and those living in rural areas have significantly reduced likelihood of using any method. Conclusion This study highlights the dynamics of contraceptive use among married women considering household composition. While our study serves as a primer to understanding contraceptive use in households where a woman and her spouse are usual household members, improved family planning interventions to increase uptake through demand creation will require deeper and more comprehensive work to understand the dynamics among women in more complex household settings.
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Affiliation(s)
| | - Mayowa Alade
- Department of Global Health School of Public Health Boston University, Boston, MA, United States
| | - Samuel Adebayo
- Center for Research, Evaluation Resources and Development, Abuja, Nigeria
| | | | | | - Saudatu Yaradua
- Health, Nutrition, and Population, World Bank, Abuja, Nigeria
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Nanvubya A, Wanyenze RK, Abaasa A, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Bagaya B, Chinyenze K, Price MA, Van Geertruyden JP. Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of Lake Victoria in Uganda: a randomized controlled trial. BMC Health Serv Res 2022; 22:506. [PMID: 35421987 PMCID: PMC9012015 DOI: 10.1186/s12913-022-07898-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Family planning knowledge is poor and use is low in Ugandan fishing communities. We compared the effectiveness of enhanced family planning (FP) education with routine counselling on FP knowledge and use.
Methods
Individuals aged 15–49 years were randomly assigned to intervention or control arm. The intervention constituted enhanced FP education based on a simplified handout extracted from the WHO FP guidance tool called, “Family planning: A global handbook for FP providers” which participants took home for additional reading. The control arm constituted FP counselling following Uganda Ministry of Health guidelines. FP knowledge score and contraceptive prevalence rate (CPR) were compared between trial arms at baseline and at 12 months. Negative binomial regression models were used to estimate the effect of the intervention on FP knowledge and use.
Results
Overall, 1410 participants were screened to enrol 1004 (502 per study arm, 48.5% women). Subsequently, 384 (76.5%) and 383 (76.3%) completed the 12 months’ follow-up in the intervention and control arms respectively. At baseline, a median FP knowledge score of 8 and a < 70% FP knowledge score was observed for all participants with a CPR of 36.8%. At month-12, the median FP knowledge score improved in both arms, higher in the intervention arm than the control arm (46 vs 30; p < 0.001). In the intervention arm, 304 (79.2%) had a score of ≥70 compared with 21 (5.5%) in the control arm (p < 0.001). In the negative binomial regression model, the change in FP knowledge score was 47% higher in the intervention arm than in the control arm (score ratio: 1.47, 95%CI: 1. 43-1.51, p < 0.001). The change in CPR was 16% higher in the intervention arm than in the control arm (Prevalence ratio: 1.16, 95%CI: 1.01-1.34, p < 0.040).
Interpretation
Enhanced FP education using a simplified FP education handout was more effective in increasing FP knowledge and use compared to routine FP counselling for people living in fishing communities. Innovative FP education interventions are recommended for improving FP knowledge and optimizing uptake in remote-rural settings where literacy levels are low.
Trial registration
The study was registered by the Pan African Clinical Trial Registry on 03 July 2021 with a Trial Registration Number PACTR202107891858045. “Retrospectively registered”.
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Mac-Seing M, Zarowsky C, Yuan M, Zinszer K. Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016. BMC Public Health 2022; 22:438. [PMID: 35246094 PMCID: PMC8897881 DOI: 10.1186/s12889-022-12708-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services. METHODS We analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups. RESULTS From 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 - 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 - 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer. CONCLUSION This study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.
- Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - Mengru Yuan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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Achen S, Rwabukwali CB, Atekyereza P. Contraceptive use among young women of pastoral communities of Karamoja sub-region in Uganda. CULTURE, HEALTH & SEXUALITY 2022; 24:167-179. [PMID: 33030402 DOI: 10.1080/13691058.2020.1823482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Sexual and reproductive health is an important part of general health globally recognised in Sustainable Development Goal (SDG) 3. Access to sexual and reproductive health services such as contraception provides young people with the opportunity to make informed choices regarding reproductive health. However, poor sexual and reproductive health is evident in numerous forms including sexually transmitted infections, unwanted pregnancies and unsafe abortion. In this paper, we examine the experiences of contraceptive use among young women living in pastoral communities. Findings derive from a qualitative contextual analysis of adolescent sexual and reproductive health conducted in the Karamoja sub-region of Uganda. Focus group discussions and in-depth interviews were conducted with married young women aged 15-19. Audio recordings and field notes were taken during interviews. Thematic data analysis was conducted aided by Atlas.ti software. Findings reveal that young women living in pastoralist communities experience challenges which deter their use of contraception. Contraceptive use experiences, socio-cultural values and practices, the attitudes of service providers, and livelihood necessities of pastoralism cause low uptake of contraception. Adequate understanding of the experiences and associated values encountered by such vulnerable and marginalised groups in the use of contraception is critical in addressing the challenge to achieving SDG targets.
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Affiliation(s)
- Stella Achen
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | | | - Peter Atekyereza
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
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Atukunda EC, Matthews LT, Musiimenta A, Agaba A, Najjuma JN, Lukyamuzi EJ, Kaida A, Obua C, Mugyenyi GR. Understanding the Effect of a Healthcare Provider-Led Family Planning Support Intervention on Contraception use and Pregnancy Desires among Postpartum Women Living with HIV in Southwestern Uganda. AIDS Behav 2022; 26:266-276. [PMID: 34292430 PMCID: PMC8782928 DOI: 10.1007/s10461-021-03380-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 01/03/2023]
Abstract
Modern contraceptive prevalence among women living with HIV (WLWH) in Uganda is still low at 45%, and up to a third of women are likely to discontinue the method within the first year of initiation. This increases risks of unplanned pregnancies, perinatal HIV transmission and pregnancy complications. We aim to explore and explain the mechanism of effect of a family planning support intervention investigated in a randomized controlled trial conducted between October 2016 and June 2018 among 320 postpartum WLWH at a referral hospital in Southwestern Uganda that led to improved uptake, decreased contraception discontinuation and lowered pregnancy rates. Thirty WLWH and 10 of their primary sexual partners who participated in this trial were purposively selected and interviewed in the local language; interviews were digitally recorded. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive descriptive categories using an inductive content analytic approach. Up to 83% of women wanted to avoid pregnancy within the first year postpartum. Qualitative data showed that contraception uptake and use were influenced by: 1) Participant awareness and understanding of different methods available; 2) Participant perception of offered health services; 3) Healthcare provider (HCP) socio-cultural sensitivity to individual experiences and (mis)conceptions surrounding contraception; 4) Having tactile engagement, follow-up reminders and a reference to prompt action or discussions with partners. Supportive and culturally sensitive HCPs and systems facilitated information sharing leading to increased patient awareness and understanding of the contraceptive methods, and improved health user experience, care engagement, confidence and willingness to take up and continue using modern contraceptive methods.
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Affiliation(s)
| | - Lynn T Matthews
- Division of Infectious Diseases and Center for Global Health, Massachusetts General Hospital, Boston, M, USA
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Amon Agaba
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Vancouver, Canada
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
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Gualeni B, Hughes L, Stauber I, Ackers L, Gorman A, Gashuga D, Dzabala N, Chimimba F, Chikowe I, Coulman SA, Birchall JC. Human-centred design of a new microneedle-based hormonal contraceptive delivery system. Gates Open Res 2021; 5:96. [PMID: 35492866 PMCID: PMC9020198 DOI: 10.12688/gatesopenres.13233.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/28/2022] Open
Abstract
Background: It is estimated that 225 million women worldwide have an unmet need for family planning, and more than half live in low- and middle-income countries. Increasing the choice of contraceptive methods available can reduce this unmet need. Microneedle drug delivery systems represent a new technology for minimally invasive self-administration of contraceptives. We explored stakeholders’ views on different aspects of a proposed microneedle-based hormonal contraceptive delivery system. The feedback was used to iteratively develop this delivery system. Methods: Focus group discussions and semi-structured interviews were conducted with potential stakeholders (women and trans males of childbearing age, their partners, and health professionals and organisations that provide family planning advice and contraception services) in Uganda, The Gambia, Malawi, and the UK, exploring concept acceptability and gathering feedback on different aspects of design and usability of the proposed delivery system. Results: Participants viewed the concept of a new, microneedle-based contraceptive favourably. In Uganda, participants were presented with 7 different prototype applicators and identified desirable features of a preferred delivery device; their input reducing the number of prototypes that were subsequently evaluated by stakeholders in The Gambia and the UK. Participants in these countries helped to identify and/or confirm the most desirable characteristics of the applicator, resulting in design consolidation into a refined concept applicator. The final, optimised applicator prototype was validated during user research in Malawi. This human-centred design approach was also used to iteratively develop an information leaflet for the device. During these user studies, other preferred aspects of a contraceptive delivery system were also evaluated, such as anatomical site of application, duration of action, and return to fertility. Conclusions: A new microneedle-based contraceptive delivery system was iteratively developed using a human-centred design approach and was favourably received by potential stakeholders. The product is now being refined for testing in pre-clinical studies.
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Affiliation(s)
- Benedetta Gualeni
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Isabelle Stauber
- Maddison Limited, Walnut Tree Yard, Lower Street, Fittleworth, RH20 1JE, UK
| | - Louise Ackers
- School of Health and Society, University of Salford, Allerton Building, Salford, M6 6PU, UK
- Knowledge for Change, Plot 39 Saaka Road, Kagote, Fort Portal, P.O. Box 392, Uganda
| | - Angela Gorman
- Life for African Mothers, Suite 18, Big Yellow Storage, Cardiff, CF10 5DL, UK
| | - Dorothy Gashuga
- Knowledge for Change, Plot 39 Saaka Road, Kagote, Fort Portal, P.O. Box 392, Uganda
| | - Nettie Dzabala
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi
| | - Frider Chimimba
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi
| | - Ibrahim Chikowe
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi
| | - Sion A. Coulman
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - James C. Birchall
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
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Kikula AI, Pembe AB, Sunguya B. Short inter-pregnancy interval: why is it still high among women in Dar es Salaam? Pan Afr Med J 2021; 40:17. [PMID: 34733385 PMCID: PMC8531956 DOI: 10.11604/pamj.2021.40.17.29770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. Methods a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. Results twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young (<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45, 95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38, 95% CI=1.15-9.93). Conclusion about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age.
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Affiliation(s)
- Amani Idris Kikula
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Barnabas Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Bukuluki P, Kisaakye P, Houinato M, Ndieli A, Letiyo E, Bazira D. Social norms, attitudes and access to modern contraception for adolescent girls in six districts in Uganda. BMC Health Serv Res 2021; 21:1040. [PMID: 34598684 PMCID: PMC8487130 DOI: 10.1186/s12913-021-07060-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Social norms continue to be entrenched in Uganda. Understanding social norms helps to uncover the underlying drivers that influence attitudes and behavior towards contraceptive access and use. This study therefore seeks to investigate the factors that influence the social norm – access to contraception by adolescent girls – in six districts in Uganda. Data and methods: Using data from a community cross-sectional survey in six districts (Amudat, Kaberamaido, Kasese, Moroto, Tororo and Pader) in Uganda, a binary logistic regression model was fitted to examine the variation in individual beliefs and socio-economic and demographic factors on ‘allowing adolescent girls to access contraception in a community’ – we refer to as a social norm. Results Results demonstrate that a higher proportion of respondents hold social norms that inhibit adolescent girls from accessing contraception in the community. After controlling for all variables, the likelihood for adolescent girls to be allowed access to contraception in the community was higher among respondents living in Kaberamaido (OR = 2.58; 95 %CI = 1.23–5.39), Kasese (OR = 2.62; 95 %CI = 1.25–5.47), Pader (OR = 4.35; 95 %CI = 2.15–8.79) and Tororo (OR = 9.44; 95 %CI = 4.59–19.37), those aged 30–34 years likely (OR = 1.73; 95 %CI = 1.03–2.91). However, the likelihood for respondents living in Moroto to agree that adolescent girls are allowed to access contraception was lower (OR = 0.27; 95 %CI = 0.11–0.68) compared to respondents living in Amudat. Respondents who were not formally employed (OR = 0.63; 95 %CI = 0.43–0.91), and those who agreed that withdrawal prevents pregnancy (OR = 0.45; 95 %CI = 0.35–0.57) were less likely to agree that adolescent girls are allowed to access contraception in the community. Respondents who agreed that a girl who is sexually active can use contraception to prevent unwanted pregnancy (OR = 1.84; 95 %CI = 1.33–2.53), unmarried women or girls should have access to contraception (OR = 2.15; 95 %CI = 1.61–2.88), married women or girls should have access to contraception (OR = 1.55; 95 %CI = 0.99–2.39) and women know where to obtain contraception for prevention against pregnancy (OR = 2.35; 95 %CI = 1.19–4.65) were more likely to agree that adolescent girls are allowed to access contraception. Conclusions The findings underscore the need for context specific ASRH programs that take into account the differences in attitudes and social norms that affect access and use of contraception by adolescents.
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Affiliation(s)
- Paul Bukuluki
- School of Social Sciences, Makerere University, Kampala, Uganda.
| | - Peter Kisaakye
- School of Statistics and Planning, Makerere University, Kampala, Uganda
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Gualeni B, Hughes L, Stauber I, Ackers L, Gorman A, Gashuga D, Dzabala N, Chimimba F, Chikowe I, Coulman SA, Birchall JC. Human-centred design of a new microneedle-based hormonal contraceptive delivery system. Gates Open Res 2021; 5:96. [DOI: 10.12688/gatesopenres.13233.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is estimated that 225 million women worldwide have an unmet need for family planning, and more than half live in low- and middle-income countries. Increasing the choice of contraceptive methods available can reduce this unmet need. Microneedle drug delivery systems represent a new technology for minimally invasive self-administration of contraceptives. We explored stakeholders’ views on different aspects of a proposed microneedle-based hormonal contraceptive delivery system. The feedback was used to iteratively develop this delivery system. Methods: Focus group discussions and semi-structured interviews were conducted with potential stakeholders (women and trans males of childbearing age, their partners, and health professionals and organisations that provide family planning advice and contraception services) in Uganda, The Gambia, Malawi, and the UK, exploring concept acceptability and gathering feedback on different aspects of design and usability of the proposed delivery system. Results: Participants viewed the concept of a new, microneedle-based contraceptive favourably. In Uganda, participants were presented with 7 different prototype applicators and identified desirable features of a preferred delivery device; their input reducing the number of prototypes that were subsequently evaluated by stakeholders in The Gambia and the UK. Participants in these countries helped to identify and/or confirm the most desirable characteristics of the applicator, resulting in design consolidation into a refined concept applicator. The final, optimised applicator prototype was validated during user research in Malawi. This human-centred design approach was also used to iteratively develop an information leaflet for the device. During these user studies, other preferred aspects of a contraceptive delivery system were also evaluated, such as anatomical site of application, duration of action, and return to fertility. Conclusions: A new microneedle-based contraceptive delivery system was iteratively developed using a human-centred design approach and was favourably received by potential stakeholders. The product is now being refined for testing in pre-clinical studies.
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Gualeni B, Hughes L, Stauber I, Ackers L, Gorman A, Gashuga D, Dzabala N, Coulman SA, Birchall JC. Human-centred design of a new microneedle-based hormonal contraceptive delivery system. Gates Open Res 2021; 5:96. [DOI: 10.12688/gatesopenres.13233.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is estimated that 225 million women worldwide have an unmet need for family planning, and more than half live in low- and middle-income countries. Increasing the choice of contraceptive methods available can reduce this unmet need. Microneedle drug delivery systems represent a new technology for minimally invasive self-administration of contraceptives. We explored stakeholders’ views on different aspects of a proposed microneedle-based hormonal contraceptive delivery system. The feedback was used to iteratively develop this delivery system. Methods: Focus group discussions and semi-structured interviews were conducted with potential stakeholders (women and trans males of childbearing age, their partners, and health professionals and organisations that provide family planning advice and contraception services) in Uganda, The Gambia, Malawi, and the UK, exploring concept acceptability and gathering feedback on different aspects of design and usability of the proposed delivery system. Results: Participants viewed the concept of a new, microneedle-based contraceptive favourably. In Uganda, participants were presented with 7 different prototype applicators and identified desirable features of a preferred delivery device; their input reducing the number of prototypes that were subsequently evaluated by stakeholders in The Gambia and the UK. Participants in these countries helped to identify and/or confirm the most desirable characteristics of the applicator, resulting in design consolidation into a refined concept applicator. The final, optimised applicator prototype was validated during user research in Malawi. This human-centred design approach was also used to iteratively develop an information leaflet for the device. During these user studies, other preferred aspects of a contraceptive delivery system were also evaluated, such as anatomical site of application, duration of action, and return to fertility. Conclusions: A new microneedle-based contraceptive delivery system was iteratively developed using a human-centred design approach and was favourably received by potential stakeholders. The product is now being refined for testing in pre-clinical studies.
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Abdi B, Okal J, Serour G, Temmerman M. Muslim men's perceptions and attitudes on family planning: a qualitative study in Wajir and Lamu counties in Kenya. Sex Reprod Health Matters 2021; 29:1893890. [PMID: 33719937 PMCID: PMC8009019 DOI: 10.1080/26410397.2021.1893890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In patriarchal societies like Kenya, understanding men’s perceptions and attitudes on family planning is critical given their decision-making roles that affect uptake of contraception. Yet, most programmes mainly target women as primary users of contraceptive methods since they bear the burden of pregnancy. However, women-focused approaches tend to overlook gender power dynamics within relationships, with men wielding excessive power that determines contraception use or non-use. A qualitative study involving focus group discussions and in-depth interviews was conducted in the two predominantly Muslim communities of Lamu and Wajir counties, Kenya. Open-ended questions explored perspectives, attitudes and men’s understanding of contraception, family size, decision making on family planning and general views on contraceptive use. Thematic content analysis was used. Findings show that men in Wajir and Lamu held similar viewpoints of family planning as a foreign or western idea and associated family planning with ill health and promiscuity. They believed family planning is a “woman’s affair” that requires little or no input from men. Men from Wajir desired a big family size. There is a need for a shift in family planning programmes to enable men’s positive engagement. The findings from this study can be used to develop culturally appropriate approaches to engage men, challenge negative social norms and foster positive social change to improve uptake of family planning.
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Affiliation(s)
- Batula Abdi
- Policy Advisor, United Nations Population Fund, Uganda Country Office, Kampala, Uganda; PhD Student, International Centre for Reproductive Health, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Correspondence:
| | - Jerry Okal
- Senior Research Associate, Population Council, Nairobi, Kenya
| | - Gamal Serour
- Professor of Obstetrics and Gynecology and Director, International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt
| | - Marleen Temmerman
- Professor, International Centre for Reproductive Health, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Director, Centre of Excellence of Women and Child Health, Aga Khan University, Nairobi, Kenya
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Bwambale MF, Bukuluki P, Moyer CA, Van den Borne BHW. Utilisation of sexual and reproductive health services among street children and young adults in Kampala, Uganda: does migration matter? BMC Health Serv Res 2021; 21:169. [PMID: 33622341 PMCID: PMC7903651 DOI: 10.1186/s12913-021-06173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the nexus of migration and health outcomes is well acknowledged, the effect of rural-urban migration on the use of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural-urban migration on the use of SRH services, while controlling for confounding, and whether there is a difference in the use of SRH services among migrant and non-migrant street children and young adults. METHODS Data were collected from 513 street children and young adults aged 12-24 years, using venue-based time-space sampling (VBTS). We performed multivariate logistic regression analysis using Stata 16.0 to identify factors associated with SRH services use, with rural-urban migration status as the main predictor. Participants were further classified as new migrants (≤ 2 years of stay in city), established migrants (> 2 years of stay in city) or non-migrants (lifelong native street children) with no rural-urban migration history. RESULTS Overall, 18.13% of the street children and young adults had used contraception/family planning, 58.67% had tested for human immunodeficiency virus (HIV) and knew their status and 34.70% had been screened for sexually transmitted infections (STIs). Non-migrants were 2.70 times more likely to use SRH services (HIV testing, STI screening and family planning) compared to the migrants (aOR = 2.70, 95% CI 1.23-5.97). Other factors associated with SRH services use among street children and young adults include age (aOR = 4.70, 95% CI 2.87-7.68), schooling status (aOR = 0.33, 95% CI 0.15-0.76), knowledge of place of care (aOR = 2.71, 95% CI 1.64-4.46) and access to SRH information (aOR = 3.23, 95% CI 2.00-5.24). CONCLUSIONS SRH services utilisation among migrant street children and young adults is low compared to their non-migrant counterparts and is independently associated with migration status, age, schooling status, knowledge of place of care and access to SRH information. Our findings call for the need to design and implement multi-dimensional interventions to increase the use of SRH services among street children and young adults, while taking into consideration their migration patterns.
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Affiliation(s)
- Mulekya F Bwambale
- Department of Health Promotion and Education, Faculty of Health Medicine and Life Sciences, Maastricht University Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands.
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda.
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Cheryl A Moyer
- Departments of Learning Health Sciences and Obstetrics and Gynaecology, University of Michigan Medical School, Ann Arbor, USA
| | - Bart H W Van den Borne
- Department of Health Promotion and Education, Faculty of Health Medicine and Life Sciences, Maastricht University Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
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Hoyt J, Krishnaratne S, Hamon JK, Boudarene L, Chantler T, Demissie SD, Landegger J, Moseti E, Marcus S, Kambanje M, Pryor S, Spilotros N, Gnintoungbe M, Curry D, Webster J. "As a woman who watches how my family is… I take the difficult decisions": a qualitative study on integrated family planning and childhood immunisation services in five African countries. Reprod Health 2021; 18:41. [PMID: 33588879 PMCID: PMC7885443 DOI: 10.1186/s12978-021-01091-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Family planning (FP) has the potential to improve maternal and child health outcomes and to reduce poverty in sub-Saharan Africa. However, substantial unmet need for modern contraceptive methods (MCMs) persists in this region. Current literature highlights multi-level barriers, including socio-cultural norms that discourage the use of MCMs. This paper explores women’s choices and decision-making around MCM use and examines whether integrating FP services with childhood immunisations influenced women’s perceptions of, and decision to use, an MCM. Methods 94 semi-structured interviews and 21 focus group discussions with women, health providers, and community members (N = 253) were conducted in health facilities and outreach clinics where an intervention was delivering integrated FP and childhood immunisation services in Benin, Ethiopia, Kenya, Malawi and Uganda. Data were coded using Nvivo software and an analytical framework was developed to support interpretative and thematic analyses on women’s decision-making about MCM use. Results Most women shared the reproductive desire to space or limit births because of the perceived benefits of improved health and welfare for themselves and for their children, including the economic advantages. For some, choices about MCM use were restricted because of wider societal influences. Women’s decision to use MCMs was driven by their reproductive desires, but for some that was stymied by fears of side effects, community stigma, and disapproving husbands, which led to clandestine MCM use. Health providers acknowledged that women understood the benefits of using MCMs, but highlighted that the wider socio-cultural norms of their community often contributed to a reluctance to use them. Integration of FP and childhood immunisation services provided repeat opportunities for health providers to counter misinformation and it improved access to MCMs, including for women who needed to use them covertly. Conclusions Some women chose to use MCMs without the approval of their husbands, and/or despite cultural norms, because of the perceived health and economic benefits for themselves and for their families, and because they lived with the consequences of short birth intervals and large families. Integrated FP and childhood immunisation services expanded women’s choices about MCM use and created opportunities for women to make decisions autonomously.
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Affiliation(s)
- Jenna Hoyt
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Shari Krishnaratne
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessie K Hamon
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lydia Boudarene
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Massenga J, Noronha R, Awadhi B, Bishanga DR, Safari O, Njonge L, Kim YM, van Roosmalen J, van den Akker T. Family Planning Uptake in Kagera and Mara Regions in Tanzania: A Cross-Sectional Community Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1651. [PMID: 33572305 PMCID: PMC7916100 DOI: 10.3390/ijerph18041651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
In Tanzania, 27.1% of all women of reproductive age are currently using modern contraception and 16.8% have an unmet need for family planning. We therefore examined factors associated with family planning uptake after giving birth in two regions of Tanzania. The survey, which collected information beyond that collected in the Tanzania Demographic Health Survey, used a two-stage, stratified-cluster sampling design, conducted in April 2016 in Mara and Kagera regions in Tanzania. A total of 1184 women aged 15-49 years, who had given birth less than two years prior to the survey were included. Logistic regression mixed effect modelling was used to examine factors associated with family planning uptake. A total of 393 (33.2%) women used family planning methods and 929 (79%) required prior approval from their partners. Participation of men in utilization of maternal health care was low, where 680 (57.8%) women responded that their partners accompanied them to at least one antenatal care (ANC) counselling visit and 120 (10%) responded that their partners participated in family planning counselling. Women who did not want to disclose whether they had discussed family planning with their partners, strikingly had the highest percentage of using family planning methods after birth. Factors independently associated with family planning uptake included: having discussed family planning with the partner (aOR 3.22; 95% CI 1.99-5.21), having been counselled on family planning during antenatal care (aOR 2.68; 95% CI 1.78-4.05), having discussed family planning with a community health worker (CHW) (aOR 4.59; 95% CI 2.53-8.33) and with a facility health care worker (aOR 1.93; 95% CI 1.29-2.90), having primary or higher educational level (aOR 1.66; 95% CI 1.01-2.273), and being in union (aOR 1.86; 95% CI 1.02-3.42). Educational interaction with community and facility health workers, as well as having a supportive partner as facilitator increased uptake of family planning. This needs to be prioritized in regions with similar socio-cultural norms in Tanzania and beyond.
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Affiliation(s)
- Joseph Massenga
- Jhpiego Tanzania, Dar es Salaam 9170, Tanzania; (R.N.); (B.A.); (L.N.)
- Athena Institute, Vrije Universiteit, 1081HV Amsterdam, Noord-Holland, The Netherlands; (J.v.R.); (T.v.d.A.)
| | - Rita Noronha
- Jhpiego Tanzania, Dar es Salaam 9170, Tanzania; (R.N.); (B.A.); (L.N.)
| | - Bayoum Awadhi
- Jhpiego Tanzania, Dar es Salaam 9170, Tanzania; (R.N.); (B.A.); (L.N.)
| | - Dunstan R. Bishanga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania;
| | - Oliva Safari
- Medical Teams International Kibondo, Dar es Salaam 47401, Tanzania;
| | - Lusekelo Njonge
- Jhpiego Tanzania, Dar es Salaam 9170, Tanzania; (R.N.); (B.A.); (L.N.)
| | | | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit, 1081HV Amsterdam, Noord-Holland, The Netherlands; (J.v.R.); (T.v.d.A.)
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 9300RC Leiden, Zuid-Holland, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, 1081HV Amsterdam, Noord-Holland, The Netherlands; (J.v.R.); (T.v.d.A.)
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 9300RC Leiden, Zuid-Holland, The Netherlands
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43
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Potasse MA, Yaya S. Understanding perceived access barriers to contraception through an African feminist lens: a qualitative study in Uganda. BMC Public Health 2021; 21:267. [PMID: 33530960 PMCID: PMC7852360 DOI: 10.1186/s12889-021-10315-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are many barriers that impact a woman's access to contraception in rural sub-Saharan Africa, such as financial constraints, supply shortages, stigma, and misconceptions. Through and African Feminist lens, this study examines how these perceived barriers intersect with each other, and how they negatively impact women's access to family planning and their perceived value of contraceptives in Luweero, Uganda. METHODS This qualitative study analyzed data collected from healthcare workers at one private clinic and one public clinic that offer family planning services in four focus group discussions in Luweero, Central Region, Uganda. Two focus group discussions were held in each clinic. Eligible participants spoke English, were at least 18 years of age, and had at least 3 years of experience as a healthcare worker in Luweero. Among the participants were nurses, midwives, family planning counsellors, and village health workers, both male and female. Coded transcripts were analyzed using a reflexive methodology through an African Feminist lens. RESULTS Most of the responses indicated that financial constraints experienced either by the clinic or the women significantly impact access to family planning. Certain social barriers were discussed, and the participants explained that barriers such as stigma, misconceptions, lack of knowledge, religiosity and cultural values impact women's motivation or ability to access contraceptive methods. Side effects also have a significant role to play in women's ability or motivation to navigate through these perceived social barriers. CONCLUSIONS Participants determined that increased funding for transportation for village health teams, consistent funding for free contraception, and expanded sensitization efforts that particularly target men would be some of the most impactful methods they can adapt to address some of these barriers.
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Affiliation(s)
- Meghan A. Potasse
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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44
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Wagner GJ, Mindry D, Hurley EA, Beyeza-Kashesya J, Gwokyalya V, Finocchario-Kessler S, Wanyenze RK, Nanfuka M, Tebeka MG, Goggin K. Reproductive intentions and corresponding use of safer conception methods and contraception among Ugandan HIV clients in serodiscordant relationships. BMC Public Health 2021; 21:156. [PMID: 33468072 PMCID: PMC7814634 DOI: 10.1186/s12889-021-10163-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Context Among people living with HIV in Uganda, desires to have a child and unplanned pregnancies are both common, while utilization of safer conception methods (SCM) and modern contraceptives are low. Methods Three hundred eighty-nine HIV clients who reported considering childbearing with their uninfected partner enrolled in a safer conception counseling intervention trial in Uganda. Multiple regression analysis and baseline data were used to examine correlates of reproductive intentions and behaviors, including use of safer conception methods and contraception. Results Most (n = 313; 80.5%) reported that both they and their partner wanted to have a child now, which was associated with being married, in a longer relationship, not having a child with partner, greater SCM knowledge, lower internalized childbearing stigma, and higher perceived community stigma of childbearing. However, just 117 reported trying to conceive in the prior 6 months, which was associated with being female, not having a child with their partner, less decision-making control within the relationship, and greater perceived cultural acceptability of SCM. Among those who had tried to conceive in the past 6 months, 14 (11.9%) used SCM, which was associated with greater control in decision making. Of the 268 who were not trying to conceive, 69 (25.7%) were using a modern contraceptive, which was associated with being in a shorter relationship, less control over decision-making, more positive attitudes towards contraception and lower depression. Conclusion Methods to promote reproductive goals are underused by HIV serodiscordant couples, and relationships characteristics and childbearing-related stigma appear to be most influential and thus targets for intervention. Trial registration Clinicaltrials.gov, NCT03167879; date registered May 23, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10163-7.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA.
| | - Deborah Mindry
- UC Global Health Institute, Center for Women's Health Gender and Empowerment, Los Angeles, CA, USA
| | - Emily A Hurley
- Children's Mercy Research Institute, Children's Mercy Kansas City, Kansas City, USA
| | - Jolly Beyeza-Kashesya
- Mulago Hospital Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Violet Gwokyalya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | - Mahlet G Tebeka
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA
| | - Kathy Goggin
- Children's Mercy Research Institute, Children's Mercy Kansas City, Kansas City, USA.,Schools of Medicine and Pharmacy, University of Missouri - Kansas City, Kansas City, USA
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Wasswa R, Kabagenyi A, Atuhaire L. Determinants of unintended pregnancies among currently married women in Uganda. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2020; 39:15. [PMID: 33287906 PMCID: PMC7722439 DOI: 10.1186/s41043-020-00218-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda. METHODS In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15-49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model. RESULTS The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman's age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies. CONCLUSION Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.
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Affiliation(s)
- Ronald Wasswa
- Department of Statistical Methods and Actuarial Science, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Allen Kabagenyi
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Leonard Atuhaire
- Department of Planning and Applied Statistics, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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Jabeen S, Rathor A, Riaz M, Zakar R, Fischer F. Demand- and supply-side factors associated with the use of contraceptive methods in Pakistan: a comparative study of demographic and health surveys, 1990-2018. BMC WOMENS HEALTH 2020; 20:265. [PMID: 33256703 PMCID: PMC7708094 DOI: 10.1186/s12905-020-01112-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/27/2020] [Indexed: 12/01/2022]
Abstract
Background A remarkable decline in fertility rates has been observed in many countries, with a primary determinant being an increase in the use of contraceptives. However, the birth rate in Pakistan is still higher compared to the other countries of the region. Therefore, this study aims to assess the effect of demand- and supply-side factors associated with the use of contraceptive measures in Pakistan. Methods Secondary data analysis of four data series of the Pakistan Demographic and Health Surveys (PDHS 1990–1991, 2006–2007, 2012–2013 and 2017–2018) were used. The data includes ever-married women aged 15–49 years who had given birth in the previous five years and participated in the family planning module of the PDHS. A total of 25,318 women were included in the analysis. Data were analysed by investigating the associations between independent variables (demand- and supply-side factors) and the use of contraceptive measures through unadjusted odds ratios (OR) and adjusted OR (AOR). Results The results among demand-side factors indicated that in 2012–2013, women without media exposure were less likely to use contraceptives and the trend remains almost constant for 2017–2018 (AOR = 0.664, 95% CI 0.562–0.784) in 2012–2013 and (AOR = 0.654, 95% CI 0.483–0.885) in 2017–2018. However, they still show a lower likelihood of using contraceptives without media exposure. The results among supply-side factors indicated that absence of transport (2012–2013) and limited visits by family planning workers over the previous 12 months (2006–2007, 2012–2013 and 2017–2018) remained significant factors for not using contraceptive methods. Conclusions The results of the study indicate that certain demand- and supply-side factors are associated with the use of contraceptive measures in Pakistan. It highlights the need for the provision of family planning resources and further structural factors, particularly in remote areas.
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Affiliation(s)
| | - Adnan Rathor
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Maria Riaz
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany.
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Yah CS, Ndlovu S, Kutywayo A, Naidoo N, Mahuma T, Mullick S. The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub: A systematic review and meta-analysis. Health Promot Perspect 2020; 10:325-337. [PMID: 33312928 PMCID: PMC7723002 DOI: 10.34172/hpp.2020.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. Methods: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. Results: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI:19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I=99.78%, P < 0.001), even within individual countries. Conclusion: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/STIs, as well as other risk strategies.
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Affiliation(s)
- Clarence S. Yah
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sithembiso Ndlovu
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Kutywayo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepo Mahuma
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nanvubya A, Wanyenze RK, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Kamacooko O, Chinyenze K, Price M, Van Geertruyden JP. Correlates of knowledge of family planning among people living in fishing communities of Lake Victoria, Uganda. BMC Public Health 2020; 20:1642. [PMID: 33143684 PMCID: PMC7607714 DOI: 10.1186/s12889-020-09762-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 10/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Knowledge of family planning (FP) is a key determinant of contraceptive use which ultimately plays a role in attainment of good health and in conduct of clinical research. People living in fishing communities (FCs) have limited access to health services including FP and are targeted for future clinical research but their knowledge of FP and its correlates are scantily known. We determined correlates of knowledge of FP among people living in FCs of L. victoria in Uganda to inform future FP education programs in FCs. Methods We conducted a comparative cross-sectional survey among participants aged 15–49 years from Kigungu and Nsazi. Participants were asked if they were aware of any FP method. All those who responded in the affirmative were further asked to mention what FP methods they had heard of or knew. Those who reported knowledge of at least one FP method were asked a series of questions about FP methods and their side effects. Knowledge was categorized into good or poor knowledge based on their mean total score. Poor knowledge constituted a score below the mean while good knowledge constituted a score of more than or equal to the mean total score. To further explore attitudes and perceptions of FP, ten in-depth interviews and four focus group discussions were conducted. Results Of the 1410 screened participants, 94.5% were aware of at least one FP method. Pills and injectable hormonal methods were the most commonly known methods. Slightly over a third (38%) had good knowledge of FP. Correlates of knowledge of FP were; being female (aOR: 1.92 95% CI: 1.39–2.67), residing in Kigungu (aOR: 4.01 95% CI: 2.77–5.81), being married (aOR: 1.59 95% CI: 1.11–2.28) and currently being in a sexual relationship (aOR: 1.75 95% CI: 1.18–2.60). Concerns about safety and effectiveness of some modern FP methods exist. Misconceptions on effects of FP like sterility, cancers and foetal abnormalities were common. Conclusion FP awareness among people living in FCs of L. Victoria in Uganda is high. However, good knowledge about specific methods tends to be low. Correlates of knowledge of FP include gender, residence, marital status and sexual engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09762-7.
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Affiliation(s)
- Annet Nanvubya
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda. .,Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Rhoda K Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Teddy Nakaweesa
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Juliet Mpendo
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Barbarah Kawoozo
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Francis Matovu
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Sarah Nabukalu
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Geoffrey Omoding
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Jed Kaweesi
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - John Ndugga
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | | | | | - Matt Price
- IAVI, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
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Anita P, Nzabona A, Tuyiragize R. Determinants of female sterilization method uptake among women of reproductive age group in Uganda. Contracept Reprod Med 2020; 5:25. [PMID: 33042574 PMCID: PMC7542725 DOI: 10.1186/s40834-020-00131-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite its great effectiveness, safety and convenience for women who do not wish to have more children; female sterilization method uptake in Uganda is very low. This study aimed at establishing factors associated with female sterilization uptake in Uganda. Methods Secondary data were sourced from the 2016 Uganda Demographic and Health Survey (UDHS). We analyzed all (18,506) women aged 15–49 years who were interviewed in the 2016 UDHS. This sample was categorized into women who were sterilized and those using other modern methods. We used a Chi-square test to measure the association between the current uptake of female sterilization by the women and selected independent variables. Multivariate analysis applied the complimentary log-log model to determine the net effect of selected characteristics on female sterilization uptake in Uganda. Results The overall prevalence of female sterilization among modern contraceptive users was 2%. Female sterilization uptake was highly associated with age of 30 years and older (OR = 34.49;, 95%CI:13.33–99.88), middle wealth status (OR = 0.65, 95% CI:0.47–0.92), women who had ever given birth to at least four children (OR = 3.19, 95% CI:1.63–6.22) and decision making by either the husband/partner (OR = 2.42, 95% CI:1.55–3.78) or jointly between a woman and her husband/partner (OR = 1.38, 95% CI:1.02–1.86). Conclusions The uptake of female sterilization was very low, and this was associated with; age, household wealth, parity and contraceptive decision-maker. The uptake of Family planning programs needs to focus on male engagement to increase joint decision making on family planning issues especially those relating to fertility limitation. Government and its other implementing partners need to scale-up efforts that increase accessibility to information on female sterilization services for women who have completed their fertility.
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Affiliation(s)
- Paula Anita
- School of Statistics and Planning, Makerere University, Kampala, Uganda.,Marie Stopes Uganda, Kampala, Uganda
| | - Abel Nzabona
- School of Statistics and Planning, Makerere University, Kampala, Uganda
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Massawa O, Kazaura M. Use of modern contraceptives among advanced-level secondary school girls in the Rukwa Region, Tanzania, 2018. Int J Adolesc Med Health 2020; 33:449-456. [PMID: 32549184 DOI: 10.1515/ijamh-2019-0211] [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: 10/08/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
| | - Method Kazaura
- Muhimbili University of Health and Allied Sciences, Epidemiology/Biostatistics, P. O. Box 65015, Dar es Salaam, Tanzania
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