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Bertrand JT, Ross JA, Sauter SR. Trends in contraceptive method mix among adolescents and youth aged 15-24 in low- and middle-income countries. Front Glob Womens Health 2023; 3:1061648. [PMID: 36713979 PMCID: PMC9875564 DOI: 10.3389/fgwh.2022.1061648] [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: 10/04/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
Background Method mix - the percent distribution of contraceptive use by method among contraceptive users - reflects both client choice of method and method availability. In a country where clients have access to a wide range of methods at an affordable price, method mix is a strong proxy for method choice. In contrast, where access is limited by numerous factors - method availability, cost, or provider attitudes - method mix may not capture method choice well. Given that method mix can be measured reliably from population-based surveys, it is useful in exploring method choice. While the method mix for all women of reproductive age (15-49 years) has been described previously, the method mix for adolescents and young women aged 15-24 remains unexplored despite this population's high risk for unintended pregnancy. Objectives This study investigates the contraceptive method mix for women aged 15-24 in low- and middle-income countries (LMICs) with national survey data and describes how the method mix differs by age group, geographic region, and marital status for women. Methods Using data from the Demographic and Health (DHS) Surveys, the contraceptive method mix among women aged 15-24 across 64 LMICs is analyzed by age, marital status, and region, with measures of skew and average deviation. Three case studies are presented in which the trend over time in the method mix is examined. Results There are large variations in method mixes across regions, which reflect their differences in various supply and demand constraints. However, there is consistently high usage of short-acting methods among both age groups, 15-19 and 20-24, compared to the full population of all women of reproductive age. Male condoms overwhelmingly predominate as the method used by women 15-24 in all regions. Conclusion The marked differences found by marital status, region, and age show the need for programs to be tailored to local circumstances. Additionally, the large unmet need for contraception signals the ongoing urgency for strengthened programmatic efforts, and for a wider offering of methods to enlarge the choices available to young women. Unmarried women in particular deserve attention, as well as young married women who wish to postpone a pregnancy.
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Affiliation(s)
- Jane T. Bertrand
- Tulane University School of Public Health and Tropical Medicine, Department of International Health and Sustainable Development, New Orleans, LA, United States,Correspondence: Jane T. Bertrand
| | - John A. Ross
- Independent Demographic Consultant, New Paltz, New York, United States
| | - Sydney R. Sauter
- Tulane University School of Public Health and Tropical Medicine, Department of International Health and Sustainable Development, New Orleans, LA, United States
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Jadhav A, Short Fabic M. Dynamic stagnation: reasons for contraceptive non-use in context of fertility stall. Gates Open Res 2019; 3:1458. [PMID: 37795519 PMCID: PMC10547112 DOI: 10.12688/gatesopenres.12990.1] [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] [Accepted: 04/26/2019] [Indexed: 10/06/2023] Open
Abstract
Background: While most countries have experienced reductions in the total fertility rate (TFR), there are countries where the fertility transition has not begun and others where the fertility transition has stalled with TFR still well above replacement level. We use these contexts of "fertility stagnation" to explore reasons behind contraceptive non-use among women who desire to delay or avoid a future birth. Specifically, we explore whether women's reasons for not using contraception are stagnant as the population-level indicator, TFR, suggests or are more dynamic. This nuanced understanding can inform programmatic direction for countries especially in need. Methods: Using Demographic and Health Survey (DHS) data from the two most recent surveys of ten study countries-five countries that have not yet experienced a fertility transition ("pre-transitional") and five countries that began the fertility transition but stalled ("transitional")-we explore trends in reasons for non-use. Results: We find that that reasons for non-use are changing. Specifically, in pre-transition study countries, women are increasingly citing attitudes opposing contraception as reasons for non-use. In transition countries, women are increasingly citing reasons related to service quality and method side effects. Perceived low fecundability is increasingly cited among both pre-transition and transition study countries. Geographical access and cost are not prominent frequently cited at either time point. Conclusions: These findings highlight the need for prioritized programmatic attention aimed at: reducing opposition to contraception in pre-transitional countries; improving service quality and addressing issues of side-effects, both experienced and perceived, in transitional countries; and addressing fecundability perceptions in both types of country contexts. We remind policy makers that even in contexts of fertility stagnation, underlying attitudes, norms, and barriers to contraceptive uptake are shifting. Lack of change at the population-level can mask important changes at the individual-level that must be accounted for in program development and implementation.
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Affiliation(s)
- Apoorva Jadhav
- Office of Population and Reproductive Health, USAID, Arlington, VA, 22202, USA
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Akaba G, Ketare N, Tile W. A community-based, mixed-methods study of the attitudes and behaviors of men regarding modern family planning in Nigeria. Int J Gynaecol Obstet 2016; 135:86-90. [DOI: 10.1016/j.ijgo.2016.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/14/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
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Mosha I, Ruben R, Kakoko D. Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC Public Health 2013; 13:523. [PMID: 23721196 PMCID: PMC3679800 DOI: 10.1186/1471-2458-13-523] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/21/2013] [Indexed: 11/28/2022] Open
Abstract
Background Contraceptive use is low in developing countries which are still largely driven by male dominated culture and patriarchal values. This study explored family planning (FP) decisions, perceptions and gender dynamics among couples in Mwanza region of Tanzania. Methods Twelve focus group discussions and six in-depth interviews were used to collect information from married or cohabiting males and females aged 18–49. The participants were purposively selected. Qualitative methods were used to explore family planning decisions, perceptions and gender dynamics among couples. A guide with questions related to family planning perceptions, decisions and gender dynamics was used. The discussions and interviews were tape-recorded, transcribed verbatim and analyzed manually and subjected to content analysis. Results Four themes emerged during the study. First, “risks and costs” which refer to the side effects of FP methods and the treatment of side -effects as well as the costs inherit in being labeled as an unfaithful spouse. Second, “male involvement” as men showed little interest in participating in family planning issues. However, the same men were mentioned as key decision-makers even on the number of children a couple should have and the child spacing of these children. Third, “gender relations and communication” as participants indicated that few women participated in decision-making on family planning and the number of children to have. Fourth, “urban–rural differences”, life in rural favoring having more children than urban areas therefore, the value of children depended on the place of residence. Conclusion Family Planning programs should adapt the promotion of communication as well as joint decision-making on FP among couples as a strategy aimed at enhancing FP use.
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Affiliation(s)
- Idda Mosha
- School of Public Health and Social Sciences, Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, P,O, Box 65015, Dar es Salaam, Tanzania.
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Shahjahan M, Mumu SJ, Afroz A, Chowdhury HA, Kabir R, Ahmed K. Determinants of male participation in reproductive healthcare services: a cross-sectional study. Reprod Health 2013; 10:27. [PMID: 23680449 PMCID: PMC3663737 DOI: 10.1186/1742-4755-10-27] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 05/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background The role of male’s participation in reproductive healthcare is now well-recognized. The present study investigated the role of men in some selected reproductive health issues, characterizing their involvement, including factors influencing their participation in reproductive healthcare services. Methods This study was conducted in the working areas of urban and rural implemented by NGOs. The sample-size was determined scientifically. The systematic sampling procedure was used for selecting the sample. The study included 615 men aged 25-45 years. Bivariate analysis was performed between male’s involvement as the dependent variable with several independent variables. Logistic regression analysis was applied to assess the effects of risk factors on the participation of men in reproductive health care services. Results The mean age of the respondents was little over 34 years while their mean years of schooling was 3.7, and their mean monthly income was about Tk 3,400 (US$ 1 = Tk 70) at the time of the study. Rickshaw-pulling and driving was the main occupation of the respondents from the urban while farming were main occupation in the rural area respectively. About two-thirds of the respondents discussed reproductive health issues with their wives and accompanied them to healthcare facilities. The current contraceptive-use rate was 63% among the men who attended the evening clinics. Results of bivariate analysis showed a significant association with education, occupation, income, access to media, and number of living children. Results of logistic regression analysis showed that secondary to higher education level, number of living children, paid employment status, long marital duration, and access to media were important correlates of males’ involvement in reproductive healthcare services. Conclusions The results imply that a greater integration of reproductive healthcare matters with the Millennium Development Goals and increasing perception of men through enrollment in various components of reproductive activities will produce synergistic effects.
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Abstract
Research on fertility trends in Islamic northern Nigeria has rarely sought the perspectives of the people of that region concerning the causes of high fertility in the area. Relying on qualitative data elicited from women in northwestern Nigeria, we explore their views on high fertility in the region. A principal finding is that respondents ascribed to their husbands the responsibility for high parity; these women reported deliberately giving birth to many children in order to inhibit men's tendency to divorce or engage in plural marriage. We contend that the social meanings that women ascribe to their husbands' behaviors and the ways they respond to them are significant contributors to current high fertility in northern Nigeria.
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Affiliation(s)
- Chimaraoke O Izugbara
- African Population and Health Research Center, Shelter Afrique Center, Post Office Box 10787-00100, GPO, Nairobi, Kenya.
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Okunlola MA, Owonikoko KM, Roberts OA, Morhason-Bello IO. Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan. J OBSTET GYNAECOL 2006; 26:152-6. [PMID: 16483976 DOI: 10.1080/01443610500443667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.
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Affiliation(s)
- M A Okunlola
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
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Grossman D, Ellertson C, Abuabara K, Blanchard K, Rivas FT. Barriers to contraceptive use in product labeling and practice guidelines. Am J Public Health 2006; 96:791-9. [PMID: 16449602 PMCID: PMC1470589 DOI: 10.2105/ajph.2004.040774] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2004] [Indexed: 11/04/2022]
Abstract
Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist labeling, is a leading reason that women do not use contraceptives. In the United States, hormonal methods currently require a prescription, although research suggests that women can adequately screen themselves for contraindications, manage side effects, and determine an appropriate initiation date, leaving little need for routine direct physician involvement. Sizing, spermicidal use, and length-of-wear limits burden users of cervical barriers and may be unnecessary. Despite recent changes in the labeling of intrauterine devices, clinicians commonly restrict use of this method and in some countries may limit the types of providers authorized to insert them. Although in some cases additional research is necessary, existing data indicate that evidence-based demedicalization of contraceptive provision could reduce costs and improve access.
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Affiliation(s)
- Daniel Grossman
- Ibis Reproductive Health, 2 Brattle Square, Cambridge, MA 02138, USA.
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Ikechebelu JI, Joe-Ikechebelu NN, Obiajulu FN. Knowledge, attitude and practice of family planning among Igbo women of south-eastern Nigeria. J OBSTET GYNAECOL 2006; 25:792-5. [PMID: 16368587 DOI: 10.1080/01443610500328231] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A total of 200 Nigerian women visiting Nnamdi Azikiwe University Teaching Hospital's antenatal clinic were interviewed about their knowledge, attitude and practice of family planning. About 90% were literate. Their knowledge (80%) and approval (87%) of family planning was high, but the practice of modern family planning was low (25%) with most women involved in Billings/safe period (56%). The common methods used were Billings/safe period, condom, withdrawal and the intrauterine contraceptive device (IUCD). A total of 81.5% of the respondents are still willing to give birth while 77% agreed that their last pregnancy was planned. A total of 58.5% of respondents were educated about family planning in the antenatal clinic. The most common source of family planning information was mass media, closely followed by health workers, while the most common single reason for non-practice of family planning was rejection by the husband. We therefore conclude that despite the high education/literacy with the attendant and high knowledge and approval rate of family planning in this part of Nigeria, the practice of family planning is still low, especially due to partner objection. Policy makers should therefore increase male involvement in family planning programmes and pursue a more aggressive public awareness campaign.
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Affiliation(s)
- J I Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
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Onwuhafua PI, Kantiok C, Olafimihan O, Shittu OS. Knowledge, attitude and practice of family planning amongst community health extension workers in Kaduna State, Nigeria. J OBSTET GYNAECOL 2005; 25:494-9. [PMID: 16183589 DOI: 10.1080/01443610500171201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A self-administered opportunistic questionnaire was given to 232 community health extension workers (Chews) in Kaduna state, Nigeria. Seventy-eight were male and 154 female. All could recall at least one modern method of family planning. The oral contraceptive pill (OCP) (85.8%), injectable contraceptives (85.3%), and the intra-uterine contraceptive device (IUCD) (56.0%), were most widely known about. Emergency contraception was not known about. A high percentage of female Chews have practised family planning: 115 (74.7%) have used at least one method and this is more among the married women. Methods ever used included injectable contraceptive (57.4%), OCP (47.0%), and IUCD (22.6%). Fifty percent of females were current users. Non-current users were likely to be between the ages of 25 - 29 years especially when not married, and 35 - 39 years when married. Reasons for the non-use of family planning by female Chews were side effects, not being married, not being sexually active and religious beliefs.
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Affiliation(s)
- P I Onwuhafua
- Rotary International 3-H Project, Kaduna State, Nigeria.
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Yelibi S, Valenti P, Volpe C, Caprara A, Dedy S, Tape G. Sociocultural aspects of AIDS in an urban peripheral area of Abidjan (Côte d'Ivoire). AIDS Care 1993; 5:187-97. [PMID: 8392384 DOI: 10.1080/09540129308258599] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study aimed to gain a better understanding of the social dynamics--migration, urbanization, the status of women, education--related to AIDS in an urban peripheral area of Abidjan. Structured interviews were administered to 420 people, selected through cluster random sampling. Focus groups and semi-structured interviews were performed with key-informants. The results show that 26.9% of the interviewees are foreigners and 40% of all people interviewed participate in ethnic associations. Knowledge of AIDS is associated with age, gender, educational level and purchasing power. Those who are generally better informed about AIDS are: younger people; people with a higher education; and wealthier people. Men respond correctly to questions more frequently than women. French, the chosen language of the education campaigns, is not understood by 18% of the immigrants, and when considering only immigrant women, the figure increases to 38%. Particular attention should be paid to the design of health education messages and strategies for specific groups, such as non-educated people, women and immigrants. Care must also be taken to match the language used to the target population. Ethnic associations constitute an important starting point, particularly in relation to their use by immigrants, and these should be involved in educational programmes.
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Affiliation(s)
- S Yelibi
- Istituto Superiore di Sanità, Rome, Italy
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Fakeye O. Contraception with subdermal levonorgestrel implants as an alternative to surgical contraception at Ilorin, Nigeria. Int J Gynaecol Obstet 1991; 35:331-6. [PMID: 1682181 DOI: 10.1016/0020-7292(91)90667-t] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acceptability and social characteristics of a cohort of Norplant, IUD, pill and depo-med-roxyprogesterone acetate (DMPA) acceptors who were seen at the University of Ilorin Family Planning Clinic over a 10-week period of the pre-introductory clinical trial of Norplant, are compared. Findings indicate that Norplant and DMPA are adopted as an alternative to sterilization by women advanced in reproductive age and of high parity. The pill and IUD are adopted mainly as birth-spacing methods. Women's education, but not previous use of a contraceptive method, influenced the adoption of Norplant. The continuation rate at 12 months, a measure of acceptability, was highest, 93.7 per 100 women, for Norplant and 77.9, 46.7 and 27.7 per 100 women for the IUD, DMPA and the pill, respectively. The need to address the high family size norms in the African subregion is discussed.
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Affiliation(s)
- O Fakeye
- Department of Obstetrics and Gynecology, University of Ilorin Teaching Hospital, Nigeria
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