Evaluation of the effect of the Momentum project on family planning outcomes among first-time mothers aged 15-24 years in Kinshasa, DRC

OBJECTIVES

This article presents the effect of Momentum, a nursing student-led community-based service delivery project, on postpartum family planning (FP) outcomes among first-time mothers in Kinshasa, Democratic Republic of the Congo.

STUDY DESIGN

We employed a quasi-experimental design, with three intervention and three comparison health zones (HZ). Data were collected through interviewer-administered questionnaires in 2018 and 2020. The sample consisted of 1927 nulliparous women aged 15-24 years who were 6 months pregnant at baseline. Random effects and treatment effects models were used to assess the effect of Momentum on 14 postpartum FP outcomes.

RESULTS

The intervention group was associated with a unit increase of 0.6 (95% confidence interval [CI]: 0.4, 0.8)) in contraceptive knowledge and personal agency (95% CI: 0.3, 0.9), a unit decrease of 0.9 (95% CI: -1.2, -0.5) in the number of FP myths/misconceptions endorsed, and percentage point increases of 23.4 (95% CI: 0.2, 0.3) in FP discussion with a health worker, 13.0 (95% CI: 0.1, 0.2) in obtaining a contraceptive method within 6 weeks of delivery, and 13.3 (95% CI: 0.1, 0.2) in modern contraceptive use within 12 months of delivery. Intervention effects included percentage point increases of 5.4 (95% CI: 0.0, 0.1) in partner discussion and 15.4 (95% CI: 0.1, 0.2) in perceived community support for postpartum FP use. The level of exposure to Momentum was significantly associated with all behavioral outcomes.

CONCLUSIONS

The study demonstrated the effect of Momentum on increased postpartum FP-related knowledge, perceived norms, personal agency, partner discussion, and modern contraceptive use.

IMPLICATIONS

Community-based service delivery by nursing students can potentially lead to improved postpartum FP outcomes among urban adolescent and young first-time mothers in other provinces of the Democratic Republic of the Congo and other African countries.

Sustained impact of community-based interventions on contraceptive use among married adolescent girls in rural Niger: Results from a cluster randomized controlled trial

OBJECTIVE

To evaluate the sustained impact of community-based family planning (FP) interventions on current modern contraceptive and long-acting reversible contraceptive (LARC) use among married adolescent girls in rural Niger.

METHODS

We used a cluster randomized controlled trial design following married adolescent girls and their husbands over 3 years. Villages were randomized to one of four arms: household visits, small group discussions, combined intervention, or control. For 1.5 years, couples were exposed to one intervention activity per month and 1.5 years after implementation ended, we used a multi-level mixed effects logistic regression model to evaluate changes in key FP outcomes.

RESULTS

We analyzed survey data from 404 married adolescent girls with data at baseline and endline. Small group discussions (+35.6%; adjusted odds ratio [aOR] 7.94, P < 0.001) and the combined intervention (+17.9%: aOR 4.53, P = 0.005) led to statistically significant increases in the odds of using modern contraceptives at endline compared with the control. The combined intervention (+14.2%; aOR 7.98, P < 0.001) and home visits (+12.6%; aOR 8.09, P < 0.001) led to statistically significant increases in odds of using LARC methods at endline compared with the control. Increase in LARC use was driven by implant use across all intervention groups.

CONCLUSION

This study contributes to the empirical evidence base on the sustained impact of community-based interventions on increases in FP use among married adolescent girls in low- and middle-income countries.

Creating Reproductive Health Behavioral Profiles for Women of Reproductive Age in Niger Using Cross-Sectional Survey Data: A Latent Class Analysis

Objectives: To identify health behavioral profiles for women of reproductive age in Niger. Methods: We interviewed married women of reproductive age in Niger in April 2021 (N = 2,709). Latent class analysis based on sociodemographic and behavioral determinants was used to identify classes of women related to use of antenatal care, facility delivery, and modern family planning (FP) use. Results: We found similar classes between the use of antenatal care and facility-based delivery classes with the first class composed of less educated and poor women with weaker behavioral determinants while the second class was more educated and had stronger behavioral determinants. In the facility-based delivery class was the presence of a third class that was poor and uneducated with low levels of knowledge and social norms, but in contrast had much higher levels of positive attitudes, self-efficacy, and partner communication than the first class. A fourth class of younger, more educated women with strong behavioral determinants emerged related to FP. Conclusion: The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimizing maternal and reproductive health.

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.

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

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

Low contraceptive utilization among young married women is associated with perceived social norms and belief in contraceptive myths in rural Ethiopia

Introduction

Despite the increasingly wider availability of contraceptives and the high levels of unmet need for family planning in rural Ethiopia, contraceptive utilization among young married women is low. Studies on associated factors in Ethiopia so far have been focused on individual factors with little emphasis on socio-cultural factors. This study aimed to assess the association between contraceptive utilization and socio-cultural factors among young married women in Eastern Ethiopia.

Methods

A community-based survey was conducted among young married women aged 14–24 years. A total of 3039 women were interviewed by trained data collectors using a structured questionnaire. Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was used to identify factors associated with contraceptive utilization using multivariable logistic regression analysis.

Results

The current contraceptive prevalence rate was 14.1% (95% CI: 12.8–15.5). Perceived social approval (AOR = 1.90; 95% CI = 1.60–2.30) and perception of friends’ contraceptive practice (AOR = 1.34; 95% CI: 1.20–1.54) were significantly and positively associated with contraceptive utilization. On the contrary, increased score of belief in contraceptive myths was significantly and negatively associated with contraceptive use (AOR = 0.60; 95% CI: 0.49–0.73). Moreover, recent exposure to family planning information (AOR = 1.67; 95% CI: 1.22–2.28), ever-mother (AOR = 9.68; 95% CI: 4.47–20.90), and secondary and above education level (AOR = 1.90; 95% CI: 1.38–2.70) were significantly associated with higher odds of contraceptive utilization.

Conclusion

Only about one-in-seven young married women were using contraceptive methods. Socio-cultural factors significantly influence young married women’s contraceptive utilization. Interventions to address social norms and pervasive myths and misconceptions could increase the use of contraceptive methods in young married women.

Individual-level and community-level factors associated with the family planning use among pastoralist community of Ethiopia: a community-based cross-sectional study

OBJECTIVE

The study aimed to identify the effects of the individual-level and community-level factors on the use of family planning (FP) among married women in the pastoralist community of Ethiopia.

DESIGN

A community-based cross-sectional study was conducted in September 2018. Data were analysed using R software. To determine the fixed effect of individual-level and community-level factors of FP use, a two-level mixed-effects logistic regression was used. The result was described using the Adjusted OR (AOR), and the variance partition coefficient.

SETTING AND PARTICIPANTS

Afar, Ethiopia (2018; n=891) married women of reproductive age (15-49) years.

PRIMARY OUTCOME MEASURES

FP use or non-use.

RESULTS

The current use of FP was 18.7% (16.31%-21.43%). Women who need to walk 1 hour and more to the nearest health facility (AOR 0.14, 95% CI 0.05 to 0.3), have ANC visit of 4 and above (AOR 6.02, 95% CI 1.74 to 20.8), had their last birth at a health facility (AOR 2.71 95% CI 1.27 to 5.81), have five and more children (AOR 4.71, 95% CI 1.86 to 11.9), have high knowledge on FP (AOR 2.74, 95% CI 1.11 to 6.74) and had high intentions to use FP (AOR 10.3, 95% CI 3.85 to 27.6) were more likely to report FP use. The magnitude of the effect of for FP use was smaller than that of 9 of the 13 individual factors. Apart from this 19.4% of the total variance in the odds of using FP attributed to between community difference (intraclass correlation coefficient=0.194). Regarding the community-level characteristics, clusters of having higher electronic media possession (AOR 2.84, 95% CI 1.2 to 6.72) and higher women decision making on FP (AOR 8.35, 95% CI 2.7 to 27.1) were significantly associated with increased FP use compared with clusters with lower reports of these aspects.

CONCLUSION

FP use among the pastoralist community is influenced by both individual cluster/community-level characteristics or factors. Even though the effect of clustering in FP use was large in comparison with the unexplained between-cluster variation, it was lower than the individual-level factors.

TRAIL REGISTRTION NUMBER

NCT03450564.

Knowledge, attitudes, and practices related to family planning and gender equity among husbands of adolescent girls in Niger

Despite having the highest fertility rate in the world, research on Niger men and family planning (FP) is limited. We collected survey data collected in the Dosso region of Niger in 2016 from 1136 men who are the husbands of adolescent girls. We report descriptive statistics, bivariate and multivariable logistic regression on three dichotomous outcomes: (a) knowledge of modern contraceptives, (b) beliefs that only husbands should make FP decisions, and (c) current FP use. About 56% had ever heard of the pill, 6% had ever heard of an intrauterine device, and 45% had ever heard of an injectable. In our multivariable analyses, we found: a man knowing at least one modern method was significantly associated with his age, wife’s education level, gender ideology, and wife’s say in healthcare decisions; men’s belief that men alone should make FP decisions was associated with husband’s Quranic education, gender ideology, and attitudes towards violence against women; men’s reports of adolescent wives’ current family planning use was associated with men’s Quranic education, women’s involvement in her own healthcare decisions, and belief that men alone should decide about family planning. Finding suggests that interventions should target aim to reduce gender inequities to increase family planning utilisation.