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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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Mavodza CV, Mackworth-Young CRS, Nyamwanza R, Nzombe P, Dauya E, Dziva Chikwari C, Tembo M, Ferrand RA, Bernays S. Fertility preservation and protection: young women's decision-making about contraceptive use in Zimbabwe. CULTURE, HEALTH & SEXUALITY 2024; 26:824-838. [PMID: 37729466 DOI: 10.1080/13691058.2023.2258175] [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: 03/29/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
The study explored social and health system influences on young women's decision-making about family planning in a community setting with low uptake. Seventy-two semi-structured interviews were conducted between April 2020 and November 2021, with both young women accessing, and healthcare workers providing, a community-based integrated package of HIV and sexual and reproductive health services (CHIEDZA) in Zimbabwe. Data were thematically analysed. Although long-acting contraception was freely available as part of the CHIEDZA initiative, uptake was low. Young women's contraception choices were influenced by a desired reproductive sequence, which reflected prevailing social norms and was conveyed by peers and female relatives. Nulliparous young women preferred short-term contraception and avoided hormonal contraceptives prepartum to 'preserve' their fertility. Once fertility had been confirmed within marriage through the birth of a child, hormonal contraceptive use became socially permissible. Healthcare workers, cognisant of community discourse, sensitively proposed alternative approaches. Increasing the availability of correct and adequate information and commodities is critical to improving the uptake of contraceptives for young women, but it is insufficient alone. Recognising and responding to local contextual understandings which frame considerations of appropriateness is paramount. Successful implementation of family planning interventions requires engaging with social norms and the influential groups that perpetuate them.
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Affiliation(s)
- Constancia V Mavodza
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Constance R S Mackworth-Young
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rangarirayi Nyamwanza
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Portia Nzombe
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mandikudza Tembo
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
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Gebrekidan H, Alemayehu M, Debelew GT. Determinants of unmet need for modern contraceptives in Ethiopia. BMJ Open 2024; 14:e079477. [PMID: 38692721 PMCID: PMC11086180 DOI: 10.1136/bmjopen-2023-079477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To identify the determinants of the unmet need for modern contraceptives in Ethiopia. DESIGN Community-based cross-sectional study. SETTING Ethiopia. PARTICIPANTS A group of 6636 women of reproductive age (15-49 years) who were sexually active were included in the study. OUTCOME Unmet need for modern contraceptives METHOD: The study used data from the 2019 Performance Monitoring for Action-Ethiopia survey, which was community-based and cross-sectional. The sample consisted of women aged 15-49 from households randomly selected to be nationally representative. Multinomial logistic regression and spatial analysis were performed to determine the factors influencing unmet needs for modern contraceptives. The descriptive analysis incorporated svy commands to account for clustering. RESULTS The proportion of unmet need for modern contraceptives was 19.7% (95% CI: 18% to 21.5%). Women with supportive norms towards family planning had a lower risk of unmet need for spacing (relative risk ratio (RRR)=0.92, 95% CI: 0.86 to 0.99). Older age lowered the risk of unmet need for spacing 40-44 (RRR=0.28, 95% CI: 0.13 to 0.59) and 45-49 (RRR=0.11, 95% CI: 0.04 to 0.31). Being married increased the unmet need for spacing (RRR=1.9, 95% CI: 1.36 to 2.7) and limiting (RRR=3.7, 95% CI: 1.86 to 7.4). Increasing parity increases the risk of unmet need for spacing (RRR=1.27, 95% CI: 1.16 to 1.38) and limiting (RRR=1.26, 95% CI: 1.15 to 1.4). Contrarily, older age increased the risk of unmet need for limiting 40-44 (RRR=10.2, 95% CI: 1.29 to 79.5), 45-49 (RRR=8.4, 95% CI: 1.03 to 67.4). A clustered spatial unmet need for modern contraceptives was observed (Global Moran's I=0.715: Z-Score=3.8496, p<0.000118). The SaTScan identified 102 significant hotspot clusters located in Harari (relative risk (RR)=2.82, log-likelihood ratio (LLR)=28.2, p value<0.001), South Nations Nationalities and People, Oromia, Gambella and Addis Ababa (RR=1.33, LLR=15.6, p value<0.001). CONCLUSIONS High levels of unmet need for modern contraceptives were observed in Ethiopia, showing geographical variations. It is essential to address the key factors affecting women and work towards reducing disparities in modern contraceptive unmet needs among different regions.
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Affiliation(s)
- Hailay Gebrekidan
- Population and Family Health, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Oromia, Ethiopia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mussie Alemayehu
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gurmesa Tura Debelew
- Population and Family Health, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Oromia, Ethiopia
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Gosse RA, Msengi EA, Chona EZ, Ambikile JS. Experiences of caring for women with cervical cancer: A qualitative study among male partners in Dar es Salaam, Tanzania. Health Expect 2024; 27:e14038. [PMID: 38561909 PMCID: PMC10985225 DOI: 10.1111/hex.14038] [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: 09/30/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND More than three-fourths of cervical cancer cases occur in low- and middle-income countries, with sub-Saharan Africa (SSA) accounting for approximately 25% of global mortality. The significant rise in the prevalence of cervical cancer in SSA amplifies the burden on caregivers, contributing to elevated rates of mental illness, particularly among spouses who provide care. Men who assume the role of caregivers for their partners with cervical cancer encounter unique challenges and substantial adjustments across multiple facets of life, impacting both their own quality of life and that of their partners. Despite this, there is a notable lack of extensive research on the experiences of male partners in caregiving roles, particularly within SSA countries like Tanzania. Therefore, this study aimed to explore the experiences of male partners providing care for women with cervical cancer in Dar es Salaam, Tanzania. METHODS An exploratory qualitative study was undertaken to explore the experiences of 13 male partners, selected purposively and guided by the principle of saturation. Data gathering employed in-depth interviews utilizing a semistructured interview guide, with subsequent analysis conducted via a thematic analysis approach. RESULTS Five themes and 13 subthemes were generated, encompassing psychosocial distress, attitudes towards cervical cancer, unity in the provision of care, economic burden, and altered sexual relationships. Participants reported experiencing emotional distress, shifts in social responsibilities, financial challenges, and unfulfilled sexual needs. Moreover, they expressed the need for social, psychological, financial, and sexual and reproductive support. CONCLUSION This study underscores the numerous challenges encountered by male partners caring for women with cervical cancer, encompassing emotional distress, financial strain, and shifts in social and sexual dynamics. The identified themes and subthemes highlight the intricate interplay of these difficulties and stress the necessity for holistic support systems addressing the social, psychological, financial, and sexual aspects of male partners' experiences. The findings emphasize the importance of designing and implementing comprehensive support programmes tailored to the diverse needs of male partners, ultimately enhancing their quality of life and overall well-being. PATIENT OR PUBLIC CONTRIBUTION Before the study, the nursing manager assisted in selecting three male partners randomly. These partners were involved in the design of the participants' information sheet, the evaluation of the interview schedule and rooms, and the dissemination of information about the study's purpose to the target population. Their valuable input contributed to improving the participant information sheet, refining data collection procedures and addressing ethical considerations. However, these individuals were not considered study participants. Throughout the study, in-charge nurses in the hospital were informed about the study's goals and helped organize appointments with participants and manage the interview schedule.
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Affiliation(s)
- Rashid A. Gosse
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Emanueli Amosi Msengi
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Emmanuel Z. Chona
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Joel S. Ambikile
- Department of Clinical NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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Damtew SA, Fantaye FT. Women alone modern contraceptive use decision making and its correlates, evidence from PMA CS 2021 survey. BMC Womens Health 2024; 24:205. [PMID: 38555426 PMCID: PMC10981343 DOI: 10.1186/s12905-024-03050-x] [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: 09/20/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Women alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners' effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health. METHODS Nationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance. RESULTS This study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use. CONCLUSION 59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.
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Allotey NK, Bosoka SA. Demographic, Sociocultural, and Behavioral Predictors of Modern Contraceptive Uptake Among Couples in Northern Ghana. Open Access J Contracept 2024; 15:23-40. [PMID: 38495450 PMCID: PMC10941790 DOI: 10.2147/oajc.s430288] [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: 08/12/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Background Despite efforts to increase modern contraceptive use in Ghana, prevalence rates remain low; particularly in Northern Ghana. This study, therefore, sought to determine the predictors of modern contraceptive use among couples in Northern Ghana. This research was the baseline assessment for a broader study aimed at determining the effect of an intervention to improve outcomes of modern contraception. Methods The study was a cross-sectional design. Data was collected from 508 couples (1016 participants), using a multistage sampling technique; both members of each couple were interviewed separately. Univariate and stepwise multivariate logistic regression were used to identify predictors associated with modern contraceptive use. Qualitative data were analyzed to triangulate the findings from the quantitative data. Results More than 97% of couples were Muslims. Qualitative data indicates that Muslims are less inclined to use Modern Contraceptives. Most participants had no education. The regression model shows that all demographic characteristics were not significant in Model 3 for men. Socio-culturally, men who gave the reason of "unconcerned" for men's non-involvement in contraceptive adoption, had less odds of using modern contraception (AOR=0.19). Men with high subjective norms were more than 15 times more likely to use modern contraception. Female farmers were less likely to use contraceptives (AOR= 0.45). Women who reported that "nothing prevented men" from getting involved in contraceptive adoption had greater odds of adopting modern contraception (AOR= 11.15). Women with good perceived behavioral control were more likely to use modern contraception (AOR=5.03). Women with high enacted stigma and men and women with high interspousal communication were more likely to adopt modern contraception. Conclusion Taking cognizance of demographic and sociocultural characteristics and behavioral constructs is needed when determining the predictors of modern contraceptive use among couples in Northern Ghana.
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Affiliation(s)
- Naa-Korkor Allotey
- Ethics and Research Management Department, Research and Development Division, Ghana Health Service, Accra, Ghana
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Samuel Adolf Bosoka
- Disease Surveillance Unit, Volta Regional Health Directorate, Ghana Health Service, Ho, Ghana
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Islam M, Habib SE. "I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh. Reprod Health 2024; 21:32. [PMID: 38454434 PMCID: PMC10919042 DOI: 10.1186/s12978-024-01763-8] [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: 09/09/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. METHOD A qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15-49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman's three-phase coding system. RESULTS Five broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. CONCLUSION Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.
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Affiliation(s)
- Mansura Islam
- School of General Education, BRAC University, Dhaka 1212, Bangladesh.
| | - Shah Ehsan Habib
- Department of Sociology, University of Dhaka, Dhaka 1000, Bangladesh
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Achola R, Atuyambe L, Nabiwemba E, Nyashanu M, Garimoi Orach C. Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study. PLoS One 2024; 19:e0278731. [PMID: 38427612 PMCID: PMC10906906 DOI: 10.1371/journal.pone.0278731] [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: 11/20/2022] [Accepted: 12/22/2023] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathew Nyashanu
- Department of Health & Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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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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Ökem ZG, Pekkurnaz D. Determinants of unmet need for family planning: Evidence from the 2018 Turkey Demographic and Health Survey. J Biosoc Sci 2024; 56:90-103. [PMID: 37309650 DOI: 10.1017/s0021932023000123] [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] [Indexed: 06/14/2023]
Abstract
Unmet need for family planning is a valuable concept to indicate the discrepancy between women's fertility preferences and contraceptive use. Unmet need may lead to unintended pregnancies and unsafe abortions. These may result in health deterioration and reduced employment opportunities for women. The 2018 Turkey Demographic and Health Survey report indicated that the estimated unmet need for family planning doubled from 2013 to 2018, returning to the high levels of the late 1990s. Considering this unfavourable change, this study aims to investigate the determinants of unmet need for family planning among married women of reproductive age in Turkey by using the 2018 Turkey Demographic and Health Survey data. Logit model estimations revealed that women who were at older ages, more educated, wealthier, and had more than one child were less likely to have unmet need for family planning. Employment statuses of women and their spouses and place of residence were significantly associated with unmet need. Results emphasised that training and counselling to enhance the use of family planning methods should effectively target young, less educated, and poor women.
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Affiliation(s)
- Zeynep Güldem Ökem
- Faculty of Economics and Administrative Sciences, Department of International Entrepreneurship, TOBB University of Economics and Technology, Ankara, Turkey
| | - Didem Pekkurnaz
- Faculty of Economics and Administrative Sciences, Department of Economics, Başkent University, Ankara, Turkey
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11
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Newmann SJ, Zakaras JM, Rocca CH, Gorrindo P, Ndunyu L, Gitome S, Withers M, Bukusi EA, Dworkin SL. Transforming masculine norms to improve men's contraceptive acceptance: results from a pilot intervention with men in western Kenya. Sex Reprod Health Matters 2023; 31:2170084. [PMID: 36811906 PMCID: PMC9970212 DOI: 10.1080/26410397.2023.2170084] [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] [Indexed: 02/24/2023] Open
Abstract
Men's adherence to constraining male gender norms can lead them to resist contraceptive use. Very few interventions have attempted to transform masculine norms to encourage greater contraceptive acceptance and gender equality. We designed and evaluated a small-scale community-based intervention targeting the masculine norms tied to contraceptive resistance among partnered men (N = 150) in two western Kenya communities (intervention vs. control). Pre-post survey data fit to linear and logistic regression models evaluated differences in post-intervention outcomes, accounting for pre-intervention differences. Intervention participation was associated with increases in contraceptive acceptance scores (adjusted coefficient (aβ) 1.04; 95% confidence interval (CI) 0.16, 1.91; p = 0.02) and contraceptive knowledge scores (aβ 0.22; 95% CI 0.13, 0.31; p < 0.001) and with contraceptive discussions with one's partner (adjusted Odds Ratio (aOR) 3.96; 95% CI 1.21, 12.94; p = 0.02) and with others (aOR 6.13; 95% CI 2.39, 15.73; p < 0.001). The intervention was not associated with contraceptive behavioural intention or use. Our findings demonstrate the promise of a masculinity-driven intervention on increasing men's contraceptive acceptance and positive contraceptive involvement. A larger randomised trial is needed to test the effectiveness of the intervention among men as well as among couples.
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Affiliation(s)
- Sara J. Newmann
- Professor of Clinical Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, 1001 Potrero Avenue, 6D22, San Francisco, CA94110, USA.,Correspondence:
| | - Jennifer Monroe Zakaras
- Research Associate, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Corinne H. Rocca
- Professor, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Phillip Gorrindo
- GloCal Fellow, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | | | - Serah Gitome
- Research Officer, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mellissa Withers
- Associate Professor, University of Southern California Institute for Global Health, Los Angeles, CA, USA
| | | | - Shari L. Dworkin
- Dean and Professor, School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
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12
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Gudu W, Bekele D, Surur F, Teklu A, Abesha Y, Nigatu B, Kassa M, Lako TK, Sium AF. Role of male partner in women's fertility decision and family planning utilization in four regional states of Ethiopia: A mixed-method study. Int J Gynaecol Obstet 2023; 163:672-678. [PMID: 37395318 DOI: 10.1002/ijgo.14973] [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: 02/22/2023] [Revised: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To determine the role of male partner involvement in fertility decision-making and intention to use contraceptives by women in four regional states of Ethiopia. METHODS A mixed-method quantitative-qualitative cross-sectional study was conducted among 2891 women of reproductive age in four emerging regions (Benishangul-Gumuz, Gambela, Afar, and Somali) of Ethiopia. Key informant interview, in-depth interview, and focus group discussion were performed for qualitative data extraction. Simple descriptive statistics were used to analyze quantitative data, and frequency, means, and proportions were used to present the results. Qualitative data were analyzed. RESULTS Approximately half of the women (1519/2891, 52.5%) discussed contraceptive methods with their partners. Most women did not have the freedom to make independent decisions on fertility preference, with the highest being in the Afar region (376/643, 58.5%). In all regions, the male partner was the dominant decision-maker behind the intention to start using or continue using family planning methods by the woman. Better educational status of male partners and a good attitude towards use of family planning by the woman were associated with contraceptive use by the women. CONCLUSIONS Male partners play a predominant role in fertility preferences and decisions on family planning use by women.
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Affiliation(s)
- Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Feiruz Surur
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alula Teklu
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yonas Abesha
- Individual Consultant Based in Ethiopia, Addis Ababa, Ethiopia
| | - Balkachew Nigatu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Munir Kassa
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | | | - Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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13
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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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14
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Söderbäck K, Holter H, Salim SA, Elden H, Bogren M. Barriers to using postpartum family planning among women in Zanzibar, Tanzania. BMC Womens Health 2023; 23:182. [PMID: 37069560 PMCID: PMC10111817 DOI: 10.1186/s12905-023-02330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar. METHODS Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach. RESULTS Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband. CONCLUSIONS The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.
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Affiliation(s)
| | - Herborg Holter
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Helen Elden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
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15
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Sack DE, Emílio A, Graves E, Matino A, Paulo P, Aboobacar AU, De Schacht C, Audet CM. Attitudes and perceptions towards postpartum contraceptive use among seroconcordant partners with HIV in rural Mozambique: a qualitative study. Glob Health Res Policy 2023; 8:7. [PMID: 36918959 PMCID: PMC10014407 DOI: 10.1186/s41256-023-00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Postpartum contraceptive uptake reduces short interpregnancy intervals, unintended pregnancies, and their negative sequalae: poor maternal and fetal outcomes. Healthy timing and spacing of pregnancy in people living with HIV (PLHIV) also allows time to achieve viral suppression to reduce parent-to-child HIV transmission. There is scant understanding about how couples-based interventions impact postpartum contraceptive uptake among PLHIV in sub-Saharan Africa. METHODS We interviewed 38 recently pregnant people and 26 of their partners enrolled in the intervention arm of the Homens para Saúde Mais (HoPS+) [Men for Health Plus] trial to assess their perceptions of, attitudes towards, and experiences with contraceptive use. Individuals in the HoPS+ intervention arm received joint-as opposed to individual-HIV-related services during pregnancy and postpartum periods, six counseling and skills sessions, and nine sessions with a peer support couple. Our thematic analysis of the 64 in-depth interviews generated 14 deductive codes and 3 inductive codes across themes within the Information, Motivation, and Behavior Model of health behavior change. RESULTS Participants reported accurate and inaccurate information about birth spacing and contraceptive methods. They described personal (health, economic, and religious) and social (gender norms, desired number of children) motivations for deciding whether to use contraceptives-with slightly different motivations among pregnant and non-pregnant partners. Finally, they explained the skills needed to overcome barriers to contraceptive use including how engagement in HoPS+ improved their shared decision-making skills and respect amongst partners-which facilitated postpartum contraceptive uptake. There were also several cases where non-pregnant partners unilaterally made family planning decisions despite disagreement from their partner. CONCLUSIONS These findings suggest that couples-based interventions during pregnancy and post-partum periods aimed at increasing postpartum contraceptive uptake must center pregnant partners' desires. Specifically, pregnant partners should be allowed to titrate the level of non-pregnant partner involvement in intervention activities to avoid potentially emboldening harmful gender-based intercouple decision-making dynamics.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | - Paula Paulo
- Friends in Global Health, Quelimane, Mozambique
| | | | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
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16
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Zinke-Allmang A, Bhatia A, Gorur K, Hassan R, Shipow A, Ogolla C, Keizer K, Cislaghi B. The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study. Reprod Health 2023; 20:41. [PMID: 36894997 PMCID: PMC9997433 DOI: 10.1186/s12978-023-01581-4] [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: 12/13/2021] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.
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Affiliation(s)
- Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Amy Shipow
- Busara Center for Behavioral Economics, Nairobi, Kenya
| | | | - Kees Keizer
- University of Groningen, Groningen, Netherlands
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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17
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Sedlander E, Dahal M, Bingenheimer JB, Puri MC, Rimal RN, Granovsky R, Diamond-Smith NG. Adapting and Validating the G-NORM (Gender Norms Scale) in Nepal: An Examination of How Gender Norms Are Associated with Agency and Reproductive Health Outcomes. Stud Fam Plann 2023; 54:181-200. [PMID: 36715570 DOI: 10.1111/sifp.12231] [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] [Indexed: 01/31/2023]
Abstract
Research calls for the sexual and reproductive rights field to prioritize gender norms to ensure that women can act on their reproductive rights. However, there is a gap in accepted measures. We addressed this by including important theoretical components of gender norms: differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated the G-NORM, a gender norms scale, in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. We administered items to women of reproductive age, conducted exploratory and confirmatory factor analysis, and examined associations between the subscales and reproductive health outcomes. Like the original G-NORM, our factor analyses showed that descriptive norms and injunctive norms comprise two distinct scales which fit the data well and had Cronbach alphas of 0.92 and 0.89. More equitable descriptive gender norms were associated with higher decision-making scores, increased odds of intending to use family planning, disagreeing that it is wrong to use family planning, and older ideal age at marriage. Injunctive gender norms were only associated with disagreeing that it is wrong to use family planning. Findings offer an improved measure of gender norms in Nepal and provide evidence that gender norms are critical for agency and reproductive health outcomes.
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Affiliation(s)
- Erica Sedlander
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Minakshi Dahal
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | | | - Mahesh C Puri
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Granovsky
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nadia G Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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18
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Medley A, Tsiouris F, Pals S, Senyana B, Hanene S, Kayeye S, Casquete RR, Lasry A, Braaten M, Aholou T, Kasonde P, Chisenga T, Mweebo K, Harris TG. An Evaluation of an Enhanced Model of Integrating Family Planning Into HIV Treatment Services in Zambia, April 2018-June 2019. J Acquir Immune Defic Syndr 2023; 92:134-143. [PMID: 36240748 PMCID: PMC10913187 DOI: 10.1097/qai.0000000000003111] [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: 05/03/2022] [Accepted: 09/13/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND We designed and implemented an enhanced model of integrating family planning (FP) into existing HIV treatment services at 6 health facilities in Lusaka, Zambia. METHODS The enhanced model included improving FP documentation within HIV monitoring systems, training HIV providers in FP services, offering contraceptives within the HIV clinic, and facilitated referral to community-based distributors. Independent samples of women living with HIV (WLHIV) aged ≥16 years were interviewed before and after intervention and their clinical data abstracted from medical charts. Logistic regression models were used to assess differences in key outcomes between the 2 periods. RESULTS A total of 629 WLHIV were interviewed preintervention and 684 postintervention. Current FP use increased from 35% to 49% comparing the pre- and postintervention periods ( P = 0.0025). Increased use was seen for injectables (15% vs. 25%, P < 0.0001) and implants (5% vs. 8%, P > 0.05) but not for pills (10% vs. 8%, P < 0.05) or intrauterine devices (1% vs. 1%, P > 0.05). Dual method use (contraceptive + barrier method) increased from 8% to 18% ( P = 0.0003), whereas unmet need for FP decreased from 59% to 46% ( P = 0.0003). Receipt of safer conception counseling increased from 27% to 39% ( P < 0.0001). The estimated total intervention cost was $83,293 (2018 USD). CONCLUSIONS Our model of FP/HIV integration significantly increased the number of WLHIV reporting current FP and dual method use, a met need for FP, and safer conception counseling. These results support continued efforts to integrate FP and HIV services to improve women's access to sexual and reproductive health services.
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Affiliation(s)
- Amy Medley
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA
| | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Sherri Pals
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA
| | - Brenda Senyana
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Susan Hanene
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Shadrick Kayeye
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | | | - Arielle Lasry
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA
| | - Mollie Braaten
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Tiffiany Aholou
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA
| | - Prisca Kasonde
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | | | - Keith Mweebo
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lusaka, Zambia
| | - Tiffany G. Harris
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
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Mukose AD, Bastiaens H, Makumbi F, Buregyeya E, Naigino R, Musinguzi J, Van Geertruyden JP, Wanyenze RK. Challenges and commonly used countermeasures in the implementation of lifelong antiretroviral therapy for PMTCT in Central Uganda: Health providers' perspective. PLoS One 2023; 18:e0280893. [PMID: 36662894 PMCID: PMC9858842 DOI: 10.1371/journal.pone.0280893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Uganda has implemented lifelong antiretroviral therapy for the prevention of mother-to-child HIV transmission since September 2012. Implementation of this strategy has been met with health provider and client challenges which have persisted up to date. This study explored providers' perspectives on the challenges and countermeasures of the implementation and scale-up of lifelong ART among pregnant and breastfeeding women. METHODS A qualitative descriptive study was conducted whereby 54 purposively selected participants from six facilities in three districts of Central Uganda namely; Masaka, Mityana, and Luwero were recruited. A key informant interview guide was used to collect data from the study participants. The data were thematically analysed using Atlas-ti, Version 7. RESULTS Study participants reported challenges under the themes of 1) inadequacy of HIV service delivery (lack of relevant training, health provider shortages, inadequate counselling, stock-outs of essential HIV commodities); 2) Non-utilization of HIV services (Non-disclosure of HIV- positive results, denial of HIV positive results, fear to be followed up, unwillingness to be referred, large catchment area, lack of transport); and 3) Suboptimal treatment adherence (fear of ART side effects, preference for traditional medicines, low male partner involvement in care and treatment). Strategies such as on-job training, mentorship, task shifting, redistribution of HIV commodities across facilities, accompanying of women to mother-baby care points, ongoing counseling of women, peers, and family support groups were commonly used countermeasures. CONCLUSIONS This study highlights key challenges that health providers face in implementing lifelong antiretroviral therapy services among pregnant and postpartum women. Context-specific, innovative, and multilevel system interventions are required at national, district, health facility, community and individual levels to scale up and sustain the lifelong antiretroviral therapy strategy among pregnant and breastfeeding women.
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Affiliation(s)
- Aggrey David Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Antwerp, Belgium
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rose Naigino
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Jean-Pierre Van Geertruyden
- Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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20
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Hassan R, Bhatia A, Zinke-Allmang A, Shipow A, Ogolla C, Gorur K, Cislaghi B. Navigating family planning access during Covid-19: A qualitative study of young women's access to information, support and health services in peri-urban Nairobi. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100031. [PMID: 34927130 PMCID: PMC8665648 DOI: 10.1016/j.ssmqr.2021.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/12/2023]
Abstract
The COVID-19 response has profoundly affected women's access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women's FP choices. In this qualitative study, we interviewed 16 women (aged 18-25 years), 10 men in partnerships with women, and 14 people in women's social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.
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Affiliation(s)
- Rahma Hassan
- University of Nairobi, Kenya,Corresponding author
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
| | - Anja Zinke-Allmang
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
| | - Amy Shipow
- Busara Center for Behavioral Economics, Kenya
| | | | | | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
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21
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Aristide C, Bullington BW, Kuguru M, Sundararajan R, Nguyen NT, Lambert VJ, Mwakisole AH, Wamoyi J, Downs JA. Health providers' perspectives on contraceptive use in rural Northwest Tanzania: A qualitative study. Contracept X 2022; 4:100086. [PMID: 36324829 PMCID: PMC9618975 DOI: 10.1016/j.conx.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives In Tanzania, contraceptive use is limited, particularly in rural communities and even among women who would like to delay childbearing. This paper aims to present health providers' perspectives on populations seeking contraception and barriers that could be addressed to increase access to and uptake of contraception, given their interface with large portions of their communities. Study Design We conducted 18 in-depth interviews with providers stationed at health dispensaries in six rural villages in northwest Tanzania. Two investigators independently coded interviews using a stepwise process to achieve consensus on prevalent topics. Results Three topics emerged from our analysis: (1) nature of clients seeking contraception; (2) barriers to uptake of contraception; and (3) the role of secrecy in obtaining and using contraception. Health providers reported that married women with children were the most frequent users of contraception, alongside some single women, men, sex workers, and students. Barriers to contraception included lack of supplies and trained staff, misconceptions and fears, stigma, and unsupportive partners. Providers observed that contraception was often used secretly. They reported surreptitious visits and described clients' preferential use of discreet methods. Providers respected and supported clients' desires to keep visits confidential. Conclusion Our data suggest maintaining high stocks of discreet contraceptive methods and deploying more trained staff to dispensaries could increase availability and access to contraceptives. At the community level, more education campaigns are warranted to address barriers, especially those related to stigma. Implications Our work highlights the need for additional contraceptive methods that are easy to administer and discreet for women who must maintain secrecy. Future studies of the effectiveness of interventions and new contraceptives should obtain healthcare providers' perspectives, as they can provide important insights to service provision.
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Affiliation(s)
- Christine Aristide
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
- Corresponding author.
| | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Natalie T. Nguyen
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
| | | | | | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
- Department of Medicine, Bugando Medical Center, Mwanza, Tanzania
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Agyekum MW, Henry EG, Kushitor MK, Obeng-Dwamena AD, Agula C, Opoku Asuming P, Toprah T, Agyei-Asabere C, Shah I, Bawah AA. Partner support and women's contraceptive use: insight from urban poor communities in Accra, Ghana. BMC Womens Health 2022; 22:256. [PMID: 35752803 PMCID: PMC9233795 DOI: 10.1186/s12905-022-01799-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Despite the benefits associated with contraceptive use, there is a low prevalence of contraceptive use in sub-Saharan Africa and Ghana. Previous studies have partly and consistently attributed the low prevalence of contraceptive use to partner opposition. However, little is known about the influence of men in contraceptive related choices of their partners, particularly within the context of urban poverty. This study examines the influences of partners on women’s contraceptive choices.
Methods The study utilized a cross-sectional household survey data of 1578 currently married women and women in a union of reproductive ages 16–44 years. Women who were pregnant and those trying to be pregnant were excluded from the analysis. The dependent variables for the study were current use of any contraceptive method, types of contraceptive methods and types of modern contraceptive methods. The independent variable for the study was a woman’s report of partner support in contraceptive related choices. A binary logistic regression model was used to examine the associations between partner support in contraceptive related choices and contraceptive use of women.
Results The results of the study show that partner support of contraceptive related choices has a significant influence on contraceptive use of women. Women who indicated support from their partners were more likely to be current users of any contraceptive method, yet were less likely to use modern contraceptive methods.
Conclusion The study highlights the need to involve men in family planning programs and research, as well as educating them on the various contraceptive modern methods and the side effects.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Iqbal Shah
- Harvard TH Chan School of Public Health, Boston Massachusetts, USA
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Seth K, Nanda S, Sahay A, Verma R, Achyut P. Men, The Missing Link In Gender-equitable Family Planning: A Scoping Review. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13536.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Across societies, gender norms often allow men to hold key decision-making power within relationships, households and communities. This extends to almost all domains, consisting of family planning (FP) as well. FP programs have largely engaged men as clients and rarely as equal partners or influencers although across lower- and middle-income countries (LMICs), and especially in South Asia, men hold key decision-making power on the domain of family planning. The objective of this article is to explore couple dynamics through the lens of spousal communication and decision-making and unpack male engagement and spousal dynamics in family planning. Methods: This review presents a synthesis of evidence from two peer-reviewed databases, PubMed and Jstor, and and insights from programmatic documents to shed light on gender equitable engagement of young married men in family planning. Inclusion and exclusion criteria for both these databases was set and search strategies were finalized. This was followed by title and abstract screening, data extraction, synthesis and analysis. Results: Study participants included unmarried men (16%, n=8), married men (19%, n=9), married women (19%, n=9), married couples (25%, n=12) or more than two respondent categories (21%, n=10). Almost three quarters (71%, n=34) of the studies selected had FP as the primary area of inquiry. Other prominent thematics on which the studies reported were around norms (n=9, 16%), couple dynamics and intimacy (n=12, 22%). Conclusions: The evidence presented provides sufficient impetus to expand on gender-equitable male engagement, viewing men as equal and supportive partners for informed, equitable and collaborative contraceptive uptake and FP choices by couples.
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Namasivayam A, Schluter PJ, Namutamba S, Lovell S. Understanding the contextual and cultural influences on women's modern contraceptive use in East Uganda: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000545. [PMID: 36962757 PMCID: PMC10022157 DOI: 10.1371/journal.pgph.0000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
Unmet need for contraception, defined as the percentage of women who are sexually active and want to avoid, space or limit pregnancies, but are not using a method of contraception, stands at 28.4% of all married women in Uganda. An understanding of women's contraceptive behaviours, and the motivations that drive these, are key to tackling unmet need, by way of designing, implementing and improving family planning programs to effectively meet the needs of different population groups. This qualitative study sought to understand women's contraceptive use and identify strategies to strengthen contraceptive uptake among women in the Busoga region of east Uganda (chosen due to its low contraceptive prevalence of 31.3% and high unmet need of 36.5% among married women of reproductive age). Six focus group discussions were conducted with single and married women across different age groups (18-24, 25-34, and ≥ 35 years), living in three urban and three rural districts. Thematic analyses of the data highlighted three major themes pertaining to the complex, multi-level nature of contributors to unmet need and women's use of contraception in the Busoga region. Within a largely patriarchal society, women had to navigate many obstacles. Some of these included: fears about contraceptive side effects; partner opposition, community beliefs and stigma that dissuaded contraceptive use; traditional gender and socio-cultural norms that dictated women's fertility choices; and service delivery limitations. Changing community narratives about family planning through testimonies from satisfied users, increasing male acceptance of contraception, and encouraging joint-decision making on matters of reproductive health are strategic focal areas for family planning initiatives to effectively tackle the problem of unmet need among women, and make contraceptives more accessible to women in Uganda.
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Affiliation(s)
- Amrita Namasivayam
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - Philip J Schluter
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand
- Medical School-General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Sarah Namutamba
- Institute of Public Health, Makerere University, Kampala, Uganda
| | - Sarah Lovell
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand
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25
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Obare F, Odwe G, Cleland J. Men's needs and women's fears: gender-related power dynamics in contraceptive use and coping with consequences in a rural setting in Kenya. CULTURE, HEALTH & SEXUALITY 2021; 23:1748-1762. [PMID: 32795154 DOI: 10.1080/13691058.2020.1807605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
This paper examines gender-related power influences on contraceptive use and coping with consequences in a rural setting in Kenya. Data come from in-depth interviews conducted in 2018 with 42 women who participated in a longitudinal study implemented in Homa Bay County. Data were analysed using an exploratory inductive content analytic approach. The findings show that the key drivers of gender-related power influence on contraceptive use and coping with consequences included: 1) the extent to which the women managed to provide sex and sexual pleasure to their partners when they were using contraception; 2) men's readiness to provide permission and resources that women needed and the latter's ability to overcome challenges in obtaining the same from their partners; and 3) women's fears concerning infidelity and partner violence, which influenced the actions they took to reduce instances that could make their partners suspect them of engaging in extra-marital affairs, drive their partners into such affairs, or encourage their partners to direct emotional or physical violence on them. Findings suggest the need for gender-transformative actions combining empowerment programmes for women with information, education and communications activities targeting both men and women.
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Affiliation(s)
| | | | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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26
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Exploring Readiness for Birth Control in Improving Women Health Status: Factors Influencing the Adoption of Modern Contraceptives Methods for Family Planning Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211892. [PMID: 34831646 PMCID: PMC8618296 DOI: 10.3390/ijerph182211892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022]
Abstract
Background: Pakistan is the world’s sixth most populated country, with a population of approximately 208 million people. Despite this, just 25% of legitimate couples say they have used modern contraceptive methods. A large body of literature has indicated that sexual satisfaction is a complex and multifaceted concept, since it involves physical and cultural components. The purpose of this study is to investigate the impact of influencing factors in terms of contraceptive self-efficacy (CSE), contraceptive knowledge, and spousal communication on the adoption of modern contraceptive methods for family planning (FP) under the moderating role of perceived barriers. Methods: Data were collected using an adopted questionnaire issued to married women of reproductive age belonging to the Rawalpindi and Neelum Valley regions in Pakistan. The sample consisted of 250 married women of reproductive age. SPSS was used to analyze the respondents’ feedback. Results: The findings draw public attention towards CSE, contraceptive knowledge, and spousal communication, because these factors can increase the usage of modern methods for FP among couples, leading to a reduction in unwanted pregnancies and associated risks. Regarding the significant moderation effect of perceived barriers, if individuals (women) are highly motivated (CSE) to overcome perceived barriers by convincing their husbands to use contraceptives, the probability to adopt modern contraceptive methods for FP practices is increased. Conclusions: Policymakers should formulate strategies for the involvement of males by designing male-oriented FP program interventions and incorporating male FP workers to reduce communication barriers between couples. Future research should address several other important variables, such as the desire for additional child, myths/misconceptions, fear of side effects, and partner/friend discouragement, which also affect the adoption of modern contraceptive methods for FP practices.
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27
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Perceptions of secondary school teachers towards school expulsion of pregnant adolescents at Igunga District, Tanzania-a qualitative study. Porto Biomed J 2021; 6:e141. [PMID: 34651089 PMCID: PMC8509993 DOI: 10.1097/j.pbj.0000000000000141] [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: 10/12/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background: In Tanzania, adolescent pregnancy results in a denial of the girl's fundamental right to education. School expulsion of pregnant adolescents is a common practice exercised by teachers in this country for decades. This study aimed to explore the perceptions and feelings of secondary school teachers towards this practice. Methods: The study used a qualitative approach comprising focus groups and individual semistructured interviews with a purposive sample of sixteen teachers and nine headmasters (n = 25) from nine secondary schools of the rural Igunga district, in Tabora region, Tanzania. Data was collected in March to June 2017 and submitted to thematic analysis. Results: Though most participants were not satisfied with the practice, their role on the expulsion of pregnant students was perceived as mandatory by law and regulations. Main argument in favor was its deterrent effect, yet the review of schools’ registries did not sustain that perception. Stigma and fear of contamination added a relevant contribution to its implementation. Conflicting feelings among teachers were also disclosed. Conclusion: This study was of most value to understand current perceptions and feelings of those who exercise the practice of banning pregnant adolescents from school in Tanzania, while having identified some of the cultural and social believes acting as influential factors in its pervasiveness. International and national human rights organizations should increase their efforts and campaigns in order to strength social awareness of the benefit of females’ education to society as a whole and of adopting policies and practices in support of their equal right to education.
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28
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Mooij R, Kapanga RR, Mwampagatwa IH, Mgalega GC, van Dillen J, Stekelenburg J, de Kok BC. Role of male partners in the long-term well-being of women who have experienced severe pre-eclampsia and eclampsia in rural Tanzania: a qualitative study. J OBSTET GYNAECOL 2021; 42:906-913. [PMID: 34558378 DOI: 10.1080/01443615.2021.1958766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Men can be essential sources of support in maternal health, even more so in case of severe acute maternal morbidity (SAMM), affecting 1-2% of childbearing women in low-resource settings. In a qualitative study using semi-structured interviews, we explored the perspectives of nine male partners of women who suffered from (pre-)eclampsia six to seven years earlier in rural Tanzania. Male partners considered their role to be pivotal regarding finances, decision-making in healthcare-seeking and family planning and provided physical and emotional support. After SAMM, households may be affected in the long run. Some men took over their female partner's household duties until up to two years after birth. Providing men with more information on complication readiness and birth preparedness would enable them to extend their role in maternal morbidity prevention.IMPACT STATEMENTWhat is already known on this subject? The essential role of male partners in maternal health in low- and middle-income countries is well-studied in relation to its impact on care-seeking behaviour. After childbirth, the long-term role of male partners has not yet been studied.What do the results of this study add? We demonstrated the important role of men during, but also after SAMM. Households may be affected years after women suffered from SAMM. For women with the most urgent support needs, this study suggest that at least some men feel responsible for their partner and have different pivotal roles.What are the implications of these findings for clinical practice and/or further research? Because of their motivation to support their female partner, strategies to reduce recurring complications in subsequent pregnancies should include targeting male partners, for example, by increasing birth preparedness and complication readiness. Further studies should confirm the results from our innovative but small-scale study, as well as investigate the long-term role of male partners after uncomplicated births. Other studies could investigate the separation of couples after SAMM, family planning decisions after SAMM and strategies for involving men and increasing complication readiness and birth preparedness.
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Affiliation(s)
- Rob Mooij
- Ndala Hospital, Ndala, Tanzania.,University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Ruth R Kapanga
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
| | | | | | - Jeroen van Dillen
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jelle Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Gynaecology and Obstetrics, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Bregje C de Kok
- Anthropology Department, University of Amsterdam, Amsterdam, The Netherlands
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Nuwasiima A, Watsemba A, Eyapu A, Kaddu P, Loiseau J. Sex differences in family planning knowledge, attitudes, and use in Uganda. Contracept Reprod Med 2021; 6:23. [PMID: 34332633 PMCID: PMC8325843 DOI: 10.1186/s40834-021-00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Literature is satiated with studies focusing on knowledge, attitude, and practices of family planning (FP) among the female population, conversely, the gaps in sex-disaggregated data on FP continue to exist. This study sought to report sex differences existing in FP knowledge, attitude, and use in Uganda. METHODS This study uses data from a household survey that covered 16 districts in Uganda. Multi-stage cluster randomized sampling was employed for participant selection. Bivariate analysis for categorical data was conducted. Multilevel logistic regression model was applied to model the effects of socio-demographic characteristics on the use of modern FP methods. RESULTS Data from 4,352 respondents in the ratios of 70 % females and 30 % of males were analyzed. The mean age was 28.7 SD (8.5) and was not significantly different between males and females. More male respondents had secondary or higher level of education (44 %) than females (36 %). Knowledge of at least one modern FP method was high, but small significant differences were revealed between males (96 %) and females (98 %). Significant knowledge differences were seen in specific FP methods. A higher proportion of females (71 %) than males (67 %) perceived modern FP methods as always available in the community whereas more males (40 %) believed that modern FP methods can result in infertility than females (35 %). There was high self-efficacy about family planning methods use in both males and females. The proportion of married females that reported using or their partner using a modern FP method was 39 % compared to 45 % reported by the married males. Approx. 53 % of the males compared to 37 % of the females that reported condom use also cited STI/HIV prevention as the main reason for condom use suggesting dual protection as a driver for use. Males, young adults, the more educated, and those in marriage or active relationships were more likely to use modern FP methods. CONCLUSIONS Our study found significant sex differences in knowledge, attitudes, and use of FP methods. The young adults and more educated respondents were more likely to use FP methods. The high self-efficacy observed for both males and females is a signal that both sexes can use FP methods. Project strategies and implementation should take into consideration the existing differences by sex and devise sex-tailored approaches to improve FP knowledge, attitudes, and use in this population. There was increased reporting of condom use as an FP and STI/HIV prevention method, follow-up studies aiming at succinctly measuring dual protection, and its drivers for both sex should be done.
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Affiliation(s)
| | | | | | | | - Justin Loiseau
- Global Research & Evidence Strategy Living Goods, Nairobi, Kenya
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30
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Newmann SJ, Zakaras JM, Dworkin SL, Withers M, Ndunyu L, Gitome S, Gorrindo P, Bukusi EA, Rocca CH. Measuring Men's Gender Norm Beliefs Related to Contraception: Development of the Masculine Norms and Family Planning Acceptance Scale. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2691-2702. [PMID: 33821378 PMCID: PMC8416878 DOI: 10.1007/s10508-021-01941-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Male partner resistance is identified as a key factor that influences women's contraceptive use. Examination of the masculine norms that shape men's resistance to contraception-and how to intervene on these norms-is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measure men's contraceptive acceptance-the Masculine Norms and Family Planning Acceptance (MNFPA) scale. We developed draft scale items based on qualitative research and administered them to partnered Kenyan men (n = 150). Item response theory-based methods were used to reduce and psychometrically evaluate final scale items. The MNFPA scale had a Cronbach's α of 0.68 and loaded onto a single factor. MNFPA scores were associated with self-efficacy and intention to accept a female partner's use of contraception; scores were not associated with current contraceptive use. The MNFPA scale is the first rigorously developed and psychometrically evaluated tool to assess men's contraceptive acceptance as a function of male gender norms. Future work is needed to test the MNFPA measure in larger samples and across different contexts. The scale can be used to evaluate interventions that seek to shift gender norms to increase men's positive engagement in pregnancy spacing and prevention.
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Affiliation(s)
- Sara J Newmann
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Unit 6D-14, San Francisco, CA, 94110, USA.
| | - Jennifer Monroe Zakaras
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Mellissa Withers
- University of Southern California Institute On Inequalities in Global Health, Los Angeles, CA, USA
| | - Louisa Ndunyu
- Kenya Medical Research Institute, Nairobi, Kenya
- The Department of Public Health, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Phillip Gorrindo
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, Oakland, CA, USA
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Maruf F, Tappis H, Lu E, Yaqubi GS, Stekelenburg J, van den Akker T. Health facility capacity to provide postabortion care in Afghanistan: a cross-sectional study. Reprod Health 2021; 18:160. [PMID: 34321023 PMCID: PMC8317397 DOI: 10.1186/s12978-021-01204-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01204-w. Afghanistan has one of the highest burdens of maternal mortality in the world. Infections, bleeding around childbirth, and unsafe abortion are the three leading causes of mortality in the country. The uptake of contraceptives is low, and only one-fifth of married women use contraceptives. A National Maternal and Newborn Health Quality of Care Assessment was conducted in 2016 at a selected number of public and private health facilities (n = 226; n = 20) to evaluate health facilities’ capacity to provide postabortion care, and skilled birth attendants’ knowledge and perceptions with regard to such care. Postabortion care is an essential package of services to make women survive complications of miscarriage and abortion and reduce unplanned pregnancies by providing postabortion family planning counseling and services, community empowerment, and mobilization. The result of this study showed that most facilities had supplies, equipment, and drugs to give postabortion care, including family planning services provision. However, there are gaps in birth attendants’ knowledge and their capacity to deliver high-quality postabortion care services at public and private facilities. This study provides evidence that there is room for improvement in postabortion care services provision at health facilities in Afghanistan. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, and availability of supplies.
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Affiliation(s)
- Farzana Maruf
- Jhpiego Afghanistan, Kabul, Afghanistan. .,Global Financing Facility, World Bank Group, Kabul, Afghanistan. .,Athena Institute, Vrije Universitate, Amsterdam, The Netherlands.
| | | | | | | | - Jelle Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Vrije Universitate, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
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Akoth C, Oguta JO, Gatimu SM. Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study. BMC Public Health 2021; 21:1316. [PMID: 34225673 PMCID: PMC8256600 DOI: 10.1186/s12889-021-11375-7] [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: 07/22/2020] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya. Methods We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions. Results The prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95% CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR 0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–0.99) reduced the odds of CCU. Conclusion About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make independent choices.
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Affiliation(s)
- Catherine Akoth
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
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Eaton J, Krishna A, Sudi C, George J, Magomba C, Eckman A, Houck F, Taukobong H. Gendered Social Norms Change in Water Governance Structures Through Community Facilitation: Evaluation of the UPWARD Intervention in Tanzania. FRONTIERS IN SOCIOLOGY 2021; 6:672989. [PMID: 34291106 PMCID: PMC8287258 DOI: 10.3389/fsoc.2021.672989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
Background: In rural Tanzania, women and girls disproportionately bear the burden of water scarcity. Gendered social norms on the acceptability of women's participation in the public sphere limit their decision-making power within local water governance structures. The UPWARD (Uplifting Women's Participation in Water-Related Decision-Making) intervention sought to understand how a community-based gendered social norms approach using organized diffusion can lead to changes in the gendered social norms impacting women's participation in water-related governance structures. Methods: As part of WARIDI, a 5-years integrated water resource management (IWRM) program, a gendered-social norms change (GSNC) activity (UPWARD: Uplifting Women's Participation in Water-Related Decision-Making) was implemented in two villages in Iringa and Kilombero districts. Encouraging organized diffusion, UPWARD promoted gender-equitable norms among a critical mass of community members. WARIDI identified and trained a Community Facilitation Team (CFT) of three women and men to lead a series of education and empowerment sessions in two communities. The intervention reached >300 individuals directly (∼10% of total village population). Changes in social norms were assessed through social norms analysis plots (SNAP) delivered in focus group discussions (FGDs) of 8-12 participants. Results: At baseline, most participants reported that women's involvement in water-related decision-making was restricted to household decisions. Men viewed themselves as primary decision-makers in water governance. Women who spoke in village meetings experienced sanctions for disrespect and outspokenness; their husbands were teased for being "controlled." At endline, participants reported fewer instances of ridicule towards women's participation. Women expressed a greater sense of solidarity with each other; men reported greater respect for men whose wives contribute. The intervention's effects appeared more pronounced in areas with greater cultural heterogeneity, suggesting norm change may be harder to affect where norms are tighter. Conclusion: UPWARD provides evidence that gendered social norms change programs can have identifiable impacts on women's participation in water-related decision-making over a short time. While other interventions have used larger, multi-level strategies to affect gender norms, UPWARD has shown that community mobilization with brief (∼4 months) but concentrated engagement with communities can promote changes in social norms that persist at least 6 months after intervention's end.
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Affiliation(s)
| | | | | | | | - Christopher Magomba
- Iris Group, Chapel Hill, NC, United States
- School of Agricultural Economics and Business Studies (SAEBS), Sokoine University of Agriculture, Morogoro, Tanzania
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Kenny L, Hassan R, Bacchus LJ, Smith M, Shell-Duncan B, Dagadu NA, Muriuki A, Aden AH, Jelle IA, Cislaghi B, Hossain M. Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis. Reprod Health 2021; 18:108. [PMID: 34039368 PMCID: PMC8157425 DOI: 10.1186/s12978-021-01164-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). METHODS Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. RESULTS Women named 10-12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. CONCLUSIONS Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks.
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Affiliation(s)
- Leah Kenny
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
- Present Address: Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Rahma Hassan
- Institute for Development Studies, University of Nairobi, 4 Harry Thuku Rd, Nairobi, Kenya
| | - Loraine J. Bacchus
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
| | - Matthew Smith
- The Business School, Edinburgh Napier University, Edinburgh, EH14 1DJ UK
| | - Bettina Shell-Duncan
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100 USA
| | - Nana Apenem Dagadu
- Save the Children US, 899 North Capitol St NE, Suite 900, Washington, DC 20002 USA
| | - Angela Muriuki
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Abdullahi Hussein Aden
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Ibrahim Abdirizak Jelle
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Beniamino Cislaghi
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
| | - Mazeda Hossain
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
- Present Address: Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
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Karim SI, Irfan F, Saad H, Alqhtani M, Alsharhan A, Alzhrani A, Alhawas F, Alatawi S, Alassiri M, M. A. Ahmed A. Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City. PLoS One 2021; 16:e0249292. [PMID: 33901184 PMCID: PMC8075244 DOI: 10.1371/journal.pone.0249292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Male partners have a considerable role in influencing women's contraceptive decision making to reduce the chance of unintended pregnancy. Most studies are focused on women's knowledge and barriers for emergency contraception (EC) use. There is limited research on this topic from the male perspective. This study aimed to gather baseline data on men's knowledge, attitudes and barriers about EC. METHODS Descriptive analytic cross-sectional study was conducted from Dec 2019 -May 2020 at the King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Data were collected using a structured pretested questionnaire and analyzed using SPSS version 23.0. Descriptive statistics and Chi square tests were used. Multivariate logistic regression analysis was used to find significant predictors for EC awareness and use. A p value < 0.05 was considered statistically significant. RESULTS A total of 461 participants completed the questionnaire (response rate 86%). The majority (82%) of the participants were unaware of EC; with only 18% having some knowledge. Knowledgeable men had positive attitudes (73.5%) about EC as compared to non- knowledgeable ones (55.0%). Factors found to be associated with less knowledge of EC were cultural [0.46, 95%CI 0.22. 0.96] and religious unacceptability [OR 0.51, 95%CI 0.29, 0.89)]. Higher level of education [OR 1.83, 95%CI 0.94, 3.53] was associated with more knowledge regarding EC. The study showed that correct information about using contraceptives within 3 days of unprotected sex [OR 4.96, 95%CI 1.81, 13.60]; availability without prescription [OR 5.06, 95%CI 1.68, 15.30], EC advertisement [OR 4.84, 95%CI 0.96, 24.27] and receipt of information from family/friends [OR 18.50, 95%CI 5.19, 65.93] were factors that contributed to men using EC. CONCLUSION The current knowledge of EC among men is limited. Social determinants affect these levels of knowledge, as well as the usage of EC. Factors that were associated with the use of ECPs were correct knowledge, advertisement, availability and receipt of information from family/friends. The findings highlight the need to educate men on this important topic to avoid unintended pregnancy, keeping in view cultural and social values. Future qualitative studies are needed to understand the male perspective.
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Affiliation(s)
- Syed Irfan Karim
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Chair for Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Farhana Irfan
- Department of Family and Community Medicine, King Saud University Chair for Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hussain Saad
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Ahmed Alzhrani
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Feras Alhawas
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alatawi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Abdullah M. A. Ahmed
- Department of Family and Community Medicine, King Saud University Chair for Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alem AZ, Agegnehu CD. Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2021; 11:e044060. [PMID: 33837100 PMCID: PMC8043003 DOI: 10.1136/bmjopen-2020-044060] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia. DESIGN Cross-sectional study. SETTING Ethiopia. PARTICIPANTS Reproductive age group women. PRIMARY OUTCOME Unmet need for family planning. METHODS This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables. RESULTS The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning. CONCLUSION Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Bryson JM, Patterson K, Berrang-Ford L, Lwasa S, Namanya DB, Twesigomwe S, Kesande C, Ford JD, Harper SL. Seasonality, climate change, and food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda: Implications for maternal-infant health. PLoS One 2021; 16:e0247198. [PMID: 33760848 PMCID: PMC7990176 DOI: 10.1371/journal.pone.0247198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/02/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women's perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women. METHODS Using a community-based research approach, we conducted eight focus group discussions-four in Indigenous Batwa communities and four in non-Indigenous communities-in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis. RESULTS Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe. CONCLUSIONS Programs promoting women's adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate.
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Affiliation(s)
- Julia M. Bryson
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Didacus B. Namanya
- Department of Community Health, Ugandan Ministry of Health, Kampala, Uganda
| | | | | | - James D. Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | | | - Sherilee L. Harper
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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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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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:ijerph18041651. [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.)
- Correspondence: ; Tel.: +255-782-411-376
| | - 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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Twizelimana D, Muula AS. Unmet contraceptive needs among female sex workers (FSWs) in semi urban Blantyre, Malawi. Reprod Health 2021; 18:11. [PMID: 33468198 PMCID: PMC7814425 DOI: 10.1186/s12978-020-01064-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background Research has paid limited attention to understanding factors that are associated with unmet contraceptive needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods We used systematic sampling to recruit 290 female sex workers in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Results Out of the 290 study participants 102 (35.2%) reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: female sex workers’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p < 0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p < 0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p < 0.001. Conclusion Reproductive Health services should address barriers to contraceptives use for instance: violence by female sex workers’ clients, fear and misinformation on contraceptives. There is need to improve awareness of contraceptives. Specific health promotion interventions on female sex workers engaged in a steady partnership are recommended. It is important to enhance the knowledge, attitudes, and counseling skills of health care providers in order to address unmet contraceptive needs among female sex workers in semi-urban Blantyre. Plain English summary Unmet contraceptive needs are defined as lack of contraceptives use in heterosexually active women of childbearing age who do not wish to become pregnant. Unmet contraceptive needs are the main cause of short inter-pregnancy intervals, early childbearing, physical abuse, unintended pregnancy, poor maternal and child health outcomes. Several studies have documented low contraceptives use among female sex workers (FSWs), but research has paid limited attention to understanding factors associated with unmet contraceptive needs among this population in semi urban Blantyre Malawi. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined factors that were associated with unmet contraceptive needs among FSWs in semi urban Blantyre, Malawi. We recruited 290 FSWs and collected quantitative data. These data were analyzed to obtain descriptive statistics. Logistic regression analysis was used to investigate the association between unmet contraceptive needs (the outcome variable) and explanatory variables such as: FSWs with history of physical and sexual violence by clients, having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Out of the 290 FSWs, 35% reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: FSWs’ history of physical and sexual violence by clients, participants with a steady partner and participants who feared contraceptive side effects. Sexual and Reproductive Health services should address barriers to contraceptives use, female sex workers exposure to violence, having a steady partners and concerns about side effects. There is also a need to improve the knowledge, attitudes, and counseling skills of health providers in order to address unmet contraceptive needs among FSWs.
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Affiliation(s)
- Donatien Twizelimana
- Ekwendeni Mission Hospital, P.O. Box: 19, Ekwendeni, Mzimba, Malawi. .,Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi. .,The Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM) College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi.
| | - Adamson S Muula
- Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi.,The Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM) College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi
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Mooij R, Kapanga RR, Mwampagatwa IH, Mgalega GC, van Dillen J, Stekelenburg J, de Kok BC. Beyond severe acute maternal morbidity: a mixed-methods study on the long-term consequences of (severe pre-)eclampsia in rural Tanzania. Trop Med Int Health 2020; 26:33-44. [PMID: 33151624 DOI: 10.1111/tmi.13507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore the long-term (perceived) consequences of (severe pre-)eclampsia in rural Tanzania. METHODS Women were traced for this mixed-methods study 6-7 years after the diagnosis of (severe pre-)eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi-structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy. RESULTS Of 74 patients, 25 (34%) were available for follow-up, and 24 were included. Five (20%) had suffered from (pre-)eclampsia twice. Hypertension was more common after (pre-)eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long-lasting. CONCLUSIONS Women who suffered from (severe pre-)eclampsia may experience long-term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.
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Affiliation(s)
- R Mooij
- Ndala Hospital, Ndala, Nzega region, Tanzania.,Department of Gynaecology and Obstetrics, Beatrix Hospital, Gorinchem, The Netherlands.,University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - R R Kapanga
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - I H Mwampagatwa
- College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - G C Mgalega
- Ndala Hospital, Ndala, Nzega region, Tanzania.,Nzega District Hospital, Nzega, Tanzania
| | - J van Dillen
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Gynaecology and Obstetrics, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - B C de Kok
- Anthropology Department, University of Amsterdam, Amsterdam, The Netherlands
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Bakyono R, Tapsoba LDG, Lépine A, Berthé A, Ilboudo PG, Diallo CO, Méda N, D'Exelle B. [Contraceptive use by married women or concubines living in rural areas in Burkina Faso: a qualitative study of free voucher use]. Pan Afr Med J 2020; 37:72. [PMID: 33244335 PMCID: PMC7680239 DOI: 10.11604/pamj.2020.37.72.23786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction low levels of contraceptive use in Western Africa are responsible for high fertility rates, which limits economic development. The cost of modern contraceptives is a significant constraint, then the government of Burkina Faso has implemented free family planning. Given this new policy, we provided rural women with a healthcare voucher giving free access to modern contraceptives. We conducted an analysis of the determinants of good free voucher use in order to implement adequate government policy. Methods six months after the distribution of vouchers to women living in 30 villages in the Houet Province, we conducted a focus-group study based on individual in-depth health care provider interviews in partner healthcare centers. Results the benefits of family planning, free contraceptive use, husband's approval and moral obligation were factors facilitating voucher use. The desire to become pregnant, husband's opposition, women's reluctance, women's lack of knowledge of contraceptives and factors associated with the intervention were the leading reasons for not using the vouchers. Conclusion the promotion of modern contraceptive use among married women or concubines requires a holistic approach combining free access to modern contraceptives, effective policies involving men in family planning and the reduction of fertility preferences among the couples.
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Affiliation(s)
- Richard Bakyono
- Observatoire National de la Santé de la Population, Ouagadougou, Burkina Faso.,Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | | | | | - Abdramane Berthé
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso.,Université de Dédougou, Dédougou, Burkina Faso
| | | | - Cheick Omar Diallo
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Nicolas Méda
- Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ben D'Exelle
- University of East Anglia, Norwich, United Kingdom
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Gupta S, Bernays S, Black KI, Ramsay P, Bolnga J, Kelly-Hanku A. Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea. Reprod Health 2020; 17:136. [PMID: 32891171 PMCID: PMC7487833 DOI: 10.1186/s12978-020-00985-w] [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: 11/22/2019] [Accepted: 08/30/2020] [Indexed: 08/29/2023] Open
Abstract
Background Despite targeted interventions to improve contraceptive implant acceptability and uptake in rural Papua New Guinea (PNG), ongoing use of this method remains limited. Previous literature has suggested community attitudes and intrinsic factors within the decision-making process may be negatively impacting on implant uptake, however these elements have not previously been studied in detail in this context. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG. Methods We conducted 10 focus-group (FGD) and 23 in-depth interviews (IDI) using semi-structured topic guides. Key sampling characteristics included age, exposure or non-exposure to implants, marital status, education and willingness to participate in discussion. Four FGDs were held with women, four with men and two with mixed gender. IDIs were carried out with five women (current implant users, former implant users, implant never users), five men, five religious leaders (Catholic and non-Catholic), four village leaders and four health workers. Two in-depth interviews (four participants) were analysed as dyads and the remaining participant responses were analysed individually. Results Men were supportive of their wives using family planning but there was a community-wide lack of familiarity about the contraceptive implant which influenced its low uptake. Men perceived family planning to be ‘women’s business’ but remained strongly influential in the decision making processes around method use. Young men were more receptive to biomedical information than older men and had a greater tendency towards wanting to use implants. Older men preferred to be guided by prominent community members for decisions concerning implants whilst young men were more likely to engage with health services directly. Conclusions In communities where a couple’s decision to use the contraceptive implant is strongly coloured by gendered roles and social perceptions, having a detailed understanding of the relational dynamics affecting the decision-making unit is useful in targeting future healthcare interventions. Engaging groups who are reluctant to connect with health information, as well as those who are most influential in the decision making process, will have the greatest impact on increasing implant acceptability and uptake.
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Affiliation(s)
- Sarika Gupta
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Sarah Bernays
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
| | - Kirsten Isla Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Department of Women's Health, Neonatology and Pediatrics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Philippa Ramsay
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Department of Women's Health, Neonatology and Pediatrics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - John Bolnga
- Department of Obstetrics and Gynaecology, Modilon General Hospital, Modilon Road, Madang, Madang Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, 2052, Australia
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Yadav K, Agarwal M, Shukla M, Singh JV, Singh VK. Unmet need for family planning services among young married women (15-24 years) living in urban slums of India. BMC Womens Health 2020; 20:187. [PMID: 32883262 PMCID: PMC7469334 DOI: 10.1186/s12905-020-01010-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND NFHS-4 stated high unmet need for family planning (FP) among married women in Uttar Pradesh. Unmet need is highest among age groups: 15-19 and 20-24 years. Currently few data is available about unmet need for FP among vulnerable section of the community, i.e.15-24 year's age group living in the urban slums. Therefore this study was conducted to assess the unmet need for FP services and its determinants among this under-privileged and under-served section of society residing in urban slums of Uttar Pradesh, India. METHODS Cross sectional study was conducted in the slums of Lucknow, India. One Urban-Primary Health Centre (U-PHC) was randomly selected from each of the eight Municipal Corporation zones in Lucknow and two notified slums were randomly selected from each U-PHC. All the households in the selected slums were visited for interviewing 33 young married women (YMW) in each slum, with a pre-structured and pre tested questionnaire, to achieve the sample size of 535. Analysis of the data was done using logistic regression. RESULTS The unmet need for family planning services among YMW was 55.3%. About 40.9% of the unmet need was for spacing methods and 14.4% for limiting methods. Important reasons cited for unmet need for family planning services were negligent attitude of the women towards family planning, opposition by husband or others, embarrassment / hesitation / shyness for contraceptive use, poor knowledge of the FP method or availability of family planning services. Among method related reasons health concerns and fear of side effects were frequently cited reasons. On multiple logistic regression: age, educational status, duration of marriage, number of pregnancies, knowledge of contraceptive methods, opposition to contraceptive use and contact with Auxiliary Nurse Midwife (ANM) showed independently significant association with unmet need for family planning services. CONCLUSIONS Unmet need for family planning services is very high among the YMW of urban slums. The findings stress that program managers should take into cognizance these determinants of high level of unmet need for family planning among YMW and make intense efforts for addressing these issues in a holistic manner.
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Affiliation(s)
- Kriti Yadav
- Assistant Professor, Vir Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand India
| | - Monika Agarwal
- Department of Community Medicine & Public Health, K.G. Medical University, Lucknow, UP India
| | - Mukesh Shukla
- Assistant Professor, Vir Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand India
| | - Jai Vir Singh
- Principal, Hind Institute of Medical Sciences, Lucknow, UP India
| | - Vijay Kumar Singh
- Department of Community Medicine & Public Health, K.G. Medical University, Lucknow, UP India
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Karp C, Wood SN, Galadanci H, Sebina Kibira SP, Makumbi F, Omoluabi E, Shiferaw S, Seme A, Tsui A, Moreau C. 'I am the master key that opens and locks': Presentation and application of a conceptual framework for women's and girls' empowerment in reproductive health. Soc Sci Med 2020; 258:113086. [PMID: 32521413 PMCID: PMC7369639 DOI: 10.1016/j.socscimed.2020.113086] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022]
Abstract
RATIONALE A renewed focus on women's and girls' empowerment in the era of Sustainable Development Goals reflects the belief that empowerment is central to health and development. Sexual and reproductive health (SRH) outcomes, including pregnancy and contraceptive use, may contribute to and result from empowerment. However, enhanced understanding of how women become empowered for SRH requires clear conceptualization of empowerment. OBJECTIVE We aimed to assess the applicability of a proposed framework for women's and girls' SRH empowerment (WGE-SRH) in sub-Saharan Africa. We sought to understand what shapes and motivates preferences for childbearing and contraception, exploring how women and girls navigate external pressures or rewards to exercise and achieve their reproductive goals. METHODS Grounded in the WGE-SRH framework, we conducted a qualitative study in four distinct contexts (Ethiopia, Kano and Anambra States in Nigeria, and Uganda). We implemented and analyzed 120 in-depth interviews and 38 focus group discussions with 440 women and men and translated results to refine the WGE-SRH framework. RESULTS Findings demonstrate the salience of women's internal motivations, including the social value and joys of motherhood, in shaping existence of reproductive choices. However, existence of choice was limited by couples' economic situations, pressures from providers, partners, and family members, and women's fears of contraceptive side effects or relationship dissolution. Despite these constraints, many found ways to exercise their reproductive choices through negotiation with partners, third party involvement in reproductive discussions, non-verbal communication, and covert use of contraception. CONCLUSIONS The WGE-SRH framework is useful for exploring SRH empowerment, embracing the multilevel, dynamic nature of empowerment, as a process transitioning from existence of choice (autonomy) to exercise of choice (self-efficacy, decision-making, negotiation), and, ultimately, to achievement of choice. Future research and programs related to SRH empowerment should distinguish between existence and exercise of choices to promote the health and well-being of women and girls.
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Affiliation(s)
- Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Hadiza Galadanci
- Center for Advanced Medical Research and Training, Bayero University Kano, Nigeria
| | - Simon Peter Sebina Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Uganda
| | | | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Ethiopia
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA; Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, F-94805, Villejuif, France
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Aristide C, Mwakisole A, Mwakisole N, Emmanuel M, Laizer E, Kihunrwa A, Downs D, Wamoyi J, Downs J. Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:226-233. [PMID: 31937520 PMCID: PMC7392489 DOI: 10.1136/bmjsrh-2019-200505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided. METHODS We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar. RESULTS Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members. CONCLUSIONS Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.
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Affiliation(s)
- Christine Aristide
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | | | | | - Mary Emmanuel
- St Paul College, Mwanza, United Republic of Tanzania
| | | | - Albert Kihunrwa
- Department of Gynecology and Obstetrics, Weill Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - David Downs
- Keble College, University of Oxford, Oxford, UK
| | - Joyce Wamoyi
- National Institute for Medical Research Mwanza Research Centre, Mwanza, United Republic of Tanzania
| | - Jennifer Downs
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Internal Medicine, Weill Bugando Medical Centre, Mwanza, United Republic of Tanzania
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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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Kibira SPS, Karp C, Wood SN, Desta S, Galadanci H, Makumbi FE, Omoluabi E, Shiferaw S, Seme A, Tsui A, Moreau C. Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges. BMC Public Health 2020; 20:865. [PMID: 32503485 PMCID: PMC7275340 DOI: 10.1186/s12889-020-08977-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The balance between increasing men's participation in family planning and rights-based initiatives favoring women's empowerment is highlighted with the issue of covert use of contraception. While covert use has been documented in low- and middle-income countries as a way for women to obtain contraception in light of partner opposition, little is known about women's decision-making processes, actions, and potential consequences of discreet contraceptive use. We aimed to understand women's choices to use contraception covertly and the challenges they faced in concealing their use across three sub-Saharan African countries. METHODS Women aged 15-49 and their male partners were purposively sampled from urban and rural sites in Ethiopia, Northern and Southern Nigeria, and Uganda for 120 in-depth interviews and 38 focus group discussions. Semi-structured interviews explored women's and girls' empowerment surrounding sex, childbearing, and contraception. Interviews were conducted in local languages, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data; covert use codes were reviewed and matrices were created based on themes and sub-themes. RESULTS Findings comprised three thematic areas: the practice of covert contraceptive use and reasons for using covertly; challenges for women who use contraception covertly; and consequences of disclosure or being discovered. While some women initiated using contraception covertly due to tensions within relationships or to keep peace within the home due to known partner opposition, others did not consider family planning to be a male responsibility. Though covert use was commonly discussed, it was also socially sanctioned, and portrayed as an act of female disobedience that questioned the social order of patriarchy. Further challenges of using covertly included lack of financial and social support, and suspicions surrounding delayed fertility and contraceptive-related side effects. Repercussions comprised increased suspicion, threats, or violence, though some women reported improved couple communication with disclosure. CONCLUSIONS Results indicate that while covert use of contraception is common, continued covert use is challenging, especially when side effects manifest. Covert use may further suggest women taking independent action, symbolizing some level of empowerment. Results underscore the importance of disentangling unique reasons for covert use and the severity of repercussions of disclosure.
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Affiliation(s)
- Simon P S Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Selamawit Desta
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hadiza Galadanci
- Center for Advanced Medical Research and Training, Bayero University Kano, Kano State, Nigeria
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Elizabeth Omoluabi
- Centre for Research Evaluation Resources and Development, Ile-Ife Osun State, Nigeria
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807, Le Kremlin-Bicêtre, France
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Dagnew GW, Asresie MB, Fekadu GA, Gelaw YM. Modern contraceptive use and factors associated with use among postpartum women in Ethiopia; further analysis of the 2016 Ethiopia demographic and health survey data. BMC Public Health 2020; 20:661. [PMID: 32398123 PMCID: PMC7216498 DOI: 10.1186/s12889-020-08802-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background The postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia. Methods We used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance. Results About 23.7% (23.7, 95% CI: 20.7–27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34–3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04–3.10), women who attended 1–3 (AOR = 2.33; 95%CI:1.27–4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43–4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23–2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01–3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13–3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01–1.88) had higher odds of modern contraceptive use. Conclusion Postpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls’ education and encouraging women’s participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.
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Affiliation(s)
- Gizachew Worku Dagnew
- Department of Reproductive Health and population studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Melash Belachew Asresie
- Department of Reproductive Health and population studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gedefaw Abeje Fekadu
- Department of Reproductive Health and population studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yared Mulu Gelaw
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Abdi B, Okal J, Serour G, Temmerman M. "Children are a blessing from God" - a qualitative study exploring the socio-cultural factors influencing contraceptive use in two Muslim communities in Kenya. Reprod Health 2020; 17:44. [PMID: 32245521 PMCID: PMC7119281 DOI: 10.1186/s12978-020-0898-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background Family planning (FP) is one of the high impact public health interventions with huge potential to enhance the health and wellbeing of women and children. Yet, despite the steady progress made towards expanding access to family planning, major disparities across different regions exist in Kenya. This study explored the socio cultural factors influencing FP use among two Muslim communities in Kenya. Methods A qualitative study involving Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) was conducted (from July to October 2018) in two predominant Muslim communities of Lamu and Wajir counties. Open ended questions explore key thematic areas around knowledge, attitudes and understanding of contraception, perceived FP barriers, and decision making for contraceptives, views on Islam and contraception, and fertility preference. All interviews were conducted in the local language, recorded, transcribed verbatim and translated into English. Data was analyzed using thematic content analyses. Results Although Islam is the predominant religion the two communities, perceptions and belief around FP use were varied. There were differing interpretations of Islamic teaching and counter arguments on whether or not Islam allows FP use. This, in addition to desire for a large family, polygamy, high child mortality and a cultural preference for boys had a negative impact on FP use. Similarly, inability of women to make decisions on their reproductive health was a factor influencing uptake of FP. Conclusion Misinterpretation of Islamic teaching on contraception likely influences uptake of family planning. Cultural beliefs and lack of women’s decision power on fertility preferences were a key inhibitor to FP use. Countering the negative notions of FP use requires active engagement of religious leaders and Muslim scholars who are in position of power and influence at community level.
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Affiliation(s)
- Batula Abdi
- United Nations Population Fund Tanzania country Office, Zanzibar, Tanzania. .,Ghent University, Ghent, Belgium.
| | | | - Gamal Serour
- International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt
| | - Marleen Temmerman
- International Centre for Reproductive Health, Department of Public Health, Ghent University, Ghent, Belgium.,Centre of Excellence Women and Child Health, Aga Khan University, Nairobi, Kenya
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