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Oni TO, Petlele R, Banjo OO, Bankole A, Akinyemi AI. Measurement and conceptualization of male involvement in family planning: a bibliometric analysis of Africa-based studies. Contracept Reprod Med 2024; 9:29. [PMID: 38867339 PMCID: PMC11170783 DOI: 10.1186/s40834-024-00293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Male involvement in Family Planning (FP) is an exercise of men's sexual and reproductive health rights. However, the measurement of male involvement has been highly inconsistent and too discretional in FP studies. As a result, we used bibliometric tools to analyze the existing measures of male involvement in FP and recommend modifications for standard measures. METHODS Using developed search terms, we searched for research articles ever published on male involvement in FP from Scopus, Web of Science, and PubMed databases. The search results were filtered for studies that focused on Africa. A total of 152 research articles were selected after the screening, and bibliometric analysis was performed in R. RESULTS Results showed that 54% of the studies measured male involvement through approval for FP, while 46.7% measured it through the attitude of males to FP. About 31% measured male involvement through input in deciding FP method, while others measured it through inputs in the choice of FP service center (13.6%), attendance at FP clinic/service center (17.8%), and monetary provision for FP services/materials (12.4%). About 82.2% of the studies used primary data, though the majority (61.2%) obtained information on male involvement from women alone. Only about one in five studies (19.1%) got responses from males and females, with fewer focusing on males alone. CONCLUSION Most studies have measured male involvement in FP through expressed or perceived approval for FP. However, these do not sufficiently capture male involvement and do not reflect women's autonomy. Other more encompassing measures of male involvement, which would reflect the amount of intimacy among heterosexual partners, depict the extent of the exercise of person-centered rights, and encourage the collection of union-specific data, are recommended.
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Affiliation(s)
- Tosin Olajide Oni
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Rebaone Petlele
- Department of Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Akanni Ibukun Akinyemi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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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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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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Mwadhi MK, Bangha M, Wanjiru S, Mbuthia M, Kimemia G, Juma K, Shirima J, Unda S, Achieng A, Both J, Ouedraogo R. Why do most young women not take up contraceptives after post-abortion care? An ethnographic study on the effectiveness and quality of contraceptive counselling after PAC in Kilifi County, Kenya. Sex Reprod Health Matters 2023; 31:2264688. [PMID: 37937821 PMCID: PMC10653685 DOI: 10.1080/26410397.2023.2264688] [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: 11/09/2023] Open
Abstract
Post-abortion care (PAC) counselling and the provision of contraceptive methods are core components of PAC services. Nevertheless, this service is not uniformly provided to PAC patients. This paper explores the factors contributing to young women leaving health facilities without counselling and contraceptive methods. The paper draws from an ethnographic study conducted in Kilifi County, Kenya, in 2021. We conducted participant observation in health facilities and neighbouring communities, and held in-depth interviews with 21 young women aged 15-24 who received PAC. In addition, we interviewed 11 healthcare providers recruited from the public and private health facilities observed. Findings revealed that post-abortion contraceptive counselling and methods were not always offered to patients as part of PAC as prescribed in the PAC guidelines. When PAC contraceptive counselling was offered, certain barriers affected uptake of the methods, including inadequate information, coercion by providers and partners, and fears of side effects. Together, these factors contributed to repeat unintended pregnancies and repeat abortions. The absence of quality contraceptive counselling therefore infringes on the right to health of girls and young women. Findings underscore the need to strengthen the capacities of health providers on PAC contraceptive counselling and address their attitudes towards young female PAC patients.
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Affiliation(s)
- Mercy Kadzo Mwadhi
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Martin Bangha
- Associate Research Scientist, African Population and Health Research Center, Nairobi, Kenya
| | - Shelmith Wanjiru
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Mbuthia
- Communications Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kimemia
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Juma
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Shirima
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Shilla Unda
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Anne Achieng
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Jonna Both
- Senior Researcher, Rutgers, Utrecht, Netherlands
| | - Ramatou Ouedraogo
- Research Scientist, African Population and Health Research Center, Nairobi, Kenya
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Dang TNH, Le DD, Chuanwan S, Dwomoh D. What do outlet's and provider's characteristics mean for family planning consumers? A comparative study of Kenya, Nigeria and Uganda. BMC Womens Health 2023; 23:537. [PMID: 37845693 PMCID: PMC10580626 DOI: 10.1186/s12905-023-02699-0] [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: 02/04/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND This research investigated the determinants of the number of family planning consumers in Kenya, Nigeria and Uganda, with a focus on outlet's and provider's characteristics which are important factors influencing the choice of using contraceptive methods but largely unexplored in previous literature. METHODS We utilized a unique panel survey on outlet's in Kenya (n = 1,321), Nigeria (n = 1,255) and Uganda (n = 842), which is part of the Consumer Market for Family Planning conducted in between 2019 and 2020, for the analysis of the pooled data (n = 3,418) and individual country. Random effects Poisson regressions were performed. RESULTS The pooled data results showed that the expected number of consumers were significantly lower in Nigeria and Uganda than in Kenya, and that working experience (provider's characteristics), types of stores, duration of providing family planning services, participations in community outreach and host community events, and sign of family planning services (outlet's characteristics) were significant determinants of the number of customers. The results for each country revealed interesting similarities and differences in the determinants across the three countries. CONCLUSIONS This study sheds light on the relationship between the number of family planning customers and outlet's and provider's characteristics, thus providing informative evidence-based to on-going debates on the coverage of family planning services, which is still insufficient in developing countries. As a result, the government's family planning expenditures should instead prioritize small, private enterprises such as pharmacies or drug stores. Furthermore, it is critical to focus on several critical tasks to improve the qualities of outlets and providers to attract customers, such as ensuring that they are eye-catching, advertising FP services, have professional credentials, fulfil providers' obligations to counsel contraceptive users, provide long-term services and community care, and have female providers.
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Affiliation(s)
- Truc Ngoc Hoang Dang
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Duc Dung Le
- Institute of Social and Medical Studies, Hanoi, Vietnam.
| | - Sutthida Chuanwan
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Duah Dwomoh
- Department of Biostatistics, University of Ghana, Accra, Ghana
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Sarnak D, Wood SN, Anglewicz P, Gummerson E, Gichangi P, Thiongo M, Moreau C. Differential discontinuation by covert use status in Kenya. Contracept X 2023; 5:100102. [PMID: 37928365 PMCID: PMC10625140 DOI: 10.1016/j.conx.2023.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Objectives Qualitative research suggests that covert users may be more likely to discontinue contraception due to the logistics of discretion and fear of disclosure. This study sought to quantify whether covert users are more likely to discontinue contraception than overt users. Study design We used a national longitudinal survey from Kenya conducted from November 2019/February 2020 to November 2020/April 2021 to test whether the time to discontinuation between covert and overt users still in need of contraception differed using survival analyses over a period of 5 years since method initiation. Results Multivariate Cox regression results showed there was an interaction with time and covert use on the risk of discontinuation; for every additional month of use, there was an increased risk of discontinuation of covert users compared to overt users (3% increased hazard, p = 0.02). At 1 and 2 years, there were no differences in the hazard of discontinuation (adjusted hazard ratio [aHR]1 year 0.95, 95% CI 0.54-1.65 and aHR2 years 1.37, 95% CI 0.85-2.21), yet at 3, 4, and 5 years, the hazard of discontinuation was higher for covert compared to overt users (aHR3 years 1.99, 95% 1.11-3.56; aHR4 years 2.89, 95% CI 2.0-6.40; aHR5 years 4.18, 95% CI 1.45-12.0). Conclusions These results suggest efforts are needed to support covert users in managing their contraceptive use and for improving contraceptive counseling surrounding covert use. Our findings shed light on the increasing challenge covert users face after approximately the first 2 years of use; covert users require additional follow-up in both research and care provision. Implications Covert users are at a higher risk of discontinuation of contraception while still trying to avoid pregnancy, particularly after the first 2 years of use. Family planning providers and programs must protect access to and maintain the privacy of reproductive services to this population, focusing on follow-up care provision and counseling.
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Affiliation(s)
- Dana Sarnak
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shannon N. Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Phil Anglewicz
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Gummerson
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
- Department of Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
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7
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Kushitor M, Henry EG, Obeng-Dwamena AD, Agyekum MW, Agula C, Toprah T, Shah I, Bawah AA. Covert Contraceptive Use amongst the urban poor in Accra, Ghana: experiences of health providers. Reprod Health 2022; 19:205. [PMID: 36333714 PMCID: PMC9636747 DOI: 10.1186/s12978-022-01516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background An estimated one-third of women in Ghana use contraceptives without the knowledge of their partners, a phenomenon known as Covert Contraceptive Use (CCU). Most research on CCU to date has focused on individual women to the neglect of the role of health system. This study explores CCU in urban poor communities of Accra, Ghana, from the experiences and perspectives of health providers. Methods Qualitative in-depth interviews were conducted with health care providers in both the public and private sectors at multiple levels, from the community clinic to the tertiary hospital, to gain insights into the strategies women use and the ways in which the health system supports the practice of CCU. Results Five major thematic areas emerged: use of easily concealed-methods, discrete-access-and-information-keeping, time-of-day, non-verbal-communication and use of relationships. The study further revealed that fear, mistrust, shyness, myths, and misperceptions regarding contraceptives explain CCU among women in the communities that the providers serve. Conclusion Importantly, disclosure of methods used by providers without women’s consent could potentially lead to violent outcomes for both women and the providers. Our results highlight the pivotal role that providers play in confidentially supporting women’s choices regarding the use of contraceptives. Sometimes women use contraceptives without the knowledge of their sexual partners. That is to say, they hide their contraceptive use. Many studies have explored why women hide their contraceptive use. Reasons include the desire of men to have absolute control of their women’s bodies including their sexuality and fertility regulation. This occurs in cultures where women do not have as much power as men. In Ghana, as much as one-in-three women hide their contraceptive use from their partners. This study explores the ways in which health facilities assist women to hide their contraceptives use by talking to leaders of units responsible for providing contraceptives in the hospitals. First, people prefer contraceptives like injectables that are not visible on the bodies of those using them. Second, some hospitals have modified their space to provide ample privacy and security for women. Third, some women visit the facilities at odd hours, such as very early in the morning, very late at night and at other favorable times. Sometimes nurses arrange to meet women outside the facility. Lastly, nurses create avenues through various personal relationships. For example, leaving their contacts in market spaces and arranging meeting places with market queens.
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McLellan-Lemal E, Deaton SR, Betts JE, Ondenge K, Mudhune V, O'Connor SM, Nyagol B, Thurman AR, Doncel GF, Allen SA, Heffron R, Mugo NR. Acceptability of an intravaginal ring for simultaneously preventing HIV infection and pregnancy: Qualitative findings of the Kisumu Combined Ring Study, 2019. Contemp Clin Trials 2022; 122:106935. [PMID: 36162740 PMCID: PMC11265295 DOI: 10.1016/j.cct.2022.106935] [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: 07/31/2021] [Revised: 04/06/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023]
Abstract
Multipurpose prevention technology intravaginal rings (MPT IVRs) may offer a promising solution for addressing women's multiple sexual and reproductive health needs. We describe MPT IVR acceptability perspectives and examine user experiences of 25 cisgender women aged 18-34 years enrolled in a phase IIa randomized, partially blinded, placebo-controlled evaluation of tenofovir-based IVRs with and without contraceptive co-formulation. All took part in an individual, audio-recorded, semi-structured qualitative interview. A thematic analysis of transcribed interviews was completed in MaxQDA. Participants shared little to no knowledge of or experience with IVRs prior to joining the study. Four MPT IVR themes were identified: physical well-being, method reliability, personal management, and societal endorsement. Commonly cited of concern, but less described as being experienced, were physical discomforts (e.g., painful insertion/removal; inability to carry out daily activities/chores; foreign body sensation; expulsion; sexual interference, or debilitating side effects). Uncertainty regarding efficacy influenced perspectives about intended prevention benefits. Personal choices in managing reproduction and sexual behaviors had to be congruent with sociocultural values and norms for acceptance beyond the individual user level. Participants viewed broader community acceptance as likely to be mixed given community opposition to the use of modern family planning methods. They also shared concerns that IVR use could lead to infertility, especially among nulliparous women, or that it would encourage premarital sex or high-risk sexual behaviors among adolescent and young women. While a MPT IVR may not be suitable for all women, first-hand testimonials could help influence collective receptivity. Additional community acceptability research is needed. Clinical Trial Registration The study is registered at http://ClinicalTrials.gov under the identifier NCT03762382.
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Affiliation(s)
- Eleanor McLellan-Lemal
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | | | | | - Ken Ondenge
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Victor Mudhune
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Siobhan M O'Connor
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Beatrice Nyagol
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | | | | | - Shannon A Allen
- United States Agency for International Development, Washington, DC, USA
| | - Renee Heffron
- University of Washington, Department of Global Health, International Clinical Research Center, Seattle, WA, USA
| | - Nelly R Mugo
- University of Washington, Department of Global Health, International Clinical Research Center, Seattle, WA, USA; Kenya Medical Research Institute, Center for Clinical Research, Nairobi, Kenya
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Orwa J, Gatimu SM, Ngugi A, Agwanda A, Temmerman M. Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties. PLoS One 2022; 17:e0275575. [PMID: 36201509 PMCID: PMC9536593 DOI: 10.1371/journal.pone.0275575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.
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Affiliation(s)
- James Orwa
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health Sciences, Aga Khan University, Nairobi, Kenya
- * E-mail:
| | | | - Anthony Ngugi
- Department of Population Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Alfred Agwanda
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
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10
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Sarnak DO, Gummerson E, Wood SN, OlaOlorun FM, Kibira SPS, Zimmerman LA, Anglewicz P. Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study. Contracept X 2022; 4:100077. [PMID: 35620730 PMCID: PMC9127266 DOI: 10.1016/j.conx.2022.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/26/2022] Open
Abstract
Objectives A more nuanced understanding of contributors to covert contraceptive use remains critical to protecting covert users and reducing its necessity. This study aimed to examine the overall prevalence of covert use, and sociodemographic characteristics associated with covert vs overt use across multiple geographies in sub-Saharan Africa and Asia. Study Design Performance Monitoring for Action (PMA) is one of the few nationally representative surveys that measures covert use across socially diverse contexts via a direct question. Utilizing PMA 2019-2020 phase 1 data from Burkina Faso, Côte D'Ivoire, Kenya, Democratic Republic of Congo (DRC; Kinshasa and Kongo Central regions), Uganda, Nigeria (Kano and Lagos), Niger, and Rajasthan, we estimated overall prevalence of covert use. We conducted bivariate analyses and multivariate logistic regressions for 6 sites, comparing the odds of covert use with overt use among users of contraception by sociodemographic characteristics. Results Covert use ranged from 1% in Rajasthan to 16% in Burkina Faso. Marital status was the only sociodemographic characteristic consistently associated with type of use across sites. Specifically, polygynous marriage (compared to monogamous) increased odds of using covertly, ranging from adjusted odds ratio (aOR) of 1.8 [95% confidence interval (CI) 1.2-2.7] in Burkina Faso to 6.2 [95% CI 2.9-13.3] in Kinshasa. Unmarried women with partners or boyfriends were also more likely to be using covertly compared with their monogamously married counterparts in all sites (aORs ranged from 2.2 [95% CI 1.0-4.7] in Uganda to 4.4 [95% CI 1.7-11.0] in Kinshasa). Conclusion Understanding factors associated with covert use has programmatic and policy implications for women's reproductive autonomy. Implications Covert use is a common phenomenon across most sites, representing a small but programmatically important contingent of users. Family planning providers and programs must protect access to and maintain privacy of reproductive services to this population, but should also focus on creating interventions and environments that support overt use.
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Affiliation(s)
- Dana O Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Gummerson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Funmilola M OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Simon Peter Sebina Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Vishwakarma M, Shekhar C. Covert use of reversible contraceptive methods and its association with husband's egalitarian gender attitude in India. BMC Public Health 2022; 22:460. [PMID: 35255867 PMCID: PMC8903557 DOI: 10.1186/s12889-022-12882-x] [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: 04/13/2021] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background In a patriarchal society, women often keep their use of contraceptives secret in order to meet their reproductive goals and satisfy their reproductive preferences. Nevertheless, to our knowledge, women’s covert contraceptive use and its association with husband’s gender attitude have not been studied in the Indian settings. The present study estimates the extent of covert modern contraceptive use (CCU) among women and its linkage with husbands’ gender attitudes in India. Methods The study is based on fecund and monogamous couples using modern, reversible contraceptive methods. The numbers of such couples were 4,825 and 7,824 in the national family health surveys 2005–06 and 2015–16 respectively. The outcome variable in the study was CCU, while the independent variables were husband’s gender attitude, women’s education, freedom of mobility, freedom to spend money independently, surviving number of children, concordance regarding additional children, couple-level information such as age and educational gap between spouses, and some socioeconomic status (SES) variables. We used latent class analysis to measure the gender attitude and used bivariate descriptive analysis and multivariate binary logistic regression to assess the linkages between husband’s gender attitude and CCU. Results This study found that the prevalence of CCU increased from 15% in 2005–06 to 27% in 2015–16. In both the time periods, contraceptive pills were the most preferred covert method, followed by intrauterine device (IUD). The results of the multivariate logistic regression show that women with husbands of moderate and low egalitarian gender attitudes were, respectively, 50% and 40% more likely to hide their contraceptive use than those with husbands of a high gender attitude. Women’s education, wealth index, number of living children, and region of residence were also found to be significantly associated with CCU. Conclusion The study reveals that husband’s low egalitarian gender attitude can be a potential barrier between spouses, preventing them from opening up about their fertility preferences and contraceptive needs to each other. A couple-oriented approach to family planning is needed so that both members of a couple can satisfy their fertility desires and preferences eventually. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12882-x.
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Affiliation(s)
- Minakshi Vishwakarma
- Research Scholar, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India, 400088
| | - Chander Shekhar
- Professor, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India, 400088
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