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Ahmed S, McLoughlin Dymond A, Correa M, Willcox ML. Views and experiences of long-acting reversible contraception among ethnic minorities in high-income countries: a systematic review of qualitative studies. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:53-66. [PMID: 37949640 DOI: 10.1136/bmjsrh-2023-201864] [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: 03/12/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BackgroundEthnic minorities in high-income countries have higher rates of unintended pregnancies but are less likely to use highly efficacious long-acting reversible contraception (LARC). The reasons for this are unclear. AIM To understand the views and experiences of ethnic minorities within high-income countries about LARC. METHODOLOGY Medline, CINAHL, EMBASE and Sociological Abstracts were searched systematically to find qualitative articles about views on LARC. Titles and abstracts were screened to select qualitative studies about LARC whose participants were mainly from ethnic minorities in high-income countries. Quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis was conducted. RESULTS Seventeen studies (19 articles) met the inclusion criteria, 14 of which were from the USA (227 participants identified as Latina, 222 Black, 15 multiracial, 4 Asian). Two studies included 32 Chinese women in the UK and Australia and one included 20 Aboriginal women in Australia. Factors influencing uptake of LARC included side effects, convenience, and perceived efficacy of LARC compared with other methods; women's ideas, concerns and expectations; and external influences (partner, family/friends, health professionals and society). Convenience of LARC, control over reproductive decisions, and desire to prevent pregnancy were the main facilitators. Barriers included specific cultural concerns about irregular bleeding, concerns about racial discrimination, and family/friends having negative views on LARC. CONCLUSIONS Ethnic minority women often have additional needs and concerns about LARC compared with the White majority. Further research is needed to develop and evaluate customised respectful counselling on contraception options for ethnic minority women and their partners.
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Affiliation(s)
- Sumayyah Ahmed
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Abigail McLoughlin Dymond
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Michele Correa
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Merlin L Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
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Kibonire RA, Mphuthi DD. Perceptions of indigenous ugandan men on the use of long acting reversible contraceptives (LARCs) by rural women. Contracept Reprod Med 2023; 8:50. [PMID: 37845682 PMCID: PMC10577931 DOI: 10.1186/s40834-023-00246-8] [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: 05/12/2023] [Accepted: 08/22/2023] [Indexed: 10/18/2023] Open
Abstract
Worldwide, unintended pregnancies remain a critical public health challenge, with 74 million women in low- and middle-income countries getting these pregnancies yearly. The African continent alone contributes about 25% of all unintended pregnancies globally. Even though not all unintended pregnancies are unwanted, they can lead to many health problems for mothers and children, like malnutrition, sickness, neglect, or abuse, as well as maternal and infant morbidities and mortalities. Globally, many women die due to complications related to childbirth, either during or after pregnancy. Contraceptives, especially for long-acting reversible Contraceptive methods (LARCs), are among the best interventions to reduce maternal death. LARCs help the mother delay pregnancy and allow for longer intervals in childbirth spacing. However, utilising LARCs globally and in Uganda remains low because of limited male partner support.The purpose of this phenomenological qualitative research study was to elicit an understanding of the perceptions and beliefs of rural indigenous Ugandan men towards the use of LARCs by rural women. Ultimately the study designed strategies to enhance the uptake of those methods. Purposive sampling was used to identify 65 participants for focus group interviews and 30 for individual interviews comprising married men aged 20 to 49 years. The study was conducted in the Rubanda and Kiboga Districts of Uganda. The researcher used semi-structured questions for individual and focus group interviews.The data analysis was done by transcribing the interviews, sorting the field notes, organising, and storing the data, listening to recordings, and reading field notes and interviews to look for patterns related to the perceptions and belief systems. Using the identified patterns, the researcher coded and categorised the data to build themes emerging on the phenomenon.The study established negative perceptions and belief systems among rural indigenous Ugandan men regarding the use of LARCs by their rural women, which acted as barriers to utilisation. These perceptions included side effects, fears, desires, and cultural and religious beliefs. The study recommends strengthening social and behavioural change communication, strengthening service provision for LARCs, and monitoring and evaluation systems for LARCs. Additionally, policymakers should provide a conducive environment for LARC services provision, and the Ministry of Education and Sports, through health training institutions and universities, should prepare pre-service and in-service healthcare workers to provide LARC services.
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Affiliation(s)
- Ronald Arineitwe Kibonire
- College of Human Sciences, School of Social Sciences, Department of Health Studies, University of South Africa, City of Tshwane, South Africa.
| | - David D Mphuthi
- College of Human Sciences, School of Social Sciences, Department of Health Studies, University of South Africa, City of Tshwane, South Africa
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Sajjad W, Ishaq K, Asghar S. Why Pakistani Women Do Not Use Intrauterine Contraceptive Devices: A Systematic Review of Barriers and Misconceptions. Cureus 2023; 15:e47378. [PMID: 38022103 PMCID: PMC10657553 DOI: 10.7759/cureus.47378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
This review explores barriers limiting the adoption of Intrauterine Contraceptive Devices (IUCDs) in Pakistan, focusing exclusively on local articles. As Pakistan's high population calls for widespread contraception, we aim to pinpoint obstacles hindering IUCD utilization, irrespective of parity. We conducted a comprehensive search of PubMed, Google Scholar, PakMedinet, and Wiley Online Library for English-language primary studies published between 2000 and 2022, reporting on IUCD utilization in Pakistan. Our analysis reveals multiple barriers impeding IUCD use in Pakistan. These encompass patriarchal social norms, male dominance, low education, socioeconomic status, and unemployment. Post-insertion health concerns, inadequate counseling, government commitment, and awareness were also identified barriers. Provider confidence, client trust, women's autonomy, social constraints, and limited male partner involvement hindered IUCD adoption. A desire for larger families and male offspring, vague religious beliefs, fear, and misconceptions further restricted usage. Accessibility and high service costs also posed challenges. This review highlights prevailing impediments to IUCD adoption in Pakistan, encompassing knowledge gaps, motivation deficits, resistance from husbands and in-laws, cultural and religious beliefs, limited access, and communication barriers. To promote IUCDs as a modern contraceptive method, it is essential to raise awareness among both men and women. Active involvement of religious leaders and community stakeholders is crucial in addressing these social factors hindering IUCD utilization.
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Affiliation(s)
- Waseem Sajjad
- Department of Community Medicine and Public Health, Mayo Hospital, Lahore, PAK
| | - Khadija Ishaq
- Department of Community Medicine and Public Health, Mayo Hospital, Lahore, PAK
| | - Sunaina Asghar
- Department of Community Medicine and Public Health, Mayo Hospital, Lahore, PAK
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Aguemi AK, Torloni MR, Okamura MN, Guazzelli CAF. Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e524-e534. [PMID: 37846185 PMCID: PMC10579915 DOI: 10.1055/s-0043-1772187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. METHODS Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. RESULTS One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥ 7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. CONCLUSION Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.
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Affiliation(s)
- Adalberto Kiochi Aguemi
- Women's Health Technical Area, Secretaria Municipal da Saúde de São Paulo, SP, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | | | - Mirna Namie Okamura
- Coordination of Epidemiology and Information, Secretaria Municipal da Saúde de São Paulo, SP, Brazil
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Factors Associated with the Choice of Contraceptive Method following an Induced Abortion after Receiving PFPS Counseling among Women Aged 20-49 Years in Hunan Province, China. Healthcare (Basel) 2023; 11:healthcare11040535. [PMID: 36833069 PMCID: PMC9956072 DOI: 10.3390/healthcare11040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND There is limited research on postabortion family planning (PAFP) services and subsequent contraception in China. The current study aimed to identify women's contraceptive methods choices and associated factors after receiving PAFP services. METHODS A cross-sectional study used a cluster, stratified and multistage random sample to collect data. All eligible data were analyzed using SPSS 26.0. The chi-square test was used to assess the association between categorical variables. Significant variables (p < 0.05) and all potential variables were then included in the binary logistic regression model for analysis. RESULTS Approximately 84.7% (1043/1231) of participants had received pre-abortion PAFP counselling, and approximately 90% of them chose reliable methods. Farmers or workers (OR = 0.297, 95% CI: 0.130-0.683), family monthly income (3000-4999 RMB, OR = 0.454, 95% CI: 0.212-0.973; ≥5000 RMB, OR = 0.455, 95% CI: 0.228-0.909), reliable advice from services providers before abortion (OR = 0.098, 95% CI: 0.039-0.250), painless surgical abortion (OR = 3.465, 95% CI 1.177-10.201), and postabortion follow-up (OR = 0.543, 95% CI: 0.323-0.914) and were associated with contraception choice after receiving PAFP services. CONCLUSIONS This study emphasizes the importance of pre-abortion PAFP counselling, postabortion follow-up, and increased focus on women who have experienced painless abortion. The study provides direction for PAFP services policymakers, as well as a reference for contraceptive counselling research around the world.
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Wang N, Creedy DK, Zhang M, Lu H, Elder E, Allen J, Guo L, Xiao Q, Gamble J. Designing a Needs-Oriented Psychological Intervention for Chinese Women Undergoing an Abortion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:782. [PMID: 36613103 PMCID: PMC9819149 DOI: 10.3390/ijerph20010782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Accessing good quality abortion care is a fundamental human right and contributes to achieving Sustainable Development Goals. However, well-designed abortion care that meets women's needs is limited. This study aims to systematically develop an intervention to promote the psychological well-being of Chinese women undergoing an abortion. A five-step iterative approach informed by intervention mapping was undertaken to determine the intervention design. Step 1 used in-depth interviews with 14 Chinese women undergoing an abortion to assess real-life stressors and support needs. We identified eight stressors and found women's support needs varied with the time trajectory of the abortion. Step 2 used a focus group discussion with care providers to select modifiable stressors that impact negative psychological outcomes. In Step 3 and Step 4, we determined and integrated the exact strategies to eliminate or mitigate possible modifiable stressors by incorporating information from in-depth interviews and the Transactional Model of Stress and Coping. The integrated strategies were instructional support, informational support, and timely communication. In Step 5, we composed the detailed intervention design according to the best available evidence and, to confirm content validity, consulted 10 women who had undergone abortion in the previous 2-6 weeks. The intervention was titled STress-And-coping suppoRT (START), which included four interacting components: (1) a face-to-face consultation at the first appointment; (2) a printed booklet with information on abortion, self-care, and managing emotions and intimate relationships; (3) a WeChat-based online public profile page offering the same information as the booklet; (4) a telephone hotline. This study paves the way for a new approach to addressing the psychological needs of women experiencing abortion in China. The rigorous process provides an example of developing tailored health promotion interventions.
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Affiliation(s)
- Na Wang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Gold Coast, QLD 4215, Australia
| | - Debra K. Creedy
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| | - Mingna Zhang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Hong Lu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Elizabeth Elder
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Gold Coast, QLD 4215, Australia
| | - Jyai Allen
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| | - Li Guo
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Jenny Gamble
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
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Negash WD, Belachew TB, Asmamaw DB. Long acting reversible contraceptive utilization and its associated factors among modern contraceptive users in high fertility sub-Saharan Africa countries: a multi-level analysis of recent demographic and health surveys. Arch Public Health 2022; 80:224. [PMID: 36280847 PMCID: PMC9590189 DOI: 10.1186/s13690-022-00977-1] [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: 06/05/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives (LARC) have been hailed as one of the safest and most effective methods of contraception. However, the use of LARC is low in the world, including Sub Saharan Africa; therefore, the aim of this study was to assess LARC utilization and associated factors among modern contraceptive users in high fertility SSA countries. METHODS Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 14,828 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of long acting reversible contraception utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance. RESULTS Overall prevalence of LARC utilization was observed to be 20.1% (19.45, 20.74). The factors significantly associated with the utilization were women's age ≥ 35 years (AOR = 1.42; 95% CI: 1.19,1.68), having media exposure (AOR = 1.13; 95% CI: 1.05, 1.28), number of alive children: 1-2 (AOR = 2.35; 95% CI: 1.38, 4.01), 3-4 (AOR = 2.98; 95% CI: 1.74, 5.10), [Formula: see text] 5 (AOR = 2.82; 95% CI:1.63, 4.86), have no history of abortion (AOR = 1.33; 95% CI: 1.17,1.51) and who have no big problem with distance to the health facility (AOR = 1.29; 95% CI: 1.16, 1.43). CONCLUSION The use of long acting reversible contraception in this study was relatively low. To improve the utilization of long acting reversible contraceptives governments, policymakers, and stakeholders should implement health promotion strategies through media and improve accessibilities of health facilities.
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Affiliation(s)
- Wubshet Debebe Negash
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mihretie GS, Abebe SM, Abebaw Y, Gedefa L, Gure T, Alemayehu BA, Amenu D, Tadesse D, Fanta GA, Abubeker FA, Yemane A, G/Michael AD, Teklu AM, Damtew MH, Girma B. Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia. BMJ Open 2022; 12:e059372. [PMID: 35918115 PMCID: PMC9351308 DOI: 10.1136/bmjopen-2021-059372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users. DESIGN A facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women. SETTING The study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study. PARTICIPANTS The study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period. INTERVENTIONS A pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation. RESULT From the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation. CONCLUSION The majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.
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Affiliation(s)
- Getasew Sisay Mihretie
- Department of Obstetrics and Gynecology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- University of Gondar, Gondar, Ethiopia
- University of Gondar, Gondar, Ethiopia
- Human Nutrition, Institute of Public Halth, Gondar, Ethiopia
| | - Yeshiwas Abebaw
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
- Obstetrics and Gynecology, School of Medicine, Gondar, Ethiopia
| | - Leta Gedefa
- Haramaya University, Dire Dawa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Haromaya, Ethiopia
| | - Tadesse Gure
- Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, Harar, Ethiopia
- Obstetrics and Gynaecology, Haramaya University College of Health and Medical Sciences, Haramaya, Oromia, Ethiopia
| | - Birtukan Asmare Alemayehu
- Department of Obstetrics and Gynecology, Menelik II Referral Hospital, Ethiopia, Addis Ababa, Ethiopia
| | | | - Daniel Tadesse
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research and project unit, Addis Ababa, Ethiopia
| | - Girma Abraham Fanta
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Addis Ababa, Ethiopia
| | - Ferid Abbas Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Medical College, Addis Ababa, Ethiopia
| | - Awol Yemane
- Mekelle University, Mekelle, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Mekella, Ethiopia
| | - Amanuel Desta G/Michael
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
- College of Health Science, Mekelle, Ethiopia
| | - Alula M Teklu
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research, MERQ PLC LLC, Baltimore, Maryland, USA
- Research Unit, Addis Ababa, Ethiopia
| | - Mengistu Hailemariam Damtew
- University of Michigan Center for International Reproductive Health Training Ethiopia, Addis Ababa, Oromia, Ethiopia
- CIRHT, Addis Ababa, Ethiopia
| | - Bisrat Girma
- Jimma University, Jimma, Ethiopia
- College of health and Medical Sciences, Jimma, Ethiopia
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Laksono AD, Rohmah N, Megatsari H. Barriers for multiparous women to using long-term contraceptive methods in Southeast Asia: case study in Philippines and Indonesia. BMC Public Health 2022; 22:1425. [PMID: 35883076 PMCID: PMC9327156 DOI: 10.1186/s12889-022-13844-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia. Methods The study population was women aged 15–49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression. Results In both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM. Conclusion The study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency, The Republic of Indonesia, Jakarta, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia
| | - Hario Megatsari
- Faculty of Public Health, University of Airlangga, Surabaya, Indonesia.
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Chen H, Song H, Li M, Hu S, Xiong X, Jiang H, Xu J. The impact of awareness and attitudes towards long-action reversible contraceptives on the intention to use: a survey among youth with unintended pregnancies. EUR J CONTRACEP REPR 2022; 27:121-126. [PMID: 35133237 DOI: 10.1080/13625187.2022.2029396] [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: 11/03/2022]
Abstract
PURPOSE To understand the associations between awareness, attitudes, and intentions to use long-acting reversible contraceptives (LARCs) among youth seeking induced abortion services in Shanghai, China. MATERIALS AND METHODS A cross-sectional survey was carried out among 1,215 nulliparous youth with unintented pregnancies in 41 hospitals of Shanghai, China, through a stratified sampling process between January and May 2019. Multivariable logistic regression was used to test the associations between awareness, attitudes and intentions to use LARCs. RESULTS Around 70% of youth had heard of at least one method of LARCs. About 38% of youth perceived that the copper-bearing intrauterine contraceptive device (Cu-IUD) was safe; the rate was 8% and 7%, respectively, for levonorgestrel-releasing intrauterine system (LNG-IUS) and subdermal implants. Less than 40% of youth thought Cu-IUD was effective in contraception, and it was around 6% for LNG-IUS and subdermal implants. Overall, less than 8% of youth expressed intentions to use LARCs. Positive attitudes towards LARCs were highly associated with the intentions to use LARCs [adjusted Odds Ratio (OR) 3.22, 95% confidence interval (CI) 1.96-5.42, p < 0.001]. CONCLUSIONS Low awareness and negative attitudes towards LARCs were found in this study, and the negative attitudes towards LARCs could contribute to low intentions to use LARCs among youth who had already experienced unintended pregnancies.
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Affiliation(s)
- Hainan Chen
- Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heqing Song
- School of Public Health, Key Lab of Health Technology Assessment (National Health Commission), Fudan University, Shanghai, China
| | - Mu Li
- School of Public Health, University of Sydney, Sydney, Australia
| | - Shuyi Hu
- Shanghai Center for Women and Children's Health, Shanghai, China
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hong Jiang
- School of Public Health, Key Lab of Health Technology Assessment (National Health Commission), Fudan University, Shanghai, China
| | - Jieshuang Xu
- Shanghai Center for Women and Children's Health, Shanghai, China
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Boydell V, Galavotti C. Getting Intentional about Intention to Use: A Scoping Review of Person-Centered Measures of Demand. Stud Fam Plann 2022; 53:61-132. [PMID: 35119110 PMCID: PMC9303959 DOI: 10.1111/sifp.12182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention‐to‐use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer‐range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use.
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Affiliation(s)
- Victoria Boydell
- School of Health and Social Care, University of Essex, Colchester, UK
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Moges Mittiku Y, Tamiru AT, Rade BK. The significant influence of history of induced abortion on the utilisation of long-acting reversible contraceptive methods in the immediate post abortion period, Northern Ethiopia. EUR J CONTRACEP REPR 2021; 26:367-373. [PMID: 33860731 DOI: 10.1080/13625187.2021.1901878] [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: 10/21/2022]
Abstract
BACKGROUND Rapid population growth, untended pregnancy, and related consequences remain the concern of Sub-Saharan African countries, including Ethiopia. Despite this, long-acting reversible contraceptives methods are still underutilised and no studies have sought the factors in this study setting. Therefore, this study conducted to assess the prevalence and determining factors of long-acting reversible contraceptives utilisation following an abortion in Northern Ethiopia. METHOD Facility-based cross-sectional study design was employed. A total of340 post aborted women selected by a systematic sampling method from August 1 to October 30, 2018. Data were entered into Epi-Info version 7 software and exported to SPSS version 20 for analysis. Both bivariate and multivariate logistic regression models were used to identify factors associated with the outcome variable. RESULTS The overall post-abortion long-acting reversible contraceptives utilisation was 57(16.76%) with 47(82.46%) implantand 10 (17.54%) intrauterine devices. Age range 20-29 years (AOR = 0.09, 95% CI 0.02-0.37), employed (AOR = 5.22, 95% CI 1.99-13.67), had ≥2 alive children (AOR = 7.02, 95% CI 1.58-31.23), induced abortion (AOR = 8.41, 95% CI 3.28-21.59), surgical abortion (AOR = 5.99, 95% CI 2.25-15.94), previous awareness (AOR = 3.18, 95% CI 1.14-8.82) and history of prior utilisation (AOR = 3.59, 95% CI 1.08-11.97) were the factors significantly associated with utilisation of post-abortion long-acting reversible contraceptives. CONCLUSION Long-acting reversible contraceptive methods level of utilisation following an abortion in this study was low. Advocating and raising awareness should always consider on benefits and effectiveness of long-acting reversible contraceptives for all type of abortion and methods of termination as an integral part of reproductive health care services.
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Affiliation(s)
- Yohannes Moges Mittiku
- Department of Midwifery, Institute of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Animut Tagele Tamiru
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bayew Kelkay Rade
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dolan H, Li M, Bateson D, Thompson R, Tam CWM, Bonner C, Trevena L. 'Every medicine is part poison': a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia. BMC WOMENS HEALTH 2021; 21:100. [PMID: 33685463 PMCID: PMC7938530 DOI: 10.1186/s12905-021-01226-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/16/2021] [Indexed: 11/10/2022]
Abstract
Background In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way.
Methods A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method. Results Four major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’; ‘intrauterine device, a device used in the past for married women’; ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’; and ‘it is not necessary to seek medical advice in choosing contraceptive methods’. Conclusions Our findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01226-3.
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Affiliation(s)
- Hankiz Dolan
- School of Public Health, The University of Sydney, Room 125, Edward Ford Building, Sydney, NSW, 2006, Australia. .,Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Mu Li
- School of Public Health, The University of Sydney, Room 125, Edward Ford Building, Sydney, NSW, 2006, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, NSW, 2131, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel Thompson
- School of Public Health, The University of Sydney, Room 125, Edward Ford Building, Sydney, NSW, 2006, Australia.,Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Carissa Bonner
- School of Public Health, The University of Sydney, Room 125, Edward Ford Building, Sydney, NSW, 2006, Australia.,Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Lyndal Trevena
- School of Public Health, The University of Sydney, Room 125, Edward Ford Building, Sydney, NSW, 2006, Australia.,Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, NSW, 2006, Australia
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Kumbeni MT, Apanga PA, Ayamga EA. Nexplanon failure in a woman with HIV infection in rural Ghana: A case report. Clin Case Rep 2020; 8:2369-2372. [PMID: 33363743 PMCID: PMC7752638 DOI: 10.1002/ccr3.3156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/06/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023] Open
Abstract
Although Nexplanon is one of the most effective and most utilized long-acting reversible contraceptives in Ghana. We report a rare event of Nexplanon failure in a woman with human immunodeficiency virus (HIV) infection in rural Ghana.
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Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia. Am J Obstet Gynecol 2020; 222:S917.e1-S917.e15. [PMID: 31953114 DOI: 10.1016/j.ajog.2019.12.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/05/2019] [Accepted: 12/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Integrating family planning interventions with HIV studies in developing countries has been shown to prevent mother-to-child HIV transmission and simultaneously reduce HIV and unintended pregnancy in high-risk populations. As part of a prospective cohort study on HIV incidence and risk factors in Zambian women having unprotected sex, we also offered family planning counseling and immediate access to long-acting reversible contraceptives. Although long-acting reversible contraceptives are the most effective form of contraception, many Zambian women are limited to oral or injectable methods because of a lack of knowledge or method availability. This project offers to single mothers who are enrolled in a cohort study information about and access to long-acting reversible contraceptives at enrollment and at each follow-up visit. OBJECTIVE This study evaluates how fertility intentions affect long-acting reversible contraceptive use in HIV-negative single mothers in Zambia. Our primary outcome was long-acting reversible contraceptive use throughout the study participation. We also estimated rates of long-acting reversible contraceptive uptake and discontinuation. We specifically studied single mothers because they are at high risk for unintended pregnancy, which can have significant negative ramifications on their financial, social, and psychologic circumstances. STUDY DESIGN From 2012-2017, Zambia Emory HIV Research Project recruited 521 HIV-negative single mothers ages 18-45 years from government clinics in Lusaka and Ndola, Zambia's 2 largest cities. Participants were followed every 3 months for up to 5 years. At each visit, we discussed fertility goals and contraceptive options and offered a long-acting reversible method to any woman who was not pregnant or who already was using a long-acting reversible or permanent contraceptive method. Data were collected on demographic factors, sexual behavior, and reproductive history. Multivariable logistic regression was used to model baseline fertility intentions with long-acting reversible contraceptive use. RESULTS We enrolled 518 women; 57 women did not return for any follow-up visits. There was a significant increase in long-acting reversible contraceptive use during the study. At baseline, 93 of 518 women (18%) were using a long-acting reversible method, and 151 of 461 women (33%) used a long-acting reversible method at the end of follow-up period (P<.0001). Four women chose an intrauterine device, and 91 women chose an implant for their first uptake event. After we adjusted the data for other confounders, we found that women in Ndola who did not desire any more children were more likely to use a long-acting reversible contraceptive (adjusted prevalence ratio, 2.02; 95% confidence interval, 1.88-3.42). During follow up, 37 of 183 long-acting reversible contraceptive users (20%) discontinued their method; women who desired future children at baseline were more likely to discontinue earlier (P=.016). CONCLUSION This study demonstrates that integrated family planning services can increase long-acting reversible contraceptive use successfully among Zambian single mothers, who are a vulnerable population that disproportionately is affected by unintended pregnancy. A steady increase in use over time confirms the importance of repeated messaging about these unfamiliar methods. Thus, it is imperative that family planning interventions target single mothers in developing countries to promote effective contraceptive use.
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Khatri B, Khadka A, Amatya A, Shrestha SM, Paudel R. Perception And Use Of Intrauterine Contraceptive Devices (IUCD) Among Married Women Of Reproductive Age In Bhaktapur, Nepal. Open Access J Contracept 2019; 10:69-77. [PMID: 31819678 PMCID: PMC6886550 DOI: 10.2147/oajc.s219188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The copper-T (TCu-380A), an intrauterine contraceptive device (IUCD), is widely available and is highly effective in terms of safety and effectiveness. Despite this fact, there is low utilization of IUCD in Nepal. This paper describes the perception and use of IUCD among married women of reproductive age attending an institutional clinic in Bhaktapur, Nepal. Methods An institution-based cross-sectional study was conducted among 273 married women attending the institutional clinic of Bhaktapur hospital who were interviewed by trained staff nurses using semi-structured questionnaires. Systematic random sampling method was applied to select the participants. Logistic regression analysis was used to determine the relationship between factors associated with utilization of IUCD. Results Just below half (48.7%) of the participants had heard about IUCD. Only 7.0% of the potential users were currently using IUCD, and all of them had discussed using it with their husbands. Among women aware of IUCD, nearly a quarter of them (23.8%) did not want to use it because of their husband's disapproval and their assumed fear of decreased sexual pleasure. There was a significant association between previous abortion and use of IUCD, where the women who had a history of abortion had increased odds of using the IUCD by 5.45-times compared to those who had not (p=0.01). The women who were counseled about IUCD by health workers were 2.83-times more likely to use an IUCD than those who were not. The women who had a good knowledge level about IUCD as a method of modern contraception had 2.85-times increased odds of using the IUCD compared to those who had poor or no knowledge about it. Conclusion The use of IUCD depends on the support of husbands, knowledge about its safety, efficacy, and counseling.
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Affiliation(s)
- Bijay Khatri
- Academic and Research Department, B.P. Eye Foundation, Kathmandu, Nepal
| | - Anjana Khadka
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Archana Amatya
- Save the Children International, Nepal Country Office, Kathmandu, Nepal
| | - Sushan Man Shrestha
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rajan Paudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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