Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

Assessing the inequalities in demand for family planning satisfied in Ghana: evidence from the 1993-2014 Demographic and Health Surveys

BACKGROUND

Family planning is essential in promoting the well-being of women and their families and communities and ensuring quality of care in contraceptive use. This study sought to assess the trend and inequalities in the demand for family planning satisfied (DFPS) in Ghana from 1993 to 2014.

METHODS

The World Health Organization's Health Equity Assessment Toolkit was employed to analyse the data. We disaggregated DFPS by five equity stratifiers: age, economic status, education, residence and region. Inequality was measured using difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF).

RESULTS

The study showed an increment in DFPS from 17.8% to 38.7% between 1993 and 2014. With respect to age, we noted substantial inequality in 2003 (D=21.9 [95% confidence interval {CI} 15.2 to 28.7]), 1993 (D=4.8 [95% CI -1.8 to 11.4]) and 2014 (D=15 [95% CI 3 to 26.9]). The greatest economic inequality occurred in 1993 (PAF=69.7 [95% CI 50.8 to 88.6]; D=20.1 [95% CI 14.8 to 25.4]). Regarding education, significant inequality existed in 1993 (PAF=112 [95% CI 100.8 to 123.2]; D=29.7 [95% CI 21.9 to 37.4]). Ashanti and the Upper West regions reported significant inequalities (PAF=55.6 [95% CI 33.1 to 78.2]; D=16.1 [95% CI 8.9 to 23.3]).

CONCLUSIONS

There are age-, education-, wealth-, residence- and region-related inequalities with respect to DFPS. Policymakers will have to prioritize the needs of women with no formal or low educational attainment in order to improve DFPS coverage. Special attention needs to be given to adolescent girls since they suffer greater inequalities than adult women.

Contraception and intersection with HIV services in 11 high HIV burden sub-Saharan African countries: Results from the population-based HIV Impact Assessment cross-sectional studies conducted from 2015 to 2018

OBJECTIVE

The United Nations' Sustainable Development Goal 3.7.1 addresses the importance of family planning. The objective of this paper is to provide information on family planning to policymakers to help increase access to contraceptive methods to women in sub-Saharan Africa.

METHODS

We analyzed data from the Population-based HIV Impact Assessment studies conducted in 11 sub-Saharan African countries from 2015 to 2018 to assess the relationship between HIV services and family planning. Analyses were restricted to women aged 15-49 years who reported being sexually active within the past 12 months and had data on contraceptive use.

RESULTS

Approximately 46.4% of participants reported using any form of contraception; 93.6% of whom used modern contraceptives. Women with a positive HIV status were more likely to use contraceptives (P < 0.0001) than HIV-negative women. Unmet need was higher among women who were confirmed to be HIV-negative in Namibia, Uganda, and Zambia than confirmed to be positive. Women aged 15-19 years used contraception less than 40% of the time.

CONCLUSION

This analysis highlights crucial gaps in progress among HIV-negative and young women (aged 15-19 years). To provide access to modern contraception for all women, programs and governments need to focus on women who desire but do not have access to these family planning resources.

What are the sources of contraceptives for married and unmarried adolescents: Health services or friends? Analysis of 59 low- and middle-income countries

Background

Despite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status.

Methods

We used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15-19, 20-34, or 35-49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union.

Results

mDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions.

Conclusions

Our findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.

Four in ten married women demands satisfied by modern contraceptives in high fertility sub-Saharan Africa countries: a multilevel analysis of demographic and health surveys

BACKGROUND

Demand satisfied with modern contraceptive can be seen on both a health and economic level. Additionally, family planning helps to regulate fertility, prevent unintended pregnancies and their consequences. Thus, the aim of this study was to identify the magnitude of demand satisfied with modern contraceptive among married/in-union women in ten high fertility sub Saharan African countries.

METHODS

Recent Demographic and Health Surveys that included a weighted sample of 43,745 women of reproductive age provided the data for this study. All statistical analyses were conducted once the data had been weighted, and Stata version 16.0 was used. A multilevel mixed-effect binary logistic regression model was fitted. To determine statistically significant individual and community-level factors associated with demand satisfied for modern contraceptive, odds ratios with a 95% confidence interval was generated. A p-value less than 0.05 was declared as statistical significance.

RESULTS

Overall, demand satisfied to use modern contraceptive in high fertility sub-Saharan Africa countries was 39.53% (95%CI: 39.06, 39.98). Women aged 25-34 (AOR: 1.34, 95%CI: 1.26, 1.42) and 35-49 (AOR: 1.28, 95%CI: 1.20, 1.38), women education: primary (AOR: 1.35, 95%CI: 1.27, 1.44) and secondary (AOR: 2.05, 95%CI: 1.90, 2.21), husband education: primary (AOR: 1.26, 95%CI: 1.18, 1.35) and secondary (AOR: 1.54, 95%CI: 1.43, 1.66), husband residence (AOR: 1.75, 95%CI: 1.60, 1.91), media exposure (AOR: 1.22, 95%CI: 1.15, 1.29), wealth index: poorer (AOR: 1.1, 95%CI: 1.02, 1.19), middle (AOR: 1.18, 95%CI: 1.08, 1.28), richer (AOR: 1.37, 95%CI: 1.26, 1.49) and richest (AOR: 1.34, 95%CI: 1.56, 1.89), number of children: 4-6 (AOR: 0.48, 95%CI: 0.43, 0.55) and above 6 (AOR: 0.39, 95%CI: 0.29, 0.59), perceived distance to the health facility not big problem (AOR: 1.11, 95%CI: 1.04, 1.15), urban residence (AOR: 1.18, 95%CI: 1.10, 1.27), high community level poverty (AOR: 0.85, 95%CI: 0.74, 0.97) were significantly associated with demand satisfied for modern contraceptives.

CONCLUSION

Only four in ten married reproductive age women demands satisfied with modern contraceptives in high fertility Sub Saharan African countries. Modern contraceptives should therefore be more widely available, especially in rural areas and for those living away from health facilities. Also, increasing media exposure and education, providing financial support, and making contraceptive access easier for married women from poor households are important interventions that need to be put in place.

Recurrence of teenage pregnancy: associated maternal and neonatal factor outcomes

The present study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes. It is a cross-sectional study, based on data from "Nascer no Brasil", comprised of adolescent mothers and their newborns. Univariate and multiple logistic regression were used to indicate the factors associated with this recurrence. Recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59); an inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), with no intention of becoming pregnant; residency in the state capital; and the fact that the partner is the head of the family. However, as independent primiparous teenagers, there is a greater chance of hypertension and restricted intrauterine growth. It can therefore be concluded that there is a high percentage of teenage pregnancies in Brazil. Teenagers with a partner, inadequate education, and no reproductive planning are more likely to have two or more pregnancies before the age of 20, demonstrating difficulties in postponing the first pregnancy. However, as primiparous teenagers, they are more likely to have complications than multiparous teenagers.

Recurrence of teenage pregnancy: associated maternal and neonatal factor outcomes

Abstract The present study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes. It is a cross-sectional study, based on data from “Nascer no Brasil”, comprised of adolescent mothers and their newborns. Univariate and multiple logistic regression were used to indicate the factors associated with this recurrence. Recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59); an inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), with no intention of becoming pregnant; residency in the state capital; and the fact that the partner is the head of the family. However, as independent primiparous teenagers, there is a greater chance of hypertension and restricted intrauterine growth. It can therefore be concluded that there is a high percentage of teenage pregnancies in Brazil. Teenagers with a partner, inadequate education, and no reproductive planning are more likely to have two or more pregnancies before the age of 20, demonstrating difficulties in postponing the first pregnancy. However, as primiparous teenagers, they are more likely to have complications than multiparous teenagers.

Adolescent experiences of mistreatment during childbirth in health facilities: secondary analysis of a community-based survey in four countries

INTRODUCTION

Pregnancy and childbearing among adolescents-especially younger adolescents-is associated with health complications and lost opportunities for education and personal development. In addition to established challenges adolescents and young women face in sexual and reproductive healthcare, evidence suggests that they also face mistreatment during childbirth.

METHODS

This is a secondary analysis of the WHO study 'How women are treated during facility-based childbirth' cross-sectional community survey in Ghana, Guinea, Myanmar and Nigeria. We used descriptive analysis to assess experiences of mistreatment among adolescents (15-19 years) and young women (20-24 years) and multivariable logistic regression models to assess the association between experiences of mistreatment and satisfaction with care during childbirth.

RESULTS

862 participants are included (15-19 years: 287, 33.3%; 20-24 years: 575, 66.7%). The most common mistreatment was verbal abuse (15-19 years: 104/287, 36.2%; 20-24 years: 181/575, 31.5%). There were high levels of poor communication (15-19 years: 92/287, 32.1%; 20-24 years: 171/575, 29.7%), lack of supportive care (15-19 years: 22/287, 42.5%; 20-24 years: 195/575, 33.9%) and lack of privacy (15-19 years: 180/287, 62.7%; 20-24 years: 395/575, 68.7%). Women who were verbally abused were less likely to report satisfaction with care (adjusted OR (AOR): 0.19, 95% CI: 0.12 to 0.31) and less likely to recommend the facility (AOR: 0.24, 95% CI: 0.15 to 0.38). There were similar reports among those who were physically abused, had long waiting time, did not mobilise and did not give consent for vaginal examinations.

CONCLUSION

Our study shows that adolescents and young women mistreatment during childbirth, contributing to low satisfaction with care. It is critical to recognise adolescents and young women's unique needs in maternal healthcare and how their needs may intersect with social stigma around sex and pregnancy.

The public-sector family planning program impact scores in association with long acting reversible contraceptive use among young women in 22 Sub-Saharan African countries; A pooled multi-level analysis

OBJECTIVE

The objective of this study was to evaluate the role of public-sector family planning program impact scores and other country-level factors on LARC use among young women aged 15-24.

STUDY DESIGN

We conducted this research using a large population database covering several decades' worth of multi-wave cross-sectional samples of the demographic health survey (DHS) and the World Bank website data. We carried out a multi-level analysis on data from 1990 to 2019 from 22 Sub-Saharan African countries, with 163,242 participants.

RESULTS

We found LARC use was at 3.1% of all young women under study. Sierra Leone, 2019 survey had the highest LARC use at 21,961 per 100,000. A 10% increase in public-sector family planning program impact scores was positively associated with LARC use with odds ratio of 1.44, 95% CI, 1.43- 1.45). We also noted that a 1% increase in HIV prevalence was associated with a reduced odds ratio of LARC use at 0.75 (95% CI, 0.70-0.81).

CONCLUSIONS

Findings from this study provide empirical evidence highlighting the importance of country-level factors in influencing LARC use among young women in sub-Saharan Africa IMPLICATIONS: For young women in Africa, policymakers need to increase their effort on national family planning programs especially in the public sector. Broader societal level interventions to improve LARC use are required. Specific interventions must address the complexities of HIV prevention and LARC use to benefit young women living in countries with a high HIV prevalence.