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McGuire C, Atieno MA, Hoke T, Jeckonia P, K'orimba K, Lorenzetti L, Ngure K, Niyibeshaho MM, Njuguna N, Torjesen K, Fonner V. PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice. Curr HIV/AIDS Rep 2024; 21:282-292. [PMID: 39046639 PMCID: PMC11377463 DOI: 10.1007/s11904-024-00704-1] [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] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Despite the growing availability of oral PrEP, coverage remains suboptimal. Through the introduction of additional PrEP methods, including vaginal rings and long-acting injectable formulations, health systems globally are on the cusp of offering PrEP methods that vary by route of administration, efficacy, and frequency of use. With PrEP choice, it will be important to explore PrEP use patterns to better understand how the ability to choose and switch products affects coverage and continuation. In this review, we draw parallels with family planning (FP) by summarizing how method choice and product switching affected contraceptive coverage globally, synthesize what is known about PrEP product switching, and outline evidence gaps to help guide future research on PrEP switching in the context of choice. RECENT FINDINGS Decades of research in FP has demonstrated that product switching is common and can lead to more satisfaction and increases in contraceptive use. While research on PrEP product switching is nascent, findings suggest switching is common, and that providing more than one PrEP option can increase coverage. Key evidence gaps include understanding product switching in the context of full versus constrained choice, switching in the context of temporary need, and developing interventions that promote product switching for those who could benefit. Providing choice and allowing people to start, stop, and switch products according to their needs and desires is a core component of a rights-based approach to HIV prevention. More research is needed to better understand what drives use patterns, including switching, and how to leverage choice to improve coverage. Standard definitions -some of which have been proposed in this review-are needed to inform comparable measurement. Finally, there is a need to holistically frame PrEP use to acknowledge changes in need over the life course, thus making method switching a standard part of HIV prevention.
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Affiliation(s)
- Courtney McGuire
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | | | - Theresa Hoke
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | | | | | - Lara Lorenzetti
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | - Virginia Fonner
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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Zimmerman LA, Sarria I, Kassa M, Karp C, Seme A, Shiferaw S. Identifying what contraceptive side effects women are told about during counseling using nationally representative PMA Ethiopia 2019 cross-sectional data. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002111. [PMID: 39146378 PMCID: PMC11326631 DOI: 10.1371/journal.pgph.0002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/09/2024] [Indexed: 08/17/2024]
Abstract
Despite widespread concerns about contraceptive side effects among contraceptive users, few studies explore the specific side effects women are told about during contraceptive counseling. It is thus unclear whether women receive appropriate and sufficient information on side effects they may experience. The objective of this study is to describe which specific side effects of hormonal contraception or copper IUD users are counseled on and identify relevant user characteristics associated with receipt of counseling, using nationally representative cross-sectional data from Ethiopia. Data were collected from a nationally representative sample of women between October and December 2019. Analyses were restricted to 2,039 current users of hormonal contraception (implant, injectable, pill, or emergency contraception) or the copper IUD. Descriptive analyses identified the types and number of side effects, across all methods and by the injectable, implant, and pill. Multinomial regression identified factors associated with receipt of counseling on bleeding changes only, non-bleeding changes only, or both, relative to no counseling on side effects, adjusting for method type, source, and socio-economic characteristics. Less than 10% of users were told of at least one bleeding and non-bleeding side effect. Relative to implant users, injectable and other method users were less likely to be told about bleeding changes only (aRRR: 0.65, 95% CI: 0.46-0.93 and aRRR: 0.31, 95% CI: 0.16-0.61, respectively) and users of other methods were less likely to be told about both a bleeding and non-bleeding change (aRRR: 0.43, 95% CI: 0.19-0.93). Users who received their method from a non-public source were less likely to receive counseling on any kind of side effect and nulliparous women were less likely to be told about both kinds of side effects. There is need to improve counseling on the method specific side effects on which women are counseled, particularly in the private sector.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Isabella Sarria
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Munir Kassa
- Federal Ministry of Health, Ethiopia, Addis Ababa, Ethiopia
| | - Celia Karp
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Hofmeyr GJ, Singata-Madliki M, Batting J, Steyn P, Thomas KK, Issema R, Beesham I, Mbatsane E, Morrison C, Deese J, Smit J, Philip N, Palanee-Phillips T, Reddy K, Onono M, Mastro TD, Baeten JM. Sexual behaviour among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: Data from the ECHO randomized trial. PLoS One 2024; 19:e0299802. [PMID: 38722832 PMCID: PMC11081305 DOI: 10.1371/journal.pone.0299802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/31/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Contraceptive use has complex effects on sexual behaviour and mood, including those related to reduced concerns about unintended pregnancy, direct hormonal effects and effects on endogenous sex hormones. We set out to obtain robust evidence on the relative effects of three contraceptive methods on sex behaviours, which is important for guiding contraceptive choice and future contraceptive developments. METHODS This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression. RESULTS We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the '>' and '<' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively. CONCLUSIONS These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.
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Affiliation(s)
- G. Justus Hofmeyr
- University of Botswana, Gaborone, Botswana
- Effective Care Research Unit, University of the Witwatersrand/Walter Sisulu University, East London, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, University of Witwatersrand, University of Fort Hare, East London, South Africa
| | - Joanne Batting
- Effective Care Research Unit, University of Witwatersrand, University of Fort Hare, East London, South Africa
| | - Petrus Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Katherine K. Thomas
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Rodal Issema
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ivana Beesham
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, MatCH Research Unit (MRU), University of the Witwatersrand, Durban, South Africa
| | | | | | - Jen Deese
- Pfizer Inc., Collegeville, Pennsylvania, United States of America
| | - Jenni Smit
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, MatCH Research Unit (MRU), University of the Witwatersrand, Durban, South Africa
| | - Neena Philip
- Mailman School of Public Health, ICAP at Columbia University, New York, New York, United States of America
| | - Thesla Palanee-Phillips
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Wits Reproductive Health and HIV Institute, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Maricianah Onono
- Kenya Medical Research Institute, Centre for Microbiology Research, Kisumu, Kenya
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Gilead Sciences, Foster City, California, United States of America
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Gemmill A, Sarnak D, Bradley SEK, Brecker E, Patierno K. Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002143. [PMID: 37939155 PMCID: PMC10631694 DOI: 10.1371/journal.pgph.0002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Abstract
Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women's risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in LMICs over the last decade. Using cross-sectional data from 49 Demographic and Health Surveys, we applied competing risks estimation to calculate monthly probabilities of contraceptive resumption and pregnancy over a 12-month period among pooled, regional, and country-specific samples of women who discontinued contraception for method-related reasons (corresponding to 174,726 episodes of discontinuation). We also examined the pregnancy intention status of births/current pregnancies among those who became pregnant in the 12 months following contraceptive discontinuation for method-related reasons. In the pooled sample, the three-month probability of pregnancy and resumption of contraceptive use was 12% and 47%, respectively; by 12 months these probabilities increased to 22% and 55%, respectively. Country-specific analyses show that the probabilities of resuming contraception by three months ranged from 15% in Liberia, Mali, and Sierra Leone to 85% in Bangladesh. On average, the majority of pregnancies/births that occured following discontinuation for method-related reasons were subsequently reported as unintended. However, reports varied depending on when women became pregnant within the 12 months following discontinuation. Our findings suggest the need for more nuanced measures of contraceptive use dynamics-including measures that distinguish between women who resume use of contraception from women who remain at risk of pregnancy in the short period after discontinuation-to better inform specific policies and interventions, particularly aimed at those who remain at risk of pregnancy.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dana Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Eve Brecker
- Population Reference Bureau, Washington, District of Columbia, United States of America
| | - Kaitlyn Patierno
- Population Reference Bureau, Washington, District of Columbia, United States of America
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Ssanyu JN, Kananura RM, Birabwa C, Kizito F, Namutamba S, Akongo D, Namara E, Kyangwa M, Kaula H, Nakimuli D, Magunda A, Kakaire O, Waiswa P. How a co-design process led to more contextually relevant family planning interventions in emerging urban settings in Eastern Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002421. [PMID: 37773920 PMCID: PMC10540946 DOI: 10.1371/journal.pgph.0002421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023]
Abstract
Voluntary, rights-based family planning upholds women's right to determine freely the number and spacing of their children. However, low-resource settings like Uganda still face a high unmet need for family planning. And, while urban areas are often indicated to have better access to health services, emerging evidence is revealing intra-urban socio-economic differentials in family planning utilization. To address the barriers to contraceptive use in these settings, understanding community-specific challenges and involving them in tailored intervention design is crucial. This paper describes the use of co-design, a human-centred design tool, to develop context-specific interventions that promote voluntary family planning in urban settings in Eastern Uganda. A five-stage co-design approach was used: 1) Empathize: primary data was collected to understand the problem and people involved, 2) Define: findings were shared with 56 participants in a three-day in-person co-design workshop, including community members, family planning service providers and leaders, 3) Ideate: workshop participants generated potential solutions, 4) Prototype: participants prioritized prototypes, and 5) Testing: user feedback was sought about the prototypes. A package of ten interventions was developed. Five interventions targeted demand-side barriers to family planning uptake, four targeted supply-side barriers, and one addressed leadership and governance barriers. Involving a diverse group of co-creators provided varied experiences and expertise to develop the interventions. Participants expressed satisfaction with their involvement in finding solutions to challenges in their communities. However, power imbalances and language barriers were identified by the participants as potential barriers to positive group dynamics and discussion quality. To address them, participants were separated into groups, and medical terminologies were simplified during brainstorming sessions. These changes improved participation and maximized the contributions of all participants. It is therefore important to consider participant characteristics and their potential impact on the process, especially when engaging diverse participant groups, and implement measures to mitigate their effects.
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Affiliation(s)
- Jacquellyn Nambi Ssanyu
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
| | - Catherine Birabwa
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | | | - Henry Kaula
- Kampala Slum Maternal and Newborn Health Project, Kampala Capital City Authority, Kampala, Uganda
| | | | - Andrew Magunda
- Kampala Slum Maternal and Newborn Health Project, Kampala Capital City Authority, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere university College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
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Nakaggwa F, Kimuli D, Kasule K, Katwesige JF, Kintu D, Ssempebwa R, Sevume S, Komakech P, Mubiru N, Maggwa B, Carrasco MA, Namuwenge N, Nsubuga RN, Amuron B, Bukenya D, Wandera B. Postpartum family planning uptake in Uganda: findings from the lot quality assurance sampling survey. Contracept Reprod Med 2023; 8:44. [PMID: 37608320 PMCID: PMC10463570 DOI: 10.1186/s40834-023-00243-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The initiation and use of family planning (FP) services within the first 12 months following childbirth, postpartum family planning (PPFP), promotes safe motherhood by reducing unintended pregnancies and ensuring appropriate pregnancy spacing. However, there is a paucity of information on PPFP uptake from community surveys. This study aimed to quantify the reported use of PPFP and identify predictors and barriers to PPFP uptake from a large community survey. METHODS We analysed data collected from the 2021 Lot Quality Assurance Sampling (LQAS) survey, a cross-sectional community and household survey that covered 68 districts in Uganda. The survey uses small sample sizes to designate health or administrative geographical areas which are assessed to determine whether they achieved the pre-determined target for defined indicators of interest. We abstracted and analysed data collected from mothers of children aged 12 months or younger on reproductive health and FP. PPFP use was defined as the reported use of modern FP by the mother or their partner. Associations were measured using Pearson's chi-square test at 5% significance. Multivariate logistic regression was performed for variables that were significantly associated with PPFP use to identify the predictors of PPFP. RESULTS Overall, 8103 mothers of children aged less than 12 years were included in the analysis; the majority of mothers, 55.8% (4521/8103) were above 24 years while 11.7% (950/8103) were 19 years and under. 98% (7942/8103) of the mothers attended at least one antenatal care (ANC) visit and 86.3% (6997/8103) delivered at a health facility. Only 10% (814/8103) of mothers who participated in the survey reported PPFP use at the time of the survey. Reporting of PPFP use was 5 times higher among mothers of children aged 7-12 months (AOR 4.9; 95%CI 4.1-5.8), 50% higher among mothers with secondary education (AOR 1.5; 95%CI 1.0-2.3), 80% higher among breastfeeding mothers (AOR 1.8; 95%CI 1.3-2.4) and 30% lower among those that didn't receive a health worker visit within 3 months preceding the survey (AOR 0.7; 95% CI 0.5-0.8). Among 4.6% (372/8103) who stated a reason for non-use of PPFP, the most cited reasons for not using were breastfeeding 43% (161/372), fear of side effects 26.9% (100/372), respondent/partner opposition 17.6% (48/372) and infrequent sex 12.1% (48/372). CONCLUSION The analysis showed a low proportion of PPFP uptake among mothers of children under 12 years. Possible barriers included child age, education, a health worker visit, and side effects and perceived benefits of possibly improperly implementing lactation amenorrhea method. Integration of social, community and health services could provide a more holistic approach to improving PPFP uptake.
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Affiliation(s)
- Florence Nakaggwa
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda.
| | - Derrick Kimuli
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Kenneth Kasule
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Justine Fay Katwesige
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Denis Kintu
- Office of Health and HIV, USAID/Uganda, US Mission Compound - South Wing, Plot 1577 Ggaba Road, P. O. Box 7856, Nsambya, Kampala, Uganda
| | - Rhobbinah Ssempebwa
- Office of Health and HIV, USAID/Uganda, US Mission Compound - South Wing, Plot 1577 Ggaba Road, P. O. Box 7856, Nsambya, Kampala, Uganda
| | - Solome Sevume
- Office of Health and HIV, USAID/Uganda, US Mission Compound - South Wing, Plot 1577 Ggaba Road, P. O. Box 7856, Nsambya, Kampala, Uganda
| | - Patrick Komakech
- Office of Health and HIV, USAID/Uganda, US Mission Compound - South Wing, Plot 1577 Ggaba Road, P. O. Box 7856, Nsambya, Kampala, Uganda
| | - Norbert Mubiru
- Office of Health and HIV, USAID/Uganda, US Mission Compound - South Wing, Plot 1577 Ggaba Road, P. O. Box 7856, Nsambya, Kampala, Uganda
| | - Baker Maggwa
- Office of Family Planning and Reproductive Health, USAID, 05.4.1A, 500 D Street SW, 20547, Washington, DC, USA
| | - Maria Augusta Carrasco
- Office of Family Planning and Reproductive Health, USAID, 05.4.1A, 500 D Street SW, 20547, Washington, DC, USA
| | - Norah Namuwenge
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Rebecca N Nsubuga
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Barbara Amuron
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Daraus Bukenya
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
| | - Bonnie Wandera
- Social & Scientific Systems, Inc., a DLH Holdings Company / USAID SITES, Plot 2730 Church Road, Kironde Zone, P.O.Box 12761, Kampala, Uganda
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Mukanga B, Mwila N, Nyirenda HT, Daka V. Perspectives on the side effects of hormonal contraceptives among women of reproductive age in Kitwe district of Zambia: a qualitative explorative study. BMC Womens Health 2023; 23:436. [PMID: 37596577 PMCID: PMC10439553 DOI: 10.1186/s12905-023-02561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/21/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Globally, hormonal contraceptives have proved to be effective in the prevention of unwanted pregnancies. However, despite evidence of the many benefits associated with the use of hormonal contraceptives, concerns related to their safety and side effects have been reported. We conducted a study to explore the perspectives on the side effects of hormonal contraceptives among women of reproductive age in Kitwe district of Zambia. METHODS An explorative qualitative study was done among 32 women of reproductive age (18-45 years). Participants were selected conveniently as they accessed family planning services at a designated reproductive, maternal, and child health facility. Data collection was done through in-depth interviews (IDIs). Recruitment of participants and data collection continued until the saturation point was reached. The interviews were recorded, translated, and transcribed verbatim. Data were imported into NVivo.x64 for coding and node generation after which categories and themes were developed manually. RESULTS Overall, participants demonstrated a considerable amount of knowledge of family planning, recounting the economic and health benefits as well as demerits of family planning use. The main reasons for discontinuing and switching hormonal contraceptive methods were the desire to get pregnant and the fear of unpleasant side effects, including excessive bleeding or prolonged menstruation, headache, dizziness, lower abdominal/back pain, and weight gain. Most importantly, participants cited concerns about the delay in the resumption of fertility after the termination of contraception and how the side effects disrupted their daily activities at home. CONCLUSION There is a need for family planning providers to offer family planning services that address the side effects of hormonal contraceptives during counselling and how women can manage them. Family planning services should adopt a patient-centred approach that takes into consideration the concerns regarding side effects and how this affects the quality of life among women. Also, there is a need to extend family planning services to include scheduled follow-ups and clinical management of contraceptive side effects among women.
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Affiliation(s)
- Bright Mukanga
- Michael Chilufya Sata School of Medicine, Public Health Department, The Copperbelt University, P.O Box 71769, Ndola, Zambia.
| | - Natasha Mwila
- Michael Chilufya Sata School of Medicine, Public Health Department, The Copperbelt University, P.O Box 71769, Ndola, Zambia
| | - Herbert Tato Nyirenda
- Michael Chilufya Sata School of Medicine, Public Health Department, The Copperbelt University, P.O Box 71769, Ndola, Zambia
| | - Victor Daka
- Michael Chilufya Sata School of Medicine, Public Health Department, The Copperbelt University, P.O Box 71769, Ndola, Zambia
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Sarnak D, Anglewicz P, Ahmed S. Unmet need and intention to use as predictors of adoption of contraception in 10 Performance Monitoring for Action geographies. SSM Popul Health 2023; 22:101365. [PMID: 36909928 PMCID: PMC9996096 DOI: 10.1016/j.ssmph.2023.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
The determinants of fertility typically feature demand as the key motivation driver for contraceptive use. Yet relatively little is known about the extent to which demand for contraception predicts future contraceptive use, primarily due to the lack of longitudinal data that captures these measures at different time points. Two ways in which demand is often measured are unmet need and intention to use. Despite its intended use as a population measure, unmet need is commonly used in individual-level analyses and as a marker for individual-level demand for contraception. Few studies have assessed the extent to which unmet need predicts or reflects women's true latent demand as demonstrated by their future contraceptive use; the same is true for intention to use contraception in the future. We expand on previous research to assess whether and the degree to which unmet need and intention to use contraception predict adoption of contraception within a year, among nonusers in ten representative geographies using Performance Monitoring for Action (PMA) data. Findings show that in nine of ten sites, intention to use within a year was significantly associated with subsequent adoption, while in eight of ten sites, unmet need for spacing or limiting was not associated with adoption. Our results are important for programs as they try to identify true dynamic demand for contraception.
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Affiliation(s)
- Dana Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Phil Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
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Nkonde H, Mukanga B, Daka V. Male partner influence on Women's choices and utilisation of family planning services in Mufulira district, Zambia. Heliyon 2023; 9:e14405. [PMID: 36950585 PMCID: PMC10025139 DOI: 10.1016/j.heliyon.2023.e14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023] Open
Abstract
Background Family planning services are essential in reducing maternal deaths as well as improving the reproductive and sexual health of women. Although family planning services are frequently focused on women, men are often the primary decision-makers. We conducted a study to explore male partner influence on women's choices and utilisation of family planning services in Mufulira district, Zambia. Methods A qualitative explorative study design that utilised two focus group discussions (n = 20) and in-depth interviews (n = 30) involving women of reproductive age was conducted. Convenient sampling was employed to select participants. In-depth interviews and focus group discussions were recorded, translated, and transcribed verbatim. Content analysis was utilised through code classification and theme identification. Data were imported into NVivo.×64 for coding and node generation. Findings The study revealed key themes on male partner influence on contraception use such as fear of infidelity, fear of physical abuse, preference for a large family size , disruption of sexual pleasure, and perceived side effects of contraceptives. These themes highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Participants described how their male partners exhibited prenatal attitudes and control over them thereby limiting their decision-making power on contraception use. Undesirable contraception side effects such as reduced vaginal lubrication contributed to sexual pleasure disruption among men. Concerns that women's use of contraception can lead to infidelity also contributed to male partner disapproval of contraception use. Conclusions Understanding barriers to contraception utilisation presented by male partners is essential in preventing contraception discontinuation and can increase contraception uptake among women. Our findings highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Therefore, male partner education on family planning services is key. Also, men need to be incorporated as key stakeholders when planning and implementing family planning programmes.
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Key Words
- Contraception
- FGD, Focus group discussions
- FP, Family planning
- Family planning
- HIV, human immunodeficiency virus
- IDI, Indepth Interviews
- IUD, Intra uterine devices
- LAM, Lactational Amenorrhea Method
- LMIC, Low middle income countries
- Male partner
- SSA, Subsaharan Africa
- STIs, Sexually transmitted Infections
- TDRC, Tropical Diseases Research Centre
- WHO, World Health Organisation
- Zambia
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Affiliation(s)
- Hildah Nkonde
- The Copperbelt University, Michael Chilufya Sata School of Medicine, Public Health Department, P. O. Box 71769, Ndola, Zambia
| | - Bright Mukanga
- The Copperbelt University, Michael Chilufya Sata School of Medicine, Public Health Department, P. O. Box 71769, Ndola, Zambia
| | - Victor Daka
- The Copperbelt University, Michael Chilufya Sata School of Medicine, Public Health Department, P. O. Box 71769, Ndola, Zambia
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Stevens R, Machiyama K, Mavodza CV, Doyle AM. Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. Stud Fam Plann 2023; 54:309-321. [PMID: 36753058 DOI: 10.1111/sifp.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.
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Affiliation(s)
- Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Kazuyo Machiyama
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Department of Public Health and Policy, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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11
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Kisuza RK, Kicaber S, Abila DB, Bongomin F, Garimoi CO. Prevalence of discontinuation of contraceptives due to failure among women aged 14 to 49 years in Uganda: a nation wide cross-sectional survey. Contracept Reprod Med 2023; 8:12. [PMID: 36755292 PMCID: PMC9909952 DOI: 10.1186/s40834-022-00210-y] [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: 03/30/2022] [Accepted: 12/14/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Sustained motivation is essential for effective use of contraceptive methods by women in low- and middle-income countries as many women are likely to abandon contraceptives, especially when they continually experience episodes of failure. We aimed to determine the prevalence of discontinuation of contraceptives due to failure and its associated factors among Ugandan women aged 14-49 years. METHODS A cross sectional study was conducted using the UDHS 2016 data. Multi stage stratified sampling was used to select participants. All eligible women aged 15 to 49 years at the time of the survey were enrolled. Bivariable and Multivariable logistic regression analysis were used to determine the factors associated with contraceptive failure. All analysis were done using Stata version 13. Contraceptive failure (getting pregnant while on contraceptives) within five years preceding the survey was the dependent variable. RESULTS A total of 9061 women were included in the study. The overall prevalence of contraceptive failure was 5.6% [n = 506, 95% CI: 5.1-6.1] and was higher (6.2%) among women aged 20-29 years or had completed secondary education (6.1%). Having informed choice on contraceptives [aOR = 0.59, 95% CI: 0.49 - 0.72] and older age [aOR = 0.46, 95% CI: 0.24-0.89] were associated with lower odds of contraceptive failure. CONCLUSION The burden of contraceptive failure among women of reproductive age in Uganda is substantial and significantly varied by women's age, level of education, exposure to the internet, mass media, and informed choice. These findings highlight the need for improved counseling services and contraceptive quality to help women and couples use methods correctly and consistently.
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Affiliation(s)
- Ruth Ketty Kisuza
- College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Saviour Kicaber
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Derrick Bary Abila
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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12
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Hoppes E, Nwachukwu C, Hennegan J, Blithe DL, Cordova-Gomez A, Critchley H, Doncel GF, Dorflinger LJ, Haddad LB, Mackenzie ACL, Maybin JA, Moley K, Nanda K, Sales Vieira C, Vwalika B, Kibira SPS, Mickler A, OlaOlorun FM, Polis CB, Sommer M, Williams KM, Lathrop E, Mahajan T, Rademacher KH, Solomon M, Wilson K, Wilson LC, Rountree L. Global research and learning agenda for building evidence on contraceptive-induced menstrual changes for research, product development, policies, and programs. Gates Open Res 2022; 6:49. [PMID: 35614964 PMCID: PMC9114387 DOI: 10.12688/gatesopenres.13609.1] [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] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Contraceptive-induced menstrual changes (CIMCs) can affect family planning (FP) users' lives in both positive and negative ways, resulting in both opportunities and consequences. Despite this, and despite the important links between FP and menstrual health (MH), neither field adequately addresses CIMCs, including in research, product development, policies, and programs globally. Methods: In November 2020, a convening of both MH and FP experts reviewed the existing evidence on CIMCs and identified significant gaps in key areas. Results: These gaps led to the establishment of a CIMC Task Force in April 2021 and the development of the Global Research and Learning Agenda: Building Evidence on Contraceptive-Induced Menstrual Changes in Research, Product Development, Policies, and Programs Globally (the CIMC RLA) , which includes four research agendas for (1) measurement, (2) contraceptive research and development (R&D) and biomedical research, (3) social-behavioral and user preferences research, and (4) programmatic research. Conclusions: Guided by the CIMC RLA, researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders are urged to conduct research and implement strategies to address the beneficial and negative effects of CIMCs and support the integration of FP and MH. CIMCs need to be addressed to improve the health and well-being of women, girls, and other people who menstruate and use contraceptives globally. Disclaimer : The views expressed in this article are those of the authors. Publication in Gates Open Research does not imply endorsement by the Gates Foundation.
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Affiliation(s)
| | - Chukwuemeka Nwachukwu
- United States Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | - Julie Hennegan
- Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Amanda Cordova-Gomez
- United States Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | - Hilary Critchley
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Gustavo F Doncel
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, 23507, USA
| | | | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, New York, 10017, USA
| | | | - Jacqueline A Maybin
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Kelle Moley
- Bill & Melinda Gates Foundation, Seattle, Washington, 98109, USA
| | | | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Bellington Vwalika
- Departments of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Alexandria Mickler
- United States Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | | | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, 10032, USA
| | | | - Eva Lathrop
- Population Services International, Washington, District of Columbia, 20526, USA
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13
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Measuring experiences and concerns surrounding contraceptive induced side-effects in a nationally representative sample of contraceptive users: Evidence from PMA Ethiopia. Contracept X 2022; 4:100074. [PMID: 35368853 PMCID: PMC8971853 DOI: 10.1016/j.conx.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
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