Expanding contraceptive choice among first-time mothers age 15-24 in Kinshasa: The Momentum pilot project

Introduction

Evidence shows that an expanded range of contraceptive methods, client-centered comprehensive counseling, and voluntary informed choice are key components of successful family planning programs. This study assessed the effect of the Momentum project on contraceptive choice among first-time mothers (FTMs) age 15-24 who were six-months pregnant at baseline in Kinshasa, Democratic Republic of the Congo, and socioeconomic determinants of the use of long-acting reversible contraception (LARC).

Methods

The study employed a quasi-experimental design, with three intervention health zones and three comparison health zones. Trained nursing students followed FTMs for 16 months and conducted monthly group education sessions and home visits consisting of counseling and provision of a range of contraceptive methods and referrals. Data were collected in 2018 and 2020 through interviewer-administered questionnaires. The effect of the project on contraceptive choice was estimated using intention-to-treat and dose-response analyses, with inverse probability weighting among 761 modern contraceptive users. Logistic regression analysis was used to examine predictors of LARC use.

Results

Project effect was detected on receipt of family planning counseling, obtaining the current contraceptive method from a community-based health worker, informed choice, and current use of implants vs. other modern methods. There were significant dose-response associations of the level of exposure to Momentum interventions and the number of home visits with four of five outcomes. Positive predictors of LARC use included exposure to Momentum interventions, receipt of prenatal counseling on both birth spacing and family planning (age 15-19), and knowledge of LARCs (age 20-24). The FTM's perceived ability to ask her husband/male partner to use a condom was a negative predictor of LARC use.

Discussion

Given limited resources, expanding community-based contraceptive counseling and distribution through trained nursing students may expand family planning access and informed choice among first-time mothers.

Women's household decision-making power and contraceptive use in Mali

BACKGROUND

Utilization of contraceptives remains low in several countries in sub-Saharan Africa despite evidence of its benefits. Several factors are associated with contraceptive use. However, little is known about the association between women's decision-making capacity and the utilization of contraceptives in Mali. This study sought to determine the effect of women's household decision-making power on contraceptive use in Mali.

METHODS

This study involved a cross-sectional analysis of data from the 2018 Mali Demographic and Health Survey. A total of 7893 married women were included in the final analysis. A binary logistic regression analysis was conducted with statistical significance set at p < 0.05.

RESULTS

Contraceptive use among married women in Mali was 17.1%. The odds of using contraceptives were higher among women with joint decision-making with their husbands on how to spend respondent's earnings [aOR = 1.79; 95% CI = 1.12, 2.85], joint decision-making with their husbands on what to do with their husband's earnings [aOR = 1.43; 95% CI = 1.12, 1.83], and joint decision-making with husband on large household purchases [aOR = 1.32; 95% CI = 1.10, 1.59]. Deciding alone on a visit to family or relatives was associated with lower odds of contraceptive use [AOR = 0.72; 95% CI = 0.58, 0.89].

CONCLUSION

The study has revealed that joint household decision-making is positively associated with contraceptive use. Therefore, to achieve Sustainable Development Goal 3, the ministry for the advancement of women, children and families and related stakeholders must unearth strategies to empower women in joint decision-making and encourage men's involvement in contraceptive decision-making.

Women’s empowerment and contraceptive use: a community-based survey in peri-urban Kumasi, Ghana

Background: Many reasons have been used to explain why contraceptive uptake in Ghana has not been as impressive as desired. One area that has not received enough attention is that of women’s empowerment. This study sought a better understanding of how women’s empowerment influences contraceptive uptake. Methods: A structured questionnaire was used to interview 761 currently married or cohabiting women aged 15-49 years who were residents of Asawasi and Oforikrom for at least two years and consented to be part of the study. Bivariate and multivariate analyses were used to link the exposure variables: the three measures of empowerment and other variables such as age, marital status, religion, education, ethnicity, income and number of living children with the outcome variable (current or future contraceptive use). Excel was used for data entry and STATA for analyses. Results: In total, 29% of respondents were empowered in all the three categories used to measure empowerment in this study; 34% were empowered in two of the three categories, 29% were empowered in only one category while 9% of the women were not empowered in any of the categories. In multivariate logistic regression analysis, the odds of empowered women using contraceptives was significantly higher than the odds of women who were not empowered. Conclusions: Provision of economic interventions to empower and uplift conditions of women is needed to bring change in the economic status of their families and remove their dependence upon family members. This would make women in peri-urban Kumasi economically independent in making contraceptive choices and decisions, which would help in the realization of the Sustainable Development Goals: One (to end poverty in all its forms everywhere) and Five (to achieve gender equality and empower all women and girls).