Associations of spousal communication with contraceptive method use among adolescent wives and their husbands in Niger

Factors associated with male acceptance of modern contraceptive methods. A descriptive cross-sectional study in a peri-urban municipality

BACKGROUND

Male knowledge and acceptance of modern contraceptive use play a significant role in uptake. This study assessed the factors associated with male acceptance of modern contraceptive methods in Ho Municipality.

METHODS

A cross-sectional study with a quantitative approach was employed. Systematic random sampling was used to select 503 participants from households with married men and women. A structured pre-tested questionnaire, including open-ended and closed-ended questions, was researcher assistant administered. Data analysis was conducted using STATA version 17.

RESULTS

The majority of the respondents identified that contraceptives are used to prevent pregnancy (91.19%), and also identified the following as birth control commodities: birth control pills (64.94%), female condoms (15.71%), intrauterine devices - IUDs (4.79%), and implants (4.21%). Factors such as affordability, employment status, income, and access significantly influenced male acceptance of contraceptives. The study revealed that men (84.67%) agreed with their partner to use contraceptives after sexual intercourse while only 37% agreed to use contraceptives before sexual intercourse. Among those who did not accept the use of modern contraceptives, the reason provided was the fear of side effects (65.13%). Men who find modern contraceptives affordable were more likely to use them (AOR = 8.15; 95%CI:3.49-19.02; p-value < 0.001). Also, unemployed men were less likely to use modern contraceptives (AOR = 0.14; 95%CI:0.044-0.44; p-value = 0.001). Men with lower income (50-900 cedis average monthly income level) were less likely to use modern contraceptives (AOR = 0.28; 95%CI:0.07-1.02; p-value = 0.05).

CONCLUSION

Increasing interventions aimed at continuously reducing the cost of modern contraceptives is essential for improving male acceptance and the overall success of modern contraceptive use in other communities with low male involvement. The government, Healthcare agencies, community leaders, and family planning organizations should work together to actively intervene in lowering the cost of modern contraceptives to improve access by men.

Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger

BACKGROUND

Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors.

METHODS

Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making.

RESULTS

Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage.

CONCLUSION

Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).

Application of the integrated gateway model on child nutrition behaviors in Niger: An exploratory analysis

OBJECTIVE

To identify potential gateway factors and behaviors that are associated with infant and young child feeding (IYCF) practices in the Maradi and Zinder regions of Niger through application of the Integrated Gateway Model.

METHODS

We analyzed data from 2,727 married women of reproductive age including details on child feeding practices for their 2,551 children between the ages of 0 to 23 months. We assessed the association of three gateway behaviors (i.e., any antenatal care, facility delivery, and communication on nutrition practices) and gateway factors (i.e., behavioral determinants, exposure to information, decision-making agency, and woman's group participation) on four IYCF practices (i.e., early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency, and minimum dietary diversity) while controlling for age, parity, educational attainment, and household wealth.

RESULTS

We found antenatal care was associated with exclusive breastfeeding of children 0-5 months [adjusted odds ratio (aOR): 1.17 (95% confidence interval (CI): 1.03-1.33)], and minimum meal frequency of children 6-23 months [aOR: 1.10 (95% CI: 1.03-1.17)], and facility delivery was associated with early initiation of breastfeeding among children 0-5 months [aOR: 2.08 (95% CI: 1.39-3.12)]. We found negative associations with exclusive breastfeeding and communication on nutrition practices with husbands, family/friends, and health workers. Exposure to nutrition messages through radio, women's groups participation, and with health workers was positively associated with minimum dietary diversity. Self-efficacy was positively associated with both early initiation of breastfeeding, exclusive breastfeeding among children 0-5 months and minimum dietary diversity among children 6-23 months. Women's agency was positively associated with early initiation of breastfeeding.

CONCLUSION

The association of antenatal care and facility delivery with child nutrition outcomes suggest intervening before a woman becomes pregnant or early in her pregnancy could improve nutrition outcomes. Programs strengthening the continuum of care should identify gateway behaviors to maximize adoption of priority health behaviors.

Time to initiation of modern contraceptive method use after childbirth and its predictors in Southern Ethiopia: a retrospective follow-up study

BACKGROUND

Timely initiation of modern contraceptive use is vital to prevent unintended pregnancy and its related morbidities and mortalities. However, there is a scarcity of evidence about the duration of time elapsing from childbirth to initiating modern contraceptive use following childbirth and its associated factors in the study area for evidence-based interventions. Therefore, we aimed to assess the time to initiation of modern contraceptive method use and its predictors in Hossana town, southern Ethiopia.

METHODS

A retrospective follow-up study was conducted at public health facilities in Hosanna town. A total of 503 study participants were included in the study using a systematic random sampling technique. The Box and Whisker plot was used to estimate the time to initiation of modern contraceptive use. A Weibull regression model was applied to identify predictors of time to initiation of modern contraceptive use. Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was used to interpret the strength of the association.

RESULTS

The median time to initiation of modern contraceptive use was 6 months, with an interquartile range of 3 months. Husband/partner attending higher education [AHR = 1.64, 95% CI: 1.04, 2.57], women who had parity of more than two [AHR = 1.93, 95% CI: 1.01, 3.67], and women who had communicated with their husband/partner about modern contraceptive methods [AHR = 3.03, 95% CI: 1.41, 6.67] were more likely to initiate modern contraceptive method use within six months after childbirth. In contrast, women with an older age of greater than or equal to 30 years [AHR = 0.32, 95% CI: 0.13, 0.82] and who did not resume sexual intercourse after childbirth [AHR = 0.02, 95% CI: 0.01, 0.03] were less likely to initiate modern contraceptive method use within six months after childbirth.

CONCLUSIONS

The median time to initiation of modern contraceptive method use after childbirth in the postpartum period was delayed from the World Health Organization recommendation of at most 6 weeks. Emphasis should be given to older women, women with lower parity, and men's participation in contraceptive communication to improve timing for initiation of modern contraceptive use after childbirth and to curb the five-month lag periods.

Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi

Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.

Creating Reproductive Health Behavioral Profiles for Women of Reproductive Age in Niger Using Cross-Sectional Survey Data: A Latent Class Analysis

Objectives: To identify health behavioral profiles for women of reproductive age in Niger. Methods: We interviewed married women of reproductive age in Niger in April 2021 (N = 2,709). Latent class analysis based on sociodemographic and behavioral determinants was used to identify classes of women related to use of antenatal care, facility delivery, and modern family planning (FP) use. Results: We found similar classes between the use of antenatal care and facility-based delivery classes with the first class composed of less educated and poor women with weaker behavioral determinants while the second class was more educated and had stronger behavioral determinants. In the facility-based delivery class was the presence of a third class that was poor and uneducated with low levels of knowledge and social norms, but in contrast had much higher levels of positive attitudes, self-efficacy, and partner communication than the first class. A fourth class of younger, more educated women with strong behavioral determinants emerged related to FP. Conclusion: The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimizing maternal and reproductive health.

Associations between Contraceptive Decision-Making and Marital Contraceptive Communication and use in Rural Maharashtra, India

Women's contraceptive decision-making control is crucial for reproductive autonomy, but research largely relies on the Demographic and Health Survey (DHS) measure which asks who is involved with decision-making. In India, this typically assesses joint decision-making or male engagement. Newer measures emphasize female agency. We examined three measures of contraceptive decision-making, the DHS and two agency-focused measures, to assess their associations with marital contraceptive communication and use in rural Maharashtra, India. We analyzed follow-up survey data from women participating in the CHARM2 study (n = 1088), collected in June-December 2020. The survey included the DHS (measure 1), Reproductive Decision-Making Agency (measure 2), and Contraceptive Final Decision-Maker measures (measure 3). Only Measure 1 was significantly associated with contraceptive communication (adjusted odds ratio [AOR]: 2.75, 95 percent confidence interval [CI]: 1.69-4.49) and use (AOR: 1.73, 95 percent CI: 1.14-2.63). However, each measure was associated with different types of contraceptive use: Measure 1 with condom (adjusted relative risk ratio [aRRR]: 1.99, 95 percent CI: 1.12-3.51) and intrauterine device (IUD) (aRRR: 4.76, 95 percent CI: 1.80-12.59), Measure 2 with IUD (aRRR: 1.64, 95 percent CI: 1.04-2.60), and Measure 3 with pill (aRRR: 2.00, 95 percent CI: 1.14-3.52). Among married women in Maharashtra, India, male engagement in decision-making may be a stronger predictor of contraceptive communication and use than women's agency, but agency may be predictive of types of contraceptives used.

Unmet need for contraception among married adolescent girls and young women in Haramaya Health and demographic surveillance system, Eastern Ethiopia

Background

The prevalence of unmet need for contraception is the highest in low- and middle-income countries (LMIC). Contraceptive use among young married or unmarried women is lower than that among older women in developing countries. Previous studies generalized the findings to all women of reproductive age and have not investigated psychosocial factors that influence contraceptive use. This study aimed to identify factors associated with unmet need for contraception among young married women in the Haramaya Health and Demographic Surveillance System (HDSS), eastern Ethiopia.

Methodology

A cross-sectional, community-based study of young married women aged 15-24 years was conducted. A simple random sampling method was used to select 550 young married women. Data were collected using a pretested structured questionnaire. Using adjusted odds ratio (AOR) with a 95% confidence interval (CI), factors associated with unmet need for contraception were identified using multivariable logistic regression analysis.

Results

The overall prevalence of unmet need for contraception was 154 (30.3%). Adolescents (15-19) (AOR = 2.05, 95% CI: 1.16-3.62), husbands' negative attitude toward contraception (AOR = 2.1, 95% CI: 1.05-4.46), and no previous use of contraception (AOR = 3.9, 95% CI: 2.29-6.71) were significantly and positively associated with unmet need for contraception. On the contrary, young women with secondary education or higher (AOR = 0.55, 95% CI: 0.28-1.084) were negatively and significantly associated with unmet need for contraception.

Conclusion

The prevalence of unmet need for contraception among young women in Haramaya was high. Unmet need was affected by age, husbands' attitude toward contraceptives, the educational status of women, and previous use of contraception. This study underscored the need to improve girls' educational status to empower them in making contraceptive use decisions with their partners. Programs should also engage male partners who are perceived as key decision-makers when it comes to contraceptive use.

"When you live in good health with your husband, then your children are in good health …." A qualitative exploration of how households make healthcare decisions in Maradi and Zinder Regions, Niger

Background

Gender dynamics influence household-level decision-making about health behaviors and subsequent outcomes. Health and development programs in Niger are addressing gender norms through social and behavior change (SBC) approaches, yet not enough is known about how health care decisions are made and if gender-sensitive programs influence the decision-making process.

Methods

We qualitatively explored how households make decisions about family planning, child health, and nutrition in the Maradi and Zinder regions, Niger, within the context of a multi-sectoral integrated SBC program. We conducted 40 in-depth interviews with married women (n = 20) and men (n = 20) between 18 and 61 years of age.

Results

Male heads of household were central in health decisions, yet women were also involved and expressed the ability to discuss health issues with their husbands. Participants described three health decision-making pathways: (1^st pathway) wife informs husband of health issue and husband solely decides on the solution; (2^nd pathway) wife informs husband of health issue, proposes the solution, husband decides; and (3^rd pathway) wife identifies the health issue and both spouses discuss and jointly identify a solution. Additionally, the role of spouses, family members, and others varied depending on the health topic: family planning was generally discussed between spouses, whereas couples sought advice from others to address common childhood illnesses. Many participants expressed feelings of shame when asked about child malnutrition. Participants said that they discussed health more frequently with their spouses’ following participation in health activities, and some men who participated in husbands’ schools (a group-based social and behavior change approach) reported that this activity influenced their approach to and involvement with household responsibilities. However, it is unclear if program activities influenced health care decision-making or women’s autonomy.

Conclusions

Women are involved to varying degrees in health decision-making. Program activities that focus on improving communication among spouses should be sustained to enhance women role in health decision-making. Male engagement strategies that emphasize spousal communication, provide health information, discuss household labor may enhance couple communication in Niger. Adapting the outreach strategies and messages by healthcare topic, such as couples counseling for family planning versus community-based nutrition messaging, are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13683-y.

Her, his, and their fertility desires and contraceptive behaviours: A focus on young couples in six countries

Most studies examining contraceptive use among women focus on their own fertility desires and family planning attitudes and do not incorporate the desires and attitudes of their partner. Using Demographic and Health Survey data from young couples (wife is aged 15-24) from six countries, we use descriptive and multivariate analyses to examine the association between couple-level fertility desires and current contraceptive use and women's future intention to use contraception. Results demonstrate that young couples want to have children immediately or may want to delay having children for two or more years; very few do not want (more) children. Discordant fertility desires were found in all countries. Compared to couples where both partners want a child soon, young couples that want to delay childbearing or where the husband wants a child, and the wife wants to delay or avoid childbearing are significantly more likely to use contraception. Similar results are found for women's intention to use contraception. When discordant fertility desires are associated with the outcomes, the young wife's fertility desire matters more than her husband's. Among young couples, promoting communication and positive social norms for delaying a first or second birth can lead to positive health outcomes for mothers and babies.

A New Contraceptive Diaphragm in Niamey, Niger: A Mixed Methods Study on Acceptability, Use, and Programmatic Considerations

Through a pilot introduction in Niamey, Niger, we found that expanding method options to include the Caya diaphragm, a new self-care contraceptive product without side effects for most users, may address some of the challenges that contribute to very low contraceptive use.

Introduction:

Methods:

Results:

Discussion: