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Wood FE, Gage AJ, Mafuta E, Bertrand JT. Involving men in pregnancy: a cross-sectional analysis of the role of self-efficacy, gender-equitable attitudes, relationship dynamics and knowledge among men in Kinshasa. BMC Pregnancy Childbirth 2024; 24:444. [PMID: 38926666 PMCID: PMC11202384 DOI: 10.1186/s12884-024-06638-1] [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: 04/09/2023] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Although male participation in maternal health has gained increasing recognition and support over the years, little is known about male involvement during pregnancy in the Democratic Republic of the Congo. This paper identified male involvement patterns during pregnancy and evaluated their associations with pregnancy and birth preparedness knowledge, gender-equitable attitudes, self-efficacy, and co-parental relationship factors. Lastly, it explored the moderating effect of gender-equitable attitudes and intimate partner violence on the association between relationship satisfaction and male involvement. METHODS Data from the 2018 Momentum baseline study were analyzed to determine the predictors of involvement. Factor analysis was used to create male involvement indices for antenatal carebirth preparedness and shared decision making. The sample consisted of 1,674 male partners of nulliparous pregnant women who were 6 months pregnant at baseline. RESULTS Male involvement in individual pregnancy-related activities was low, ranging from 11% (finding a blood donor) to 49% (saving money during emergencies). Knowledge of the number of antenatal care visits, birth preparedness steps, and newborn danger signs were positively associated with involvement in antenatal care/birth preparedness activities while knowledge of antenatal care benefits was positively associated with involvement in shared decisions. Increasing relationship satisfaction and self-efficacy were associated with antenatal care/birth preparedness involvement and for shared decisions, a positive association with gender-equitable attitude and a negative association with self-efficacy were observed. Moderation effects were also detected. CONCLUSIONS The findings suggest that male involvement is multifaceted and factors influencing involvement vary depending on the type of involvement. Addressing these factors can improve male participation in maternal health.
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Affiliation(s)
- Francine E Wood
- Center On Gender Equity On Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Anastasia J Gage
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Eric Mafuta
- School of Public, Health University of Kinshasa, Kinshasa, DR, Congo
| | - Jane T Bertrand
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA
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Gage AJ, Wood FE, Gay R, Akilimali P. Effects of the Momentum project on postpartum family planning norms and behaviors among married and unmarried adolescent and young first-time mothers in Kinshasa: A quasi-experimental study. PLoS One 2024; 19:e0300342. [PMID: 38547207 PMCID: PMC10977807 DOI: 10.1371/journal.pone.0300342] [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: 05/12/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
This study evaluated the effect of Momentum-an integrated family planning, maternal and newborn health, and nutrition intervention-on postpartum family planning norms and behaviors among ever married and never-married first-time mothers age 15-24 in Kinshasa, Democratic Republic of the Congo. Using data collected in 2018 and 2020, we conducted an intent-to-treat analysis among 1,927 first-time mothers who were about six-months pregnant at enrollment. Difference-in-differences models were run for panel data and treatment effects models with inverse-probability weighting for endline-only outcomes. Average treatment effects (ATE) were estimated. Momentum had positive effects on partner discussion of family planning in the early postpartum period (ever married 15-19: ATE = 0.179, 95% CI = 0.098, 0.261; never married 15-19: ATE = 0.131, 95% CI = 0.029, 0.232; ever married 20-24: ATE = 0.233, 95% CI = 0.164, 0.302; never married 20-24: ATE = 0.241, 95% CI = 0.121, 0.362) and discussion with a health worker, and on obtaining a contraceptive method in the early postpartum period, except among never married adolescents. Among adolescents, intervention effects on modern contraceptive use within 12 months of childbirth/pregnancy loss were larger for the never married (ATE = 0.251, 95% CI = 0.122, 0.380) than the ever married (ATE = 0.114, 95% CI = 0.020, 0.208). Full intervention exposure had consistently larger effects on contraceptive behaviors than partial exposure, except among ever married adolescents. Momentum had no effect on normative expectations about postpartum family planning use among adolescents, and on descriptive norms and personal agency among those who were never married. Results for normative outcomes and personal agency underscored the intersectionality between young maternal age and marital status. Future programs should improve personal agency and foster normative change in support of postpartum family planning uptake and tailor interventions to different age and marital status subsets of first-time mothers.
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Affiliation(s)
- Anastasia J. Gage
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Los Angeles, United States of America
| | - Francine E. Wood
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Rianne Gay
- Tulane International, LLC, Kinshasa, Democratic Republic of the Congo
| | - Pierre Akilimali
- Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Khan AG, Tavrow P, Adamu F. Does girls' empowerment predict contraceptive intentions? Evidence from a survey of secondary school girls in Northwest Nigeria. Sex Reprod Health Matters 2023; 31:2146034. [PMID: 36876650 PMCID: PMC10013444 DOI: 10.1080/26410397.2022.2146034] [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: 03/07/2023] Open
Abstract
In sub-Saharan Africa, women's empowerment has been linked to contraceptive use, but little is known about whether girls' empowerment affects contraceptive intentions, particularly in more traditional societies where early marriage and childbearing are common. Drawing on a survey of 240 secondary school students in Kebbi State, Northwest Nigeria, in September-November 2018, we examined whether dimensions of girls' empowerment (academic self-mastery, perceived career feasibility, progressive gender norms, and marriage autonomy) and family planning indicators (knowledge, desired family size) were associated with future intentions to use family planning. We found that half of the girls had no intention to use contraception, and only one-fourth intended to use contraception for both delaying/spacing and stopping pregnancies. Multivariate analysis revealed that one dimension of empowerment (perceived career feasibility) and family planning knowledge were significantly associated with intentions. These results suggest that girls perceive contraceptive use as risky, and require contraceptive knowledge and an anticipated career to overcome their trepidation. To increase girls' intentions to use contraceptives, it is vital that they receive comprehensive sexuality education and career counselling.
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Affiliation(s)
- Angubeen G Khan
- PhD Student, UCLA Fielding School of Public Health, Los Angeles, CA, USACorrespondence:
| | - Paula Tavrow
- Adjunct Professor, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Fatima Adamu
- Executive Director, Nana Girls and Women Empowerment Initiative, Sokoto, Nigeria
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Gage AJ, Akilimali PZ, Wood FE, Gay R, Olivia Padis C, Bertrand JT. Evaluation of the effect of the Momentum project on family planning outcomes among first-time mothers aged 15-24 years in Kinshasa, DRC. Contraception 2023; 125:110088. [PMID: 37331463 DOI: 10.1016/j.contraception.2023.110088] [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: 08/05/2021] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES This article presents the effect of Momentum, a nursing student-led community-based service delivery project, on postpartum family planning (FP) outcomes among first-time mothers in Kinshasa, Democratic Republic of the Congo. STUDY DESIGN We employed a quasi-experimental design, with three intervention and three comparison health zones (HZ). Data were collected through interviewer-administered questionnaires in 2018 and 2020. The sample consisted of 1927 nulliparous women aged 15-24 years who were 6 months pregnant at baseline. Random effects and treatment effects models were used to assess the effect of Momentum on 14 postpartum FP outcomes. RESULTS The intervention group was associated with a unit increase of 0.6 (95% confidence interval [CI]: 0.4, 0.8)) in contraceptive knowledge and personal agency (95% CI: 0.3, 0.9), a unit decrease of 0.9 (95% CI: -1.2, -0.5) in the number of FP myths/misconceptions endorsed, and percentage point increases of 23.4 (95% CI: 0.2, 0.3) in FP discussion with a health worker, 13.0 (95% CI: 0.1, 0.2) in obtaining a contraceptive method within 6 weeks of delivery, and 13.3 (95% CI: 0.1, 0.2) in modern contraceptive use within 12 months of delivery. Intervention effects included percentage point increases of 5.4 (95% CI: 0.0, 0.1) in partner discussion and 15.4 (95% CI: 0.1, 0.2) in perceived community support for postpartum FP use. The level of exposure to Momentum was significantly associated with all behavioral outcomes. CONCLUSIONS The study demonstrated the effect of Momentum on increased postpartum FP-related knowledge, perceived norms, personal agency, partner discussion, and modern contraceptive use. IMPLICATIONS Community-based service delivery by nursing students can potentially lead to improved postpartum FP outcomes among urban adolescent and young first-time mothers in other provinces of the Democratic Republic of the Congo and other African countries.
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Affiliation(s)
- Anastasia J Gage
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Pierre Z Akilimali
- University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of the Congo.
| | - Francine E Wood
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Rianne Gay
- Tulane International, LLC, Kinshasa, Democratic Republic of the Congo.
| | - C Olivia Padis
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Jane T Bertrand
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
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Johnson EK. Telemedicine and direct to consumer advertising attitudes and the future of telehealth: Women report telemedicine as a comfortable option for accessing birth control. Health Mark Q 2023; 40:309-325. [PMID: 35762706 DOI: 10.1080/07359683.2022.2092377] [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: 10/17/2022]
Abstract
PURPOSE This paper addresses what variables predict and mediate relationships involving accessing telemedicine in the form of online birth control websites that are often advertised online on social media. BASIC PROCEDURES This is a survey study of N = 252 under 60 women (Mage = 24.71); multiple linear regression and mediation analyses were done to examine the influence of IBM variables on behavioral intentions. MAIN FINDINGS Women who currently use contraceptives report comfort and likelihood to use telemedicine services if they have positive attitudes about telemedicine and DTC advertising. Comfort with using an online contraceptive prescription service mediated the relationship between contraceptive use and likelihood to use telemedical services and between positive telemedicine attitudes and likelihood. PRINCIPAL CONCLUSIONS Women who are positive about telemedicine and DTC ads are comfortable using these resources, and comfort is a salient mediator. Comfort and its antecedents are important predictors and facilitators of telemedicine intentions and behaviors. Using telemedicine can improve the patient experience by offering alternatives to face-to-face visits (i.e., removing barriers to provider-to-patient communication).
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Affiliation(s)
- Erika Katherine Johnson
- School of Communication, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Calhoun LM, Winston J, Beňová L, Speizer IS, Delvaux T, Shiferaw S, Seme A, Karp C, Zimmerman L, van den Akker T. The more, the better: influence of family planning discussions during the maternal, newborn and child health continuum of care on postpartum contraceptive uptake and method type among young women in Ethiopia. Gates Open Res 2023; 7:67. [PMID: 37426595 PMCID: PMC10323130 DOI: 10.12688/gatesopenres.14626.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 07/11/2023] Open
Abstract
Background: This study examines the association between family planning (FP) discussions with health professionals during contact points on the maternal, newborn and child health continuum of care and timing of modern contraceptive uptake and method type in the one-year following childbirth in six regions of Ethiopia among adolescent girls and young women (AGYW). Methods: This paper uses panel data of women aged 15-24 who were interviewed during pregnancy and the postpartum period between 2019-2021 as part of the PMA Ethiopia survey (n=652). Results: Despite the majority of pregnant and postpartum AGYW attending antenatal care (ANC), giving birth in a health facility, and attending vaccination visits, one-third or less of those who received the service reported discussion of FP at any of these visits. When considering the cumulative effect of discussions of FP at ANC, pre-discharge after childbirth, postnatal care and vaccination visits, we found that discussion of FP at a greater number of visits resulted in increased uptake of modern contraception by one-year postpartum. A greater number of FP discussions was associated with higher long-acting reversible contraceptive use relative to non-use and relative to short-acting method use. Conclusions: Despite high attendance, there are missed opportunities to discuss FP when AGYW access care.
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Affiliation(s)
- Lisa M. Calhoun
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27516, USA
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer Winston
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27516, USA
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ilene S. Speizer
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27516, USA
- Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Linnea Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Department of Obstetrics and Gynecology, Universiteit Leiden Medical Center, Leiden, South Holland, The Netherlands
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Gage AJ, Wood FE, Kittoe D, Murthy P, Gay R. Association of Male Partners' Gender-Equitable Attitudes and Behaviors with Young Mothers' Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12182. [PMID: 36231485 PMCID: PMC9565980 DOI: 10.3390/ijerph191912182] [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: 08/23/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners' gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15-24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project's 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners' willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners' gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers' health outcomes are shaped by their male partners' gender-related attitudes and behaviors.
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Affiliation(s)
- Anastasia J. Gage
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Francine E. Wood
- Center on Gender Equity and Health, University of California San Diego, La Jolla, CA 92093, USA
| | - Darling Kittoe
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Preethi Murthy
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Rianne Gay
- Tulane International LLC, Ngaliema, Kinshasa, Democratic Republic of the Congo
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