Knowledge and Attitude Towards Family Planning Among Women of Reproductive Age in Emerging Regions of Ethiopia

Rationalization, facilitators, and impediments of fertility transition in Ethiopia: qualitative exploration of the community readiness, willingness, and ability

Background

High fertility and rapid population growth can threaten human development and increase risks to maternal and child health. The diffusion of the benefits of lower fertility requires readiness to plan, and willingness and ability to adopt and use family planning measures.

Objective

This assessment aimed to explore the readiness, willingness, and ability (RWA) among selected Ethiopian communities, and identify the facilitators and impediments of fertility transition.

Design

This exploratory phenomenological qualitative study collects data from purposefully selected community members and experts in Addis Ababa, Arbaminch, and Jigjiga.

Method

The analysis follows deductive coding and a thematic presentation of findings under the RWA domains. Readiness deals with four themes: (1) the rationalization of the value of children, (2) recognition of the burden of high-risk fertility, (3) readiness to define the ideal number of children, and (4) socio-cultural norms about family size. Willingness contains three themes: (1) the psychosocial legitimacy of contraceptives, (2) the religious legitimacy of contraceptives, and (3) women's power to cope with barriers to family planning. The ability domain contains (1) women's knowledge about contraception and (2) access to and utilization of contraceptives.

Results

The communities involved in this study recognized the burden of high-risk fertility behaviors (early-age fertility, and frequent and many births), but they prefer large family sizes. Consequently, they exhibit good family planning willingness and practice for birth spacing but not for birth limitation. Recognizing the socio-economic burden of high-risk fertility, accepting and using contraceptives for the health of mothers and children are possible facilitators of fertility transition. Conversely, the desire for high parity, husbands and religious disapproval of contraceptives, side effects of contraceptives, and limited access to method mix are possible impediments.

Conclusion

The RWA to space births are adequately diffused and adopted by the community, but birth limitation is not yet recognized. Beyond promoting birth spacing, Ethiopia's fertility transition requires a shift in societal values from large to small family size. Overcoming barriers to contraceptive use also requires tailored efforts to improve the availability of method mix and involve male and religious leaders.

Effectiveness of an Interactive Mobile Health Intervention (IMHI) to enhance the adoption of modern contraceptive methods during the early postpartum period among women in Northeast Ethiopia: A cluster Randomized Controlled Trial (RCT)

BACKGROUND

Women in the early postpartum period face substantial unmet needs in contraception to encourage birth intervals and reduce unintended pregnancies. The widespread ownership of mobile devices offers an opportunity to employ mobile health strategies for enhancing communication between healthcare providers and clients. However, little is known about the effectiveness of mobile health interventions to improve early adoption of contraceptive methods after childbirth in Ehiopia.

OBJECTIVE

This study aimed to evaluate the effectiveness of a mobile health intervention in enhancing the uptake of modern contraceptive methods in the early postpartum period in Dessie and Kombolcha cities, northeast Ethiopia.

METHODS

The research was conducted in Dessie and Kombolcha cities zones located in the Amhara region of Northeast Ethiopia from 15th January to 15th June, 2023. Pregnant women with a confirmed gestation of 30 weeks were enrolled and followed up to the 45-day postpartum period. The study employed a cluster randomized control trial involving 764 participants (381 controls and 383 in the intervention group). The intervention group received a new mobile health intervention in addition to the existing healthcare practices, while the control group solely adhered to the current healthcare practices. Data were collected using the Open Data Kit (ODK) and exported to STATA 17 for analysis. The marginal model Generalized Estimating Equations (GEE) through the application of an exchangeable working correlation was applied. The effect of the intervention on the outcome was measured using the odds ratio with a 95% confidence interval at a p-value less than 0.05 significant level.

RESULTS

The study found that 78.7% of participants in the control group and 77.3% in the intervention group had sexual practice after childbirth. The proportion of early postpartum contraceptive uptake in the intervention group (51.6%) was significantly higher than in the control group (38%). The odds of adopting modern contraceptive methods during the early postpartum period were 1.6 times higher among mothers who received the mHealth intervention compared to those in the control group (AOR: 1.6, 95% CI: 1.249-2.123). The study identified significant predictors for the uptake of contraceptive methods during the early postpartum period, including having a live newborn (AOR: 3.7, 95% CI: 1.034-13.353), parity (AOR: 1.7, 95% CI: 1.069-2.695), and previous experience with contraceptive initiation (AOR: 0.5, 95% CI: 0.358-0.912).

CONCLUSION

This study findings demonstrated that the potential effectiveness of mobile health interventions in promoting timely contraceptive adoption during early postpartum period. The mobile health intervention, combined with factors such as timing of previous contraceptive initiation, newborn status, and maternal parity, significantly enhances the likelihood of early contraceptive adoption. These nuanced insights provide a strong foundation for developing targeted health interventions and policies aimed at improving early postpartum contraception.

REGISTRATION

The trial was registered on December 23, 2022, in the Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ID: ClinicalTrials.gov ID: NCT05666037.

Bridging disparity in knowledge and utilization of contraceptive methods among married couples in the pastoralist community of Fentale District, Eastern Ethiopia

BACKGROUND

Despite progress in national reproductive health, pastoralist regions, including the Fentale District in Eastern Ethiopia, face challenges with limited contraceptive coverage due to gaps in understanding and adoption among couples.

METHODS

This cross-sectional study of 1496 couples in Fentale District, Eastern Ethiopia, from October 1 to December 25, 2021, utilized multistage sampling. Data entered into EPI Data underwent analysis with SPSS (v23.0) and STATA (v14.0), employing descriptive statistics, bivariate analysis, and binary logistic regression to identify predictors of contraceptive knowledge.

RESULTS

Of the 1496 couples, 93.8% (1404) participated in the survey. Significant educational disparities were observed, with 53.8% having no formal education, particularly among women (65.2%). Despite this, 80.2% of couples were aware of at least one family planning (FP) method, and 78.6% knew modern methods. The median knowledge of contraception methods was 3 for both genders. Men showed higher awareness of male (43.2%) and female condoms (17.4%) compared to women (31.8% and 6.0%). Overall, 27.4% of couples used contraception, with a significant gender difference: 41.2% of women and 13.5% of men. Modern contraceptives were used by 18.2% of couples, predominantly by women (34.8%). Binary logistic regression analysis indicated positive associations between contraceptive knowledge and education, bank account ownership, occupation, proximity to healthcare, and media exposure, while a nomadic-pastoralist lifestyle and specific treatment preferences showed negative associations.

CONCLUSION

The limited knowledge and utilization of family planning in the Fentale District stem from gaps in comprehension and disparities among couples. Factors influencing this situation include socio-demographic considerations, such as variations based on education, occupation, media exposure, bank account ownership, treatment preferences, and distance from healthcare facilities. This ensures that the interventions are having the desired effect and allows for adjustments as needed to promote family planning uptake.

Addressing disparity in attitudes and utilization of family planning among married couples in the pastoralist community of Fentale District, Eastern Ethiopia

BACKGROUND

Despite progress in national reproductive health programs, pastoralist regions like Fentale District in Eastern Ethiopia face challenges with low contraceptive coverage, attributed to insufficient positive attitudes and uptake among couples.

METHODS

This cross-sectional study was conducted from October 1 to December 25, 2021, in Fentale District, Eastern Ethiopia. It involved 1,496 couples selected using multistage sampling. Data were entered into EPI Data and analyzed with SPSS (v23.0) and STATA (v14.0), employing descriptive statistics, bivariate analysis, and binary logistic regression to identify predictors of contraceptive attitudes and use.

RESULTS

The study's response rate was 93.8%, with 1,404 pastoralist couples participating, equally split between women and men. A nomadic-pastoralist lifestyle was common (64.6%), and family planning discussions were rare (93.2%). Gender disparities in contraceptive attitudes and use were evident. Contraception use was reported by 27.4%, with women (41.2%) outnumbering men (13.5%). Women showed more positive attitudes towards contraception (87.9% vs. 31.9% for men). Only 33% had favorable attitudes towards different contraceptive methods, with women more likely to be positive. Modern contraception use was low (18.2%), with women (34.8%) predominating over men (1.7%). Among users, women had a more favorable attitude (78.5% vs. 6.6% for men). Health extension workers were key information providers. Predictors of contraceptive attitudes and use included sex, education, occupation, electronic device ownership, migration frequency, treatment preferences, and family planning discussions.

CONCLUSION

The limited positive attitude towards and use of family planning in Fentale District may stem from unfavorable attitudes, low adoption, and couple disparities. Key factors include gender, education, occupation, electronic device ownership, migration, treatment preferences, and family planning discussions. Targeted educational campaigns for men are needed to address these issues and reduce the gender gap in contraceptive attitudes and use.

Access to family planning services and associated factors among young people in Lira city northern Uganda

BACKGROUND

Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda.

METHODS AND MATERIALS

A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15-24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data.

RESULTS

Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09-0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01-0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01-0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24-0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60-7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05-0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02-5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services.

CONCLUSION

The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda.

An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique

BACKGROUND

Given the health and economic benefits of family planning (FP), Nigeria's very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria.

MATERIALS AND METHODS

A multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities.

RESULTS

The mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women's husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women's empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of '1', signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities.

CONCLUSIONS

Our study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey

BACKGROUND

Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence.

METHODS

The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models.

RESULTS

The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India.

CONCLUSION

Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Family planning uptake and its associated factors among women of reproductive age in Uganda: An insight from the Uganda Demographic and Health Survey 2016

Despite the government efforts to reduce the high fertility levels and increase the uptake of family planning services in Uganda, family planning use was still low at 30% in 2020 which was the lowest in the East African region. This study was undertaken to determine the prevalence and factors associated with the uptake of family planning methods among women of reproductive age in Uganda. This community-based cross-sectional study utilized secondary data from the Uganda Demographic and Health Survey (UDHS) of 2016. The survey data was downloaded from the Measure Demographic Health Survey website after data use permission was granted. Data was collected from a representative sample of women of the reproductive age group (15-49 years) from all 15 regions in Uganda. A total of 19,088 eligible women were interviewed but interviews were completed with 18,506 women. Data analysis was performed using SPSS statistical software version 32.0 where univariable, bivariable, and multivariable analyses were conducted. The prevalence of family planning use was found to be 29.3% and that of modern contraceptive use was found to be 26.6%. Multivariable analysis showed higher odds of current family planning use among older women (40-44 years) (aOR = 2.09, 95% CI: 1.40-3.12); women who had attained the secondary level of education (aOR = 1.91, 95% CI: 1.32-2.76); those living in households with the highest wealth index (aOR = 1.87, 95% CI: 1.29-2.72); and awareness of the availability of family planning methods (aOR = 1.41, 95% CI: 1.17-1.72). In conclusion, the study suggests improving women's education attainment, socio-economic position, and awareness may help increase use in the population.

The Effect of a Decade Implemented Project in Improving the Uptake of Comprehensive Contraception: Difference-In-Difference Analysis

Background

Promotion and use of family planning in countries with high birth rates have the potential to avert a third of all maternal deaths and nearly a tenth of childhood deaths. To support government efforts in creating wider access to comprehensive contraceptive methods, EngenderHealth has contributed to the government of Ethiopia's long-term goal of improving maternal health outcomes through its Access to Better Reproductive Health Initiative project.

Methods

Difference-in-Difference approach is the main methodology in this analysis to estimate the "contribution" or "effect" of the ABRI intervention by comparing the changes in family planning outcomes from 2005 to 2016 between the ABRI and non-ABRI areas. This analysis was based on pooled data from the 2005 and 2016 Ethiopian Demographic and Health Surveys. To track temporal changes in the family planning indicators in the ABRI and non-ABRI areas, we employed simple trend analysis.

Results

The results show that overall contraceptive prevalence rate, use of injectables, women's knowledge of Long-Acting Reversible Contraception (LARC) methods, and their exposure to family planning information/messages from health workers all significantly improved in the ABRI intervention areas beyond what occurred in the non-ABRI areas. The greatest increase in the use of modern contraception was among adolescents aged 15-19 years, with a DID estimate of 22.4% (p=0.007), ABRI areas compared to no-ABRI areas.

Conclusion

In the ABRI areas, family planning indicators recorded positive and significant changes. EngenderHealth has contributed its part in improving access to the uptake of comprehensive contraception and supporting government programs.

Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression

BACKGROUND

Despite the availability of exempted family planning services, a significant proportion of women in African countries continue to experience inadequately spaced pregnancies. To the authors' knowledge, evidence of suboptimal birth intervals at the SSA level is lacking and previous studies have been limited to specific geographic area. Therefore, this analysis was aimed to estimate the pooled prevalence of suboptimal birth spacing and its predictors among childbearing women in SSA.

METHODS

Pooled DHS data from 35 SSA countries were used and a weighted sample of 221,098 reproductive-age women was considered in the analysis. The survey across all countries employed a cross-sectional study design and collected data on basic sociodemographic characteristics and different health indicators. Forest plot was used to present the overall and country-level prevalence of suboptimal birth spacing. Multilevel mixed-effects models with robust Poisson regression were fitted to identify the predictors of suboptimal birth spacing. Akaike's and Bayesian information criteria and deviance were used to compare the models. In a multivariable regression model, a p-value less than 0.05 and an adjusted prevalence ratio with the corresponding 95% CI were used to assess the statistical significance of the explanatory variables.

RESULTS

The pooled prevalence of suboptimal birth spacing among women in SSA was 43.91% (43.71%-44.11%), with South Africa having the lowest prevalence (23.25%) and Chad having the highest (59.28%). It was also found that 14 of the 35 countries had a prevalence above the average for SSA. Rural residence [APR (95% CI) = 1.10 (1.12-1.15)], non-exposure to media [APR (95% CI) = 1.08 (1.07-1.11)], younger maternal age [APR (95% CI) = 2.05 (2.01-2.09)], non-use of contraception [APR (95% CI) = 1.18 (1.16-1.20)], unmet need for family planning [APR (95% CI) = 1.04 (1.03-1.06)], higher birth order [APR (95% CI) = 1.31 (1.28-1.34)], and desire to have at least six children [APR (95% CI) = 1.14 (1.13-1.16)] were the predictors of suboptimal birth spacing practice.

CONCLUSION

More than four out of ten reproductive-age women in SSA countries gave birth to a subsequent child earlier than the recommended birth spacing, with considerable variations across the countries. Thus, interventions designed at enhancing optimal birth spacing should pay particular attention to young and socioeconomically disadvantaged women and those residing in rural regions. Strengthening community health programs and improving accessibility and availabilities of fertility control methods that ultimately impacts optimal reproductive behaviors is crucial to address contraceptive utilization and unmet need.

Factors associated with knowledge of the postpartum intrauterine contraceptive device and attitude towards its use among women attending antenatal care at Debre Tabor town, Northwest Ethiopia, 2021: a cross-sectional study

BACKGROUND

Intrauterine contraceptive device is a highly effective, long-acting, reversible family planning method that is safe to use by most postpartum women including those who are breastfeeding. Family planning methods used mainly, the postpartum intrauterine contraceptive device can tackle unintended pregnancy, short birth intervals, and pregnancy-related maternal death. Knowledge and attitude about the postpartum intrauterine contraceptive device were significant predictors of subsequent method use. However, the magnitude, Knowledge, and attitude toward intrauterine contraceptive device is still low in Ethiopia. Nevertheless, limited studies were done to assess Knowledge and attitude toward the postpartum intrauterine contraceptive device and their associated factors. Therefore, this study aimed to assess Knowledge, Attitudes, and associated factors toward postpartum intrauterine contraceptive devices.

OBJECTIVE

This study aimed to assess Knowledge, Attitudes, and associated factors toward postpartum intrauterine contraceptive devices among pregnant women attending antenatal care at Debre tabor town public health institutions Northwest Ethiopia, 2021.

METHODS

an institutional-based cross-sectional study was conducted from March 1- April-30/2021. Four hundred twenty-three participants were recruited by using a systematic random sampling technique. The data were collected through face-to-face interviews using a pretested and structured questionnaire. Multivariable logistic regression analyses were computed to identify factors associated with the outcome variable. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance.

RESULTS

Knowledge and attitude towards postpartum intrauterine contraceptive devices were found to be 36 and 48.7% respectively. Government employee (AOR = 4.98,95%CI:2.79-8.91), student (AOR = 5.29,95%CI:1.29-21.80), urban residence (AOR = 1.9095%CI: 1.02-3.53) and ever discussed on a postpartum intrauterine contraceptive device with health care provider (AOR = 6.01,95%CI:3.70-.7.44) were associated with the knowledge about the postpartum intrauterine contraceptive device. Attained secondary education (AOR = 3.22, 95%CI: 1.41-7.31), attended college and above education (AOR = 3.62, 95%CI: 1.75-7.51), government-employee (AOR = 2.76, 95CI:1.11-6.81), student (AOR = 32.10, 95%CI: 3.22-44.79), good knowledge,(AOR = 13.72, 95%CI: 6.63-28.42), ever discussed on a postpartum intrauterine contraceptive device with health care provider (AOR = 2.24,95CI:1.18-4.24), were associated with attitude toward postpartum intrauterine contraceptive device.

CONCLUSION AND RECOMMENDATION

knowledge and positive attitude toward postpartum intrauterine contraceptive devices were low as compared with other studies. Mothers' employment status, residence, and discussions about a postpartum intrauterine contraceptive device with healthcare providers improve women's knowledge about the postpartum intrauterine contraceptive device. Maternal educational status, occupational status, ever discussed postpartum intrauterine contraceptive devices with a health care provider and several antenatal cares follow up were improves women's attitude towards the postpartum intrauterine contraceptive device. The finding highlights the importance of discussing postpartum intrauterine contraceptive devices during pregnancy, which in turn enhances the knowledge and attitude, of mothers about postpartum intrauterine contraceptive devices.

C. Singh Y, Karkee R, Khatri RB. Knowledge and practices of modern contraceptives among religious minority (Muslim) women: A cross-sectional study from Southern Nepal

BACKGROUND

Uptake of family planning (FP) services could prevent many unwanted pregnancies, and unsafe abortions and avert maternal deaths. However, women, especially from ethnic and religious minorities, have a low practice of contraceptives in Nepal. This study examined the knowledge and practices of modern contraceptive methods among Muslim women in Nepal.

METHODS

A cross-sectional study was conducted among 400 Muslim women in the Khajura Rural Municipality of Banke district. Data were collected using face to face structured interviews. Two outcome variables included i) knowledge of and ii) practices of contraceptives. Knowledge and practice scores were estimated using the list of questions. Using median as a cut-off point, scores were categorised into two categories for each outcome variable (e.g., good knowledge and poor knowledge). Independent variables were several sociodemographic factors. The study employed logistic regression analysis, and odds ratios (OR) were reported with 95% confidence intervals (CIs) at a significance level of p<0.05 (two-tailed).

RESULTS

Almost two-thirds (69.2%) of respondents had good knowledge of modern contraceptive methods, but only 47.3% practised these methods. Women of nuclear family (adjusted odds ratio (aOR) = 0.60; 95% CI: 0.38,0.95), and who work in agricultural sector (aOR = 0.38; 95% CI: 0.22, 0.64) were less likely to have good knowledge on modern contraceptives. Women with primary (aOR = 2.59; 95% CI: 1.43, 4.72), secondary and above education (aOR = 4.41; 95% CI:2.02,9.63), women with good knowledge of modern contraceptives (aOR = 2.73; 95% CI: 1.66, 4.51), who ever visited a health facility for FP counselling (aOR = 4.40; 95% CI: 2.58, 7.50) had higher odds of modern contraceptives practices.

CONCLUSION

Muslim women had low use of modern contraceptive methods despite having satisfactory knowledge about them. There is a need for more equitable and focused high-quality FP practices. Targeted interventions are needed to increase the knowledge and practices of contraceptives in the Muslim community. The study highlights the need to target FP interventions among socially disadvantaged women, those living in a nuclear family, and those with poor knowledge of modern contraceptives.

Parental Knowledge, Willingness, and Attitude towards Contraceptive Usage among Their Unmarried Adolescents in Ekpoma, Edo State, Nigeria

Background. Adolescence is a time of opportunity, vulnerability, and risk, particularly in relation to health, unsafe sexual activity, and reproductive health. Neglecting their reproductive health issues leads to a great risk of agonizing transition to parenthood, lifetime effects, and early pregnancy, which can compromise educational achievements and economic potentials. Meeting the reproductive health needs of adolescents mostly rests on the parents’ shoulders. Thus, this study explored parental knowledge, willingness, and attitude towards contraceptive use among their unmarried adolescents. Methods. This was an analytical cross-sectional study design. The multistage sampling technique was used to recruit 360 parents from Ekpoma community, Edo State, Nigeria. A structured questionnaire was used to generate data for this study. Data processing and analysis were done using SPSS version 24. In order to determine association with outcome variables, chi-square ( ${\chi }^2$ ) and Fisher’s exact test statistics were used while statistical significance was set at $p<0.05$ . Results. The proportion of parental knowledge on contraceptive methods was at 96.9%, parental willingness for their adolescents’ contraceptive uptake at 31.7%, and positive attitude at 24.2%. Associated factors for parental knowledge of contraceptives include gender ( ${\chi }^{2=}8.655$ , $p=0.003$ ), age ( $†=13.377$ , $p=0.001$ ), marital status ( $†=133.730$ , $p<0.001$ ), educational level ( $†=103.689$ , $p<0.001$ ), religion ( $†=164.592$ , $p<0.001$ ), ethnicity ( $†=25.273$ , $p<0.001$ ), and duration of marriage ( $†=11.365$ , $p=0.008$ ). Factors such as educational level ( $†=21.220$ , $p<0.001$ ), marital status ( $†=9.001$ , $p=0.022$ ), and religion ( $†=6.058$ , $p=0.046$ ) were associated with parental attitude towards contraceptives for their unmarried adolescents. Education level ( $†=19.905$ , $p<0.001$ ) was associated with parental willingness for their unmarried adolescents’ use of contraceptives. Conclusion. Although parents have good knowledge of contraception, this knowledge has not been passed on to their adolescents. However, few parents would encourage their adolescents to use contraceptives and advise the use of condoms if they are sexually active. Parents should be advised about contraceptive matters further to influence their adolescents’ attitudes towards its usage. Establishing youth-friendly health centers will also encourage health information use and exposure.

Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study

Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya.

Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions.

Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend.

Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.

Individual and facility-level factors associated with women's receipt of immediate postpartum family planning counseling in Ethiopia: results from national surveys of women and health facilities

BACKGROUND

Immediate postpartum family planning (IPPFP) helps prevent unintended and closely spaced pregnancies. Despite Ethiopia's rising facility-based delivery rate and supportive IPPFP policies, the prevalence of postpartum contraceptive use remains low, with little known about disparities in access to IPPFP counseling. We sought to understand if women's receipt of IPPFP counseling varied by individual and facility characteristics.

METHODS

We used weighted linked household and facility data from the national Performance Monitoring for Action Ethiopia (PMA-Ethiopia) study. Altogether, 936 women 5-9 weeks postpartum who delivered at a government facility were matched to the nearest facility offering labor and delivery care, corresponding to the facility type in which each woman reported delivering (n = 224 facilities). We explored women's receipt of IPPFP counseling and individual and facility-level characteristics utilizing descriptive statistics. The relationship between women's receipt of IPPFP counseling and individual and facility factors were assessed through multivariate, multilevel models.

RESULTS

Approximately one-quarter of postpartum women received IPPFP counseling (27%) and most women delivered government health centers (59%). Nearly all facilities provided IPPFP services (94%); most had short- and long-acting methods available (71 and 87%, respectively) and no recent stockouts (60%). Multivariate analyses revealed significant disparities in IPPFP counseling with lower odds of counseling among primiparous women, those who delivered vaginally, and women who did not receive delivery care from a doctor or health officer (all p < 0.05). Having never used contraception was marginally associated with lower odds of receiving IPPFP counseling (p < 0.10). IPPFP counseling did not differ by age, residence, method availability, or facility type, after adjusting for other individual and facility factors.

CONCLUSION

Despite relatively widespread availability of IPPFP services in Ethiopia, receipt of IPPFP counseling remains low. Our results highlight important gaps in IPPFP care, particularly among first-time mothers, women who have never used contraception, women who delivered vaginally, and those who did not receive delivery care from a doctor or health officer. As facility births continue to rise in Ethiopia, health systems and providers must ensure that equitable, high-quality IPPFP services are offered to all women.