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Odjesa E, Okonofua FE. 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. PLoS One 2024; 19:e0300744. [PMID: 38512904 PMCID: PMC10956820 DOI: 10.1371/journal.pone.0300744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
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.
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Affiliation(s)
- Emomine Odjesa
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Edo State, Nigeria
| | - Friday Ebhodaghe Okonofua
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Edo State, Nigeria
- Department of Obstetrics and Gynaecology, University of Benin, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
- Women’s Health and Action Research Centre (WHARC), Benin City, Edo State, Nigeria
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Asrese ET, Adem YF. Contraceptive utilization and associated factors among polygamous and monogamous women in Worebabo Woreda, South Wollo Zone, Ethiopia: a comparative cross sectional study. BMC Womens Health 2023; 23:39. [PMID: 36710331 PMCID: PMC9885600 DOI: 10.1186/s12905-023-02180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In Ethiopia high population growth and unintended pregnancies are posing pressures where the economy is incapable of holding overpopulation. Despite this problem, utilization of modern contraception is low in rural areas of the country, especially in the areas where polygamy is common. Therefore, this study was conducted to assess contraceptive utilization and associated factors among polygamous and monogamous women in, Ethiopia. METHOD A community-based comparative cross-sectional and phenomenological study design was employed from July 1 to September 30, 2021, on the total sample size of 774 selected married women of the reproductive age group by using a multistage sampling method and a purposive sampling method were used for the qualitative part of the study. A pre-tested interview with a structured questionnaire was used to collect data and key informants were interviewed using semi-structured questionnaire. Associated factors were analyzed by using bivariable and multivariable binary logistic regression models. The odds ratio, with a 95% confidence level, was used to declare a statistically significant association. RESULT A total of 703 married women of the reproductive age groups were interviewed, yielding a 90.89% response rate; among these married women, 352 and 351 were in monogamous and polygamous relationships. The proportion of women who use modern contraceptives was 161 (45.7%) in monogamous relationship, and 151 (43.0%) in polygamous relationships. Overall, utilization of modern contraceptives was significantly associated with educational status (AOR = 2.143, CI:1.428-3.216), religion (AOR = 1.704, CI: 1.144-2.539), undesired fertility (AOR = 3.17,CI:1.939-5.183), who decides on the number of children (AOR = 3.054, CI:1.93-4.832), getting clear information by Health care provider (AOR = 4.624, CI:3.132-6.828), family pressure (AOR = 1.855, CI:1.351-2.75), fear of social stigma (AOR = 2.482, CI:1.666-3.699), and accepts myths about contraceptives (AOR = 1.878, CI:1.278-2.761). CONCLUSION This study identified that utilization of modern contraception was low in the study area. The district health office and concerned stakeholders should implement interventions that scale up contraceptive use, need family involvement in decision making, addressing myths around contraceptives, helping women to get education, and training of health care providers.
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Affiliation(s)
- Eueail Teferi Asrese
- Department of Public Health, Dessie College of Health Sciences, P.O.Box: 1212, Dessie, Ethiopia
| | - Yonas Fissha Adem
- Department of Public Health, Dessie College of Health Sciences, P.O.Box: 1212, Dessie, Ethiopia
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Mangimela-Mulundano A, Black KI, Cheney K. A cross-sectional study of women's autonomy and modern contraception use in Zambia. BMC Womens Health 2022; 22:550. [PMID: 36575426 PMCID: PMC9793589 DOI: 10.1186/s12905-022-02101-5] [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: 11/09/2021] [Accepted: 11/30/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women's autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women's autonomy and modern contraception use among partnered women in Zambia. METHODS This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women's autonomy using three indices: women's participation in decision-making, women's attitude towards wife-beating and women's household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR). RESULTS The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women's autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048-1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013-1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091-1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105-1.766) and age, 15-24 (AOR = 1.266, P value = 0.007, 95% CI 1.182-2.113,) and 25-34 (AOR = 1.163, P value = 0.002, 95% CI 1.052-1.273). CONCLUSION This study argues that increasing women's assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women's autonomy, which in turn would support gender equality and reproductive health.
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Affiliation(s)
- Abigail Mangimela-Mulundano
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Kirsten I. Black
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Kate Cheney
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Bolarinwa OA, Babalola TO, Adebayo OA, Ajayi KV. Health insurance coverage and modern contraceptive use among sexually active women in Nigeria: Further analysis of 2018 Nigeria Demographic Health Survey. Contracept Reprod Med 2022; 7:22. [PMID: 36316721 PMCID: PMC9624092 DOI: 10.1186/s40834-022-00187-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background Studies have shown that affordable health insurance can influence healthcare visits and increase the choice of medication uptake in sub-Saharan Africa. However, there is a need to document the influence of health insurance coverage and modern contraceptive use in order to encourage its uptake. Thus, this study examined the influence of health insurance coverage on modern contraceptive use among sexually active women in Nigeria. Methods The secondary dataset utilised in this study were derived from the 2018 Nigeria Demographic and Health Survey (NDHS). Data analyses were restricted to 24,280 women of reproductive age 15–49 years who were sexually active in the survey dataset. Weighted bivariate and multivariable logistic regression models were used to examine the influence of health insurance coverage on modern contraceptive use while controlling for possible confounders. A Significant level of alpha was determined at p < 0.05 using STATA 16.0. Results The prevalence of health insurance coverage and modern contraceptive use among sexually active women in Nigeria were 25.47% and 13.82%, respectively. About 1 out of every 4 sexually active women covered by health insurance were using a modern contraceptive, while 86.50% of the women not covered by health insurance were not using any modern contraceptive method. After adjusting for socio-demographic characteristics, the odds of using any modern contraceptive were significantly higher for sexually active women who were covered by any health insurance [aOR = 1.28; 95% (CI = 1.01–1.62)] compared to sexually active women not covered by health insurance in Nigeria. Conclusion The study demonstrated that health insurance coverage is a significant driver of health service utilization, including modern contraceptive use. Health insurance benefits are recommended to be expanded to cover a broader spectrum of family planning services in Nigeria. More research is required to understand the influence of different health insurance schemes and the use of modern family planning methods in Nigeria.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK ,grid.16463.360000 0001 0723 4123Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Taiwo Oladapo Babalola
- Institute of Governance, Humanities, and Social Sciences [PAUGHSS], PAN African University, Yaoundé, Cameroon
| | | | - Kobi V. Ajayi
- Education, Direction, Empowerment, & Nurturing (EDEN) Foundation, Abuja, Nigeria ,grid.264756.40000 0004 4687 2082Department of Health Behavior, School of Public Health, Texas A&M University, 77843 College Station, TX USA
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Goyomsa GG, Albe TA, Debela SA, Kitaw LD. Current intimate partner violence and associated factors among sero-positive women attending Adama town ART Clinics, Central Ethiopia 2019. Int J Equity Health 2022; 21:44. [PMID: 35361220 PMCID: PMC8973560 DOI: 10.1186/s12939-022-01647-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence against women is a behavior within an intimate relationship that causes physical, sexual, or psychological harm to the victim. It is well recognized as a gross violation of human rights and affects the health of women, families, and the community at large. However, the level to which Human Immuno Deficiency virus sero-positive women are experiencing recent intimate partner violence and its associated factors have not been well investigated as the majority of the study done so far were focused on the study of lifetime violence and violence among women in the general population. The study was conducted to determine the prevalence and factors associated with current intimate partner violence among sero-positive women. METHODS A facility-based cross-sectional study was conducted from March 2019 to April 2019 among 396 sero-positive women visiting anti-retroviral therapy (ART) units of Adama town public health facilities. A systematic random sampling technique was used to select individual participants. Validated World Health Organization (WHO) tools were used to collect information on the outcomes and key independent variables. The collected data were entered into Epidata version 4.4.6 and analyzed using SPSS version 24. Descriptive statistics were used to compute summary statistics and proportion. Variables at a cut-off value of 0.25 on bivariate analysis and 0.05 during multivariate logistic regression were used to identify factors associated with recent intimate partner violence. RESULT The response rate in this study was 100% since all women approached took part in this study. The prevalence of current intimate partner violence was 32.3% while lifetime intimate partner violence (IPV) was 45.5%. Exposure to coerced first sexual intercourse [AOR = 3.0 (1.73, 5.44)], male multi-partnership [AOR = 2.2 (1.21, 4.06)], believing in the husband's right to sex [AOR = 2.3 (1.29, 4.12)], contraceptive use [AOR = 3.33 (1.67, 6.62)], and having farmer partner [AOR = 3.9 (1.43, 10.79)] were significantly associated with current intimate partner violence. CONCLUSION One-in-three women reported at least 2 or more forms of violence from their intimate partner. Individual-level factors (Exposure to coerced first sexual intercourse, partner's occupation, contraceptive use, and believing in husband's right to sex and relationship factor (Male multi-partnership) were significantly associated with recent intimate partner violence. Combined efforts are required to avert intimate partner violence among women on ART while targeting risky sexual behavior practiced among male partner factors significantly associated with violence.
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Affiliation(s)
| | - Teklu Arga Albe
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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He Z, Ghose B, Yaya S, Cheng Z, Zhou Y. Perceived neighborhood safety and exercise behavior among community dwellers in Gauteng, South Africa. Medicine (Baltimore) 2020; 99:e23552. [PMID: 33371081 PMCID: PMC7748175 DOI: 10.1097/md.0000000000023552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Maintaining a physically active life is an important determinant of overall health and psychosocial wellbeing among adults. Physical exercise behavior can be influenced by various social and environmental circumstances including neighborhood safety. Using data from South Africa Quality of life Survey 2015/16, this study aimed to assess the hypothesis that lack of perceived neighborhood safety (PNS) can reduce the likelihood of engaging in physical exercise (PE). The participants were 30,002 men and women aged 18 years and above. The association between self-reported PE behavior and neighborhood safety were assessed by multivariable regression method while adjusting for potentially confounding factors. Less than a quarter (23.41%) of the participants reported taking exercise on daily basis whereas 27.90% reported never taking any. Respectively 6.0% and 38.1% of the participants reported feeling very unsafe walking in the neighborhood during day and night. In regression analysis, both the pooled and stratified models indicated that lack of PNS was inversely associated with regular PE. Lack of PNS (bit unsafe) during day was associated with lower odds of PE both among men (OR = 0.776, P < .001) and women (OR = 0.874, P < .001). The negative association between lack of PNS and PE during day was significant among those living with disability (OR = 0.758, P < .001). Further analysis showed that the negative association between lack of PNS with regular PE during day was significant in Johannesburg (OR = 0.800, P < .001), Tshwane (OR = 0.735, P < .001) and Emfuleni (OR = 0.619, P < .001) only, while that during night was significant in Johannesburg (OR = 0.737, P < .001), Ekurhuleni (OR = 0.673, P < .001), Emfuleni (OR = 0.418, P < .001), Lesedi (OR = 0.385, P < .001), Mogale City (OR = 0.693, P < .001), and Randfontein (OR = 0.565, P < .001). Overall, the findings highlight a significantly inverse association between lack of PNS and PE behavior. In light of the current findings, it is recommended that PE promotion programs pay special attention on population living in the neighborhoods fraught with crime concerns.
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Affiliation(s)
- Zhifei He
- School of Politics and Public Administration, Southwest University of Political Science and Law, Chongqing
| | | | - Sanni Yaya
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, Canada
| | - Zhaohui Cheng
- Chongqing Health Information Center, Chongqing, China
| | - Yan Zhou
- School of Politics and Public Administration, Southwest University of Political Science and Law, Chongqing
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Akamike IC, Okedo-Alex IN, Eze II, Ezeanosike OB, Uneke CJ. Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy. Contracept Reprod Med 2020; 5:30. [PMID: 33292842 PMCID: PMC7603738 DOI: 10.1186/s40834-020-00133-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Over the years, family planning uptake in Nigeria has remained low and this is as a result of the various challenges and barriers faced by women. The aim of this study was to systematically review studies on family planning services undertaken in Nigeria in order to understand the challenges to uptake of the services and the policy implications. METHODS A PubMed search was performed in June 2020 and studies that investigated challenges of family planning uptake in Nigeria published in English between 2006 and 2020 were sought. A combination of the search terms family planning, contraceptives, challenges, barriers, Nigeria was used. Review articles, case reports, and case studies were excluded. Studies that did not report barriers or challenges to family planning or contraceptives were excluded. RESULT Twenty seven studies carried out in Nigeria which provided sufficient information were identified and used for this review. The Uptake of family planning recorded in the reviewed studies ranges from 10.3 to 66.8%. Challenges that are client related include education, desire for more children, uncertainty about its need, partner disapproval, previous side effects, religious beliefs, culture disapproval, age, marital status, and wealth index, residence, ignorance, embarrassment, domestic violence and sexual factor. Health service related factors identified include cost, difficulty accessing services, and procurement difficulties. Recommendations for family planning propram and policy include targeting of health service delivery for improvement, focus on gender issues and male involvement, involvement of religious leaders, targeting of younger women for better education and counseling, and continuous awareness creation and counseling among others. CONCLUSION The review has shown that uptake of family planning remains low in Nigeria and challenges abound. We recommend that strategies that are multi-sectoral should be applied to address the multi-pronged challenges facing uptake of family planning services.
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Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Irene Ifeyinwa Eze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | | | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Tiruye TY, Harris ML, Chojenta C, Holliday E, Loxton D. The mediation effect of contraceptive use and women's autonomy on the relationship between intimate partner violence and unintended pregnancy in Ethiopia. BMC Public Health 2020; 20:1408. [PMID: 32938435 PMCID: PMC7493352 DOI: 10.1186/s12889-020-09514-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy. Methods This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects. Results Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively. Conclusion Women’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.
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Affiliation(s)
- Tenaw Yimer Tiruye
- Public health department, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. .,Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia
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Iliyasu Z, Galadanci HS, Zubair KA, Abdullahi HM, Jalo RI, Aliyu MH. Fertility desire concordance and contraceptive use among couples living with HIV in northern Nigeria. EUR J CONTRACEP REPR 2020; 25:372-380. [PMID: 32880492 DOI: 10.1080/13625187.2020.1807499] [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: 10/23/2022]
Abstract
OBJECTIVES We aimed to determine the concordance between own and perceived partner fertility intentions and identify predictors of contraceptive use among couples receiving antiretroviral therapy in Kano, Nigeria. METHODS A structured, validated questionnaire was used to interview 399 married men and women receiving antiretroviral therapy. Adjusted odds ratios for predictors of contraceptive use were derived from multivariate logistic regression models. RESULTS Most couples (68.9%) had concordant fertility intentions. Only 10.0% of couples had discordant fertility intentions. Among 232 couples (58.1%) at least one partner used contraception. Male condoms were used by 45.9% of couples (n = 183). Female methods were used by 175 couples (43.9%). Contraceptive use was significantly higher in participants who were older (≥30 years), better educated (secondary or post-secondary), had a higher monthly income (NGN ≥30,000), longer marriage duration (≥5 years), at least one living child, >1 year of antiretroviral treatment, and who were living with a serodiscordant partner and in circumstances where the decision on contraception was made by the female partner or jointly by both partners (all p < 0.05). Contraceptive use was significantly lower in participants who had not been sexually active in the last 6 months, where both partners wanted more children, and in situations lacking spousal communication about family planning (all p < 0.05). CONCLUSION One in 10 couples had discordant fertility intentions. Contraceptive use was suboptimal and was predicted by age, education, income, length of marriage, number of children, duration of antiretroviral therapy, partner's serostatus, sexual activity, fertility intention, spousal communication and the contraceptive decision-maker. Our findings highlight the need for spousal communication, joint contraceptive decision making and the integration of reproductive health services with antiretroviral therapy services.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Hadiza S Galadanci
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
| | | | | | - Rabiu I Jalo
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Muktar H Aliyu
- Department of Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Hamon JK, Krishnaratne S, Hoyt J, Kambanje M, Pryor S, Webster J. Integrated delivery of family planning and childhood immunisation services in routine outreach clinics: findings from a realist evaluation in Malawi. BMC Health Serv Res 2020. [PMID: 32838774 DOI: 10.1186/s12913-020-05571-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Family planning (FP) needs among postpartum women in low- and middle-income countries remain largely unmet. Integrating FP with childhood immunisation services could partially reduce this unmet need by creating multiple opportunities for timely contact with FP services during the 12 months following childbirth. METHODS A realist evaluation of an intervention integrating FP and childhood immunisation services in routine outreach clinics in two rural districts of Malawi was conducted. A Context-Mechanism-Outcome (CMO) framework was used to describe the drivers of the intervention. A detailed programme theory was developed based on the analysis of semi-structured interviews and focus group discussions with 50 stakeholders. RESULTS A total of 9 core mechanisms were identified, which centred on constructs of access. Findings revealed that on the demand side, women were motivated to attend outreach clinics due to shorter travel distances; they felt confident they could access FP services and use contraceptive methods covertly if needed; and when supported by their husband, they were empowered to take up the use of contraceptive methods. On the supply side, providers were empowered through the training they received to provide integrated services; they were confident in their ability to provide essential services; and they were motivated by teamwork and by the recognition they received for their work. Additionally, some providers were found to be unwilling to walk long distances to reach remote clinics, which was seen to negatively affect the availability of services. CONCLUSIONS The delivery of integrated FP and childhood immunisation services in the context of routine outreach clinics in rural Malawi was seen to trigger mechanisms of accessibility and to improve the acceptability and availability of FP services. However, further research is needed to understand how the integration of these services in a routine outreach clinic setting may affect other dimensions of accessibility, including the approachability, appropriateness and affordability of services.
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Affiliation(s)
- Jessie K Hamon
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Shari Krishnaratne
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Jenna Hoyt
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Hamon JK, Krishnaratne S, Hoyt J, Kambanje M, Pryor S, Webster J. Integrated delivery of family planning and childhood immunisation services in routine outreach clinics: findings from a realist evaluation in Malawi. BMC Health Serv Res 2020; 20:777. [PMID: 32838774 PMCID: PMC7447579 DOI: 10.1186/s12913-020-05571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family planning (FP) needs among postpartum women in low- and middle-income countries remain largely unmet. Integrating FP with childhood immunisation services could partially reduce this unmet need by creating multiple opportunities for timely contact with FP services during the 12 months following childbirth. METHODS A realist evaluation of an intervention integrating FP and childhood immunisation services in routine outreach clinics in two rural districts of Malawi was conducted. A Context-Mechanism-Outcome (CMO) framework was used to describe the drivers of the intervention. A detailed programme theory was developed based on the analysis of semi-structured interviews and focus group discussions with 50 stakeholders. RESULTS A total of 9 core mechanisms were identified, which centred on constructs of access. Findings revealed that on the demand side, women were motivated to attend outreach clinics due to shorter travel distances; they felt confident they could access FP services and use contraceptive methods covertly if needed; and when supported by their husband, they were empowered to take up the use of contraceptive methods. On the supply side, providers were empowered through the training they received to provide integrated services; they were confident in their ability to provide essential services; and they were motivated by teamwork and by the recognition they received for their work. Additionally, some providers were found to be unwilling to walk long distances to reach remote clinics, which was seen to negatively affect the availability of services. CONCLUSIONS The delivery of integrated FP and childhood immunisation services in the context of routine outreach clinics in rural Malawi was seen to trigger mechanisms of accessibility and to improve the acceptability and availability of FP services. However, further research is needed to understand how the integration of these services in a routine outreach clinic setting may affect other dimensions of accessibility, including the approachability, appropriateness and affordability of services.
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Affiliation(s)
- Jessie K Hamon
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Shari Krishnaratne
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Jenna Hoyt
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Ashimi A, Amole T, Ibrahim H. Domestic violence: The pre- and post-diagnosis experience of women living with HIV in a rural community in Northwest Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dingeta T, Oljira L, Worku A, Berhane Y. Unmet Need for Contraception Among Young Married Women in Eastern Ethiopia. Open Access J Contracept 2019; 10:89-101. [PMID: 31908548 PMCID: PMC6925555 DOI: 10.2147/oajc.s227260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Addressing the contraceptive needs of young married women is critical to improve their health and well-being. In patriarchal societies, young married women are under intense pressure to demonstrate their fecundity. Therefore, research that specifically address the needs for contraception of young married women have been generally given less emphasis in Ethiopia. This study assessed the extent of unmet needs for contraception and its associated factors among young married women in Eastern Ethiopia. Methods A community-based cross-sectional study was conducted among young married women (14–24 years of age) in Eastern Ethiopia. Data were collected using a structured questionnaire. The prevalence ratio (PR) with 95% confidence intervals (CIs) was calculated, and factors associated with unmet needs for contraception were identified using log-binomial regression statistical model. Results Among 2933 young women interviewed, the unmet need for contraception was 1014 (34.6%; 95% CI, 32.9%–36.4%). The prevalence of unmet needs for contraception decreased with increased young women’s household decision-making autonomy score (APR= 0. 76; CI=0.62–0.94). Exposure to family planning (FP) information during the last 12 months (APR= 1.24; CI=1.1–1.42), age 18 or more years (APR=1.25; CI=1.04–1.5), multiparty (APR= 1. 9; CI=1.7–2.1) and desire to have 5 children or lesser than 5 children (APR= 1. 2; CI=1.06–1.32) were associated with higher prevalence of unmet needs for contraception. Conclusion One-third of married young women had unmet needs for contraception. More efforts to empower women to make decisions that affect their own life and providing appropriate family planning information are necessary to reduce the burden of unmet needs among young married women in rural settings in Ethiopia.
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Affiliation(s)
- Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Abstract
Intimate partner violence (IPV) is recognised as a fundamental violation of women’s human rights and a widespread phenomenon in Africa. Women’s low socioeconomic empowerment, cultural acceptability, and lack of social support exacerbate the health and psychosocial outcomes of IPV among African women. To date, there is no systematic research on IPV and its association with healthcare use among adult women in Uganda. Therefore, we conducted the present study on IPV among Ugandan women of childbearing age (15–49 years). Cross-sectional data on 7536 women were collected from the Uganda Demographic and Health Survey (UDHS—Uganda Demographic and Health Survey 2016). The objectives were to assess the predictors of IPV as well as help-seeking behaviour for victims of IPV. IPV was assessed by women’s experience of physical, emotional and sexual violence and healthcare use was assessed by self-reported medical visits during the last 12 months. Logistic regression methods were used to analyse the data. According to descriptive findings, which showed that more than half of the women reported experiencing any IPV (55.3%, 95%CI = 53.6, 57.0), emotional IPV (41.2%, 95%CI = 39.6, 42.8) was the most prevalent of all three categories, followed by physical (39.3%, 95%CI = 37.7, 40.9) and sexual IPV (22.0%, 95%CI = 20.7, 23.3). In the multivariate analysis, higher age, rural residence, religious background (non-Christian), ethnicity (Banyankore and Itseo), secondary/higher education and husband’s alcohol drinking habit were positively associated with women’s experience of IPV. Husband’s alcohol drinking was found to be a significant barrier to seeking help among those who experienced IPV. In conclusion, our findings suggest a noticeably high prevalence of IPV among Ugandan women. There are important sociodemographic and cultural patterns in the occurrence of IPV that need to be taken into account when designing intervention policies. Special attention should be given to women living with husbands/partners who drink alcohol, as this might increase their odds of experiencing IPV, as well as reduce the likelihood of seeking help.
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Alcohol Drinking by Husbands/Partners is Associated with Higher Intimate Partner Violence against Women in Angola. SAFETY 2019. [DOI: 10.3390/safety5010005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intimate partner violence (IPV), as the most prevalent form of violence against women, is a commonly encountered phenomenon across sub-Saharan African countries, including Angola. As a fast-growing economy, Angola is experiencing a booming alcohol industry and persistent IPV and women’s rights issues, along with weak prohibition and enforcement against this practice. However, so far, there is no systematic research investigating the predictors of IPV in Angola and whether spousal alcohol drinking has any relationship with women’s experience of IPV. Therefore, in this study, we aimed to assess the predictors of IPV (defined as physical, emotional, and sexual violence) among Angolan women with a special focus on their partners’ alcohol drinking habit. Cross-sectional data on 7669 women aged 15–49 years from the Angola Demographic and Health Survey were used for this study. Data were analyzed using descriptive and logistic regression methods. Results indicated that physical IPV (32.3%, 95% Confidence Interval = 30.3 to 34.5) was most prevalent, followed by emotional (27.3%, 95% CI = 25.3 to 29.4) and sexual IPV (7.4%, 95% CI = 6.6 to 8.4). In the multivariate analysis, higher education and household wealth status showed protective effects against certain forms of IPV. Alcohol drinking by husbands/partners was associated with significantly higher odds of experiencing physical [OR = 2.950; 95% CI = 2.632, 3.306], emotional [OR = 2.470; 95% CI = 2.187,2.789], and sexual IPV [OR = 2.729; 95% CI = 2.220, 3.354] among women. Women who reported experiencing physical IPV had increased odds of drinking alcohol [OR = 1.474; 95% CI = 1.290, 1.684] compared with those who did not. These findings reflect the widespread prevalence of IPV in sub-Saharan African countries. Special focus should be given to married men with alcohol drinking habits to reduce women’s vulnerability to IPV and dependence on alcohol use.
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