La pratique contraceptive moderne chez les adolescentes au Bénin: Tendances, déterminants et perspectives / Modern contraceptive use among adolescents in Benin: trends, determinants and prospects

RésuméLa pratique contraceptive moderne augmente lentement parmi les jeunes générations au Bénin. La présente étude analyse les tendances, les déterminants du recours aux contraceptifs et leurs mécanismes d'actions chez les adolescentes. Les approches socio-écologique et intersectionnelle ont été adoptées, avec une méthode d'étude mixte portant sur les adolescentes de 15 à 19 ans sexuellement actives et non enceintes. Le volet quantitatif recourt aux données des cinq enquêtes démographiques et de santé du Bénin entre 1996 et 2017-18, avec une analyse descriptive et une régression logistique binaire pas à pas. Les données qualitatives collectées par des observations, discussions de groupe et entretiens individuels auprès de différents acteurs nationaux, ont fait l'objet d'analyse de contenu. Les résultats révèlent une prévalence contraceptive moderne basse, passant de 4,6% en 1996 à 13,3% en 2017-18, avec le préservatif comme principale méthode utilisée (8,2%). En 2017-18, la probabilité d'utiliser les contraceptifs était plus élevée chez les adolescentes des ménages riches (OR = 2,3), les scolarisées (OR = 2,3), les célibataires (OR = 2,1), celles fréquentant les services de planification familiale (PF) (OR = 1,8), connaissant le cycle menstruel (OR = 1,6), et économiquement actives (OR = 1,5). Cependant, être Yoruba réduit les chances d'utiliser les contraceptifs (OR = 0,5). Les données qualitatives confirment ces résultats et les complètent en mettant en avant l'effet du cadre juridique favorable à la pratique contraceptive, la stigmatisation sociale des utilisatrices, et les infox véhiculées en communauté. Nous recommandons des efforts pour le maintien des filles à l'école, la généralisation des services de PF pour les adolescents, la communication communautaire, et la subvention des contraceptifs.

Influence of "Decide + Be Ready" Contraceptive Decision Aid on Pre-deployment Health Decisions

INTRODUCTION

The number of active duty servicewomen and the career opportunities available to them continue to increase. Of the approximately 350,000 women in uniform, 97% are estimated to be of reproductive age, underscoring the importance of reproductive health care. This study aimed to explore the influence of the Decide + Be Ready (DABR) contraceptive decision aid on providing contraceptive knowledge, facilitating a servicewoman's contraceptive choice before and during deployment, and enabling understanding of individual preferences around contraception in a population of active duty women most at risk for unintended pregnancy.

MATERIALS AND METHODS

We conducted a qualitative study, recruiting active duty women between the ages of 17 and 24 with at least one prior deployment who were stationed at Naval Station Norfolk and presented for evaluation at a primary care clinic. Participants downloaded and reviewed the DABR application. A semi-structured interview was conducted and audio-recorded. Interviews were transcribed and underwent thematic analysis.

RESULTS

Twenty women participated in the study over 2 weeks. Analysis revealed three overarching themes: perceived utility of and attitudes toward DABR, knowledge of and comfort with contraceptive options, and challenges specific to active duty women. In total, eight subthemes were also identified and explored.

CONCLUSIONS

The DABR app provided study participants with new information about contraception. Participants reported improved knowledge of gynecologic and reproductive health options available during deployment. Other findings raise interest for future studies exploring incorporation of peer validation in counseling and decision-making tools, challenges with the deployed environment for obstetric/gynecologic health, and medical support on naval deployments.

A socioecological perspective to contraceptive access for women experiencing homelessness in the United States

OBJECTIVE

Although persons who are pregnancy-capable and experiencing homelessness may have a strong desire to avoid pregnancy, they face unique barriers to contraception. This multimethod qualitative study aimed to identify preferences for, barriers to, and facilitators of contraceptive access and use among women experiencing homelessness in the United States using a systems perspective.

STUDY DESIGN

We conducted semistructured interviews with women experiencing homelessness (n = 19), healthcare providers (n = 6), and social service providers (n = 6). We recruited participants from community-based, housing, and medical organizations in North Texas in the United States. Two coders conducted thematic analysis and reached consensus for codes.

RESULTS

Women participants were in emergency shelter, unsheltered, or transitional/rapid rehousing. We stratified themes using the Socioecological Framework to illustrate factors affecting contraception access at individual, interpersonal, organizational and community, and societal levels. Notable results include women's preferences for long-acting reversible contraception, difficulties healthcare providers face in initiating contraceptive counseling, and the underutilized role of social service providers in reproductive healthcare. Insurance policies, connections between health clinics and community organizations, and organizational priorities both facilitated and hindered women experiencing homelessness's access to women's healthcare services.

CONCLUSION

This study identified opportunities throughout the healthcare and social service systems to support contraceptive access for women experiencing homelessness. Future interventions should strengthen and leverage these connections to promote access among this vulnerable population with the goal of supporting reproductive autonomy.

IMPLICATIONS

This study explored the reproductive health needs of women experiencing homelessness. Multilevel interventions, such as interdisciplinary care, patient-centered approaches, and an emphasis on health literacy, are needed to adequately provide the preferred methods of contraception for women experiencing homelessness, thus enabling reproductive autonomy for this population.

Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

The knowledge levels of midwifery students on contraceptive methods: A cross-sectional study

BACKGROUND

Effective contraceptives used correctly offer many benefits to both women's and children's health. However, public data reports that the rate at which women use an effective contraceptive method is still insufficient. Midwives, including the students, have an essential role in contraceptive counselling so there is a need to determine midwives' knowledge level on contraceptives.

OBJECTIVE

To evaluate midwifery students' knowledge levels of contraceptive methods.

DESIGN

Cross-sectional and descriptive study.

SETTINGS

Online survey.

PARTICIPANTS

290 midwifery students who met the inclusion criteria.

METHODS

The study was conducted between December 2020-March 2021 through Sociodemographic Form and Contraceptive Methods Information Form.

RESULTS

The mean age of the participants was 20.93 ± 1.97. There were 7.72 ± 3.21 correct answers to 15 questions measuring knowledge level of contraceptive methods. The most known modern contraceptive method was the condom, and the most known traditional method was the calendar method. 59.7 % of the participants considered the post-coital contraceptive method as a family planning method. The knowledge level on contraceptives of students who had not received prior training before was lower; and the knowledge level of students who received information about contraceptives through their courses in the curriculum was higher than those who learned from other sources. The level of knowledge increased as age and grade increased.

CONCLUSIONS

Midwifery students had insufficient level of knowledge about contraceptives. Since midwifery students play an active role in family planning, interventions are necessary to deliver more detailed and accurate information about contraceptive methods.

Prevalence and determinants of unmet need for contraception among women in low and high-priority segments for family planning demand generation in Nigeria

BACKGROUND

Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study.

METHODS

The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables.

RESULTS

Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments.

CONCLUSION

The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.