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Zielinski R, Abdelnabi S, Amankwah G, Kukula VA, Apetorgbor V, Awini E, Williams J, Moyer C, Ghosh B, Lori JR. Knowledge, Acceptance, and Uptake of Family Planning: A Cluster Randomized Controlled Trial of Group Antenatal Care in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1025. [PMID: 39200636 PMCID: PMC11355032 DOI: 10.3390/ijerph21081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 09/02/2024]
Abstract
The use of family planning (FP) methods significantly contributes to improved outcomes for mothers and their offspring. However, the use of FP remains low, particularly in low- and middle-income countries. A cluster randomized controlled clinical trial was implemented in Ghana, comparing group antenatal care (ANC) with routine care. The group ANC intervention included eight meetings where the seventh group meeting incorporated information and discussion regarding methods of FP. Data collection occurred at five time points: baseline (T0), 34 weeks' gestation (T1), 6-12 weeks post birth (T2), 5-8 months post birth, and 11-14 months post birth (T4). At T1, there was a significantly greater increase in the knowledge of FP methods as well as the intention to use FP after the birth among the intervention group. The uptake of FP was significantly higher in the intervention group for all post-birth timepoints except for T4 where the control group had significantly higher rates. The reasons for the diminishing effect are unclear. An increasing uptake of FP methods requires a multifaceted approach that includes increasing accessibility, knowledge, and acceptability as well as addressing societal and cultural norms.
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Affiliation(s)
- Ruth Zielinski
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA; (S.A.); (B.G.); (J.R.L.)
| | - Samia Abdelnabi
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA; (S.A.); (B.G.); (J.R.L.)
| | - Georgina Amankwah
- Dodowa Health Research Center, Ghana Health Service, Dodowa P.O. Box DD1, Greater Accra Region, Ghana; (G.A.); (V.A.K.); (V.A.); (E.A.); (J.W.)
| | - Vida A. Kukula
- Dodowa Health Research Center, Ghana Health Service, Dodowa P.O. Box DD1, Greater Accra Region, Ghana; (G.A.); (V.A.K.); (V.A.); (E.A.); (J.W.)
| | - Veronica Apetorgbor
- Dodowa Health Research Center, Ghana Health Service, Dodowa P.O. Box DD1, Greater Accra Region, Ghana; (G.A.); (V.A.K.); (V.A.); (E.A.); (J.W.)
| | - Elizabeth Awini
- Dodowa Health Research Center, Ghana Health Service, Dodowa P.O. Box DD1, Greater Accra Region, Ghana; (G.A.); (V.A.K.); (V.A.); (E.A.); (J.W.)
| | - John Williams
- Dodowa Health Research Center, Ghana Health Service, Dodowa P.O. Box DD1, Greater Accra Region, Ghana; (G.A.); (V.A.K.); (V.A.); (E.A.); (J.W.)
| | - Cheryl Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, USA;
| | - Bidisha Ghosh
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA; (S.A.); (B.G.); (J.R.L.)
| | - Jody R. Lori
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA; (S.A.); (B.G.); (J.R.L.)
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Bolarinwa OA. Inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. BMC Womens Health 2024; 24:317. [PMID: 38824536 PMCID: PMC11143664 DOI: 10.1186/s12905-024-03167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/28/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Inequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. METHODS This study employed the World Health Organisation's Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF). RESULTS The study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20-49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018. CONCLUSION The inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health, York St John University, London, UK.
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa.
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Kebede N, Kefale B, Yigezu M, Bogale EK, Zewdie A, Wasihun Y, Adane M. Individual and community level factors associated with modern contraceptive utilization among married women in the emerging region of Ethiopia: a multilevel mixed effects analysis of the 2019 Ethiopia Mini-Demographic and health survey. BMC Womens Health 2023; 23:652. [PMID: 38062400 PMCID: PMC10704797 DOI: 10.1186/s12905-023-02822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND A demonstrated technique to enhance reproductive health and economic progress is through ensuring that family planning services are accessible universally. Those studies that used Ethiopia Demographic and Health Survey (EDHS) data did not assess individual and community-level factors in contraceptive utilization. Thus, the study employs a multilevel mixed effects analysis approach, which allows for the examination of individual and community-level factors that influence contraceptive utilization. METHODS This study analyzed the 2019 Ethiopia Min Demographic and Health Survey datasets. A total of 1916 married women in the 2019 surveys were included in the analysis. The data were analyzed using Stata version 17.0. The data were analyzed using Multi-level mixed-effect logistic regression to identify the individual and community-level factors associated with modern contraceptive utilization. An adjusted odds ratio with a 95% confidence interval was used to. Show the strength and direction of the association and statistical significance was declared at a P value less than 0.05. RESULTS Factors significantly associated with modern contraceptive utilization were; Muslim and protestant followers [AOR = 0.31, 95% CI: (0.134, 0.714)] and [AOR = 0.35, 95% CI: (0.173, 0.691)] respectively, women with no education (OR = 0.46; 95% CI: 0.293, 0.710), those women who belong to the poor and middle wealth of household [AOR = 0.35, 95% CI: (0.237, 0.527)] and [AOR = 0.56, 95% CI: (0.347, 0.919)] respectively, women who had one to five and greater than or equal to six living children [AOR = 11.36, 95% CI:(2.119, 60.918)] and [AOR = 7.44, 95% CI:(1.437, 38.547)]respectively, Women in clusters poor wealth status [AOR = 0.40, 95% CI: (0.183, 0.875)] and women who belong to the Somali region [AOR = 0.20, 95% CI: (0.0.070, 0.506)]. CONCLUSION The study revealed that both individual and community-level factors determined modern contraceptive utilization. At the individual level, the religion of women, educational status, the wealth of the household, and the total number of living children were significantly associated with modern contraceptive utilization. At community-level factors, community wealth status and belonging to the Somali region were significantly associated with modern contraceptive utilization. The findings suggest that interventions aimed at increasing modern contraceptive utilization should target women with lower levels of education, those living in households with lower wealth, and those with larger families. Additionally, efforts should be made to improve access to modern contraceptives in communities with lower wealth status and in regions where traditional beliefs may hinder their use.
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Affiliation(s)
- Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Muluken Yigezu
- Department of Public Health College of Medicine & Health Science, Dire Dawa, Dire Dawa University, Dire Dawa, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion, College of Medicine Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite 07, Ethiopia
| | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Kebede N, Kefale B, Yigezu M, Ayele K, Addisu E, Tsega Y, Kasaye MD, Wasihun Y. A multivariate decomposition analysis of modern contraceptive utilization among married women in the emerging region of Ethiopia (2000-2019). Sci Rep 2023; 13:20902. [PMID: 38017089 PMCID: PMC10684594 DOI: 10.1038/s41598-023-48176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Abstract
Ensuring universal access to family planning services is a proven strategy to improve reproductive health as well as economic development. Assessing the trend and identifying the factors for the change in modern contraceptive utilization is crucial to design effective measures, but trend analysis was not conducted previously. Thus, this study aimed to assess the trend and determinants of modern contraceptive utilization change among married women in emerging regions of Ethiopia. This study used the 2000 Ethiopia Demographic and Health Survey and the 2019 Ethiopia Min Demographic and Health Survey datasets for analysis. A total of 2555 and 1916 married women in the 2000 and 2019 surveys were included in the analysis, respectively. The data were analyzed using Stata version 17.0. Logit-based decomposition analysis was executed to identify factors for modern contraceptive utilization change. Statistical significance was declared at a P value of less than 0.05. The trend of contraceptive utilization change increased from 6.26% in 2000 to 21.97% in 2019. About - 65.87% and 165.87% of the change in contraceptive utilization was due to changes in composition and behavior, respectively. The change in composition was due to the change in the composition of women according to religion, educational status, region, and the number of living children. The change in behaviors of not educated women, rural women, Muslim women, and those who resided in the afar region was the source of change in modern contraceptive utilization. Modern contraceptive utilization has increased in the last two decades. The change in modern contraceptive utilization is due to changes in population composition and behavior. Interventions targeting uneducated and rural women are vital to increasing contraceptive utilization. Strategic interventions are also required for the Somali regions of Ethiopia.
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Affiliation(s)
- Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia.
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Muluken Yigezu
- Department of Public Health College of Medicine & Health Science, Dire Dawa University, Dire Dawa City, Ethiopia
| | - Kokeb Ayele
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Mulugeta Desalegn Kasaye
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
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Budu E, Okyere J, Osei MD, Seidu AA, Ahinkorah BO. Determinants of contraceptive continuation among women in sub-Saharan Africa. BMC Womens Health 2023; 23:447. [PMID: 37620922 PMCID: PMC10463526 DOI: 10.1186/s12905-023-02578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Contraceptive continuation is an important factor that has significant implications on total fertility rates and reproductive health outcomes, like unintended pregnancies. Therefore, it is imperative to understand the factors that influence women's decision to continue the use of contraceptives. The present study examined the determinants of contraceptive continuation among women in sub-Saharan Africa (SSA). METHODS Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of twenty-four (24) countries in SSA. Descriptive and multivariable binary logistic regression analysis were conducted. Frequencies, percentanges, and an adjusted odds ratio with 95% confidence intervals were used to present the results. RESULTS Compared to adolescents, adult women aged 45-49 years [aOR: 1.24; CI: 1.13-1.37] had higher odds of contraceptive continuation. The odds of contraceptive continuation were lower among those working [aOR: 0.96; CI: 0.93-0.98] compared to those not working. Also, the study shows that the likelihood of contraceptive continuation was lower among those exposed to family planning messages compared to those not exposed [aOR: 0.91; CI: 0.88-0.93]. Compared to women who used LARCs, women who used pills [aOR: 0.34; CI: 0.33-0.36], injectable [aOR: 0.42; CI: 0.40-0.43], other modern contraceptives [aOR: 0.72; CI: 0.68-0.75] or traditional methods [aOR: 0.50; CI: 0.478-0.523] were less likely to continue with their contraception. Women with one birth [aOR: 0.86; CI: 0.83-0.90] and those with 2 + births in the last five years [aOR: 0.54; CI: 0.512-0.56] reported lower odds of contraceptive continuation as compared to those with no births. Compared to women with no children living, those with 4 + children living had lower odds of contraceptive continuation [aOR: 0.62; CI: 0.57-0.67]. The study also found that the likelihood of contraceptive continuation was higher among those with secondary education [aOR: 1.08; CI: 1.04-1.12] as compared to those with no formal education. Contraceptive continuation was also higher among those who have information on choice [aOR: 3.91; CI: 3.82-4.01], and also higher among those who were undecided about having an additional child [aOR: 1.39; CI: 1.33-1.46]. Compared to West AfricaAngola, women from all other sub-regions were less likely to continue using contraceptives Comoros were more likely to continue with contraception [aOR: 1.49; CI: 1.24-1.78]. CONCLUSION To improve contraceptive continuation among women of reproductive age, countries in SSA must invest heavily in advocacy and dissemination of family planning messages, and information of choice. Also, much commitment should be directed towards enhancing the use of long-acting reversible contraceptive use.
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Affiliation(s)
- Eugene Budu
- Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Mary Dansoah Osei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Kamei A, Sato R, Thornton R. Factors associated with knowledge and use of home pregnancy test kits in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002165. [PMID: 37440465 DOI: 10.1371/journal.pgph.0002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/13/2023] [Indexed: 07/15/2023]
Abstract
Early detection of pregnancy status may help women initiate earlier antenatal care and healthy pregnancy behaviors, which could lead to healthier mothers and infants. Pregnancy tests are inexpensive and easy to use; meanwhile, little attention has been given to understanding women's knowledge and use of home pregnancy tests, especially in developing countries. We analyze cross-sectional data collected from 1,008 women ages 18-35, living in Northern Uganda in 2019, who are most likely to be uncertain about their pregnancy status. The survey asked women if they had knowledge of or had ever used a home pregnancy test kit, and barriers to purchasing a home pregnancy test kit. Among the 1,008 women, 65 percent report knowledge of home pregnancy test kits, and 29 percent report having ever used a test kit. Women who have heard of pregnancy test kits have higher levels of education, are in higher wealth quintiles, are more likely to have a salaried occupation and live closer to a health facility. Among women who report knowledge of home pregnancy test kits (N = 657), 90 percent report needing to ask their husband or partner for money to purchase a test kit, seven percent report they would hide the purchase, and 31 percent report that their husband or partner would not support the purchase. Women who report a lack of support from their husband or partner tend to be older, are more likely to have had prior pregnancies, are less likely to have a salaried occupation, are less likely to want a/another child, and are more likely to have a husband or partner desiring more children than herself. Future research aimed at understanding how and whether these barriers affect the utilization of home pregnancy test kits could help inform policymakers on how to increase the use of home pregnancy test kits. Trial registration: NCT03975933. Registered 05 June 2019, https://clinicaltrials.gov/ct2/show/record/NCT03975933.
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Affiliation(s)
- Akito Kamei
- University of Chicago, Chicago, IL, United States of America
| | - Ryoko Sato
- Harvard University, Boston, MA, United States of America
| | - Rebecca Thornton
- Hankamer School of Business, Baylor University, Waco, TX, United States of America
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Orwa J, Gatimu SM, Ngugi A, Agwanda A, Temmerman M. Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties. PLoS One 2022; 17:e0275575. [PMID: 36201509 PMCID: PMC9536593 DOI: 10.1371/journal.pone.0275575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.
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Affiliation(s)
- James Orwa
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health Sciences, Aga Khan University, Nairobi, Kenya
- * E-mail:
| | | | - Anthony Ngugi
- Department of Population Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Alfred Agwanda
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
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