Investing in Family Planning: Key to Achieving the Sustainable Development Goals

Protocol to assess bottlenecks inhibiting the scaling up of evidence-based family planning practices in low-income and middle-income countries using mixed methods

INTRODUCTION

Scaling up evidence-based practices (EBPs) in family planning (FP), as recommended by the WHO, has increasingly been accepted by global health actors as core to their mission, goals and activities. National policies, strategies, guidance, training materials, political commitment and donor support exist in many countries to adopt and scale up a range of EBPs, including postpregnancy FP, task sharing for FP and the promotion of social and behaviour change (SBC) for FP. While there has been some success in implementing these practices, coverage remains inadequate in many countries. To gain a better understanding of the factors that may be hindering the sustained scale-up of these interventions, WHO has developed an assessment protocol to systematically identify the health systems' 'bottlenecks' to implementation and to then identify solutions and develop strategies to address them.

METHODS AND ANALYSIS

A mixed method approach that includes document review, secondary data analysis (from surveys, service delivery data and case studies) and key informant interviews with policymakers, programme managers, health providers and community groups will be used to identify bottlenecks. This will be followed by a workshop to prioritise bottlenecks and characterise their root causes. Finally, solutions for the root causes of prioritised bottlenecks will be proposed. The protocol is structured in a modular format, with separate modules on postpregnancy FP, task sharing and SBC. Assessment themes and questions are informed by a wide body of literature on the three programmatic components, as well as studies on health policy implementation and scale-up.

ETHICS AND DISSEMINATION

The protocol was exempt from ethical review by the WHO ethics committee. The findings of the bottleneck analysis will be presented at local, national and international conferences and disseminated through peer-reviewed publications and webinars.

Post pregnancy family planning in Latin America and the Caribbean analysis and strengths in training on immediate contraception post obstetric event by CLAP/PAHO

Virtual courses developed by the Pan American Health Organization (PAHO) on family planning and immediate contraception post obstetric event (ICPOE) were launched in 2021 as training actions on ICPOE in the region. A total of 89,899 people enrolled in these courses; 36,494 (40.7%) of them enrolled in the course on ICPOE, and almost 60% of participants from Latin America passed the course. Moreover, 37% of participants were nurses, and 36% were physicians; most participants were from 20 to 39 years old. Eighty per cent completed the course in a week, and 89% had finished it by the 15th day. Students who passed the course expressed high overall satisfaction (95%), with ease of taking the course at home (63%) and at the workplace (33%) identified most frequently. Furthermore, practice training sessions (including simulation models) were conducted with 165 candidates to be trainers, physicians, and obstetricians. Approved trainers came from the Dominican Republic, Honduras, Bolivia, and Paraguay. CONCLUSION: There was evidence of the need for ICPOE training, and the innovative virtual courses developed by PAHO.

Effective Coverage of Modern Contraceptive Use in Ethiopia: An Ecological Linking Analysis of Service Provision Assessment and National Health Equity Surveys

The increase in contraceptive prevalence rate (crude coverage) in Ethiopia over the past two decades does not necessarily reflect service quality, and although the proportion of women with unmet needs has decreased, it remains unacceptably high. Hence, this study aimed to estimate the effective coverage (EC) of modern contraceptive methods in Ethiopia, considering the quality of care. We used nationally representative surveys, such as health facility surveys (Ethiopia Service Provision Assessment, 2021/22) and household surveys (National Health Equity Survey, 2022/2023). The descriptive analysis and ecological linking of the two surveys were used to assess the relationship between service quality and utilization among married/in union women in need of limiting or spacing children. In 2022, about 78% of health facilities in Ethiopia were ready to provide Family Planning (FP) services using modern contraceptive methods. Met FP need was 48%, with the quality of services assessed at 36%. After accounting for both service quality and readiness, Ethiopia's effective coverage of family planning services using modern methods was estimated at 16%, with the highest coverage in the Sidama region (21%) and the lowest in the Somali region (2%). The EC of FP services in Ethiopia was low, largely attributed to the poor overall quality of the FP services provided. It is therefore important to ameliorate the quality of FP services in the country.

Integration of family planning into the primary health care in Ethiopia: results from national assessment

BACKGROUND

Family planning (FP) is part of Ethiopia's essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia.

METHODS

This was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units.

RESULTS

This national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers.

CONCLUSION

Data from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities.

Discontinuation of family planning use among women of reproductive age in Rwanda: analysis from three Rwandan Demographic Health Survey (RDHS) 2010-2020

BACKGROUND

Family planning (FP) is fundamental in addressing unwanted pregnancies, unplanned pregnancies, unsafe abortions, maternal and child mortalities. It plays a crucial role in achieving the Sustainable Development Goals (SDGs), especial Goal 3. However, despite a high FP discontinuation percentage of 30% in Rwanda, there is limited studies on the contributing factors. Thus, the purpose of this study was to assess the discontinuation of FP use and associated factors among women aged 15-49 years in Rwanda.

METHODS

A pooled data analysis of three consecutive Rwandan Demographic and Health Surveys (RDHS) for the years 2010-11, 2014-15, and 2019-20 was performed using Stata Version 17.0. A multistage stratified sampling method was used to select study participants, and weighted analysis was conducted. Both bivariate and multivariate logistic regression models were used to identify factors associated with FP discontinuation. A statistical significance was determined at p < 0.05.

RESULTS

The findings showed that 17%, 28%, and 29% of Rwandan women of reproductive age discontinued using FP in 2010-11, 2014-15, and 2019-20, respectively. Pooled multivariate analysis indicated that FP discontinuation rates was more than double folds higher in 2014-15 (AOR: 2.17; 95% CI: 2.01 to 2.35) and 2019-20 (AOR: 2.71; 95% CI: 2.49 to 2.93) compared to 2010-11. The odds of FP discontinuation were higher among women aged 20-34 years (AOR: 7.71; 95% CI: 5.87 to 10.13) and women aged 35-49 years (AOR: 3.43; 95% CI: 2.59 to 4.55); those with four or more children (AOR: 1.38; 95% CI: 1.28 to 1.49); women from poor households (AOR: 5.19; 95% CI: 1.85 to 14.57); those who attending a health facility in the last year (AOR: 1.56; 95% CI: 1.46 to 1.66); women with a history of pregnancy termination (AOR: 1.17; 95% CI: 1.09 to 1.26); those with no education (AOR: 1.39; 95% CI: 1.28 to 1.51) and currently married women (AOR: 11.57; 95% CI: 10.21 to 13.10). Additionally, the most common reasons for FP discontinuation were fear of side effects (31.2%) and the desire to become pregnant (27.5%).

CONCLUSIONS

The trend of FP discontinuation among reproductive-age women in Rwanda has significantly increased from 200 - 11 to 2019-20. Key contributing factors include region, older age, higher parity, poor household status, health facility attendance, history of pregnancy termination, lack of education, being married and fear of side effects. Therefore, interventions should focus on addressing these factors to reduce FP discontinuation rates.

Family planning in the Eastern Democratic Republic of the Congo: personal beliefs, intimate partner negotiations and social pressure

The Democratic Republic of the Congo (DRC) has a low prevalence of family planning use. Recent studies have highlighted the significant role that socio-cultural factors play in the decision to use family planning or not. This qualitative study explored barriers to women's use of family planning methods in an ongoing conflict region, South-Kivu, DRC. Focus group discussions and individual in-depth interviews were conducted to understand perceptions and habits regarding family planning. An inductive approach was used to analyse the data. Precariousness of life, religious beliefs and fear of side effects were limiting factors to the use of family planning. Power relations within the couple also played an important role in decision-making. Sole provider ('breadwinner') women were more likely to use family planning, including hormonal methods. Our findings highlight the continued importance of family planning programmes that respond to socio-cultural factors, personal beliefs, and fear of side effects in parallel with addressing availability and accessibility. This will require including the community in their design and implementation in order to meet unmet family planning needs. Health care providers' capacity building and training to help women manage family planning side effects will also be beneficial.

Family Planning, Reproductive Health, and Progress Toward the Sustainable Development Goals: Reflections and Directions on the 30th Anniversary of the International Conference on Population and Development

Investing in family planning and reproductive health—broadly defined as the services, policies, information, attitudes, practices, and commodities, including contraceptives, that help individuals achieve their fertility intentions—is integral to attaining many Sustainable Development Goals.

Spatial Heterogeneity and association between the survey-based Women's Empowerment Index (SWPER) and unmet need for birth spacing in sub-Saharan Africa

BACKGROUND

Unmet need for birth spacing can significantly impact maternal and child health outcomes, leading to unintended or mistimed births, neonatal mortality, pregnancy loss, induced abortions, small-sized births, and malnutrition. Considering the role of women empowerment in women's sexual and reproductive health, we examined the association between the survey-based women's empowerment index (SWPER) and unmet need for spacing in sub-Saharan Africa (SSA).

METHODS

We used data from the Demographic and Health Surveys of 21 in SSA conducted between 2015 and 2021. In this study, the unit of analysis was women of reproductive age (15 to 49 years) who were married or living together and required family planning during the survey period. Multilevel logistic regression was fitted to examine the association between SWPER and the unmet need for spacing. The results were presented using adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

RESULTS

The hotspot countries for unmet need for birth spacing were Angola, Benin, Liberia, Mauritania, and Sierra Leone. The findings showed that with the empowerment indicators, women with high attitude to violence (disagreement or rejection of violence) (AOR = 0.95; 95% CI 0.91, 0.99), and women with high decision-making (AOR = 0.90; 95% CI 0.85, 0.95) exhibited lower odds of unmet spacing need relative to women with low attitude to violence and those with low decision making. Women with high autonomy (AOR = 1.32; 95% CI 1.25, 1.39) were more likely to experience unmet need for spacing compared to those with low autonomy.

CONCLUSION

Unmet need for spacing has been linked to indices of women's empowerment such as attitudes toward violence, independence, and decision-making. Organizations such as UNICEF, UNFPA, and the Bill & Melinda Gates Foundation should consider incorporating SWPER indicators when planning interventions to address the high unmet need for spacing among women in SSA. Additionally, various governments and aid organizations must give women's empowerment a high priority as a tactical intervention strategy to increase access to contraception in the countries considered in this study. These programmes would contribute to attaining SDGs 3.1 and 3.7.

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.

Cohort profile: the ADAPT study, a prospective study of pregnancy preferences, pregnancy, and health and well-being in the southwestern USA

PURPOSE

Significant methodological shortcomings limit the validity of prior research on pregnancy decision-making and the effects of 'unintended' pregnancies on people's health and well-being. The Attitudes and Decisions After Pregnancy Testing (ADAPT) study investigates the consequences for individuals unable to attain their pregnancy and childbearing preferences using an innovative nested prospective cohort design and novel conceptualisation and measurement of pregnancy preferences.

PARTICIPANTS

This paper describes the characteristics of the ADAPT Study Cohort, comprised of 2015 individuals aged 15-34 years, assigned female at birth, recruited between 2019 and 2022 from 23 health facilities in the southwestern USA.

FINDINGS TO DATE

The cohort was on average 25 years old. About 59% identified as Hispanic/Latine, 21% as white, and 8% as black, 13% multiracial or another race. Over half (56%) were nulliparous. About 32% lived in a household with income <100% of the federal poverty level. A significant minority (37%) reported a history of a depressive, anxiety or other mental health disorder diagnosis, and 30% reported currently experiencing moderate or severe depressive symptoms. Over one-quarter (27%) had ever experienced physical intimate partner violence, and almost half (49%) had ever experienced emotional abuse. About half (49%) had been diagnosed with a chronic health condition, and 37% rated their physical health as fair or poor. The 335 (17%) participants who experienced incident pregnancy over 1 year were similar to selected non-pregnant matched comparison participants in terms of age, racial and ethnic identity, and parity but were more likely to live with a main partner than comparison participants.

FUTURE PLANS

We will continue to follow participants who experienced incident pregnancy and non-pregnant comparison participants until 2026. Analyses will examine pregnancy decision-making and investigate differences in health and well-being by prepregnancy pregnancy desires and feelings after the discovery of pregnancy, offering new insights into the consequences of not attaining one's reproductive preferences.

TRIAL REGISTRATION NUMBER

NCT03888404.

The role of doulas and community birth workers in abortion and contraception care: An international scoping review

OBJECTIVES

Equitable and safe access to abortion and contraception is essential to protecting reproductive autonomy. Despite this, barriers to access remain. Nonclinical support people, may be able to facilitate access to abortion and contraception services and care, but evidence on the scope and efficacy of doulas in abortion and contraception care is lacking. The aim of this scoping review was to synthesize what is known about the role of doulas in abortion and contraception care.

STUDY DESIGN

We followed the Joanna Briggs Institute methodology for scoping reviews. A clinical librarian performed an initial search of all relevant databases. Three reviewers independently screened the titles and abstracts for assessment against the inclusion and exclusion criteria. The populations of interest included doulas, and/or untrained birth attendants and birth companions, and patients who use doula services. The concept of interest was the doula and the context was access to abortion or contraception.

RESULTS

Our review identified relevant studies conducted in different countries, published between 1976 and 2023. Studies broadly focused on three key themes: doulas performing procedural abortions, doulas supporting abortion care, and doulas supporting contraception. Outcomes of interest included client outcomes, barriers to access, doula training, and attitudes.

CONCLUSIONS

Doulas have the potential to improve client satisfaction and mitigate barriers to accessing abortion and contraception services. Further research is needed to identify the training needs of doulas, the potential for their integration into interdisciplinary care teams, and the role in supporting medication abortion.

Factors influencing contraceptive utilisation among postpartum adolescent mothers: a cross sectional study at China-Uganda friendship hospital

BACKGROUND

Globally, modern contraceptives remain underutilized among postpartum mothers resulting in the rise of short birth intervals. While there are a range of other factors that moderate the uptake of contraceptive services, understanding the significance of their influence is critical in public health programming. This study sought to analyze maternal and health facility factors influencing the utilization of contraceptives among postpartum mothers in urban areas of Uganda.

METHODS

Using a cross-sectional study design, a health facility-based study in urban areas of Kampala was conducted from January to March 2023. A total of 332 women aged between 15 and 22 years were randomly selected for the interviews using semi-structured questionnaires. The data was analyzed using a statistical software program R version 4.1.2. Chi-square and multivariable logistic regression were used to determine factors associated with postpartum contraceptive intake among adolescent mothers.

RESULTS

Overall, 28.3% of contraceptive usage was reported in the current study. The majority of the respondents, 98 (29.52%), were within the age group of 17-18 years, and the unmarried were 255 (76.81%). Factors associated with contraception use were income below UgX 500,000 (OR 4.546; CI 1.785-12,193, p = 0.002), occupation status of housewife and student (OR: 3.526; CI: 1.452-8.812, p = 0.006), distance of less than 5 km from health facility (OR: 2.62; CI 1.97-3.55; p = 0.028), and having a contraceptive preference (OR: 3.526; CI: 1.452-8.812, p = 0.006).

CONCLUSIONS

Contraceptive use is low among adolescent post-partum mothers. Income, occupation status, proximity to a health facility, and preference for a particular contractive method are factors associated with contraceptive use in this study. Understanding attitudes and views regarding contraception use is therefore essential for creating effective interventions, given the detrimental effects of adolescent pregnancy.

Evaluation of telemedicine for contraceptive counseling given to pregnant women during the COVID-19 pandemic: A randomized controlled trial

In this study, we aimed to evaluate the impact of telemedicine for contraceptive counseling on knowledge levels and satisfaction with Family Planning Services. We collected data from 77 third-trimester pregnant women using a personal information form, Family Planning Knowledge Questionnaire, and the Satisfaction with Family Planning Services Scale and compared the data using chi-square test, Fisher's exact chi-square test, t-test for independent and dependent groups and Mann-Whitney U analysis. The experimental group participants (n = 37) received two informative video visits for contraceptive counseling, while the women in the control group (n = 40) received routine face-to-face Family Planning Services at their primary health care center. Participants in the experimental group showed a greater increase in knowledge levels and higher satisfaction with Family Planning Services than those in the control group (p < 0.05). In conclusion, we determined that telemedicine for contraceptive counseling is a promising option even beyond the pandemic.

Understanding the association between family planning and fertility reduction in Southeast Asia: a scoping review

OBJECTIVES

We aimed to explore and understand the extent and type of evidence on fertility reduction and its association with family planning (FP) in Southeast Asia.

DESIGN

Scoping review, following the methodological principles developed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines for reporting.

DATA SOURCE

We searched PubMed/MEDLINE, ProQuest, EBSCO, Scopus, Web of Science, Google Scholar and reference lists of relevant articles between 1 January 2012 and 31 December 2022. Only open-access articles in English were considered.

STUDY SELECTION

For inclusion, observational studies were selected for eligibility based on the original articles investigating the uptake of FP on women aged 15-49 years and its association with fertility decline in Southeast Asian (SEA) countries.

DATA EXTRACTION AND ANALYSIS

Two reviewers screened the records independently for eligibility and extracted all data. The specific details of the studies, including data on the authors, year of publication, setting, study design, aims/objectives of the study, specific intervention, outcomes and main findings, were reported.

RESULTS

We retrieved 615 articles and retained 12 articles included in the analysis. Of these, 11 were quantitative studies and 1 was qualitative study. The frequently reported strategy of FP was the use of contraception. FP not only allows women to control their birth by spacing and limiting their pregnancies but also delay their first childbirth by using contraceptive methods.

CONCLUSION

Our review suggests that the FP programmes aiming at reducing fertility should have a specific focus on improving the uptake and continuation of FP services.

"The burden is upon your shoulders to feed and take care of your children, not religion or culture": qualitative evaluation of participatory community dialogues to promote family planning's holistic benefits and reshape community norms on family success in rural Uganda

BACKGROUND

Family planning has significant health and social benefits, but in settings like Uganda, is underutilized due to prevalent community and religious norms promoting large family size and gender inequity. Family Health = Family Wealth (FH = FW) is a multi-level, community-based intervention that used community dialogues grounded in Campbell and Cornish's social psychological theory of transformative communication to reshape individual endorsement of community norms that negatively affect gender equitable reproductive decision-making among couples in rural Uganda.

METHODS

This study aimed to qualitatively evaluate the effect of FH = FW's community dialogue approach on participants' personal endorsement of community norms counter to family planning acceptance and gender equity. A pilot quasi-experimental controlled trial was implemented in 2021. This paper uses qualitative, post-intervention data collected from intervention arm participants (N = 70) at two time points: 3 weeks post-intervention (in-depth interviews, n = 64) and after 10-months follow-up (focus group discussions [n = 39] or semi-structured interviews [n = 27]). Data were analyzed through thematic analysis.

RESULTS

The community dialogue approach helped couples to reassess community beliefs that reinforce gender inequity and disapproval of family planning. FH = FW's inclusion of economic and relationship content served as key entry points for couples to discuss family planning. Results are presented in five central themes: (1) Community family size expectations were reconsidered through discussions on economic factors; (2) Showcasing how relationship health and gender equity are central to economic health influenced men's acceptance of gender equity; (3) Linking relationship health and family planning helped increase positive attitudes towards family planning and the perceived importance of shared household decision-making to family wellness; (4) Program elements to strengthen relationship skills helped to translate gender equitable attitudes into changes in relationship dynamics and to facilitate equitable family planning communication; (5) FH = FW participation increased couples' collective family planning (and overall health) decision-making and uptake of contraceptive methods.

CONCLUSION

Community dialogues may be an effective intervention approach to change individual endorsement of widespread community norms that reduce family planning acceptance. Future work should continue to explore innovative ways to use this approach to increase gender equitable reproductive decision-making among couples in settings where gender, religious, and community norms limit reproductive autonomy. Future evaluations of this work should aim to examine change in norms at the community-level.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT04262882).

Women's health and rights in the twenty-first century

In the twenty-first century, the complex relationship between women's health and rights has been influenced by a range of interconnected challenges, including gender inequity, reproductive health disparities, maternal mortality and morbidity, and women's inability to access life-saving, high-quality healthcare services including family planning. Going forward, the world needs to find ways to implement the unfinished agenda of the International Conference on Population and Development (ICPD) 1994 and the Sustainable Development Goals (SDGs), thus prioritizing health and rights for women and girls as essential not only to their survival but also to their progress, agency and empowerment. It is also important to consider the interconnection between women's health and rights and climate change, with its disproportionate impact on the well-being of girls and women, and to address the impact and opportunities afforded by digital technologies. By embracing a holistic approach, societies might be able to advance the cause of women's health and rights in a more inclusive and sustainable manner.

The Challenge Initiative: Lessons on Rapid Scale-Up of Family Planning and Adolescent and Youth Sexual and Reproductive Health Services

The articles in this supplement showcase The Challenge Initiative’s strategies and insights for sustainably scaling evidence-based family planning and adolescent and youth sexual and reproductive health interventions and emphasize the need for multipronged interventions that address the complex web of factors influencing adolescents’ and youth’s access to contraceptive services.

Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol

INTRODUCTION

While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?"

METHODS

We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why.

DISCUSSION

Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context.

REGISTRATION

This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).

Use of family planning information by primary healthcare clinic managers in South Africa

BACKGROUND

Routine family planning data in South Africa are managed using a routine health information system, which facilitates data collection, storage, processing, presentation and dissemination. Healthcare providers generate data daily as they carry out their duties. The information generated should be used for planning and evaluating health program performance and policy development.

OBJECTIVE

To explore the use of family planning information by primary healthcare (PHC) clinic managers in South Africa.

METHOD

A qualitative descriptive exploratory study was carried out in 11 PHC clinics in Tshwane District. Individual semi-structured interviews were conducted with 11 clinic managers. The data were analysed using a thematic analysis approach.

RESULTS

Managers used the information to disseminate performance and feedback, monitor the program's performance and make decisions to improve the family planning service. However, they experienced challenges that hampered the effective use of the information.

CONCLUSION

The use of family planning information is critical for improving the performance of the program. The clinics need sufficient skilled healthcare providers who are able to provide comprehensive family planning and generate accurate and reliable information that can be used to improve the service. Collaboration between the private and public sectors is critical in monitoring the program's performance.

Factors associated with modern contraceptive utilization among reproductive age women in Kenya; evidenced by the 2022 Kenyan demographic and health survey

BACKGROUND

Globally, sexual and reproductive health is a significant public health issue for women of the reproductive age group. A modern contraceptive method enables individuals and families to manage fertility by reducing unintended pregnancies, abortions, pregnancy-related morbidity, and death. A modern contraceptive method is a drug or medical treatment that prevents sexual activity from leading to pregnancy. However, there is limited reliable and updated data on factors associated with modern contraceptive utilization among reproductive-age women at the national level in Kenya. So, the major goal of this study was to evaluate factors associated with modern contraceptive utilization among women of reproductive age in Kenya at the national level, as evidenced by the 2022 Kenyan demographic and health survey.

METHODS

The most recent datasets from the Kenyan Demographic and Health Survey were used for secondary data analysis. In all, 14,987 women of reproductive age participated in the investigation. Data for multivariable analysis on the factors influencing modern contraceptive utilization among Kenyan women of reproductive age can be obtained from the Kenyan Demographic and Health Survey. Finally, the odd ratio and percentages were presented along with their 95% confidence intervals.

RESULT

This study includes a total weighted sample of 14,987 reproductive-age women from the Kenyan demographic and health survey. Of the total contraceptive use, 90.1% of the study participants used modern contraceptives. Being married [AOR: 1.593, 95% CI (1.302, 1.948)], living in an urban area [AOR: 1.230, 95% CI (1.060, 1.428)], reading a magazine [1.002, 95% CI (0.921, 1.091)], listening to radio [AOR: 1.265, 95% CI (1.101, 1.454)], not breastfeeding [AOR: 1.296, 95% CI (1.114, 1.507), and having more than two children [AOR: 2.350, 95% CI (1.603, 3.445)] were the factors that promote modern contraceptive utilization. Conversely, having a history of terminated pregnancy [AOR: 0.767, 95% CI (0.657, 0.897), being Muslim [AOR: 0.566, 95% CI (0.418, 0.766)], and being in the 35-39 age range [AOR: 0.766, 95% CI (0.605, 0.971)] were all associated with a lower use of modern contraceptives.

CONCLUSION

Certain factors such as marriage, living in urban areas, having more than two children, having a female-led household, belonging to the middle class, reading magazines, listening to the radio, and not breastfeeding have a positive correlation with the use of modern contraceptives. Conversely, being a Muslim, aged between 35 and 39, and having a history of miscarriages are negatively correlated with the use of modern contraceptives. This indicates that addressing socioeconomic, geographic, and cultural barriers could improve the effectiveness of modern contraceptive.

Effect of postpartum family planning intervention and associated factors during child immunization in Addis Ababa, Ethiopia

Introduction

World Health Organization (WHO) recommends postpartum family planning (PPFP) as a critical component of health care that has the potential to save millions of maternal and infant lives in low- and middle-income countries.

Methods

participants in our randomized, controlled trial were mothers coming for vaccination of their child in three selected health centers in Addis Ababa during the first 10 weeks postpartum. Eligible mothers were randomly assigned to intervention (pamphlet-supported counseling about the benefits of family planning) and non-intervention (routine care) arms. Data were collected when mothers came with their infants for a routine measles vaccination at nine months of life. Family planning (FP) use was compared between the groups using logistic regression, and bivariate and multivariate analyses. The study also used Kaplan Meier and Cox regressions to compare the median time of PPFP use and its correlation using SPSS version 26. The research was undertaken from December 2019 to June 2021.

Results

a total of 347 women (177 control, 170 intervention) enrolled in the study. Fifty-eight percent were 24-30 years old. Young age, knowledge about FP, previous use of an FP method, and being married were found to be independent predictors for PPFP use. When comparing intervention and non-intervention groups, there was no significant effect on contraceptive use (adjusted OR 0.633 [95% CI 0.385-1.040]).

Conclusion

pamphlet-supported counseling of mothers in the first 10 weeks postpartum did not increase PPFP at nine months postpartum. Successful interventions will likely require holistic strategies, especially in resource-limited settings. The trial had been registered with clinicaltrials.gov (NCT04521517) on September 24, 2019.

Determinants and Patterns of Contraceptive Use among Sexually Active Women Living with HIV in Ibadan, Nigeria

Background

Contraception is a strategy to meet the family planning goals of women living with human immunodeficiency virus (WLHIV) as well as to reduce the transmission of HIV. There is limited data from Nigeria, where HIV prevalent is the second-largest in the world. This study aimed to examine contraceptive use and identify factors influencing its use among sexually active WLHIV in Ibadan, Nigeria.

Methods

A facility-based cross-sectional study was conducted among 443 sexually active WLHIV across three HIV treatment centers in Ibadan, Oyo State. The inclusion criteria were WLHIV, aged 18-49 years, who asserted being fecund and sexually active. An adopted questionnaire was used to collect data, and the data was analyzedusing the Statistical Package for Social Sciences (SPSS) Windows version 25. Statistical significance was set at p < 0.05.

Results

Among sexually active WLHIV (n = 443), 73.1% used contraceptives, with 26.9% having unmet needs. The results revealed a significant association between employment status and the use of contraceptives (AOR = 2.150; 95% CI 1.279-3.612 p=0.004); accessibility to contraceptive methods and the use of contraceptives (AOR = 21.483; 95% CI 7.279-63.402 p=0.00). Also, a significant association was found between payment for service and contraceptive use (AOR = 14.343; 95% CI 2.705-76.051; p = 0.003). Previous reactions towards contraceptive use were also significantly associated with contraceptive use (AOR = 14.343; 95% CI 2.705-76.051 p = 0.003). The dual contraceptives usage rate was 30.7%.

Conclusions

Although contraceptive use among sexually active WLHIV was high, the study highlighted the need for increased adoption of dual contraceptive methods to mitigate the risk of unintended pregnancy and HIV re-infection among this population. It emphasized the importance of continuous sensitization and counseling services healthcare providers provide to promote contraceptive use among WLHIV.

Family planning saves maternal and newborn lives: Why universal access to contraception must be prioritized in national maternal and newborn health policies, financing, and programs

We highlight why integrating contraceptive services within maternal and newborn health programs is essential for improving outcomes. We offer effective, actionable recommendations that can be implemented easily.

Contraceptive uses among married women in Bangladesh: a systematic review and meta-analyses

BACKGROUND

Although Bangladesh's economy has shown significant improvement over the past two decades, the high population growth rate has hindered development efforts. This study aimed to review the prevalence of different contraceptive methods used among women of reproductive age in Bangladesh, which could help control the population growth rate.

METHODS

We conducted an extensive literature review and meta-analysis of 82 articles, identifying 20 articles for analysis. The analyses included heterogeneity and publication bias in published papers.

RESULTS

The pooled prevalence of various contraceptive methods was as follows: condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices (IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage, while traditional methods constituted 8.79%. On average, only 1.95% of women opted for the implant method. The overall prevalence of contraceptive method usage was 59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically significant heterogeneity for all contraceptive methods used by women in Bangladesh. The funnel plot and Egger's test showed no publication bias for any of the contraceptive methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by women in rural areas also showed publication bias (Z = -3.04, P = 0.0024).

CONCLUSION

A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies to ensure adherence to and provision of the most appropriate contraceptive method for couples.

The impact of accredited social health activists in India on uptake of modern contraception: A nationally representative multilevel modelling study

The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019-21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030.

Perceived self-efficacy and willingness to teach family planning among nursing and midwifery faculty in higher learning institutions in Rwanda

BACKGROUND

Promoting family planning (FP) is a key strategy for health, economic and population growth, and achieving sustainable development goals (SDGs) especially SDG 3, which promotes health and well-being for all. The quality of FP services depends on the training of competent nursing and midwifery graduates before entering the workforce. In order to ensure graduates are well-trained and capable of meeting the needs of the population, their teachers need to demonstrate high self-efficacy and willingness to teach FP. However, there is a lack of research on the capacity and willingness of nursing and midwifery faculty to teach FP at higher learning institutions (HLIs) in Rwanda. The objective is to investigate and articulate the perceived self-efficacy and willingness of the nursing and midwifery faculty to instruct HLIs students on FP.

RESEARCH DESIGN/METHODOLOGY

We conducted a mixed methods study using a sequential explanatory design among almost all the HLIs (n = 6, 1 institution declined) that train nurses and midwives in Rwanda. One hundred thirty-six nursing and midwifery faculty who were actively teaching FP either in class, simulation lab, or clinical practice were invited to participate in a self-administered questionnaire and four qualitative focused group discussions. Participants answered questions ranking their self-efficacy in four domains from 0 - not confident to 3 - completely confident. Scores were calculated for each domain. A semi-structured interview guide was developed based on quantitative survey findings to gain a deep understanding of the ability and willingness to teach FP. Data were analyzed using thematic analysis. Ethical approval was obtained from the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board.

RESULTS

A total number of 89 nursing and midwifery faculty participated in the study and only 85 completed the questionnaires fully, yielding a response rate of 95.5%. The mean age was 40.39 and there were more females (62.4%) compared to their male counterparts (37.6%). Respondents scored highest for perceived self-efficacy in course preparation (mean = 2.37), evaluation and examination (mean = 2.12) and instructor behavior and delivery (mean = 2.35). However, the score was low for clinical practices (mean = 1.79). There was a significant correlation among the four items of self-efficacy (p < 0.05). Being a female, a midwife, and having more years of experience in nursing education were each significantly associated with perceived self-efficacy to teach FP (p < 0.05). In the qualitative phase, 32 study participants participated in four focus group discussions. Four themes were identified: (a) educational background as a determinant of confidence to teach FP; (b) willingness to teach FP; (c) enabling factors of teaching FP; and (d) structural challenges.

CONCLUSION

Nursing and midwifery faculty reported inadequate self-confidence in teaching FP in clinical practice. Addressing personal and structural challenges in teaching FP should be a top priority. This requires a collective effort between nursing and midwifery faculty and HLIs to dismantle individual and systemic barriers that hinder self-efficacy and willingness to teach FP. There is a need for HLIs and different stakeholders to invest in training the nursing and midwifery faculty on FP practical skills to have a nursing and midwifery workforce providing up-to-date clinical FP services that will help Rwanda reach the SDGs.

Time to initiation of modern contraceptive method use after childbirth and its predictors in Southern Ethiopia: a retrospective follow-up study

BACKGROUND

Timely initiation of modern contraceptive use is vital to prevent unintended pregnancy and its related morbidities and mortalities. However, there is a scarcity of evidence about the duration of time elapsing from childbirth to initiating modern contraceptive use following childbirth and its associated factors in the study area for evidence-based interventions. Therefore, we aimed to assess the time to initiation of modern contraceptive method use and its predictors in Hossana town, southern Ethiopia.

METHODS

A retrospective follow-up study was conducted at public health facilities in Hosanna town. A total of 503 study participants were included in the study using a systematic random sampling technique. The Box and Whisker plot was used to estimate the time to initiation of modern contraceptive use. A Weibull regression model was applied to identify predictors of time to initiation of modern contraceptive use. Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was used to interpret the strength of the association.

RESULTS

The median time to initiation of modern contraceptive use was 6 months, with an interquartile range of 3 months. Husband/partner attending higher education [AHR = 1.64, 95% CI: 1.04, 2.57], women who had parity of more than two [AHR = 1.93, 95% CI: 1.01, 3.67], and women who had communicated with their husband/partner about modern contraceptive methods [AHR = 3.03, 95% CI: 1.41, 6.67] were more likely to initiate modern contraceptive method use within six months after childbirth. In contrast, women with an older age of greater than or equal to 30 years [AHR = 0.32, 95% CI: 0.13, 0.82] and who did not resume sexual intercourse after childbirth [AHR = 0.02, 95% CI: 0.01, 0.03] were less likely to initiate modern contraceptive method use within six months after childbirth.

CONCLUSIONS

The median time to initiation of modern contraceptive method use after childbirth in the postpartum period was delayed from the World Health Organization recommendation of at most 6 weeks. Emphasis should be given to older women, women with lower parity, and men's participation in contraceptive communication to improve timing for initiation of modern contraceptive use after childbirth and to curb the five-month lag periods.

Prevalence and factors associated with female sterilization in Rwanda: evidence from the demographic and health survey data (2019-2020)

BACKGROUND

Female sterilization is a safe and effective surgical procedure of achieving contraception. There is disparity in the prevalence of female sterilization globally, with high income countries having higher rates than low- and middle-income countries. However, current evidence of the uptake of female sterilization in Rwanda is not known. We therefore evaluated the prevalence and factors associated with female sterilization among women of reproductive age in Rwanda.

METHODOLOGY

This was a secondary data analysis of 14,634 women of reproductive age (15-49) in Rwanda. The data utilized was from the Rwanda Demographic Health and Survey (RDHS) 2019/2020. The predictors of female sterilization were determined using multivariable binary logistic regression analysis.

RESULTS

We found that the prevalence of female sterilization was 1.1% among women of reproductive age in Rwanda. Women older than 35 years had about 8 times higher chance of being sterilized as compared to younger women (aOR: 7.87, 95% CI: 4.77-12.99). Women living with their partners had higher odds of being sterilized as compared to never married women (aOR: 19.23, 95% CI: 4.57-80.82), while women from minority religion are more likely to be sterilized as compared to those of the catholic religion (aOR: 2.12, 95% CI: 1.03-4.37). Women from rich household had a higher chance to be sterilized as compared to their counterparts from poor households (aOR: 3.13, 95% CI: 1.94-5.03). Women from the Western region were more likely to accept sterilization compared to women from Kigali (aOR: 2.025, 95% CI: 1.17-3.49) and women who had more than 5 children had higher odds when compared to women who had 5 or less children (aOR: 1.49, 95% CI: 1.06-2.10).

CONCLUSION

The overall prevalence of sterilization among Rwandan women of reproductive age was 1.1%, which was very low as compared to India (29%), China (14.1%) and United States of America (13.7%). The age, marital status, religion, household wealth quintile, region and children ever born were associated with the uptake of female sterilization among Rwandan women. Public awareness campaign on the advantages of female sterilization should be done to improve uptake.

Women's Perception of Using Modern Family Planning Methods in Wete District, Pemba, Tanzania

Background

Only 11% of women use family planning in Pemba, Tanzania. Among them, 9% use modern family planning (FP). Inadequate use of modern FP in the area may result in rapid population increase and attendant negative impact on social and economic development in the country.

Methods

An exploratory descriptive study was conducted in Wete District, Pemba. Thirty-eight women aged between 20 to 49 years were conveniently recruited for the study. The saturation was achieved with 4 FGDs and thematic framework guided analysis of data.

Results

Modern FP methods are available and accessible in all government healthcare facilities in Pemba. However, some women perceived that modern FP are effective and others think they are ineffective in preventing pregnancy. Male dominancy, religious beliefs, polygamy, and the economy influence the low uptake of modern FP.

Conclusion

Modern FP methods are widely accessible for free in Wete Pemba; however, their low uptake is influenced by social-cultural and economic factors. Community-based education on the benefit of Modern FP will facilitate positive perceptions of using modern FP and increase its use by women in Wete Pemba.

Level of knowledge, attitude, and practice on modern contraceptive method and its associated factors among housemaids living in Debre Tabor town, northwest Ethiopia: a community-based cross-sectional study

BACKGROUND

Contraception is widely recognized as an effective technique for avoiding unplanned pregnancies and sexually transmitted diseases. Promoting contemporary contraceptive methods would minimize the number of unplanned pregnancies and the high number of maternal fatalities connected with unsafe abortions.

OBJECTIVE

This study aims to assess the level of knowledge, attitude, and practice of modern contraceptive methods and its associated factors among housemaid residents of Debre Tabor Town, northwest Ethiopia: METHODS: A structured questionnaire supplemented with face-to-face interviews was used to conduct a community-based cross-sectional study with 423 housemaids' women of reproductive age in Debre Tabor City. The data were analyzed using descriptive analysis, binary analysis, and multivariable logistic regression.

RESULTS

A 12.8% of respondents in this study used modern contraceptive methods. A 44.68% of study participants had good knowledge of modern contraceptive methods, and 36.40% had a positive attitude towards them. Housemaids' older age, urban location, educational status, work experience, and family situation were found to be positive predictors of a good understanding of current contraceptive techniques. Housemaids' older age, urban residence, educational level, work experience, family situation, and first sex before now are all positive predictors of a positive attitude and good practices.

CONCLUSIONS

Housemaids' knowledge, attitude, and practice of modern contraceptive methods were influenced by a variety of socio-demographic factors. As a result, housemaids should be educated about modern contraceptive methods by the health sector and other stakeholders to improve their knowledge, attitude, and practices.

Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review

BACKGROUND

Demand generation aims to increase clients' desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning.

METHODS

We searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings.

RESULTS

Forty-six studies (published 1990-2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services.

CONCLUSIONS

Demand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization.

TRIAL REGISTRATION

Systematic review registration: Center for Open Science, osf.io/286j5.

Changes of people's fertility attitudes based on analysis of online public opinion on three-child policy in China

In response to the population aging, on May 31, 2021, the Political Bureau of the Central Committee of the Communist Party of China (CPC) proposed the policy that a couple can have three children and rolled out more supportive measures to further optimize fertility policies, which is another major initiative following the universal two-child policy introduced in November 2015. Currently, a series of population policy innovations have aroused great attractions among the public and triggered a hot debating on the Internet. People's fertility attitude tendency under different related policies can reflect their current fertility intentions. Based on the fact, this paper firstly classifies the sentiment of online comment data on the three-child policy and analyzes people's sentiment tendency toward the three-child policy from the spatio-temporal perspectives. Secondly, people's points of view on the three-child policy are summarized by using Latent Dirichlet Allocation (LDA) thematic clustering. The reasons for the change in people's fertility attitude tendency under different fertility policies are analyzed by comparing the change in people's fertility attitude tendency with the change in people's attentions. Finally, a multiple regression equation is constructed to analyze the key factors influencing people's intention to have three children by using public opinion data and its extension data. The findings demonstrate: (1) people's fertility attitudes toward the three-child policy are negative and similar among different regions; (2) compared to the two-child policy, the percentage of negative and neutral attitudes toward the three-child policy increases, while the percentage of positive attitudes decreases; (3) the increase in fertility costs, the deterioration of women's employment environment, and the change in the concept of marriage and childbirth become important reasons for the negative change in people's fertility attitudes toward different policies. Therefore, the government should take measures to reduce the burden of childbirth and guide the correct concept of marriage and childbirth to improve people's fertility intentions.

The effect of social media entrepreneurship on sustainable development: Evidence from online clothing shops in Bangladesh

The study examines the effect of rural women's participation in social media entrepreneurship on sustainable development in Bangladesh. The study collects 376 responses from the entrepreneurs of online clothing shops employing the simple random sampling technique. The data analysis was conducted using the PLS-SEM technique using Smart PLS 3.3v software. Developing the quantitative research design, the authors test the conceptual model by employing the deductive approach. The study finds a positive effect of women's participation in social media entrepreneurship on sustainable development within online clothing shops in Bangladesh. Bangladesh is capable of creating employment opportunities for rural women through ICT project offerings. Consistently this study also proves social media entrepreneurship increases women's contribution to their family income. Furthermore, this study finds that rural women's family income contribution positively affects sustainable development in Bangladesh. The study can help to achieve SDG 5: Gender Equality and Vision 2041 of Bangladesh at the earliest. Thus, the government, policymakers, and academics can use the study findings as a policy dialogue.

Immediate postpartum family planning utilization and its associated factors among postpartum women in Ethiopia: a systematic review and meta-analysis

Background

Family planning integration in areas where women contact the healthcare system routinely is essential for addressing the high unmet need for family planning among postpartum women and reducing the risk of short interpregnancies. Immediate postpartum family planning (IPPFP) is an integrated service, and opportunities exist for women by providing family planning (FP) counseling and contraceptives as part of care following childbirth within 48 h. Therefore, this review aimed to assess the pooled estimate of immediate postpartum family planning utilization and its associated factors in Ethiopia.

Method

Electronic databases were used to conduct an extensive search of all published studies, and the digital library was used to identify any unpublished studies. An observational study that reports the prevalence/magnitude and/or associated factors/predictors/determinants of IPPFP utilization in Ethiopia was included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA Version 11. A random-effects model was applied to determine the pooled prevalence of immediate postpartum family planning utilization with a 95% confidence interval (CI). Inverse variance (I2) was used to identify the presence of heterogeneity, and a funnel plot and Egger's test were used to check the presence of publication bias. Subgroup analysis was conducted based on the sample size, region, and year of study to identify the source of heterogeneity.

Result

Of 15 primary studies, the overall pooled prevalence of immediate postpartum family planning utilization among postpartum women in Ethiopia was 21.04% (95% CI: 13.08, 29.00). Received counseling on FP [OR: 3.59; 95% CI (1.84, 7.01; P < 0.001), having a positive attitude toward FP [OR: 3.2; 95% CI (1.23, 8.35); P = 0.017], and partner support to use FP [OR: 5.85; 95% CI (1.12, 30.54; P = 0.036) were significant predictors of immediate postpartum family planning utilization.

Conclusion

Generally, IPPFP utilization in Ethiopia was insufficient. Therefore, to enhance the utilization, integrating FP counseling at all maternal service care points, strengthening community awareness to develop a favorable attitude toward family planning, and promoting partner involvement in family planning counseling are essential.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239053, identifier: CRD42021239053.

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

OBJECTIVE

To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort.

METHODS

Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors.

RESULTS

The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6).

CONCLUSIONS

Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan

BACKGROUND

Population growth in Pakistan necessitates the implementation of comprehensive family planning (FP) initiatives. The adoption of modern contraceptives, especially long-acting reversible contraceptives (LARC), and permanent family planning methods in the country is challenging and has yet to reach an optimal level. These challenges are deeply rooted in the lack of informed decision-making, as well as demographic and maternal obstetric history. Interventions tailored according to women's needs can address the challenges faced by FP programs. This paper presents the findings of the implementation of a client-centered counseling and facilitation approach in an urban slum in Karachi, Pakistan. Such an approach has the potential to inform women and help them make better decisions regarding their health.

METHODS

In Rehri Goth, a slum located in Karachi, client-centered counseling along with facilitation at the facility was implemented to encourage the adoption of any modern contraceptive methods, with a specific emphasis on promoting the use of LARCs and permanent methods (where needed) among married women of reproductive age (MWRA). This approach was integrated into the existing Maternal, Neonatal, and Child Health (MNCH) services established in 2014. During the routine delivery of services, data were collected on various aspects including demographic characteristics, obstetric history, motivation to adopt LARCs, and reasons for refusal.

RESULTS

A total of N = 3079 eligible MWRA received client-centered counseling, and 60.3% accepted modern contraceptive methods after counseling. Furthermore, 32.5% of these MWRA adopted LARCs or permanent methods. Factors explaining reluctance to adopt any method by MWRA despite specialized counselling were: age >25 years (AOR:1.28, 95% CI:1.08-1.51), no formal education (AOR:1.58, 95% CI:1.36-1.89), having no decision making role at household (AOR:1.60, 95% CI:1.36-1.89), the desire of female or male progeny (AOR:1.86, 95% CI:1.59-2.25) and age of youngest alive ≥3 years (AOR:1.50, 95% CI:1.22-1.84). Factors explaining adoption of short-term methods instead of LARCs or permanent method were: being resident in high under-five mortality clusters (AOR:1.56, 95% CI:1.14-2.14), maternal age > 25 years (AOR:1.88, 95% CI: 1.47-2.40), no decision-making role (AOR:11.19, 95% CI:8.74-14.34), no history of abortions (AOR:2.59, 95% CI:1.79-3.75), no female child (AOR:1.85, 95% CI:1.30-2.65) and ≤ 2 children (AOR:1.74, 95% CI:1.08-2.81).

CONCLUSION

Considering the obstacles mothers face when it comes to accessing extended contraception, public health officials can devise effective strategies that empower MWRA to make well-informed and empowered choices regarding their families and reproductive health.

Modern contraceptive method utilization and determinant factors among women in Ethiopia: Multinomial logistic regression mini- EDHS-2019 analysis

BACKGROUND

Globally, approximately 290,000 women between the ages of 15 and 49 died from pregnancy-related problems in 2014 alone, with these sub-Saharan Africa accounts for 65% (179,000) of the deaths. Although studies are conducted on modern contraceptives, information is scarce on multinomial regression analysis at the national level data. Therefore, this study aimed to assess modern contraceptive method utilization and determinant factors among women in Ethiopia.

METHODS

Data for this study were extracted from the national representative 2019 Ethiopian Mini Demographic and Health Survey. Data was collected using a 2-stage cluster design, in which enumeration areas formed the first stage and households made the second stage. The survey was conducted from March 21, 2019, to June 28, 2019. The analysis was done using multinomial logistic regression using STATA software version 14. The overall categorical variables with a P value of < 0.25 at the binomial analysis were included in the final model of the multinomial logistic regression model in which odds ratios with 95% CIs were estimated to identify the independent variables of women's modern contraceptive utilization. P values less than 0.05 were used to declare statistical significance. All analysis was done on weighted data.

RESULTS

A total of 8885 (weighted) participants were included in the current study from these,. The current study revealed that the prevalence of modern contraceptive utilization was 28.1% (95%CI: 27.6.7-28.6%). Factors like: women 25 to 34 years (aRRR = 1.5;95% CI:1.2-1.9), 35 to 44 years (aRRR = 2.4; 95% CI: 3.3-5.4), and greater than 45 years (aRRR = 2.9; 95% CI: 2.2-3.7); place of residence (rural; aRRR = 0.89; 95% CI 0.81-0.99), higher educational status (aRRR = 0.035;95%CI:0.61-0.98), grandmultipara (aRRR = 1.73;95%CI:1.6-1.9), and wealth index (poorer aRRR = 0.541;95%CI:0.46-0.631.9) were the factors significantly associated with the outcome variable.

CONCLUSIONS

In this, modern contraceptive utilization is low as compared to other countries. It was influenced by age, place of residence, education, the number of children, and wealth index. This suggests that creating awareness of contraceptive utilization is paramount for rural residence women by policymakers and health managers to empower women for family planning services. Moreover, all stakeholders, including governmental and nongovernmental organizations, better to emphasize on modern contraceptive use.

Implementation strategies, facilitators, and barriers to scaling up and sustaining post pregnancy family planning, a mixed-methods systematic review

BACKGROUND

Post pregnancy family planning includes both postpartum and post-abortion periods. Post pregnancy women remain one of the most vulnerable groups with high unmet need for family planning. This review aimed to describe and assess the quality of the evidence on implementation strategies, facilitators, and barriers to scaling up and sustaining post pregnancy family planning.

METHODS

Electronic bibliographic databases (MEDLINE, PubMed, Scopus, the Cochrane Library, and Global Index Medicus) were searched from inception to October 2022 for primary quantitative, qualitative, and mixed method reports on scaling up post pregnancy family planning. Abstracts, titles, and full-text papers were assessed according to the inclusion criteria to select studies regardless of country, language, publication status, or methodological limitations. Data were extracted and methodological quality assessed using the Mixed Methods Appraisal Tool. The convergent integrated approach and a deductive thematic synthesis were used to identify themes and sub-themes of strategies to scale up post pregnancy family planning. The health system building blocks were used to summarize barriers and facilitators. GRADE-CERQual was used to assess our confidence in the findings.

RESULTS

Twenty-nine reports (published 2005-2022) were included: 19 quantitative, 7 qualitative, and 3 mixed methods. Seven were from high-income countries, and twenty-two from LMIC settings. Sixty percent of studies had an unclear risk of bias. The included reports used either separate or bundled strategies for scaling-up post pregnancy family planning. These included strategies for healthcare infrastructure, policy and regulation, financing, human resource, and people at the point of care. Strategies that target the point of care (women and / or their partners) contributed to 89.66% (26/29) of the reports either independently or as part of a bundle. Point of care strategies increase adoption and coverage of post pregnancy contraceptive methods.

CONCLUSION

Post pregnancy family planning scaling up strategies, representing a range of styles and settings, were associated with improved post pregnancy contraceptive use. Factors that influence the success of implementing these strategies include issues related to counselling, integration in postnatal or post-abortion care, and religious and social norms.

TRIAL REGISTRATION

Center for Open Science, OSF.IO/EDAKM.

Effects of continuum of care for maternal health service utilisation on intention to use family planning among pastoralist women of Ethiopia: a robust regression analysis and propensity score matching modelling

OBJECTIVES

This study examines the effect of continuum care for maternal health service utilisation on intention to use family planning among the pastoralist community in Ethiopia.

DESIGN

A community-based cross-sectional study.

SETTING

Data were collected from three districts of the pastoralist community of the Afar region.

PARTICIPANTS

Randomly selected 891 married pastoralist women.

PRIMARY OUTCOME

Intention to use family planning.

RESULTS

Intention to use family planning would increase (β=0.122, 95% CI: 0.036, 0.287) or by 12.2%, if all married pastoralist women received continuum of care for maternal health service utilisation compared with their counterparts. Results from the robust regression analysis indicate that intention to use family planning was higher among women who had a discussion about family planning with their husband (β=0.31, SE=0.035, p<0.001), women who possessed an electronic devices (β=0.096, SE=0.029, p<0.001) and women who had an unmet need for family planning (β=0.056, SE=0.026, p<0.000). However, intention to use family planning was lower for women who were in a polygamous marriage (β=-0.168, SE=0.065, p<0.01). There was a significant linear increase in the score of intention to use family planning for attitude towards family planning (β=0.009, SE=0.001, p<0.000), subjective norm (β=0.003, SE=0.001, p<0.003) and perceived control over family planning (β=0.002, SE=0.008, p<0.024) given other explanatory variables in the model.

CONCLUSION

Continuum of care for maternal health service utilisation increases pastoralist women's intention to use family planning. Maximising any opportunity to counsel women who come to health facilities about family planning would be vital to increase their intention to use family planning.

TRIAL REGISTRATION NUMBER

NCT03450564.

A narrative review of evidence to support increased domestic resource mobilization for family planning in Nigeria

BACKGROUND

Family planning (FP) is an important public health intervention that is proven to reduce unplanned pregnancies, unsafe abortions, and maternal mortality. Increasing investments in FP would ensure stability and better maternal health outcomes in Nigeria. However, evidence is needed to make a case for more domestic investment in family planning in Nigeria. We undertook a literature review to highlight the unmet needs for family planning and the situation of its funding landscape in Nigeria. A total of 30 documents were reviewed, including research papers, reports of national surveys, programme reports, and academic/research blogs. The search for documents was performed on Google Scholar and organizational websites using predetermined keywords. Data were objectively extracted using a uniform template. Descriptive analysis was performed for quantitative data, and qualitative data were summarized using narratives. Frequencies, proportions, line graphs and illustrative chart were used to present the quantitative data. Although total fertility rate declined over time from 6.0 children per woman in 1990 to 5.3 in 2018, the gap between wanted fertility and actual fertility increased from 0.2 in 1990 to 0.5 in 2018. This is because wanted fertility rate decreased from 5.8 children per woman in 1990 to 4.8 per woman in 2018. Similarly, modern contraceptive prevalence rate (mCPR) decreased by 0.6% from 2013 to 2018, and unmet need for family planning increased by 2.5% in the same period. Funding for family planning services in Nigeria comes from both external and internal sources in the form of cash or commodities. The nature of external assistance for family planning services depends on the preferences of funders, although there are some similarities across funders. Irrespective of the type of funder and the length of funding, donations/funds are renewed on annual basis. Procurement of commodities receives most attention for funding whereas, commodities distribution which is critical for service delivery receives poor attention.

CONCLUSION

Nigeria has made slow progress in achieving its family planning targets. The heavy reliance on external donors makes funding for family planning services to be unpredictable and imbalanced. Hence, the need for more domestic resource mobilization through government funding.

Predictors of Knowledge, Attitude, and Practice (KAP) Towards Family Planning (FP) Among Pregnant Women in Fiji

OBJECTIVE

This study aimed to determine the predictors of Knowledge, Attitude and Practice (KAP) towards Family Planning (FP) among pregnant Fijian women.

METHODS

A cross-sectional study was conducted over two months in 2019 with adult pregnant women attending the Antenatal Clinic (ANC) at Ba Mission Hospital (BMH), Fiji. Data was collected using a self-administrated questionnaire. Statistical analysis included correlation tests and regression analysis in determining predictors of KAP.

RESULTS

240 pregnant women participated in this study with a mean age of 26.02 (± SD = 4.13). The results showed a moderate level of knowledge (mean 14.95, SD ± 3.15), positive attitude (mean 20.56, SD ± 5.68), and good practice (mean 4.97, SD ± 1.73). Linear regression identified that women with more than seven children had a knowledge score of 3.65, lower than null parity (t value = -2.577, p = 0.011). Women aged 20 to 24 had a 6.47 lower attitude score than women aged 18 to 19 (t value = -2.142, p = 0.033). Women in defacto relationships had a 2.12 lower attitude score compared to the married category (t value = -2.128, p = 0.034). Fijian women of Indian descent had a 1.98 lower attitude score than the I Taukei women (t value = -2.639, p = 0.009). Women aged 30-34 had 2.41 lower practice scores than those aged 18-19 (t value = -2.462, p = 0.015).

CONCLUSION

This study found a medium knowledge of FP among pregnant women. These findings support a recommendation for further research to implement effective strategies.

Socio-economic inequalities in non-use of modern contraceptives among young and non-young married women in India

BACKGROUND

It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities.

METHODS

The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study.

RESULTS

The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p < 0.001). Women from non-young age group had 39% significantly lower odds of non-use of modern contraceptive use than women from young age group (15-24 years) [AOR: 0.23; CI: 0.23, 0.23]. The value of concentration quintile was -0.022 for young and -0.058 for non-young age groups which also confirms that the non-use of modern contraceptives was more concentrated among women from poor socio-economic group and the inequality is higher among non-young women compared to young women. About 87.8 and 55.5% of the socio-economic inequality was explained by wealth quintile for modern contraceptive use in young and non-young women. A higher percent contribution of educational status (56.8%) in socio-economic inequality in non-use of modern contraceptive use was observed in non-young women compared to only -6.4% in young women. Further, the exposure to mass media was a major contributor to socio-economic inequality in young (35.8%) and non-young (43.2%) women.

CONCLUSION

Adverse socioeconomic and cultural factors like low levels of education, no exposure to mass media, lack of or limited knowledge about family planning, poor household wealth status, religion, and ethnicity remain impediments to the use of modern contraceptives. Thus, the current findings provide evidence to promote and enhance the use of modern contraceptives by reducing socioeconomic inequality.

Male Involvement in Family Planning Decisions in Malawi and Tanzania: What Are the Determinants?

The participation of males in joint spousal decisions is urgently needed in achieving the fundamental indicators of reproductive health. The low involvement of males in family planning (FP) decision-making is a major determining factor in low FP usage in Malawi and Tanzania. Despite this, there are inconsistent findings regarding the extent of male involvement and the determinants that aid male participation in FP decisions in these two countries. The objective of this study was to assess the prevalence of male involvement in FP decisions and its associated determinants within the household context in Malawi and Tanzania. We used data from the 2015-2016 Malawi and Tanzania Demographic and Health Surveys (DHSs) to examine the prevalence and the determinants inhibiting male involvement in FP decisions. The total sample size of 7478 from Malawi and 3514 males from Tanzania aged 15-54 years was employed in the analysis by STATA version 17. Descriptive (graphs, tables and means), bi-variate (chi-square) and logistic regression analyses (unadjusted (U) and adjusted odds ratio (AOR)) were performed to identify the determinants associated with male involvement in FP decisions. The mean age of respondents in Malawi was 32 years (±8 SD) and in Tanzania, 36 years (±6 SD), with the prevalence of male involvement in FP decisions being 53.0% in Malawi and 26.6% in Tanzania. Being aged 35-44 years [AOR = 1.81; 95% CI: 1.59-2.05] and 45-54 years [AOR = 1.43; 95% CI: 1.22-1.67], educated (secondary/higher) [AOR = 1.62; 95% CI: 1.31-1.99], having access to media information [AOR = 1.35; 95% CI: 1.21-1.51] and having a female head of household [AOR = 1.79; 95% CI: 1.70-1.90] were determinant factors of male involvement in FP decisions in Malawi. Primary education [AOR = 1.94; 95% CI: 1.39-2.72], having a middle wealth index ranking [AOR = 1.46; 95% CI: 1.17-1.81], being married [AOR = 1.62; 95% CI: 1.38-1.90] and working [AOR = 2.86; 95% CI: 2.10-3.88] were higher predictors of male involvement in FP decisions in Tanzania. Increasing the role of males in FP decisions and involvement in FP utilization may improve uptake and continuity of FP usage. Therefore, the findings from this cross-sectional study will support redesigning the ineffective strategic FP programs that accommodate socio-demographic determinants that may increase the likelihood of male involvement in FP decisions, especially in the grassroots settings in Malawi and Tanzania.

Women's marital status and use of family planning services across male- and female-headed households in low- and middle-income countries

Background

As more households are being led by women, who are often seen as disadvantaged, more attention is being given to the potential association of female household headship with health. We aimed to assess how demand for family planning satisfied by modern methods (mDFPS) is associated with residence in female or male headed households and how this intersects with marital status and sexual activity.

Methods

We used data from national health surveys carried out in 59 low- and middle-income countries between 2010 and 2020. We included all women aged 15 to 49 years in our analysis, regardless of their relationship with the household head. We explored mDFPS according to household headship and its intersectionality with the women's marital status. We identified households as male-headed households (MHH) or female-headed households (FHH), and classified marital status as not married/in a union, married with the partner living in the household, and married with the partner living elsewhere. Other descriptive variables were time since the last sexual intercourse and reason for not using contraceptives.

Results

We found statistically significant differences in mDFPS by household headship among reproductive age women in 32 of the 59 countries, with higher mDFPS among women living in MHH in 27 of these 32 countries. We also found large gaps in Bangladesh (FHH = 38%, MHH = 75%), Afghanistan (FHH = 14%, MHH = 40%) and Egypt (FHH = 56%, MHH = 80%). mDFPS was lower among married women with the partner living elsewhere, a common situation in FHH. The proportions of women with no sexual activity in the last six months and who did not use contraception due to infrequent sex were higher in FHH.

Conclusions

Our findings indicate that a relationship exists between household headship, marital status, sexual activity, and mDFPS. The lower mDFPS we observed among women from FHH seems to be primarily associated with their lower risk of pregnancy; although women from FHH are married, their partners frequently do not live with them, and they are less sexually active than women in MHH.

Does Voluntary Family Planning Contribute to Food Security? Evidence from Ethiopia

This study aims to explore the effects of voluntary family planning (FP) utilization on food security in selected districts of Ethiopia. Quantitative research methods were used to conduct a community-based study among a sample of 737 women of reproductive age. The data were analyzed using a hierarchical logistic regression constructed in three models. The findings showed 579 (78.2%) were using FP at the time of the survey. According to the household-level food insecurity access scale, 55.2% of households experienced food insecurity. The likelihood of food security was lower by 64% for women who used FP for less than 21 months (AOR = 0.64: 95%CI: 0.42-0.99) in comparison to mothers who used FP for more than 21 months. Households having positive adaptive behaviors were three times more likely (AOR = 3.60: 95%CI 2.07-6.26) to have food security in comparison to those not having positive adaptive behaviors. This study also revealed that almost half of the mothers (AOR: 0.51: 95%CI: 0.33-0.80) who reported being influenced by other family members to use FP had food security, in comparison to their counterparts. Age, duration of FP use, positive adaptive behaviors, and influence by significant others were found to be independent predictors of food security in the study areas. Culturally sensitive strategies need to be considered to expand awareness and dispel misconceptions that lead to hesitancy around FP utilization. Design strategies should take into account households' resilience in adaptive skills during shocks, natural disasters, or pandemics which will be invaluable for food security.

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews

BACKGROUND

To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use.

METHODS

Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria.

FINDINGS AND CONCLUSION

Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.

Prevalence of discontinuation of contraceptives due to failure among women aged 14 to 49 years in Uganda: a nation wide cross-sectional survey

BACKGROUND

Sustained motivation is essential for effective use of contraceptive methods by women in low- and middle-income countries as many women are likely to abandon contraceptives, especially when they continually experience episodes of failure. We aimed to determine the prevalence of discontinuation of contraceptives due to failure and its associated factors among Ugandan women aged 14-49 years.

METHODS

A cross sectional study was conducted using the UDHS 2016 data. Multi stage stratified sampling was used to select participants. All eligible women aged 15 to 49 years at the time of the survey were enrolled. Bivariable and Multivariable logistic regression analysis were used to determine the factors associated with contraceptive failure. All analysis were done using Stata version 13. Contraceptive failure (getting pregnant while on contraceptives) within five years preceding the survey was the dependent variable.

RESULTS

A total of 9061 women were included in the study. The overall prevalence of contraceptive failure was 5.6% [n = 506, 95% CI: 5.1-6.1] and was higher (6.2%) among women aged 20-29 years or had completed secondary education (6.1%). Having informed choice on contraceptives [aOR = 0.59, 95% CI: 0.49 - 0.72] and older age [aOR = 0.46, 95% CI: 0.24-0.89] were associated with lower odds of contraceptive failure.

CONCLUSION

The burden of contraceptive failure among women of reproductive age in Uganda is substantial and significantly varied by women's age, level of education, exposure to the internet, mass media, and informed choice. These findings highlight the need for improved counseling services and contraceptive quality to help women and couples use methods correctly and consistently.

Getting Up to Date with What Works: A Systematic Review on the Effectiveness and Safety of Task Sharing of Modern Methods in Family Planning Services

Objective

This systematic review was conducted to provide up-to-date evidence on the safety and effectiveness of task sharing in the delivery of modern contraceptives. Study Design. The review followed the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. We searched Medline, Embase, Cochrane CENTRAL, and Google Scholar for peer-reviewed studies that reported on effectiveness and/or safety outcomes of task sharing of any modern contraceptive method. Only Cochrane Effective Practice of Organizations of Care (EPOC) study designs were eligible, and quality assessment of the evidence was performed using the Cochrane risk of bias (RoB) tools. Meta-analyses, where possible, were carried out using Stata, and certainty of the evidence for outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool (GRADE).

Results

Six studies met the inclusion criteria: five reported on self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to administered by trained health providers; and one assessed tubal ligation performed by associate clinicians compared to advanced-level associate clinicians. Self-injection improved contraceptive continuation, with no increase in unintended pregnancy and no difference in side effects compared to provider administered. In tubal ligation, the rate of adverse events, time to complete procedure, and participant satisfaction were similar among associate clinicians and advanced clinicians.

Conclusion

The evidence suggests that self-injection of DMPA-SC and tubal ligation performed by associate clinicians are safe and effective. These findings should be complemented with the evidence on the feasibility and acceptability of task sharing of these methods. The review protocol was registered with PROSPERO CRD42021283336.

Sexual and reproductive health of CDC plantation camp residents: a focus on unmet need for family planning among women in union

BACKGROUND

Sexual and reproductive health is crucial to a normal and healthy female life. However, little interest has been placed on this subject particularly in the resource-limited settings of Cameroon. The study assessed the sexual and reproductive health of women in union, resident in the Cameroon Development Corporation (CDC) plantation camps, Cameroon.

METHODS

This was a cross-sectional study carried out from December 2019 to February 2020 in which a multi-stage sampling was applied in two purposively selected CDC plantation camps (Tiko and Penda Mboko). Out of the 16 clusters making up the camps, 8 were randomly selected using simple balloting. The main street junctions of the sampled clusters were identified and a direction of sampling randomly chosen. All houses left to the data collectors were sampled for eligible participants (one participant per household) and data were collected using validated interviewer-administered questionnaires. The number of participants per cluster was proportionate to population size of cluster. Data was analysed using SPSS 16 and statistical significance was set at p < 0.05. Regression analysis was used to determine predictors of unmet need for family planning.

RESULTS

Out of the 414 participants included, primary education was the highest level of education for a majority (43.0%). Most of the participants (44.7%) earned between 44.5-89.0USD/month. Relatively high proportions of some sexual and reproductive indicators like early sexual contacts (before 15 years) [87(21.0%)], grand multiparity [41(9.9%)], and abortion ≥ 3 [8(1.9%)] were recorded in the study. Two hundred and seventy-eight (278) participants (67.1%) [95%CI:62.4-71.7] used contraceptives and 90 (21.7%) [95%CI:17.9-26.0] had an unmet need for family planning with 3 major reasons for non-use of contraception among them being fear of side effects, discouragement from the partner, and lack of sufficient information on contraception. Of the different predictors of unmet need for family planning assessed, nulliparity/primiparity were protective for unmet need, and this was statistically significant (AOR = 0.284[0.086-0.934]).

CONCLUSION

The sexual and reproductive health of CDC plantation camp residents is poor, and a health intervention is needed to improve it.