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Lemu YK, Terfa YB, Inkosa LT, Mohammed AA, Yadeta GB, Tulu YT, Negari DH, Mamo Y, Mamo A. Women's Experiences on Injectable Contraceptive Preference Among Jimma Town Public Health Facilities, Southwest Ethiopia 2023. A Phenomenological Study Design. Open Access J Contracept 2024; 15:1-12. [PMID: 38404542 PMCID: PMC10886205 DOI: 10.2147/oajc.s443453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 02/27/2024] Open
Abstract
Background Contraception is the information, devices, and medications that enable individuals to decide whether and when to have children. It is a cost-effective method of limiting and spacing childbirth. In Ethiopia, the prevalence of modern contraceptives is increasing, and injection contraceptives represent a high prevalence. However, it is unclear why the women preferred injection contraception. Objective To explore Women's experiences on contraceptive preference among Jimma town public health facilities, southwest Ethiopia, 2023. Methods An interpretative phenomenological study design was employed. Women aged between 18 and 49 who have been using injectable contraceptives for more than one year were our study population. Data were collected through in-depth interviews using an open-ended, structured interview guide. The purposive sampling technique was used to select 12 participants from three randomly selected public health facilities in Jimma town. Audio data were transcribed verbatim into word files, and finally, Atlas.ti 7.0 software was used to facilitate coding and categorizing. Results Twelve women who have been using injectable contraceptives for the last year were involved in this study. Religious beliefs, fear of side effects, visiting Arab countries, and previous contraceptive experiences were the main reasons for respondents to prefer injectable contraceptive methods. This study revealed that women were experiencing positive and negative effects while using injection contraceptives. The majority of the respondents felt comfortable and pleased and had not encountered any health-related issues since beginning to use injection contraceptives. Conclusion The key factors influencing respondents' preference for injection methods of contraception included fear of side effects, religious convictions, travel to Arab nations, and prior contraceptive experiences. The majority of respondents felt at ease and pleased and reported no substantial health difficulties associated with injection contraception, despite a few women reporting minor adverse effects. Therefore, switching to long-acting methods of contraception necessitates increased women's understanding of contraceptives.
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Affiliation(s)
- Yohannes Kebede Lemu
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Yonas Biratu Terfa
- School of Nursing, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Ahmed Andiye Mohammed
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Geremu Bayissa Yadeta
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Yidnekachew Tafesse Tulu
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Desalegn Hundera Negari
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Yiftusira Mamo
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Obong DT, Oyibo P. Family planning service availability and readiness assessment of primary health care facilities in Delta State, Nigeria: a mixed methods survey. Reprod Health 2023; 20:158. [PMID: 37872573 PMCID: PMC10594699 DOI: 10.1186/s12978-023-01693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The availability of contraceptives, family planning guidelines, and Information, Education, and Communication (IEC) materials can increase access to family planning services. This study assessed the availability of commodities and readiness of primary health care (PHC) facilities in Delta State to offer family planning services. METHODS A cross-sectional design with an explanatory mixed-method approach was used i.e., the authors first collected the quantitative data, and after preliminary analysis of quantitative information, the qualitative approach was utilised to gather data on the perspectives of 32 PHC facility managers and 6 reproductive health supervisors on factors affecting family planning service availability and readiness. RESULTS Twenty-one (65.6%) of the PHC facilities surveyed offered at least five modern methods of family planning. Stock-outs of emergency contraceptives, implants, intra-uterine contraceptive device (IUCD), oral contraceptive pills (OCP), condoms, and injectables were observed in 31 (96.9%), 17 (53.1%), 13 (40.6%), 4 (12.5%), 2 (6.3%), and 1 (3.1%) of the facilities respectively. Eleven (34.4%) and 8 (25.0%) of the facilities had IEC materials and family planning guidelines, and contraceptive commodity checklists respectively. Seventeen (53.1%) of the facilities did not have complete records of family planning activities. CONCLUSION This study shows that a significant proportion of PHC facilities had stock-outs of contraceptive commodities, no complete records of contraceptive activities, no IEC materials and no family planning checklists. Continuous training of health providers and increased government commitment can help to improve contraceptive services.
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Affiliation(s)
- Dorcas Tom Obong
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
| | - Patrick Oyibo
- Health Services Research and Management Division, School of Health and Psychological Sciences City, University of London, London, UK.
- Department of Community Medicine, Faculty of Clinical Medicine, College of Health Sciences, Delta State University, Abraka, Nigeria.
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Takyi A, Sato M, Adjabeng M, Smith C. Factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in Gomoa West District, Ghana: a qualitative study. Trop Med Health 2023; 51:40. [PMID: 37537649 PMCID: PMC10398952 DOI: 10.1186/s41182-023-00531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Fertility declines with age, but it remains important to protect women from unplanned pregnancies throughout their reproductive lives. The objective of this study was to describe factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in Gomoa West District of Ghana. METHODS In-depth interviews were conducted remotely for 22 women, 15 male partners of the women interviewed and seven family planning (FP) providers. In all, a total of 44 participants took part in the study. Seven refusals were recorded, four females and three males. Four focus group discussions were organized for 21 participants who took part in the in-depth interviews. Data collected were transcribed and coded after exporting to Nvivo12 qualitative analysis software. Thematic analysis was undertaken using an abductive approach. RESULTS Factors that influenced the use of modern contraceptives included: achieved desired family size, providing for the family, counselling by health professionals, influence of the male partner, and health reasons. Barriers cited included: religious or socio-cultural reasons, experience or fear of side effects, rumors or misconceptions, declining fertility, and the belief that contraceptive use is a matter for women. Within the study group, roughly half of women used modern contraceptives, while the majority of male partners were non-users. CONCLUSION Contraception among women aged 35 to 49 years and their male partners is influenced by several factors such as achieved desired family size, influence of the male partner, rumors or misconceptions, and declining fertility. Strengthening male involvement in family planning activities and health educational activities could alleviate fear and reduce misconceptions about using modern contraceptives.
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Affiliation(s)
- Amy Takyi
- School of Tropical Medicine and Global Health, Nagasaki University Japan, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University Japan, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Michael Adjabeng
- World Health Organization (WHO) Country Office Accra, Korle-Bu, Box KB 493, Accra, Ghana
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University Japan, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT, UK.
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Calhoun LM, Mandal M, Onyango B, Waga E, McGuire C, van den Akker T, Beňová L, Delvaux T, Zulu EM, Speizer IS. "So let me give you money, you give me what I want": decision-making priorities around contraceptive method and source choice among young women in Kenya. Reprod Health 2023; 20:96. [PMID: 37365630 PMCID: PMC10294346 DOI: 10.1186/s12978-023-01641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Many factors influence young women's choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya. METHODS In August-September 2019, 30 in-depth interviews were conducted with women ages 18-24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically. RESULTS The majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method. CONCLUSIONS This study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women's needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care.
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Affiliation(s)
- Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
| | | | - Erick Waga
- African Institute for Development Policy, Nairobi, Kenya
| | - Courtney McGuire
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eliya M. Zulu
- African Institute for Development Policy, Nairobi, Kenya
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Cartwright AF, Mackenzie ACL, Callahan RL, Bahamondes MV, Dorflinger LJ. IUD self-removal as self-care: Research is needed in low and middle-income countries. Front Glob Womens Health 2022; 3:992639. [PMID: 36159884 PMCID: PMC9490080 DOI: 10.3389/fgwh.2022.992639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice F. Cartwright
- FHI 360, Durham, NC, United States
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Alice F. Cartwright
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Mayanja Y, Kamacooko O, Lunkuse JF, Muturi-Kioi V, Buzibye A, Omali D, Chinyenze K, Kuteesa M, Kaleebu P, Price MA. Oral pre-exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: a prospective cohort study. J Int AIDS Soc 2022; 25:e25909. [PMID: 35543110 PMCID: PMC9092160 DOI: 10.1002/jia2.25909] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 04/22/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Oral pre‐exposure prophylaxis (PrEP) has been scaled up; however, data from real‐world settings are limited. We studied oral PrEP preference, uptake, adherence and continuation among adolescent girls and young women (AGYW) vulnerable to HIV in sub‐Saharan Africa. Methods We conducted a prospective cohort study among 14‐ to 24‐year‐old AGYW without HIV who were followed for 12 months in Kampala, Uganda. Within at least 14 days of enrolment, they received two education sessions, including demonstrations on five biomedical interventions that are; available (oral PrEP), will be available soon (long‐acting injectable PrEP and anti‐retroviral vaginal ring) and in development (PrEP implant and HIV vaccine). Information included mode and frequency of delivery, potential side effects and method availability. Volunteers ranked interventions, 1 = most preferred to 5 = least preferred. Oral PrEP was “preferred” if ranked among the top two choices. All were offered oral PrEP, and determinants of uptake assessed using Poisson regression with robust error variance. Adherence was assessed using plasma tenofovir levels and self‐reports. Results Between January and October 2019, 532 volunteers were screened; 285 enrolled of whom 265 received two education sessions. Mean age was 20 years (SD±2.2), 92.8% reported paid sex, 20.4% reported ≥10 sexual partners in the past 3 months, 38.5% used hormonal contraceptives, 26.9% had chlamydia, gonorrhoea and/or active syphilis. Of 265 volunteers, 47.6% preferred oral PrEP. Willingness to take PrEP was 90.2%; however, uptake was 30.6% (n = 81). Following enrolment, 51.9% started PrEP on day 14 (same day PrEP offered), 20.9% within 30 days and 27.2% after 30 days. PrEP uptake was associated with more sexual partners in the past 3 months: 2–9 partners (aRR = 2.36, 95% CI: 1.20–4.63) and ≥10 partners (aRR 4.70, 95% CI 2.41–9.17); oral PrEP preference (aRR 1.53, 95% CI 1.08–2.19) and being separated (aRR 1.55, 95% CI 1.04–2.33). Of 100 samples from 49 volunteers during follow up, 19 had quantifiable tenofovir levels (>10 μg/L) of which only three were protective (>40 μg/L). Conclusions Half of AGYW preferred oral PrEP, uptake and adherence were low, uptake was associated with sexual behavioural risk and oral PrEP preference. Development of alternative biomedical products should be expedited to meet end‐user preferences and, community delivery promoted during restricted movement.
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Affiliation(s)
- Yunia Mayanja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | | | - Allan Buzibye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Denis Omali
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Matt A Price
- IAVI, New York, New York, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Dev R, Kohler P, Begnel E, Achwoka D, McGrath CJ, Pintye J, Muthigani W, Singa B, Gondi J, Ng'ang'a L, Langat A, John-Stewart G, Kinuthia J, Drake AL. Contraceptive counseling experiences among women attending HIV care and treatment centers: A national survey in Kenya. Contraception 2021; 104:139-146. [PMID: 33894251 PMCID: PMC8286320 DOI: 10.1016/j.contraception.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To characterize contraceptive counseling experiences among women living with HIV (WLWH) receiving HIV care in Kenya. STUDY DESIGN Sexually active, WLWH aged 15 to 49 years were purposively sampled from 109 high-volume HIV Care and Treatment Centers in Kenya between June and September 2016. Cross-sectional surveys were administered to enroll women on a tablet using Open Data Kit. Poisson generalized linear regression models adjusted for facility-level clustering were used to examine cofactors for receiving family planning (FP) counseling with a provider. RESULTS Overall, 4805 WLWH were enrolled, 60% reported they received FP counseling during the last year, 72% of whom reported they were counseled about benefits of birth spacing and limiting. Most women who received FP counseling were married (64%) and discussed FP with their partner (78%). Use of FP in the last month (adjusted Prevalence Ratio [aPR] = 1.74, 95% confidence interval [CI]: 1.41-2.15, p < 0.001), desire for children in >2 years (aPR = 1.18, 95% CI: 1.09-1.28, p < 0.001), and concern about contraceptive side-effects (aPR = 1.13, 95% CI 1.02-1.25, p < 0.05) were significantly higher among WLWH who received FP counseling compared to those that did not. CONCLUSIONS Over one-third of WLWH did not receiving FP counseling with an HIV care provider during the last year, and counseling was more commonly reported among women who were using FP or desired children in >2 years. IMPLICATIONS There are missed opportunities for FP counseling in HIV care. FP integration in HIV care could improve FP access and birth spacing or limiting among WLWH.
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Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Emily Begnel
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Dunstan Achwoka
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Christine J McGrath
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Jillian Pintye
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Wangui Muthigani
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Joel Gondi
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Lucy Ng'ang'a
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Agnes Langat
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Grace John-Stewart
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Research and Programs, Kenyatta Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States.
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Keogh SC, Otupiri E, Castillo PW, Chiu DW, Polis CB, Nakua EK, Bell SO. Hormonal contraceptive use in Ghana: The role of method attributes and side effects in method choice and continuation. Contraception 2021; 104:235-245. [PMID: 33992609 DOI: 10.1016/j.contraception.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To understand the barriers and facilitators of hormonal contraceptive use among Ghanaian women, in order to help improve contraceptive counseling and reduce the high rates of unintended pregnancy. STUDY DESIGN We conducted a nationally representative community-based survey of 4143 women aged 15-49 in 2018, and used descriptive statistics and logistic regression to examine correlates of current hormonal method use, preferred method attributes and their association with method choice, and the role of side effects in hormonal method discontinuation. RESULTS Hormonal method use (vs. contraceptive non-use) was associated with younger age, higher parity and education, but not with union status, wealth or residence. Preferences for key method attributes were associated with choosing particular methods. Most valued attributes were effectiveness at preventing pregnancy, and low risks of harming health and future fertility. These last 2 concerns are echoed in the second most common reason for discontinuation (health concerns). While menstrual changes were a common concern, leading some respondents to discontinue hormonal contraceptives, many were willing to endure these effects. In contrast, having experienced long-term health issues as a perceived result of hormonal method use more than halved the odds of current use. Contraceptive counseling on menstrual changes, other side effects, and impacts on future fertility had not been universally provided. CONCLUSIONS Ghanaian women value hormonal methods for their effectiveness against pregnancy. However, concerns about side effects (particularly bleeding changes), future fertility impairment, and long-term health issues led some women to discontinue hormonal methods. Counseling on these issues was reportedly inadequate. IMPLICATIONS Identifying barriers to, and facilitators of, hormonal contraceptive use, as well as method attributes important to Ghanaian women, can help to better tailor contraceptive counseling to individual needs, in order to ensure that all women can access the method that suits them best, and decide whether and how to manage side effects, switch methods or discontinue.
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Affiliation(s)
| | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | - Doris W Chiu
- Guttmacher Institute, New York, NY, United States.
| | - Chelsea B Polis
- Guttmacher Institute, New York, NY, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Emmanuel K Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Muyama DL, Musaba MW, Opito R, Soita DJ, Wandabwa JN, Amongin D. Determinants of Postpartum Contraception Use Among Teenage Mothers in Eastern Uganda: A Cross-Sectional Study. Open Access J Contracept 2020; 11:187-195. [PMID: 33335432 PMCID: PMC7737944 DOI: 10.2147/oajc.s281504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction In Uganda, the proportion of women having another live birth before age 20 years (repeat adolescent birth) has not declined in 30 years. More women want to delay the next birth. We determined the prevalence and factors associated with postpartum contraceptive use among teenage mothers in Mbale City. Patients and Methods We conducted a cross-sectional study in all the six government-supported health facilities within Mbale City. Over a period of 3 months, 511 teenage mothers in the postpartum period were consecutively enrolled by midwives/nurses. Data were collected using a pretested interviewer-administered questionnaire. We used logistic regression in STATA version 14, to determine the association between various sociodemographic characteristics and utilization of contraception. We set the level of significance at 5% and report odds ratios and the corresponding 95% confidence intervals. Results Most of the respondents - 314/511 [61.5%, 95% CI= 57.1-65.6%] - were using contraceptives. More than three-fourth (238/314) of the respondents opted for short-term methods of contraception. In the adjusted analyses, intention to resume school [AOR 1.79 (1.16-2.74)], and utilization of maternal Child Heath services such as postnatal care services [AOR 0.40 (0.25-0.63)] were significantly associated with utilisation of postpartum contraception. Conclusion We found a high prevalence of postpartum contraceptives use - over 6 in 10 women - although they were using mainly short-term methods. Those with intentions of resuming schooling and utilised postnatal care services were most likely to use contraceptives. This is encouraging and calls for inquiry into why their use is higher than the national averages. Further, the results call for renewed efforts to maintain adolescent mothers in school.
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Affiliation(s)
- Doreen L Muyama
- Department of Public and Community Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ronald Opito
- Department of Programs, Population Services International, Kampala, Uganda
| | - David J Soita
- Department of Public and Community Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Julius N Wandabwa
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Alyahya MS, Hijazi HH, Alshraideh HA, Al-Sheyab NA, Alomari D, Malkawi S, Qassas S, Darabseh S, Khader YS. Do modern family planning methods impact women's quality of life? Jordanian women's perspective. Health Qual Life Outcomes 2019; 17:154. [PMID: 31615524 PMCID: PMC6794850 DOI: 10.1186/s12955-019-1226-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/24/2019] [Indexed: 01/27/2023] Open
Abstract
Background Although Jordan has made progress in meeting Family Planning (FP) needs in last decades, recently the use of FP methods has declined significantly. Women’s personal experiences, knowledge, and perceptions of how a FP method might impact their quality of life (QoL) can influence FP decisions. However, a lack of comprehensive understanding of the impact of modern FP methods on women’s QoL continues to exist among Jordanian couples. Therefore, this study aimed to investigate the relationship between the use of common modern FP methods and QoL among Jordanian women. Methods Using the WHOQOL-BREF questionnaire along with other questions, non-pregnant women of reproductive age were interviewed at their homes through face-to-face structured interviews. Women who visited the obstetrics and gynecology clinic of King Abdullah University Hospital for contraceptive advice and follow-up consultations were also included. Results A total of 548 women aged between 18 and 49 participated in the study. Based on the WHOQOL-BREF scale, the overall mean (SD) scores of the four domains were found to be average. Our findings show that women who used Intra Uterine Devices (IUDs) and women whose husbands used condoms had better QoL in the four domains (physical health, psychological health, social relationships, and environment) than those who used Oral Contraceptives (OCs). Women who used implant and injectable hormonal contraceptives had better QoL in terms of the physical health and social relationships domains. In contrast, women who had undergone permanent sterilization had lower QoL scores in all of the four domains. Further analysis revealed that women who had undergone tubal sterilization were less satisfied overall and more likely to experience side effects than women who used OCs. Conclusion The choice to use contraceptives and decide freely whether and when to have children is regarded as a fundamental reproductive health right and is strongly linked to women’s health and QoL. Women who use OCs and women who have undergone permanent sterilization are likely to have lower QoL than women who use IUDs or implant and injectable hormones and those whose husbands use condoms.
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
| | - Heba H Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Hussam A Alshraideh
- Industrial Engineering, Faculty of Engineering, Jordan University of Science and Technology, P.O.Box (3030), Irbid, 22110, Jordan
| | - Nihaya A Al-Sheyab
- Allied Medical Sciences Department/Faculty of Applied Medical Sciences, Jordan University of Science and Technology, P.O.Box (3030), Irbid, 22110, Jordan
| | - Dana Alomari
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Sara Malkawi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Sarah Qassas
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Samah Darabseh
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Yousef S Khader
- Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
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Kanma-Okafor OJ, Asuquo EJ, Izuka MO, Balogun MR, Ayankogbe OO. Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria. Niger Postgrad Med J 2019; 26:182-188. [PMID: 31441457 DOI: 10.4103/npmj.npmj_52_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. AIM This study was aimed at assessing the use and preferences of FP services among women. SUBJECTS AND METHODS A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. RESULTS Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). CONCLUSION Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.
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Affiliation(s)
- Oluchi Joan Kanma-Okafor
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Eucharia Justin Asuquo
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
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Guure C, Maya ET, Dery S, da-Costa Vrom B, Alotaibi RM, Rezk HR, Yawson A. Factors influencing unmet need for family planning among Ghanaian married/union women: a multinomial mixed effects logistic regression modelling approach. Arch Public Health 2019; 77:11. [PMID: 30911385 PMCID: PMC6413448 DOI: 10.1186/s13690-019-0340-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need for family planning is high (30%) in Ghana. Reducing unmet need for family planning will reduce the high levels of unintended pregnancies, unsafe abortions, maternal and neonatal morbidity and mortality. The purpose of this study was to examine factors that are associated with unmet need for family planning to help scale up the uptake of family planning services in Ghana. METHODS This cross sectional descriptive and inferential study involved secondary data analysis of women in the reproductive age (15-49 years) from the Ghana Demographic and Health Survey 2014 data. The outcome variable was unmet need for family planning which was categorized into three as no unmet need, unmet need for limiting and unmet need for spacing. Chi-squared test statistic and bivariate multilevel multinomial mixed effects logistic regression model were used to determine significant variables which were included for the multivariable multilevel multinomial mixed effects logistic regression model. All significant variables (p < 0.05) based on the bivariate analysis were included in the multinomial mixed effects logistic regression model via model building approach. RESULTS Women who fear contraceptive side effects were about 2.94 (95% CI, 2.28, 3.80) and 2.58 (95% CI, 2.05, 3.24) times more likely to have an unmet need for limiting and spacing respectively compared to those who do not fear side effects. Respondents' age was a very significant predictor of unmet need for family planning. There was very high predictive probability among 45-49 year group (0.86) compared to the 15-19 year group (0.02) for limiting. The marginal predictive probability for spacing changed significantly from 0.74 to 0.04 as age changed from 15 to 19 to 45-49 years. Infrequent sexual intercourse, opposition from partners, socio-economic (wealth index, respondents educational level, respondents and partner's occupation) and cultural (religion and ethnicity) were all significant determinants of both unmet need for limiting and spacing. CONCLUSIONS This study reveals that fear of side effect, infrequent sex, age, ethnicity, partner's education and region were the most highly significant predictors of both limiting and spacing. These factors must be considered in trying to meet the unmet need for family planning.
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Affiliation(s)
- Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra Ghana
| | - Ernest Tei Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra Ghana
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra Ghana
| | - Baaba da-Costa Vrom
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra Ghana
| | - Refah M. Alotaibi
- Department of Mathematical Sciences, Faculty of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hoda Ragab Rezk
- Department of Mathematical Sciences, Faculty of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Alfred Yawson
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra Ghana
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Rademacher KH, Sergison J, Glish L, Maldonado LY, Mackenzie A, Nanda G, Yacobson I. Menstrual Bleeding Changes Are NORMAL: Proposed Counseling Tool to Address Common Reasons for Non-Use and Discontinuation of Contraception. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:603-610. [PMID: 30287535 PMCID: PMC6172120 DOI: 10.9745/ghsp-d-18-00093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
A new family planning counseling tool uses the simple mnemonic device “NORMAL” to help family planning counselors and providers communicate to their clients key messages about menstrual bleeding changes associated with use of hormonal contraception and the copper IUD.
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Affiliation(s)
| | | | - Laura Glish
- Population Services International, Washington, DC, USA
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Velonjara J, Crouthamel B, O'Malley G, Wiggins M, Matemo D, John-Stewart G, Unger JA, Kinuthia J, Drake AL. Motherhood increases support for family planning among Kenyan adolescents. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:124-131. [PMID: 29804756 DOI: 10.1016/j.srhc.2018.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/23/2018] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adolescent fertility rates are high in Kenya, and increase the risks of unintended repeat pregnancies and maternal and infant morbidity and mortality. Our objective was to examine knowledge, practices, and influences surrounding contraceptive access and use among Kenyan postpartum adolescents. STUDY DESIGN We conducted a mixed methods study (surveys and focus group discussions) with postpartum adolescents and family planning (FP) providers at two maternal and child health clinics in Kenya. MAIN OUTCOME MEASURES Four focus group discussions (FGDs) were conducted with postpartum adolescents (stratified by age and site), and two FGDs were conducted with FP providers (stratified by site). Transcripts were analyzed for prevalent themes. The participants also completed individual surveys that were analyzed for contraceptive knowledge. RESULTS Adolescent contraceptive decision-making and use were shaped by social norms of adolescent sexual behaviour. Lack of FP knowledge, community misinformation, and insufficient counselling and time with providers all contributed to adolescent concerns about FP. However, as adolescents transitioned to motherhood, they felt more encouraged to use FP and had increased awareness of FP benefits. CONCLUSION Both postpartum adolescents and providers felt delivery of FP services could be improved if providers had better training and counselling tools.
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Affiliation(s)
- Julia Velonjara
- Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA 98104, United States.
| | - Bonnie Crouthamel
- Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA 98195, United States.
| | - Gabrielle O'Malley
- Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA 98104, United States.
| | - Mona Wiggins
- School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Daniel Matemo
- Research and Programs, Kenyatta National Hospital, Box 259000202, Nairobi, KE 00202, United States.
| | - Grace John-Stewart
- Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA 98104, United States.
| | - Jennifer A Unger
- Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA 98104, United States.
| | - John Kinuthia
- Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA 98104, United States; Research and Programs, Kenyatta National Hospital, Box 259000202, Nairobi, KE 00202, United States; Department of Global Health, University of Washington, Seattle, WA 98104, United States.
| | - Alison L Drake
- Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA 98104, United States.
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