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Sarnak D, Magalona S, Anglewicz P. The Reliability of Contraceptive Discontinuation Reporting in Burkina Faso, Kenya, and Uganda. Stud Fam Plann 2024. [PMID: 39090968 DOI: 10.1111/sifp.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Family planning researchers have been studying the discontinuation of contraception-the prevalence and reasons for it-for decades, as it has implications for contraceptive prevalence, total fertility, and unintended fertility. However little is known about the reliability of contraceptive discontinuation reporting: only two studies have examined the reliability of reported discontinuation in low-resource contexts. We use longitudinal and overlapping data from reproductive calendars to test the reliability of women's reporting of contraceptive discontinuation in Burkina Faso, Kenya, and Uganda. We test whether recent discontinuations reported at baseline are reported one year later, and if the same reason for discontinuation is reported. Results reveal moderate reliability at the aggregate level of reporting of the index discontinuation; however, reliability is low when the timing of discontinuation is considered. There is variability across the reliability of reasons for discontinuation; discontinuation due to desired pregnancy is reported reliably while other reasons are less reliably reported. Our findings have important implications for the field, particularly in how the data are used and interpreted; we urge caution around event-level analyses of contraceptive discontinuation and reasons for discontinuation, given low reliability.
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Rothschild CW, Bulama A, Odeh R, Chika-Igbokwe S, Njogu J, Tumlinson K, Musau A. Preference-aligned fertility management among married adolescent girls in Northern Nigeria: assessing a new measure of contraceptive autonomy. BMJ Glob Health 2024; 9:e013902. [PMID: 38760023 PMCID: PMC11103226 DOI: 10.1136/bmjgh-2023-013902] [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: 09/07/2023] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Universal access to sexual and reproductive healthcare-including family planning (FP)-is a global priority, yet there is no standard outcome measure to evaluate rights-based FP programme performance at the regional, national or global levels. METHODS We collected a modified version of preference-aligned fertility management (PFM), a newly proposed rights-based FP outcome measure which we operationalised as concordance between an individual's desired and actual current contraceptive use. We also constructed a modified version (satisfaction-adjusted PFM) that reclassified current contraceptive users who wanted to use contraception but who were dissatisfied with their method as not having PFM. Our analysis used data collected 3.5 months after contraceptive method initiation within an ongoing prospective cohort of married adolescent girls aged 15-19 years in Northern Nigeria. We described and compared prevalence of contraceptive use and PFM in this population. RESULTS Ninety-seven per cent (n=1020/1056) of respondents were practising PFM 3.5 months after initiating modern contraception, while 93% (n=986/1056) were practising satisfaction-adjusted PFM. Among participants not practising satisfaction-adjusted PFM (n=70), most were using contraception but did not want to be (n=30/70, 43%) or wanted to use contraception but were dissatisfied with their method (n=34/70, 49%), while the remaining 9% (n=6/70) wanted but were not currently using contraception. CONCLUSION PFM captured meaningful discordance between contraceptive use desires and behaviours in this cohort of married Nigerian adolescent girls. Observed discordance in both directions provides actionable insights for intervention. PFM is a promising rights-focused FP outcome measure that warrants future field-testing in programmatic and population-based research.
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Affiliation(s)
- Claire W Rothschild
- Sexual and Reproductive Health, Population Services International, Washington, District of Columbia, USA
| | | | - Roselyn Odeh
- Society for Family Health Nigeria, Abuja, Nigeria
| | | | - Julius Njogu
- Sexual and Reproductive Health, Population Services International, Nairobi, Kenya
| | - Katherine Tumlinson
- University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Abednego Musau
- Sexual and Reproductive Health, Population Services International, Nairobi, Kenya
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Holt K, Challa S, Alitubeera P, Atuyambe L, Dehlendorf C, Galavotti C, Idiodi I, Jegede A, Omoluabi E, Waiswa P, Upadhyay U. Conceptualizing Contraceptive Agency: A Critical Step to Enable Human Rights-Based Family Planning Programs and Measurement. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300299. [PMID: 38346841 PMCID: PMC10906552 DOI: 10.9745/ghsp-d-23-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
We propose a detailed framework for contraceptive agency to serve as a rights-based guide for centering individuals’ ability to make and act on their own contraceptive choices, regardless of what those choices are, in program design and evaluation.
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Affiliation(s)
- Kelsey Holt
- University of California, San Francisco, San Francisco, CA, USA.
| | - Sneha Challa
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Lynn Atuyambe
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
| | - Ushma Upadhyay
- University of California, San Francisco, San Francisco, CA, USA
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Kristiansen D, Boyle EH, Svec J. The impact of local supply of popular contraceptives on women's use of family planning: findings from performance-monitoring-for-action in seven sub-Saharan African countries. Reprod Health 2023; 20:171. [PMID: 37990268 PMCID: PMC10664543 DOI: 10.1186/s12978-023-01708-7] [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: 03/23/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
Contraceptive use has substantial implications for women's reproductive health, motivating research on the most effective approaches to minimize inequalities in access. When women prefer to limit or delay fertility but are not using contraception, this potentially reflects demand for contraception that is not being satisfied. Current literature emphasizes a nuanced integration of supply and demand factors to better understand this gap. In this research, we examine the interconnectedness of supply and demand factors both conceptually and methodologically by augmenting existing measures of local supply with a demand-side factor-community-level preferences for contraceptive methods. Using novel data from Performance Monitoring for Action (PMA) in seven sub-Saharan African countries, we test whether the available supply of locally preferred methods at nearby service delivery points (SDP) explains variation in women's uptake of contraception beyond the more typical measure of contraceptive stockouts. Findings from logistic regression analyses (N = 32,282) suggest that demand and supply can be understood as tightly interconnected factors which are directly affected by local social preferences. The odds of women using modern contraception increase significantly when locally preferred methods are available, and this is true even after controlling for the availability of methods in general. The new measure tested in this research centers women and their specific desires in a manner consistent with the promotion of contraceptives as an important human right.
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Affiliation(s)
- Devon Kristiansen
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Joseph Svec
- Social Sciences Department, Saint Joseph's University, Patchogue, NY, USA.
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Bhan N, McDougal L. Centring agency and norms to meet the health needs of pregnant adolescents. Lancet 2023; 402:1505-1507. [PMID: 37837992 DOI: 10.1016/s0140-6736(23)02226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Nandita Bhan
- Jindal School of Public Health and Human Development, OP Jindal Global University, Sonipat 131001, India.
| | - Lotus McDougal
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
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6
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Montt-Maray E, Adamjee L, Horanieh N, Witt A, González-Capella T, Zinke-Allmang A, Cislaghi B. Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2023; 4:1149632. [PMID: 37674903 PMCID: PMC10478786 DOI: 10.3389/fgwh.2023.1149632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.
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Affiliation(s)
- Eloisa Montt-Maray
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lamiah Adamjee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nour Horanieh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alice Witt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thaïs González-Capella
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Marston C, Tabot M. How can we put rights at the core of global family planning? Lancet 2023; 401:2096-2098. [PMID: 37003288 DOI: 10.1016/s0140-6736(23)00523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Mallah Tabot
- International Planned Parenthood Federation, Africa Regional Office, Nairobi, Kenya
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Allagh KP, Triulzi I, Kiarie J, Kabra R. Scoping review on the use of South-South learning exchange to scale up evidence-based practices in family planning. BMJ Glob Health 2023; 8:e011635. [PMID: 37316440 PMCID: PMC10277101 DOI: 10.1136/bmjgh-2022-011635] [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: 12/23/2022] [Accepted: 04/01/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND South-South learning exchange (SSLE) is an interactive learning process where teams from low-income and middle-income countries exchange knowledge and experience to support one or both team's work towards a change in policies, programmes or practices. SSLE has been used by countries to improve family planning (FP) outcomes such as increased contraceptive prevalence rate and reduced unmet need for FP, but at present, there are no reviews that summarise its use. We conducted a scoping review with stakeholder consultations to summarise the use of SSLE to change FP outcomes. OBJECTIVE To systematically identify and map the purposes, approaches, outputs, outcomes, enablers and barriers to using SSLE in FP. METHODS A search was conducted on electronic databases, grey literature sources, websites and the reference list of included studies. The scoping review is based on an adapted version of Arksey and O'Malley's scoping review framework suggested by Levac et al. Experts were interviewed on their experiences in SSLE. RESULTS The initial search yielded 1483 articles; however, only 29 were selected in the final analysis. The articles were published between 2008 and 2022. Most of the articles were reports, case studies or press releases, only two were peer-reviewed publications. Capacity building of FP providers, policy-makers and community was the most commonly reported purpose of SSLE, with study tours (57%) being the most common approach. Policy dialogue was the most common (45%) output and improved contraceptive prevalence was the most frequently reported outcome. The experiences of the 16 interviewed experts aligned with the scoping review findings. CONCLUSION The evidence on the effectiveness of SSLE for addressing FP outcomes is very limited and of very low quality. We call on stakeholders conducting SSLE to document their experiences in detail, including the outcomes achieved.
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Affiliation(s)
- Komal Preet Allagh
- Consultant- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Rita Kabra
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Sarnak D, Anglewicz P, Ahmed S. Unmet need and intention to use as predictors of adoption of contraception in 10 Performance Monitoring for Action geographies. SSM Popul Health 2023; 22:101365. [PMID: 36909928 PMCID: PMC9996096 DOI: 10.1016/j.ssmph.2023.101365] [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: 10/01/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
The determinants of fertility typically feature demand as the key motivation driver for contraceptive use. Yet relatively little is known about the extent to which demand for contraception predicts future contraceptive use, primarily due to the lack of longitudinal data that captures these measures at different time points. Two ways in which demand is often measured are unmet need and intention to use. Despite its intended use as a population measure, unmet need is commonly used in individual-level analyses and as a marker for individual-level demand for contraception. Few studies have assessed the extent to which unmet need predicts or reflects women's true latent demand as demonstrated by their future contraceptive use; the same is true for intention to use contraception in the future. We expand on previous research to assess whether and the degree to which unmet need and intention to use contraception predict adoption of contraception within a year, among nonusers in ten representative geographies using Performance Monitoring for Action (PMA) data. Findings show that in nine of ten sites, intention to use within a year was significantly associated with subsequent adoption, while in eight of ten sites, unmet need for spacing or limiting was not associated with adoption. Our results are important for programs as they try to identify true dynamic demand for contraception.
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Affiliation(s)
- Dana Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Phil Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
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10
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Senderowicz L, Bullington BW, Sawadogo N, Tumlinson K, Langer A, Soura A, Zabre P, Sie A. Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It. Stud Fam Plann 2023; 54:231-250. [PMID: 36841972 PMCID: PMC10257191 DOI: 10.1111/sifp.12233] [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] [Indexed: 02/27/2023]
Abstract
Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.
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Affiliation(s)
- Leigh Senderowicz
- Department of Gender and Women’s Studies, University of Wisconsin-Madison, USA
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Burkina Faso
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | - Ali Sie
- Centre de Recherche en Santé de Nouna, Burkina Faso
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Stevens R, Machiyama K, Mavodza CV, Doyle AM. Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. Stud Fam Plann 2023; 54:309-321. [PMID: 36753058 DOI: 10.1111/sifp.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.
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Affiliation(s)
- Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Kazuyo Machiyama
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Department of Public Health and Policy, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Averbach S, Johns NE, Ghule M, Dixit A, Begum S, Battala M, Saggurti N, Silverman J, Raj A. Understanding quality of contraceptive counseling in the CHARM2 gender-equity focused family planning intervention: Findings from a cluster randomized controlled trial among couples in rural India. Contraception 2023; 118:109907. [PMID: 36328094 PMCID: PMC10695301 DOI: 10.1016/j.contraception.2022.10.009] [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: 07/07/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The CHARM2 (Counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) intervention engages health care providers to deliver gender-equity and family planning sessions to couples using a person-centered shared decision-making approach for contraception counseling. We previously showed that the intervention improved contraceptive use at 9-month follow-up. We sought to assess whether the intervention was further associated with the quality of care reported by participants and whether the quality of care reported mediated the effect of the intervention on contraceptive use. STUDY DESIGN This is a planned secondary analysis of the effect of the CHARM2 intervention on 1201 married couples in rural Maharashtra, India in a cluster randomized controlled trial completed between 2018 and 2020. We assessed the effect of CHARM2 on perceived quality of care as measured by the Interpersonal Quality of Family Planning (IQFP) scale using a difference-in-differences linear regression approach including a mixed-effects model with nested random effects to account for clustering. We assessed whether the association between CHARM2 and modern contraceptive use was mediated by quality of family planning care. RESULTS Intervention participants had higher mean IQFP scores than control participants at 9-month follow-up (intervention 3.2, SD 0.6 vs. control 2.3 mean, SD 0.9, p < 0.001). The quality of care reported mediated the effect of the intervention on contraceptive use (indirect effect coefficient 0.29, 95% CI 0.07-0.50). CONCLUSION Family planning interventions such as CHARM2, which utilize person-centered shared decision-making contraceptive counseling approaches improve women's perceived quality of care. Effects on quality of care mediate observed effects of the intervention on contraceptive use. IMPLICATIONS Contraceptive interventions should focus on improving person-centered outcomes, such as quality of care, rather than contraceptive use targets. By focusing on improving person-centered care, interventions will improve contraceptive use among those who desire a method while meeting the holistic reproductive health needs of clients and couples.
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Affiliation(s)
- Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States.
| | - Nicole E Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Anvita Dixit
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Jay Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Education Studies, Division of Social Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States
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Biddlecom A, Sully EA, Kantorová V, Wheldon MC, Lince-Deroche N, Riley T. Setting Health Targets Using Information from Probabilistic Projections: A Research Brief on an Application to Contraceptive Coverage. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:13. [PMID: 36789331 PMCID: PMC9913024 DOI: 10.1007/s11113-023-09766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 02/12/2023]
Abstract
Broad and aspirational targets to meet health service needs are useful for advocacy, but setting measurable, time-defined targets for accelerated yet feasible progress is necessary for national monitoring and planning purposes. Information from probabilistic projections of health outcomes and service coverage can be used to set country-specific targets that reflect different starting points and rates of change. We show the utility of this approach in an application to contraceptive coverage in 131 low- and middle-income countries (LMICs) and the related cost and impact of different coverage scenarios. We use the sustainable development goal (SDG) indicator of the proportion of women who have their need for family planning satisfied with modern contraception. The results show that accelerated progress targets would collectively result in 83% of the need satisfied in 2030 for LMICs, which is 5% points higher than the projected level based on the current pace of progress. This translated into 41 million fewer women with an unmet need for modern methods and 14 million fewer unintended pregnancies. Annual direct costs would be $480 million more in 2030 to support contraceptive services compared with costs in 2030 based on the current pace of progress. As governments plan and budget for expanded health service coverage, information from probabilistic projections can guide them in setting measurable, ambitious yet realistic targets that are relevant to their particular contexts. Supplementary Information The online version contains supplementary material available at 10.1007/s11113-023-09766-2.
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Affiliation(s)
| | | | - Vladimíra Kantorová
- Population Division, Department of Economic and Social Affairs, United Nations, New York, NY USA
| | - Mark C. Wheldon
- Population Division, Department of Economic and Social Affairs, United Nations, New York, NY USA
| | | | - Taylor Riley
- Department of Epidemiology, University of Washington, Seattle, WA USA
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Speizer IS, Zavier AJF, Calhoun L, Nanda P, Saggurti N, Hainsworth G. Longitudinal examination of young married women's fertility and family planning intentions and how they relate to subsequent family planning use in Bihar and Uttar Pradesh India. BMJ Open 2022; 12:e064487. [PMID: 35863832 PMCID: PMC9310155 DOI: 10.1136/bmjopen-2022-064487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study examines which fertility and family planning (FP) intentions are related to subsequent FP use in a sample of young, married women in India. DESIGN We use 3-year longitudinal data from married women ages 15-19 in 2015-2016 (wave 1) who are not using contraception to examine factors associated with any use of FP in 2018-2019 (wave 2). SETTING Data were collected in the states of Bihar and Uttar Pradesh, India. PARTICIPANTS A representative sample of 4893 young married women ages 15-19 was surveyed in 2015-2016 and 4000 of them were found and interviewed 3 years later. This analysis focused on the 3614 young women who were not using FP at wave 1. PRIMARY OUTCOMES This study examines FP use at wave 2 as the main outcome variable. RESULTS Multivariate analyses demonstrated that young women who wanted to delay childbearing three or more years or who did not want any(more) children at wave 1 were more likely to use contraception at wave 2. Additionally, intention to use FP in the next 12 months at wave 1 was significantly associated with FP use at wave 2 whereas unmet need at wave 1 was not significantly related to subsequent use. A combined measure of fertility desires and intention to use FP demonstrated the importance of both measures on subsequent use. Having any children and being pregnant at wave 1 were both related to FP use at wave 2. CONCLUSIONS It is important to reach young, married women prior to a first pregnancy with nuanced messages addressing their fertility and FP intentions. Programmes targeting women at antenatal and postpartum visits are important for young women to help support them to use FP to address their desires to delay or limit future childbearing for the health and well-being of themselves and their children.
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Affiliation(s)
- Ilene S Speizer
- Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Lisa Calhoun
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Priya Nanda
- Bill and Melinda Gates Foundation India, New Delhi, India
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Fabic MS. What Do We Demand? Responding to the Call for Precision and Definitional Agreement in Family Planning’s “Demand” and “Need” Jargon. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00030. [PMID: 35294394 PMCID: PMC8885353 DOI: 10.9745/ghsp-d-22-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
This commentary offers a response to the call to improve family planning language that describes “need” and “demand” and proposes a set of recommendations to add precision, improve measurement, and foster shared understanding in family planning.
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Affiliation(s)
- Madeleine Short Fabic
- Associate Editor, Global Health: Science and Practice Journal; Supervisory Public Health Advisor, U.S. Agency for International Development, Washington, DC, USA.
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