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.

Demographic and socio-cultural factors influencing contraceptive uptake among women of reproductive age in Tamale Metropolis, Northern Region, Ghana

Background

This study assessed some demographic and socio-cultural factors that influence contraceptive uptake among reproductive-aged women in Tamale Metropolis of the Northern Region, Ghana.

Design

This was a cross-sectional study conducted from February to March 2015.

Setting

All three sub Metropolis in Tamale.

Participants

All community members and women of reproductive age (15-49 years).

Intervention

The study used cluster sampling to recruit women who were interviewed using a structured questionnaire. Nine focus group discussions (FGDs) were also held among community members who were purposively selected.

Main outcome measures

contraceptive uptake (use of contraceptive).

Results

The mean age of the women was 26 years. The prevalence of contraceptive uptake among reproductive-age women was 36.8% (165/448). Women with secondary school education [AOR=4.4(95%CI:1.6-12.4)], and those in homes where decisions on having children were made by both partners [AOR=2.1(95%CI:1.1-04.42)] were more likely to use contraceptives. Unemployed women [AOR=0.3(95%CI:0.1-0.8)], women whose husbands were unaware of their contraceptive use [AOR=0.4(95%CI:0.2-0.9)] and those having a culture or religion that frowns on contraceptive use [AOR=0.4(95%CI:0.2-0.8)] were less likely to use contraceptive among women in the Tamale Metropolis.

Conclusion

The study found a contraceptive prevalence rate (CPR) in Tamale Metropolis, Northern Ghana to be 36.8%. Education and living in a home where childbearing decisions are made together were identified as positive factors influencing contraceptive uptake.

Funding

This work was funded by the authors.

A study on contraceptive prevalence rate and factors influencing it in a rural area of Coimbatore, South India

Introduction

India is the first country to implement National Family Program in 1952. Acceptance of contraceptive methods is influenced by various factors at the individual, family, and community level with their roots in the socioeconomic and cultural milieu of Indian society. This study was carried to find the contraceptive prevalence rate among eligible couples as well as to find the factors influencing it in a rural area of Coimbatore.

Methodology

The study was carried out using the data extracted from the family health survey conducted by trained field staff for the purpose of furnishing details regarding people residing in the field practice area of Rural Health Training Centre (RHTC), Vedapatti located in Coimbatore district after obtaining Institutional Human Ethical clearance. All eligible couples were included for the study. Contraceptive prevalence is expressed in percentage with 95% Confidence interval. Univariate analysis (Chi-square test) was done to find the association between contraceptive acceptance and independent variables. Strength of association is determined by odds ratio with 95% Confidence Interval (CI). P < 0.05 was considered statistically significant.

Results

Contraceptive Prevalence Rate among eligible couples was found to be 75% (95% CI: 73.6-76.4). Most commonly used method among the study participants was tubectomy (81.6%), followed by condoms (11.4%), intrauterine devices (6.3%), and oral contraceptive pills (0.7%). Higher age of the women, religion, educational status of the women, socioeconomic status, working status of the women, number of living children, age at the time of marriage, and age at the time of first child birth were found to have statistical significant association with higher usage of contraception.

Conclusion

The contraceptive prevalence rate was found to be higher in this study population and multiple factors were influencing the contraception usage among the eligible couples.

Assessment of contraceptive use in Puerto Rico during the 2016 Zika virus outbreak

OBJECTIVES

The objectives of this analysis were to 1) estimate prevalence of contraceptive use among women at risk for unintended pregnancy and 2) identify correlates of contraceptive use among women with ongoing or potential need for contraceptive services in Puerto Rico during the 2016 Zika virus (ZIKV) outbreak.

STUDY DESIGN

We conducted a cell-phone survey July-November, 2016. Women aged 18-49 years living in Puerto Rico were eligible. We completed 3059 interviews; the overall response rate was 69.2%. After weighting, the data provide population-based estimates. For this analysis, we included women at risk for unintended pregnancy, and assessed ongoing or potential need for contraceptive services in this group, excluding women using permanent contraceptive methods.

RESULTS

Most women reported using contraception (82.8%), and use increased with age. Female sterilization and male condoms were most frequently reported (40.8% and 17.1%, respectively). Among women with ongoing or potential need for contraceptive services, 24.7% talked to a healthcare provider about ZIKV, and 31.2% reported a change in childbearing intentions due to ZIKV. Most women were at least a little worried about getting infected with ZIKV (74.3%) or having a baby with a birth defect (80.9%). Being very worried about getting infected with ZIKV and already having Zika were significantly associated with use of any contraception (adjusted prevalence ratio: 1.19, 95% CI: 1.03-1.38 and 1.32, 95% CI: 1.01-1.72, respectively).

CONCLUSIONS

These findings underscore the need for regular contraceptive prevalence studies to inform programs about contraceptive needs, especially during public health emergencies.

IMPLICATIONS

When the 2016 Zika virus outbreak began in Puerto Rico there were no recent population-based data available on contraceptive prevalence. To fill this information gap, we conducted a population-based survey. Our findings provided baseline contraceptive prevalence estimates to support response planning and allocation of health resources.

Overview of modern contraception

The large-scale initiatives to address the global unmet needs for family planning (FP) have gathered and compelled scientists, providers, program managers, and other stakeholders (including users) to re-examine the various methods of modern contraception, focusing on those that are proven to be more effective (long-acting reversible contraceptives and permanent methods), historically more widely used (oral contraceptives, condoms), and in development (male hormonal contraception). Implementing FP programs requires an understanding of the human rights principles underpinning the delivery of contraceptive services, the various indicators related to demand, need, and use (demand satisfied, unmet need, and contraceptive prevalence), and its effectiveness (perfect or correct use and typical use), which will be presented in this article. Tools and guidance documents developed using the best available evidence have also been listed in this review article. This issue will also look at new initiatives about providing care (self-care), and key population groups (post-pregnancy and adolescence). The clinical use of the methods should go hand in hand with the programmatic initiatives to ensure that women, men, or couple take up the appropriate method of choice and continue using these based on their reproductive health goals.

Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education

Since the 1990s some countries in Africa have experienced very rapid increases in contraceptive prevalence (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study aims to shed light on the causes of these different trends which remain controversial. We assess the role of family planning programs vs. socioeconomic development (especially, women's educational attainment). Estimates of the effects of different explanatory factors are obtained by country level regressions in which the prevalence of modern contraception is the dependent variable and women's educational attainment, Gross National Income (GNI) per capita, percent urban and child mortality as well as the family planning program score are the independent variables. The statistical analysis finds no significant effects of GNI per capita, percent urban and child mortality. In contrast, women's educational attainment and program score have highly significant effects and are the dominant drivers of contraceptive prevalence trends. Voluntary family planning programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impact above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even where education levels have risen substantially.

Family planning practices in couples with children affected by β-thalassemia major and its relationship with their education: An epidemiological study

BACKGROUND

Although prevention the birth of children with β-thalassemia major (β-TM) is an important health issue, it is rarely explored. With this background, the study was designed to find family planning practices and related factors of couples with children affected by β-TM.

MATERIALS AND METHODS

This was a cross-sectional, observational study, conducted among 324 parents with children affected by β-TM attending a tertiary care health facility in Eastern India. Data were analyzed using univariate and multivariable logistic regression using SPSS.

RESULTS

Of 324 parents, 89.5% were sexually active, 44.8% of which were currently using family planning method to prevent the birth of another child with the oral contraceptive pill most preferred (46.9%) followed by tubectomy (33.9%). Those who were sexually active, but not desirous of a child were 223, of which 41.7% had the unmet need for family planning with religious belief (41.9%) being the most predominant reason followed by unaware of methods (26.9%). In multivariable analysis, religion, caste, per capita monthly income, mothers' education level, and working status were significant predictors of unmet need for family planning adjusted with others.

CONCLUSIONS

Burden of unmet need for family planning among the study population was alarmingly high. Parents of the thalassemic children should be counseled in easily comprehensible local language to increase the rate of contraception among them.

Multiple contraceptive method use and prevalence of fertility awareness based method use in the United States, 2013-2015

OBJECTIVES

Contraceptive prevalence in the United States is typically calculated according to the most effective method of contraception reported. This could theoretically underestimate the number of women using fertility-awareness based methods (FABMs), including those who use other methods (e.g., condoms) during the fertile window, but the extent of any such underestimation has not been assessed.

STUDY DESIGN

We used data from the 2013-2015 National Survey of Family Growth to examine the extent to which women report use of an FABM alone or with other methods. We investigated FABM use patterns and compared demographic profiles of FABM users versus other contraceptive users. We considered how to most appropriately define FABM prevalence.

RESULTS

One in six (16.5%) female contraceptors 15-44 reported use of multiple contraceptive methods in their month of interview. Among women reporting current FABM use, 67% used it alone or with withdrawal, 24% also used condoms or emergency contraception, and 9% also used hormonal contraception or sterilization. An FABM was the most effective method reported for 2.2% of current contraceptive users; while 3.2% of contraceptors reported any current FABM use. We posit an FABM prevalence of 3% (1,113,000 users) among US female contraceptors (2013-2015). FABM users had similar sociodemographic characteristics as other method users, but were more likely married.

CONCLUSIONS

Currently, consideration of multiple method use has modest implications for estimation of FABM prevalence among contraceptors (i.e., an increase from 2.2% to 3%). However, multiple method use patterns with FABMs may merit special consideration if FABM use continues to increase.

IMPLICATIONS

Researchers and providers need to be familiar with the unique patterns of use among FABM users in order to more effectively measure and counsel about these methods.

Cross-sectional study of contraceptive use among Chinese women of reproductive age: results based on a mobile application (APP)-derived data

PURPOSE

To evaluate the contraceptive status among Chinese women of reproductive age and factors associated with contraceptive methods.

METHODS

A cross-sectional study from November 2015 to January 2016 was conducted. We used APP to collect demographics and contraceptive use information of women aged 14-44 years in China.

RESULTS

A total of 23,669 women completed the study. After data cleaning, 19,768 (83.5%) women were included in the final analysis. The prevalence of contraceptive use was 78.9%; while 21.05% of women did not use any method, condoms (40.10%), rhythm, or withdrawal (31.03%) were the most commonly used methods. When contraceptive methods were divided into four categories-long-acting contraceptives (LAC), short-acting contraceptive (SAC), Others, and "No use"-the prevalence was 6.1% (601/19,678), 40.8% (8022/19,678), 35.1% (6912/19,678), and 21.1% (4143/19,678), respectively. Women with a high level of education, being unmarried, and sexually active women tended to choose SAC; married women were associated with LAC usage. Women with irregular menstrual cycle used a high proportion of emergency contraception.

CONCLUSIONS

The prevalence of contraceptive use was 78.9%, with condom use being most prominent. Young women of reproductive age have low awareness of contraception. Relevant departments should take necessary measures to improve this situation.

Challenges in sexual and reproductive health of Roma people who live in settlements in Serbia

OBJECTIVE

To investigate the differences in sexual and reproductive health (SRH) between Roma women of reproductive age who live in settlements and the general population of women of the same age in Serbia who do not live in settlements.

METHODS

The Multiple Indicator Cluster Survey 4 (MICS4) was administered to Roma and Serbian women and the results were compared between the two groups. In order to get a qualitative perspective, a specifically designed, short open-ended questionnaire about Roma women was given to Roma Health Mediators (RHMs).

RESULTS

Roma women have a higher total fertility rate and adolescent birth rate, and early marriage is much more common among them. Differences are less clear regarding antenatal care and assistance during delivery from skilled personnel. Roma women more frequently rely on traditional contraception, and are less likely to use modern contraceptives than the general female population. Problems in the socio-economic sphere, poor school enrolment and maintenance of traditional patterns in Roma people living in settlements contribute to the disparities observed.

CONCLUSION

Although data on the SRH of the general population of women in Serbia are far from being satisfactory, those for women who live in Roma settlements are much worse. Political actions aimed at the empowerment of Roma women in the spheres of education, employment and health promotion have been implemented with the hope that they might improve the SRH of this vulnerable population group.