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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Magnitude of unmet need for family planning and its predictors among reproductive age women in high fertility regions of Ethiopia: Evidence from Ethiopian Demographic and Health Survey

BACKGROUND

Unmet need for family planning refers to fertile women who want to limit or space their delivery but are not using contraceptive methods. Despite multiple studies were conducted to address family planning in Ethiopia, there is limited information on unmet need in high fertility regions. Knowing the magnitude and predictors of unmet need in the study area helps as an impute for interventions. Therefore, this study aims to assess the magnitude and predictors of unmet need for family planning among reproductive age women in high fertility regions of Ethiopia.

METHODS

A secondary data analysis was performed using the Ethiopian Demographic and Health Survey 2016. A total sample weight of 4312 currently married reproductive age women were included in this study. A multilevel mixed-effect binary logistic regression model was fitted. Finally, the odds ratios along with the 95% confidence interval were generated to determine the individual and community level factors of unmet need for family planning. A p-value less than 0.05 was declared as statistical significance.

RESULTS

The overall unmet need for family planning among currently married reproductive-age women in high fertility regions of Ethiopia was 29.78% (95% CI: 28.26, 31.3). Women with no formal education (AOR: 1.65, 95% CI: 1.17, 2.15), women in the poor wealth quantile (AOR: 1.67, 95% CI: 1.34, 2.09), women with no media exposure (AOR: 1.32, 95% CI: 1.09, 1.58), multiparous women (AOR: 1.57, 95% CI: 1.15, 2.16), sex of household head (AOR: 1.39, 95% CI: 1.11, 1.77) and rural residency (AOR: 2.45, 95% CI: 1.12, 3.59) were predictors of unmet need for family planning.

CONCLUSION

The magnitude of unmet need for family planning among currently married reproductive-age women in high fertility regions of Ethiopia was high when compared to the national average and the United Nations sphere standard of unmet need for family planning. Education, wealth index, mass media, parity, sex of household head, and residence were independent predictors of unmet need for family planning among reproductive-age women in high fertility regions of Ethiopia. Any interventional strategies that reduce the unmet need for family planning should consider these factors to overcome the problems in the regions.

The power of women's and men's Social Networks to catalyse normative and behavioural change: evaluation of an intervention addressing Unmet need for Family Planning in Benin

Background

In Benin, despite good knowledge and availability, modern contraceptive prevalence remains relatively low, and the unmet need for family planning is relatively high. This is partly due to insufficient attention to socio-normative barriers that influence need and method use. Applying social network theory, Tékponon Jikuagou (TJ) aims to reduce socio-normative barriers preventing modern contraceptive use in rural Benin. After community identification, TJ trains influential network actors who encourage critical dialogue about unmet need, family planning, gender, and other social norms within their networks, complemented by radio and services linkages. This paper evaluates TJ's effectiveness and how intervention components affect intermediate and primary FP outcomes.

Methods

We report findings from pre/post-intervention cross-sectional research with a comparison group conducted at baseline with 1,043 women and 1,030 men, and 14 months later at endline with 1,046 women and 1,045 men. Using sex-stratified models, we assessed balance across intervention and comparison groups on background characteristics using Pearson's chi-square tests of independence; performed bivariate tests of independence to assess differences between baseline to endline on intermediate outcomes and primary FP outcomes; used logistic regression to examine the effect of intervention components on intermediate and primary FP outcomes.

Results

Statistically significant improvements in primary outcomes: women's intentions to use modern contraception, achieve met need, and reduce perceived met need. The fourth primary outcome, actual use, showed substantial gains, although not statistically significant. Men's achievement of met FP need and reduced perceived met need were also statistically significant. Assessing intermediate outcomes at individual, couple, normative-network levels, TJ led to statistically significant increases in couple and network communication on fertility desires and family planning use and self-efficacy and confidence to access services. Both women and men showed significant shifts in the acceptability of discussing FP in public. Results for other indicators of norms change were inconsistent.

Conclusions

An easy-to-implement, short-duration, gender-equitable social network intervention with a limited set of network actors, TJ effectively decreases social and normative barriers preventing women and men from seeking and using FP services. Results support the broader use of innovative social and behaviour change strategies that diffuse family planning ideas through social networks, diminish normative and communication barriers, and catalyse modern family planning use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12681-4.

In many places with relatively low family planning use, insufficient program attention is paid to socio-normative barriers that influence need and method use. TJ catalyses women and men's social networks to spread new ideas and break communication and other social barriers that prevent women and men with unmet needs – people who wish to space their next birth but are not using effective family planning methods - from acting on their desires. A rigorous evaluation of the approach in rural Benin showed after only 14 months, TJ led to statistically significant improvements in intention to use contraception and met need. While showing substantial gains, women's use of contraception was not statistically significant.

TJ increased women's and men's partner and network communication on fertility desires and family planning use and individual self-efficacy and confidence to act on intentions to address unmet need. The network influence on family planning use was equally significant. TJ led to new ideas within communities/social networks, including the perception that one's social networks approve of FP. Women and men who report that their network approves of FP were significantly more likely to discuss method use with their partners and seek services. TJ led to new perceptions that one's networks support FP.

TJ represents an underused strategy for social and behaviour change. The social network approach encourages addressing the often-neglected social factors that stop women and men from acting on their desires to space births and use modern family planning methods.

Factors related to the incidence of unmet need in couples of reproductive age in the working area of Marawola Health Center

OBJECTIVE

This study aimed at determining factors associated with the incidence of unmet need for family planning among couples of reproductive age in the working area of Marawola Health Center, Sigi Regency.

METHOD

This research was an analytic observational study with a cross-sectional study design. The variables in this study included age, education, family planning history, husband's support and unmet need. Data were in the form of primary and secondary data. Data were collected using a questionnaire. The data were analyzed using univariate and bivariate analysis utilizing the Chi-Square test. Population in this study were 4715 couples of reproductive age in the working area of Marawola Health Center. By using Lemeshow's calculation technique and simple random sampling, a sample of 90 people was obtained.

RESULT

The results demonstrated a relationship between age and the incidence of unmet need with p value=0.004 (p-value ≤0.05); education and the incidence of unmet deed with p value=0.005 (p-value ≤0.05); family planning history and the incidence of unmet need with p value=0.002 (p-value ≤0.05); as well as husband's support and the incidence of unmet need with p value=0.001 (p-value ≤0.05).

CONCLUSION

This study concludes that there is a relationship between age, education, family planning history, and husband's support and the incidence of unmet need for family planning in the working area of Marawola Health Center, Sigi Regency. Therefore, health workers, local governments, and traditional institutions are expected to provide education about family planning to couples of reproductive age (husband and wife) as an attempt to reduce the number of unmet needs in the working area of Marawola Health Center.

The relationship of parity and patriarchal culture with unmet need for family planning of eligible women in Gadungan Village, Selemadeg Timur District, Tabanan Bali in 2019

BACKGROUND AND OBJECTIVES

Unmet need for KB (family planning) is a multidimensional problem due to the influences of various factors such as demographic characteristics, socio-economic, attitudes and access to services. Therefore, this research was conducted with the aim of knowing the relationship between parity and patriarchal culture with unmet need for family planning in the Gadungan Village in order to reduce the percentage of unmet need based on the causes.

METHOD

This study employed a cross-sectional survey study which was carried out from August 2018 to February 2019. The researcher also utilized simple random sampling to select the sample. The number of samples taken were 54 eligible women in Desa Gadungan. Data collection was conducted using a questionnaire filled in by respondents. Further, the data analysis was done by administering Chi-square test.

FINDINGS

This study finds out that there is a significant correlation between parity and patriarchal culture with the unmet need for family planning in eligible women in Gadungan Village, Selemadeg Timur Tabanan District, Bali with p-values of 0.03 and 0.02. There needs to be counseling about unmet need for family planning and its impact so that public knowledge improves of unmet need.

A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya

BACKGROUND

Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives.

METHODS

Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach.

RESULTS

Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods.

CONCLUSION

This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.

Socio-demographic determinants of unmet need for family planning among married women in Pakistan

BACKGROUND

Family planning is considered as an effective tool to control population and to bring improvement in maternal and child health. The Government of Pakistan has been continuously struggling to improve the availability of family planning services. However, like many other developing countries of the world, unmet need for family planning still exists in the country. According to Pakistan Demographic and Health Survey 2012-13, the prevalence of unmet need for family planning is 21% in the country. The objective of this study is to investigate the determinants of unmet need for family planning among married women in Pakistan.

METHODS

Secondary data of Pakistan Demographic and Health Survey 2012-13 has been used to analyze the determinants of unmet need for family planning through Binary and Multinomial Logistic regressions.

RESULTS

Outcomes of the study show that the likelihood of unmet need for family planning among married women in Pakistan goes on to decrease with an increase in their age and education. The likelihood of unmet need for family planning decreases with the increase in wealth status of women's household, number of living children and husband's education. Similarly, the women residing in rural areas are more likely to have unmet need for family planning as compared with women living in urban areas. The women who lack mass media exposure, who are not employed and who have fear of side effects for using contraceptives are more likely to have unmet need for family planning.

CONCLUSIONS

Fear of side effects for using contraceptives has been identified as the major cause of unmet need for family planning in Pakistan. The Government of Pakistan has been putting a lot of efforts to convince people about the usefulness of population control programs. A huge media campaign has been launched to persuade people about the benefits of birth control. But the efforts of the government do not seem to be very much effective to clear the perception of people about side effects of contraceptive use. Hence, fear of side effects still remains one of the most important reason behind unmet need for family planning.

Counseling on family planning during ANC service increases the likelihood of postpartum family planning use in Bahir Dar City Administration, Northwest Ethiopia: a prospective follow up study

BACKGROUND

Closely spaced pregnancies within the first year postpartum increases the risk of death for both the mother and baby. Many countries recommend providing pregnant women with post-partum family planning counselling during antenatal care visits. However, data on the extent to which providers utilize these opportunities and the role of family planning counseling during antenatal care in promoting the use of postpartum modern family planning remain limited especially in developing countries. Therefore, this study was aimed at investigating the role of family planning counseling during antenatal care in promoting postpartum modern family planning use within 6 weeks after birth.

METHODS

Nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first Antenatal Care (ANC) visit were enrolled and followed until 6 weeks after delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist to assess whether or not the providers counsel pregnant women on post-partum family planning use during their four focused ANC visits. Exit interview was also conducted at 6 weeks after they gave birth when they came to immunize their child to assess whether they were starting to use postpartum modern family planning. Completed data were obtained from 823 women. Generalized Estimating Equation was carried out to identify predictors of postpartum modern family planning use by controlling the cluster effect among women who received ANC services in the same health facility.

RESULTS

Postpartum modern family planning use within 6 weeks after delivery among the study women was 157(19.1%) with 95%CI (16.4, 21.9); Among 187 pregnant women who were counseled at least once, 72(38.5%) of them used post-partum modern family planning compared to 13.4% of post-partum women who were not counseled at all (p < 0.001). Counseling about postpartum family planning during antenatal care, satisfaction on the antenatal care services women received while they were pregnant, counseling on birth preparedness and complication readiness plan, counseling on breast feeding and post-natal care use were independent predictors for postpartum modern family planning use.

CONCLUSION

Less than one in five post-partum women were using postpartum family planning within 6 weeks after birth. Family planning counseling during ANC services had a significant effect on promoting postpartum modern family planning use. Therefore, health providers need to ensure continuity of care through strengthening integration of family planning counseling services during ANC and referral linkages between community and health workers.

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

Background

Unmet need for family planning points to the gap between women’s reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women’s self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women’s perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys.

Methods

A multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods.

Discussion

Policy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.