Associations Between Recent Contraceptive Use and First Sex Behaviors of Scottish Adolescents: A Brief Report

Objectives

We examined associations between recent contraceptive use and first-sex behaviors (early initiation, substance use, contraceptive use) among adolescents in Scotland.

Methods

We used data from the Health Behavior in School-aged Children study.

Results

Controlling for early initiation and substance use, girls and boys who used contraceptives at first sex were 7.5 and 12.3 times more likely to use contraceptives at most recent sexual intercourse than adolescents who did not (p < .001). We also present preliminary evidence on contraceptive use of Scottish adolescents in 2022.

Conclusions

Experiences during adolescents' first sex may have lasting implications for later sexual behavior.

A cluster randomized controlled trial

BACKGROUND

Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings.

OBJECTIVE

The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia.

METHODS

A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention.

RESULT

After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups.

CONCLUSIONS

School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.

Transforming masculine norms to improve men's contraceptive acceptance: results from a pilot intervention with men in western Kenya

Men's adherence to constraining male gender norms can lead them to resist contraceptive use. Very few interventions have attempted to transform masculine norms to encourage greater contraceptive acceptance and gender equality. We designed and evaluated a small-scale community-based intervention targeting the masculine norms tied to contraceptive resistance among partnered men (N = 150) in two western Kenya communities (intervention vs. control). Pre-post survey data fit to linear and logistic regression models evaluated differences in post-intervention outcomes, accounting for pre-intervention differences. Intervention participation was associated with increases in contraceptive acceptance scores (adjusted coefficient (aβ) 1.04; 95% confidence interval (CI) 0.16, 1.91; p = 0.02) and contraceptive knowledge scores (aβ 0.22; 95% CI 0.13, 0.31; p < 0.001) and with contraceptive discussions with one's partner (adjusted Odds Ratio (aOR) 3.96; 95% CI 1.21, 12.94; p = 0.02) and with others (aOR 6.13; 95% CI 2.39, 15.73; p < 0.001). The intervention was not associated with contraceptive behavioural intention or use. Our findings demonstrate the promise of a masculinity-driven intervention on increasing men's contraceptive acceptance and positive contraceptive involvement. A larger randomised trial is needed to test the effectiveness of the intervention among men as well as among couples.

La pratique contraceptive moderne chez les adolescentes au Bénin: Tendances, déterminants et perspectives / Modern contraceptive use among adolescents in Benin: trends, determinants and prospects

RésuméLa pratique contraceptive moderne augmente lentement parmi les jeunes générations au Bénin. La présente étude analyse les tendances, les déterminants du recours aux contraceptifs et leurs mécanismes d'actions chez les adolescentes. Les approches socio-écologique et intersectionnelle ont été adoptées, avec une méthode d'étude mixte portant sur les adolescentes de 15 à 19 ans sexuellement actives et non enceintes. Le volet quantitatif recourt aux données des cinq enquêtes démographiques et de santé du Bénin entre 1996 et 2017-18, avec une analyse descriptive et une régression logistique binaire pas à pas. Les données qualitatives collectées par des observations, discussions de groupe et entretiens individuels auprès de différents acteurs nationaux, ont fait l'objet d'analyse de contenu. Les résultats révèlent une prévalence contraceptive moderne basse, passant de 4,6% en 1996 à 13,3% en 2017-18, avec le préservatif comme principale méthode utilisée (8,2%). En 2017-18, la probabilité d'utiliser les contraceptifs était plus élevée chez les adolescentes des ménages riches (OR = 2,3), les scolarisées (OR = 2,3), les célibataires (OR = 2,1), celles fréquentant les services de planification familiale (PF) (OR = 1,8), connaissant le cycle menstruel (OR = 1,6), et économiquement actives (OR = 1,5). Cependant, être Yoruba réduit les chances d'utiliser les contraceptifs (OR = 0,5). Les données qualitatives confirment ces résultats et les complètent en mettant en avant l'effet du cadre juridique favorable à la pratique contraceptive, la stigmatisation sociale des utilisatrices, et les infox véhiculées en communauté. Nous recommandons des efforts pour le maintien des filles à l'école, la généralisation des services de PF pour les adolescents, la communication communautaire, et la subvention des contraceptifs.

Contraceptive use and discontinuation among women aged 15-24 years in Kenya

Introduction

The 15-24-year-old age group of young women make up about 15% of the population of 47 million Kenyans which comes to 7 million. Addressing the reproductive health goals of this cohort is thus a policy priority because of the high potential they pose for unintended pregnancy through incorrect and intermittent use of contraception.

Objective

The study sought to present evidence on contraceptive use among women aged 15-24 in Kenya between 2012 and 2014 using Kenya Demographic and Health Survey (KDHS) 2014 Contraceptive calendar data and make recommendations on enhancing the correct and consistent use of contraception.

Methodology

The data used was obtained from the Choices and Challenges tool developed by Population Reference Bureau (PRB) and visualized innovatively using Sankey Diagrams that show contraceptive use/non-use, continuation, switching/discontinuation, and pregnancy.

Results

The use of contraceptives went up by about 30% during the study period while the use of modern methods went up by 83%. The uptake of Long-Acting Reversible Contraception (LARC) went up by 87% while that of Short Acting Methods (SAM) went up by 70% but the progress was clouded by discontinuation rates of 35% with side effects being the leading reason for the abandonment of contraception.

Conclusion

For Kenya to achieve transformative results in ending the unmet need for contraception and preventable maternal deaths, it is critical to sustaining the current gains in contraceptive prevalence rate (CPR) by promoting the retention of youth users and encouraging new users.

Nigerian men and modern contraceptives: who are the non-users and what are their perceptions about family planning?

Introduction

the decision of men is pertinent to contraceptive uptake in a patriarchal society like Nigeria. Earlier studies on contraception in Nigeria have focused majorly on women. In this paper, we identified factors influencing contraceptive use, and non-users' perceptions about family planning among Nigerian men.

Methods

using data from the 2018 Nigeria Demographic and Health Survey, this retrospective cross-sectional study focused on men aged 15-59 years. Three outcome variables were analysed: modern contraceptive use categorised as non-users or users; perception about contraception captured using two statements- "contraception is woman's business"; "women who use contraception may become promiscuous". Data were analyzed using multivariable logit model with robust standard errors (α= 0.05).

Results

mean age of the men was 37.3 years (SD=10.2). Out of 9622 study participants, 71.0% do not use any modern contraceptive method; 19.9% believed that contraception is woman's business while 38.1% believed that women who used contraceptives may become promiscuous. Significant predictors of non-use of contraceptives and perceptions about family planning were older age, low education, Islamic religion, exposure to family planning messages, desire for more children and residence in Northern part of Nigeria.

Conclusion

large proportion of contraceptive non-users had negative perceptions. Educational intervention and advocacy among Nigerian men are essential to increase contraceptive uptake.

Women's Sexual Empowerment and Its Relationship to Contraceptive Use in Bangladesh: Findings From a Recent National Survey

Objectives: This study aimed to assess the relationship between women's sexual empowerment and contraceptive use among married Bangladeshi women from a nationally representative sample. Methods: Secondary data analysis was conducted using the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The investigation covered a total of 14,515 married, non-pregnant women who were residing with their spouses. Multivariable logistic regression analysis was fitted to assess the relationship between the variables of interest. Results: A unit increase in the sexual empowerment scale increases the odds of contraceptive use by 13%. While increasing age, being Muslim, having a spouse who is older by more than 10 years, and living in rural areas are associated with lower odds of using contraceptives than their respective counterparts, secondary or higher levels of education, having more living children, exposure to TV or radio, and employment are associated with higher odds of using contraceptives. Conclusion: The study's findings point to the need for addressing women's perceptions of their right to sexual and reproductive health and equity in order to further efforts to achieve universal access to reproductive health services.

Factors contributing to changes in contraceptive use among adolescent girls in Zambia: a decomposition analysis

Despite its documented benefits, contraceptive use among adolescents remains low, particularly in low-and middle-income countries. This study aimed to decompose the main factors contributing to the changes in contraceptive use among adolescent girls in Zambia over the period 1996 to 2014. Data on adolescent girls aged 15-19 years from Zambia Demographic and Health Survey data were analysed using multivariate decomposition analysis of change. Stata 15/MP (Stata-Corp LLC) was used for analysis, at a 95% confidence level. A P-value of 0.05 was used to determine statistical significance. The sample included 9,072 adolescent girls. Contraceptive use increased by 3% from 7.6% in 1996 to 10.6% in 2013/14. Change in modern contraceptive use among adolescents was mainly due to differences in coefficients (changes in population behaviour). Increases in age contributed to the change in contraceptive use, resulting in 2.94 and 9.33% increases for 17- and 18-year-olds respectively. Marriage or living with a partner contributed the largest change (44%) while living in a rural area accounted for approximately 20%. Interventions targeting improving contraceptive use in adolescents should be responsive to the needs of various age groups, places of residence, and educational levels for maximum benefits.

The relevance of knowledge, perception, and factors that influence contraceptive use among married women living in Uaddara Barracks, Ghana

Background

Contraceptive use has many advantages for personal growth and societal advancement, but there is still the problem of unmet needs for women, which highlights the gap between women's reproductive intentions and contraceptive use. This study investigated knowledge, perceptions, and factors that influence contraceptive use among married women living in a military base in Ghana.

Methods

This cross-sectional study involved 350 married women between the ages of 20 and 58 years at the Uaddara Barracks, Kumasi. A structured questionnaire was used to collect information on the background, knowledge, perceptions on contraceptive use, and contraceptive methods used by participants. Data was entered into an Excel sheet and analysed using R version 4.2.1.

Results

Most of the participants were between the age range of 36 and 40 years (25.5%). Almost all study participants (97.4%), had heard about contraceptives with 80.6% showing a high level of knowledge on contraceptives. The majority of the women (84.6%) had previously used some form of contraceptives and 53.1% presently do. More than half of the participants (69.4%) had a positive perception of contraceptive use; 80.6% responded it was their own decision to use contraceptives, and 80.3% had the support of their husbands. Husbands' support of contraception resulted in a 5 times higher usage of contraceptives among women (aOR =  5.35; p < 0.001) while women who were married to military men were 45% (aOR = 0.45; p = 0.007) less likely to use contraceptive when compared to civilian wives. Demographic characteristics like being above 40 years (aOR = 0.25; p = 0.014), being a housewife (aOR = 0.42; p = 0.043) and working in the private sector (aOR = 0.33; p = 0.015) were significantly linked with less contraceptive use.

Conclusion

The study showed that women used contraceptives at a rate that was much higher than the national norm at the Uaddara Barracks, demonstrating the beneficial influence men had on women's contraceptive use. This thereby underscores the need for interventional policies that prioritized the male as much as women, while emphasizing the benefits of contraceptive use to the family and not just as an awareness program only.

Socioeconomic Inequalities and Factors Associated with the Use of Modern Contraceptive Methods in Women of Childbearing Age in Ecuador, 2018

The objective of this study was to determine the socioeconomic inequalities and factors associated with the use of modern contraceptive methods (MCM) in the population of sexually active women of childbearing age in Ecuador. This was an analytical observational study, based on a secondary data analysis of the 2018 National Health and Nutrition Survey (ENSANUT). Information on 19,106 sexually active, married, or cohabiting women between the ages of 15 and 49 were included. Concentration curves (CC) and Erreygers concentration indices (ECI) were calculated, taking into account the use of MCM as the dependent variable and the wealth index as the independent variable. Crude and adjusted prevalence ratios with 95% confidence intervals were calculated using generalized linear models of the Poisson family. We found that 92.8% of the women surveyed used some type of MCM in the last month. A higher educational level presented a significant pro-rich concentration in the use of MCM (EIC: 0.05; p = 0.004). On the other hand, women belonging to the age group of 20 to 29 years (ECI: -0.027; p = 0.027), women with no job (ECI: -0.025; p = 0.004), and non-indigenous women (EIC: -0.031; p < 0.001), presented a pro-poor concentration. Factors significantly associated with MCM use were age, marital status, occupation, parity, ethnicity, area of residence, and living on the coast. In Ecuador, there are socioeconomic inequalities at different levels of population subgroups in women of childbearing age. Measures to promote the use of MCM are required, focusing on groups that present inequality, taking into account the factors associated with their use.

Reproductive experiences and factors influencing contraceptive use among female head-porters in Ghana: A cross-sectional study

Background and Aims

Female head-porters are a cohort of women who have migrated from their rural communities into commercial cities in search of better economic opportunities. These young women are vulnerable to untoward reproductive experiences. The study assesses the reproductive experiences of women and the factors influencing contraceptive use among them.

Methods

A cross-sectional study was conducted from January to May 2021 in the Kumasi Metropolis (n = 280). The study included 280 female head-porters within the reproductive age of 15-49 years. Convenience sampling and consecutive recruitment were used to obtain the needed sample size. All statistical significance was declared at a p-value of <0.05.

Results

Forty-two percent of respondents had a history of contraceptive use (all modern or artificial contraception). The study found gravidity (p < 0.0001), parity (p < 0.0001), number of sexual partners post-migration (p = 0.008), and age of first sex (p = 0.033) to be associated with contraceptive use among female head-porters.

Conclusion

Fourteen percent had experienced sexual exploitation post-migration, the first sexual encounter of one-third of participants were nonconsensual, 19% had sex at or before 16 years, and 72% were aware of contraception. Reproductive experiences such as gravidity and sexual debut (age at first sex) have a significant influence on the use of contraception.

Understanding the Relationship between Illness Perceptions and Health Behaviour among Women with Polycystic Ovary Syndrome

This paper aims to delineate the cognitive, emotional, and behavioural responses of women with polycystic ovary syndrome (PCOS) to their illness by applying the Common-Sense Model of Self-Regulation (CSM) to their health behaviour. An online cross-sectional design was used to examine the relationship between participants' illness perceptions (illness identity, consequence, timeline, control, and cause) and emotional representations of their PCOS, and their health behaviours (diet, physical activity, and risky contraceptive behaviour). The participants were 252 women between the ages of 18 and 45 years, living in Australia, and self-reporting a diagnosis of PCOS, recruited through social media. Participants completed an online questionnaire regarding illness perceptions as well as their diet, physical activity, and risky contraceptive behaviour. Illness identity was positively associated with the number of maladaptive dietary practices (B = 0.71, 95% CI: 0.003, 0.138; p = 0.04), and perception of longer illness duration was associated with reduced physical activity (OR = 0.898, 95% CI: 0.807, 0.999; p = 0.49) and risky contraceptive behaviour (OR = 0.856, 95% CI: 0.736, 0.997; p = 0.045). The limitations of the study include all data being self-reported (including PCOS diagnosis), and the potential for analyses of physical activity and risky contraceptive use being underpowered due to reduced sample sizes. The sample was also highly educated and restricted to those who use social media. These findings suggest that illness perceptions may play a role in influencing health behaviour in women with PCOS. A better understanding of the illness perceptions of women with PCOS is needed to increase health-promoting behaviour and improve health outcomes for women with PCOS.

Time Trends of Environmental and Socioeconomic Risk Factors in Patients with Inflammatory Bowel Disease over 40 Years: A Population-Based Inception Cohort 1977-2020

BACKGROUND

Data from population-based studies investigating trends in environmental factors associated with inflammatory bowel disease (IBD) is lacking. We aimed to assess long-term time trends of environmental and socioeconomic factors in IBD patients from a well-defined population-based cohort from Veszprem, Hungary.

METHODS

Patients were included between 1 January 1977, and 31 December 2020. Trends of environmental and socioeconomic factors were evaluated in three periods based on the decade of diagnosis, representing different therapeutic eras: cohort-A,1977-1995; cohort-B,1996-2008 (immunomodulator era); and cohort-C, 2009-2020 (biological era).

RESULTS

A total of 2240 incident patients with IBD were included (ulcerative colitis (UC) 61.2%, male 51.2%, median age at diagnosis: 35 years (IQR 29-49)). Rates of active smoking significantly decreased over time in Crohn's disease (CD): 60.2%, 49.9%, and 38.6% in cohorts A/B/C (p < 0.001). In UC, the rates were low and stable: 15.4%, 15.4%, and 14.5% in cohorts A/B/C (p = 0.981). Oral contraceptive use was more common in CD compared to UC (25.0% vs. 11.6%, p < 0.001). In UC, prevalence of appendectomy before diagnosis decreased over time: 6.4%, 5.5%, and 2.3% in cohorts A/B/C (p = 0.013). No significant changes were found in the socio-geographic characteristics of the IBD population (urban living: UC, 59.8%/64.8%/ 62.5% (p = 0.309) and CD, 62.5%/ 62.0%/ 59.0% (p = 0.636), in cohorts A/B/C). A greater percentage of patients had completed secondary school as the highest education level in later cohorts in both UC (42.9%/50.2%/51.6%, p < 0.001) and CD (49.2%/51.7%/59.5%, p = 0.002). A higher percentage of skilled workers (34.4%/36.2%/38.9%, p = 0.027) was found in UC, but not in CD (p = 0.454).

CONCLUSION

The association between trends of known environmental factors and IBD is complex. Smoking has become less prevalent in CD, but no other major changes occurred in socioeconomic factors over the last four decades that could explain the sharp increase in IBD incidence.

Association of traditional marital practices with contraceptive decision-making, couple communication, and method use among couples in rural Maharashtra, India

In India, traditional social practices around marriage, such as non-involvement of prospective brides in choice of partner and timing of marriage, child/early marriage, dowry and purdah, compromise women's agency at the time of marriage and may also affect contraceptive practices in marriage. This paper examines the associations between traditional marital practices and contraceptive behaviours, including women's control over contraceptive decision-making, couples' communication about contraception, and ever use of contraceptives, among married women aged 18-29 years (N = 1,200) and their husbands in rural Maharashtra, India. Multivariable logistic regression was used to examine the association between these marginalising social practices and family planning behavioural outcomes, adjusting for demographic and parity confounders. Wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (AOR 1.76, 95% CI 1.16-2.68), and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Women's involvement in marital choice may facilitate couples' engagement related to family planning, possibly via the establishment of better communication between partners.

Impact of contraceptive coverage policies on contraceptive use and risky sexual behavior among adolescent girls in the USA

OBJECTIVE

This study used representative data to examine the impact of changes in contraceptive coverage policies (contraceptive insurance mandates and pharmacy access to emergency contraception) on contraceptive use and risky sexual behavior among adolescent girls.

STUDY DESIGN

Using 2003-17 Youth Risk Behavior Survey data on 116 180 adolescent girls from 34 states, we conducted difference-in-differences models to examine changes in contraceptive use and unprotected sexual intercourse with the implementation of contraceptive coverage policies. We also tested interactions between age and pharmacy access to emergency contraception.

RESULTS

Findings indicate that contraceptive insurance mandates and pharmacy access to emergency contraception were not associated with changes in contraceptive use or unprotected sexual intercourse among adolescent girls, although some changes were observed in specific age groups. Despite this, our results show an overall increase in reported use of birth control pills and longer-acting methods from 2003 through 2017.

CONCLUSIONS

Using representative data, this study lends support to existing evidence that increased access to emergency contraception does not impact contraceptive method used or unprotected sexual intercourse among adolescent girls. The results underscore the need for expanding access to a wide range of contraceptive options for adolescents, with a focus on safer and more effective longer-acting methods.

Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia

Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.

Expanding contraceptive choice among first-time mothers age 15-24 in Kinshasa: The Momentum pilot project

Introduction

Evidence shows that an expanded range of contraceptive methods, client-centered comprehensive counseling, and voluntary informed choice are key components of successful family planning programs. This study assessed the effect of the Momentum project on contraceptive choice among first-time mothers (FTMs) age 15-24 who were six-months pregnant at baseline in Kinshasa, Democratic Republic of the Congo, and socioeconomic determinants of the use of long-acting reversible contraception (LARC).

Methods

The study employed a quasi-experimental design, with three intervention health zones and three comparison health zones. Trained nursing students followed FTMs for 16 months and conducted monthly group education sessions and home visits consisting of counseling and provision of a range of contraceptive methods and referrals. Data were collected in 2018 and 2020 through interviewer-administered questionnaires. The effect of the project on contraceptive choice was estimated using intention-to-treat and dose-response analyses, with inverse probability weighting among 761 modern contraceptive users. Logistic regression analysis was used to examine predictors of LARC use.

Results

Project effect was detected on receipt of family planning counseling, obtaining the current contraceptive method from a community-based health worker, informed choice, and current use of implants vs. other modern methods. There were significant dose-response associations of the level of exposure to Momentum interventions and the number of home visits with four of five outcomes. Positive predictors of LARC use included exposure to Momentum interventions, receipt of prenatal counseling on both birth spacing and family planning (age 15-19), and knowledge of LARCs (age 20-24). The FTM's perceived ability to ask her husband/male partner to use a condom was a negative predictor of LARC use.

Discussion

Given limited resources, expanding community-based contraceptive counseling and distribution through trained nursing students may expand family planning access and informed choice among first-time mothers.

Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

Knowledge, Attitude, and Practice of Contraception Use Among Childbearing Women in Makkah Region, Saudi Arabia

Introduction The rapid growth of the Saudi Arabian economy led to socio-demographic changes, with an increasing need for birth spacing and the use of contraceptives. This study evaluated the knowledge, attitude, and practice of contraception use in the Makkah region of Saudi Arabia. Methods This cross-sectional study used an online questionnaire involving women aged 18-49 in Makkah, Saudi Arabia. Descriptive analyses were performed and the Chi-squared test was used to compare variables. A p-value of < 0.05 was considered statistically significant. Results The study included 352 women aged 32±9.1 years with a response rate of 91%. Among them, 72.1% had a diploma or bachelor's degree, and two-thirds were married (63.4%). Nearly all respondents had heard of contraception before (96.9%). However, only 44.3% knew contraception is a method of family planning, and 23.9% knew it prevents unwanted pregnancy. During the period of conducting the research, 37.8% reported using some contraception. Oral contraceptive pills (OCP) (97.2%, 33.8%), intrauterine devices (IUD) (97.2%, 22.7%), and male condoms (92.9%, 16.9%) were the most known and popular contraception methods used. Respondents' primary sources of information regarding contraception were relatives or friends (38.3%) and websites (30.2%), and 61.9% needed education on family planning. We found that women with multiple children were significantly more likely to practice family planning (p=0.005). Conclusion We found that participants were aware of and had a good attitude toward family planning. However, they had poor knowledge and poor practice of family planning. Raising awareness and education are recommended to improve knowledge and practice of family planning.

Mapping evidence on postpartum modern family planning service uptake among women in Ethiopia: A scoping review

Background

In Ethiopia, different fragmented studies have been conducted to assess the determinants and uptake of postpartum modern family planning services. There is discrepancy and inconsistency among reported studies on postpartum modern family planning service uptake. The scoping review aimed to collect evidence on postnatal birth control service use and supply a chance to spot key ideas and gaps to research, policy revision, and changes in strategies.

Methods

There were different process steps in this scoping review which included analysis questions, distinctive relevant studies, study choice, charting the information, and eventually collating, summarizing, and reporting the results. A search was conducted through scientific databases like PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Hinari, and Google Scholar. The first outcome of this scoping review was postpartum family planning service uptake after childbirth in Ethiopia. The Preferable Reporting Information in Systematic Review and Meta-Analysis (PRISMA) flow diagram was used to select and summarize the selection procedure of the articles. The information of the chosen studies was sorted using the subsequent categories: authors, year of publication, study location, main study objective, and method employed for information analyses.

Results

A total of 1,607 records were reclaimed from the database searches and reference list review. A total of 596 articles were identified in PubMed, 375 in CINAHL, 576 in Hinari, and 60 records in Google Scholar. A total of 1,607 literature studies were checked for replication, and 840 records were excluded. The bulk of articles (n = 420) were excluded because they did not focus on postpartum family planning service, and 322 articles were excluded due to study setting discrepancy. The remaining 28 full-text articles were read in full using the preidentified inclusion criteria and included in the scoping review for analysis.

Conclusion

Generally, this scoping review identified different fragmented and inconsistent research findings on the uptake of postpartum modern family planning in Ethiopia. Almost all studies were observational studies that lack interventional study designs to provide evidence-based interventions to improve postpartum family planning uptake. There is a definite need for further interventional and qualitative research to improve early postpartum family planning service uptake that improves maternal and child health.

Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States

In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; M_age  = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = -0.014, 95% confidence interval: -0.041, -0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities.

Gender relations and the utilization of contraceptives and antenatal care services in Kenya, Namibia and Nigeria

The impacts of gender relations (GR) on reproductive health in sub-Saharan Africa (SSA) have received little attention. Virtually non-existent are studies that take cognizance of the socio-cultural diversity of SSA countries in assessing the impacts. Using Demographic and Health Survey data from Namibia, Kenya and Nigeria, this study investigated whether feminine gender relations (FGR) predict higher uptake of contraceptives and antenatal care services (ANC) in SSA. Results from univariate, bivariate and multivariate analyses showed that Namibia had the highest prevalence of FGR (20.0%) and contraceptive use (57.8%) while Nigeria had the lowest FGR (5.7%) but highest ANC utilization (42.1%). At the unadjusted levels, FGR predicted higher contraceptive use in Namibia and Nigeria but became insignificant when sociodemographic confounders were controlled for. Masculine gender relations (MGR) however predicted increased contraceptive and ANC utilization in the three countries at the unadjusted levels and contraceptive use in Kenya and Nigeria when adjusted. That MGR predicted higher odds of using contraceptives in a largely gender egalitarian Kenya and patriarchal Nigeria while FGR was insignificant even in the largely feministic Namibia, suggests that promoting equality in GR, rather than emphasizing female autonomy, possesses greater capacity for improving reproductive health outcomes in SSA.

Effects of technology-based contraceptive decision aids: a systematic review and meta-analysis

OBJECTIVE

This study aimed to conduct a systematic review and meta-analysis of the effects of technology-based decision aids on contraceptive use, continuation, and patient-reported and decision-making outcomes.

DATA SOURCES

A systematic search was conducted in OVID MEDLINE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, Embase, PsycINFO, and SocINDEX databases from January 2005 to April 2022. Eligible references from a concurrent systematic review evaluating contraceptive care were also included for review.

STUDY ELIGIBILITY CRITERIA

Studies were included if a contraceptive decision aid was technology-based (ie, mobile/tablet application, web, or computer-based) and assessed contraceptive use and/or continuation or patient-reported outcomes (knowledge, self-efficacy, feasibility/acceptability/usability, decisional conflict). The protocol was registered under the International Prospective Register of Systematic Reviews (CRD42021240755).

METHODS

Three reviewers independently performed data abstraction and quality appraisal. Dichotomous outcomes (use and continuation) were evaluated with an odds ratio, whereas continuous outcomes (knowledge and self-efficacy) were evaluated with the mean difference. Subgroup analyses were performed for the mode of delivery (mobile and tablet applications vs web and computer-based) and follow-up time (immediate vs >1 month).

RESULTS

This review included 18 studies evaluating 21 decision aids. Overall, there were higher odds of contraceptive use and/or continuation among decision aid users compared with controls (odds ratio, 1.27; 95% confidence interval, [1.05-1.55]). Use of computer and web-based decision aids was associated with higher odds of contraceptive use and/or continuation (odds ratio, 1.36; 95% confidence interval, [1.08-1.72]) than mobile and tablet decision aids (odds ratio, 1.27; 95% confidence interval, [0.83-1.94]). Decision aid users also had statistically significant higher self-efficacy scores (mean difference, 0.09; 95% confidence interval, [0.05-0.13]), and knowledge scores (mean difference, 0.04; 95% confidence interval, [0.01-0.07]), with immediate measurement of knowledge having higher retention than measurement after 1 month. Other outcomes were evaluated descriptively (eg, feasibility, applicability, decisional conflict) but had little evidence to support a definite conclusion. Overall, the review provided moderate-level evidence for contraceptive use and continuation, knowledge, and self-efficacy.

CONCLUSION

The use of technology-based contraceptive decision aids to support contraceptive decision-making has positive effects on contraceptive use and continuation, knowledge, and self-efficacy. There was insufficient evidence to support a conclusion about effects on other decision-making outcomes.

Mechanisms Linking High Residential Mobility to Decreased Contraceptive Use: The Importance of Method Availability

While research has demonstrated that high residential mobility has negative consequences for an array of outcomes, particularly among women and young adults, the mechanisms underlying these associations are unclear. The consequences of high residential mobility may be comprised solely of a series of short-term disruptions surrounding individual moves, or there may also be long-term, cumulative effects from repeated moves. High residential mobility may diminish access to resources as individuals move to different neighborhoods, impose a cognitive burden that impairs their ability to plan ahead, or decrease the relative power they have in their relationships to limit exposure to risk behaviors. We adjudicate between these possibilities by predicting the effects of high residential mobility on sexual intercourse and contraceptive use, the proximate determinants of pregnancy, during women's transition to adulthood. Using 2.5 years of monthly address data for 882 respondents in the Relationship Dynamics and Social Life study-a random sample of young women in Genesee County, Michigan-we find that high residential mobility is associated with long-term decreases in contraceptive use. These long-term consequences are independent of the short-term effects of individual moves and attributable to diminished contraceptive access. We disentangle the effects of home-leaving, which is distinct from subsequent moves.

Relationships between Penile-Vaginal Intercourse Frequency and Condom/Contraceptive Use from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

Objectives

To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use.

Methods

Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults.

Results

Use of condoms and highly effective hormonal contraceptives decreased while long-acting reversible contraceptive use increased from 2009 to 2018 among adults. Increased penile-vaginal intercourse frequency was associated with decreased use of most contraceptive methods but an increase in condom use for adolescents.

Conclusions

Sexual frequency should be considered when assessing condom/contraceptive use.

Ranges of pregnancy preferences and contraceptive use: Results from a population-based survey in the southeast United States

CONTEXT

Understanding how pregnancy preferences shape contraceptive use is essential for guiding contraceptive interventions and policies that center individuals' preferences and desires. Lack of rigorous measurement of pregnancy preferences, particularly on the population level, has been a methodologic challenge.

METHODS

We investigated associations between prospective pregnancy preferences, measured with a valid instrument, the Desire to Avoid Pregnancy (DAP) scale, and contraceptive use in a representative sample of 2601 pregnancy-capable self-identified women, aged 18-44 years, in Alabama and South Carolina (2017-2018). We used multivariable regression with weighting to investigate how probability of modern contraceptive use, and use of different contraceptive method types, changed with increasing preference to avoid pregnancy.

RESULTS

Desire to Avoid Pregnancy scale scores (range:0-4, 4 = greater preference to avoid pregnancy, median = 2.29, IQR: 1.57-3.14; α:0.95) were strongly associated with contraceptive use among sexually active respondents (aPR = 1.15 [1.10, 1.20]; predicted 45% using contraception among DAP = 0, 62% among DAP = 2, 86% among DAP = 4). Method types used did not differ by DAP score. The most common reasons for nonuse were concern over side effects and not wanting to use a method (32% each) among respondents with mid-range and high DAP scores. Among those with mid-range DAP scores, 20% reported nonuse due to not minding if pregnancy were to occur (vs. 0% among those with high DAP scores).

CONCLUSIONS

Pregnancy preferences strongly influence likelihood of contraceptive use. Providion of appropriate contraceptive care to those not explicitly desiring pregnancy must differentiate between ranges of feelings about pregnancy, perceived drawbacks to contraceptive use, and legitimate psychological and interpersonal benefits of nonuse to promote autonomy in contraceptive decision-making.

Use of a Practitioner-Friendly Behavior Model to Identify Factors Associated with COVID-19 Vaccination and Other Behaviors

The lack of capacity for the design and implementation of behavioral interventions in low-and-middle income countries (LMICs) has been recognized by the World Health Organization (WHO) and other global health institutions. There is a need to task-shift, to translate social and behavioral science concepts into "practitioner-friendly" models-models which can be used by intervention designers, implementers, and evaluators with limited technical and financial resources. We illustrate the use of the Fogg Behavior Model (FBM), a model identified as being easy for practitioners to adopt in low-resource settings. The study uses data across four different behaviors in Nigeria, Pakistan, and India. The behaviors examined are COVID-19 vaccine uptake, condom use, iron folate use, and modern contraceptive use. The data are from surveys of healthcare workers (HCWs), married men, women of reproductive age, and adolescents, respectively. The FBM states that behavior happens when both motivation and ability are present, and a prompt occurs. In other words, persons with high motivation and high ability are the first to adopt a behavior. We created a categorical variable for motivation and ability and tested whether high motivation and high ability are associated with a greater likelihood of adopting a behavior. In Nigeria, HCWs with high motivation and high ability had 27 times higher odds of being vaccinated. In Pakistan, married men with high motivation and high ability had 35 times higher odds of condom use with their wives. In India, women with high motivation and high ability had 9 times higher odds of iron folate use. In Nigeria, adolescents and young women with high motivation and high ability had 8 times higher odds of contraceptive use. The study findings suggest that the FBM has the potential to be applied in low resource settings for the design, implementation, and evaluation of behavioral interventions. Rigorous testing of the FBM using data from experimental or quasi-experimental studies is recommended.

Unmet Need for Family Planning Service and Associated Factors Among Homeless Women of Reproductive Age Group in Jimma Zone Administrative Towns, Ethiopia

Background

The majority of homeless women (75%) do not wish to have or delay a pregnancy during this difficult time, yet many do not use contraception in developing countries. In Ethiopia, there is limited evidence of unmet need for family planning in settings where homelessness is on the increase. This study aims to assess the unmet need for family planning services among homeless women and identify associated factors in Jimma Town, southwestern, Ethiopia.

Methods

A community-based cross-sectional study was conducted on May 3rd and 4th, 2021. The complete enumeration was done to include 206 homeless women. Epidata version 3.1 data entry and exported to SPSS version 20 were used for analysis. Bivariate and multivariable logistic regressions were used to identify factors associated with the unmet need for family planning. Associated factors were determined by a 95% confidence interval of AOR and P-value <0.05 in the multivariable model.

Results

The unmet need for family planning among homeless women was 47.3% [95% CI (38.2, 49.7)]. Being with a disability; [(AOR: 4.10, 95% CI (1.73–9.56), visited by a health care provider in the last 12 months; [(AOR: 0.25, CI (0.09–0.65)], and a number of living children; [(AOR: 0.42, CI (0.18–96)] were significantly associated with an unmet need for family planning.

Conclusion

The unmet need for family planning methods among homeless women was high compared to the national standard of unmet need for family planning, being with a physical disability, visited by a health care provider in the last twelve months, and having a number of living children contributed to the unmet need for family planning. Therefore, health care professionals should focus on providing health education on family planning among these women at the grass-root level to reduce the unmet need for family planning among these women.

Levels, method choice and predictors of contraceptive use among males in southern Africa

This study assessed the relative risk of using male and partner contraceptive methods relative to non-use, identified the types of methods preferred by participants, and assessed the associated determinants of the use of male and partner methods. It used secondary data from the Demographic and Health Surveys conducted in Lesotho, Namibia, South Africa, and Zimbabwe. Participants were sexually active men aged 15-54. The study found that 32% of respondents did not utilize any method, while 36% and 32% used partner and male methods, respectively. The male method was more prevalent among men who had two or more sexual partners and among urban dwellers, while the partner method was predominant among those with less than two children and those who were indifferent about whether contraception is a woman's business. The study recommends that family planning programs should pay attention to male contraceptive needs and concerns.

The causal effect of a family planning intervention on women's contraceptive use and birth spacing

SignificanceImproving access to family planning may promote contraceptive use after childbirth and reduce the likelihood of closely spaced high-risk births; however, empirical evidence for these claims is limited. We present findings from a field experiment that examines the causal impact of a broad-based family-planning intervention on postpartum contraceptive use and fertility over a 2-y period, which allows us to assess impact on high-risk short pregnancy intervals. Our findings demonstrate that the benefits of family planning extend beyond contraceptive use to improve fertility and healthy birth spacing. Evidence from this study will contribute to the design of effective family-planning programs and to informing the ongoing policy debate about how such programs impact longer-term health and development more broadly.

Social Resources, Abortion, and Contraceptive Use Among Women With Criminal Justice Histories

Women in the criminal legal system face structural barriers to social resources such as education, employment, and benefits. Little is known how these resources intersect with their reproductive lives, specifically with obtaining abortions. We explored the relationship between social resources and abortion history among women incarcerated in a county jail through a secondary analysis of survey data from a 2014 to 2016 jail-based sexual health intervention. Regression analyses determined correlates of having an abortion history. Thirty percent of participants had an abortion and were more likely to have at least a high school education (adjusted odds ratio [aOR] = 3.3; 95% confidence interval [CI] = 1.25-8.77) and a history of sexually transmitted infections (aOR = 3.2; 95% CI = 1.25-8.06). Appropriate systems-level efforts should be expanded to support women with criminal legal histories in their reproductive lives.

Family Planning Research in African Immigrant and Refugee Women: A Scoping Review

INTRODUCTION

African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States.

METHODS

Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020.

RESULTS

The small number of retrieved studies for the literature review clearly highlights a dearth of research. Available evidence indicates stark disparities in health care access, unmet individual needs, and unacknowledged preferences.

DISCUSSION

Ignoring cultural considerations for the growing African immigrant population perpetuates the divide in family planning practices.

Men's Attitude Towards Contraception and Sexuality, Women's Empowerment, and Demand Satisfied for Family Planning in India

Whilst the prevalence of unmet need and contraceptive use remained unchanged for 10 years (between 2005-2015) in India, gender restrictive norms and power imbalances also have persisted, preventing married women from meeting their family planning desires. Data for this study are from the 2015-6 National Family Household Survey, which contains information on fertility preferences and family planning for women in reproductive age. As a proxy for men's attitudinal norms, we aggregated men's perceptions regarding contraception (contraception is women's business, women who use contraception may become promiscuous) and control over their wife (if his wife refuses to have sex, men have the right to deny financial support, have sex with another woman, or beat wife) at district level. Using a three-level random intercepts model, we assessed individual and contextual-level associations of men's attitudinal norms and met need for contraception among sexually active women (aged 15-49) with any demand for family planning, while adjusting for women's empowerment indicators [education, job status, and adult marriage] and individual demographic factors. Our results indicate that men's attitudinal norms are negatively associated with women's contraceptive use; for instance, a 1 standard deviation increase in the proportion of men who believe that contraception is women's business was associated with a 12% reduced likelihood of contraceptive use (OR = 0.88, 95% CI 0.82-0.95). Similar associations remained or were stronger after considering only modern methods, or when excluding female sterilization. Furthermore, our contextual effects analysis revealed that women's higher education or wealth did not improve contraceptive uptake in communities with strong attitudinal norms, but working women or women married as children were more likely to use contraception in those communities. Our results suggest that men's attitudinal norms may be dominating over women's empowerment regarding family planning choices among reproductive age women. However, employment appeared to play a strong protective role associated with women's contraceptive use. It is important for programs seeking to transform gender equality and empower women in making contraceptive choices to consider women's employment opportunities and to also address male attitudinal norms in the context of the ecosystem in which men and women coexist and interact.

Teenage pregnancy prevention: The church, community, culture and contraceptives

It is important to prevent teenage pregnancies to enhance their health, educational level and economic prospects. Peer education should be explored as a strategy to prevent teenage pregnancies. The purpose of this paper is to share the perceptions of peer educators who underwent a peer education-training programme and the effect it had on their own sexual behaviour. A qualitative descriptive, explorative and contextual research design was conducted, using in-depth interviews from 15 participants to gather data. The findings revealed that participants had positive educational experiences; positive personal growth; and wanted to become mentors for their peers. Despite their increased level of knowledge and positive experiences, some found it difficult to mentor others due to religion, culture as well as the opinion of their parents and community. Peer education will only have an effect on contraceptives if the church, the community, diverse cultural norms and traditions are included in the dialogue about contraception.

Men's needs and women's fears: gender-related power dynamics in contraceptive use and coping with consequences in a rural setting in Kenya

This paper examines gender-related power influences on contraceptive use and coping with consequences in a rural setting in Kenya. Data come from in-depth interviews conducted in 2018 with 42 women who participated in a longitudinal study implemented in Homa Bay County. Data were analysed using an exploratory inductive content analytic approach. The findings show that the key drivers of gender-related power influence on contraceptive use and coping with consequences included: 1) the extent to which the women managed to provide sex and sexual pleasure to their partners when they were using contraception; 2) men's readiness to provide permission and resources that women needed and the latter's ability to overcome challenges in obtaining the same from their partners; and 3) women's fears concerning infidelity and partner violence, which influenced the actions they took to reduce instances that could make their partners suspect them of engaging in extra-marital affairs, drive their partners into such affairs, or encourage their partners to direct emotional or physical violence on them. Findings suggest the need for gender-transformative actions combining empowerment programmes for women with information, education and communications activities targeting both men and women.

Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention

Background: Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics. Methods: From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15-24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5-15% HIV incidence) defined "high" HIV risk. Results: Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20-23], median completed education was 12 years (IQR 10-12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09-1.29, p < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09-2.10, p = 0.012); injectable use was not associated with HIV risk scores ≥5. Conclusions: Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.

When Do Nigerian Women of Reproductive Age Initiate and What Factors Influence Their Contraceptive Use? A Contextual Analysis

Background

Contraceptive use initiation and continuation is one of the major interventions for reducing maternal deaths worldwide. Nigeria aimed to achieve a 27% prevalence rate of modern contraceptive uptake by 2020, however, this seems to have remained unachieved. The objective of this study was to investigate when Nigerian women initiate contraceptive use and its associated factors, using nationally representative data.

Methods

Data on 11,382 Nigerian women (aged 15–49 years) from the 2017 Performance Monitoring and Accountability 2020 (PMA2020) survey were used to determine the prevalence of lifetime contraceptive use. The Kaplan–Meier test was used to determine median time (years) to contraceptive uptake. In addition, the factors associated with contraceptive use were determined using multivariable logistic regression model. Statistical significance was determined at 5%.

Results

The prevalence of modern contraceptive use was 14.2%. There were disparities in the timing (years) of contraceptive use initiation across several women’s characteristics. Women from urban residence, highest household wealth index, nulliparous, unmarried, and highly educated women had the minimum median time (years) to contraceptive use initiation. The multivariable logistic model showed that rural women were 26% less likely to initiate contraceptive use, when compared with the urban dwellers (OR= 0.74; 95% CI: 0.65, 0.84). Furthermore, married women were 24% less likely to initiate contraceptive use, when compared with the unmarried (OR= 0.76; 95% CI: 0.63, 0.93). In addition, geographical region, wealth, television source, ever given birth, education, age, and religion were significantly associated with contraceptive use.

Conclusion

The prevalence of contraceptive use is low in Nigeria. There were differences in contraceptive use initiation among women of reproductive age in Nigeria. There is a need to adopt sustainable strategies to improve contraceptive uptake and to re-iterate the benefits of contraception, including providing enlightenment programs among key populations such as the rural dwellers and low income earners.

Understanding unwanted pregnancy from the perspectives of the Namibian male youth

The aim of this paper was to understand the perceptions of Namibian male youth regarding unwanted pregnancy. This study is based on secondary data from the study titled "Understanding factors associated with unwanted pregnancy in Namibia, it used mixed methods, integrating qualitative and quantitative data collection and analysis. For this study, only responses pertaining to male youth aged 15 to 22 years were used for analysis. The research findings showed that, even though the male youth knew about the consequences of pregnancy, they still engaged in unprotected sex. Male condoms were the only male controlled contraceptive available to male youth and condoms were seen to protect against HIV, STIs and unwanted pregnancies. Even though the male youth had this knowledge, it appears that inconsistent condom use remained a challenge. The respondents were aware of and had limited access to condoms, more than 30% of the male youth had impregnated female youth. Impregnating and being a learner-parent inhibit the educational attainment of male youth. Unwanted pregnancy is a concern among male youth and this study recommends targeted sexual and reproductive health intervention for male youth.

Contexts and persistence of age of consent for accessing family planning services in Lagos, Nigeria: A qualitative study

Nigeria has one of the lowest adolescents family planning uptake in sub-Saharan Africa. Previous studies show that a high age of consent is a significant predictor. Little evidence exists about the contexts and persistence of the high age of consent for accessing family planning in Nigeria. Hence, this study used a qualitative methodology to explore the contexts, persistence and implications of high age of consent for accessing family planning in Lagos State. Forty-four in-depth interviews and 31 key-informant interviews were conducted in two Local Government Areas. NVIVO 12 plus was used to analyse data. The results suggest that contexts consisted of health and moral concerns, religious opposition and negative attitudes, which were underlying the persistence of high age of consent for accessing family planning. The contexts formed the basis for the exclusion of adolescents from family planning services. Consequently, sexually active adolescents adopted local herbs, a combination of different medicines, concoctions and local alcoholic drink (ogogoro) to prevent or abort pregnancies. Therefore, community-based NGOs should engage communities to promote perception change about adolescents accessing family planning and motivate the communities to begin to demand of their representatives in government a policy to lower age of consent for accessing family planning.

Women's perspectives on relationship dynamics with their partners and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use

Background: Limited information exists about relationship dynamics and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use among women in Malawi.Methods: Ninety-seven women aged 18-45 years were randomly assigned to initiate the depot medroxyprogesterone acetate injectable or levonorgestrel implant from May 2014 to April 2015 in Lilongwe, Malawi. Women were recruited after randomisation to participate in semi-structured interviews about HIV and family planning using purposive sampling. Interviews were thematically analysed using within and between group comparisons.Results: We conducted individual interviews and/or focus group discussions with 41 women: 30 (73%) women living with HIV and 11 (27%) women not living with HIV. Most women living with HIV who participated in in-depth interviews disclosed their status to their partners, and most partners agreed to get HIV tested only after disclosure. Nearly all women said their partners agreed to use condoms, but few used them consistently. Nearly all women believed their current and former partners had outside partners. Most women living with HIV who participated in in-depth interviews believed their current or other serious partners were the source of their infection. Some women thought their partner's infidelity was due to their partner's disinterest in sex with them during menstrual/ breakthrough bleeding. Some women included their partners in contraceptive decision-making when the partner was supportive.Discussion: Relationship dynamics affected decision-making for contraceptive and condom use, as well as serodisclosure for the women living with HIV in the study. All women reported challenges with consistent condom use with their male partners, although contraceptive use was generally more acceptable. Women included their partners in their decision-making concerning contraceptive use when they were supportive.

Effect of distance to health facilities and access to contraceptive services among urban Turkish women

OBJECTIVE

Worldwide unmet need for contraception remains high at 21.6%. As access to health facilities is one of the potential barriers to contraceptive uptake, the aim of our study was to evaluate the effect of distance to a health facility, according to its service availability, on contraceptive uptake among married Turkish women.

METHODS

To calculate respondents' distance to a health facility, we used data from a household survey conducted among married women, as well as data from a health facility survey conducted among the facilities that were visited for contraceptive services by the respondents. The data were collected from the Istanbul area of Turkey under the Willows Impact Evaluation project in 2018. Health facilities were categorised according to contraceptive availability and the accurate distance from respondents' homes to each type of health facility was calculated. Logistic regression was used to estimate the effect of distance to each type of health facility on uptake of each type of contraception.

RESULTS

The prevalence of overall contraceptive use among urban Turkish women was 71.9%. The most common method was withdrawal (32.5%), followed by the intrauterine device (IUD) (14.9%) and male condoms (12.4%). Distance to a health facility that did not provide long-acting contraception was not associated with any type of contraceptive use. On the other hand, distance to a health facility that provided long-acting contraception was negatively associated with the use of long-acting methods such as the IUD but was positively associated with the use of short-acting contraception such as condoms.

CONCLUSION

The effect of distance to a health facility on contraceptive use significantly differed according to contraceptive availability at the facility. Further distance to a health facility that provided long-acting contraception decreased the use of long-acting contraception but had a substitute effect on the use of short-acting contraception. We conclude that when women face an accessibility barrier to the provision of long-acting contraception, they modify their behaviour by shifting from long- to short-acting contraception, which is less effective.

User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial

Background

To achieve informed choice within the framework of reproductive autonomy, family planning programs have begun to adopt user-centered approaches to service provision, which highlight the individual client as the focal point of interaction and key decision maker. However, little is known about how user-centered approaches to family planning, particularly family planning counseling, shape contraceptive preferences and choices.

Objective

We conducted a multiarmed randomized controlled trial to identify the causal impact of user-centered approaches to family planning counseling on women’s contraceptive decision making in urban Malawi. This study aims to determine how a tailored, preference-driven approach to family planning counseling and the involvement of male partners during the counseling process may contribute to shaping women’s contraceptive preferences and choices.

Methods

Married women aged 18-35 years were recruited and randomly assigned to 1 of the 3 intervention arms or a control arm characterized by the following two interventions: an intervention arm in which women were encouraged to invite their husbands to family planning counseling (husband invitation arm) and an intervention arm in which women received targeted, tailored counseling on up to five contraceptive methods (as opposed to up to 13 contraceptive methods) that reflected women’s stated preferences for contraceptive methods. Women were randomized into a control arm, T0 (no husband invitation, standard counseling); T1 (husband invitation, standard counseling); T2 (no husband invitation, targeted counseling); and T3 (husband invitation, targeted counseling). Following counseling, all women received a package of family planning services, which included free transportation to a local family planning clinic and financial reimbursement for family planning services. Follow-up surveys were conducted with women 1 month after counseling.

Results

A total of 785 women completed the baseline survey, and 782 eligible respondents were randomized to 1 of the 3 intervention groups or the control group (T1, n=223; T2, n=225; T3, n=228; T0, n=108). Furthermore, 98.1% (767/782) of women were contacted for follow-up. Among the 767 women who were contacted, 95.3% (731/767) completed the follow-up survey. The analysis of the primary outcomes is ongoing and is expected to be completed by the end of 2021.

Conclusions

The results from this trial will fill knowledge gaps on the effectiveness of tailored family planning counseling and male involvement in family planning on women’s stated and realized contraceptive preferences. More generally, the study will provide evidence on how user-centered counseling may affect women’s willingness to use and continue contraception to realize their contraceptive preferences.

Trial Registration

American Economics Association’s Registry for Randomized Controlled Trials AEARCTR-0004194; https://www.socialscienceregistry.org/trials/4194/history/46808. Registry for International Development Impact Evaluations RIDIE-STUDY-ID-5ce4f42bbc2bf; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=823.

International Registered Report Identifier (IRRID)

DERR1-10.2196/24884

Contraceptive use and fertility behaviour among Syrian migrant women

OBJECTIVES

This study aimed to investigate fertility behaviours and contraceptive use among Syrian migrant women in western Turkey.

METHODS

An epidemiological, single-centre, cross-sectional, descriptive study was conducted. The survey collected data on sociodemographic characteristics and types of marriage, use of contraceptive methods and fertility behaviours among 223 Syrian migrant women.

RESULTS

The women's mean (± standard deviation) age range was 29.6 ± 9.1 (range 18-49) years; 29.6% had no formal marriage status; 61.0% had had an arranged marriage. The mean age at first pregnancy was 19.5 ± 3.4 (13-39) years; 26.4% had become pregnant before the age of 18. In total, 94.2% of participants had knowledge of contraceptive methods. However, 47.5% did not use contraception and the main reason for this was to become pregnant again. Intrauterine devices and oral contraceptive pills were known as contraceptive methods by 67.7% and 72.2% of women, but used by only 16.1% and 8.5%, respectively. Withdrawal (22.0%) was the most used contraceptive method. There was a risk of unwanted pregnancy in 13.0% of participants. Arranged marriage and low educational level were determined to be risk factors for adolescent pregnancy.

CONCLUSION

Although Syrian migrant women were aware of contraceptive methods, the rate of method use was low.

Contraceptive Use Among Korean High School Adolescents: A Decision Tree Model

Although the rate of sexual intercourse among adolescents has increased in Asian countries, including Korea, many sexually active adolescents still do not use contraception. The aim of this study was to identify the risk factors for contraceptive nonuse among adolescents using decision tree analysis of the 2018 Korea Youth Risk Behavior Survey data from 2,460 high school students who had an experience of sexual intercourse. The findings indicated that the highest risk group who did not use contraception during sexual intercourse did not receive sexual health education in school and was involved in habitual or purposeful drug use. The experience of ever receiving treatment due to violence and the experience of sexual intercourse after drinking were also identified as risk factors for contraceptive nonuse. To encourage contraceptive use, development of standard sexual health education, counseling, and educational intervention intended to prevent risky behaviors is needed.

Types of Lifetime Reproductive Coercion and Current Contraceptive Use

Background: Intimate partner violence and differential power dynamics are associated with contraceptive behaviors. This study examines the role of reproductive coercion (RC) by an intimate partner in women's decisions about contraceptive use. Materials and Methods: A self-report survey was administered to a probability sample of a diverse group of women of reproductive age in Delaware's Title X health care facilities. Currently used contraceptive methods were categorized into three effectiveness levels based on typical use failure rates: no method or low effectiveness (>10% failure), moderate effectiveness (>1% and <10% failure), and high effectiveness (<1% failure). The short-form RC scale was used to categorize RC experiences: no RC, verbal only, or behavioral. We conducted multinomial logistic regression to examine the association between types of RC and effectiveness level of current contraceptive method, taking our sampling design into account and adjusting for covariates. Results: Among 240 women (weighted n = 6529) included in the sample, 13.9% reported experiencing only verbal RC, and 16.1% reported behavioral RC. Women who reported behavioral RC were more likely to currently be using highly versus moderately (adjusted relative risk ratio [aRRR]: 26.71, 95% confidence interval [CI]: 4.59-156.0) and low effective methods (aRRR: 3.08, 95% CI: 0.97-9.82), but less likely to be using moderately (aRRR: 0.12, 95% CI: 0.02-0.77) than low effective methods. Conclusions: Using highly and low effective methods may indicate two opposing ways of managing behavioral RC experiences: controlling fertility by choosing less detectable but highly effective methods or feeling disempowered and using no or low effective partner-dependent methods.

Factors associated with modern contraceptive use: a comparative analysis between younger and older women in Umlazi Township, KwaZulu-Natal, South Africa

INTRODUCTION

Unplanned pregnancy continues to be a global reproductive and public health concern among women. This study aimed to investigate whether factors associated with modern contraceptive use differ by age-group among young and older women of reproductive age.

METHODS

This was a cross-sectional study conducted among 433 women of reproductive age, with the median age of 25 years (interquartile range: 21-28), and aged between 18 and 49. Data were collected from 10 public health care clinics in Umlazi Township, KwaZulu-Natal, using a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson's chi-square test and logistic regression models were employed to assess the level of the association between the predictor and outcome variables, and the p-value of 0.05 or lower was considered statistically significant.

RESULTS

Most women in the sample (n = 351, 81%) had obtained a secondary level of education, while 53% (n = 230) were unemployed and 89% (n = 387) were single. We found that women with secondary level of education (AOR: 2.89, 95% CI: 0.99-5.38) or a tertiary level of education (AOR 3.80, 95% CI: 1.07-3.53) were more likely to use contraceptive methods compared to women with lower education. Women who experienced unplanned pregnancy (AOR 0.51, 95% CI: 0.22-3.79) were more likely to use contraceptives. Women aged 25-49 years who experienced pregnancy, whether planned (AOR 3.87, 95% CI: 1.08-3.89) or unplanned (AOR 3.60, 95% CI: 2.15-4.19), were more likely to use a contraceptive method. Results showed that the level of education (p = 0.942) and whether one experienced unplanned pregnancy (p = 0.913) were not significant predictors of contraceptive use among women aged 18-24 years.

CONCLUSION

Concerted educational efforts to addressing existing barriers deterring women from accessing contraception among young women are necessary. Different groups of women should be targeted with family planning interventions specific to their needs.

Determinants of Postpartum Contraception Use Among Teenage Mothers in Eastern Uganda: A Cross-Sectional Study

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.

Awareness and Use of Contraceptive Methods and Perceptions of Long-Acting Reversible Contraception Among White and Non-White Women

Background: Unintended pregnancies continue to account for half of all pregnancies in the United States, primarily due to incorrect or inconsistent use of contraception methods. Long-acting reversible contraception (LARC) methods are safe and highly effective, yet underutilized. Low uptake of LARC may be due to inadequate education, misconceptions, and cultural factors such as race, ethnicity, or religion. This study examined racial differences in contraceptive awareness and use among women seeking care at family health centers. Materials and Methods: Focus groups were used to identify recurrent themes in contraceptive choice of participants and develop a survey, completed by nonpregnant female patients 18-45 years of age from seven family health centers. Results: Among a total of 465 participants, 210 (46.2%) of whom were non-white, awareness of most types of birth control was generally high. Awareness of all types of contraceptives was significantly higher among white than non-white women (p < 0.001). Across most types of contraceptives, use was significantly higher among white women than non-white women with the exception of injectable hormones which were used significantly more often by non-white women (46.0% vs. 28.5%; p < 0.001). Reasons for using LARC did not vary by type nor by race but reasons for not using LARC varied by race and by specific method. Conclusions: Differing patterns of awareness, use, and perceptions of contraceptive methods between white and non-white women were revealed. By understanding factors that influence contraceptive awareness, use, and perceptions, clinicians can better address the contraceptive needs and concerns of their female patients. Clinical Trial # NCT03486743.

Use of Modern Contraceptive Methods in Burkina Faso: What are the Obstacles to Male Involvement in Improving Indicators in the Centre-East and Centre-North Regions?

Introduction

In Burkina Faso, despite several efforts to improve contraceptive uptake, contraceptive prevalence remains low. Studies suggest that the low levels of family planning (FP) practices can be partially attributed to the low participation of men in reproductive health programmes. Involving men in FP programmes in Burkina Faso is thus imperative, but the obstacles to this are poorly documented. This study has two objectives to explore the perspectives of men and women on barriers to contraceptive use and to identify the strategies to increase male involvement in family planning.

Methods

It is a qualitative study using 20 focus groups and 52 in-depth individual interviews in two regions (North Central Region and Central East Region) with a sample of 29 adult men and 23 women who were married and had children or not. Interviews were conducted in Moore (the national language commonly spoken in both regions). All interviews were recorded and transcribed into French using Microsoft Word. Then, content analysis was carried out using the constant comparison method to identify the major themes.

Results

The results show that men’s attitudes are still a significant barrier to women’s use of modern contraceptives. The reasons women do not use contraception and men do not adhere to FP programmes include lack of method knowledge, negative beliefs and perceptions about modern contraceptive methods, and the side effects of contraceptives. Cultural norms and preferences for large families are also common barriers to FP. However, the results showed that men’s awareness of FP, communication between spouses, and access to FP services can promote men’s adherence to FP programmes in the Centre-East and Centre-North regions of Burkina Faso.

Conclusion

Efforts should be made to improve educational standards, especially for men, and reorient FP services to make them more accessible to men.

Fertility desire concordance and contraceptive use among couples living with HIV in northern Nigeria

OBJECTIVES

We aimed to determine the concordance between own and perceived partner fertility intentions and identify predictors of contraceptive use among couples receiving antiretroviral therapy in Kano, Nigeria.

METHODS

A structured, validated questionnaire was used to interview 399 married men and women receiving antiretroviral therapy. Adjusted odds ratios for predictors of contraceptive use were derived from multivariate logistic regression models.

RESULTS

Most couples (68.9%) had concordant fertility intentions. Only 10.0% of couples had discordant fertility intentions. Among 232 couples (58.1%) at least one partner used contraception. Male condoms were used by 45.9% of couples (n = 183). Female methods were used by 175 couples (43.9%). Contraceptive use was significantly higher in participants who were older (≥30 years), better educated (secondary or post-secondary), had a higher monthly income (NGN ≥30,000), longer marriage duration (≥5 years), at least one living child, >1 year of antiretroviral treatment, and who were living with a serodiscordant partner and in circumstances where the decision on contraception was made by the female partner or jointly by both partners (all p < 0.05). Contraceptive use was significantly lower in participants who had not been sexually active in the last 6 months, where both partners wanted more children, and in situations lacking spousal communication about family planning (all p < 0.05).

CONCLUSION

One in 10 couples had discordant fertility intentions. Contraceptive use was suboptimal and was predicted by age, education, income, length of marriage, number of children, duration of antiretroviral therapy, partner's serostatus, sexual activity, fertility intention, spousal communication and the contraceptive decision-maker. Our findings highlight the need for spousal communication, joint contraceptive decision making and the integration of reproductive health services with antiretroviral therapy services.