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Bapolisi WA, Bisimwa G, Merten S. Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey. BMJ Open 2023; 13:e061564. [PMID: 36764708 PMCID: PMC9923293 DOI: 10.1136/bmjopen-2022-061564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. DESIGN Longitudinal study. SETTING A community-based approach was used to investigate FP use in the North and South-Kivu regions. PARTICIPANTS Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. PRIMARY AND SECONDARY OUTCOMES FP use and intention to use FP. RESULTS The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052). CONCLUSION TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Epidemiology, University of Basel Faculty of Science, Basel, Switzerland
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Catholic University of Bukavu, Bukavu, South-Kivu, Congo (the Democratic Republic of the)
| | - Sonja Merten
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Mailloux NA, Henegan CP, Lsoto D, Patterson KP, West PC, Foley JA, Patz JA. Climate Solutions Double as Health Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13339. [PMID: 34948948 PMCID: PMC8705042 DOI: 10.3390/ijerph182413339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
The climate crisis threatens to exacerbate numerous climate-sensitive health risks, including heatwave mortality, malnutrition from reduced crop yields, water- and vector-borne infectious diseases, and respiratory illness from smog, ozone, allergenic pollen, and wildfires. Recent reports from the Intergovernmental Panel on Climate Change stress the urgent need for action to mitigate climate change, underscoring the need for more scientific assessment of the benefits of climate action for health and wellbeing. Project Drawdown has analyzed more than 80 solutions to address climate change, building on existing technologies and practices, that could be scaled to collectively limit warming to between 1.5° and 2 °C above preindustrial levels. The solutions span nine major sectors and are aggregated into three groups: reducing the sources of emissions, maintaining and enhancing carbon sinks, and addressing social inequities. Here we present an overview of how climate solutions in these three areas can benefit human health through improved air quality, increased physical activity, healthier diets, reduced risk of infectious disease, and improved sexual and reproductive health, and universal education. We find that the health benefits of a low-carbon society are more substantial and more numerous than previously realized and should be central to policies addressing climate change. Much of the existing literature focuses on health effects in high-income countries, however, and more research is needed on health and equity implications of climate solutions, especially in the Global South. We conclude that adding the myriad health benefits across multiple climate change solutions can likely add impetus to move climate policies faster and further.
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Affiliation(s)
- Nicholas A. Mailloux
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
| | - Colleen P. Henegan
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
| | - Dorothy Lsoto
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
| | | | - Paul C. West
- Project Drawdown, San Francisco, CA 94118, USA; (K.P.P.); (P.C.W.); (J.A.F.)
- Department of Applied Economics, University of Minnesota, St. Paul, MN 55108, USA
| | - Jonathan A. Foley
- Project Drawdown, San Francisco, CA 94118, USA; (K.P.P.); (P.C.W.); (J.A.F.)
| | - Jonathan A. Patz
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
- Global Health Institute, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53726, USA
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Barnard P, Moomaw WR, Fioramonti L, Laurance WF, Mahmoud MI, O’Sullivan J, Rapley CG, Rees WE, Rhodes CJ, Ripple WJ, Semiletov IP, Talberth J, Tucker C, Wysham D, Ziervogel G. World scientists' warnings into action, local to global. Sci Prog 2021; 104:368504211056290. [PMID: 34763547 PMCID: PMC10450599 DOI: 10.1177/00368504211056290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
'We have kicked the can down the road once again - but we are running out of road.' - Rachel Kyte, Dean of Fletcher School at Tufts University.We, in our capacities as scientists, economists, governance and policy specialists, are shifting from warnings to guidance for action before there is no more 'road.' The science is clear and irrefutable; humanity is in advanced ecological overshoot. Our overexploitation of resources exceeds ecosystems' capacity to provide them or to absorb our waste. Society has failed to meet clearly stated goals of the UN Framework Convention on Climate Change. Civilization faces an epochal crossroads, but with potentially much better, wiser outcomes if we act now.What are the concrete and transformative actions by which we can turn away from the abyss? In this paper we forcefully recommend priority actions and resource allocation to avert the worst of the climate and nature emergencies, two of the most pressing symptoms of overshoot, and lead society into a future of greater wellbeing and wisdom. Humanity has begun the social, economic, political and technological initiatives needed for this transformation. Now, massive upscaling and acceleration of these actions and collaborations are essential before irreversible tipping points are crossed in the coming decade. We still can overcome significant societal, political and economic barriers of our own making.Previously, we identified six core areas for urgent global action - energy, pollutants, nature, food systems, population stabilization and economic goals. Here we identify an indicative, systemic and time-limited framework for priority actions for policy, planning and management at multiple scales from household to global. We broadly follow the 'Reduce-Remove-Repair' approach to rapid action. To guide decision makers, planners, managers, and budgeters, we cite some of the many experiments, mechanisms and resources in order to facilitate rapid global adoption of effective solutions.Our biggest challenges are not technical, but social, economic, political and behavioral. To have hope of success, we must accelerate collaborative actions across scales, in different cultures and governance systems, while maintaining adequate social, economic and political stability. Effective and timely actions are still achievable on many, though not all fronts. Such change will mean the difference for billions of children and adults, hundreds of thousands of species, health of many ecosystems, and will determine our common future.
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Affiliation(s)
- Phoebe Barnard
- Stable Planet Alliance, USA
- Center for Environmental Politics, University of Washington, USA
- African Climate and Development Initiative, University of Cape Town, South Africa
| | - William R Moomaw
- Fletcher School, Tufts University and Woodwell Climate Research Center, USA
| | - Lorenzo Fioramonti
- Center for the Study of Governance Innovation, University of Pretoria, South Africa
- Member of Parliament, Italy
| | - William F Laurance
- Centre for Tropical Environmental and Sustainability Science, College of Science and Engineering, James Cook University, Cairns, Queensland, Australia
| | | | - Jane O’Sullivan
- School of Agriculture and Food Sciences, The University of Queensland, Australia
| | | | - William E Rees
- School of Community and Regional Planning, University of British Columbia, Canada
| | | | - William J Ripple
- Department of Forest Ecosystems and Society, Oregon State University, USA
| | - Igor P Semiletov
- Laboratory of Arctic Research, Pacific Oceanological Institute, Far Eastern Branch of the Russian Academy of Sciences
- Institute of Ecology, Higher School of Economics, Russia
| | | | | | | | - Gina Ziervogel
- Department of Environmental and Geographic Science, University of Cape Town, South Africa
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Gichangi P, Waithaka M, Thiongo M, Agwanda A, Radloff S, Tsui A, Zimmerman L, Temmerman M. Demand satisfied by modern contraceptive among married women of reproductive age in Kenya. PLoS One 2021; 16:e0248393. [PMID: 33836006 PMCID: PMC8034745 DOI: 10.1371/journal.pone.0248393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Demand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs. Materials and methods Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014–2018 was used. PMA2020 surveys are cross-sectional including women 15–49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15. Results Of the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15–19 and 45–49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0–13.8% over the 5-years, p<0.001. Married adolescent 15–19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7–79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9–37.2% and decrease in short acting methods from 49.9–42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence. Conclusions Results show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.
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Affiliation(s)
- Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- International Centre for Reproductive Health, Mombasa, Kenya
- * E-mail: , ,
| | | | - Mary Thiongo
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Alfred Agwanda
- Population Services Research Institute (PSRI), University of Nairobi, Nairobi, Kenya
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Linea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya
- Aga Khan University, Kenya, Nairobi, Kenya
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Dodson JC, Dérer P, Cafaro P, Götmark F. Population growth and climate change: Addressing the overlooked threat multiplier. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 748:141346. [PMID: 33113687 DOI: 10.1016/j.scitotenv.2020.141346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Demographic trends will play a role in determining the magnitude of climate disruption and the ability of societies to adapt to it. Yet policy makers largely ignore the potential of fertility changes and population growth when designing policies to limit climate disruption and lessen its impacts. Here we argue that rights-based policy interventions could decrease fertility rates to levels consistent with low population pathways. We review country and global level studies that explore the effects of low population pathways on climate change mitigation and adaptation. We then provide rights-based policy recommendations, such as the expansion of voluntary family planning programs that incorporate elements from successful past programs, and highlight current research gaps. In concert with policies that end fossil fuel use and incentivize sustainable consumption, humane policies that slow population growth should be part of a multifaceted climate response. These policies require attention from scientists, policy analysts and politicians.
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Affiliation(s)
- Jenna C Dodson
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Patrícia Dérer
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Philip Cafaro
- School of Global Environmental Sustainability, Colorado State University, Fort Collins, CO, USA
| | - Frank Götmark
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden.
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Tal A, Kerret D. Positive psychology as a strategy for promoting sustainable population policies. Heliyon 2020; 6:e03696. [PMID: 32280798 PMCID: PMC7138908 DOI: 10.1016/j.heliyon.2020.e03696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/18/2019] [Accepted: 03/25/2020] [Indexed: 11/29/2022] Open
Abstract
Demographic stability constitutes a paramount global environmental objective. Yet, decades of efforts, highlighting the perils of overpopulation, have failed to slow the rapid global population growth. In considering an alternative strategy, insights from the field of positive psychology are explored for their potential to inform future demographic policies. After briefly reviewing sustainable advocacy efforts, different theories behind individual fertility decisions are presented. Following, key components of prominent successful family planning interventions are analysed using a 'positive psychology' perspective. Three 'positive psychology' strategies are explored for their potential to inform sustainable population: a "direct" approach that emphasizes individual benefits rather than indirect gains through mitigation of damages; an emphasis on the convergence between the collective and individual benefits of two--child families; and application of behavioral change theories in demographic policies to better facilitate sustainable individual fertility decisions. The paper posits that a positive psychology conceptualization offers a promising way to re-think the design of demographic policies and frame sustainable population interventions.
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Affiliation(s)
| | - Dorit Kerret
- The Department of Public Policy, Tel-Aviv University, Tel-Aviv 6997801, Israel
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Mohan V, Hardee K, Savitzky C. Building community resilience to climate change: The role of a Population-Health-Environment programme in supporting the community response to cyclone Haruna in Madagascar. ACTA ACUST UNITED AC 2020; 12:730. [PMID: 32158513 PMCID: PMC7059243 DOI: 10.4102/jamba.v12i1.730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Vikas Mohan
- Blue Ventures Conservation, London, United Kingdom
| | - Karen Hardee
- What Works Association, Morristown, New Jersey, United States
| | - Caroline Savitzky
- Blue Ventures Conservation, London, United Kingdom.,Boston Medical Center, Boston, United States
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