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Phiri M, Odimegwu C, Adewoyin Y. Social context of contraceptive use transition among sexually active women in Zambia (1992-2018): A decomposition analysis. PLoS One 2024; 19:e0300506. [PMID: 38625959 PMCID: PMC11020625 DOI: 10.1371/journal.pone.0300506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/28/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Contraception is an important public health initiative for addressing maternal health outcomes associated with unplanned pregnancies, unsafe abortions and maternal deaths. Although contraceptive use has been on the rise globally, the observed increases in sub-Saharan Africa (SSA) are sub-optimal and vary among countries. In Zambia, drivers of contraceptive use transition are not well documented. Thus, this study examined the drivers of contraceptive use change among sexually active women in Zambia between 1992 and 2018. METHODS Data came from the six Zambia Demographic and Health Surveys conducted between 1992 and 2018. A sample of 44,762 fecund sexually active women aged 15-49 years was analysed using multivariable Blinder Oaxaca decomposition regression analysis. Analysis took into account the complex survey design. Results were presented using adjusted coefficients, their 95% confidence intervals, and percentages. RESULTS The prevalence of contraceptive use among sexually active women increased significantly by 30.8 percentage points from 14.2% (95% CI: 12.8, 15.6) to 45.0% (95% CI: 43.6, 46.4) during the period 1992 to 2018. The major share of the increase happened during the period 1992-1996 (10.2%) while the least increase occurred between 2013 and 2018 (0.2%). Overall, about 15% of the increase in the prevalence of contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 85% of the increase was due to change in contraceptive behaviour of sexually active women. Changes in women's compositional characteristics such as secondary education (5.84%), fertility preference (5.63%), number of living children (3.30%) and experience of child mortality (7.68%) were associated with the increase in contraceptive use prevalence. CONCLUSION Change in contraceptive behaviour of sexually active women contributed largely to the observed increase in contraceptive use prevalence in Zambia. Increase in the proportion of women attaining secondary education, decrease in the percentage of women who want large families and improvement in child survival were the major compositional factors driving the rise in contraceptive use. The findings imply that increasing investment in education sector and enhancing existing family planning programmes has the potential to further improve contraceptive use prevalence in Zambia.
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Affiliation(s)
- Million Phiri
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yemi Adewoyin
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Geography, University of Nigeria, Nsukka, Nigeria
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Gebrerufael GG, Hagos BT. Prevalence and predictors associated with modern contraceptive method utilization among women in the nomadic community of Ethiopia: a cross-sectional study. Contracept Reprod Med 2024; 9:11. [PMID: 38566158 PMCID: PMC10988917 DOI: 10.1186/s40834-024-00272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Ethiopia is one of the countries in sub-Saharan Africa with the lowest prevalence of the use of modern contraceptive methods. On the frequency and determinants of modern contraceptive method in the Ethiopian women who live a nomadic lifestyle, there is, however, scant research. Therefore, the purpose of this study was to evaluate the factors that influence how often women in Ethiopia's nomadic tribes use modern contraceptive method. METHODS In the nomadic community of Ethiopia, a community-based retrospective cross-sectional study was carried out between January 18 and June 27, 2016. From the 15,683 nationally representative datasets on the 2016 Ethiopian Demography and Health Survey, a sample of 3,415 women from nomadic communities was chosen. To determine factors linked to modern contraceptive method usage within the nomadic group, a multivariable logistic regression model analysis was considered. RESULT In the nomadic population of Ethiopia, 10% (95% CI (9.10, 11.1)) of respondents reported using modern contraceptive method overall. The most popular way to use modern contraceptive method was through injection (73.5%). In the multivariable logistic regression model analysis, secondary and above-educated husbands (AOR = 1.6, 95% CI (1.01, 2.24)) and primarily educated husbands (AOR = 1.4, 95% CI (1.027, 2.0)), rich (AOR = 1.6, 95% CI (1.03, 2.74)) and middle wealth index (AOR = 1.58, 95% CI (1.25, 2.38)), public health place of delivery (AOR = 2.5, 95% CI (1.55, 3.0)), being a working husband (AOR = 3.8, 95% CI (1.96, 4.22)), and respondents working (AOR = 1.5, 95% CI (1.04, 1.79)) were positively critical risk predictors associated with modern contraceptive method usages. Compared to the Somali region, women living in the Afar (AOR = 2.58, 95% CI (1.68, 3.95)) and Benshangul-Gumuz (AOR = 3.40, 95% CI (2.22, 5.21)) regions had higher use of modern contraceptive method. CONCLUSION In Ethiopia, modern contraceptive method usage is still quite uncommon among women who live in nomadic communities. Therefore, in order to increase modern contraceptive method service utilization and improve the wealth index of households, two key strategies, government professionals and concerned body service providers should pay special attention to educational opportunities for husbands and give valuable and effective counseling information during child delivery for women.
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Affiliation(s)
- Gebru Gebremeskel Gebrerufael
- Department of Statistics, College of Natural and Computational Science, Adigrat University, Adigrat, P.O. Box 50, Ethiopia.
| | - Bsrat Tesfay Hagos
- Department of Statistics, College of Natural and Computational Science, Mekelle University, Mekelle, P.O. Box 231, Ethiopia
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Saraswati CM, Judge MA, Weeda LJZ, Bassat Q, Prata N, Le Souëf PN, Bradshaw CJA. Net benefit of smaller human populations to environmental integrity and individual health and wellbeing. Front Public Health 2024; 12:1339933. [PMID: 38504675 PMCID: PMC10949988 DOI: 10.3389/fpubh.2024.1339933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/13/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction The global human population is still growing such that our collective enterprise is driving environmental catastrophe. Despite a decline in average population growth rate, we are still experiencing the highest annual increase of global human population size in the history of our species-averaging an additional 84 million people per year since 1990. No review to date has accumulated the available evidence describing the associations between increasing population and environmental decline, nor solutions for mitigating the problems arising. Methods We summarize the available evidence of the relationships between human population size and growth and environmental integrity, human prosperity and wellbeing, and climate change. We used PubMed, Google Scholar, and Web of Science to identify all relevant peer-reviewed and gray-literature sources examining the consequences of human population size and growth on the biosphere. We reviewed papers describing and quantifying the risks associated with population growth, especially relating to climate change. Results These risks are global in scale, such as greenhouse-gas emissions, climate disruption, pollution, loss of biodiversity, and spread of disease-all potentially catastrophic for human standards of living, health, and general wellbeing. The trends increasing the risks of global population growth are country development, demographics, maternal education, access to family planning, and child and maternal health. Conclusion Support for nations still going through a demographic transition is required to ensure progress occurs within planetary boundaries and promotes equity and human rights. Ensuring the wellbeing for all under this aim itself will lower population growth and further promote environmental sustainability.
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Affiliation(s)
| | - Melinda A. Judge
- Telethon Kids Institute, Perth, WA, Australia
- School of Mathematics and Statistics, University of Western Australia, Nedlands, WA, Australia
| | - Lewis J. Z. Weeda
- School of Medicine, University of Western Australia, Nedlands, WA, Australia
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Ndola Prata
- Bixby Center for Population Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Peter N. Le Souëf
- School of Medicine, University of Western Australia, Nedlands, WA, Australia
| | - Corey J. A. Bradshaw
- Global Ecology | Partuyarta Ngadluku Wardli Kuu, College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage, Wollongong, NSW, Australia
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Abubeker FA, Tufa TH, Tolu LB, Sium AF, Grentzer JM, Welderufael MB, Prager S. Localization and removal of nonpalpable contraceptive implants: Experience from a teaching hospital in Ethiopia: A case series. Int J Gynaecol Obstet 2024; 164:1125-1131. [PMID: 37787448 DOI: 10.1002/ijgo.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. METHODS We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. RESULTS Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented. CONCLUSION Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.
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Affiliation(s)
- Ferid A Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye H Tufa
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jaclyn M Grentzer
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekdes Bahru Welderufael
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sarah Prager
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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Ajijola L, Igharo V, Anieto N, Mwaikambo L. Improving State Government's Responsiveness to Family Planning Interventions in Nigeria Using an Innovative Reflection and Action Tool. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200189. [PMID: 38110207 PMCID: PMC10727459 DOI: 10.9745/ghsp-d-22-00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The Challenge Initiative (TCI) works with state governments in Nigeria to scale high-impact family planning and reproductive health (FP/RH) interventions rapidly and sustainably. The Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool is an innovative responsive feedback (RF) mechanism developed by TCI to periodically monitor governments' readiness to sustain implementation of their FP/RH interventions. RAISE DESCRIPTION The RAISE tool-a facilitated, self-administered tool used quarterly to track program improvements, identify gaps, and provide feedback-contains FP/RH progress indicators across 4 pillars: political and financial commitment, government capacity, institutionalization, and sustained demand. As a maturity matrix that helps state governments to understand the extent of their self-reliance in leadership and program management, the tool measures the stages of capacity: "beginning" (54% and below), "developing" (55-69%), "expanding" (70-84%), and "mature" (85% and above). Participants self-administer the tool with a trained government facilitator, develop a remediation plan with timelines and responsible persons assigned to address identified gaps, and communicate the plan to the broader FP/RH program team. ASSESSMENT RESULTS Thirteen supported states have completed 5 rounds of assessments between June 2020 and September 2022. Baseline results revealed that 4 states were at the developing stage, 8 were at the expanding stage, and 1 had a mature program. The most recent assessment revealed mature capacity for 9 states while the 4 others are in the expanding stage. Consequently, all the states demonstrated improved government self-reliance over the course of the year. CONCLUSION To ensure objectivity, RAISE participants, who include government policymakers, program managers, and implementers, use available government data sources to complement assessment findings. As an RF mechanism, the RAISE tool contributed to governments' enhanced leadership and management of their FP/RH programs, with current considerations for modifications to serve other primary health care programs.
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Affiliation(s)
- Lekan Ajijola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria.
| | - Victor Igharo
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Nneoma Anieto
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Lisa Mwaikambo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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Compton S, Nakua E, Moyer C, Dzomeku V, Treleaven E, Otupiri E, Lori J. Contraceptive use by number of living children in Ghana: Evidence from the 2017 maternal health survey. PLoS One 2023; 18:e0295815. [PMID: 38096259 PMCID: PMC10721096 DOI: 10.1371/journal.pone.0295815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND There is a significant literature describing the link between parity and contraceptive use. However, there is limited knowledge about the disaggregation by parity of the type of contraceptives. In this study, we describe the use of contraceptives by parity among women of reproductive age in Ghana, focusing on use of highly effective methods (injection, pill, intrauterine device, implant, and sterilization). METHODS Using the 2017 Ghana Maternal Health Survey, a nationally-representative cross-sectional household survey, we describe contraceptive method use by number of living children among sexually active women of reproductive age. We then estimated predictors of use of highly effective contraception in a multilevel logistic regression model. RESULTS Most women in this survey are not using any method of contraception, although this varies by whether or not they have begun childbearing. Contraceptive method use varies by number of living children. Before having children, natural (periodic abstinence and withdrawal) and episodic (condoms) methods dominate. Once a woman has one living child, method preference changes to injectables and implants. Factors associated with using a highly effective method of contraception are: having >3 children, being in a relationship, having had an abortion, being younger than age 30, and having had sexual intercourse within days of answering the survey (p < .001 for all). CONCLUSION In this analysis, the number of living children a woman has, her age, and timing of last intercourse are the most significant predictors of using a highly effective method of contraception. However, the majority of participants in this study report not using any method of contraception to avoid unwanted pregnancies. Future research that attempts to unpack the disconnect between not wanting to become pregnant and not using contraception is warranted.
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Affiliation(s)
- Sarah Compton
- Department of Obstetrics and Gynecology, Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cheryl Moyer
- Department of Learning Health Sciences and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Veronica Dzomeku
- Department of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emily Treleaven
- Institute for Social Research, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Easmon Otupiri
- Department of Population, Family, and Reproductive Health, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Jody Lori
- Global Affairs and Community Engagement, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
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Kibira SPS, Stillman M, Makumbi FE, Giorgio M, Nabukeera S, Nalwoga GK, Sully EA. Lived experiences and drivers of induced abortion among women in central Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002236. [PMID: 38055682 DOI: 10.1371/journal.pgph.0002236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023]
Abstract
Although unsafe abortions are preventable, they are one of the leading causes of maternal mortality and morbidity. Despite the serious potential health consequences, there is limited published information about drivers and challenges of obtaining abortions in restrictive settings such as Uganda. This limits efforts to improve programing for preventing unsafe abortion and providing comprehensive post abortion care. This study sought to understand the drivers and explain the lived abortion experiences among women from central Uganda, in an effort to promote greater access to safe reproductive healthcare services, and reduce unsafe abortions. This qualitative study included 40 purposely selected women who self-reported an abortion, living in Kampala and greater Rakai district, Uganda. They were part of a larger survey using respondent driven sampling, where seed participants were recruited from selected facilities offering post-abortion care, or through social referrals. Data were collected from May to September 2021 through in-depth interviews. Audio data were transcribed, managed using Atlas.ti 9, and analyzed thematically. The findings show that the underlying drivers stemmed from partners who were unsupportive, denied responsibility, or had raped/defiled women. Career and education decisions, stigma and fear to disappoint family also contributed. Women had feelings of confusion, neglect, betrayal, or shame after conception. Abortion and post-abortion experiences were mixed with physical and emotional pain including stigma, even when the conditions for safe abortion in the guidelines were satisfied. Although most women sought care from health facilities judged to provide safe and quality care, there was barely any counselling in these venues. Confidantes and health providers informed the choice of abortion methods, although the cost ultimately mattered most. The mental health of women whose partners are unsupportive or who conceive unintendedly need consideration. Abortion provided psychological relief from more complicated consequences of having an unplanned birth for women.
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Affiliation(s)
| | | | - Fredrick E Makumbi
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sarah Nabukeera
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Tampah-Naah AM, Yendaw E, Sumankuuro J. Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis. BMC Womens Health 2023; 23:550. [PMID: 37875940 PMCID: PMC10594689 DOI: 10.1186/s12905-023-02684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Modern contraceptive refers to "a product or medical procedure that interferes with reproduction from acts of sexual intercourse". The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana. METHODS We examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15-49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05. RESULTS In the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097-1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065-1.289), middle (AOR = 1.24; 95% CI = 1.118-1.385), and fourth (AOR = 1.25; 95% CI = 1.113-1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042-1.830), rural-middle (AOR = 1.45; 95% CI = 1.084-1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128-2.059), and rural-high (AOR = 1.42; 95% CI = 1.019-1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20-24 (AOR = 2.33; 95% CI = 2.054-2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981-1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385-1.736), Central (AOR = 1.48; 95% CI = 1.296-1.682) and Eastern (AOR = 1.48; 95% CI = 1.289-1.695) regions significantly predicted modern contraceptive use. CONCLUSION Modern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.
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Affiliation(s)
- Anthony Mwinilanaa Tampah-Naah
- Department of Geography, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Post Office Box WA64, Ghana.
| | - Elijah Yendaw
- Department of Governance and Development Management, Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
- Centre for Environment, Migration and International Relations, Simon Diedong Dombo, University of Business and Integrated Development Studies, Wa, Ghana
| | - Joshua Sumankuuro
- Department of Public Policy and Management, Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Allied Health, Exercise and Sports Sciences, Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Budu E, Dadzie LK, Salihu T, Ahinkorah BO, Ameyaw EK, Aboagye RG, Seidu AA, Yaya S. Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis. BMC Womens Health 2023; 23:444. [PMID: 37612594 PMCID: PMC10463475 DOI: 10.1186/s12905-023-02601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Contraceptive use is crucial to achieving Sustainable Development Goal 3. Evidence of socioeconomic inequality in the use of modern contraceptives is essential to address the developing inequality in its utilisation given the low prevalence of contraceptive use among women in Benin. This study examined the socioeconomic inequalities in modern contraceptive use among women in Benin. METHODS We performed a cross-sectional analysis of the 2017-18 Benin Demographic and Health Survey data. A weighted sample of 7,360 sexually active women of reproductive age was included in the study. We used a concentration curve to plot the cumulative proportion of women using modern contraception. Decomposition analysis was conducted to determine factors accounting for the socioeconomic disparities in modern contraceptive use. RESULTS We noted that the richest women had higher odds of modern contraceptive use (adjusted odds ratio [aOR] = 1.67, CI = 1.22-2.30) compared to the poorest women. Other factors that showed significant associations with modern contraception use were age, marital status, religious affiliation, employment status, parity, women's educational level, and ethnicity. We found that modern contraceptive use is highly concentrated among the rich, with rich women having a higher propensity of using modern contraception relative to the poor. Also, the disadvantaged to modern contraceptive use included the poor, those aged 45-49, married women, those working, those with four or more live births, rural residents, and women of Bariba and related ethnicity. Conversely, favourable concentration in modern contraceptive use was found among the rich, women aged 20-24, the divorced, women with two live births, the highly educated, those with media exposure, and women of Yoruba and related ethnicity. CONCLUSION The study has shown that wealthy women are more likely to utilize contraceptives than the poor. This is because wealthy women could afford both the service itself and the travel costs to the health facility, hence overcoming any economic barriers to using modern contraception. Other factors such as age, marital status, religion, employment status, parity, mother's educational level, and ethnicity were associated with contraceptive use in Benin. The Benin government and other stakeholders should develop family planning intercession techniques that address both the supply and demand sides of the equation, with a focus on reaching the illiterate and under-resourced population without admittance to modern contraception.
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Affiliation(s)
- Eugene Budu
- Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Tarif Salihu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- REMS Consult Limited, Sekondi-Takoradi, Western Region Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Wa, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Abdul-Aziz Seidu
- REMS Consult Limited, Sekondi-Takoradi, Western Region Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Montt-Maray E, Adamjee L, Horanieh N, Witt A, González-Capella T, Zinke-Allmang A, Cislaghi B. Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2023; 4:1149632. [PMID: 37674903 PMCID: PMC10478786 DOI: 10.3389/fgwh.2023.1149632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.
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Affiliation(s)
- Eloisa Montt-Maray
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lamiah Adamjee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nour Horanieh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alice Witt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thaïs González-Capella
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Amoak D, Konkor I, Mohammed K, Saaka SA, Antabe R. Exposure to mass media family planning messages among men in Nigeria: analysis of the Demographic and Health Survey data. PeerJ 2023; 11:e15391. [PMID: 37273544 PMCID: PMC10237178 DOI: 10.7717/peerj.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/19/2023] [Indexed: 06/06/2023] Open
Abstract
Background Family planning (FP) is essential for improving health and achieving reproductive goals. Although men are important participants in FP decision-making within households in Nigeria, a country with one of the highest rates of maternal mortality, we know very little about their exposure to mass media FP messages. Methods Drawing theoretical insights from the structural influence model of health communication and using the 2018 Nigeria Demographic and Health Survey (n = 13,294), and applying logistic regression analysis, we explored the factors associated with men's exposure to mass media FP messages in Nigeria. Results A range of socioeconomic, locational, and demographic factors were associated with men's exposure to mass media FP messages. For example, wealthier, more educated, and employed men were more likely to be exposed to mass media FP messages than their poorer, less educated, and unemployed counterparts. In addition, compared to those in rural areas and other regions, men in urban areas as well as South East Region, were more likely to be exposed to mass media FP messages. Finally, younger men and those who belong to the traditional religion were less likely to be exposed to mass media FP messages, compared to their older and Christian counterparts. Conclusions Based on these findings, we discuss implications and recommendations for policymakers as well as directions for future research.
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Affiliation(s)
- Daniel Amoak
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | - Roger Antabe
- University of Toronto, Scarborough, Ontario, Canada
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12
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Milali MP, Resar D, Kaftan D, Campbell J, Olowu A, Edwards D, Platais I, Kim HY, Jenkins S, Bershteyn A. Cost-effectiveness of the dual prevention pill for contraception and HIV pre-exposure prophylaxis. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1144217. [PMID: 37266447 PMCID: PMC10230827 DOI: 10.3389/frph.2023.1144217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Women in sub-Saharan Africa (SSA) experience the world's highest rates of both HIV infection and unintended pregnancy. The Dual Prevention Pill (DPP) is a novel multipurpose prevention technology (MPT) that co-formulates HIV pre-exposure prophylaxis (PrEP) and combined hormonal oral contraception into a single daily pill. As a dual indication product, the DPP may be preferred by women facing these overlapping health risks. However, most SSA countries face severe healthcare resource constraints. Research is needed to assess whether, in what populations, and in what use cases the DPP would be cost-effective. Methods We augmented an agent-based SSA HIV model with maternal health parameters including unintended pregnancy, abortion, and maternal mortality. Based on a previous market analysis, we assumed a primary DPP user population of current oral contraceptive users ages 25-49, and alternative user populations in different risk groups (age 15-24, sex workers, HIV-serodiscordant couples) and baseline product use profiles (unmet need for contraception, oral PrEP use, condom use). In three geographies (western Kenya, Zimbabwe, South Africa), we estimated HIV infections averted, pregnancies averted, disability-adjusted life-years (DALYs) averted, and the incremental cost-effectiveness ratio (ICER) over a 30-year time horizon, assuming equivalent adherence to the DPP as to oral contraceptives, higher adherence, or lower adherence. Results The DPP is likely to be a cost-effective alternative to oral PrEP among users in need of contraception. Among women not already using PrEP, the DPP is likely to be cost-saving in sex workers and serodiscordant couples. The DPP is unlikely to be cost-effective in oral contraceptive users in the general population. Switching from oral contraception to the DPP could be net harmful in some settings and populations if it were to substantially reduces adherence to oral contraception. Results were robust to a range of time horizons or discount rates. Conclusion The DPP has the potential to be cost-effective and cost-saving in populations at substantial HIV risk. Outcomes are sensitive to adherence, implying that effective counseling and decision-making tools for users considering the DPP will be essential. More research is needed to understand real-life adherence patterns and ensure health benefits achieved from contraception alone are not lost.
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Affiliation(s)
- Masabho P. Milali
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Danielle Resar
- Clinton Health Access Initiative, Boston, MA, United States
| | - David Kaftan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Adebanjo Olowu
- Clinton Health Access Initiative, Boston, MA, United States
| | - Danny Edwards
- Clinton Health Access Initiative, Boston, MA, United States
| | - Ingrida Platais
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Hae-Young Kim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sarah Jenkins
- Clinton Health Access Initiative, Boston, MA, United States
| | - Anna Bershteyn
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Makumbi FE, Nabukeera S, Tumwesigye NM, Namanda C, Atuyambe L, Mukose A, Ssali S, Ssenyonga R, Tweheyo R, Gidudu A, Sekimpi C, Hashim CV, Nicholson M, Ddungu P. Socio-economic and education related inequities in use of modern contraceptive in seven sub-regions in Uganda. BMC Health Serv Res 2023; 23:201. [PMID: 36855140 PMCID: PMC9972732 DOI: 10.1186/s12913-023-09150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 10/17/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Advocacy for equity in health service utilization and access, including Family Planning (FP) continues to be a cornerstone in increasing universal health coverage. Inequities in Family planning are highlighted by the differences in reproductive health outcomes or in the distribution of resources among different population groups. In this study we examine inequities in use of modern contraceptives with respect to Socio-economic and Education dimensions in seven sub-regions in Uganda. METHODS The data were obtained from a baseline cross-sectional study in seven statistical regions where a program entitled "Reducing High Fertility Rates and Improving Sexual Reproductive Health Outcomes in Uganda, (RISE)" is implemented in Uganda. There was a total of 3,607 respondents, half of whom were women of reproductive age (15-49 years) and the other half men (18-54 years). Equity in family planning utilization was assessed by geography, wealth/economic and social-demographics. The use of modern family planning was measured as; using or not using modern FP. Concentration indices were used to measure the degree of Inequality in the use of modern contraceptives. Prevalence Ratios to compare use of modern FP were computed using modified Poisson regression run in STATA V15. RESULTS Three-quarters (75.6%) of the participants in rural areas were married compared to only 63% in the urban. Overall use of modern contraceptives was 34.2% [CI:30.9, 37.6], without significant variation by rural/urban settings. Women in the higher socio-economic status (SES) were more advantaged in use of modern contraceptives compared to lower SES women. The overall Erreygers Concentration Index, as a measure of inequity, was 0.172, p<0.001. Overall, inequity in use of modern contraceptives by education was highest in favor of women with higher education (ECI=0.146, p=0.0001), and the concentration of use of modern contraceptives in women with higher education was significant in the rural but not urban areas CONCLUSION: Inequities in the use of modern contraceptives still exist in favor of women with more education or higher socio-economic status, mainly in the rural settings. Focused programmatic interventions in rural settings should be delivered if universal Family Planning uptake is to be improved.
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Affiliation(s)
- Fredrick E Makumbi
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Sarah Nabukeera
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Cissie Namanda
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Lynn Atuyambe
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Aggrey Mukose
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Sarah Ssali
- School of Women and Gender studies, Makerere University, Makerere Hill, P.O. Box 7062, Kampala, Uganda
| | - Ronald Ssenyonga
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Ritah Tweheyo
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| | - Andrew Gidudu
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| | - Carole Sekimpi
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| | | | - Martha Nicholson
- Marie Stopes International, 1 Conway Street, Fitzroy Square, London, W1T 6LP UK
| | - Peter Ddungu
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
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Shitindi GW, Millanzi WC, Herman PZ. Perceived motivators, knowledge, attitude, self-reported and intentional practice of female condom use among female students in higher training institutions in Dodoma, Tanzania. Contracept Reprod Med 2023; 8:16. [PMID: 36750970 PMCID: PMC9906861 DOI: 10.1186/s40834-022-00208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/07/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Unplanned pregnancies and sexually transmitted infections (STIs) Human Immunodeficiency Virus (HIV) inclusive, have remained to be a significant public health challenges among young people, especially across middle and low-income countries. Self-efficacy on the right ways of using condoms appears to be effective against the aforementioned health-related problems. However, most women of reproductive age tend not to use them when they are using highly effective contraceptives such as implants, and/or injectable hormones. It is unknown whether the uptake of female condoms among young girls is significantly high or not. Examining female students' perceived motivators, knowledge, attitudes, and self-reported and intentional female condom practice in training institutions seems to be a key precursor in addressing the challenge. METHODS The institutional-based analytical cross-sectional survey in a quantitative research approach was adopted to study 384 randomly selected female students from higher training institutions, in Tanzania. Interviewer-administered structured questionnaires from previous studies were the main data collection tools. Data analysis was done using a statistical package for social science (SPSS) with the strength of statistical limits set at a 95% confidence interval and a 5% significance level. RESULTS The response rate of the study was 100% with 24 ± 2.122 years respondents' mean age while and 32.7% of them were in the third year of their studies. Only 6.2% of the respondents reported having used female condoms while 26.3% of them have not ever seen packages of female condoms. The minority of the respondents (21.7%, 23.3%, and 9.4%) demonstrated good knowledge, positive attitude, and intention to use female condoms respectively. Their age, accommodation, marital status, peer groups, previous training, knowledge, and attitude related significantly to their intentional practices of female condom use (p < 0.05). CONCLUSION Given the existing governmental and non-governmental efforts that advocate awareness creation and the uptake of various contraceptives, this study has found that knowledge, attitude, self-reported and intentional practices of female students admitted in higher training institutions within Dodoma region, Tanzania is low. Institutionalized educational programs on sexual and reproductive health matters may need to be prioritized to increase the availability, accessibility, and uptake of female condoms among female students in higher training institutions.
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Affiliation(s)
- Getrude W. Shitindi
- grid.442459.a0000 0001 1998 2954Department of Nursing Management and Education, The University of Dodoma, Dodoma, Tanzania
| | - Walter C. Millanzi
- grid.442459.a0000 0001 1998 2954Department of Nursing Management and Education, The University of Dodoma, Dodoma, Tanzania
| | - Patricia Z. Herman
- grid.442459.a0000 0001 1998 2954Department of Nursing Management and Education, The University of Dodoma, Dodoma, Tanzania
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Mensah F, Okyere J, Azure SA, Budu E, Ameyaw EK, Seidu AA, Ahinkorah BO. Age, geographical and socio-economic related inequalities in contraceptive prevalence: evidence from the 1993-2014 Ghana Demographic and Health Surveys. Contracept Reprod Med 2023; 8:20. [PMID: 36750918 PMCID: PMC9903545 DOI: 10.1186/s40834-022-00194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Contraceptives afford individuals the opportunity to meet their reproductive needs and reduce maternal mortality. We aimed at assessing the trend and inequalities of contraceptive use in Ghana based on the 1993-2014 Ghana Demographic and Health Surveys. METHODS We used the World Health Organization's Health Equity Assessment Toolkit (HEAT) software in analysing the data. We adopted two approaches for the analysis. First, we disaggregated inequalities in contraceptive use using four equity stratifiers: wealth index, education, residence, and region. Second, summary measures (D), (PAR), (R), and (PAF) were also employed. A 95% uncertainty interval (UI) was constructed for point estimates to measure statistical significance. RESULTS Contraceptive prevalence increased from 20.3% in 1993 to 26.7% in 2014. The contraceptive prevalence among women aged 20-49 increased from 20.6% [95% UI = 19.1, 22.3] in 1993 to 26.8% [95% UI = 24.9, 28.9] in 2014 and this exceeded the increase that was recorded among those aged 15-19 (from 13% [95 UI = 8.7, 19] to 18% [95% UI = 11.5, 28.6]), in the same period. It was evident that substantial inequality existed with respect to contraceptive use, from 1993 to 2014, with widest inequality occurring in 2003 (PAF = 2.7, 95% UI = -16.6-21.9; D = 17.4, 95% UI = 12.7-22.1). In terms of wealth index, the least inequality was observed in 2014 (PAR = 1.3, 95% UI = -1-3.6; D = 5.9, 95% UI = -0.1-12). Regarding education, the widest inequality occurred in 1993 (PAF = 138.6, UI = 132.1-145.1; D = 40.1, 95% UI = 34.4-45.9). With place of residence, the widest gap in inequality occurred in 1993 (PAF = 51.2, 95% UI = 46.2-56.3; D = 15.3, 95% UI = 11.8-18.7). There was inequality in contraceptive use with respect to sub-national regions. In 2014, the Difference (D = 21, 95% UI = 14.6-27.4) and the PAF (PAF = 20.9, 95% UI = 11.2 - 30.5) measures revealed substantial absolute and relative regional inequality between the regions. CONCLUSION There was a steady increase in contraceptive use from 20.3% in 1993 to 26.7% in 2014. Nevertheless, the percentage change is minimal. The trends of inequality indicate that inequalities in contraceptive use was evident across the dimension of age, place of residence, wealth index, education, and region. Yet, there was a substantial reduction in inequalities related to contraceptive use in 2014. Therefore, targeting adolescents, women in rural areas, low wealth quintile, and those with no formal education is key to substantially improving contraceptive use across the country.
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Affiliation(s)
- Felix Mensah
- grid.413081.f0000 0001 2322 8567Department of Data Science and Economic Policy, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. .,Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Simon Agongo Azure
- grid.412737.40000 0001 2186 7189School of Public Health, Population and Reproductive Health Division, University of Port Harcourt, Choba, Nigeria
| | - Eugene Budu
- grid.415489.50000 0004 0546 3805Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Edward Kwabena Ameyaw
- L & E Research Consult Ltd., Wa, Upper West Region Ghana ,grid.411382.d0000 0004 1770 0716Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, New Territories, Hong Kong
| | - Abdul-Aziz Seidu
- REMS Consult LTD, Takoradi, Ghana ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bright Opoku Ahinkorah
- REMS Consult LTD, Takoradi, Ghana ,grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Tumlinson K, Britton LE, Goland E, Chung S, Bullington BW, Williams CR, Wambua DM, Onyango DO, Senderowicz L. Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study. BMC Health Serv Res 2023; 23:74. [PMID: 36694177 PMCID: PMC9872072 DOI: 10.1186/s12913-023-09047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The prevalence of modern contraception use is higher in Kenya than in most countries in Sub-Saharan Africa. The uptake has however slowed down in recent years, which, among other factors, has been attributed to challenges in the supply chain and increasing stockouts of family planning commodities. Research on the frequency of contraceptive stockouts and its consequences for women in Kenya is still limited and mainly based on facility audits. METHODS This study employs a set of methods that includes mystery clients, focus group discussions, key informant interviews, and journey mapping workshops. Using this multi-method approach, we aim to quantify the frequency of method denial resulting from contraceptive stockout and describe the impact of stockouts on the lived experiences of women seeking contraception in Western Kenya. RESULTS Contraceptives were found to be out of stock in 19% of visits made to health facilities by mystery clients, with all contraceptive methods stocked out in 9% of visits. Women experienced stockouts as a sizeable barrier to accessing their preferred method of contraception and a reason for taking up non-preferred methods, which has dire consequences for heath, autonomy, and the ability to prevent unintended pregnancy. Reasons for contraceptive stockouts are many and complex, and often linked to challenges in the supply chain - including inefficient planning, procurement, and distribution of family planning commodities. CONCLUSIONS Contraceptive stockouts are frequent and negatively impact patients, providers, and communities. Based on the findings of this study, the authors identify areas where funding and sustained action have the potential to ameliorate the frequency and severity of contraceptive stockouts, including more regular deliveries, in-person data collection, and use of data for forecasting, and point to areas where further research is needed.
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Affiliation(s)
- Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Emilia Goland
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Stephanie Chung
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - Brooke W Bullington
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Caitlin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Leigh Senderowicz
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Hellwig F, Barros AJD. Learning from success cases: ecological analysis of pathways to universal access to reproductive health care in low- and middle-income countries. Gates Open Res 2023; 6:59. [PMID: 36726686 PMCID: PMC9873636 DOI: 10.12688/gatesopenres.13570.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more vulnerable groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most vulnerable in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,
| | - Aluisio JD Barros
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
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18
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Hellwig F, Barros AJD. Learning from success cases: ecological analysis of pathways to universal access to family planning care in low- and middle-income countries. Gates Open Res 2023; 6:59. [PMID: 36726686 PMCID: PMC9873636 DOI: 10.12688/gatesopenres.13570.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more vulnerable groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most vulnerable in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,
| | - Aluisio JD Barros
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
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Hellwig F, Barros AJD. Learning from success cases: ecological analysis of potential pathways to universal access to family planning care in low- and middle-income countries. Gates Open Res 2023; 6:59. [PMID: 36726686 PMCID: PMC9873636 DOI: 10.12688/gatesopenres.13570.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced an important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more disadvantaged groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most disadvantaged in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,
| | - Aluisio JD Barros
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
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Sachdeva R, Kumar N, Brache V, Friedland BA, Plagianos M, Zhang S, Kizima L, Cochon L, Tabar AST, Blanc A, Merkatz RB. New approaches for developing biomarkers of hormonal contraceptive use. Sci Rep 2023; 13:245. [PMID: 36604469 PMCID: PMC9816169 DOI: 10.1038/s41598-022-24215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 11/11/2022] [Indexed: 01/07/2023] Open
Abstract
To identify biomarkers of hormonal contraceptive (HC) use in urine and saliva, we conducted a pilot study with 30 women initiating levonorgestrel (LNG) containing combined oral contraceptives (COCs) or depot medroxyprogesterone acetate (DMPA) (15/group). Based on established COC pharmacokinetics, we collected serum and urine samples before COC ingestion and during Days one and three of use, or before DMPA injection and on Days 21 and 60 post-injection. We used liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure serum/urine LNG and MPA. LNG was undetectable at baseline (specificity 100%); post ingestion, most urine samples had detectable LNG levels (sensitivity: 80% 6 h post Dose one, 93% 6 h post Dose three). We used a DetectX LNG immunoassay kit and showed 100% sensitivity measuring urine LNG. Urine MPA levels were undetectable in 14/15 women at baseline (specificity 91%); post-injection all urine samples had detectable MPA levels (sensitivity: 100% days 21 and 60). Results suggest urine sampling can be used to identify a biomarker of LNG and MPA use. Based on evidence from other steroidal hormonal studies showing changes affecting the transcriptome profile of saliva at 24 h, we used the same (COC, DMPA) timepoints to collect saliva. We performed transcriptome analysis and detected several differentially expressed genes in DMPA users' saliva on Days 21 and 60 compared to baseline; none among COC users. We plan further research of differential gene expression in saliva as a HC biomarker of DMPA use, and will explore longer periods of COC use and saliva collection times, and application of microRNA sequencing to support using saliva as a COC biomarker.
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Affiliation(s)
- Rakhee Sachdeva
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
| | - Narender Kumar
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
| | - Vivian Brache
- grid.420363.00000 0001 0707 9020Clinica de Profamilia, Nicolas de Ovando Esq. Calle 16, Ens. Luperon, Santo Domingo, Dominican Republic
| | - Barbara A. Friedland
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
| | - Marlena Plagianos
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
| | - Shimin Zhang
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
| | - Larisa Kizima
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
| | - Leila Cochon
- grid.420363.00000 0001 0707 9020Clinica de Profamilia, Nicolas de Ovando Esq. Calle 16, Ens. Luperon, Santo Domingo, Dominican Republic
| | - Ana Sofía Tejada Tabar
- grid.420363.00000 0001 0707 9020Clinica de Profamilia, Nicolas de Ovando Esq. Calle 16, Ens. Luperon, Santo Domingo, Dominican Republic
| | | | - Ruth B. Merkatz
- grid.250540.60000 0004 0441 8543Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY 10065 USA
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Negash WD, Belachew TB, Fetene SM, Addis B, Amare T, Kidie AA, Endawkie A, Zegeye AF, Tamir TT, Wubante SM, Fentie EA, Asmamaw DB. Magnitude of optimal access to ANC and its predictors in Ethiopia: Multilevel mixed effect analysis of nationally representative cross-sectional survey. PLoS One 2023; 18:e0284890. [PMID: 37083707 PMCID: PMC10121037 DOI: 10.1371/journal.pone.0284890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Optimal access to ANC, such as the first ANC visit at first trimester, four or more ANC visits, and skilled health care provider can significantly reduce maternal mortality in an inclusive way. Previous studies conducted in Ethiopia on optimal ANC are restricted to frequencies of ANC visit. Therefore, the aim of this study was to assess the magnitude of optimal ANC access as a comprehensive way and its predictors among pregnant women in Ethiopia. METHODS Secondary data source from a recent demographic and health survey was used for analysis. This study includes a weighted sample of 4771 pregnant women. A multilevel mixed-effect binary logistic regression analyses was done to identify both the individual and community level factors. Odds ratio along with the 95% confidence interval was generated to identify the predictors of optimal access to ANC. A p-value less than 0.05 was declared as statistical significant. RESULTS In Ethiopia, one in five (20%) pregnant women had optimal access to antenatal care. Regarding the factors at individual level, pregnant women aged 25-34 years [aOR = 1.58, 95% CI = 1.23-2.03] and 35-49 years [aOR = 2.04, 95% CI = 1.43-2.89], those who had educated primary [aOR = 1.67, 95% CI = 1.33-2.09], secondary and higher [aOR = 1.81, 95% CI = 1.15-2.85], Primipara [aOR = 2.45, 95% CI = 1.68-3.59] and multipara [aOR = 1.48, 95% CI = 1.11-1.98] had higher odds of accessing optimal ANC. With the community level factors, the odds of optimal access to ANC was higher among pregnant women who lived in urban area [aOR = 2.08, 95% CI = 1.33-3.27], whereas, lower odds of optimal ANC access among those pregnant women who reported distance to the health facility as a big problem [aOR = 0.78, 95% CI = 0.63-0.96]. CONCLUSION AND RECOMMENDATION The study concludes that in Ethiopia, optimal access to ANC was low. The study identified that both individual and community level factors were predictors for optimal ANC access. Therefore, the Ethiopian government should intensify extensive education on ANC in a comprehensive way. Moreover, especial attention from the Ethiopian ministry of health for those women who reported distance as a big problem and for rural resident women is mandatory.
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Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Banchilay Addis
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atitegeb Abera Kidie
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sisay Maru Wubante
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Otondi L, Aloo N, Kagwe P, Matekwa A, Miriti K, Njoki L, Sama DJ, Owino K, Nyachae P. Sustainable financing of AYSRH programs by local governments through the TCI model. Front Glob Womens Health 2023; 4:1060857. [PMID: 37066037 PMCID: PMC10101433 DOI: 10.3389/fgwh.2023.1060857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Despite the existence of a legal policy framework, financing of adolescent and youth sexual and reproductive health (AYSRH) services has remained weak. External donors are the main financing agents, which has implications for the sustainability of service provision. International development partners have reduced funding for health programs from historically high levels. In Kenya, the health sector's budget allocation has remained below the 15% committed to under the Abuja declaration. With Kenya's devolved government structure, a greater proportion of financial resources are dedicated towards recurrent and structural expenses as opposed to addressing health systems gaps. Objectives The purpose of this manuscript is to assess the contribution of The Challenge Initiative (TCI) Business Unusual model on AYSRH services in the counties of Kilifi and Migori, as well as to examine the institutionalization of high impact interventions (HIIs) within the annual work plan, budget, and systems of the said counties. Additionally, this study aims to analyse the trend in contraceptive uptake among adolescent and young women aged 15 to 24 in Kilifi and Migori counties. Methods Migori and Kilifi Counties chose to partner with TCI to implement the Business Unusual model. Interested counties apply for the initiative's support and commit to contributing a portion of the funding needed to adapt and implement high impact interventions (HIIs). Based on the identified gaps, TCI supported the counties to prioritize the HIIs including integrated outreaches, youth fixed days, whole site orientation, youth champions, and youth dialogues. The program was implemented between July 2018 to June 2021 in 60 and 68 public health facilities of Kilifi and Migori Counties, respectively. The county teams identified and selected program implementation team whose key role was to coordinate, review, monitor, mobilize resources and report AYSRH program implementation progress. Results The results showed a 60% increase in financial commitments on AYSRH programming from 2018 to 2021 in both counties. The average expenditure for committed funds for Kilifi and Migori Counties was 116% and 41% respectively. As the counties continued to allocate and spend funds on the implementation of HIIs, there was a noticeable increase in contraceptive uptake among the young people aged 15 to 24 who visited health facilities for services. There was a 59% and 28% percentage increase in contraceptive uptake among young people (15-24 years) between 2018 and 2021. The proportion of adolescents amongst those presenting for first ANC clinic dropped from 29.4% in 2017 to 9% in 2021 in Kilifi County and from 32.2% in 2017 to 14% in 2021 in Migori County. Using the TCI's Sisi kwa Sisi coaching model of lead-assist-observe-monitor, 20 master coaches were trained. The master coaches cascaded the training to over 97 coaches. The coaches will continue to build capacity of peers in advocacy for resource mobilization and implementation of HIIs. At least nine of TCI's HIIs have been adopted in Kilifi and Migori County strategies and annual work plans, and there is financial support for their sustainability. Discussion The increase in adolescent contraceptive uptake might have been as a result of the system strengthening through self-financing of AYSRH programs, the institutionalization of HIIs, and the coaching. Local governments can invest in and sustain their own AYSRH programs, which will lead to an improvement in adolescent and youth access to contraceptive services and, as a result, a reduction in adolescent pregnancies, maternal mortality, and infant mortality.
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Affiliation(s)
- Levis Otondi
- The Challenge Initiative Project, Jhpiego Kenya Country Office, Nairobi, Kenya
- Correspondence: Levis Otondi
| | - Nancy Aloo
- The Challenge Initiative Project, Jhpiego Kenya Country Office, Nairobi, Kenya
| | - Peter Kagwe
- The Challenge Initiative Project, Jhpiego Kenya Country Office, Nairobi, Kenya
| | - Assumpta Matekwa
- The Challenge Initiative Project, Jhpiego Kenya Country Office, Nairobi, Kenya
| | - Kenneth Miriti
- Department of Health, County Government of Kilifi, Kilifi, Kenya
| | - Lilly Njoki
- Department of Health, County Government of Migori, Migori, Kenya
| | - Denis Joel Sama
- The Challenge Initiative Project, Jhpiego Uganda Country Office, Kampala, Uganda
| | - Kenneth Owino
- The Challenge Initiative Project, Jhpiego Kenya Country Office, Nairobi, Kenya
| | - Paul Nyachae
- The Challenge Initiative Project, Jhpiego Kenya Country Office, Nairobi, Kenya
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Mangimela-Mulundano A, Black KI, Cheney K. A cross-sectional study of women's autonomy and modern contraception use in Zambia. BMC Womens Health 2022; 22:550. [PMID: 36575426 PMCID: PMC9793589 DOI: 10.1186/s12905-022-02101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/30/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women's autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women's autonomy and modern contraception use among partnered women in Zambia. METHODS This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women's autonomy using three indices: women's participation in decision-making, women's attitude towards wife-beating and women's household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR). RESULTS The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women's autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048-1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013-1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091-1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105-1.766) and age, 15-24 (AOR = 1.266, P value = 0.007, 95% CI 1.182-2.113,) and 25-34 (AOR = 1.163, P value = 0.002, 95% CI 1.052-1.273). CONCLUSION This study argues that increasing women's assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women's autonomy, which in turn would support gender equality and reproductive health.
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Affiliation(s)
- Abigail Mangimela-Mulundano
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Kirsten I. Black
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Kate Cheney
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Negash WD, Eshetu HB, Asmamaw DB. Predictors of modern contraceptive use among reproductive age women in high fertility countries in sub-Saharan Africa: evidence from demographic and health surveys. BMC Womens Health 2022; 22:520. [PMID: 36514075 PMCID: PMC9746200 DOI: 10.1186/s12905-022-02121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The world's population has increased faster than expected due to high fertility rates, with sub-Saharan Africa accounting for most of the increase. Modern contraceptive use is the best option to reduce the high fertility rate. There is limited information on the prevalence of modern contraception and its predictors in sub-Saharan Africa's high-fertility countries. Therefore, this study aimed to assess the prevalence and predictors of modern contraception among reproductive-age women in high fertility countries in sub-Saharan Africa. METHODS We used Demographic and Health Survey data sets from the top 10 high fertility countries in sub-Saharan Africa. Stata version 16.0 software was used to analyze the data, and all statistical analyses were completed after the data had been weighted. Multilevel binary logistic regression was performed to identify factors associated with modern contraceptive use. Adjusted odds ratio with a 95% confidence interval, and a p value < 0.05 was used to declare statistical significance. RESULTS The prevalence of modern contraceptive use in all the countries considered in this study was 10.72% (95% CI 10.57, 10.87). In terms of the predictor variables, young aged women, those who had attended a primary or secondary level of formal education, women who received antenatal care follow up, women who reported distance to the health facility as not a big problem, and women from rich families were more likely to use modern contraceptives. CONCLUSION Only one in 10 women of reproductive age used modern contraceptive methods in high fertility countries in sub-Saharan Africa. To improve the use of modern contraceptives, governments and non-governmental organizations studied in the countries should intensify programs that focus on those women who are economically poor, those with no formal education, no media exposure, and those with no antenatal care follow up.
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Affiliation(s)
- Wubshet Debebe Negash
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- grid.59547.3a0000 0000 8539 4635Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Otekunrin OA, Olasehinde L, Oliobi C, Otekunrin O, Osuolale K. Exploring women's preferences for attributes of long-acting reversible contraceptive (LARC) methods: a discrete choice experiment. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Bolarinwa OA, Babalola TO, Adebayo OA, Ajayi KV. Health insurance coverage and modern contraceptive use among sexually active women in Nigeria: Further analysis of 2018 Nigeria Demographic Health Survey. Contracept Reprod Med 2022; 7:22. [PMID: 36316721 PMCID: PMC9624092 DOI: 10.1186/s40834-022-00187-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background Studies have shown that affordable health insurance can influence healthcare visits and increase the choice of medication uptake in sub-Saharan Africa. However, there is a need to document the influence of health insurance coverage and modern contraceptive use in order to encourage its uptake. Thus, this study examined the influence of health insurance coverage on modern contraceptive use among sexually active women in Nigeria. Methods The secondary dataset utilised in this study were derived from the 2018 Nigeria Demographic and Health Survey (NDHS). Data analyses were restricted to 24,280 women of reproductive age 15–49 years who were sexually active in the survey dataset. Weighted bivariate and multivariable logistic regression models were used to examine the influence of health insurance coverage on modern contraceptive use while controlling for possible confounders. A Significant level of alpha was determined at p < 0.05 using STATA 16.0. Results The prevalence of health insurance coverage and modern contraceptive use among sexually active women in Nigeria were 25.47% and 13.82%, respectively. About 1 out of every 4 sexually active women covered by health insurance were using a modern contraceptive, while 86.50% of the women not covered by health insurance were not using any modern contraceptive method. After adjusting for socio-demographic characteristics, the odds of using any modern contraceptive were significantly higher for sexually active women who were covered by any health insurance [aOR = 1.28; 95% (CI = 1.01–1.62)] compared to sexually active women not covered by health insurance in Nigeria. Conclusion The study demonstrated that health insurance coverage is a significant driver of health service utilization, including modern contraceptive use. Health insurance benefits are recommended to be expanded to cover a broader spectrum of family planning services in Nigeria. More research is required to understand the influence of different health insurance schemes and the use of modern family planning methods in Nigeria.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK ,grid.16463.360000 0001 0723 4123Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Taiwo Oladapo Babalola
- Institute of Governance, Humanities, and Social Sciences [PAUGHSS], PAN African University, Yaoundé, Cameroon
| | | | - Kobi V. Ajayi
- Education, Direction, Empowerment, & Nurturing (EDEN) Foundation, Abuja, Nigeria ,grid.264756.40000 0004 4687 2082Department of Health Behavior, School of Public Health, Texas A&M University, 77843 College Station, TX USA
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Tiendrebeogo CO, Joseph V, Bicaba F, Bila A, Bicaba A, Druetz T. Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso. J Glob Health 2022; 12:04086. [PMID: 36227754 PMCID: PMC9559360 DOI: 10.7189/jogh.12.04086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Unmet needs for contraception constitute a major public health problem in sub-Saharan Africa. Several mechanisms have been tested to reduce the financial barrier and facilitate access to family planning services, with inconclusive results. Based on the positive impacts following the introduction of free health care for pregnant women, Burkina Faso decided to extend its national policy and abolished direct payment for family planning services. This study aims to evaluate the impact of this policy on contraceptive use and unmet needs for contraception among women of reproductive age (WRA) in Burkina Faso. Methods This study uses two different study designs to examine the impact of a user fee removal policy on contraceptive use across a panel of 1400 households randomly selected across eight health districts. Data were collected using a standardized socio-demographic questionnaire at three different time points during the pilot and scale-up phases of the fee abolition program. The questionnaire was administered six months after the launch of the pilot fee abolition program in four health districts. For the remaining four health districts, the survey was conducted one year prior to and six months after the implementation of the program in those areas. All WRA in the households were eligible to participate. A cross-sectional study design was used to determine the association between knowledge of the fee abolition policy among WRA and actual use of contraceptives by WRA six months after the policy’s implementation and across all eight districts. Additionally, a pre-post study with a non-randomized, reflexive control group was designed using repeated surveys in four health districts. Hierarchical logistic mixed effects models were adjusted for a set of time-variant individual variables; the impact was assessed by a difference-in-differences approach that compared pre-post changes in contraception use in women who knew about the new policy and those who did not. Results Of the 1471 WRA surveyed six months after the removal of user fees for family planning services, 56% were aware of the policy’s existence. Knowledge of the fee abolition policy was associated with a 46% increase probability of contraceptive use among WRA six months after the policy’s implementation. Among the subset of the participants who were surveyed twice (n = 507), 65% knew about the fee removal policy six months after its introduction and constitute the intervention group. Pre-post changes in contraceptive use differed significantly between the intervention (n = 327) and control groups (n = 180). Removing user fees for family planning led to an 86% (95% confidence interval (CI) = 0.49, 1.31) increase in the likelihood of using contraception. In the study area, the policy reduced the prevalence of unmet needs for contraception by 13 percentage points. Conclusions Removing user fees for family planning services is a promising strategy to increase access to, and reduce unmet needs for, contraception. A broader dissemination of the policy’s existence will likely increase its impact on the overall population.
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Affiliation(s)
- Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Vena Joseph
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso.,Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Alice Bila
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche en santé publique, Montreal, Quebec, Canada.,Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Hubacher D, Byamugisha J, Kakaire O, Nalubwama H, Emtell Iwarsson K, Bratlie M, Chen PL, Gemzell-Danielsson K. Removal of a well-palpable one-rod subdermal contraceptive implant using a dedicated hand-held device or standard technique: a randomized, open-label, non-inferiority trial. Hum Reprod 2022; 37:2320-2333. [PMID: 35960174 PMCID: PMC9527454 DOI: 10.1093/humrep/deac179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is a mechanical hand-held device for removing a single-rod subdermal contraceptive implant safe for implant users? SUMMARY ANSWER In terms of safety, the device is non-inferior to the standard technique for implant removal. WHAT IS KNOWN ALREADY An easy-to-use device for removing a subdermal contraceptive implant may be helpful in settings where skilled providers are in short supply. Prior to this study, the only report on the world’s first hand-held, mechanical device with build-in incisor was a Swedish study using earlier versions of the product. STUDY DESIGN, SIZE, DURATION From December 2019 to November 2020, we conducted a three-arm, open-label non-inferiority randomized trial involving 225 Ugandan women to assess safety (primary outcome) and measure implant removal efficacy (secondary outcomes) of a newly developed, hand-held device, compared to the standard removal technique. PARTICIPANTS/MATERIALS, SETTING, METHODS We randomized participants desiring removal of their one-rod contraceptive implant in a 1:1:1 ratio: standard technique/lidocaine injection, new device/lidocaine patch or new device/lidocaine injection. For primary safety endpoints, we examined removal complications and grouped them according to severity. For secondary endpoints on efficacy, we defined three device outcomes: intact implant removed without additional tools (primary), implant removed allowing implant breakage, but without tools (secondary) and implant removed allowing implant breakage and non-scalpel tools (tertiary). We assessed provider feedback on the device and used chi-square tests for all comparisons. MAIN RESULTS AND THE ROLE OF CHANCE We recruited 225 participants and randomly assigned (n = 75) to each group. For safety, no primary complications occurred in any treatment group, while only one secondary complication occurred in each treatment group (1%). Primary efficacy was 100% (standard technique), 85% (new device/lidocaine patch) and 73% (new device/lidocaine injection) (P < 0.0001). Secondary efficacy was 100% (standard technique), 92% (new device/lidocaine patch) and 79% (new device/lidocaine injection) (P < 0.0001). Tertiary efficacy was 100% (standard technique), 96% (new device/lidocaine patch) and 91% (new device/lidocaine injection) (P = 0.017). Unsuccessful removals with the new device did not hinder subsequent implant extractions with standard back-up tools. In over 90% of the 150 device procedures, providers agreed or strongly agreed that the product is an acceptable alternative to standard removal technique. LIMITATIONS, REASONS FOR CAUTION We tested a new removal device in the hands of Ugandan nurses who were adept at standard removal techniques; our estimates of removal efficacy may not apply to lower-level providers who arguably may be the prime beneficiaries of this technology. WIDER IMPLICATIONS OF THE FINDINGS The study was conducted in a region of the world where the new device could be used to expand access to implant removal services. Intended beneficiaries of the new product are implant users who cannot easily find skilled providers for traditional scalpel-dependent removals and/or users who are intimidated by scalpel procedures, and lower-level providers who can be trained to help deliver services to meet a growing demand. The new device is a safe, acceptable alternative; efficacy was high, but not on par with standard technique. STUDY FUNDING/COMPETING INTEREST(S) Funding for this study was provided by the RemovAid AS of Norway with grants from Research Council of Norway (GLOBVAC number 228319), Bill & Melinda Gates Foundation (grant INV-007571) and SkatteFUNN. M.B. is founder and former CEO of RemovAid AS, Norway. M.B. holds contraceptive rod remover patents (2012 1307156.8 and 2015), pre-removal test (filed) and shares in RemovAid AS. All of the remaining authors’ institutions received payments in the form of contracts to help conduct the study; the funds for these contracts emanated from RemovAid AS. TRIAL REGISTRATION NUMBER NCT04120337 TRIAL REGISTRATION DATE 9 October 2019 DATE OF FIRST PATIENT’S ENROLMENT 23 December 2019
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Affiliation(s)
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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Haakenstad A, Angelino O, Irvine CMS, Bhutta ZA, Bienhoff K, Bintz C, Causey K, Dirac MA, Fullman N, Gakidou E, Glucksman T, Hay SI, Henry NJ, Martopullo I, Mokdad AH, Mumford JE, Lim SS, Murray CJL, Lozano R. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:295-327. [PMID: 35871816 PMCID: PMC9304984 DOI: 10.1016/s0140-6736(22)00936-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019. METHODS We used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15-49 years) self-reported their, or their partner's, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study. FINDINGS In 2019, 162·9 million (95% uncertainty interval [UI] 155·6-170·2) women had unmet need for contraception, of whom 29·3% (27·9-30·6) resided in sub-Saharan Africa and 27·2% (24·4-30·3) resided in south Asia. Women aged 15-19 years (64·8% [62·9-66·7]) and 20-24 years (71·9% [68·9-74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3-48·0) women aged 15-24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15-19 years were substantially lower than among women aged 20-49 years at SDI values below 60 (on a 0-100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7-21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019. INTERPRETATION The dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15-24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Olivia Angelino
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caleb M S Irvine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kelly Bienhoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Corinne Bintz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Swedish Family Medicine, First Hill, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Thomas Glucksman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ira Martopullo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - John Everett Mumford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
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Wood SN, Magalona S, Zimmerman LA, OlaOlorun F, Omoluabi E, Akilimali P, Guiella G, Gichangi P, Anglewicz P. Self-injected contraceptives: does the investment reflect women's preferences? BMJ Glob Health 2022; 7:bmjgh-2022-008862. [PMID: 35835480 PMCID: PMC9289037 DOI: 10.1136/bmjgh-2022-008862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/25/2022] [Indexed: 11/04/2022] Open
Abstract
Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is an innovative contraceptive method aimed at meeting women's unique circumstances and needs, largely due to its ability to be self-injected. Substantial research and advocacy investments have been made to promote roll-out of DMPA-SC across sub-Saharan Africa. To date, research on the demand for DMPA-SC as a self-injectable method has been conducted largely with healthcare providers, via qualitative research, or with highly specific subsamples that are not population based. Using three recent rounds of data from Performance Monitoring for Action, we examined population-representative trends in demand, use, and preference for self-injection among current non-users in Burkina Faso, the Democratic Republic of Congo (Kinshasa and Kongo Central regions), Kenya, and Nigeria (Lagos and Kano States). We found that while over 80.0% of women had heard of injectables across settings, few women had heard of self-injection (ranging from 13.0% in Kenya to 24.8% in Burkina Faso). Despite initial increases in DMPA-SC prevalence, DMPA-SC usage began to stagnate or even decrease in all settings in the recent three years (except in Nigeria-Kano). Few (0.0%-16.7%) current DMPA-SC users were self-injecting, and the majority instead were relying on a healthcare provider for administration of DMPA-SC. Among current contraceptive non-users wishing to use an injectable in the future, only 1.5%-11.4% preferred to self-inject. Our results show that self-injection is uncommon, and demand for self-injection is very limited across six settings, calling for further qualitative and quantitative research on women's views on DMPA-SC and self-injection and, ultimately, their contraceptive preferences and needs.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophia Magalona
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Funmilola OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoluabi
- Department of Statistics and Population Studies, University of the Western Cape, Bellville, South Africa
| | - Pierre Akilimali
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population/University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health - Kenya (ICRHK), Mombasa, Kenya
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Contextual factors associated with contraceptive utilization and unmet need among sexually active unmarried women in Kenya: A multilevel regression analysis. PLoS One 2022; 17:e0270516. [PMID: 35771841 PMCID: PMC9246151 DOI: 10.1371/journal.pone.0270516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Unmarried women who report less recent sexual intercourse (>30 days from survey enumeration) are largely excluded from global health monitoring and evaluation efforts. This study investigated level and contextual factors in modern contraceptive utilization and unmet need within this overlooked female subpopulation in Kenya from 2014 to 2019. Methods This study analyzed data from the Performance Monitoring and Accountability (PMA) survey in Kenya, a nationally representative survey of female respondents, to understand the level and contextual factors for family planning utilization and unmet need within female subgroups including married, unmarried sexually active (defined as sexual intercourse within 30 days of survey enumeration), and unmarried with less recent sexual intercourse (defined as sexual intercourse 1–12 months prior to survey enumeration). The analysis included multilevel regression modeling to assess correlates on outcomes of modern contraceptive prevalence rate (mCPR), unmet need, and recent emergency contractive pill (ECP) use, which is a unique PMA question: “Have you used emergency contraception at any time in the last 12 months?”. Results Cumulatively, the surveys enumerated 19,161 women and this weighted analysis included 12,574 women aged 15–49 from three female subgroups: 9,860 married women (78.4%), 1,020 unmarried sexually active women (8.1%), and 1,694 unmarried women with less recent sexual intercourse (13.5%). In 2019, while controlling for covariates, unmarried women with less recent sexual intercourse exhibited statistically significant differences (p-value<0.02) in current mCPR, mCPR at last sexual intercourse, unmet need for modern contraceptives, and recent ECP use. As compared to an unmarried woman with less recent sexual intercourse (i.e., reported sex 1–12 months prior to survey), the odds of an unmarried sexually active woman (i.e., reported sex within last 30 days of survey) currently using modern contraceptives was 2.28 (95% CI: 1.64, 3.18), using modern contraceptives at last sexual intercourse was 1.44 (95% CI: 1.06, 1.95), and having an unmet need for modern contraceptives was 2.01 (95% CI: 1.29, 3.13) while controlling for covariates. The odds of a married woman using ECP during the last 12 months was 0.60 (95% CI: 0.44, 0.82) as compared to an unmarried woman with less recent sexual intercourse. In 2019, unmarried women with less recent sexual intercourse reported the highest rate of ECP use during the last 12 months at 13.5%, which was similar for unmarried sexually active women at 13.3%. Since 2014, summary measures of unmet need and total demand for modern contraceptives increased for unmarried women with less recent sexual intercourse, but declined for the other female subgroups. Conclusion In Kenya, unmarried women with less recent sexual intercourse exhibited significantly different contraceptive utilization, unmet need, and recent emergency contraceptive use. Moreover, changes over time in key family planning indicators were asymmetrical by female subgroup. This study identifies an important monitoring gap regarding unmarried women with less recent sexual intercourse. Evidence dissemination by the global measurement community for these unmarried women is exceedingly scarce; therefore, developing an inclusive research agenda and actionable information about these marginalized women is needed to enable targeted planning and equitable service delivery.
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Bansal A, Shirisha P, Mahapatra B, Dwivedi LK. Role of maternal and child health services on the uptake of contraceptive use in India: A reproductive calendar approach. PLoS One 2022; 17:e0269170. [PMID: 35704629 PMCID: PMC9200305 DOI: 10.1371/journal.pone.0269170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to the latest round of National Family Health Survey-4 (NFHS (2015-16)) maternal and child health care (MCH) services improved drastically compared to NFHS-3. Previous studies have established that the uptake of MCH services increases the likelihood of early adoption of contraceptives among women. So, our study aims to examine if the early initiation of contraceptive has proportionately improved with the recent increase in MCH services. METHODS This study used the reproductive calendar of NFHS-4, 2015-16, to evaluate contraceptive initiation within 12 months after the last birth among 1,36,962 currently married women in India. A complementary log-log regression model was created to examine the link between the time of initiation of contraception and MCH care at the national level. RESULTS It was found that only a quarter of women within 12 months from last birth have adopted the modern contraceptive method. Among those majority of the females adopted sterilization mostly at the time of birth. The multivariable model identified, that the period of initiation of contraceptive depends on the gender composition of children and access to MCH services. It was found that the odds of early initiation of contraceptive use was higher when a women have only son (AOR = 1.15,95% CI- 1.22, 1.18) compared to women with only daughter. Also, it was found that women who have availed MCH services were more likely to adopt contraceptives earlier. CONCLUSION The number of women availing MCH services has increased in India, but it did not result in a proportional increase in initiation of contraception after childbirth. Facilitating family planning services alongside MCH services will be beneficial in low-resource settings. It is a golden opportunity to educate and encourage women for early adoption of contraceptive.
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Affiliation(s)
- Anjali Bansal
- International Institute for Population Sciences, Govandi East, Mumbai, India
| | - P. Shirisha
- Department of Humanities and Social Sciences, Humanities and Science Block, IIT Madras, Chennai, Tamil Nadu, India
| | | | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Govandi East, Mumbai, India
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Dadzie LK, Seidu AA, Ahinkorah BO, Tetteh JK, Salihu T, Okyere J, Yaya S. Contraceptive discontinuation among women of reproductive age in Papua New Guinea. Contracept Reprod Med 2022; 7:8. [PMID: 35650648 PMCID: PMC9161543 DOI: 10.1186/s40834-022-00170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background Papua New Guinea has one of the lowest contraceptive prevalence rates among women of reproductive age in the Western Pacific Region and this makes contraceptive discontinuation in this country a critical public health issue worth studying. This study sought to assess the factors associated with contraceptive discontinuation among women of reproductive age in Papua New Guinea. Methods The data used for the analysis were obtained from the Papua New Guinea Demographic and Health Survey which was conducted in 2016–2018. The outcome variable for this study was contraceptive discontinuation among women of reproductive age. Crude odds ratios and adjusted odds ratios with 95% confidence intervals were estimated using binary logistic regression. Results About 33.26% of the women discontinued injectables, 19.15% discontinued pills and 3.77% discontinued other contraception methods. Women aged 20–24 [aOR = 2.12, CI = [= [1.04,4.31] through to those aged 30–34 [aOR = 1.98, CI = 1.03,3.79] had higher odds to discontinue contraceptive usage compared to those aged 45–49. Women with no information on choice of contraception [aOR = 2.85, CI = 2.31,3.51], those with two or more births in the last five years [aOR = 2.35, CI = 1.65,3.35] and those living in the Highland region [aOR = 1.71, CI = 1.28,2.29] were more likely to discontinue contraceptive usage compared with those with information on contraceptive choices, those with no births and those living in the Island region respectively. However, women in the rural areas [aOR = 0.78, CI = 0.61,0.99], women using LARC [aOR = 0.10, CI = 0.06,0.15], injectables [aOR = 0.43, CI = 0.30,0.63] and other modern contraception methods including condom [aOR = 0.22, CI = 0.15,0.34] were less likely to discontinue contraceptive usage. Conclusion A nationwide mass education on the benefits of contraception is recommended for the Papua New Guinea National Department of Health to tackle the key findings of this study which were high contraceptive discontinuation prevalence with lack of information on choice, disproportionately high contraceptive discontinuation rate in the Highland Region and the desire to give birth to more than two children as some factors associated with contraceptive discontinuation in Papua New Guinea.
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Affiliation(s)
- Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Estate Management, Faculty of Built and Natural Environment, Takoradi Technical University, Takoradi, Ghana.,Centre For Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Justice Kanor Tetteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
| | - Tarif Salihu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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Ejigu BA, Seme A, Zimmerman L, Shiferaw S. Trend and determinants of quality of family planning counseling in Ethiopia: Evidence from repeated PMA cross-sectional surveys, (2014–2019). PLoS One 2022; 17:e0267944. [PMID: 35622817 PMCID: PMC9140310 DOI: 10.1371/journal.pone.0267944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 04/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The modern contraceptive prevalence rate (mCPR) among married women has increased by nearly five-fold in Ethiopia from 8.1% in 2000 to 37% in 2019. Despite this increase, receipt of high quality contraceptive counselling, as measured by the percentage of contraceptive users who were told about other methods, counseled on side effects and counseled what to do in the event that they encountered side effects, has declined in recent years. The quality of family planning counseling service measured by using these three components, known as the Method Information Index(MII), is an index designed to measure quality and a key indicator of the FP2020 initiative. The effects of potential client and service provider-level factors on receipt of high quality counseling and its progress over time have not been well studied in Ethiopia. Methods We pooled data from seven Performance Monitoring for Action (PMA), formerly PMA2020, survey-rounds to examine the trend and effect of potential factors on receiving high quality of family planning counseling service in Ethiopia. Data from a total of 15,597 women aged 15 to 49 from seven survey-rounds were used in the analysis. To account for the study design and unequal probabilities of selection from target-populations for sampled women, design-based analysis was used to compute proportions. Multilevel ordinal regression model with enumeration area as a second level were employed to examine potential factors associated with quality of family planning counseling service. Results We found that the percentage of women who received high quality family planning counseling service declined from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally. Amhara region had the lowest percentage of women receiving high quality counseling at both the earliest(2014) and latest(2019) survey rounds(17% and 6%, respectively). Results show that lack of media exposure about family planning, having no formal education, using short-acting methods, and getting the service from pharmacy were the main factors associated with receiving low quality family planning counseling service. Conclusions Given the importance of continuous provision of information on the range of family planning methods, it is imperative to use media and particularly regional media which can effectively address the rural populations in local languages as an important vehicle of information on family planning. Interventions aimed at improving quality of family planning counseling need to be mindful of regional disparities in the severity of the problem to ensure equity in service access. To improve the coverage of high quality family planning counseling service, there is an urgent need to re-visit the format of family planning counselling services.
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Affiliation(s)
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Linnea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Agyekum AK, Adde KS, Aboagye RG, Salihu T, Seidu AA, Ahinkorah BO. Unmet need for contraception and its associated factors among women in Papua New Guinea: analysis from the demographic and health survey. Reprod Health 2022; 19:113. [PMID: 35527266 PMCID: PMC9080214 DOI: 10.1186/s12978-022-01417-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Unmet need for contraception is highest in low-and middle-income countries. In Papua New Guinea, about 26% of married women and 65% of unmarried sexually active women have an unmet need for contraception. This study investigated the prevalence and correlates of unmet need for contraception among women in Papua New Guinea. Methods Data for the study were extracted from the most recent 2016–18 Papua New Guinea Demographic and Health Survey. We included 7950 women with complete data on all variables of interest. Multilevel logistic regression analysis was conducted to examine the factors associated with unmet needs for contraception using four models. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were used to present the results of the regression analysis. Results We found that the overall unmet need for contraception was 32.2%. The odds of unmet needs for contraception was higher among cohabiting women [AOR = 1.25, 95% CI = 1.01, 1.56], women with 1–3 births [AOR = 1.57, 95% CI = 1.18, 2.08], and women with 4 or more births [AOR = 1.06, 95% CI = 1.13, 2.27]. Likewise, a higher probability of unmet need was found among women whose partners decided on their healthcare as compared to those who decided on their own healthcare [AOR = 1.35, 95% CI = 1.066, 1.71]. With regards to wealth, the likelihood of unmet contraceptive need decreased with an increase in wealth status. With region, it was found that women in the Mamose region had greater likelihood of unmet contraceptive need compared to those in Southern region [AOR = 1.33, 95% CI = 1.09, 1.63]. Conclusion Our study contributes to the discussion on unmet need for contraception in the context of Papua New Guinea. We found the overall prevalence of unmet need for contraception to be relatively high among women in Papua New Guinea. Public health interventions aimed at addressing women's contraception needs should be encouraged so that women can make informed decisions about contraceptive use. These interventions should be implemented taking into consideration significant socio-demographic characteristics of women as identified in this study. Unmet need for contraception is highest in low-and middle-income countries. This study investigates the prevalence and correlates of unmet need for contraception among women in Papua New Guinea. We extracted data from the most recent Demographic and Health Survey conducted in Papua New Guinea. Our study involved 7950 women with diverse contraceptive needs and those who have complete data on all variables of interest. We found that the overall unmet need for contraception was 32.2%. Marital status, parity, decision maker on respondent’s healthcare, wealth status, and region were found to have a significant relationship with unmet need for contraception. Cohabiting women recorded a higher likelihood for unmet need for contraception as compared to those married. Women with at least on child showed greater probability of unmet contraceptive need relative to women without children. Likewise, a higher probability of unmet need was found among women whose partners decided on their healthcare as compared to those who decided on their own healthcare. With regards to wealth, the likelihood of unmet contraceptive need decreased with an increase in wealth status. With region, it was found that women in the Mamose region had greater likelihood of unmet contraceptive need compared to those in Southern region. Interventions aimed at reducing unmet need for contraception should be implemented taking into consideration significant socio-demographic characteristics of women as identified in this study.
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Druetz T, Cooper S, Bicaba F, Bila A, Shareck M, Milot DM, Tiendrebeogo C, Bicaba A. Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: Results from a panel study in rural Burkina Faso. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000174. [PMID: 36962234 PMCID: PMC10021617 DOI: 10.1371/journal.pgph.0000174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Evidence on how the COVID-19 pandemic has affected women's reproductive health remains scarce, particularly for low- and middle-income countries. Deleterious indirect effects seem likely, particularly on access to contraception and risk of unwanted pregnancies, but rigorous evaluations using quasi-experimental designs are lacking. Taking a diachronic perspective, we aimed to investigate the effects of the pandemic on four indicators of women's reproductive health: history of recent adverse events during pregnancy (past), use of contraception and unwanted pregnancies (present), and childbearing intentions (future). This study was conducted in four rural health districts of Burkina Faso: Banfora, Leo, Sindou and Tenado. Two rounds of household surveys (before and during the pandemic) were conducted in a panel of 696 households using standardized questionnaires. The households were selected using a stratified two-stage random sampling method. All women aged 15-49 years living in the household were eligible for the study. The same households were visited twice, in February 2020 and February 2021. The effects were estimated by fitting hierarchical regression models with fixed effects or random intercepts at the individual level. A total of 814 and 597 women reported being sexually active before and during the COVID-19 pandemic, respectively. The odds of not wanting (any more) children were two times higher during the pandemic than before (2.0, 95% CI [1.32-3.04]). Among those with childbearing intention, the average desired delay until the next pregnancy increased from 28.7 to 32.8 months. When comparing 2021 versus 2020, there was an increase in the adjusted odds ratio of contraception use (1.23, 95% CI [1.08-1.40]), unwanted pregnancies (2.07, 95% CI [1.01-4.25]), and self-reported history of miscarriages, abortions, or stillbirths in the previous 12 months (2.4, 95% CI [1.04-5.43]). Our findings in rural Burkina Faso do not support the predicted detrimental effects of COVID-19 on the use of family planning services in LMICs, but confirm that it negatively affects pregnancy intentions. Use of contraception increased significantly among women in the panel, but arguably not enough to avoid an increase in unwanted pregnancies.
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Affiliation(s)
- Thomas Druetz
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Canada
- Centre de recherche en santé publique, Montréal, Canada
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, Louisiana, United States of America
| | - Sarah Cooper
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Canada
| | - Frank Bicaba
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Alice Bila
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Martine Shareck
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Canada
| | - David-Martin Milot
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Canada
| | - Cheick Tiendrebeogo
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Canada
| | - Abel Bicaba
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
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Nanvubya A, Wanyenze RK, Abaasa A, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Bagaya B, Chinyenze K, Price MA, Van Geertruyden JP. Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of Lake Victoria in Uganda: a randomized controlled trial. BMC Health Serv Res 2022; 22:506. [PMID: 35421987 PMCID: PMC9012015 DOI: 10.1186/s12913-022-07898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Family planning knowledge is poor and use is low in Ugandan fishing communities. We compared the effectiveness of enhanced family planning (FP) education with routine counselling on FP knowledge and use.
Methods
Individuals aged 15–49 years were randomly assigned to intervention or control arm. The intervention constituted enhanced FP education based on a simplified handout extracted from the WHO FP guidance tool called, “Family planning: A global handbook for FP providers” which participants took home for additional reading. The control arm constituted FP counselling following Uganda Ministry of Health guidelines. FP knowledge score and contraceptive prevalence rate (CPR) were compared between trial arms at baseline and at 12 months. Negative binomial regression models were used to estimate the effect of the intervention on FP knowledge and use.
Results
Overall, 1410 participants were screened to enrol 1004 (502 per study arm, 48.5% women). Subsequently, 384 (76.5%) and 383 (76.3%) completed the 12 months’ follow-up in the intervention and control arms respectively. At baseline, a median FP knowledge score of 8 and a < 70% FP knowledge score was observed for all participants with a CPR of 36.8%. At month-12, the median FP knowledge score improved in both arms, higher in the intervention arm than the control arm (46 vs 30; p < 0.001). In the intervention arm, 304 (79.2%) had a score of ≥70 compared with 21 (5.5%) in the control arm (p < 0.001). In the negative binomial regression model, the change in FP knowledge score was 47% higher in the intervention arm than in the control arm (score ratio: 1.47, 95%CI: 1. 43-1.51, p < 0.001). The change in CPR was 16% higher in the intervention arm than in the control arm (Prevalence ratio: 1.16, 95%CI: 1.01-1.34, p < 0.040).
Interpretation
Enhanced FP education using a simplified FP education handout was more effective in increasing FP knowledge and use compared to routine FP counselling for people living in fishing communities. Innovative FP education interventions are recommended for improving FP knowledge and optimizing uptake in remote-rural settings where literacy levels are low.
Trial registration
The study was registered by the Pan African Clinical Trial Registry on 03 July 2021 with a Trial Registration Number PACTR202107891858045. “Retrospectively registered”.
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Cintas C, Akinwande V, Raghavendra R, Tadesse GA, Walcott-Bryant A, Wayua C, Makumbi F, Wanyenze RK, Weldemariam K. Data-Driven Sequential Uptake Pattern Discovery for Family Planning Studies. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:324-333. [PMID: 35308993 PMCID: PMC8861714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Family planning is a crucial component of sustainable global development and is essential for achieving universal health coverage. Specifically, contraceptive use improves the health of women and children in several ways, including reducing maternal mortality risks, increasing child survival rates through birth spacing, and improving the nutritional status of both mother and children. This paper presents a data-driven approach to study the dynamics of contraceptive use and discontinuation in Sub-Saharan African (SSA) countries. We aim to provide policymakers with discriminating contraceptive use patterns under different discontinuation reasons, contraceptive uptake distributions, and transition information across contraceptive types. We used Demographic Health Survey (DHS) Calendar data from five SSA countries. One recurrent pattern found was that continuous usage of injectables resulted in discontinuation due to health concerns in four out of five countries studied. This type of temporal analysis can aid intervention development to support sustainable development goals in Family Planning.
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Affiliation(s)
| | | | | | | | | | | | - Fredrick Makumbi
- Department of Epidemiology & Biostatistics School of Public, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
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Contraceptive use and fertility transitions: The distinctive experience of sub-Saharan Africa. DEMOGRAPHIC RESEARCH 2022. [DOI: 10.4054/demres.2022.46.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Dabee S, Tanko RF, Brown BP, Bunjun R, Balle C, Feng C, Konstantinus IN, Jaumdally SZ, Onono M, Nair G, Palanee-Phillips T, Gill K, Baeten JM, Bekker LG, Passmore JAS, Heffron R, Jaspan HB, Happel AU. Comparison of Female Genital Tract Cytokine and Microbiota Signatures Induced by Initiation of Intramuscular DMPA and NET-EN Hormonal Contraceptives - a Prospective Cohort Analysis. Front Immunol 2021; 12:760504. [PMID: 34956191 PMCID: PMC8696178 DOI: 10.3389/fimmu.2021.760504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/22/2021] [Indexed: 01/17/2023] Open
Abstract
Background Cervicovaginal inflammation, bacterial microbiota and hormonal contraceptives all influence sexual and reproductive health. To date, the effects of intramuscular depo-medroxyprogesterone acetate (DMPA-IM) versus injectable norethisterone enanthate (NET-EN) on vaginal microbiota or cytokines have not been compared back-to-back, although in-vitro data suggest that DMPA-IM and NET-EN have different pharmacokinetic and biologic activities. This study aimed at comparing the effects of DMPA-IM versus NET-EN initiation on cervicovaginal cytokines and microbiota in women at high risk for sexually transmitted infections (STIs) assigned to the respective contraceptives. Methods We collected socio-demographic characteristics and vaginal samples from women initiating DMPA-IM (ECHO Trial; n = 53) and NET-EN (UChoose Trial; n = 44) at baseline and after two consecutive injections to assess cytokine concentrations by Luminex, vaginal microbiota by 16S rRNA gene sequencing, STIs, bacterial vaginosis (BV) and candidiasis. Results Cytokine concentrations did not change significantly after initiating DMPA-IM or NET-EN, although NET-EN versus DMPA-IM-associated profiles were distinct. While the abundance of bacterial taxa associated with optimal and non-optimal microbiota fluctuated with DMPA-IM use, overall community composition did not significantly change with either contraceptive. HSV-2 serology, chlamydial infection, gonorrhoea and candidiasis did not influence the associations between contraceptive type and cervicovaginal cytokines or microbiota. Conclusions Both DMPA-IM and NET-EN use did not lead to broad inflammatory or microbiota changes in the female genital tract of sub-Saharan African women. This suggests that NET-EN is likely a viable option for contraception in African women at high risk of BV and STIs.
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Affiliation(s)
- Smritee Dabee
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Ramla F. Tanko
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA) Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Bryan P. Brown
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Christina Balle
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Colin Feng
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | | | - Shameem Z. Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States,Gilead Sciences, Foster City, CA, United States
| | | | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA) Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa,National Health Laboratory Service, Cape Town, South Africa
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Heather B. Jaspan
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States,Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Department of Global Health, University of Washington, Seattle, WA, United States,*Correspondence: Heather B. Jaspan,
| | - Anna-Ursula Happel
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
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Kirui EK, Mung'atu JK, Gichangi P, Onguto NO, Kamondo DK. Multiple Logistic Regression Model for Determinants of Injectable Contraceptive Uptake Among Women of Reproductive Age in Kenya. J Family Reprod Health 2021; 15:82-90. [PMID: 34721596 PMCID: PMC8520661 DOI: 10.18502/jfrh.v15i2.6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The recent increase in the uptake of injectable contraceptives has occurred at the expense of the other modern contraceptive methods but the knowledge gap still exists on modeling dynamics and determinants associated with the use of the injectable. This study sought to model for injectable contraceptive usage to bridge the knowledge gap on the use of injectable contraceptives among women of childbearing age in Kenya. Materials and methods: Analytical cross-sectional study design was adopted. Secondary data for women collected during the (Performance Monitoring for Action) PMA2020 survey was used. PMA2020 survey used multistage stratified sampling with urban-rural representation. To establish the factors associated with the uptake of injectable contraceptives, a multiple logistic regression model was fitted using Stata version 13 and R version 3.5.3 statistical software. Hosmer-Lemeshow Test statistic was used to evaluate the goodness of model fit in predicting injectable contraceptive usage. Results: Multivariable analysis showed that women with post-primary/vocational levels of education were 54% less likely to use an injectable contraceptive compared to those who had no education at all. Hosmer-Lemeshow (HL) goodness of fit test statistic indicated that the model was a good fit for prediction. Education, marital status, wealth quintile, place of residence and number of births were significant predictors of the injectable contraceptive uptake among women of reproductive age in Kenya. Conclusion: The findings of this study will inform the design of targeted interventions aimed at addressing the increasing demand for injectable devices among women of reproductive age in Kenya.
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Affiliation(s)
- Ernest Kiplangat Kirui
- Institute of Tropical and Infectious Diseases, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Joseph Kyalo Mung'atu
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Peter Gichangi
- Department of Human Anatomy, College of Health Sciences University of Nairobi, Kenya
| | | | - Davis Kiruki Kamondo
- Institute of Tropical and Infectious Diseases, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Fatusi A, Riley T, Kayembe PK, Mabika C. Unintended pregnancy, induced abortion and abortion care-seeking experiences among adolescents in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMJ Open 2021; 11:e044682. [PMID: 34475140 PMCID: PMC8413879 DOI: 10.1136/bmjopen-2020-044682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate age-specific abortion incidence and unintended pregnancy in Kinshasa, Democratic Republic of Congo and compare care experiences between adolescents (15-19 years) and older women (20-49 years). DESIGN We used the age-specific variant of the Abortion Incidence Complications Method to estimate abortion and unintended pregnancy, with data from three primary sources: Health Facility Survey (n=361) provided postabortion care (PAC) caseloads; Prospective Morbidity Survey (n=1031) provided the age distribution and characteristics of women presenting for PAC and Health Professional Survey (n=115) provided an estimate of the proportion of abortions resulting in facility-based treatment of complications. Bivariate (χ2, t-test) and multivariable (binary logistic regression, Cox proportional hazard) analyses were used to compare abortion care experiences. SETTING Health facilities proving PAC in Kinshasa. PARTICIPANTS Women who presented to PAC facilities with abortion complications and their care providers. PRIMARY AND SECONDARY OUTCOME MEASURES The primary measures were abortion incidence and proportion of pregnancies unintended. The secondary measures were the odd of reporting specific abortion care experiences. RESULTS Adolescents had an estimated 27 590 induced abortions, constituting 18.8% of abortions in Kinshasa in 2016. Adolescents had the lowest abortion rate among women less than 35 years (55.2/1000 women) but the highest rate among ever sexually active women (138.4/1000) and recently sexually active women (167.2/1000). Also, adolescents had the highest abortion ratio (82.4/100 live births), proportion of pregnancies unintended (80%) and proportion of unintended pregnancies ending in abortion (49%). Compared with older women, adolescents had higher odds of reporting pregnancy unintendedness (adjusted OR, AOR 1.36, 95% CI 1.75 to 2.24), seeking abortion at later than first trimester (AOR 1.34, 95% CI 1.09 to 1.63) and from non-medical professionals (AOR 1.68, 95% CI 1.31 to 2.14), and not using contraceptives before pregnancy (AOR 2.23, 95% CI 2.77 to 3.43) or postabortion (AOR 2.46, 95% CI 1.87 to 3.29). CONCLUSIONS Interventions are needed to reduce unintended pregnancy among adolescents in Kinshasa and improve their abortion care experiences.
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Affiliation(s)
- Adesegun Fatusi
- Guttmacher Institute, New York, New York, USA
- School of Public Health, University of Medical Sciences, Ondo, Nigeria
| | | | - Patrick K Kayembe
- Department of Epidemiology & Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Crispin Mabika
- Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Adde KS, Dickson KS, Ameyaw EK, Amo-Adjei J. Contraception needs and pregnancy termination in sub-Saharan Africa: a multilevel analysis of demographic and health survey data. Reprod Health 2021; 18:177. [PMID: 34454510 PMCID: PMC8403371 DOI: 10.1186/s12978-021-01227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women in sub-Saharan Africa (SSA) have a higher risk of unintended pregnancies that are more likely to be terminated, most of which are unsafe with associated complications. Unmet need for contraception is highest in SSA and exceeds the global average. This study investigates the association between unmet/met need for contraception and pregnancy termination SSA. METHODS We used pooled data from Demographic and Health Surveys conducted from January 2010 to December 2018 in 32 countries in SSA. Our study involved 265,505 women with diverse contraception needs and with complete data on all variables of interest. Multilevel logistic regression at 95% CI was used to investigate the association between individual and community level factors and pregnancy termination. RESULTS We found an overall pregnancy termination rate of 16.27% ranging from 9.13% in Namibia to 38.68% in Gabon. Intriguingly, women with a met need for contraception were more likely to terminate a pregnancy [aOR = 1.11; 95% CI 1.07-1.96] than women with unmet needs. Women with secondary education were more likely to terminate a pregnancy as compared to those without education [aOR = 1.23; 95% CI 1.19-1.27]. With regards to age, we observed that every additional age increases the likelihood of terminating a pregnancy. At the contextual level, the women with female household heads were less likely to terminate a pregnancy [aOR = 0.95; 95% CI 0.92-0.97]. The least socio-economically disadvantaged women were less likely to terminate a pregnancy compared to the moderately and most socio-economically disadvantaged women. CONCLUSIONS Our study contributes towards the discussion on unmet/met need for contraception and pregnancy termination across SSA. Women with met need for contraception have higher odds of terminating a pregnancy. The underlying cause of this we argued could be poor adherence to the protocols of contraceptives or the reluctance of women to utilise contraceptives after experiencing a failure. Governments of SSA and non-governmental organisations need to take pragmatic steps to increase met needs for contraception and also utilise mass media to encourage women to adhere to the prescription of contraceptives in order to reduce the incidence of unplanned pregnancies and unsafe abortions.
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Affiliation(s)
- Kenneth Setorwu Adde
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.
| | - Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Joshua Amo-Adjei
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Family Welfare Expenditure, Contraceptive Use, Sources and Method-Mix in India. SUSTAINABILITY 2021. [DOI: 10.3390/su13179562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Making universal access to sexual and reproductive health care a reality, and thus building momentum for comprehensive family planning by 2030, is key for achieving sustainable development goals. However, in the last decade, India has been retreating from progress achieved in access to family planning. Family planning progress for a large country such as India is critical for achieving sustainable developmental goals. Against this backdrop, the paper investigated the question of how far family welfare expenditure affects contraceptive use, sources of contraceptive methods, and method-mix using triangulation of micro and macro data analyses. Our findings suggest that, except for female sterilizations, modern methods of contraception do not show a positive relationship with family welfare expenditure. Notwithstanding a rise in overall family welfare expenditure, spending on core family planning programs stagnates. State-wise and socio-economic heterogeneity in source-mix and method-mix continued to influence contraceptive access in India. Method-mix continued to skew towards female sterilization. Public sector access is helpful only for promoting female sterilization. Thus, the source-mix for modern contraceptives presents a clear public-private divide. Over time, access to all contraceptive methods by public sources declined while the private sector has failed to fill the gap. In conclusion, this study identified a need for revitalizing family planning programs to promote spacing methods in relatively lower-performing states and socio-economic groups to increase overall contraceptive access and use in India through the rise in core family planning expenditure.
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Tsui AO, Cardona C, Srivatsan V, OlaOlorun F, Omoluabi E, Akilimali P, Gichangi P, Thiongo M, Radloff S, Anglewicz P. Is Client Reporting on Contraceptive Use Always Accurate? Measuring Consistency and Change with a Multicountry Study. Stud Fam Plann 2021; 52:361-382. [PMID: 34383305 DOI: 10.1111/sifp.12172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The consistency of self-reported contraceptive use over short periods of time is important for understanding measurement reliability. We assess the consistency of and change in contraceptive use using longitudinal data from 9,390 urban female clients interviewed in DR Congo, India, Kenya, Niger, Nigeria, and Burkina Faso. Clients were interviewed in-person at a health facility and four to six months later by phone. We compared reports of contraceptive use at baseline with recall of baseline contraceptive use at follow-up. Agreement between these measures ranged from 59.1 percent in DR Congo to 84.4 percent in India. Change in both contraceptive method type (sterilization, long-acting, short-acting, nonuse) and use status (user, nonuser, discontinuer, adopter, switcher) was assessed comparing baseline to follow-up reports and retrospective versus current reports within the follow-up survey. More change in use was observed with panel reporting than within the cross section. The percent agreement between the two scenarios of change ranged from 64.8 percent in DR Congo to 84.5 percent in India, with cross-site variation. Consistently reported change in use status was highest for nonusers, followed by users, discontinuers, adopters, and switchers. Inconsistency in self-reported contraceptive use, even over four to six months, was nontrivial, indicating that studying measurement reliability of contraceptive use remains important.
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Affiliation(s)
- Amy O Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Varsha Srivatsan
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Elizabeth Omoluabi
- Center for Research, Evaluation Resources and Development, Ile-Ife, Osun, Nigeria.,Statistics and Population Studies Department, University of the Western Cape, Bellville, South Africa
| | | | - Peter Gichangi
- International Center for Reproductive Health, Nairobi, Kenya.,Technical University of Mombasa, Mombasa, Kenya.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Mary Thiongo
- International Center for Reproductive Health, Nairobi, Kenya
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- The following are other members of the PMA Agile Team: Titilope Akinlose, United Nations Foundation, Washington DC, USA; Georges Guiella and Bazie Fiacre, Institut Supérieur des Sciences de la Population, Joseph Ki-Zerbo University, 03 BP 7118 Ouagadougou, Burkina Faso; P. R. Sodani and Anupam Mehrotra, Indian Institute of Health Management and Research, Jaipur, India; Sani Oumarou and Souleymane Alzouma, Institut National de la Statistique du Niger, Niamey, Niger
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Areru HA, Dangisso MH, Lindtjørn B. Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study. BMC Health Serv Res 2021; 21:776. [PMID: 34362376 PMCID: PMC8344135 DOI: 10.1186/s12913-021-06846-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 07/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities' suggestions to improve the services. No study has assessed this in Ethiopia previously. METHODS An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases' diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis. RESULT A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18-0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08-0.09). Children in the age group of 5-14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21-0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09-4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals' skill and attitudes, and improving affordability and physical accessibility of the services. CONCLUSION The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.
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Affiliation(s)
- Hiwot Abera Areru
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.BOX: 1560, Hawassa, Ethiopia
- Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Mesay Hailu Dangisso
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.BOX: 1560, Hawassa, Ethiopia
| | - Bernt Lindtjørn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.BOX: 1560, Hawassa, Ethiopia
- Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
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Akowuah PK, Kobia-Acquah E, Donkor R, Arthur C, Senanu EN, Dadzie EE, Frimpong AA, Otabil FA, Mbilia H, Owusu E, Adjei-Anang J. PREVALENCE OF MEIBOMIAN GLAND DYSFUNCTION IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES. Ophthalmic Epidemiol 2021; 29:374-383. [PMID: 34338611 DOI: 10.1080/09286586.2021.1958351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To review and summarize information on meibomian gland dysfunction (MGD) epidemiology in Africa. METHODS A systematic search of online databases was conducted for literature/studies on MGD in Africa. Meta-analysis was conducted to estimate the prevalence of MGD in Africa. Meta-regression was used to explore sources of heterogeneity. RESULTS Twelve studies conducted in five countries were included in the review. All studies were hospital-based studies. Nine studies were included in the meta-analysis; the total sample size was 4963 and participants' age range was 17-96 years. The overall prevalence estimate of MGD in Africa was 45.9% (95% CI: 27.6-64.1%). Prevalence of MGD among males and females were each pooled from three studies and in urban and rural setting from 6 and 3 studies, respectively. Prevalence of MGD among males and females were 56.0% (95% CI: 22.4-89.5%) and 58.9% (95% CI: 28.5-89.4%) respectively; in urban and rural settings were 42.8% (95% CI: 21.1-64.5%) and 65.7% (95% CI: 25.7-95.7%), respectively. There was no association of MGD with sex (p = .872) and with study setting (p = .231). CONCLUSION There is a paucity of evidence on MGD prevalence in Africa, emphasizing the need for epidemiological studies to enhance our understanding of region-specific differences in MGD in Africa. The pooled estimate from hospital-based studies, however, suggests a substantial MGD burden in Africa. Epidemiological studies are needed to assess if this translates to a high disease burden within the general African population.
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Affiliation(s)
- Prince Kwaku Akowuah
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,College of Optometry and Visual Science, University of Houston, Houston, Texas, USA
| | - Emmanuel Kobia-Acquah
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, College of Sciences and Health, Technological University Dublin, Dublin, Ireland
| | - Richard Donkor
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Christabel Arthur
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Nutifafa Senanu
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emmanuela Esi Dadzie
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Asafo Agyei Frimpong
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fredrick Annan Otabil
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Henry Mbilia
- Eye Department, CCBRT Disability Hospital, Dar Es Salaam, Tanzania
| | - Ebenezer Owusu
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Adjei-Anang
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Muhoza P, Koffi AK, Anglewicz P, Gichangi P, Guiella G, OlaOlorun F, Omoluabi E, Sodani PR, Thiongo M, Akilimali P, Tsui A, Radloff S. Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption. Health Policy Plan 2021; 36:273-287. [PMID: 33454786 PMCID: PMC8058948 DOI: 10.1093/heapol/czaa197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception, oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.
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Affiliation(s)
- Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP) of the Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | | | | | | | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Pierre Akilimali
- Ecole de Santé Publique de l'Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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49
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Henry EG, Hackett KM, Bawah A, Asuming PO, Agula C, Canning D, Shah I. The impact of a personalized, community-based counselling and referral programme on modern contraceptive use in urban Ghana: a retrospective evaluation. Health Policy Plan 2021; 35:1290-1299. [PMID: 33097942 PMCID: PMC7886439 DOI: 10.1093/heapol/czaa082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
Community-based demand-generation family planning programmes have been associated with increased contraceptive use in rural areas of Ghana. However, rigorous evaluations of such programmes in urban contexts are lacking. We used a retrospective, cross-sectional with comparison group design to estimate the immediate and sustained impact of the Willows intervention on modern contraceptive use in Kumasi, Ghana. The Willows intervention is a home-based counselling and referral programme for women in low-income urban settlements. We analysed data from a cross-sectional representative survey of 1205 women of reproductive age in the intervention area and 1108 women in a matched comparison site. The main outcome was women's reported contraceptive use at: (1) baseline (January 2013); (2) programme close (December 2016); and (3) follow-up (August to October 2018). We estimated the programme effect at the community level and for women who reported receiving a family planning counselling visit. We used coarsened exact matching to assess the impact of the intervention relative to outcomes for matched comparison women. Comparing those who reported a family planning visit in the intervention area with matched comparison area women who reported no visit, we estimated a 10.5 percentage point increase in use of modern contraceptives from baseline to close (95%CI : 6.2, 14.8; P < 0.001) and a 7.6 percentage point increase from baseline to follow-up (95%CI : 3.3, 11.9; P < 0.001). However, only 20.2% of women in the Willows intervention area reported a visit. The Willows intervention, therefore, did not achieve its aim to reach all reproductive-aged women in the community. At the community level, we found no significant effect of the intervention at either programme close or 2 years later. We recommend that similar community-based interventions strive for greater outreach and simultaneously launch robust prospective impact evaluations.
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Affiliation(s)
- Elizabeth G Henry
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kristy M Hackett
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ayaga Bawah
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Patrick O Asuming
- Department of Finance, University of Ghana Business School, University of Ghana, Legon, Accra, Ghana
| | - Caesar Agula
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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50
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Asaolu I, Kram N, Ajala C, Aquaisua E, Asaolu A, Kato-Lagumbay K, Abuh A, Bernand M, Ehiri J. “Antibiotics Can Work as a Contraceptive:” Contraceptive Knowledge and Use Among University Students in Calabar, Nigeria. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:665653. [PMID: 36303954 PMCID: PMC9580625 DOI: 10.3389/frph.2021.665653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Many sexually active youths who wish to delay pregnancy are not using any form of modern contraceptives. In sub-Saharan Africa, less than 1 in 5 sexually active youth do not use contraceptives. In Nigeria, 48.4% of all sexually active unmarried women have an unmet need for contraception. Although the literature is replete with information on structural barriers to modern contraceptives, there is limited scholarship on contextual factors that may inhibit modern contraceptive use among Nigerian youth. This study uses a qualitative research approach to assess knowledge and use of natural, modern, and folkloric contraceptive methods among a sample of university students in Calabar, Nigeria. Methods: This study used data from focus group discussions among women and men in university halls of residence, all of whom were unmarried. Also, three male pharmacists and three female community health workers were interviewed. All focus group discussions and interviews took place in August 2017 and were conducted in Calabar Metropolis, Cross River State, Nigeria. The audio recordings were transcribed into detailed summaries of the interviews and focus group discussions. All data analysis was completed using Atlas.Ti (version 8). Results: University men and women have limited knowledge of and application of natural and modern contraception. Participants listed folkloric methods of contraceptives, including repurposing pharmaceuticals (e.g., antibiotics, quinine, and Andrews Livers Salt-a laxative) as contraceptive agents. Respondents also discussed the use of non-pharmaceuticals such as water, salt solution, and squatting after intercourse as contraceptives. Generally, university students defaulted to withdrawal, calendar method, and emergency contraceptives as preferred methods of contraception. Lastly, condoms were used among participants in causal sexual encounters. In dating relationships, however, both male and female students cited their partners' hesitancy to condom use as such act could indicate distrust. Conclusion: Awareness and use of modern contraceptives are limited among university students in Calabar, Nigeria. The use of folkloric contraceptives could lead to bodily harm and unintended pregnancy. Further research is needed to elucidate factors that promote use of folkloric methods of contraceptives. Integration of contraceptive awareness into health promotion services for young people may help to dispel myths about folkloric methods of contraceptives while promoting awareness and use of safe and effective contraception.
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Affiliation(s)
- Ibitola Asaolu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- *Correspondence: Ibitola Asaolu
| | - Nidal Kram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Christopher Ajala
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ememobong Aquaisua
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Akinsola Asaolu
- Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kylie Kato-Lagumbay
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Alice Abuh
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Moses Bernand
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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