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Ibrahimi S, Youssouf B, Potts C, Dumouza A, Duff R, Malaba LS, Brunner B. United States Government-Supported Family Planning and Reproductive Health Outreach in the Democratic Republic of the Congo: Lessons Learned and Recommendations. Open Access J Contracept 2024; 15:13-21. [PMID: 38476860 PMCID: PMC10929168 DOI: 10.2147/oajc.s446263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Background In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants' perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations. Methods Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis. Results The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects. Implications Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women's feedback about the FP outreach program and our recommendations can inform future policies and interventions.
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Affiliation(s)
- Sahra Ibrahimi
- International Development Division, Abt Associates, Rockville, MD, USA
- Department of Global Health, Denison University, Granville, OH, USA
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Bamba Youssouf
- Matchboxology, Johannesburg, Gauteng, province, South Africa
| | - Christine Potts
- International Development Division, Abt Associates, Rockville, MD, USA
| | - Alexandre Dumouza
- International Development Division, Abt Associates, Rockville, MD, USA
| | - Rani Duff
- International Development Division, Abt Associates, Rockville, MD, USA
| | | | - Bettina Brunner
- International Development Division, Abt Associates, Rockville, MD, USA
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Varelis T, Allambademel VDP, Ngarmbatedjimal A, Ndingayande A, Diarra A, Vourbane K, Madjigoto R, Luketa S, Casey SE. Sexual and reproductive health knowledge, attitudes, and behaviors: A survey of 12-17 year old Sudanese refugees in Chad. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002597. [PMID: 38271359 PMCID: PMC10810453 DOI: 10.1371/journal.pgph.0002597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Abstract
Adolescents living in humanitarian settings are often at a higher risk of negative sexual and reproductive health outcomes, and yet, limited information is available on adolescents' experiences and needs in these settings while available services do not always correspond to their needs. This study explored knowledge, attitudes, and behaviors relating to sexual and reproductive health among 12-17 year old refugees from Darfur currently living in two refugee camps in eastern Chad. The research team conducted a cross-sectional survey of 689 adolescent girls and boys, informed by participatory research activities, to explore key sexual and reproductive health topics. This study found that sexual and reproductive health knowledge among adolescents is low, with only 69.1% able to identify at least one modern contraceptive method. Early marriage was uncommon (5% of girls, 0.8% of boys), but 17.6% of adolescents had already had a romantic relationship. Few adolescents (11.4%) had ever had sex, but among these adolescents,18.4% reported using a condom the last time they had sex. No boys reported current modern contraceptive use, but 28.3% of girls, both married and unmarried, reported current use. These findings demonstrate the importance of making sexual and reproductive health services in humanitarian settings more adolescent-responsive and minimizing barriers to access, including addressing community stigma surrounding adolescents' use of sexual and reproductive health services and increasing trust in the confidentiality of sexual and reproductive health services in the camps.
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Affiliation(s)
- Theodora Varelis
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Vincent de Paul Allambademel
- Laboratoire de Sociologie, d’Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N’Djamena, N’Djamena, Chad
| | - Alexis Ngarmbatedjimal
- Laboratoire de Sociologie, d’Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N’Djamena, N’Djamena, Chad
| | | | - Aminata Diarra
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Robert Madjigoto
- Laboratoire de Sociologie, d’Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N’Djamena, N’Djamena, Chad
| | - Samy Luketa
- International Rescue Committee, N’Djamena, Chad
| | - Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Terefe B, Getnet M, Akalu Y, Belsti Y, Diress M, Gela YY, Getahun AB, Bitew DA, Belay DG. Geospatial variations and determinants of contraceptive utilization among married reproductive age women in Ethiopia: spatial and multilevel analysis of Ethiopian Demographic and Health Survey, 2019. Front Glob Womens Health 2023; 4:1151031. [PMID: 37811535 PMCID: PMC10556865 DOI: 10.3389/fgwh.2023.1151031] [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: 01/25/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Contraception is the most effective method of preventing unwanted pregnancies and their associated disadvantages. It is critical to recognize one's desire to utilize contraceptives before drafting and implementing a good family planning program, especially in developing nations like Ethiopia. Objective This study aimed to identify the geospatial variations and determinants affecting the utilization of contraceptives among married reproductive age women in Ethiopia. Method This study was based on an extensive national survey, the Ethiopian Demographic and Health Survey. A total weighted sample of 5,743 married reproductive-age women was included. Because of the hierarchical nature of the DHS data, a spatial analysis multilevel logistic regression model was used to study individual and community-level factors that may influence contraceptives. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of contraceptive usage. ArcGIS version 10.3 was used to visualize the distribution of contraceptives. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance. Result The overall utilization of contraceptives was discovered at 41.25% (39.98, 42.53). Participants age range of 25-34 years [AOR = 0.80, CI: (0.66, 0.96,)] and 35-49 years [AOR = 0.50, CI 95%:(0.66, 0.96)] times less likely to use contraceptives than 15-24 years old respectively. Having primary [AOR = 1.47, CI 95%: (1.25, 1.73)], secondary [AOR = 1.42, CI 95%: (1.09, 1.83)] and higher education level [AOR = 1.92, CI 95%: (1.41, 2.60)], middle wealth [AOR = 1.48, CI 95%: (1.14, 1.90)], richer [AOR = 1.41, CI 95%: (1.07, 1.86)] and richest [AOR = 2.17, CI 95%: (1.52, 3.11)], having 1-4 ANC follow up have [AOR = 1.60, CI 95%: (1.26, 2.03)], gave birth at age of 35-44 [AOR = 0.29, CI 95%: (0.22, 0.37)], having 3-5 children [AOR = 1.26, CI 95%: (1.03, 1.52)], being from community of high level women education [AOR = 1.61, CI 95%: (1.21, 2.15)] were associated positively. Participants from Amhara, Oromia, Benishangul and SNNPR regions have revealed [AOR = 2.40, CI 95%: (1.53, 3.77)], [AOR = 1.64, CI 95%: (1.05, 2.56)], [AOR = 1.62, CI 95%: (1.01, 2.62)] and [AOR = 2.04, CI 95: (1.31, 3.19)], in contrast, Somali and Afar regions have shown [AOR = 011, CI 95%: (0.05, 0.22)] and [AOR = 0.31, CI 95%: (0.18, 0.54)] times less likely to use contraceptive services than Tigray Region respectively. The spatial analysis of contraceptive usage discovered that the northern, central and southern parts of the country had higher utilization of contraceptives than the eastern and northeastern of the country. Conclusion The study revealed that contraceptive usage among married women is comparatively low, with wide regional variation. Raising awareness among mothers about the importance of antenatal care and assisting mothers who are financially disadvantaged or do not have access to health facilities will aid in providing better family planning services. Improving contraceptive information dissemination at community and regional levels is key to averting potential barriers.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Akalu
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yitayeh Belsti
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Belete Getahun
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tenaw Z, Gari T, Gebretsadik A. Unintended pregnancy and its associated factors among women with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis. BMC Pregnancy Childbirth 2023; 23:522. [PMID: 37460959 DOI: 10.1186/s12884-023-05848-3] [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: 01/17/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Unintended pregnancy is one of the most common reproductive health problems. The problem makes women with disabilities doubly burdened by their disabilities. The previous evidences are inconsistent and do not address all women with disabilities. The study aimed to assess the prevalence of unintended pregnancy and its associated risk factors among women with disabilities in Dale and Wonsho districts and Yirgalem city administration central Sidama National Regional State, Ethiopia. METHODS A community-based cross-sectional study design was conducted among 355 randomly selected women with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviews using a structured questionnaire. A multilevel logistic regression analysis model was employed to identify factors associated with an unintended pregnancy. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. RESULTS In this study, the prevalence of unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). After adjusting for potential confounding variables, middle economic status (AOR = 2.07; 95% CI: 1.02, 4.20), giving birth (AOR = 2.20; 95% CI: 1.21, 3.99), extremity paralysis types of disability (AOR = 0.26; 95% CI: 0.12, 0.57), living in urban residences (AOR = 0.22; 95% CI: 0.12, 0.40) and alcohol using (AOR = 0.28; 95% CI: 0.11, 0.74) were risk factors with unintended pregnancy. CONCLUSIONS Unintended pregnancy among women with disabilities is remarkably high in central Sidama National Regional State, Ethiopia. Economic status, giving birth, types of disability, residence, and alcohol use were factors associated with an unintended pregnancy. As a result, economic empowerment, strengthening education and information about unintended pregnancy and its prevention strategies in rural settings are vital.
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Affiliation(s)
- Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Taye Gari
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Achamyelesh Gebretsadik
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Mengist A, Lakew Workie D, Dessie ZG, Tesfaw LM. Spatial distribution and multilevel analysis of the ideal number of children among Ethiopian women. BMC Womens Health 2023; 23:368. [PMID: 37438793 DOI: 10.1186/s12905-023-02477-y] [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: 11/16/2022] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Ideal number of children (INC) is the number of children that a woman or man would have if they could go back to the time when they did not have any children and could choose accurately the number of children to have in their total life. Despite numerous studies on the prevalence and associated factors of the ideal number of children, there is a lack of studies that incorporated spatial and multilevel analysis. Thus, this study was aimed at the spatial and multilevel analysis of an ideal number of children and associated factors. METHODS The study design was a cross-sectional study in which the data was obtained from Ethiopian Demographic and Health Survey (EDHS) in 2016. About 13,961 women ages 15-49 who fulfill the inclusion criterion were considered. A negative binomial regression model that incorporates spatial and multilevel analysis was employed. RESULTS About 33 and 12.8% of the women had four and six ideal numbers of children respectively. The highest INC per woman was recorded in Oromia region 5055 (36.1%) and the lowest in Harare 35(0.2%). The INC per woman is high in rural 10,726 (76.6%) areas as compared to urban areas 3277(23.4%). The ideal number of children was spatially clustered (Global Moran's I = 0.1439, p < .00043). Significant hotspot clusters were found in the Somali region such as in Afder, Shabelle, Korahe, and Doolo zone. CONCLUSION The spatial analysis revealed a significant clustering of the ideal number of children in the Ethiopia zone. Specifically, higher INC was observed in the Somali region, specifically in the Afder, Shabelle, Korahe, and Doolo zones. Among the various factors considered, women's age, region, place of residence, women's education level, contraception use, religion, marital status, family size, and age at first birth year were identified as significant predictors of the ideal number of children. These findings indicate that these factors play a crucial role in shaping reproductive preferences and decisions among women in the study population. Based on these findings, responsible bodies should prioritize targeted interventions and policies in high-risk regions to address women's specific reproductive needs.
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Affiliation(s)
| | | | - Zelalem G Dessie
- Department of Statistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
- School of Mathematics, Statistics and Computer Science, KwaZulu-Natal University, Durban, South Africa
| | - Lijalem Melie Tesfaw
- Department of Statistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia.
- Epidemiology and Biostatistics Division , The University of Queensland, Brisbane, Australia.
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Mankelkl G, Kinfe B. Spatial variations and multilevel mixed effect analysis on determinants factors of modern contraceptive utilization among reproductive age women in Ethiopia; proven by Ethiopian mini demographic health survey 2019. BMC Womens Health 2023; 23:77. [PMID: 36814235 PMCID: PMC9948416 DOI: 10.1186/s12905-022-02030-3] [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] [Received: 08/24/2022] [Accepted: 10/26/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Globally, in 2019, there are 1.9 billion women of reproductive age (15-49), of which 1.1 billion have a need for family planning. Of these, 842 million use contraceptives, and 270 million still have an unmet need for contraception. Ethiopia is a low-income country with inadequate access to family planning (FP), especially in the developing regions. The Ethiopian government was striving to increase the number of health facility in order to provide quality maternal care and services. Increasing the modern contraceptive prevalence rate is one of the goals of the government to reduce maternal and child mortality and morbidity. METHODS Secondary data analysis was conducted using data from mini-EDHS of 2019 demographic and health Survey datasets. The study comprised a total of 8885 reproductive-age women. Spatial variations and multilevel mixed effect analysis on determinants factors of modern contraceptive use among reproductive age women in Ethiopia; evidenced by mini-EDHS 2019. Finally, the percentage and odd ratio, its 95% confidence intervals, and the result of spatial analysis were reported. RESULT This study includes a total weighted sample of 8885 reproductive-age women from the 2019 mini-Ethiopian demographic and health survey. The prevalence of modern contraceptive use was 25.5% in Ethiopia. living in urban area [AOR = 2.13; 95% CI = (1.75, 2.61); P = 0.000], being married [AOR = 1.42; 95% CI = (1.19, 1.70); P = 0.000] were found positively associated with contraceptive use. In contrast to this, attending primary education [AOR = 0.91; 95% CI = (0.74, 1.12); P = 0.000]., being Muslim [AOR = 0.25; 95% CI = (0.22, 0.29); P = 0.000], being poorest [AOR = 0.54; 95% CI = (0.45, 0.66); P = 0.000] were found negatively associated with contraceptive use. CONCLUSION In this study Individual and community level factors were associated with modern contraceptive use and also there were spatial variations in modern contraceptive use across the region among reproductive-age women. Empowering women to have better educational status, improving the wealth index, promoting marriage, creating awareness among rural residences women and promoting education about modern contraceptives through religiously acceptable persons, and promoting modern contraceptive use in developing regions were the key factors to improve modern contraceptive use among reproductive age women in Ethiopia.
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Affiliation(s)
- Gosa Mankelkl
- College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia.
| | - Beletu Kinfe
- College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Bapolisi WA, Bisimwa G, Merten S. Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey. BMJ Open 2023; 13:e061564. [PMID: 36764708 PMCID: PMC9923293 DOI: 10.1136/bmjopen-2022-061564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. DESIGN Longitudinal study. SETTING A community-based approach was used to investigate FP use in the North and South-Kivu regions. PARTICIPANTS Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. PRIMARY AND SECONDARY OUTCOMES FP use and intention to use FP. RESULTS The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052). CONCLUSION TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Epidemiology, University of Basel Faculty of Science, Basel, Switzerland
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Catholic University of Bukavu, Bukavu, South-Kivu, Congo (the Democratic Republic of the)
| | - Sonja Merten
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Idris IB, Syed Soffian SS, Baharom M, Baharuddin UM, Hashim S, Nawi AM. Influence of sociocultural beliefs and practices on contraception: a systematic review. Women Health 2022; 62:688-699. [DOI: 10.1080/03630242.2022.2117764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Idayu Badilla Idris
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Mazni Baharom
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ummi Mirza Baharuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Syahirah Hashim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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A Comparative Analysis of Technical Efficiency and Profitability of Agribusiness and Non-Agribusiness Enterprises in Eastern DRC. SUSTAINABILITY 2022. [DOI: 10.3390/su14148384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine whether agribusiness could be competitive compared to non-agribusiness employment opportunities in terms of technical efficiency and profitability. We used data collected on all seven operating cassava community processing centers (CCPCs) and 150 comparable non-agribusiness enterprises in South Kivu province. A Data Envelopment Analysis (DEA), as well as cost–benefit ratios and net monthly revenue, were used to examine technical efficiency and profitability. Our results showed that agribusiness was more competitive than non-agribusiness in terms of technical efficiency and profitability. The cost–benefit ratio shows that every dollar invested in agribusiness earns investors US $2.8, while it earns investors in non-agribusiness US $2.1. Moreover, technical efficiency increases significantly with agribusiness. These results show that agribusiness can compete with other non-agribusiness activities, and it remains a solution to youth unemployment in the region.
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Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey. BMC Pregnancy Childbirth 2022; 22:17. [PMID: 34991501 PMCID: PMC8734335 DOI: 10.1186/s12884-021-04371-7] [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: 04/16/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. Methods The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. Results Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30–34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15–19 years (AOR = 0.55; 95% CI: 0.32–0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3–4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1–2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. Conclusion The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.
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Samad N, Das P, Dilshad S, Al Banna H, Rabbani G, Sodunke TE, Hardcastle TC, Haq A, Afroz KA, Ahmad R, Haque M. Women's empowerment and fertility preferences of married women: analysis of demographic and health survey’2016 in Timor-Leste. AIMS Public Health 2022; 9:237-261. [PMID: 35634022 PMCID: PMC9114782 DOI: 10.3934/publichealth.2022017] [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: 10/28/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.
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Affiliation(s)
- Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Pranta Das
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | - Segufta Dilshad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Hasan Al Banna
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, Bangladesh
| | - Golam Rabbani
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Ahsanul Haq
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka-1205, Bangladesh
| | - Khandaker Anika Afroz
- Deputy Manager (Former), Monitoring, Learning, and Evaluation, CEP, BRAC, Bangladesh
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sugai Besi, 57000 Kuala Lumpur, Malaysia
- * Correspondence: ,
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Samantha G, Bartels Susan A, Sabine L, Heather S. A cross-sectional study of community perceptions of stigmatization amongst women affected by UN-peacekeeper perpetrated sexual exploitation and abuse. BMC Public Health 2021; 21:2295. [PMID: 34922504 PMCID: PMC8684182 DOI: 10.1186/s12889-021-12221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sexual exploitation and abuse (SEA) by UN peacekeepers perpetrated against local women and girls is a concern in the Democratic Republic of Congo (DRC). While stigma associated with sexual and gender-based violence is well documented more broadly, little is known about stigma associated with peacekeeper-perpetrated SEA. Methods The aim of this study was to examine how the degree of exposure to SEA affects community perceptions of a woman or girl’s (1) social status (public stigma) and (2) institutional support in her community (structural stigma). Two poisson regression models with robust variance estimation were constructed utilizing community survey data of SEA experiences from eastern DRC (n = 2867) to quantify these associations. Relevant demographic variables were assessed for confounding and effect modification. Results The prevalence of public and structural stigma were 62.9 and 19.3% respectively across the sample. A positive relationship was demonstrated between level of exposure of SEA and diminished social status in which women and girls experiencing moderate levels of SEA were at the greatest risk of public stigmatization after adjusting for confounding (RR: 1.94; CI: 1.66–2.26). Similarly, a positive relationship between exposure to SEA and inadequate institutional support was shown for female narrators wherein women and girls experiencing a high degree of SEA were 6.53 times as likely to receive inadequate support (RR: 6.53; CI: 3.63, 11.73). This contrasted with male narrated stories for whom there was no significant association between the SEA exposure level and institutional support. Conclusions Women/girls with high exposure levels to UN peacekeeper-perpetrated SEA are at the highest risk of public and structural stigmatization, which should be more routinely considered when conceptualizing the consequences of SEA in peacekeeping contexts. The frequent occurrence of both public and structural stigma, coupled with the varying perceptions by sex, demonstrates the need for a multi-faceted approach for stigma reduction.
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Affiliation(s)
- Gray Samantha
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - A Bartels Susan
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Lee Sabine
- Department of History, University of Birmingham, Birmingham, England
| | - Stuart Heather
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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The prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa, a national antenatal survey, 2019. Sci Rep 2021; 11:23740. [PMID: 34887462 PMCID: PMC8660789 DOI: 10.1038/s41598-021-03096-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022] Open
Abstract
To describe the prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa. A cross-sectional survey was conducted between October and mid-November 2019 among pregnant women aged 15–49 years in 1589 selected public antenatal care facilities. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy. Survey logistic regression examined factors associated with unintended pregnancy. Among 34,946 participants, 51.6% had an unintended pregnancy. On multivariable analysis, the odds of unintended pregnancy was higher among women who knew their HIV-positive status before pregnancy but initiated treatment after the first antenatal visit (adjusted odds ratio [aOR], 1.5 [95% confidence interval (CI):1.2–1.8]), women who initiated treatment before pregnancy (aOR, 1.3 [95% CI:1.2–1.3]), and women with a new HIV diagnosis during pregnancy (aOR, 1.2 [95% CI:1.1–1.3]) compared to HIV-negative women. Women who were single, in a non-cohabiting or a cohabiting relationship, and young women (15–24 years) had significantly higher risk of unintended pregnancy compared to married women and women aged 30–49 years, respectively. A comprehensive approach, including regular assessment of HIV clients’ pregnancy intention, and adolescent and youth-friendly reproductive health services could help prevent unintended pregnancy.
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Butler MG, Walker M, Pablo LA, Bartels SA. Relationship between women's decision-making power over their own health care and use of modern contraception in the Democratic Republic of the Congo: a cross-sectional secondary data analysis. BMC WOMENS HEALTH 2021; 21:309. [PMID: 34419026 PMCID: PMC8379842 DOI: 10.1186/s12905-021-01450-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND In sub-Saharan Africa, the use of modern contraception (MC) is a critical intervention aimed at reducing mortality rates associated with unintended, high-risk pregnancies. However, among Congolese women aged 15-49, the prevalence of MC use is low. Research suggests that women's general participation in decision-making is important in increasing MC use. However, little is known about the specific role of women's decision-making power over their own health care and how it relates to MC use. Thus, this study aimed to investigate the relationship between women's decision-making power over their own health care and use of MC. METHODS A cross-sectional secondary data analysis was conducted using the most recent data from the 2013-2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey. Women who were considered in need of contraception based on their family planning preferences were included in the study population (N = 6422). Multivariate logistic regression was used to determine whether women's decision-making power over their own health care was associated with the use of MC. RESULTS Only one in ten women reported using a modern method of contraception. Logistic regression showed that women who made decisions alone regarding their own health care were more likely to use MC than women who had no say in these decisions, even after controlling for important covariates (OR 1.48; 95% CI 1.00, 2.17). CONCLUSION The results of this study lend further support that promoting women's autonomy and right to independently make decisions regarding their own health may be important in increasing the use of MC in the DRC. However, in order to effectively empower women to negotiate for the use of MC, qualitative research is needed to further assess the relationship between decision-making power and MC use.
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Affiliation(s)
- Megan G Butler
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Melanie Walker
- Department of Emergency Medicine, Queen's University, Kingston, ON, K7L 2V7, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Lesley A Pablo
- Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Susan A Bartels
- Department of Emergency Medicine, Queen's University, Kingston, ON, K7L 2V7, Canada. .,Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada.
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Ahinkorah BO, Budu E, Aboagye RG, Agbaglo E, Arthur-Holmes F, Adu C, Archer AG, Aderoju YBG, Seidu AA. Factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa: evidence from cross-sectional surveys of 29 countries. Contracept Reprod Med 2021; 6:22. [PMID: 34332644 PMCID: PMC8325798 DOI: 10.1186/s40834-021-00165-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. This study sought to determine the factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa. METHODS This study used data from the Demographic and Health Surveys of 29 countries in sub-Saharan Africa. A total of 87,554 women aged 15-49 with no fertility intention and who had completed information on all the variables of interest were considered in this study. Using a multilevel logistic regression analysis, four models were used to examine the individual and contextual factors associated with modern contraceptive use. The results were presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p< 0.05. RESULTS The prevalence of modern contraceptive use was 29.6%. With the individual-level factors, women aged 45-49 had lower odds of using modern contraceptives (aOR = 0.33, 95% CI = 0.28, 0.39). Women who had their first sex at age 15-19 (aOR = 1.12, 95% CI = 1.07, 1.17), those with higher education (aOR = 1.93, 95% CI = 1.75, 2.13), and women who were exposed to newspaper (aOR = 1.15, 95% CI = 1.10, 1.20) and radio (aOR = 1.21, 95% CI = 1.17, 1.26) had higher odds of modern contraceptive use. In terms of the contextual factors, women living in urban areas (aOR = 1.06, 95% CI = 1.02, 1.11), women in the richest wealth quintile (aOR = 1.55, 95% CI = 1.43, 1.67), and those in communities with medium literacy level (aOR = 1.11, 95% CI = 1.06, 1.16) and medium community socio-economic status (aOR = 1.17, 95% CI = 1.10, 1.23) had higher odds of modern contraceptive use. Across the geographic regions in sub-Saharan Africa, women in Southern Africa had higher odds of modern contraceptive use (aOR = 5.29, 95% CI = 4.86, 5.76). CONCLUSION There is a relatively low prevalence of modern contraceptive use among women with no fertility intention in sub-Saharan Africa, with cross-country variations. Women's age, age at first sex, level of education, mass media exposure, place of residence, community literacy level and community socio-economic status were found to be associated with modern contraceptive use. It is, therefore, important for policy makers to consider these factors when designing and implementing programmes or policies to increase contraceptive use among women who have no intention to give birth. Also, policymakers and other key stakeholders should intensify mass education programmes to address disparities in modern contraceptive use among women.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anita Gracious Archer
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Yaa Boahemaa Gyasi Aderoju
- Department of Adult Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Australia
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Idowu A, Ukandu GC, Mattu J, Olawuyi D, Abiodun A, Adegboye P, Chibu-Jonah C, Siakpere AE, Ishola AE, Adeyeye T, Alabi S. >Modern Contraception: Uptake and Correlates among Women of Reproductive Age-Group in a Rural Community of Osun State, Nigeria. Ethiop J Health Sci 2021; 30:531-540. [PMID: 33897213 PMCID: PMC8054461 DOI: 10.4314/ejhs.v30i4.8] [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] [Indexed: 11/19/2022] Open
Abstract
Background Universal contraceptive access is one of the key strategies for achieving sustainable developments in any country. Yet, uptake has remained low in most developing nations like Nigeria. The reasons for low use must be contextually understood to aid effective contraceptive programming. This study assessed contraceptive use and its determinants among reproductive aged women in Ejigbo, Osun State, Nigeria. Methods A quantitative study involving 405 participants which were recruited using multi-stage sampling method was carried out. Data were collected using pretested semi-structured, interviewer-administered questionnaire. Chi-Square test and binary logistic regression analysis were used for inferential statistics. Result The mean age of the respondents was 28±6. The majority (92.8%) of the respondents were aware of family planning, 68.9% of them possessed good knowledge but only 53% of them demonstrated favorable contraceptive attitude. Less than half (33.0%) of those who had heard about contraception were current users of modern methods. Injectables (45.0%) and male condoms (30.0%) were the most prevalent contraceptive methods among the respondents. The main determinants of contraceptive uptake were respondents’ educational status (AOR=0.525, 95%CI=0.284-0.972), contraceptive knowledge (OR=0.512, 95%CI=1.242-1.968) and attitude (OR=0.512, 95%CI=1.2421.968). Fear of perceived side effects (45.2%), low pregnancy risk perception (35.7%) and spousal refusal (12.5%) were the main reasons for non-contraceptive use among non-users. Conclusion Contraceptive demand in the study population was low in spite of high awareness level. There is a need to increase contraceptive literacy in the study population and make the services more acceptable to rural dwellers so as to meet the SDG-3 target in Nigeria.
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Affiliation(s)
- Ajibola Idowu
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | | | - Jeremiah Mattu
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Damilola Olawuyi
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Adeola Abiodun
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Phillip Adegboye
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | | | | | | | - Titilola Adeyeye
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Samuel Alabi
- Department of Community Medicine, Bowen University, Iwo, Nigeria
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Perceived norms, personal agency, and postpartum family planning intentions among first-time mothers age 15-24 years in Kinshasa: A cross-sectional analysis. PLoS One 2021; 16:e0254085. [PMID: 34242267 PMCID: PMC8270160 DOI: 10.1371/journal.pone.0254085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Unintended pregnancy is an important global health problem and frequently occurs during the immediate postpartum period. However, few studies have examined postpartum family planning (PPFP) intentions among adolescent girls and young women. This study assessed whether perceived norms and personal agency predicted PPFP intentions among first-time mothers age 15–24 in Kinshasa, the Democratic Republic of Congo. Data were derived from the 2018 Momentum Project baseline survey. Analysis was based on 2,418 nulliparous pregnant women age 15–24 who were approximately six months pregnant with their first child in six health zones of Kinshasa. Overall PPFP intentions were low and ten to thirteen percent of women stated they were very likely to discuss PPFP next month with (a) their husband/male partner and (b) a health worker, and to (c) obtain and (d) use a contraceptive method during the first six weeks following childbirth. The results of multivariable linear regression models indicated that the PPFP intention index was predicted by description norms, perceptions of the larger community’s approval of PPFP, normative expectations, perceived behavioral control, self-efficacy, and autonomy. Rejection of family planning myths and misconceptions was also a significant predictor. Interaction terms suggested that the association of normative expectations with PPFP intentions varied across ethnic groups and that the positive association of injunctive norms with PPFP intentions was significantly increased when the larger community was perceived to disapprove of PPFP use. Normative expectations and PPFP-related self-efficacy accounted for two-thirds of the variance in PPFP intentions. The results suggested that understanding different normative influences may be important to motivate women to use contraception in the immediate postpartum period. In addition to addressing institutional, individual, and social determinants of PPFP, programs should consider integrating norm-based and empowerment strategies.
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Adofo E, Dun-Dery EJ, Kotoh AM, Dun-Dery F, Avoka JA, Ashinyo ME. Fear of infertility limits contraceptive usage among first-time mothers in Ghana: A cross-sectional study. SAGE Open Med 2021; 9:20503121211021256. [PMID: 34158936 PMCID: PMC8182170 DOI: 10.1177/20503121211021256] [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: 10/16/2020] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to determine postpartum modern contraceptive use among first-time young mothers attending child welfare clinics in the Eastern Region of Ghana and explore factors that influence family planning uptake after the first delivery, including fear of infertility. METHODS This facility-based, cross-sectional study used interviewer-administered structured questionnaires. The study recruited 422 first-time young mothers aged 15-24 years, with 6- to 18-month-old babies attending child welfare clinics. RESULTS Overall, less than half (44%) of first-time mothers used modern contraceptives within 18 months after delivery. Fear of infertility after contraceptive use (56%) is the main barrier reported as the reason for women's non-use of modern contraceptives. Mothers with tertiary education have higher odds of using postpartum contraceptives (adjusted odds ratio =1.6, 95% confidence interval: 0.4-2.0). Compared to mothers with younger children, those with children older than 6 months have higher odds of postpartum contraceptive use (adjusted odds ratio = 1.3, 95% confidence interval: 0.3-1.7). Nonspousal communication (adjusted odds ratio = 0.1, 95% confidence interval: 0.1-0.3) as compared to communication among partners about contraception and those in formal employment (adjusted odds ratio = 0.3, 95% confidence interval: 0.1-0.7), were less likely to use postpartum contraceptives. CONCLUSION Considering that there is low postpartum contraceptive utilization, mostly due to concerns about fear of infertility after use, it is paramount to intensify education on actual side effects and reformulate policies that address specific concerns of infertility among mothers and contraceptive use.
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Affiliation(s)
| | - Elvis J Dun-Dery
- Department of Population, Family and
Reproduction Health, School of Public Health, College of Health Sciences, University
of Ghana, Accra, Ghana
- Department of Population and Health
Research, Research Web Africa, Sunyani, Ghana
| | - Agnes M Kotoh
- Department of Population, Family and
Reproduction Health, School of Public Health, College of Health Sciences, University
of Ghana, Accra, Ghana
| | - Frederick Dun-Dery
- Heidelberg Institute of Global Health,
Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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Babazadeh S, Hernandez J, Anglewicz P, Bertrand J. The relationship between spatial access and modern contraceptive use: is proximity to a healthcare facility a determinant of use among women in Kinshasa, DRC? Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13229.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Spatial access has a direct effect on health service utilization in many settings. Distance to health facility has proven to affect family planning (FP) service use in many Sub-Saharan countries. Studies show that women who reside closer to facilities offering family planning services are more likely to use modern contraceptives. However, researchers often test the theory of distance decay. This study analyzed the significance of proximity to family planning services, service availability, and quality of family planning services on modern contraceptive use in Kinshasa, Democratic Republic of the Congo. Methods: We used a pool of four rounds of facility- and population-based survey data in Kinshasa from PMA2020 between 2014 and 2016. We used GPS coordinates to calculate the distance between the health facilities and households. We tested if women who live closer to service delivery points with higher level of availability and quality are more likely to use modern contraceptives or less likely to have unmet need for contraceptive services. Results: 10,968 women were interviewed over four rounds of data collection. Our findings show that living closer to an SDP is not a determinant of modern contraceptive use or having unmet need for FP services. Lack of cognitive access, economic barriers, bypassing the closest facility, and sociocultural norms are strong barriers for women in Kinshasa to use modern contraceptives. Proximity to quality services did not necessarily result in increased FP use among women of reproductive age living in Kinshasa, thus suggesting that a bypass phenomenon may occur when obtaining modern contraceptive services. Conclusions: This study notes that barriers other than proximity to access may be substantial determinants of contraceptive use or unmet need. More research should be conducted that directly measures multidimensional components of access in order to interpret women’s contraceptive seeking behaviors in urban areas of Sub-Saharan Africa.
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Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi. Reprod Health 2021; 18:94. [PMID: 33985538 PMCID: PMC8120830 DOI: 10.1186/s12978-021-01150-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background With a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members. Methods An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n = 132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes. Results The overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09–10.27 p = 0.038), those that have completed secondary school and having four or less children were significantly associated with use of family planning (aOR 1.72 (95%1.35–2.01) p = 0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. Conclusion Given that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use. In the Burundian context, community members agree that large family sizes are difficult to maintain, yet use of family planning remains consistently low. This study explored the factors behind this low utilisation of family planning in two health districts located in the South of Burundi. The findings suggest that fear of side effects is the main reason for family planning non-utilization or discontinuation. The culture and religious beliefs in Rural Burundi also espouse large family sizes and among men, this is conceived as a sign of wealth, power, and respect. Lack of spousal communication and unequal gender relations in household also impedes women from contributing decisions on family planning. The onus on making decisions on contraceptive use lies on men, whom usually, have limited understanding of family planning methods. In improving coverage of family planning in these communities, capacity of the health system to provide quality, timely and people-driven family planning services should be strengthened. At the community level, the use of community health workers to deliver family planning services to the doorstep of community members could significantly increase uptake. Finally, men and religious leaders’ involvement in promoting family planning use can contribute to reducing the impact of cultural and religious barriers to uptake.
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Nyundo L, Whittaker M, Eagle L, Low DR. Adaptation of community-based distribution of family planning services to context-specific social networks: a case of marriage counsellors in Lusaka district, Zambia. BMC Health Serv Res 2021; 21:437. [PMID: 33962591 PMCID: PMC8106238 DOI: 10.1186/s12913-021-06422-3] [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: 09/28/2020] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
Background The significant contribution of community-based distribution (CBD) of family planning services and contraceptives to the uptake of contraceptives in hard-to-reach communities has resulted in the scaling-up of this approach in many Sub-Saharan countries. However, contextual factors need to be taken into consideration. For example, social network influence (e.g. spouse/partner, in-laws, and parents) on fertility decisions in many African and Asian societies is inevitable because of the social organisational structures. Hence the need to adapt CBD strategies to the social network context of a given society. Methods Data collection involved structured interviews from August 2018 to March 2019. Randomly selected respondents (n = 149) were recruited from four purposively selected health facilities in Lusaka district, Zambia. Respondents were screened for age (> 15 yrs.) and marital status. A mix of categorical and qualitative data was generated. The Statistical Package for Social Sciences (SPSS®24) was used to carry out descriptive analysis and tests of association (Fisher’s exact) while Nvivo®12 was used to analyse the qualitative data using a deductive thematic approach. Results The results indicate that pre-marriage counselling (pre-MC) influences key elements of the husband-wife relationship (p > 0.005), namely; sexual relationship, inter-personal communication, assignation of roles and responsibilities, leadership and authority. These elements of the husband-wife relationship also affect how spouses/partners interact when making fertility decisions. More importantly, the majority (86%) of the respondents indicated having a continuing relationship with their marriage counsellors because of the need to consult them on marital issues. Conclusion Marriage counsellors, though hardly reported in fertility studies, are important ‘constituents’ of the social network in the Zambian society. This is because marriage counsellors are trusted sources of information about marital issues and often consulted about family planning but perceived not to have the correct information about modern contraceptives. In this context, pre-MC offers a readily available, sustainable and culturally appropriate platform for disseminating accurate information about modern contraceptives provided in a private and personal manner. Therefore, the CBD strategy in Zambia can harness marriage counsellors by recruiting and training them as community agents. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06422-3.
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Affiliation(s)
- Lucy Nyundo
- National Institute of Public Administration (NIPA), Lusaka, Zambia
| | - Maxine Whittaker
- Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.
| | - Lynne Eagle
- College of Law Business and Governance, James Cook University, Townsville, Australia
| | - David R Low
- Asia Pacific College of Business and Law, Charles Darwin University, Darwin, Australia
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Mukendi DM, Mukalenge FC, Ali MM, Mondo TMN, Utshudienyema GW. [Adolescents and teachers´ knowledge, attitude and practice towards contraception: results from a qualitative study conducted in the Democratic Republic of the Congo]. Pan Afr Med J 2021; 38:121. [PMID: 33912291 PMCID: PMC8051221 DOI: 10.11604/pamj.2021.38.121.21678] [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: 02/03/2020] [Accepted: 01/12/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction the purpose of this study was to assess adolescents and teachers´ knowledge, attitude and practices towards family planning (FP). Methods in 2018, a qualitative study was conducted among seven teachers and 62 teenagers aged 15-19 years based on the Theory of Reasoned Action published by Fishbein and Ajzen in 2011. Data were collected from six focus group (FG) with adolescents and seven semi-structured interviews of teachers. They were analyzed using Atlas Ti software on the basis of a deductive approach. Results periodic abstinence, male condoms and pills were the only contraceptive methods reported. Adolescents and teachers were apprehensive about using artificial contraceptive methods other than irregularly used male condom. Girls prefer natural methods fearing side effects. The majority of adolescents wanted to be informed about FP in school; however, they felt that the content of the Life Education Course (EVIE) was insufficient and that teachers lacked of openness. Peers, brothers, sisters and internet were the main sources of information. Mothers were an important source of information especially for girls, unlike fathers who were generally less appreciated. Conclusion knowledge about FP is weak. Misconceptions about contraception lead to the use of ineffective practices to prevent unintended pregnancies. Training programs to improve teachers´ knowledge should be developed and the content of the EVIE course should be formalized and regulated.
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Affiliation(s)
- Dieudonné Mpunga Mukendi
- Ecole de Santé Publique de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Faustin Chenge Mukalenge
- Ecole de Santé Publique de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Mapatano Mala Ali
- Ecole de Santé Publique de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Thérèse Mambu Nyangi Mondo
- Ecole de Santé Publique de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, République Démocratique du Congo
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Balogun FM, Bamidele OS, Bamgboye EA. Effect of intensive training in improving older women's knowledge and support for infant vaccination in Nigerian urban slums: a before-and-after intervention study. BMC Public Health 2021; 21:266. [PMID: 33530963 PMCID: PMC7851918 DOI: 10.1186/s12889-021-10310-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the strategies for improving vaccination uptake is to make communities understand the importance of immunization and this is expected to drive the demand for vaccines. Building the capacity of older women who supervise child care in Africa may improve infant vaccination in underserved communities. This study determined the impact of training of older women on their knowledge and support for infant vaccination in selected urban slum communities in Ibadan, Nigeria. METHODS This was a before-and-after study that enrolled women aged ≥35 years. They were trained with a manual and short video using participatory learning methods over an 8 month period. The content of their training includes importance of immunization timeliness and completion, how vaccines work and how to be advocates and supporters of infant vaccination. Their knowledge and support for infant vaccination at baseline were compared with post training values using Student's t test and Chi square test with the level of significance set at 5%. RESULTS There were 109 women with mean age 55.8 ± 11.6. they had a mean of 5.7 ± 2.1 training sessions. At the end of the training, their knowledge about infant vaccination and the support they give to it increased from 4.8 ± 3.8 to 10.7 ± 0.6, and 3.1 ± 3.5 to 8.1 ± 1.7 respectively. Those with good knowledge about infant vaccination increased significantly from 37(33.9%) to 82(82.8%), while those with good support for the same increased from 31(28.4%) to 85(85.9%). Women who were ≤ 64 years significantly had improved knowledge after the training compared to the older ones. Those with post secondary education had better knowledge and greater support for infant vaccination at baseline. However, there was no difference in the knowledge and support for infant vaccination among the women across the different educational levels after the training. CONCLUSIONS Participatory learning improved the knowledge about, and support for infant vaccination among older women supervising child care in these urban slum communities. Similar training may be extended to comparable settings in order to improve demand for infant vaccination.
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Affiliation(s)
- Folusho Mubowale Balogun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,University College Hospital, Ibadan, Nigeria.
| | | | - Eniola Adetola Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Sarder A, Islam SMS, Maniruzzaman, Talukder A, Ahammed B. Prevalence of unintended pregnancy and its associated factors: Evidence from six south Asian countries. PLoS One 2021; 16:e0245923. [PMID: 33524018 PMCID: PMC7850499 DOI: 10.1371/journal.pone.0245923] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
AIM Unintended pregnancy is a significant public health concern in South Asian countries because of its negative association with the socioeconomic and health outcomes for both children and mothers. The present study aimed to explore the prevalence of unintended pregnancy and explore its determinants among women of reproductive age in six South Asian countries. METHODS Nationwide latest demography and health survey data from six South Asian countries, including Bangladesh (2014), Pakistan (2017-2018), Nepal (2016), Afghanistan (2015), Maldives (2016-2017) and India (2015-2016) were pooled for the present study. Multivariate analysis was performed to explore the association between unintended pregnancy and its associated factors. RESULTS Amongst the total women (n = 41,689), overall, 19.1% pregnancies were reported as unintended (ranging from 11.9% in India to 28.4% in Bangladesh). The logistic regression model showed that younger women (15-19 years) had 1.42 times higher chance of unintended pregnancies. The odds of unintended pregnancies was 1.24 times higher for poorest women and 1.19 times higher for poorer women. Further, urban women (aOR = 0.70, 95% CI = 0.50-0.80), women having no children (aOR = 0.10, 95% CI = 0.09-0.12), smaller (≤4) family (aOR = 0.72, 95% CI = 0.67-0.78), those who intent to use contraceptive (aOR = 0.72, 95% CI = 0.60-0.86), currently living with partner (aOR = 0.90, 95% CI = 0.81-0.99), first cohabitation in teenage (≤19 years) (aOR = 0.85, 95% CI = 0.78-0.92) were less likely to report unintended pregnancies. CONCLUSIONS This study has showed that women's age, wealth index, place of residence, number of children, family size, the intention of contraceptive use, living with a partner, and first cohabitation age are essential determinants of unintended pregnancy. These factors should be considered when trying to reduce unintended pregnancy in six South Asian countries. However, there is a need to improve health education, counselling, skills-building, sex education, modern contraceptive use and its access in this region. Intervention programs regarding reproductive health and policies are warranted to reduce rates of unintended pregnancy in South Asian countries.
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Affiliation(s)
- Alamgir Sarder
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Maniruzzaman
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Ashis Talukder
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
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Chilinda IT, Cooke A, Lavender DT. Experiences of women, men and healthcare workers accessing family planning services in Malawi: A grounded theory. S Afr Fam Pract (2004) 2020; 62:e1-e8. [PMID: 33054256 PMCID: PMC8378152 DOI: 10.4102/safp.v62i1.5153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/09/2022] Open
Abstract
Background The importance of modern contraceptive methods in averting unwanted pregnancies has been acknowledged in Malawi. Currently, the country has registered the highest rates of unsafe abortions, unmet needs for contraception and a low contraceptive prevalence rate. Understanding why these rates exist is important. However, women’s views and experiences regarding uptake of family planning methods in Malawi have not been explored. Methods A grounded theory methodology was used. Data were gathered through in-depth interviews with women (n = 18), men (n = 10), healthcare workers (n = 10) and non-participant observations of family planning clinic consultations (n = 10). Data were analysed using constant comparative technique. Methods of open, axial and selective coding enabled subsequent conceptualisations until theoretical saturation occurred. Results The core category ‘disenabling environment prevents women’s family planning needs from being met’ provides an understanding of women’s, men’s and healthcare workers’ experiences of contraceptive use and non-use. The disenabling environment contributed to shaping women’s family planning experiences. This was supported by three main categories: navigating the processes, disempowerment of women and learning by chance. Conclusion Findings from this study illuminate contextual issues into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman’s family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman’s family planning needs. At national level, laws that would empower women with decision-making ought to be developed and enforced.
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Adampah T, Angwa LM, Demuyakor A, Achinkok D, Boah M. Contraceptive use among women with a history of induced abortion: findings from a national sample of sexually active, non-pregnant women in Ghana. EUR J CONTRACEP REPR 2020; 25:394-401. [PMID: 32684009 DOI: 10.1080/13625187.2020.1795117] [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: 10/23/2022]
Abstract
OBJECTIVE The aim of the study was to examine the relationship between a history of induced abortion and current use of contraception among reproductive-aged women in Ghana. METHODS The analysed data were a weighted sample of 6544 sexually active, non-pregnant women aged 15-49 years, obtained from the 2014 Ghana Demographic and Health Survey. Survey logistic regression analysis was used to estimate the odds of currently using any contraception and of using a modern method of contraception, given a history of induced abortion in the period 2009-2014. RESULTS A history of induced abortion between 2009 and 2014 was reported by 17.4% of women (95% CI 16.0%, 18.9%); 28.7% (95% CI 26.9%, 30.6%) were currently using a method of contraception and 23.0% (95% CI 21.4%, 24.7%) were currently using a modern method of contraception. The majority (80.1%) of current contraceptive users were using a modern method. The adjusted analysis revealed no statistically significant association between a history of induced abortion and current contraceptive behaviour. Other factors were associated with modern contraceptive use. CONCLUSION Overall, the use of contraception among sexually active women in Ghana was found to be low. Our findings showed that women's experience of induced abortion was unlikely to influence their current use of modern contraception.
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Affiliation(s)
- Timothy Adampah
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Center for Education, Culture and Health Opportunities (ECHO) Research Group International, Aflao, Ghana
| | - Linet Musungu Angwa
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Department of Clinical Medicine, Kabarak University, Nakuru, Kenya
| | - Abigail Demuyakor
- Key Laboratory of Myocardial Ischemia, Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, China
| | - Dominic Achinkok
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Michael Boah
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Ghana Health Service, Bolgatanga, Ghana
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Akinyemi OO, Harris B, Kawonga M. 'Our culture prohibits some things': qualitative inquiry into how sociocultural context influences the scale-up of community-based injectable contraceptives in Nigeria. BMJ Open 2020; 10:e035311. [PMID: 32690506 PMCID: PMC7371132 DOI: 10.1136/bmjopen-2019-035311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria. DESIGN A qualitative study based on inductive thematic analysis was conducted through in-depth interviews and focus group discussions. SETTING Most participants lived in Gombe State, North-East Nigeria. Other participants were from Ibadan (South-West) and Abuja (Federal Capital Territory). PARTICIPANTS Through seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study. METHODS This study conducted in 2016 was part of a larger study on scale-up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method. RESULTS Sociocultural challenges to scale-up included patriarchy and men's fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are 'divine blessings' and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale-up process as active, although they also identified the scope for further involvement and recognition. CONCLUSION Scale-up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. Policy implementers should also see scale-up as a learning process and be willing to move at the speed of the community.
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Affiliation(s)
- Oluwaseun Oladapo Akinyemi
- Health Policy and Management, University of Ibadan College of Medicine, Ibadan, Oyo State, Nigeria
- Community Health, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Kawonga
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
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Ahinkorah BO, Hagan JE, Seidu AA, Sambah F, Adoboi F, Schack T, Budu E. Female adolescents' reproductive health decision-making capacity and contraceptive use in sub-Saharan Africa: What does the future hold? PLoS One 2020; 15:e0235601. [PMID: 32649697 PMCID: PMC7351194 DOI: 10.1371/journal.pone.0235601] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Given the social, economic, and health consequences of early parenthood, unintended pregnancy, and the risks of HIV infection and subsequent transmission, there is an urgent need to understand how adolescents make sexual and reproductive decisions regarding contraceptive use. This study sought to assess the association between female adolescents' reproductive health decision-making capacity and their contraceptive usage. MATERIALS AND METHODS Data was obtained from pooled current Demographic and Health Surveys (DHS) conducted in 32 countries in sub-Saharan Africa (SSA). The unit of analysis for this study was adolescents in sexual unions [n = 15,858]. Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. All analyses were performed using STATA version 14.2. Results were presented using Odds Ratios [OR] and adjusted Odds Ratios [AOR]. Statistical significance was set at p<0.05. RESULTS The results showed that 68.66% of adolescents in SSA had the capacity to make reproductive health decisions. The overall prevalence of contraceptive use was 18.87%, ranging from 1.84% in Chad to 45.75% in Zimbabwe. Adolescents who had the capacity to take reproductive health decisions had higher odds of using contraceptives [AOR = 1.47; CI = 1.31-1.65, p < 0.001]. The odds of contraceptive use among female adolescents increased with age, with those aged 19 years having the highest likelihood of using contraceptives [AOR = 3.12; CI = 2.27-34.29, p < 0.001]. Further, the higher the level of education, the more likely female adolescents will use contraceptives, and this was more predominant among those with secondary/higher education [AOR = 2.50; CI = 2.11-2.96, p < 0.001]. Female adolescents who were cohabiting had higher odds of using contraceptives, compared to those who were married [AOR = 1.69; CI = 1.47-1.95, p < 0.001]. The odds of contraceptive use was highest among female adolescents from the richest wealth quintile, compared to those from the poorest wealth quintile [AOR = 1.65; CI = 1.35-2.01, p<0.001]. Conversely, female adolescents in rural areas were less likely to use contraceptives, compared to those in urban areas [AOR = 0.78; CI = 0.69-0.89, p < 0.001]. CONCLUSION The use of general and modern contraceptives among adolescents in SSA remains low. Therefore, there is a need to strengthen existing efforts on contraceptives usage among adolescents in SSA. This goal can be achieved by empowering these young females, particularly those in the rural areas where the level of literacy is very low to take positive reproductive health decisions to prevent unintended teenage pregnancy, HIV/AIDs and other sexually transmitted infections. This approach would help reduce maternal mortality and early childbirth in studied SSA countries.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research [ACPPHR], Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- * E-mail:
| | - Francis Sambah
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Mejía-Guevara I, Cislaghi B, Weber A, Hallgren E, Meausoone V, Cullen MR, Darmstadt GL. Association of collective attitudes and contraceptive practice in nine sub-Saharan African countries. J Glob Health 2020; 10:010705. [PMID: 32257163 PMCID: PMC7101087 DOI: 10.7189/jogh.10.010705] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is ample evidence that gender norms affect contraceptive practice; however, data are mostly qualitative with limited geographical scope. We investigated that association quantitatively using collective community-level attitudes towards premarital sex and wife-beating as proxies for gender norms. METHODS Data came from nationally representative Demographic and Health Surveys (2005-2009) for women of reproductive age (15-49 years) in nine sub-Saharan African countries. Using multilevel logistic models, controlling for individual covariates and community-level indicators of women's empowerment, we assessed the community-level association of gender norms regarding premarital sex and wife-beating with individual contraception uptake and demand satisfied among fecund sexually active women. Norms were approximated as 'collective attitudinal norms' from female/male residents (aged 15-49 years) from the same community. We assessed the magnitude and significance of the community-level effects and attributed variance across communities. The same analysis was replicated for each country. RESULTS In a fully-adjusted model with a pooled sample of 24 404 adolescent women, the odds of contraception use increased with a 1 standard deviation (SD) increase in the variation of collective permissive attitudes towards premarital sex of female (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.02-1.15) and male (OR = 1.11, 95% CI = 1.05-1.17) peers (15-24 years), while odds of contraceptive use declined by 10% (OR = 0.90, 95% CI = 0.85-0.96) with collective accepting attitudes towards wife-beating of women aged 15-49 years. Similar results were found in separate models that controlled for adults' permissive attitudes towards premarital sex. The community-level attributed variance (V2 = 1.62, 95% CI = 1.45-1.80) represented 33% (intra-class correlation (ICC) = 33.0, 95% CI = 30.0-35.4) of the total variation of contraception use, and attitudes towards premarital sex and violence jointly explained nearly 26% of that V2 variance. The community-level shared of attributed variation of contraceptive use varied significantly across countries, from 3.5% in Swaziland (ICC = 3.5, 95% CI = 0.8-13.7) to 60.2% in Nigeria (OR = 60.2, 95% CI = 56.0-64.2). CONCLUSIONS Overall, significant positive associations of collective permissive attitudes of both adolescent and adult women towards premarital sex were found for use of, and demand for, contraception, whereas collective accepting attitudes towards wife-beating were negatively associated with the use and demand for contraception. Ours is the first study to define quantitatively the influence of proxies for gender norms at the community level on women's family planning decisions. These findings offer new insights for understanding the role of sex-related attitudes and norms as important factors in shaping contraceptive practices and improving the effectiveness of family planning policies by targeting individuals as well as their groups of influence.
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Affiliation(s)
- Iván Mejía-Guevara
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Biology, Stanford University, Palo Alto, California, USA
| | | | - Ann Weber
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | - Emma Hallgren
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Valerie Meausoone
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gary L Darmstadt
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu JB, Rafanoharana RV, Spilotros N. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLoS Med 2020; 17:e1003086. [PMID: 32231356 PMCID: PMC7108687 DOI: 10.1371/journal.pmed.1003086] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adolescent girls in humanitarian settings are especially vulnerable as their support systems are often disrupted. More than 20 years of violence in the Democratic Republic of the Congo (DRC) has weakened the health system, resulting in poor sexual and reproductive health (SRH) outcomes for women. Little evidence on adolescent contraceptive use in humanitarian settings is available. CARE, International Rescue Committee (IRC), and Save the Children, in collaboration with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Columbia University, have supported the Ministry of Health (MOH) since 2011 to provide good quality contraceptive services in public health facilities in conflict-affected North and South Kivu. In this study, we analyzed contraceptive use among sexually active young women aged 15-24 in the health zones served by the partners' programs. METHODS AND FINDINGS The partners conducted cross-sectional population-based surveys in program areas of North and South Kivu using two-stage cluster sampling in six health zones in July-August 2016 and 2017. Twenty-five clusters were selected in each health zone, 22 households in each cluster, and one woman of reproductive age (15-49 years) was randomly selected in each household. This manuscript presents results from a secondary data analysis for 1,022 women aged 15-24 who reported ever having sex: 326 adolescents (15-19 years) and 696 young women (20-24 years), 31.7% (95% confidence interval [CI] 29.5-34.1), of whom were displaced at least once in the previous five years. Contraceptive knowledge was high, with over 90% of both groups able to name at least one modern contraceptive method. Despite this high knowledge, unmet need for contraception was also high: 31.7% (95%CI 27.9-35.7) among 15-19-year-olds and 40.1% (95% CI 37.1-43.1, p = 0.001) among 20-24-year-olds. Current modern contraceptive use (16.5%, 95% CI 14.7-18.4) was similar in both age groups, the majority of whom received their method from a supported health facility. Among current users, more than half of 15-19-year-olds were using a long-acting reversible contraceptive (LARC; 51.7%, 95% CI 41.1-61.9) compared to 36.5% of 20-24-year-olds (95% CI 29.6-43.9, p = 0.02). Age, younger age of sexual debut, having some secondary education, being unmarried, and having begun childbearing were associated with modern contraceptive use. The main limitations of our study are related to insecurity in three health zones that prevented access to some villages, reducing the representativeness of our data, and our defining sexually active women as those who have ever had sex. CONCLUSIONS In this study, to our knowledge one of the first to measure contraceptive prevalence among adolescents in a humanitarian setting, we observed that adolescent and young women will use modern contraception, including long-acting methods. Meaningful engagement of adolescent and young women would likely contribute to even better outcomes. Creating an enabling environment by addressing gender and social norms, however, is key to reducing stigma and meeting the demand for contraception of young women. As we continue to build such supportive environments, we can see that they will use effective contraception when contraceptive services, including short- and long-acting methods, are available, even in protracted crisis settings.
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Affiliation(s)
- Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | | | - Jessica Kakesa
- International Rescue Committee, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Nathaly Spilotros
- International Rescue Committee, New York, New York, United States of America
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Soriano-Moreno DR, Soriano-Moreno AN, Mejia-Bustamante A, Guerrero-Ramirez CA, Toro-Huamanchumo CJ. Factors associated with highly effective contraceptive use among reproductive-age women in Peru: Evidence from a nationwide survey. Eur J Obstet Gynecol Reprod Biol 2020; 245:114-120. [PMID: 31891894 DOI: 10.1016/j.ejogrb.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to assess the factors associated with highly effective contraceptive (HEC) use among reproductive-age women in Peru, using evidence from a nationwide survey. STUDY DESIGN We analyzed the data corresponding to a national representative sample of 30,169 Peruvian women aged 15-49 years, surveyed during the Demographic and Family Health Survey, 2017. Usage of HEC methods included pills, IUD, injections, sterilization and implant. We assessed the factors associated with its use using Poisson regression models, reporting the crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95 % confidence intervals (95 % CI). RESULTS The prevalence of HEC use was 29.9 %. Factors related to a more likely use of HEC methods were having one (aPR: 4.03; 95 % CI: 3.19-5.09) or more children (aPR: 5.60; 95 % CI: 4.42-7.09), and having a health insurance children (aPR: 1.14; 95 % CI: 1.05-1.24). Women from the highlands (aPR: 0.74; 95 % CI: 0.67-0.81), aged ≥35 years (aPR: 0.78; 95 % CI: 0.67-0.90), not currently married or cohabiting (aPR: 0.52; 95 % CI: 0.47-0.58), and who considered it really hard to have to take transportation when they need medical help or advice (aPR: 0.92; 95 % CI: 0.86-0.99) were less likely to use highly effective contraception. CONCLUSION Quality and access to reproductive health is still a challenge in Peru. Family planning programs should be better disseminated and integrated. Similarly, promotion of educational campaigns and easy access to HEC methods are needed.
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Affiliation(s)
| | | | | | | | - Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru; Association for the Study of Medical Education, Edinburgh, UK.
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Mpunga-Mukendi D, Mukalenge Chenge F, Ali Mapatano M, Nyangi Mondo Mambu T, Utshudienyema Wembodinga G. Assessing Comprehensive Sexuality Education Programs in the Democratic Republic of the Congo: Adolescents’ and Teachers’ Knowledge, Attitudes and Practices towards Contraception. Health (London) 2020. [DOI: 10.4236/health.2020.1211104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ameyaw EK, Budu E, Sambah F, Baatiema L, Appiah F, Seidu AA, Ahinkorah BO. Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: A multi-country analysis of demographic and health surveys. PLoS One 2019; 14:e0220970. [PMID: 31398240 PMCID: PMC6688809 DOI: 10.1371/journal.pone.0220970] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Approximately 14 million unintended pregnancies are recorded annually in sub-Saharan Africa (SSA). We sought to investigate the prevalence and determinants of unintended pregnancies among women in sub-Saharan Africa. MATERIALS AND METHODS The study pooled data from current Demographic and Health Surveys (DHS) conducted from January 1, 2010 to December 31, 2016 from 29 countries in SSA. Logistic regression analysis was used to examine the factors that influence unintended pregnancies in SSA. Results were presented using odds ratios (OR). RESULTS We found overall unintended pregnancy prevalence rate of 29%, ranging from 10.8% in Nigeria to 54.5% in Namibia. As compared to women aged 15-19 years, women of all other age categories had higher odds of unintended pregnancies. Married women were 6 times more probable to report unintended pregnancy as compared to women who had never married (OR = 6.29, CI = 5.65-7.01). The phenomenon had higher odds among rural residents as compared to urban residents (OR = 1.08, CI = 1.01-1.16). Women with primary (OR = 0.74, CI = 0.69-0.80) and secondary (OR = 0.71, CI = 0.65-0.77) levels of education had less chances of unintended pregnancies, compared to those with no education. Again, women in all other wealth categories had less probability of unintended pregnancy, as compared to women with poorest wealth status. CONCLUSION Our study contributes substantially towards the discourse of maternal wellbeing by unveiling the prevalence and determinants of unintended pregnancy across the SSA region. There is the need for SSA countries with high prevalence of unintended pregnancies to consider past and present successful interventions of other countries within the region such as health education, counselling, skills-building, comprehensive sex education and access to contraception. Much of these efforts rest with the governments of SSA countries.
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Affiliation(s)
- Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Francis Sambah
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Linus Baatiema
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Francis Appiah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Casey SE, Gallagher MC, Dumas EF, Kakesa J, Katsongo JM, Muselemu JB. Meeting the demand of women affected by ongoing crisis: Increasing contraceptive prevalence in North and South Kivu, Democratic Republic of the Congo. PLoS One 2019; 14:e0219990. [PMID: 31323055 PMCID: PMC6641211 DOI: 10.1371/journal.pone.0219990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/04/2019] [Indexed: 12/04/2022] Open
Abstract
Context Over 20 years of conflict in the DRC, North and South Kivu have experienced cycles of stability and conflict, resulting in a compromised health system and poor sexual and reproductive health outcomes. Modern contraceptive use is low (7.5%) and maternal mortality is high (846 deaths per 100,000 live births). Program partners have supported the Ministry of Health (MOH) in North and South Kivu to provide good quality contraceptive services in public health facilities since 2011. Methods Cross-sectional population-based surveys were conducted in the program areas using a two-stage cluster sampling design to ensure representation in each of six rural health zones. Using MOH population estimates for villages in the catchment areas of supported health facilities, 25 clusters in each zone were selected using probability proportional to size. Within each cluster, 22 households were systematically selected, and one woman of reproductive age (15–49 years) was randomly selected from all eligible women in each household. Results Modern contraceptive prevalence among women in union ranged from 8.4% to 26.7% in the six health zones; current use of long-acting or permanent method (LAPM) ranged from 2.5% to 19.8%. The majority of women (58.9% to 90.2%) reported receiving their current method for the first time at a health facility supported by the program partners. Over half of women in four health zones reported wanting to continue their method for five years or longer. Conclusion Current modern contraceptive use and LAPM use were high in these six health zones compared to DRC Demographic and Health Survey data nationally and provincially. These results were accomplished across all six health zones despite their varied socio-demographic characteristics and different experiences of conflict and displacement. These findings demonstrate that women in these conflict-affected areas want contraception and will choose to use it when good quality services are available to them.
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Affiliation(s)
- Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | | | | | - Jessica Kakesa
- International Rescue Committee, Kinshasa, Democratic Republic of the Congo
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Costenbader E, Zissette S, Martinez A, LeMasters K, Dagadu NA, Deepan P, Shaw B. Getting to intent: Are social norms influencing intentions to use modern contraception in the DRC? PLoS One 2019; 14:e0219617. [PMID: 31310641 PMCID: PMC6634398 DOI: 10.1371/journal.pone.0219617] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/27/2019] [Indexed: 12/02/2022] Open
Abstract
Meeting the reproductive health needs of women in post-conflict settings is a global health priority. In the Democratic Republic of the Congo, social norms perpetuate gender-based violence and contribute to low contraceptive use and high fertility. The Masculinité, Famille, et Foi (MFF) intervention is working with communities in Kinshasa to create normative environments supportive of modern contraception access and use. Our analysis uses survey data collected from 900 men and women in 17 community groups prior to the MFF intervention. We aimed to measure the extent to which social norms influence intentions to use modern contraception. Using multiple items to assess social norms and reference groups related to family planning and gender equity, we identified four distinct social norms constructs through factor analysis. Through structural equation modeling, we found that social norms influence intentions to use modern contraception overall, but that normative influence varies by gender.
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Affiliation(s)
| | | | | | - Katherine LeMasters
- FHI 360, Durham, NC, United States of America
- University of North Carolina Gillings School of Public Health, Chapel Hill, NC, United States of America
| | - Nana Apenem Dagadu
- Institute of Reproductive Health at Georgetown University, Washington, DC, United States of America
| | | | - Bryan Shaw
- Institute of Reproductive Health at Georgetown University, Washington, DC, United States of America
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Steven VJ, Deitch J, Dumas EF, Gallagher MC, Nzau J, Paluku A, Casey SE. "Provide care for everyone please": engaging community leaders as sexual and reproductive health advocates in North and South Kivu, Democratic Republic of the Congo. Reprod Health 2019; 16:98. [PMID: 31286984 PMCID: PMC6615084 DOI: 10.1186/s12978-019-0764-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 06/30/2019] [Indexed: 11/28/2022] Open
Abstract
Background Inadequate infrastructure, security threats from ongoing armed conflict, and conservative socio-cultural and gender norms that favour large families and patriarchal power structures contribute to poor sexual and reproductive health (SRH) outcomes in North and South Kivu provinces, Democratic Republic of the Congo (DRC). In order to expand contraceptive and post-abortion care (PAC) access in North and South Kivu, CARE, the International Rescue Committee and Save the Children provided technical support to the Ministry of Health and health facilities in these regions. Partners acknowledged that community leaders, given their power to influence local customs, could play a critical role as agents of change in addressing inequitable gender norms, stigma surrounding SRH service utilization, and topics traditionally considered taboo within Congolese society. As such, partners actively engaged with community leaders through a variety of activities such as community mapping exercises, values clarification and transformation (VCAT) activities, situational analyses, and education. Methods This manuscript presents findings from 12 key informant interviews (KIIs) with male political and non-political community leaders conducted in six rural health zones of North and South Kivu, DRC. Transcripts were analysed thematically to explore community leaders’ perceptions of their role in addressing the issue of unintended pregnancy in their communities. Results While community leaders in this study expressed overall positive impressions of contraception and strong support for ensuring access to PAC services following spontaneous and induced abortions, the vast majority held negative beliefs concerning women who had induced abortion. Contrasting with their professed opposition to induced abortion, leaders’ commitment to mediating interpersonal conflict arising between community members and women who had abortions was overwhelming. Conclusion Results from this study suggest that when thoughtfully engaged by health interventions, community leaders can be empowered to become advocates for SRH. While study participants were strong supporters of contraception and PAC, they expressed negative perceptions of induced abortion. Given the hypothesized link between the presence of induced abortion stigma and care-avoidance behavior, further engagement and values clarification exercises with leaders must be integrated into community mobilization and engagement activities in order to increase PAC utilization.
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Affiliation(s)
- Victoria J Steven
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B2, New York, NY, 10032, USA
| | - Julianne Deitch
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B2, New York, NY, 10032, USA
| | | | - Meghan C Gallagher
- Save the Children, 899 North Capitol Street, Suite 900, Washington, DC, 20002, USA
| | - Jimmy Nzau
- CARE USA, 151 Ellis St NE, Atlanta, GA, 30303, USA
| | - Augustin Paluku
- International Rescue Committee, 63, Ave Colonel Mondjiba, Kinshasa, Democratic Republic of the Congo
| | - Sara E Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B2, New York, NY, 10032, USA.
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Ingabire R, Mukamuyango J, Nyombayire J, Easter SR, Parker R, Mazzei A, Sinabamenye R, Tichacek A, Allen S, Karita E, Wall KM. Development and Uptake of Long-Acting Reversible Contraception Services in Rwanda, 2009-2016. J Womens Health (Larchmt) 2019; 28:1640-1649. [PMID: 31274397 DOI: 10.1089/jwh.2018.7423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Long-acting reversible contraception (LARC) is highly effective at preventing pregnancy. However, in sub-Saharan Africa, LARC education for clients is relatively limited and providers are often not skilled in their insertion. Before 2009, only 1% of family planning clients in Rwanda received an LARC. Materials and Methods: We trained Rwandan government clinic nurses to promote, insert, and remove copper intrauterine devices (IUDs) and hormonal implants. Training started in two large urban clinics, and those nurses trained three successive waves of clinic nurses. Initial LARC promotions were clinic based, but in 2015 included community-based promotions in eight clinics. We compare IUD and implant insertions by year and clinic and discuss implementation successes/obstacles. Results: From 2009 to 2016, 222 nurses from 21 government clinics were LARC trained. The nurses performed 36,588 LARC insertions (19% IUD, 81% implant). LARC insertions increased over time, peaking at 8,897 in 2013. However, in 2014, the number dropped to 4,018 after closure of one large clinic, funding discontinuation, and supply stock-outs. With new funding in 2015, insertions increased reaching 8,218 in 2016. Catholic and non-Catholic and rural and urban clinics performed similarly, whereas clinics affiliated with community-based promotions performed better (p > 0.05). Between 2012 and 2014, 13% of family planning initiators chose the implant and 4% the IUD. Conclusions: LARC supply-demand services increased the proportion of family planning initiators choosing LARC to 17%. Challenges included inconsistent funding, irregular supplies, and staff turnover. Rural and Catholic clinics performed as well as urban and non-Catholic clinics. Concerted efforts to improve IUD uptake are needed.
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Affiliation(s)
- Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Jeannine Mukamuyango
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amelia Mazzei
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Robertine Sinabamenye
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Kristin M Wall
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda.,Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia
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Zivich PN, Kawende B, Lapika B, Behets F, Yotebieng M. Effect of Family Planning Counseling After Delivery on Contraceptive Use at 24 Weeks Postpartum in Kinshasa, Democratic Republic of Congo. Matern Child Health J 2019; 23:530-537. [PMID: 30565015 DOI: 10.1007/s10995-018-2667-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Unintended pregnancy during the postpartum period is common. The aim of this study was to describe contraceptive use among postpartum women and assess whether family planning counseling offered by health care providers during well-baby clinic visits increased use of modern contraceptive methods at 6 months following delivery. Methods Data comes from a cohort of women enrolled in a breastfeeding promotion trial in Kinshasa, Democratic Republic of Congo who reported being sexually active at 24-weeks post-partum. Modern contraceptive methods included intrauterine devices, injectables, implants, and contraception pills. Logistic regression models were used to estimate odd ratios (OR) and 95% confidence intervals (CI) for the impact of nurse counseling on use of modern birth control methods. Results Of 522 participants who reported being sexually active, 251 (48.0%) reported doing at least one thing to avoid pregnancy and were included in this analysis. Of these 251, 14.3% were using a modern contraceptive method, despite availability at the clinic. Discussion with a nurse about family planning was associated with increased odds of using modern birth control relative to other methods (OR 4.0, 95% CI 1.9, 8.6). Discussion Discussion of family planning with a nurse increased the odds of using a modern contraceptive among postpartum women. Integration of family planning counseling into postpartum services offers a potential avenue to increase modern contraceptive use among women with access.
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Affiliation(s)
- Paul N Zivich
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg, CB #7435, Chapel Hill, NC, 27599, USA.
| | - Bienvenu Kawende
- School of Public Health, The University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Bruno Lapika
- Department of Anthropology, The University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Frieda Behets
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marcel Yotebieng
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Adedze M, Osei-Yeboah R. Underuse of modern contraception in sub-Saharan Africa: are there implications for sustainable development and climate change? A review of the literature. EUR J CONTRACEP REPR 2019; 24:314-318. [DOI: 10.1080/13625187.2019.1618448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Miranda Adedze
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard Osei-Yeboah
- Division of Computational Biology, Faculty of Health Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Anglewicz P, Akilimali P, Eitmann LP, Hernandez J, Kayembe P. The relationship between interviewer-respondent familiarity and family planning outcomes in the Democratic Republic of Congo: a repeat cross-sectional analysis. BMJ Open 2019; 9:e023069. [PMID: 30670510 PMCID: PMC6348299 DOI: 10.1136/bmjopen-2018-023069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected family planning outcomes, and whether this relationship changes over time between 2015 and 2016. SETTING We use data from the Performance Monitoring and Accountability 2020 Project in Kongo Central Province, Democratic Republic of Congo. PARTICIPANTS Participants include representative samples of women of reproductive ages (15 to 49), 1565 interviewed in 2015 and 1668 in 2016. The study used a two-stage cluster design: first randomly selecting enumeration areas (EAs), then randomly selecting households within each EA. DESIGN We first identify individual characteristics associated with familiarity between RE and respondent. Next, we examine the relationship between RE-respondent acquaintance and family planning outcomes. Finally, we use two waves of data to examine whether this relationship changes over time between 2015 and 2016. RESULTS In multivariate analysis, interviewer-respondent acquaintance is significantly associated with last birth unintended (OR 1.91, 95% CI 1.17 to 3.13) and reported infertility in 2015 (OR 2.26, 95% CI 1.03 to 4.95); and any contraceptive use (OR 1.51, 95% CI 1.01 to 2.28), traditional contraceptive use (OR 1.79, 95% CI 1.10 to 2.89), reported infidelity (OR 1.89, 95% CI 1.02 to 3.49) and age at first sex (coefficient -0.48, 95% CI -0.96 to -0.01) in 2016. The impact of acquaintance on survey responses changed over time for any contraceptive use (OR 2.09, 95% CI 1.33 to 3.30). CONCLUSIONS The standard in many large-scale surveys is to use interviewers from outside the community. Our results show that interviewer-respondent acquaintance is associated with a range of family planning outcomes; therefore, we recommend that the approach to hiring interviewers be examined and reconsidered in survey data collection efforts.
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Affiliation(s)
- Philip Anglewicz
- Department of Global Community Health and Behavioral Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Pierre Akilimali
- Faculty of Medicine, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Linnea Perry Eitmann
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Julie Hernandez
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Patrick Kayembe
- Division of Epidemiology and Biostatistics School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Wallace HJ, McDonald S, Belton S, Miranda AI, da Costa E, da Conceicao Matos L, Henderson H, Taft A. What influences a woman's decision to access contraception in Timor-Leste? Perceptions from Timorese women and men. CULTURE, HEALTH & SEXUALITY 2018; 20:1317-1332. [PMID: 29508638 DOI: 10.1080/13691058.2018.1433330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
Timor-Leste's Maternal Mortality Ratio remains one of the highest in Asia. There is ample evidence that maternal deaths may be reduced substantially through the provision of good-quality modern methods of contraception. Many Timorese women wish to stop or delay having children. However, even when health services make contraception available, it does not mean that people will use it. Collaborating with Marie Stopes Timor-Leste, this qualitative research project used decolonising methodology to explore perceived influences contributing to contraceptive choices, and gain insight into how women's decisions to access contraception in Timor-Leste occur. Over two fieldwork periods (2013 and 2015), we used focus group discussions and structured interviews to speak with 68 women and 80 men, aged 18-49 years, across four districts of Timor-Leste. Findings demonstrate that the decision to access contraception is often contentious and complicated. These tensions echo concerns and ambiguities contained within global and national reproductive health policy. Overwhelmingly, participants emphasised that despite her wishes, a woman can only rarely exercise her right to access contraception freely and independently. She is most often constrained by family, cultural, traditional and educational influences.
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Affiliation(s)
- Heather Julie Wallace
- a School of Nursing and Midwifery , Judith Lumley Centre, La Trobe University , Melbourne , Australia
| | - Susan McDonald
- a School of Nursing and Midwifery , Judith Lumley Centre, La Trobe University , Melbourne , Australia
| | - Suzanne Belton
- b Menzies Institute of Health Research , Darwin , Australia
| | | | | | | | | | - Angela Taft
- a School of Nursing and Midwifery , Judith Lumley Centre, La Trobe University , Melbourne , Australia
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Mulumeoderhwa M. 'It's not good to eat a candy in a wrapper': male students' perspectives on condom use and concurrent sexual partnerships in the eastern Democratic Republic of Congo. SAHARA J 2018; 15:89-102. [PMID: 30149788 PMCID: PMC6116706 DOI: 10.1080/17290376.2018.1516160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper reports on fieldwork carried out in 2011 with aim to investigate young men's perspectives about condoms use, concurrent sexual partnerships and sex in the context of HIV/AIDS. This study employed a qualitative approach to collect data from 28 boys aged 16-20 from two urban and two rural high schools in South Kivu province. Four focus group discussions and 20 individual interviews were conducted among them. The findings showed that most students identified condoms as unsafe and untrustworthy. Reasons given for the mistrust of condoms were related to the belief that condoms do not give enough protection from Sexually Transmitted Infections, HIV and pregnancies. Most participants believe that condoms have a 'small hole' or are unreliable and are therefore not effective in prevention. They also mentioned that condoms encourage inappropriate sexual activity. They prefer flesh-to-flesh sex rather than protected sex using a condom. However, a few participants acknowledged the importance of condom use. Despite the risk of HIV transmission, boys believe that it is appropriate for them to have concurrent sexual partnerships. They justified the concurrent sexual partnerships as a way of ensuring that they cannot miss a girl to satisfy their sexual desire. Given the boys' failure to use condoms and their strong inclination to concurrent sexual partnerships, there is a need for heath groups and stakeholders within the area to increase awareness about condoms' effectiveness and improve knowledge dissemination on Sexually Transmitted Diseases and how they are prevented.
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Affiliation(s)
- Maroyi Mulumeoderhwa
- Faculty of Top Management, Institute for Reconciliation and Social Justice, University of the Free State, Bloemfontein, South Africa
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McClendon KA, McDougal L, Ayyaluru S, Belayneh Y, Sinha A, Silverman JG, Raj A. Intersections of girl child marriage and family planning beliefs and use: qualitative findings from Ethiopia and India. CULTURE, HEALTH & SEXUALITY 2018; 20:799-814. [PMID: 29043910 DOI: 10.1080/13691058.2017.1383513] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Child marriage and subsequent early first birth is a considerable social, economic and health concern, and a pervasive practice in sub-Saharan Africa and South Asia. This study explores barriers and facilitators to family planning among women and girls, and their marital decision-makers subsequent to receipt of child marriage prevention programmes in Ethiopia and India. In-depth interviews with 128 women and girls who were married as minors or who cancelled or postponed marriage as minors and their marital decision-makers were analysed using content analysis. Respondents identified social norms, including child marriage and pressure to have children, and lack of information as barriers to family planning. Benefits included delayed first birth and increased birth spacing, improved maternal and child health and girls' educational attainment. Respondents associated family planning use with delayed pregnancy and increased educational attainment, particularly in Ethiopia. Child marriage prevention programmes were identified as important sources of family planning information. Ethiopia's school-based programme strengthened access to health workers and contraception more so than India's community-based programme. Findings highlight young wives' vulnerability with regard to reproductive control, and support the need for multi-sector approaches across communities, schools and community health workers to improve family planning among young wives.
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Affiliation(s)
- Katherine A McClendon
- a Center on Gender Equity and Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Lotus McDougal
- a Center on Gender Equity and Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Sankari Ayyaluru
- a Center on Gender Equity and Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Yemeserach Belayneh
- b Population and Reproductive Health Program , David and Lucile Packard Foundation , Addis Ababa , Ethiopia
| | - Anand Sinha
- c Population and Reproductive Health Program , David and Lucile Packard Foundation , New Delhi , India
| | - Jay G Silverman
- a Center on Gender Equity and Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Anita Raj
- a Center on Gender Equity and Health, Department of Medicine , University of California , San Diego , CA , USA
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Mbadu Muanda F, Gahungu NP, Wood F, Bertrand JT. Attitudes toward sexual and reproductive health among adolescents and young people in urban and rural DR Congo. Reprod Health 2018; 15:74. [PMID: 29728101 PMCID: PMC5935981 DOI: 10.1186/s12978-018-0517-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background In the Democratic Republic of Congo (DRC), onset of sexual intercourse is initiated during adolescence, however only two in ten sexually active unmarried women are using modern contraception. Improving adolescents’ and young peoples’ knowledge and practices related to sexual and reproductive health (SRH) is necessary to improve health outcomes. However, little is known about the SRH attitudes and needs among young people in the DRC. The study aims to contribute to the available evidence by examining adolescents’ and young people’s insights on their cultural norms, practices and attitudes towards SRH services. Methods Fourteen focus group discussions were conducted with a total of 224 adolescents and young people aged 15–24 years in urban and rural areas of the DRC. The topics discussed and age groups of participants differed somewhat in the urban and rural areas. Data were analyzed to identify themes in the participants’ discussion of their attitudes towards SRH. Results Regardless of age differences, common themes emerged. Both in rural and urban areas premarital sex was largely sanctioned by peers but not adults; adolescents feared pregnancy and had limited knowledge of contraceptive methods. Many were misinformed that certain common pharmaceutical products (e.g., decaris) prevent pregnancy. Key barriers to accessing contraception from health facilities and pharmacies included shame and stigma; urban participants also cited cost and judgmental attitudes of health providers. Conclusion Addressing the SRH needs of adolescents and young people can have life-long protective benefits. Increasingly decision-makers and gatekeepers in the DRC are accepting the concept of providing SRH services and information to young people. This study shows the pressing need for information and services for young people in both urban and rural areas. The continued expansion SRH programming to all health zones and the developed of the National Strategic Plan for Health and Wellbeing of Adolescents and Youth 2016–2020 are steps toward that goal.
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Affiliation(s)
- Fidèle Mbadu Muanda
- Programme National de Santé de la Reproduction (National Program for Reproductive Health) and Programme National de Santé de l'Adolescent (National Program for Adolescent Health), Ministry of Health, Avenue des Cliniques n 43/cliniques kinoises, Commune de la Gombe, Kinshasa, Democratic Republic of Congo
| | - Ndongo Parfait Gahungu
- L'Institut Supérieur de Dévéloppement Rural, Avenue des Cliniques n 43/cliniques kinoises, Commune de la Gombe, Kinshasa, Democratic Republic of Congo
| | - Francine Wood
- Department of Global Community Health and Behavioral Sciences, Tulane University School Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Jane T Bertrand
- Department of Global Health Management and Policy, Tulane University School Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA.
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Kwete D, Binanga A, Mukaba T, Nemuandjare T, Mbadu MF, Kyungu MT, Sutton P, Bertrand JT. Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:40-54. [PMID: 29602865 PMCID: PMC5878077 DOI: 10.9745/ghsp-d-17-00346] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
Abstract
Momentum for family planning in the Democratic Republic of the Congo (DRC) is evident in multiple ways: strong political will, increasing donor support, a growing number of implementing organizations, innovative family planning programming, and a cohesive family planning stakeholder group. Between 2013 and 2017, the modern contraceptive prevalence rate (mCPR) in the capital city of Kinshasa increased from 18.5% to 26.7% among married women, but as of 2013-14, it was only 7.8% at the national level. The National Multisectoral Strategic Plan for Family Planning: 2014-2020 calls for achieving an mCPR of 19.0% by 2020, an ambitious goal in light of formidable challenges to family planning in the DRC. Of the 16,465 health facilities reporting to the national health information system in 2017, only 40% offer family planning services. Key challenges include uncertainty over the political situation, difficulties of ensuring access to family planning services in a vast country with a weak transportation infrastructure, funding shortfalls for procuring adequate quantities of contraceptives, weak contraceptive logistics and supply chain management, strong cultural norms that favor large families, and low capacity of the population to pay for contraceptive services. This article describes promising initiatives designed to address these barriers, consistent with the World Health Organization's framework for health systems strengthening. For example, the national family planning coordinating mechanism is being replicated at the provincial level to oversee the expansion of family planning service delivery. Promising initiatives are being implemented to improve the supply and quality of services and generate demand for family planning, including social marketing of subsidized contraceptives at both traditional and non-traditional channels and strengthening of services in military health facilities. To expand contraceptive access, family planning is being institutionalized in nursing schools, allowing students to operate as community-based distributors. While major challenges remain, significant progress in family planning has been made in the DRC, which should be judged not in comparison with sub-Saharan African countries with high mCPR and mature programs, but rather with those starting from much further behind.
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Affiliation(s)
- Dieudonné Kwete
- Government of the Democratic Republic of the Congo (DRC), Advisor to the Prime Minister, Kinshasa, DRC
| | | | - Thibaut Mukaba
- United States Agency for International Development/DRC, Kinshasa, DRC
| | | | - Muanda Fidele Mbadu
- Programme National de Santé de l'Adolescent, Ministry of Health, Kinshasa, DRC
| | | | - Perri Sutton
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Sano Y, Antabe R, Atuoye KN, Braimah JA, Galaa SZ, Luginaah I. Married women's autonomy and post-delivery modern contraceptive use in the Democratic Republic of Congo. BMC WOMENS HEALTH 2018. [PMID: 29530032 PMCID: PMC5848529 DOI: 10.1186/s12905-018-0540-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although use of modern contraception is considered beneficial in lowering maternal and child mortality rates, the prevalence of contraceptive use remains low in the Democratic Republic of Congo. This study examined modern contraceptive use and its linkage to women's autonomy. METHODS Data were drawn from the 2013-2014 Democratic Republic of Congo Demographic and Health Survey. We selected unsterilized and non-pregnant married women who have given birth in the last three years (N = 6680). Logistic regression models were fitted to explore the relationship between women's autonomy and modern contraceptive use. RESULTS The study found that only 7.1% of married women who had delivered within three years used modern contraceptive methods. After controlling for socioeconomic and demographic factors, the association between women's autonomy and modern contraceptive use remained positively significant (OR = 1.16; 95% CI = 1.05, 1.29). CONCLUSION The findings from this study indicate that it is not enough to provide women with educational and employment opportunities to increase the uptake of modern contraception, but also to enhance women's assertiveness to make their own decisions regardless of their partners' preferences within household settings. It is critical for government and other stakeholders to roll out programs aimed at reducing gender inequality and improving women's autonomy in decision-making about reproductive health.
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Affiliation(s)
- Yuji Sano
- Department of Sociology, Western University, London, ON, Canada
| | - Roger Antabe
- Department of Geography, Western University, London, ON, Canada
| | | | | | - Sylvester Z Galaa
- Department of Social, Political and Historical Studies, Faculty of Integrated Development Studies, University for Development Studies, Tamale, Ghana.
| | - Isaac Luginaah
- Department of Geography, Western University, London, ON, Canada
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