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Aitken RJ. What is driving the global decline of human fertility? Need for a multidisciplinary approach to the underlying mechanisms. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1364352. [PMID: 38726051 PMCID: PMC11079147 DOI: 10.3389/frph.2024.1364352] [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: 02/01/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
An intense period of human population expansion over the past 250 years is about to cease. Total fertility rates are falling dramatically all over the world such that highly industrialized nations, including China and the tiger economies of SE Asia, will see their populations decline significantly in the coming decades. The socioeconomic, geopolitical and environmental ramifications of this change are considerable and invite a multidisciplinary consideration of the underlying mechanisms. In the short-term, socioeconomic factors, particularly urbanization and delayed childbearing are powerful drivers of reduced fertility. In parallel, lifestyle factors such as obesity and the presence of numerous reproductive toxicants in the environment, including air-borne pollutants, nanoplastics and electromagnetic radiation, are seriously compromising reproductive health. In the longer term, it is hypothesized that the reduction in family size that accompanies the demographic transition will decrease selection pressure on high fertility genes leading to a progressive loss of human fecundity. Paradoxically, the uptake of assisted reproductive technologies at scale, may also contribute to such fecundity loss by encouraging the retention of poor fertility genotypes within the population. Since the decline in fertility rate that accompanies the demographic transition appears to be ubiquitous, the public health implications for our species are potentially devastating.
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Affiliation(s)
- Robert John Aitken
- Priority Research Centre for Reproductive Science, Discipline of Biological Sciences, School of Environmental and Life Sciences, College of Engineering Science and Environment, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Nickels L, Yan W. Nonhormonal Male Contraceptive Development-Strategies for Progress. Pharmacol Rev 2023; 76:37-48. [PMID: 38101934 PMCID: PMC10759220 DOI: 10.1124/pharmrev.122.000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.
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Affiliation(s)
- Logan Nickels
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
| | - Wei Yan
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
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Kristiansen D, Boyle EH, Svec J. The impact of local supply of popular contraceptives on women's use of family planning: findings from performance-monitoring-for-action in seven sub-Saharan African countries. Reprod Health 2023; 20:171. [PMID: 37990268 PMCID: PMC10664543 DOI: 10.1186/s12978-023-01708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
Contraceptive use has substantial implications for women's reproductive health, motivating research on the most effective approaches to minimize inequalities in access. When women prefer to limit or delay fertility but are not using contraception, this potentially reflects demand for contraception that is not being satisfied. Current literature emphasizes a nuanced integration of supply and demand factors to better understand this gap. In this research, we examine the interconnectedness of supply and demand factors both conceptually and methodologically by augmenting existing measures of local supply with a demand-side factor-community-level preferences for contraceptive methods. Using novel data from Performance Monitoring for Action (PMA) in seven sub-Saharan African countries, we test whether the available supply of locally preferred methods at nearby service delivery points (SDP) explains variation in women's uptake of contraception beyond the more typical measure of contraceptive stockouts. Findings from logistic regression analyses (N = 32,282) suggest that demand and supply can be understood as tightly interconnected factors which are directly affected by local social preferences. The odds of women using modern contraception increase significantly when locally preferred methods are available, and this is true even after controlling for the availability of methods in general. The new measure tested in this research centers women and their specific desires in a manner consistent with the promotion of contraceptives as an important human right.
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Affiliation(s)
- Devon Kristiansen
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Joseph Svec
- Social Sciences Department, Saint Joseph's University, Patchogue, NY, USA.
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Prevalence and determinants of unmet need for contraception among women in low and high-priority segments for family planning demand generation in Nigeria. Arch Public Health 2022; 80:239. [PMID: 36404339 PMCID: PMC9677901 DOI: 10.1186/s13690-022-00997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study. METHODS The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables. RESULTS Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments. CONCLUSION The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.
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Biswas RK, Farzana M, Bhar S, Bhowmik J. Contraceptive use in South and South-East Asian region: assessment of sustainable development goal 3.7 through indicator 3.7.1. J Public Health (Oxf) 2022:6754760. [PMID: 36214514 DOI: 10.1093/pubmed/fdac105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) 3.7 concerns modern contraception use among women of reproductive ages. This study evaluated the progress of indicator 3.7.1 in 11 selected countries in South and South-East Asia and assessed the contribution of women's education to modern contraceptive use. METHODS Generalized linear models for complex surveys were fitted to Demographic and Health Survey (DHS) data from 40 surveys conducted in Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor Leste between 1990 and 2017, followed by a meta-analysis through forest plots. RESULTS Modern contraceptive coverage in most of the selected countries climbed or remained stationary over the past decades. In four countries, <50% of women used contraception. In no country was contraception used by ≥80% women. Higher education was associated with 13% higher odds of modern contraceptive use (95% confidence interval: 1.07, 1.18) among women compared to primary level or no education. DISCUSSION Completion of primary education is insufficient to broaden the coverage of modern contraceptive use. Greater national level effort from the selected countries is needed to lift the education levels of women to meet SDG 3.7 by 2030.
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Affiliation(s)
- Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, 2052, Australia.,Charles Perkin Centre, School of Health Sciences, The University of Sydney, Camperdown, New South Wales 2006, Australia
| | - Maysha Farzana
- Department of Sociology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Sunil Bhar
- School of Health Sciences, Department of Department of Psychological Sciences, Swinburne University of Technology, 3122, Australia
| | - Jahar Bhowmik
- School of Health Sciences, Department of Health Science and Biostatistics, Swinburne University of Technology, 3122, Australia
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Fadeyibi O, Alade M, Adebayo S, Erinfolami T, Mustapha F, Yaradua S. Household Structure and Contraceptive Use in Nigeria. Front Glob Womens Health 2022; 3:821178. [PMID: 35620301 PMCID: PMC9128017 DOI: 10.3389/fgwh.2022.821178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Contraceptive use in Nigeria has been consistently low despite its many benefits and several efforts by government and development partners to increase its uptake. According to the Nigeria Demographic and Health Survey, the use of any modern method staggeringly increased from 4 to 12% over 28 years (1990-2018). Studies have identified factors at the individual, household, and societal levels that affect contraceptive use. While studies have also shown that decisions such as contraceptive behavior and acquisition of family skills may vary according to the individual or societal factors, there is a dearth of knowledge on how household structure and composition influence contraceptive use in Nigeria. This article seeks to contribute to the body of knowledge by exploring contraceptive use within the household context. Method We used data from the 2018 Nigeria Demographic and Health Survey to examine the relationship between household structure and contraceptive use. We excluded pregnant and non-married women at the time of the survey from the sample and used multinomial regression analysis to examine the likelihood of using traditional or modern methods of contraception. Results Results show that having a large household size, and the presence of multiple wives in the household significantly reduces the likelihood of using any method of contraceptive. The result further shows a significant association between household wealth index and contraceptive use as the use of any method increases with household wealth index, with those from richest households being twice as likely as their counterparts in the poorest households to use traditional methods (OR:2.02, p < 0.05). Also, women living in households headed by older men (25 and above), households with under 5 children, and those living in rural areas have significantly reduced likelihood of using any method. Conclusion This study highlights the dynamics of contraceptive use among married women considering household composition. While our study serves as a primer to understanding contraceptive use in households where a woman and her spouse are usual household members, improved family planning interventions to increase uptake through demand creation will require deeper and more comprehensive work to understand the dynamics among women in more complex household settings.
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Affiliation(s)
| | - Mayowa Alade
- Department of Global Health School of Public Health Boston University, Boston, MA, United States
| | - Samuel Adebayo
- Center for Research, Evaluation Resources and Development, Abuja, Nigeria
| | | | | | - Saudatu Yaradua
- Health, Nutrition, and Population, World Bank, Abuja, Nigeria
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Leight J, Hensly C, Chissano M, Safran E, Ali L, Dustan D, Jamison J. The effects of text reminders on the use of family planning services: evidence from a randomised controlled trial in urban Mozambique. BMJ Glob Health 2022; 7:bmjgh-2021-007862. [PMID: 35428679 PMCID: PMC9014002 DOI: 10.1136/bmjgh-2021-007862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomised controlled trial in Mozambique analysing the effects of text messages encouraging use of family planning services. Methods This trial was conducted within a sample of women served by the Integrated Family Planning Program implemented by Population Services International, in which community health workers provide clinic referrals for family planning services. The evaluation enrolled 5370 women between 20 January and 18 December 2020 who received a referral, reported access to a mobile phone and provided consent. Women were randomly assigned to a treatment group that received a series of text message reminders encouraging them to visit a clinic or to a control arm. An intention-to-treat analysis was conducted to analyse the effect of reminders on the probability of a clinic visit and contraceptive uptake. The final analysis includes 3623 women; 1747 women were lost to follow-up. Results Women assigned to receive the text reminders are weakly more likely to visit a clinic (risk difference 2.3 percentage points, p=0.081) and to receive a contraceptive method at a clinic (2.2 percentage points, p=0.091), relative to a base rate of 48.0% and 46.9%, respectively. The effect on clinic visits is larger and statistically significant in the prespecified subsample of women enrolled prior to the COVID-19-related state of emergency (3.2 percentage points, p=0.042). Conclusion Evidence from this trial suggests that text message reminders are a promising nudge that increases the probability that women receive contraception. Trial registration number AEARCTR-0005383.
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Affiliation(s)
- Jessica Leight
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Catherine Hensly
- Economics Department, American University, Washington, District of Columbia, USA
| | | | - Elana Safran
- Office of Evaluation Sciences, Washington, District of Columbia, USA
| | - Liza Ali
- Population Services International, Maputo, Mozambique
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Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
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Pattnaik A, Mohan D, Tsui A, Chipokosa S, Katengeza H, Ndawala J, Marx MA. The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi. PLoS One 2021; 16:e0232504. [PMID: 34780507 PMCID: PMC8592450 DOI: 10.1371/journal.pone.0232504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/29/2021] [Indexed: 11/20/2022] Open
Abstract
To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.
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Affiliation(s)
- Anooj Pattnaik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Hans Katengeza
- Reproductive Health Directorate, Ministry of Health, Lilongwe, Malawi
| | | | - Melissa A. Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Some SYM, Pu C, Huang SL. Empowerment and use of modern contraceptive methods among married women in Burkina Faso: a multilevel analysis. BMC Public Health 2021; 21:1498. [PMID: 34344339 PMCID: PMC8336087 DOI: 10.1186/s12889-021-11541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso. METHODS We analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors. RESULTS Overall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS. CONCLUSIONS Empowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights. TRIAL REGISTRATION No clinical trial has been performed in this study.
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Affiliation(s)
- Sylvain Y. M. Some
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Christy Pu
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Song-Lih Huang
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
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Gichangi P, Waithaka M, Thiongo M, Agwanda A, Radloff S, Tsui A, Zimmerman L, Temmerman M. Demand satisfied by modern contraceptive among married women of reproductive age in Kenya. PLoS One 2021; 16:e0248393. [PMID: 33836006 PMCID: PMC8034745 DOI: 10.1371/journal.pone.0248393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Demand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs. Materials and methods Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014–2018 was used. PMA2020 surveys are cross-sectional including women 15–49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15. Results Of the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15–19 and 45–49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0–13.8% over the 5-years, p<0.001. Married adolescent 15–19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7–79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9–37.2% and decrease in short acting methods from 49.9–42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence. Conclusions Results show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.
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Affiliation(s)
- Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- International Centre for Reproductive Health, Mombasa, Kenya
- * E-mail: , ,
| | | | - Mary Thiongo
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Alfred Agwanda
- Population Services Research Institute (PSRI), University of Nairobi, Nairobi, Kenya
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Linea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya
- Aga Khan University, Kenya, Nairobi, Kenya
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12
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Cardona C, Rusatira JC, Cheng X, Silberg C, Salas I, Li Q, Bishai D, Rimon JG. Generating and capitalizing on the demographic dividend potential in sub-Saharan Africa: a conceptual framework from a systematic literature review. Gates Open Res 2020; 4:145. [PMID: 33870102 PMCID: PMC8028847 DOI: 10.12688/gatesopenres.13176.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries' understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: The final review consisted of 78 peer-reviewed articles, ten reports from the gray literature, and one book. Data were categorized according to relevant demographic dividend typology: pre-dividend and early-dividend. The results from the literature review were synthesized into a framework consisting of five sectors for pre-dividend countries, namely 1) Governance and Economic Institutions, 2) Family Planning, 3) Maternal and Child Health, 4) Education, and 5) Women's Empowerment. An additional sector, 6) Labor Market, is added for early-dividend countries. These sectors must work together to attain a demographic dividend. Conclusions: A country's demographic transition stage must guide policy and programs. Most sub-Saharan African countries have prioritized job creation and employment for youth, yet their efforts to secure a productive labor market require preliminary and complementary investments in governance, family planning, maternal and child health, education, and women's empowerment. Creating a favorable policy environment for generating and capitalizing on a demographic dividend can support their stated goals for development.
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Affiliation(s)
- Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jean Christophe Rusatira
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Xiaomeng Cheng
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Claire Silberg
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Ian Salas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Qingfeng Li
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jose G. Rimon
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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13
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Slaymaker E, Scott RH, Palmer MJ, Palla L, Marston M, Gonsalves L, Say L, Wellings K. Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys. Lancet Glob Health 2020; 8:e567-e579. [PMID: 32164880 PMCID: PMC7083224 DOI: 10.1016/s2214-109x(20)30060-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/16/2020] [Accepted: 02/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND A quarter of a century ago, two global events-the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing-placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slower than hoped. We used survey data and national-level indicators of social determinants from 74 countries to examine change in satisfaction of contraceptive need from a contextual perspective. METHODS We searched for individual-level data from repeated nationally representative surveys that included information on sexual and reproductive health, and created a single dataset by harmonising data from each survey to a standard data specification. We described the relative timings of sexual initiation, first union (cohabitation or marriage), and first birth and used logistic regression to show the change in prevalence of sexual activity, demand for contraception, and modern contraceptive use. We used linear regression to examine country-level associations between the gender development index and the expected length of time in education for women and the three outcomes: sexual activity, demand for contraception, and modern contraceptive use. We used principal component analysis to describe countries using a combination of social-structural and behavioural indicators and assessed how well the components explained country-level variation in the proportion of women using contraception with fractional logistic regression. FINDINGS In 34 of the 74 countries examined, proportions of all women who were sexually active, not wanting to conceive, and not using a modern contraceptive method decreased over time. Proportions of women who had been sexually active in the past year changed over time in 43 countries, with increases in 30 countries; demand for contraception increased in 42 countries, and use of a modern method of contraception increased in 37 countries. Increases over time in met need for contraception were correlated with increases in gender equality and with women's time in education. Regression analysis on the principal components showed that country-level variation in met contraceptive need was largely explained by a single component that combined behavioural and social-contextual variables. INTERPRETATION Progress towards satisfying demand for contraception should take account of the changing context in which it is practised. To remove the remaining barriers, policy responses-and therefore research priorities-could require a stronger focus on social-structural determinants and broader aspects of sexual health. FUNDING UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
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Affiliation(s)
- Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Rachel H Scott
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Luigi Palla
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Milly Marston
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lianne Gonsalves
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Kaye Wellings
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Gruber FS, Johnston ZC, Barratt CLR, Andrews PD. A phenotypic screening platform utilising human spermatozoa identifies compounds with contraceptive activity. eLife 2020; 9:e51739. [PMID: 31987071 PMCID: PMC7046468 DOI: 10.7554/elife.51739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/19/2020] [Indexed: 12/14/2022] Open
Abstract
There is an urgent need to develop new methods for male contraception, however a major barrier to drug discovery has been the lack of validated targets and the absence of an effective high-throughput phenotypic screening system. To address this deficit, we developed a fully-automated robotic screening platform that provided quantitative evaluation of compound activity against two key attributes of human sperm function: motility and acrosome reaction. In order to accelerate contraceptive development, we screened the comprehensive collection of 12,000 molecules that make up the ReFRAME repurposing library, comprising nearly all the small molecules that have been approved or have undergone clinical development, or have significant preclinical profiling. We identified several compounds that potently inhibit motility representing either novel drug candidates or routes to target identification. This platform will now allow for major drug discovery programmes that address the critical gap in the contraceptive portfolio as well as uncover novel human sperm biology.
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Affiliation(s)
- Franz S Gruber
- National Phenotypic Screening Centre, School of Life SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Zoe C Johnston
- National Phenotypic Screening Centre, School of Life SciencesUniversity of DundeeDundeeUnited Kingdom
- Reproductive and Developmental Biology, Division of Systems Medicine, School of MedicineNinewells Hospital and Medical School, University of DundeeDundeeUnited Kingdom
| | - Christopher LR Barratt
- Reproductive and Developmental Biology, Division of Systems Medicine, School of MedicineNinewells Hospital and Medical School, University of DundeeDundeeUnited Kingdom
| | - Paul D Andrews
- National Phenotypic Screening Centre, School of Life SciencesUniversity of DundeeDundeeUnited Kingdom
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15
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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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16
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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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