1
|
Mohammed A, Donkoh IE, Aboagye RG, Ahinkorah BO, Seidu AA. Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa. Contracept Reprod Med 2024; 9:16. [PMID: 38622719 PMCID: PMC11017582 DOI: 10.1186/s40834-024-00267-x] [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: 12/02/2023] [Accepted: 01/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Improving women's access to and use of modern contraceptives is a key global strategy for improving the sexual and reproductive health of women. However, the use of modern contraceptives among adolescent girls and young women in sub-Saharan Africa (SSA) remains relatively low, despite the numerous interventions to increase patronage. This study examined adolescent girls and young women's receipt of quality contraceptive counselling and its associated factors in SSA. METHODS Data for the study were extracted from the recent Demographic and Health Surveys of 20 countries in SSA, spanning from 2015 to 2021. A sample of 19,398 adolescent girls and young women aged 15 to 24 years was included in the study. We presented the proportion of adolescent girls and young women who received quality contraceptive counselling using a spatial map. Multilevel binary logistic regression analysis was carried out to examine the factors associated with the receipt of quality contraceptive counselling. RESULTS Overall, 33.2% of adolescent girls and young women had access to quality contraceptive counselling, ranging from 13.0% in Cameroon to 67.0% in Sierra Leone. The odds of receiving quality contraceptive counselling was higher among adolescent girls and young women aged 20-24 (AOR = 1.48, CI: 1.32-1.67), those with primary (AOR = 1.32, CI: 1.11-1.57) and secondary or higher education (AOR = 1.31, CI: 1.09-1.58), and those married (AOR = 1.32, CI: 1.15-1.52), cohabiting (AOR = 1.47, CI: 1.23-1.76), and previously married (AOR = 1.48, CI: 1.20-1.83) compared to their counterparts in the reference groups. Adolescent girls and young women who were currently working (AOR = 1.22, CI: 1.09-1.37), those who heard of family planning from radio in the last few months (AOR = 1.34, CI:1.21-1.50), those who visited the health facility in the last 12 months (AOR = 1.69, CI: 1.52-1.88), and those residing in the Southern (AOR = 5.01, CI: 3.86-6.51), Eastern (AOR = 2.54, CI: 1.96-3.30), and Western (AOR = 4.09, CI: 3.19-5.25) SSA were more likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. Conversely, adolescent girls and young women who used the internet, those who had problem getting permission to seek medical help, those facing problem in seeking medical help for not wanting to go alone, those from the middle and richest wealth indices, and those from the rural areas were less likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. CONCLUSION Receipt of quality contraceptive counselling among adolescent girls and young women was low. Considering the importance of quality contraceptive counselling on the uptake and continuation of contraception, policymakers need to institute measures that improve adolescent girls and young women's access to quality contraceptive counselling in SSA, especially in countries like Cameroon, Angola, Madagascar, Mauritania, and Guinea, taking into consideration the factors identified in the study. Increasing adolescent girls and young women's access to quality contraceptive counselling could greatly minimize the risk of unintended pregnancies and its associated maternal and child health burden in SSA and subsequently contribute to the attainment of the Sustainable Development Goal 3, target 3.7.
Collapse
Affiliation(s)
- Aliu Mohammed
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Sydney, Sydney, Australia
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
| | - Abdul-Aziz Seidu
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| |
Collapse
|
2
|
Somefun O, Banougnin BH, Smith-Greenaway E. The Relationships between Drought Exposure, Fertility Preferences, and Contraceptive Behaviors: A Multicountry Study. Stud Fam Plann 2024; 55:5-21. [PMID: 38414154 DOI: 10.1111/sifp.12258] [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] [Indexed: 02/29/2024]
Abstract
The interplay between population dynamics and the environment has long interested demographers. Although studies have explored how climate patterns affect macrolevel population processes, such as mortality and migration, little is known about their impact on individual-level demographic behaviors. This study fills this research gap by examining the linkages between exposure to drought and women's fertility preferences and contraceptive behaviors in sub-Saharan Africa. We analyze data from the Demographic and Health Surveys Program, focusing on 17 countries in East, Southern, and West Africa. We investigate whether women's recent exposure to drought episodes in their community affects their fertility preferences and modern contraceptive use. Generally, the findings show that drought is relevant to understanding women's fertility preferences and behaviors in the vast majority of countries; however, drought exposure has variable impacts. Moreover, whereas in some countries, drought exposure encourages contraceptive behaviors that align with women's preferences, in select countries it is associated with behavior that is misaligned with women's stated preferences. Overall, the study emphasizes the importance of examining climate events as complex forces that have localized meanings for demographic outcomes.
Collapse
|
3
|
Otte R, Thissen V, Mulder B. (Dis)continuation of the oral contraceptive pill: A focus group approach in the Netherlands. Heliyon 2023; 9:e19405. [PMID: 37810124 PMCID: PMC10558495 DOI: 10.1016/j.heliyon.2023.e19405] [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: 01/26/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The oral contraceptive pill (OCP) is the most used contraceptive worldwide; nevertheless, discontinuation rates are relatively high. While advantages of the OCP, like pregnancy prevention and planned parenthood, result in autonomy and independence, side effects and other aspects play a role in the decision to (dis)continue usage. Informed and deliberate decision-making is of importance to prevent adverse effects in health and quality of life. Therefore, the present study aimed to explore how women in the Netherlands decide to (dis)continue the OCP. Study design This paper reports a qualitative study using four focus groups, conducted online or face-to-face, with 20 women of different educational background aged between 18 and 23. The topic guide was based on relevant theory and literature, and focused on personal beliefs, experiences and social interactions about the OCP. The study is reported according to SRQR guidelines. Results The main themes that were found the influence decision-making were effects, side effects, towards alternatives, interpersonal communication with peers, interpersonal communication with the general practitioner, and online information seeking. Feeling responsible emerged as a relevant additional theme, embedded in the decision-making process, and influencing other themes. Some educational differences emerged. Conclusions The decision to start the OCP is a highly normalized process in the Netherlands. However, women who feel a strong sense of responsibility for pregnancy prevention may be less open to considering alternative contraception methods. Results imply that women can be better supported in the decision-making process by providing balanced information on effects and side effects of a wide range of contraceptives, as well as restoring the balance in both sexual partner's responsibility for contraception. Implications for practice and suggestions for further research on the concept of responsibility, its influence, and underlying mechanisms are provided.
Collapse
Affiliation(s)
- R.S. Otte
- Strategic Communication Group, Wageningen University & Research, P.O. BOX 8130, 6700, EW Wageningen, the Netherlands
| | - V.T.M. Thissen
- Strategic Communication Group, Wageningen University & Research, P.O. BOX 8130, 6700, EW Wageningen, the Netherlands
| | - B.C. Mulder
- Strategic Communication Group, Wageningen University & Research, P.O. BOX 8130, 6700, EW Wageningen, the Netherlands
| |
Collapse
|
4
|
Steyn PS, Cordero JP, Nai D, Shamba D, Fuseini K, Mrema S, Habib N, Nguyen MH, Kiarie J. The impact of community and provider-driven social accountability interventions on contraceptive use: findings from a cohort study of new users in Ghana and Tanzania. Int J Equity Health 2023; 22:167. [PMID: 37641059 PMCID: PMC10464246 DOI: 10.1186/s12939-023-01928-0] [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: 01/11/2022] [Accepted: 05/30/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Although contraceptive use has increased over 15 years, discontinuation rates remain high. Contraceptive use is becoming more important when addressing unmet need for family planning. Social accountability, defined here as collective processes for holding duty bearers to account for their actions, is a rights-based participatory process that supports service provision and person-centred care, as well as, informed decision-making among community members regarding their health. A study implemented in Ghana and Tanzania was designed to understand and evaluate how social accountability and participatory processes influences quality of care and client satisfaction and whether this results in increased contraceptive uptake and use. We report here on the relationship between social accountability and the use of modern contraceptives, i.e., contraceptive method discontinuation, contraceptive method switching, and contraceptive discontinuation. METHODS As part of Community and Provider driven Social Accountability Intervention (CaPSAI) Project, a cohort of women aged 15 to 49 years who were new users of contraception and accessing family planning and contraceptives services at the study facilities across both intervention and control groups were followed-up over a 12-month period to measure changes contraceptive use. RESULTS In this cohort study over a one-year duration, we did not find a statistically significant difference in Ghana and Tanzania in overall method discontinuation, switching, and contraceptive discontinuation after exposure to a social accountability intervention. In Ghana but not in Tanzania, when stratified by the type of facility (district level vs. health centre), there were significantly less method and contraceptive discontinuation in the district level facility and significantly more method and contraceptive discontinuation in the health centres in the intervention group. In Ghana, the most important reasons reported for stopping a method were fear of side-effects, health concerns and wanting to become pregnant in the control group and fear of side-effects wanting a more effective method and infrequent sex in the intervention group. In Tanzania, the most important reasons reported for stopping a method were fear of side-effects, wanting a more effective method, and method not available in the control group compared to wanting a more effective method, fear of side-effects and health concerns in the intervention group. CONCLUSIONS We did not demonstrate a statistically significant impact of a six-month CaPSAI intervention on contraceptives use among new users in Tanzania and Ghana. However, since social accountability have important impacts beyond contraceptive use it is important consider results of the intermediate outcomes, cases of change, and process evaluation to fully understand the impact of this intervention. TRIAL REGISTRATION The CaPSAI Project has been registered at Australian New Zealand Clinical Trials Registry (ACTRN12619000378123, 11/03/2019).
Collapse
Affiliation(s)
- Petrus S Steyn
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland.
| | - Joanna Paula Cordero
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Dela Nai
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar Es Salaam, Tanzania
| | - Kamil Fuseini
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Sigilbert Mrema
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar Es Salaam, Tanzania
| | - Ndema Habib
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - My Huong Nguyen
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - James Kiarie
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| |
Collapse
|
5
|
Wado YD, Mutua MK, Odwe G, Obare F, Machiyama K, Casterline JB, Cleland J. Women's beliefs about methods and contraceptive discontinuation: Results from a prospective study from Nairobi and Homa Bay counties in Kenya. Front Glob Womens Health 2023; 4:1034634. [PMID: 36994242 PMCID: PMC10040827 DOI: 10.3389/fgwh.2023.1034634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundRates of contraceptive discontinuation are high in many low and middle countries contributing to unmet need for contraception and other adverse reproductive health outcomes. Few studies have investigated how women's beliefs about methods and strength of fertility preferences affect discontinuation rates. This study examines this question using primary data collected in Nairobi and Homa Bay counties in Kenya.MethodsWe used data from two rounds of a longitudinal study of married women ages 15–39 years (2,812 and 2,424 women from Nairobi and Homa Bay respectively at round 1). Information on fertility preferences, past and current contraceptive behavior, and method-related beliefs about six modern contraceptive methods were collected, along with a monthly calendar of contraceptive use between the two interviews. The analysis focused on discontinuation of the two most commonly used methods in both sites, injectables and implants. We carry out competing risk survival analysis to identify which method related beliefs predict discontinuation among women using at the first round.ResultsThe percentages of episodes discontinued in the 12 months between the two rounds was 36%, with a higher rate of discontinuation in Homa Bay (43%) than in the Nairobi slums (32%) and higher for injectables than implants. Method related concerns and side effects were the major self-reported reasons for discontinuation in both sites. The competing risk survival analysis showed that the probability of method related discontinuation of implants and injectables was significantly lower among respondents who believed that the methods do not cause serious health problems (SHR = 0.78, 95% CI: 0.62–0.98), do not interfere with regular menses (SHR = 0.76, 95% CI: 0.61–0.95) and do not cause unpleasant side effects (SHR = 0.72, 95% CI 0.56–0.89). By contrast, there were no net effects of three method related beliefs that are commonly cited as obstacles to contraceptive use in African societies: safety for long-term use, ability to have children after stopping the method, and the approval of the husband.ConclusionThis study is unique in its examination of the effect of method-specific beliefs on subsequent discontinuation for a method-related reason, using a longitudinal design. The single most important result is that concerns about serious health problems, which are largely unjustified and only moderately associated with beliefs about side effects, are a significant influence on discontinuation. The negative results for other beliefs show that the determinants of discontinuation differ from the determinants of method adoption and method choice.
Collapse
Affiliation(s)
- Yohannes Dibaba Wado
- Health and Wellbeing Program, African Population and Health Research Center, APHRC Campus, Nairobi, Kenya
- Correspondence: Yohannes Dibaba Wado
| | - Martin K. Mutua
- Health and Wellbeing Program, African Population and Health Research Center, APHRC Campus, Nairobi, Kenya
| | | | | | - Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John B. Casterline
- Department of Sociology, Ohio State University, Columbus, OH, United States
| | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
6
|
Simmons RG, Baayd J, Waters M, Diener Z, Turok DK, Sanders JN. Assessing contraceptive use as a continuum: outcomes of a qualitative assessment of the contraceptive journey. Reprod Health 2023; 20:33. [PMID: 36793112 PMCID: PMC9930211 DOI: 10.1186/s12978-023-01573-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Contraceptive use is often a multi-decade experience for people who can become pregnant, yet few studies have assessed how this ongoing process impacts contraceptive decision-making in the context of the reproductive life course. METHODS We conducted in-depth interviews assessing the contraceptive journeys of 33 reproductive-aged people who had previously received no-cost contraception through a contraceptive initiative in Utah. We coded these interviews using modified grounded theory. RESULTS A person's contraceptive journey occurred in four phases: identification of need, method initiation, method use, and method discontinuation. Within these phases, there were five main areas of decisional influence: physiological factors, values, experiences, circumstances, and relationships. Participant stories demonstrated the ongoing and complex process of navigating contraception across these ever-changing aspects. Individuals stressed the lack of any "right" method of contraception in decision-making and advised healthcare providers to approach contraceptive conversations and provision from positions of method neutrality and whole-person perspectives. CONCLUSIONS Contraception is a unique health intervention that requires ongoing decision-making without a particular "right" answer. As such, change over time is normal, more method options are needed, and contraceptive counseling should account for a person's contraceptive journey.
Collapse
Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Megan Waters
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Zoë Diener
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jessica N. Sanders
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| |
Collapse
|
7
|
Hernandez JH, LaNasa KH, Koba T. Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC. Reprod Health 2023; 20:24. [PMID: 36717937 PMCID: PMC9887934 DOI: 10.1186/s12978-023-01571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women's contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of "ever discontinuing". However, these variables became non-significant when controlling for resupply issues. Women's self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women's choices and preferences towards successful contraceptive trajectories in fragile health systems.
Collapse
Affiliation(s)
- Julie H. Hernandez
- grid.265219.b0000 0001 2217 8588Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - Katherine H. LaNasa
- grid.265219.b0000 0001 2217 8588Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112 USA
| | - Tesky Koba
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
8
|
Tsega NT, Haile TT, Asratie MH, Belay DG, Endalew M, Aragaw FM, Tsega SS, Gashaw M. Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis. Front Public Health 2022; 10:962675. [PMID: 36187687 PMCID: PMC9516336 DOI: 10.3389/fpubh.2022.962675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/23/2022] [Indexed: 01/24/2023] Open
Abstract
Background Despite the commitments of the government to minimize unintended pregnancy, abortion, and unmet need for contraceptives, as per our search of the literature, there is no study on the pooled prevalence and determinants of informed choice of contraceptive methods in sub-Saharan Africa. Therefore, this study aimed to assess the pooled prevalence and determinants of informed choice of contraceptive methods among reproductive-aged women in sub-Saharan Africa. Methods This study was based on the 32 Sub-Saharan African countries Demographic and Health Survey data. A total weighted sample of 65,487 women aged 15-49 was included in the study. The data were cleaned, weighted, and analyzed using STATA Version 14 software. Multilevel logistic regression modeling was used to identify determinants of an informed choice of contraceptive methods. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) and p-value < 0.05 were used to declare the significant determinants. Result The pooled prevalence of informed choice of contraceptive methods among reproductive age (15-49) women in sub-Saharan Africa was 49.47% (95%CI: 44.33, 54.62%) with I 2 =99.5%, and variations in range of 19.42 to 78.42%. Women aged 25-34 years old (AOR = 1.26 95%CI: 1.21, 1.32) and 35-49 years (AOR = 1.33 95%CI: 1.27, 1.40), attending primary education (AOR = 1.26, 95% CI: 1.20, 1.32), secondary education (AOR = 1.50, 95% CI: 1.43, 1.58) and higher education (AOR = 2.01, 95% CI: 1.84, 2.19), having media exposure (AOR = 1.12, 95%CI: 1.07, 1.16), utilizing IUD (AOR = 1.98, 95%CI: 1.79, 2.19), injectable (AOR = 1.29, 95%CI: 1.23, 1.36) and implants (AOR = 1.70, 95%CI: 1.61, 1.79), survey year 2016-2020 (AOR = 1.38, 95%CI: 1.31, 1.44), women from lower middle (AOR = 1.25, 95%CI: 1.19, 1.31) and upper middle income level countries (AOR = 1.37, 95%CI: 1.23, 1.53) were associated with increased odds of informed choice of contraceptive methods. While, women who accessed contraceptives from private clinics (AOR = 0.64, 95%CI: 0.61, 0.67), pharmacies (AOR = 0.37, 95%CI: 0.35, 0.40), and others (AOR = 0.47, 95%CI: 0.43, 0.52), women in East Africa (AOR = 0.70, 95% CI: 0.67, 0.73), Central Africa (AOR = 0.52, 95% CI: 0.47, 0.57), and South Africa (AOR = 0.36, 95% CI: 0.32, 0.40) were associated with decreased odds of informed choice of contraceptive methods. Conclusion The pooled prevalence of informed choice of contraceptive methods in Sub-Saharan Africa is low with high disparities among the countries. Enhancing maternal education and media exposure, providing greater concern for the source of contraceptive methods, and strengthening the economic status of the country are recommended to enhance informed choice of contraceptive methods.
Collapse
Affiliation(s)
- Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,*Correspondence: Nuhamin Tesfa Tsega
| | - Tsion Tadesse Haile
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, School of medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
9
|
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.
Collapse
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
| | | | | |
Collapse
|
10
|
Oyeoku EK, Talabi FO, Oloyede D, Boluwatife AA, Gever VC, Ebere I. Predicting COVID-19 health behaviour initiation, consistency, interruptions and discontinuation among social media users in Nigeria. Health Promot Int 2022; 37:daab059. [PMID: 34223610 PMCID: PMC8344883 DOI: 10.1093/heapro/daab059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Literature on the predictors of health behaviour initiation, interruption, consistency and discontinuation is scarce. This study sought to fill this gap by suggesting a model that takes into account these variables. Using the structural equation modelling, we surveyed 470 social media users in Nigeria and found that perceived vulnerability, perceived seriousness; benefits to action, self-efficacy and cues to action significantly predict health behaviour initiation. Also, the predictors of health interruption were found to be perceived vulnerability, perceived seriousness, benefits to action, challenges to action and perceived realness. The predictors of health behaviour consistency were found to be perceived vulnerability, perceived seriousness, benefits to action, perceived realness, self-efficacy and cues to action. Finally, the predictors of health behaviour discontinuation were found to be perceived vulnerability, perceived seriousness, perception on realness, behaviour fatigue and behaviour discomfort. We explored the implication of these results on health promotion and made suggestions for further studies.
Collapse
Affiliation(s)
- Eke Kalu Oyeoku
- Department of Education Foundations, University of Nigeria, Nsukka, Nigeria
| | | | - David Oloyede
- Department of Mass Communication, Adeleke University, Ede Osun State, Nigeria
| | | | | | - Ibe Ebere
- Department of Science Education, University of Nigeria, Nsukka, Nigeria
| |
Collapse
|
11
|
Pakrashi D, Maiti SN, Gautam A, Nanda P, Borkotoky K, Datta N. Family planning campaigns on television and contraceptive use in India. Int J Health Plann Manage 2022; 37:1492-1511. [PMID: 35001417 DOI: 10.1002/hpm.3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The paper examines the association between viewing family planning campaigns on television and being aware, improved intention to use, and current usage of modern contraceptives in India. DATA The study uses detailed data of the currently married women from the current round of the National Family Health Survey. METHODS We use the instrumental variable approach, propensity score matching method, besides the ordinary least square regression technique to estimate the association between viewing family planning campaigns on television and knowledge, intention to use, and current usage among the currently married women. CONCLUSION The overall results suggest that currently married women who have seen family planning campaigns on television in the last few months are more likely to know, have a higher intention to use and use modern family planning methods. The effectiveness gets amplified when exposure to such campaigns is complemented with motivation provided by frontline health workers.
Collapse
Affiliation(s)
- Debayan Pakrashi
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Surya Nath Maiti
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Abhishek Gautam
- International Centre for Research on Women's (ICRW) Asia Regional Office, New Delhi, India
| | - Priya Nanda
- Bill & Melinda Gates Foundation, New Delhi, India
| | - Kakoli Borkotoky
- International Centre for Research on Women's (ICRW) Asia Regional Office, New Delhi, India
| | - Nitin Datta
- International Centre for Research on Women's (ICRW) Asia Regional Office, New Delhi, India
| |
Collapse
|
12
|
Mahande MJ, Sato R, Amour C, Manongi R, Farah A, Msuya SE, Elewonibi B, Shah I. Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania. Contracept Reprod Med 2021; 6:15. [PMID: 33934708 PMCID: PMC8091743 DOI: 10.1186/s40834-021-00157-6] [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: 11/29/2020] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania. Methods This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16–44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model. Results Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40–44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively. Conclusion Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.
Collapse
Affiliation(s)
- Michael J Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.
| | - Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Caroline Amour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | - Rachel Manongi
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | - Amina Farah
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | - Sia E Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of Community Health, KCMC Hospital, P.O Box 3010, Moshi, Tanzania
| | - Bilikisu Elewonibi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| |
Collapse
|
13
|
Bawah AA, Sato R, Asuming P, Henry EG, Agula C, Agyei-Asabere C, Canning D, Shah I. Contraceptive method use, discontinuation and failure rates among women aged 15-49 years: evidence from selected low income settings in Kumasi, Ghana. Contracept Reprod Med 2021; 6:9. [PMID: 33632324 PMCID: PMC7908716 DOI: 10.1186/s40834-021-00151-y] [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: 10/15/2020] [Accepted: 02/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This paper provides estimates of contraceptive discontinuation and failure rates in a poor urban setting in Ghana. Contraceptive use is for the purposes of preventing unintended or mistimed pregnancies. Unfortunately, evidence abounds in many parts of the world where there is considerable levels of contraceptive failure and high levels of discontinuation resulting in unintended pregnancies. METHODS We estimated discontinuation rates during a 12-month period since starting use by applying single and multiple decrement life table methods to the contraceptive calendar data collected in a survey of women in reproductive age of 15-49 years. RESULTS Modern contraceptive method use was estimated to be 13.7% at the time of the survey. The results show that contraceptive method discontinuation vary markedly by type of contraceptive method but are high for almost all methods, except for implants (23.7%). Discontinuation rate for emergency contraception was estimated at 88.5%, withdrawal 87.6%, and male condom use 80.9%. However, discontinuation rates were moderately high for rhythm (63.6%), pills (65.6%) and injectables (56%). In terms of failure rates, overall contraceptive failure for all methods was estimated at 7.9%. The factors significantly associated with method failure include being within age bracket 40-44 years (OR = 0.3, p < 0.05), having secondary/higher education (OR = 0.4, p < 0.01), belonging to the richest household wealth scale (OR = 3.3, p < 0.01), currently in union with a partner (OR = 2.2, p < 0.01), and using contraceptive methods such as rhythm (OR = 5.6, p < 0.01) and withdrawal (OR = 3.7, p < 0.01). On the flip side, the odds for method discontinuation were significantly higher for women in their 20s and mid 30s, formerly in union (OR = 1.9, p < 0.05) and use of withdrawal method (OR = 1.4, p < 0.05) and lower for women formerly in union (OR = 0.4, p < 0.01) and use of implants (OR = 0.2, p < 0.01) and injectables (OR = 0.6, p < 0.01). CONCLUSION While contraceptives use is low, both discontinuation and failure rates are high and variable among different methods. Failure and discontinuation rates are lowest for long-acting methods such as implants while higher failure rates are more prevalent among women who rely on withdrawal and the rhythm methods.
Collapse
Affiliation(s)
| | - Ryoko Sato
- TH Chan School of Public Health, Harvard University, Boston, USA
| | | | | | | | | | - David Canning
- TH Chan School of Public Health, Harvard University, Boston, USA
| | - Iqbal Shah
- TH Chan School of Public Health, Harvard University, Boston, USA
| |
Collapse
|
14
|
Coulibaly A, Millogo T, Baguiya A, Tran NT, Yodi R, Seuc A, Cuzin-Kihl A, Thieba B, Landoulsi S, Kiarie J, Mashinda Kulimba D, Kouanda S. Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the Democratic Republic of the Congo: a secondary analysis of the Yam Daabo trial. Contracept Reprod Med 2020; 5:35. [PMID: 33292708 PMCID: PMC7686716 DOI: 10.1186/s40834-020-00137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Women who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use. Methods We conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching. Results In total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods’ discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8–8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p < 0.001). The main reason for discontinuation and switching was method-related (141 over 199), followed by partner opposition with 20 women. Conclusion The results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women’s partners and influential people in the community to counter inhibiting beliefs. Trial registration Pan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784).
Collapse
Affiliation(s)
- Abou Coulibaly
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS) , 03 B.P. 7047, Ouagadougou, 03, Burkina Faso. .,Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.
| | - Tieba Millogo
- Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.,Institut Africain de la Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso
| | - Adama Baguiya
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS) , 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Nguyen Toan Tran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland.,Institute of Demography and Socioeconomics (IDESO), University of Geneva, Boulevard du Pont d'Arve 40, 1211, Geneva, Switzerland.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW, 2007, Australia
| | - Rachel Yodi
- Programme National de Santé de la Reproduction, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Armando Seuc
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | - Asa Cuzin-Kihl
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | - Blandine Thieba
- Unité de formation et de recherche en Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso
| | - Sihem Landoulsi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1211, 27, Genève, Switzerland
| | | | - Séni Kouanda
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS) , 03 B.P. 7047, Ouagadougou, 03, Burkina Faso.,Institut Africain de la Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso
| | | |
Collapse
|