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Achola R, Orach CG, Nabiwemba E, Atuyambe LM. Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study. BMC Womens Health 2024; 24:427. [PMID: 39061042 PMCID: PMC11282639 DOI: 10.1186/s12905-024-03272-z] [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: 04/04/2023] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Contraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake. METHODS A qualitative exploratory study was conducted among women of reproductive age (15-49 years) and men (15-60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14. RESULTS We found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out. CONCLUSIONS This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees. TRIAL REGISTRATION This study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number-SS809ES.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Lynn M Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Buser JM, Pebolo PF, August E, Rana GK, Gray R, Jacobson-Davies FE, Kumakech E, Endale T, Auma AG, Smith YR. Scoping review of qualitative studies on family planning in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003313. [PMID: 38959214 PMCID: PMC11221757 DOI: 10.1371/journal.pgph.0003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/11/2024] [Indexed: 07/05/2024]
Abstract
Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.
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Affiliation(s)
- Julie M. Buser
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Pebalo F. Pebolo
- Department Reproductive Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Ella August
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- PREPSS (Pre-Publication Support Service), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gurpreet K. Rana
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel Gray
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Faelan E. Jacobson-Davies
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Edward Kumakech
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Tamrat Endale
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna Grace Auma
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Yolanda R. Smith
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Bukuluki P, Okwii M, Hoffmann K, Pavin M. Using Vignettes to Gain Insights Into Social Norms Related to Voluntary Family Planning and Gender-Based Violence in South Sudan. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300489. [PMID: 38906554 PMCID: PMC11216705 DOI: 10.9745/ghsp-d-23-00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/14/2024] [Indexed: 06/23/2024]
Abstract
Social norms are the shared expectations about behaviors that are held within collective groups. These differ from attitudes and beliefs, which are individually held. In South Sudan, social norms can affect the use of voluntary family planning and reproductive health (FP/RH); some of these norms even present risks for women seeking FP/RH care and their FP/RH providers. This cross-sectional, descriptive study conducted in 5 counties in South Sudan used vignettes as a qualitative method to explore social norms related to FP/RH and decisions related to contraceptive use and gender-based violence. Participants were asked to respond to vignettes about a fictional couple during various life stages of care-seeking. Vignettes allow respondents to share their opinions and feelings without directly speaking about their own experiences. Respondents included community members, FP/RH providers, and key influencers (e.g., religious leaders, traditional leaders, elders). The study identified restrictive social norms related to FP/RH, including entrenched, dominant gender roles (i.e., requiring male consent to use contraceptives) and risk for the woman and her provider if she accesses FP/RH services. Of note, supportive social norms are gaining acceptance regarding women's voice and agency; it was found that some women can negotiate their reproductive choice with their partners and participate in planning their families, which has not always been a widely accepted norm. The use of vignettes can lead to a better understanding of the challenges and provide insights on effective implementation approaches. It is essential for programs working to promote the use of FP/RH services in South Sudan to consider the challenges presented by social norms. Findings from this study were shared with stakeholders and communities to codesign interventions aimed at increasing the use of FP/RH services. Additionally, the dialogue stimulated by this study should lead to an organic transformation toward supportive social norms through collective agency.
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Affiliation(s)
| | | | - Kamden Hoffmann
- MOMENTUM Integrated Health Resilience, IMA World Health, Washington, DC, USA
| | - Melinda Pavin
- MOMENTUM Integrated Health Resilience, John Snow, Inc., Washington, DC, USA.
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Howe K, Stites E, Bassett L, Ewart M, Hammada KA, Sulaiman S, Lony N, Maguek TN. Health and well-being of young mothers displaced by conflict: Experiences from South Sudan and the Kurdistan Region of Iraq. Soc Sci Med 2024; 348:116710. [PMID: 38636208 DOI: 10.1016/j.socscimed.2024.116710] [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: 08/01/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
Giving birth during adolescence is linked to a variety of negative outcomes, including poor health and well-being. Girls who have been displaced by conflict are at increased risk for becoming young mothers. While prevalence rates and health outcomes have been documented, rarely have the complex personal narratives of early motherhood been examined from the perspectives of mothers themselves, particularly in the Global South. This study relies on in-depth, inductive, narrative analysis of qualitative interviews with 67 young mothers and 10 relatives in South Sudan and the Kurdistan Region of Iraq (KRI) who had been displaced by conflict. This study provides deep insights into the contributing circumstances and consequences of young motherhood from sexual and reproductive health and well-being perspectives, with additional insights on mothering in humanitarian crisis.
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Damtew SA, Fantaye FT. Women alone modern contraceptive use decision making and its correlates, evidence from PMA CS 2021 survey. BMC Womens Health 2024; 24:205. [PMID: 38555426 PMCID: PMC10981343 DOI: 10.1186/s12905-024-03050-x] [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: 09/20/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Women alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners' effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health. METHODS Nationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance. RESULTS This study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use. CONCLUSION 59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.
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Achola R, Atuyambe L, Nabiwemba E, Fredrick M, Orach CG. Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study. BMC Public Health 2024; 24:754. [PMID: 38468212 DOI: 10.1186/s12889-024-18103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Uganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda. METHODS A comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed. RESULTS We found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27-2.16], acquired skills [AOR = 2.28, 95% CI: 2.11-2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3-5 years [AOR = 2.24, 95% CI: 1.46-3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods. CONCLUSION Our findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Makumbi Fredrick
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Achola R, Atuyambe L, Nabiwemba E, Nyashanu M, Garimoi Orach C. Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study. PLoS One 2024; 19:e0278731. [PMID: 38427612 PMCID: PMC10906906 DOI: 10.1371/journal.pone.0278731] [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: 11/20/2022] [Accepted: 12/22/2023] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathew Nyashanu
- Department of Health & Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Fantaye FT, Damtew SA. Women decision making on use of modern family planning methods and associated factors, evidence from PMA Ethiopia. PLoS One 2024; 19:e0298516. [PMID: 38363778 PMCID: PMC10871506 DOI: 10.1371/journal.pone.0298516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Family planning decision making is defined as women´s ability to determine the family planning methods that she wanted to use through the process of informed decision making. Despite the availability and accessibility of family planning methods, the utilization rate is not more than 41% in Ethiopia. Evidence and experts have consistently show that women decisions making ability on family planning method they desired to use is one of the possible reasons for this slow rate of family planning use increment. In consideration of this and further motives family planning use decision making has become one of the top sexual and reproductive health related sustainable development agendas. Hence, this study aimed at determining the level, trend and spatial distribution of family planning use decision making among married women and identify factors affecting it. METHODS This study was based on Performance Monitoring for Action (PMA) 2020 cross sectional national survey data. Married women who are currently using or recently used family planning method were included in this study. Frequency was computed to describe the study participants while chi-square statistics was computed to examine the overall association of independent variable with family planning use decision making. To identify predictors of family planning use decision making multinomial logistics regression was employed. Results were presented in the form of percentage and relative risk ratio with 95% CI. Candidate variables were selected using p value of 0.25. Significance was declared at p value 0.05. RESULTS This study revealed that one in two women (51.2%; 95% CI: 48.8%-53.6%) decide their family planning use by themselves while 37% (36.8%; 95% CI: 34.5%-39.2%) decide jointly with their husband and/or partner. Women alone family planning use decision making increased significantly 32.8% (95% CI: 29.4%, 36.4%) in 2014 to 51.2% (95% CI: 48.8%, 53.6%) in 2020. It also shows variation across regions from scanty in Afar and Somali to 63.6% in Amhara region and 61.5 Addis Ababa. Obtaining desired family planning method was found significantly to improve women alone and joint family planning use decision making. Women who have perceive control and feeling if they get pregnant now were found to be positively associated with women alone family planning use decision making. Discussion with husband, his feeling towards family planning were found positively to influence family planning use joint decision making. Moreover, women religion, was found reducing the likelihood of both women alone and joint family planning use decision making while experiencing side effect reduces the likelihood of joint family planning use decision making. CONCLUSION Half of the women independently decide their family planning use which calls up on further improvement. Family planning use decision making ability is expected to be improved by efforts targeted on husbands' approval on wife's family planning use, discussion on family planning use with husband/partner, improving women psychosociological readiness and trust on her own to decide her desired family planning method; informing the possible side effects and what to do when they encountered during their family planning use visit. In addition, influencing women on the use of family planning via religious leader will help much in this regard. Monitoring and evaluating reproductive health policy 2021 to2025 and addressing bottlenecks which hinder women decision making health service use is hoped to improve women family planning use decision making. Further qualitative study to identify and address factors that contribute for the variation across regions also help much.
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Affiliation(s)
| | - Solomon Abrha Damtew
- Department of Epidemiology and Biostatistics, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Zinke-Allmang A, Bhatia A, Gorur K, Hassan R, Shipow A, Ogolla C, Keizer K, Cislaghi B. The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study. Reprod Health 2023; 20:41. [PMID: 36894997 PMCID: PMC9997433 DOI: 10.1186/s12978-023-01581-4] [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: 12/13/2021] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.
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Affiliation(s)
- Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Amy Shipow
- Busara Center for Behavioral Economics, Nairobi, Kenya
| | | | - Kees Keizer
- University of Groningen, Groningen, Netherlands
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Dahir G, Kulane A, Omar B, Osman F. We have almost accepted child spacing. Let's wait on family planning and limiting children': Focus group discussions among young people with tertiary education in Somalia. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100828. [PMID: 36827891 DOI: 10.1016/j.srhc.2023.100828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Somalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu. METHODS A purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19-25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis. FINDINGS The findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable. CONCLUSION Our findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.
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Affiliation(s)
- Gallad Dahir
- School of Public Health and Research, Somali National University. Columbia Rd, Hamar Weyne, P.O. Box 15, Mogadishu, Somalia
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Bakar Omar
- School of Public Health and Research, Somali National University. Columbia Rd, Hamar Weyne, P.O. Box 15, Mogadishu, Somalia
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Falun 791 88, Falun, Sweden; School of Public Health and Research, Somali National University. Columbia Rd, Hamar Weyne, P.O. Box 15, Mogadishu, Somalia.
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Hassan R, Bhatia A, Zinke-Allmang A, Shipow A, Ogolla C, Gorur K, Cislaghi B. Navigating family planning access during Covid-19: A qualitative study of young women's access to information, support and health services in peri-urban Nairobi. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100031. [PMID: 34927130 PMCID: PMC8665648 DOI: 10.1016/j.ssmqr.2021.100031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/12/2023]
Abstract
The COVID-19 response has profoundly affected women's access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women's FP choices. In this qualitative study, we interviewed 16 women (aged 18-25 years), 10 men in partnerships with women, and 14 people in women's social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.
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Affiliation(s)
- Rahma Hassan
- University of Nairobi, Kenya,Corresponding author
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
| | - Anja Zinke-Allmang
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
| | - Amy Shipow
- Busara Center for Behavioral Economics, Kenya
| | | | | | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
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Kenny L, Lokot M, Bhatia A, Hassan R, Pyror S, Dagadu NA, Aden A, Shariff A, Bacchus LJ, Hossain M, Cislaghi B. Gender norms and family planning amongst pastoralists in Kenya: a qualitative study in Wajir and Mandera. Sex Reprod Health Matters 2022; 30:2135736. [PMID: 36416930 PMCID: PMC9704065 DOI: 10.1080/26410397.2022.2135736] [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] [Indexed: 11/24/2022] Open
Abstract
There is growing recognition among global health practitioners of the importance of rights-based family planning (FP) programming that addresses inequities. Despite Kenya achieving its national FP target, inequities in access and use of modern FP remain, especially amongst marginalised nomadic and semi-nomadic pastoralist communities. Few studies explore norms affecting FP practices amongst nomadic and semi-nomadic pastoralists and how these can influence social and behaviour change (SBC) interventions. We carried out 48 in-depth interviews and 16 focus group discussions with women and men from pastoralist communities in North Eastern Kenya in November 2018. Data were analysed thematically. Results from focus groups and interviews confirmed themes, while allowing differences between the qualitative approaches to emerge. We found that large family size was a descriptive and injunctive norm in both nomadic and semi-nomadic communities. The desire for around 10 children was sustained by religious beliefs and pastoralist ways of living. Despite a desire for large families, maintaining child spacing was encouraged and practised through breastfeeding and sexual abstinence. Most participants viewed modern FP negatively and as something used by "others". However, it was acceptable in order to prevent severe negative health outcomes. Future FP research to inform interventions should continue to consider community fertility preferences and the rationale for these, including norms, religion and power dynamics. Targeted qualitative social norms research could inform multi-component SBC interventions in this context.
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Affiliation(s)
- Leah Kenny
- Research Officer, London School of Hygiene and Tropical Medicine, London, UK
- London School of Economics and Political Science, London, UK
| | - Michelle Lokot
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Amiya Bhatia
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahma Hassan
- PhD Fellow, University of Nairobi, Nairobi, Kenya
| | - Shannon Pyror
- Family Planning Technical Lead, Save the Children, WashingtonDC, USA
| | | | - Abdullahi Aden
- Programme Manager, Wajir Field Office, Save the Children, Nairobi, Kenya
| | - Abdalla Shariff
- Programme Manager, Mandera Field Office Save the Children, Nairobi, Kenya
| | - Loraine J. Bacchus
- Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- Associate Professorial Research Fellow, London School of Hygiene and Tropical Medicine, London, UK
- Honorary Associate Professor, London School of Economics and Political Science, London, UK
| | - Beniamino Cislaghi
- Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
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13
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Githinji F, Maru SM, Karimi PN, Rutungwa E, Kayitare E. Factors affecting provision of female family planning commodities in public health facilities in Kajiado county, Kenya. J Pharm Policy Pract 2022; 15:91. [PMID: 36434712 PMCID: PMC9694591 DOI: 10.1186/s40545-022-00488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Family planning involves the use of traditional or modern methods to prevent maternal and infant mortality associated with unintended pregnancies and negative economic outcomes. In sub-Saharan Africa, the unmet need for modern family planning is approximately 66%. However, information on factors affecting utilization of female family planning commodities is limited. Therefore, this research was conducted to bridge this gap. METHODS Health facility-based descriptive cross-sectional research design was conducted and involved the public health facilities offering family planning, targeting respondents who handle the commodities and service providers themselves. A semi-structured questionnaire was used to collect data about availability of the commodities, knowledge of service providers and barriers affecting provision of the service. Data were coded and analyzed via Microsoft Excel 2019 and SPSS version 20. RESULTS The study showed that shorter term methods were more readily available, 60-75% than the long-term methods, 20-60%. Approximately 60% of the service providers did not comprehensively utilize the recommended World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision. Stock outs, myths and misconceptions, male interference and culture were the major barriers identified. CONCLUSION Provision of family planning commodities in public health facilities in Kajiado county is affected by stock levels at the national program, and provider knowledge on WHO MEC. The key factors affecting provision of family planning were stock outs, myths and misconceptions on the contraceptives, inadequate male involvement and inadequate community engagement on potential benefits of the service. These challenges need to be part of the solutions to bridging the gap identified.
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Affiliation(s)
- Fredrick Githinji
- grid.10818.300000 0004 0620 2260EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Shital M. Maru
- grid.10604.330000 0001 2019 0495Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Peter N. Karimi
- grid.10604.330000 0001 2019 0495Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Eugene Rutungwa
- grid.10818.300000 0004 0620 2260EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicines and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.10818.300000 0004 0620 2260School of Business, College of Business and Economics, University of Rwanda, Kigali, Rwanda
| | - Egide Kayitare
- grid.10818.300000 0004 0620 2260School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Lowe H, Kenny L, Hassan R, Bacchus LJ, Njoroge P, Dagadu NA, Hossain M, Cislaghi B. 'If she gets married when she is young, she will give birth to many kids': a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya. CULTURE, HEALTH & SEXUALITY 2022; 24:886-901. [PMID: 33754958 DOI: 10.1080/13691058.2021.1893821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
Child marriage is associated with adverse health and social outcomes for women and girls. Among pastoralists in Kenya, child marriage is believed to be higher compared to the national average. This paper explores how social norms and contextual factors sustain child marriage in communities living in conflict-affected North Eastern Kenya. In-depth interviews were carried out with nomadic and semi-nomadic women and men of reproductive age in Wajir and Mandera counties. Participants were purposively sampled across a range of age groups and community types. Interviews were analysed thematically and guided by a social norms approach. We found changes in the way young couples meet and evidence for negative perceptions of child marriage due to its impact on the girls' reproductive health and gender inequality. Despite this, child marriage was common amongst nomadic and semi-nomadic women. Two overarching themes explained child marriage practices: 1) gender norms, and 2) desire for large family size. Our findings complement the global literature, while contributing perspectives of pastoralist groups. Contextual factors of poverty, traditional pastoral lifestyles and limited formal education opportunities for girls, supported large family norms and gender norms that encouraged and sustained child marriage.
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Affiliation(s)
- Hattie Lowe
- Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Leah Kenny
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahma Hassan
- Institute for Development Studies, University of Nairobi, Nairobi, Kenya
| | - Loraine J Bacchus
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mazeda Hossain
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Beniamino Cislaghi
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Al-Sheyab NA, Al Nsour M, Khader YS, Yousif H, Alyahya MS, Taha H, Bardus M, Al Kattan M, Amiri M. Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics. Heliyon 2021; 7:e07810. [PMID: 34458635 PMCID: PMC8379452 DOI: 10.1016/j.heliyon.2021.e07810] [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: 11/22/2020] [Revised: 04/02/2021] [Accepted: 08/12/2021] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES This study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan. METHODS Explorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis. RESULTS Two themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality. CONCLUSIONS This study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.
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Affiliation(s)
- Nihaya A. Al-Sheyab
- Allied Medical Sciences, Department/Faculty of Applied Medical Sciences, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan
| | - Mohannad Al Nsour
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Yousef S. Khader
- Department of Community Medicine, Public Health and Family Medicine/ Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Hind Yousif
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Mohammad S. Alyahya
- Faculty of Medicine, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan
| | - Hana Taha
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Marco Bardus
- Department of Health Promotion & Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, P.O. Box (11-0236), Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Malika Al Kattan
- Department of Health Promotion & Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, P.O. Box (11-0236), Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mirwais Amiri
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
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Casey SE, Isa GP, Isumbisho Mazambi E, Giuffrida MM, Jayne Kulkarni M, Perera SM. Community perceptions of the impact of war on unintended pregnancy and induced abortion in Protection of Civilian sites in Juba, South Sudan. Glob Public Health 2021; 17:2176-2189. [PMID: 34323171 DOI: 10.1080/17441692.2021.1959939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Conflict and mass displacement into Protection of Civilian (POCs) sites in South Sudan led to the breakdown of community and family structures, increasing women and girls' vulnerability to gender-based violence and exacerbating already poor sexual and reproductive health outcomes. As one component of a study on post-abortion care, this study explores community perceptions of unintended pregnancy and abortion in a POC in Juba. Four focus group discussions were conducted with 36 women and married men aged 18-45 living in the POC. Although initial reactions to induced abortion were generally negative, participants discussed that unintended pregnancy and induced abortion appeared to have increased during the current conflict. Their discussion of abortion became less condemnatory as they described changes in people's situation due to war, including instability and poverty, transactional sex, disruption of marital norms, rape, and low contraceptive use. This is one of the first studies to investigate community perceptions and practices related to unintended pregnancy and abortion in South Sudan. Despite the beliefs that these are taboo topics, the discussions provide an opening to reduce abortion stigma. To ensure lasting stigma reduction, investment in women and girls to improve gender equity is needed.
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Affiliation(s)
- Sara E Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Monica M Giuffrida
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Meghana Jayne Kulkarni
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Perceived norms, personal agency, and postpartum family planning intentions among first-time mothers age 15-24 years in Kinshasa: A cross-sectional analysis. PLoS One 2021; 16:e0254085. [PMID: 34242267 PMCID: PMC8270160 DOI: 10.1371/journal.pone.0254085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Unintended pregnancy is an important global health problem and frequently occurs during the immediate postpartum period. However, few studies have examined postpartum family planning (PPFP) intentions among adolescent girls and young women. This study assessed whether perceived norms and personal agency predicted PPFP intentions among first-time mothers age 15–24 in Kinshasa, the Democratic Republic of Congo. Data were derived from the 2018 Momentum Project baseline survey. Analysis was based on 2,418 nulliparous pregnant women age 15–24 who were approximately six months pregnant with their first child in six health zones of Kinshasa. Overall PPFP intentions were low and ten to thirteen percent of women stated they were very likely to discuss PPFP next month with (a) their husband/male partner and (b) a health worker, and to (c) obtain and (d) use a contraceptive method during the first six weeks following childbirth. The results of multivariable linear regression models indicated that the PPFP intention index was predicted by description norms, perceptions of the larger community’s approval of PPFP, normative expectations, perceived behavioral control, self-efficacy, and autonomy. Rejection of family planning myths and misconceptions was also a significant predictor. Interaction terms suggested that the association of normative expectations with PPFP intentions varied across ethnic groups and that the positive association of injunctive norms with PPFP intentions was significantly increased when the larger community was perceived to disapprove of PPFP use. Normative expectations and PPFP-related self-efficacy accounted for two-thirds of the variance in PPFP intentions. The results suggested that understanding different normative influences may be important to motivate women to use contraception in the immediate postpartum period. In addition to addressing institutional, individual, and social determinants of PPFP, programs should consider integrating norm-based and empowerment strategies.
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18
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Kenny L, Hassan R, Bacchus LJ, Smith M, Shell-Duncan B, Dagadu NA, Muriuki A, Aden AH, Jelle IA, Cislaghi B, Hossain M. Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis. Reprod Health 2021; 18:108. [PMID: 34039368 PMCID: PMC8157425 DOI: 10.1186/s12978-021-01164-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). METHODS Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. RESULTS Women named 10-12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. CONCLUSIONS Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks.
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Affiliation(s)
- Leah Kenny
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
- Present Address: Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Rahma Hassan
- Institute for Development Studies, University of Nairobi, 4 Harry Thuku Rd, Nairobi, Kenya
| | - Loraine J. Bacchus
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
| | - Matthew Smith
- The Business School, Edinburgh Napier University, Edinburgh, EH14 1DJ UK
| | - Bettina Shell-Duncan
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100 USA
| | - Nana Apenem Dagadu
- Save the Children US, 899 North Capitol St NE, Suite 900, Washington, DC 20002 USA
| | - Angela Muriuki
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Abdullahi Hussein Aden
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Ibrahim Abdirizak Jelle
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Beniamino Cislaghi
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
| | - Mazeda Hossain
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
- Present Address: Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
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Zimmerman LA, Sarnak DO, Karp C, Wood SN, Moreau C, Kibira SPS, Makumbi F. Family Planning Beliefs and Their Association with Contraceptive Use Dynamics: Results from a Longitudinal Study in Uganda. Stud Fam Plann 2021; 52:241-258. [PMID: 34015142 PMCID: PMC9290856 DOI: 10.1111/sifp.12153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Norms and beliefs toward contraception, both positive and negative, motivate contraceptive use; however, they have seldom been explored longitudinally in low‐ and middle‐income countries, limiting our understanding of their influence on contraceptive dynamics. We used PMA2020 Uganda national longitudinal data of reproductive aged women in 2018 (baseline) and 2019 (follow‐up) to explore discontinuation and switching among modern contraceptive users at baseline (n = 688) and contraceptive use at follow‐up among nonusers at baseline (n = 1,377). Multivariable simple and multinomial logistic regressions assessed the association of individual and community‐level contraceptive beliefs with contraceptive uptake, discontinuation and switching. One‐quarter of nonusers at baseline were using contraception at follow‐up, while 37 percent of users at baseline had discontinued and 28 percent had switched methods at follow‐up. The odds of contraceptive uptake were lower among women who strongly agreed that contraception impacted future fertility or caused conflict within a couple, relative to those who strongly disagreed (adjusted odds ratio (aOR): 0.7 and aOR: 0.6, respectively), but higher among women who strongly agreed that contraception preserved beauty (aOR: 1.6). Women who strongly agreed that it was acceptable to use contraception before having children were less likely to discontinue their method than those who strongly disagreed (adjusted relative risk ratio (aRRR): 0.5), though living in a community where more women agreed with this statement was associated with higher discontinuation (aRRR: 6.0). Family planning programs that promote positive beliefs toward family planning could improve contraceptive uptake and continuation. More research is needed to understand how contraceptive beliefs shape contraceptive decisions across the life course.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Dana O Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,"Soins et Sant" primaire, CESP Centre for Research in Epidemiology and Population Health, France
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
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Shojaeian Z, Khadivzadeh T, Sahebi A, Kareshki H, Tara F. Perceived Risk in Women with High Risk Pregnancy: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:168-174. [PMID: 34036066 PMCID: PMC8132863 DOI: 10.4103/ijnmr.ijnmr_32_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/30/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
Background: Risk perception in high-risk pregnancies influences the mothers' adherence to medical treatments and recommendations. Because of the lack of information about the women's perception of risk, the aim of this study was to explain perception of risk in high-risk pregnancies. Materials and Methods: This qualitative study was conducted on 25 women with a high-risk pregnancy in educational hospitals of Mashhad, Iran, from August 2017 to August 2018. Data were collected through semi-structured interviews and data saturation was reached after 29 interviews. Data collection and analysis were simultaneously carried out using the qualitative content analysis method adopted by Elo and Kyngäs in MAXQDA software. Results: Data analysis resulted in the four main categories of perception of risk control ability (risk controlling through experience, risk tolerance through relying on a higher power, and risk tolerance to reach family goals), wrong estimation of risk (wrong calculation of possible risks based on wrong beliefs and knowledge, and incorrect risk estimation caused by misunderstanding), possibility of mutual vulnerability of pregnancy and risk condition (possibility of vulnerability of the fetus to risk factors, and possibility of the mother's vulnerability to risk factors), and induced risk (risk induced by negative experiences, induced threat of unknown pregnancy outcome, and fear of ambiguous medical terms). Conclusions: The results of this study promoted our understanding of risk perception in women with high-risk pregnancies. Therefore, it will help to establish a-Ž better link between women with a high-risk pregnancy and the health team, enhance and improve maternal and fetal care.
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Affiliation(s)
- Zahra Shojaeian
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Sahebi
- Department of Psychology, William Glaser institute, Sydney, Australia
| | - Hossein Kareshki
- Department of Counseling Educational Psychology, School of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Fatemeh Tara
- Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
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Voleti S, Okello E, Murali M, Sarnacki R, Majwala A, Ssembatya R, Bakka O, Namisanvu H, Njeri A, Matovu A, DeStigter K, Sable C, Beaton A. The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study. BMC Pregnancy Childbirth 2020; 20:611. [PMID: 33036571 PMCID: PMC7547429 DOI: 10.1186/s12884-020-03189-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/19/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015-2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. METHODS A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. RESULTS The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. CONCLUSIONS Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.
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Affiliation(s)
- Sonia Voleti
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Emmy Okello
- The Uganda Heart Institute, Ward 1 C, Mulago Hospital Complex, Kampala, Uganda
| | - Meghna Murali
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Rachel Sarnacki
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Albert Majwala
- The Uganda Heart Institute, Ward 1 C, Mulago Hospital Complex, Kampala, Uganda
| | - Renny Ssembatya
- Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda
| | - Olivia Bakka
- Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda
| | | | - Angela Njeri
- Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda
| | | | - Kristen DeStigter
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, USA
| | - Craig Sable
- Department of Cardiology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA.,The University of Cincinnati School of Medicine, Cincinnati, OH, USA
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Ahinkorah BO, Seidu AA, Appiah F, Budu E, Adu C, Aderoju YBG, Adoboi F, Ajayi AI. Individual and community-level factors associated with modern contraceptive use among adolescent girls and young women in Mali: a mixed effects multilevel analysis of the 2018 Mali demographic and health survey. Contracept Reprod Med 2020; 5:27. [PMID: 33062298 PMCID: PMC7547459 DOI: 10.1186/s40834-020-00132-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unintended pregnancy constitutes a significant public health challenge in sub-Saharan Africa and particularly among young people, who are more likely to closely space births and experience adverse obstetric outcomes. Studies on modern contraceptive use have mostly focused on women of reproductive age in general with limited attention to factors associated with modern contraceptive use among adolescents and young women (aged 15–24) in Mali. We examined the individual and community-level factors associated with modern contraceptive use among this age cohort using the 2018 Mali demographic and health survey data. Methods We analyzed data from 2639 adolescent girls and young women, and our outcome of interest was current use of modern contraceptives. We performed descriptive analysis using frequencies and percentages and inferential analysis using mixed-effects multilevel logistic regression. The results of the mixed-effects multilevel logistic regression were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Results The prevalence of modern contraceptive use among adolescent girls and young women in Mali was 17.1% [95% CI, 15–19%]. Adolescent girls and young women who were married [aOR = 0.20, CI = 0.09–0.41], had no formal education [aOR = 0.43, CI = 0.32–0.59], in the poorest wealth quintile [aOR = 0.38, CI = 0.19–0.79] and had no children [aOR = 0.38, CI = 0.27–0.53] were less likely to use modern contraceptives. Similarly, those who had low knowledge of modern contraception [aOR = 0.60, CI = 0.42–0.85] and whose ideal number of children was six or more [aOR = 0.66, CI = 0.43–0.99] were less likely to use modern contraceptives. However, those with four or more births were more likely to use modern contraceptives [aOR = 1.85, CI = 1.24–2.77]. Conclusion Modern contraceptive use among adolescent girls and young women in Mali has improved slightly relative to the prevalence of 2012, though the prevalence is still low, compared to the prevalence in other sub-Saharan African countries and the prevalence globally. Individual-level factors such as marital status, educational level, wealth quintile, parity, ethnicity and ideal number of children were associated with the use of modern contraceptive among adolescent girls and young women in Mali. Community knowledge of modern contraceptives was found as a community-level factor associated with modern contraceptive use among adolescent girls and young women. Therefore, Mali’s Ministry of Health and Public Hygiene's Health Promotion and Education unit should prioritise and intensify contraceptive education to increase coverage of modern contraceptive use and address disparities in the use of modern contraceptives. Such education should be done, taking into consideration factors at the individual and community-level of the target population.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Francis Appiah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaa Boahemaa Gyasi Aderoju
- Department of Adult Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, 00100 Kenya
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Belaid L, Bayo P, Kamau L, Nakimuli E, Omoro E, Lobor R, Samson B, Dimiti A. Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan: a scoping review. Confl Health 2020; 14:20. [PMID: 32313550 PMCID: PMC7155266 DOI: 10.1186/s13031-020-00258-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. Strengthening the healthcare system is a key strategy for the implementation of effective policies and ultimately the improvement of health outcomes. South Sudan is a fragile country that faces challenges in implementing its reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) policies. In this paper, we map the key RMNCAH policies and describe the current status of the WHO health system building blocks that impede the implementation of RMNCAH policies in South Sudan. METHODS We conducted a scoping review (39 documents) and individual interviews (n = 8) with staff from the national Ministry of Health (MoH) and implementing partners. We organized a workshop to discuss and validate the findings with the MoH and implementing partner staff. We synthesized and analyzed the data according to the WHO health system building blocks. RESULTS The significant number of policies and healthcare strategic plans focused on pregnant women, neonates, children, and adolescents evidence the political will of the MoH to improve the health of members of these categories of the population. The gap in the implementation of policies is mainly due to the weaknesses identified in different health system building blocks. A critical shortage of human resources across the blocks and levels of the health system, a lack of medicines and supplies, and low national funding are the main identified bottlenecks. The upstream factors explaining these bottlenecks are the 2012 suspension of oil production, ongoing conflict, weak governance, a lack of accountability, and a low human resource capacity. The combined effects of all these factors have led to poor-quality provision and thus a low use of RMNCAH services. CONCLUSION The implementation of RMNCAH policies should be accomplished through innovative and challenging approaches to building the capacities of the MoH, establishing governance and accountability mechanisms, and increasing the health budget of the national government.
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Affiliation(s)
- Loubna Belaid
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, Montréal, Québec Canada
| | | | - Lynette Kamau
- African population and health research center, Nairobi, Kenya
| | - Eva Nakimuli
- Partners in Population and Development Africa Regional Office, Kampala, Uganda
| | - Elijo Omoro
- Torit State Ministry of Health, Juba, South Sudan
| | - Robert Lobor
- WHO, South Sudan Country Office, Juba, South Sudan
| | | | - Alexander Dimiti
- Department of Reproductive of Health, Ministry of Health, Juba, South Sudan
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Odhiambo J, Jeffery C, Lako R, Devkota B, Valadez JJ. Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011-15. Health Policy Plan 2020; 35:313-322. [PMID: 31876921 PMCID: PMC7152724 DOI: 10.1093/heapol/czz160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 12/31/2022] Open
Abstract
Health systems resilience (HSR) is defined as the ability of a health system to continue providing normal services in response to a crisis, making it a critical concept for analysis of health systems in fragile and conflict-affected settings (FCAS). However, no consensus for this definition exists and even less about how to measure HSR. We examine three current HSR definitions (maintaining function, improving function and achieving health system targets) using real-time data from South Sudan to develop a data-driven understanding of resilience. We used 14 maternal, newborn and child health (MNCH) coverage indicators from household surveys in South Sudan collected at independence (2011) and following 2 years of protracted conflict (2015), to construct a resilience index (RI) for 9 of the former 10 states and nationally. We also assessed health system stress using conflict-related indicators and developed a stress index. We cross tabulated the two indices to assess the relationship of resilience and stress. For maintaining function for 80% of MNCH indicators, seven state health systems were resilient, compared with improving function for 50% of the indicators (two states were resilient). Achieving the health system national target of 50% coverage in half of the MNCH indicators displayed no resilience. MNCH coverage levels were low, with state averages ranging between 15% and 44%. Central Equatoria State displayed high resilience and high system stress. Lakes and Northern Bahr el Ghazal displayed high resilience and low stress. Jonglei and Upper Nile States had low resilience and high stress. This study is the first to investigate HSR definitions using a resilience metric and to simultaneously measure health system stress in FCAS. Improving function is the HSR definition detecting the greatest variation in the RI. HSR and health system stress are not consistently negatively associated. HSR is highly complex warranting more in-depth analyses in FCAS.
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Affiliation(s)
- Jackline Odhiambo
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Richard Lako
- Directorate of Policy, Planning, Budgeting and Research, Ministry of Health, Juba, South Sudan
| | - Baburam Devkota
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Joseph J Valadez
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Appiah F, Seidu AA, Ahinkorah BO, Baatiema L, Ameyaw EK. Trends and determinants of contraceptive use among female adolescents in Ghana: Analysis of 2003-2014 Demographic and Health Surveys. SSM Popul Health 2020; 10:100554. [PMID: 32140540 PMCID: PMC7047172 DOI: 10.1016/j.ssmph.2020.100554] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Thirty percent (30%) of all deliveries in 2014 were recorded among adolescents in Ghana, whom contraceptive use has been found to be low. Our study, therefore, aimed to retrospectively look at the trends and determinants of contraceptive use (modern and traditional) among female adolescents in Ghana. MATERIALS AND METHODS We used data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. The sample for this study comprised sexually active female adolescents aged 15-19 for each of the rounds thereby resulting in a sample of 426 in 2003, 389 in 2008 and 726 in 2014. We calculated the proportion of adolescents using contraceptives (either traditional or modern) for each of the three surveys. We computed the use of contraceptives among adolescents and the type of contraceptives used with respect to their socio-demographic characteristics. Multinomial Logistic Regression was used to assess the determinants of contraceptive use at 95% confidence interval and Odds Ratios (OR) and p-values were reported. RESULTS Contraceptive use declined from 22.1% in 2003 to 20.4% in 2014. Adolescents who were married had lower odds [OR = 0.09, 95% CI = 0.03-0.96] of using traditional methods of contraception compared to those who were not married. Those who read newspapers at least once a week were more likely to utilize modern contraceptives [OR=1.84, CI = 1.05-4.78] compared to adolescents who did not read newspapers at all. Similarly, those who watched television at least once a week were more likely to use modern contraceptives than those who did not watch television at all [OR = 2.25, CI = 1.06-4.78]. CONCLUSION These findings imply that intensifying educational messages on contraceptive use among adolescents using various newspapers and television stations to convey the messages and emphasizing the importance of using modern contraceptive is worthwhile.
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Affiliation(s)
- Francis Appiah
- College of Humanities and Legal Studies, Faculty of Social Science, Department of Population and Health, Ghana
| | - Abdul-Aziz Seidu
- College of Humanities and Legal Studies, Faculty of Social Science, Department of Population and Health, Ghana
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Australia
| | - Linus Baatiema
- College of Humanities and Legal Studies, Faculty of Social Science, Department of Population and Health, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Australia
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Kane S, Miedema E, Dieleman M, Broerse J. 'You have a child who will call you "mama" ': understanding adolescent pregnancy in South Sudan. Glob Health Action 2019; 12:1553282. [PMID: 30620262 PMCID: PMC6327934 DOI: 10.1080/16549716.2018.1553282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pregnancy amongst adolescent girls is common in many parts of the world. The dominant discourse in public health unquestioningly paints this as a problem; it does not pay sufficient attention to girls' views. OBJECTIVES This paper presents a critical account of adolescent South Sudanese girls' reasons for and explanations of childbearing. It discusses their experiences and views on childbearing and attempts to explain their reproductive choices and actions, in context. METHODS The study draws upon 24 interviews with adolescent boys, girls and parents from Wau, South Sudan. Data was analysed using the framework analysis approach. RESULTS Three interacting themes within which adolescent girls framed their views and decisions about childbearing are identified. The local society places high value on motherhood - adolescent girls' desires to become mothers is a reproduction of this social norm. Girls linked having a child to the possibility of making one's 'own home'; in the difficult and uncertain context they lived in, for many girls, having a child (and making a home) appeared as one of the few means to be happy. In making the decision to bear a child, the girls navigated multiple dilemmas and trade-offs between an unpromising present and an uncertain future. Bearing a child and making one's 'own home' was seen as a way to exit into the world of adults, and as a strategy towards achieving security and stability. CONCLUSIONS Instead of simplistically problematizing adolescent pregnancy in South Sudan, it is important to take into account the experiences and standpoints of adolescent girls, and to recognize that in choosing to become mothers, they are in many ways exercising agency despite being severely constrained by complex, insecure and unfair social circumstances. We argue that such an approach will allow the development of more appropriate, realistic and inclusive health and social policies and programs.
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Affiliation(s)
- Sumit Kane
- a KIT Health , KIT Royal Tropical Institute , Amsterdam , The Netherlands.,b Nossal Institute for Global Health, Melbourne School of Population and Global Health , University of Melbourne , Melbourne , Australia
| | - Esther Miedema
- c Governance and Inclusive Development Programme , University of Amsterdam , Amsterdam , The Netherlands
| | - Marjolein Dieleman
- a KIT Health , KIT Royal Tropical Institute , Amsterdam , The Netherlands.,d Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , VU University Amsterdam , Amsterdam , The Netherlands
| | - Jacqueline Broerse
- d Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , VU University Amsterdam , Amsterdam , The Netherlands
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Abd El Fatah SAM, El Habashy EM, Ismail HAH. Role of receipt of antenatal care in subsequent contraceptive use at primary health care centres serving slum areas of Cairo, Egypt. EUR J CONTRACEP REPR 2019; 24:356-361. [PMID: 31305166 DOI: 10.1080/13625187.2019.1639658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Information on family planning and use of antenatal care services is vital for understanding the main influences on fertility and evaluating the success of national family planning programmes. This study aimed to explore contraceptive use and its relation to use of antenatal care services in Egypt. Methods: A cross-sectional survey was conducted among women attending three primary health care centres serving different slum areas of Cairo. Results: Most of women who used antenatal care services obtained contraception from the state sector. Although the number of antenatal care visits was not significantly associated with contraceptive use, it was a significant determining factor for the type of method used. Reasons given for non-use of contraception were related to reproductive health concerns or disapproval of contraceptive use. Conclusion: Contraceptive use is widespread in Egypt, regardless of age and level of education. Antenatal care is no longer viewed with suspicion. Antenatal care visits are an opportunity for health care providers (HCPs) to encourage the use of contraception. Repeated antenatal care visits help to engender a relationship of trust between women and HCPs. Incorporation of family planning programmes into antenatal care programmes would be an opportunity to promote modern contraceptive use.
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Affiliation(s)
- Shaimaa A M Abd El Fatah
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University , Cairo , Egypt
| | - Eman M El Habashy
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University , Cairo , Egypt
| | - Hend Ali Hassan Ismail
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University , Cairo , Egypt
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de Vargas Nunes Coll C, Ewerling F, Hellwig F, de Barros AJD. Contraception in adolescence: the influence of parity and marital status on contraceptive use in 73 low-and middle-income countries. Reprod Health 2019; 16:21. [PMID: 30791914 PMCID: PMC6383262 DOI: 10.1186/s12978-019-0686-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background There is still a large gap in relation to effectively meet the contraceptive needs and family planning goals of adolescents. Our aim was to describe how having a partner and children impact on contraceptive behavior of sexually active female adolescents from low and middle-income countries (LMICs). Methods Analyses were based on the most recent Demographic and Health Surveys and Multiple Indicator Surveys carried out since 2005 in 73 LMICs with available data for sexually active women aged 15–19 years. Modern contraceptive prevalence and demand for family planning satisfied with modern methods of contraception (mDFPS) were estimated among three subgroups of adolescents considering their parity and marital status- not married, married without children, and married with children – at national and regional levels. Results Female adolescents who were married with no children presented the lowest median modern contraceptive prevalence in all world regions, ranging from 2.9% in West & Central Africa to 29.0% in Latin America & Caribbean. Regarding mDFPS, the lowest coverage for married adolescents without children was found in West & Central Africa (12.6%), whereas Latin America & Caribbean presented the highest (50.4%). In East Asia & Pacific, not married adolescents were the group with the lowest mDFPS (17.1%). In 12 countries, mDFPS was below 10% among married adolescents without children: Angola, Chad, Congo, Congo DR, Guinea, Mozambique, Niger, Nigeria, and Senegal in Africa, Philippines and Timor-Leste in Asia and Guyana in Latin America & Caribbean. Conclusions In most countries, modern contraceptive prevalence and mDFPS were particularly low among married female adolescents without children, which should be considered a priority group for intervention. The findings suggest that social norms regarding marriage and fertility expectations and other cultural barriers have a role at least as relevant as contraceptive availability. All these aspects need to be considered in the design of family planning strategies to effectively increase modern contraceptive use among adolescents everywhere, particularly in conservative contexts. Electronic supplementary material The online version of this article (10.1186/s12978-019-0686-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina de Vargas Nunes Coll
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, Brazil.
| | - Fernanda Ewerling
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, Brazil
| | - Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, Brazil
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Gee S, Vargas J, Foster AM. "We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:40. [PMID: 30419924 PMCID: PMC6233510 DOI: 10.1186/s12914-018-0181-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/31/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan. METHODS In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques. RESULTS We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn's umbilicus. CONCLUSIONS Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.
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Affiliation(s)
- Stephanie Gee
- United Nations High Commissioner for Refugees, Case Postale 2500, CH-1211 Genève 2, Dépôt Switzerland
| | - Josep Vargas
- United Nations High Commissioner for Refugees, Case Postale 2500, CH-1211 Genève 2, Dépôt Switzerland
| | - Angel M. Foster
- University of Ottawa, 1 Stewart Street, 312-B, Ottawa, ON K1N6N5 Canada
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Safe sex norm questionnaire for female sex workers: development and validation study in Iran. Public Health 2018; 164:82-90. [PMID: 30218915 DOI: 10.1016/j.puhe.2018.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/22/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of the present study was to develop and validate a safe sex norm questionnaire as an appropriate instrument which would be adaptable to the female sex worker (FSW) population. STUDY DESIGN A mixed method study. METHODS Appropriate content was prepared through a literature review. Content validation indices were assessed using interviews with content experts and lay experts. A conservative approach was used to assess the inter-rater agreement among the participants about the instrument relevance and clarity. The scale content validity index was computed using the average method. Non-parametric Mokken scale analysis was used for assessing scalability and unidimensionality of the questionnaire in a sample of 170 FSWs in Tehran. To evaluate the reliability and internal consistency of the questionnaire intra-class correlation and Cronbach's alpha were employed. RESULTS A list of 34 items was finalized, with subscales for actual behavioral norms and for perceived norms. The relevance of the actual and perceived norms subscales in the final questionnaire was higher than 96%; clarity of the subtests was 99% and higher. The comprehensiveness of the actual and perceived norms subscales was 85% for both. Mokken scale analysis showed that the two subscales were distinct constructs, and all items are good indicators for the constructs. CONCLUSION Our findings support that the safe sex norm questionnaire is a valid and reliable measure that would be useful to harm reduction programs and help effective HIV prevention among female sex workers.
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Chang AY, Nabbaale J, Nalubwama H, Okello E, Ssinabulya I, Longenecker CT, Webel AR. Motivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception. PLoS One 2018; 13:e0194030. [PMID: 29590159 PMCID: PMC5874006 DOI: 10.1371/journal.pone.0194030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 02/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is a leading cause of premature mortality in low- and middle-income countries (LMICs). Women of reproductive age are a unique and vulnerable group of RHD patients, due to increased risk of cardiovascular complications and death during pregnancy. Yet, less than 5% of women of childbearing age with RHD in LMICs use contraceptives, and one in five pregnant women with RHD take warfarin despite known teratogenicity. It is unclear whether this suboptimal contraception and anticoagulant use during pregnancy is due to lack of health system resources, limited health literacy, or social pressure to bear children. Methods We conducted a mixed methods study of 75 women living with RHD in Uganda. Questionnaires were administered to 50 patients. Transcripts from three focus groups with 25 participants were analyzed using qualitative description methodology. Results Several themes emerged from the focus groups, including pregnancy as a calculated risk; misconceptions about side-effects of contraceptives and anticoagulation; reproductive decision-making control by male partners, in-laws, or physicians; abandonment of patients by male partners; and considerable stigma against heart disease patients for both their reproductive and financial limitations (often worse than that directed against HIV patients). All questionnaire respondents were told by physicians that their hearts were not strong enough to support a pregnancy. Only 14% used contraception while taking warfarin. All participants felt that society would look poorly on a woman who cannot have children due to a heart condition. Conclusions To our knowledge, this is the first qualitative study of female RHD patients and their attitudes toward cardiovascular disorders and reproduction. Our results suggest that health programs targeting heart disease in LMICs must pay special attention to the needs of women of childbearing age. There are opportunities for improved family/societal education programs and community engagement, leading to better outcomes and patient empowerment.
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Affiliation(s)
- Andrew Y. Chang
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Juliet Nabbaale
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Haddy Nalubwama
- School of Public Health, Makerere University, Kampala, Uganda
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | - Christopher T. Longenecker
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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Kane S, Rial M, Kok M, Matere A, Dieleman M, Broerse JEW. Too afraid to go: fears of dignity violations as reasons for non-use of maternal health services in South Sudan. Reprod Health 2018; 15:51. [PMID: 29559000 PMCID: PMC5859446 DOI: 10.1186/s12978-018-0487-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from using services is key to developing and implementing locally appropriate public health interventions. METHODS A qualitative study was conducted to gain insight into what hinders women from using maternal health services. Focus group discussions (5) and interviews (44) were conducted with purposefully selected community members and health personnel. A thematic analysis was done to identify key themes. RESULTS While accessibility, affordability, and perceptions (need and quality of care) related barriers to the use of maternal health services exist and are important, women's decisions to use services are also shaped by a variety of social fears. Societal interactions entailed in the process of going to a health facility, interactions with other people, particularly other women on the facility premises, and the care encounters with health workers, are moments where women are afraid of experiencing dignity violations. Women's decisions to step out of their homes to seek maternal health care are the results of a complex trade-off they make or are willing to make between potential threats to their dignity in the various social spaces they need to traverse in the process of seeking care, their views on ownership of and responsibility for the unborn, and the benefits they ascribe to the care available to them. CONCLUSIONS Geographical accessibility, affordability, and perceptions related barriers to the use of maternal health services in South Sudan remain; they need to be addressed. Explicit attention also needs to be paid to address social accessibility related barriers; among others, to identify, address and allay the various social fears and fears of dignity violations that may hold women back from using services. Health services should work towards transforming health facilities into social spaces where all women's and citizen's dignity is protected and upheld.
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Affiliation(s)
- Sumit Kane
- KIT Royal Tropical Institute, Mauritskade 63, Amsterdam, 1092 AD, The Netherlands. .,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, VIC, 3010, Australia.
| | - Matilda Rial
- Independent Consultant, Wau, Western Bahr el Ghazal, South Sudan
| | - Maryse Kok
- KIT Royal Tropical Institute, Mauritskade 63, Amsterdam, 1092 AD, The Netherlands
| | - Anthony Matere
- School of Public and Environmental Health, University of Bahr el Ghazal, Wau, Western Bahr el Ghazal, South Sudan
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Mauritskade 63, Amsterdam, 1092 AD, The Netherlands.,Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline E W Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Analysis of Health Behaviors and Personal Values of Childless Women, Pregnant Women and Women Who Recently Delivered. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030411. [PMID: 29495488 PMCID: PMC5876956 DOI: 10.3390/ijerph15030411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/08/2018] [Accepted: 02/25/2018] [Indexed: 11/25/2022]
Abstract
Preconception lifestyle modifications and reduction of several known risk factors may have an influence on future pregnancy outcomes. The aim of the study was to analyze health behaviors and personal values as well as to assess the relationship between these factors in women without children, in pregnant women and in women who had already delivered babies. The questionnaire survey included the Health Behavior Inventory (HBI), the Personal Value List (PVL) and sociodemographic data and was conducted in 538 women. These women were divided into three groups: women who had recently delivered (n = 235), pregnant women (n = 121) and childless women (n = 182). Pregnant women demonstrated a significantly higher level of declared health behaviors, and also, they rated higher on the subscales values “positive mental attitude” and “health practices”, in comparison to women who had recently delivered and to childless women. In all tested groups, the highest rated personal value was “a successful family life”, while the most appreciated symbol of happiness was “love and friendship”. Our results suggest that the system of values and the perception of happiness symbols may influence women’s health behaviors. Positioning “health” in the hierarchy of personal values as the most important one may facilitate the introduction of healthy behaviors. This, in turn, could reduce several adverse pregnancy outcomes that are potentially modifiable with changing preconception health attitudes. Our results also identify several unanswered questions and highlight areas where new research is needed.
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Kane S, Rial M, Matere A, Dieleman M, Broerse JEW, Kok M. Gender relations and women's reproductive health in South Sudan. Glob Health Action 2016; 9:33047. [PMID: 27900934 PMCID: PMC5129092 DOI: 10.3402/gha.v9.33047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/10/2016] [Accepted: 11/03/2016] [Indexed: 11/17/2022] Open
Abstract
Background In South Sudan, women disproportionately bear the burden of morbidity and mortality related to sexual and reproductive health, with a maternal mortality ratio of 789 deaths per 100,000 live births. Design A qualitative study was conducted to analyze how gendered social relations among the Fertit people affect women's ability to exercise control over their reproductive lives and thereby their sexual and reproductive health. Transcripts of 5 focus group discussions and 44 semi-structured interviews conducted with purposefully selected community members and health personnel were analyzed using Connell's relational theory of gender. Results Women across all age groups report that they have little choice but to meet the childbearing demands of husbands and their families. Women, both young and old, and also elders, are frustrated about how men and society are letting them down and how they are left to bear the reproductive burden. The poverty and chronic insecurity in South Sudan mean that many men have few sources of pride and achievement; conformity and complicity with the hegemonic practices accord both security and a sense of belonging and privilege to men, often at the expense of women's reproductive health. Conclusions Inequalities in the domestic, social, and economic spheres intersect to create social situations wherein Fertit women's agency in the reproductive realm is constrained. In South Sudan, as long as economic and social opportunities for women remain restricted, and as long as insecurity and uncertainty remain, many women will have little choice but to resort to having many children to safeguard their fragile present and future. Unless structural measures are taken to address these inequalities, there is a risk of both a widening of existing health inequalities and the emergence of new inequalities.
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Affiliation(s)
- Sumit Kane
- KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands;
| | - Matilda Rial
- Independent Consultant, Wau, Western Bahr el Ghazal, South Sudan
| | - Anthony Matere
- School of Public and Environmental Health, University of Bahr el Ghazal, Wau, Western Bahr el Ghazal, South Sudan
| | | | - Jacqueline E W Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Maryse Kok
- KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands
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