Factors influencing the use of contraceptives through the lens of teenage women: a qualitative study in Iran

Identifying the causes and consequences of pregnancy in Iranian Kurdish women under the age of 18: A grounded theory study

Background

Since teenage pregnancy is one of the major challenges for healthcare systems worldwide and can pose risks to the health of young mothers and their infants, the present study was conducted to identify the Identifying the causes and consequences of pregnancy in Iranian Kurdish women under the age of 18.

Method

The present qualitative research was conducted using the grounded theory method among women with experience of pregnancy under the age of 18 and key informants who had experience and knowledge in this field. Data were collected through semi-structured face-to-face interviews with 26 women and 17 key informants who were selected through purposive, snowball, and theoretical sampling methods. Sampling continued until theoretical saturation. The data were collected and analyzed for 8 months, from November 2021 to June 2022. Data analysis was performed based on the approach of Strauss and Corbin in the MAXQDA-2018 software environment. The Guba and Lincoln criteria were observed to ensure the trustworthiness of the data and results.

Results

After the data analysis and coding process, the conceptual model of causes and consequences of pregnancy in adolescents emerged, including 1) predisposing conditions (sociocultural factors: Social learning, misconceptions about fertility and childbirth, preventing stigma), 2) causal conditions (individual factors: lack of knowledge on how to prevent pregnancy, improper use of contraceptives, inadequate knowledge about the risks of pregnancy in adolescence, fear of the side effects of using contraceptives, filling the vacuum of loneliness, family factors: husband's and his family's pressure, committing her husband to life, consolidating her position in family), 3) intervening conditions (structural factors: no barriers to pregnancy, difficult access to contraceptives), 4) strategies and interactions (positive reactions: trying to prepare herself for raising a child, taking better care of herself and her child, negative reactions: trying to kill herself and the kid, fear and concealment), and 5) consequences (destructive consequences: threats to the health of the child, threat to mother's health, inadequate access to health services, constructive consequences: increase of support, strengthen the sense of empowerment).

Conclusion

Pregnancy in adolescence is influenced by socio-cultural, family, personal, and structural factors that can lead to positive and negative consequences for women, which in most cases make the lives and health of them and their children difficult. The findings of the study can be used in the areas of health and social policy, program planning, and designing interventions and educational programs aimed at changing beliefs and cultural attitudes related to pregnancy under the age of 18 at the individual, family, and societal levels.

Contraceptive use and determinants among sexually active unmarried adolescents and young women (aged 15-24 years) in East Africa: insights from Demographic and Health Survey data

BACKGROUND

Low contraception usage among adolescents is a significant public health issue, leading to a rise in unintended pregnancies and adolescent childbearing in sub-Saharan Africa. Despite global efforts to improve access to contraception, sexually active adolescents and young women in East Africa are often overlooked, exposing them to substantial health risks. This study explored the factors influencing contraceptive use among unmarried and sexually active adolescents and young women in East African countries.

METHODS

National representative data from the 2016 Demographic and Health Survey for eight East African countries were used in the analysis. Data processing and analysis were performed using STATA 17 software. A multilevel mixed-effect logistic regression was used to identify determinants of contraceptive use at p<0.05.

RESULTS

A total of 7813 sexually active unmarried adolescents and young women were considered for the final analysis. Among these young women, 24.9% were using a contraceptive method. Age, place of residence, knowledge of contraceptive methods, employment status and educational attainment were identified as significant determining factors of contraceptive use among sexually active unmarried adolescents and young women (aged 15-24 y) in East Africa.

CONCLUSIONS

Contraceptive utilization among sexually active unmarried adolescents and young women was relatively low in East African countries. Addressing the existing inequalities in access to contraceptive services for rural adolescents and young women in East African countries is crucial. Prioritizing policies that implement comprehensive sexual education is essential to enhance their knowledge of contraceptives and empower them to make informed decisions.

The effect of an educational peer-based intervention program on sexual and reproductive health behavior

INTRODUCTION

The fact that adolescent people experience risky sexual behavior and have insufficient knowledge of sexual and reproductive health (SRH) indicates the need for SRH education. This study investigates the impact of peer-educated SRH programs on the knowledge and behaviors of adolescents.

METHOD

This study was conducted as a randomized controlled trial on 275 university students. The subjects were randomly assigned to the peer educators (n = 25), intervention (n = 125) and control (n = 125) groups using systematic random sampling. Peer educators provided face-to-face SRH education to the intervention group. The researcher provided the same education to the control group via the online conference method. SRH knowledge and behavior evaluated with scales before, after, and 3 and 6 months after the SRH education. The obtained data were analyzed using SPSS version 25 through statistical tests and analysis of covariance.

RESULTS

The female and male ratio of the participants was almost equal (49.4%, 50.6%). The mean age was found to be 20.42 ± 1.14 years. The mean scores of the students in the intervention group increased from 21.20 ± 0.14 to 35.20 ± 0.07 for sexual health knowledge questionnaire (SHKQ), and from 130.56 ± 0.55 to 147,90 ± 0,25 for reproductive health scale (RHS) after the education. Compared with the control group, these increases in the mean scores of SHKQ and RHS were found to be statistically significant.

CONCLUSION

The findings show the important role of the SRH peer education method on the effect of transferring knowledge about sexual behaviors. Health and education policy-makers are advised to implicate SRH peer education.

Pregnancy and associated factors among teenage females in Hula District, Sidama region, Ethiopia: a community-based cross-sectional study

Background

Teenage pregnancy causes serious health, social, and economic consequences, with 95% occurring in developing countries. A significant number of girls start childbearing at an early age in Ethiopia, which contributes to high infant and maternal morbidity and mortality. However, the information on teenage pregnancy and related variables is limited in the study area.

Objective

To assess the prevalence of teenage pregnancy and its associated factors among teenage females in the Hula District, Sidama, Ethiopia.

Methods

A community-based cross-sectional study was employed among 518 teenagers, randomly selected between 15 February and 15 March 2023. An interviewer-administered questionnaire was used for data collection. Bivariate and multivariate logistic regression analyses were applied to assess the relationship under study.

Results

Living in rural areas compared to urban [adjusted odds ratio (AOR) = 3.90; 95% confidence interval (CI): 1.30-11.3], lack of awareness about family planning methods (AOR = 5.90; 95% CI: 1.60-22.24), unfamiliarity with the availability of family planning services (AOR = 3.20; 95% CI: 1.08-9.24), and inadequate communication about sexual issues with parents (AOR = 3.61; 95% CI: 1.14-11.56) were independently associated with teenage pregnancy.

Conclusion

The prevalence of teenage pregnancies in the Hula District was high. Factors such as residing in rural areas, limited access to information on family planning methods and services, as well as a lack of open discussions about sexual health were associated with teenage pregnancy.

What do women need to know about long-acting reversible contraception? Perspectives of women from culturally and linguistically diverse backgrounds

AIM

To identify components of an online education intervention to improve preference for, and uptake of, long-acting reversible contraception in women from culturally and linguistically diverse backgrounds (CALD).

ISSUE ADDRESSED

Women from culturally and linguistically diverse (CALD) backgrounds have greater rates of unintended pregnancies than those born locally and are less likely to use long-acting reversible contraceptives (LARCs), which are highly effective at reducing unintended pregnancy. Increasing the uptake of LARC in women from CALD backgrounds may reduce the burden of unintended pregnancy in this high-risk group. An online education intervention has been shown to be effective at increasing preference for and uptake of LARC in young women. We aimed to describe what women from CALD backgrounds thought were the potentially effective components of an online education intervention to increase preference for, and uptake of, long-acting reversible contraception.

METHODS

This qualitative study involved semi-structured interviews with six Australian English-speaking women from each of Chinese, Indian, and Middle Eastern cultural backgrounds. Women were recruited through targeted Facebook advertising. Data were analysed using Braun and Clarke thematic analysis.

RESULTS

A total of 18 participants were interviewed. We have demonstrated the importance of messages tailored to cultural values, translating the video, widening the target audience to both men and women and using specific social media platforms. For all women, the video needs to highlight the covertness of contraceptive methods, alongside stating cost and approach to access. For Indian women, the video needs to highlight the effect of LARC methods on the menstrual period for Indian women and include basic information on women's health. For Middle Eastern women the video should be explicit about LARC not equating to abortion and emphasise the low efficacy of natural contraceptive methods. For Chinese women, the video should address the misconception that hormones damage the body. Regarding delivery of the video, it should be translated and delivered by a female doctor from the same culture. For Chinese women, the video should include women from the same culture sharing anecdotes and use WeChat and Chinese schools as a platform for dissemination. For Middle Eastern and Indian women government websites should be used for dissemination. The video should be made available to all decision-makers in the reproductive planning process including male partners of Middle Eastern women, parents and peers of Chinese women, and for Indian women the male partner, family, and community leaders.

CONCLUSIONS

There is a wide range of cultural adaptations that can be made to the online education videos about LARCs to improve uptake of LARCs and hence reduce the burden of unintended pregnancy in women from CALD grounds. SO WHAT?: Our findings will be used to modify an online education video about LARCs so that it is culturally appropriate for women from CALD backgrounds.

Exploring the challenges of men who married to adolescent girls in Western Iran: A qualitative study

Background and Aims

Men face many challenges in their lives with adolescent girls that need to be identified. No research has been conducted in this field in Iran. This research aimed to explore the challenges of men married to adolescent girls in western Iran using a qualitative approach.

Methods

This research was conducted using qualitative methods and a conventional content analysis approach. Participants were 28 men in western Iran who had the experience of marrying girls under 18 years of age. Semi-structured interviews were used both face-to-face and over the phone to collect data. Also, snowballing and purposeful sampling were used to select the participants. The data were also analysed using Granheim and Lundman's approach.

Results

From the data analysis, 1 category, 9 subcategories, and 103 primary codes were obtained. The main category was lack of empathy and consensus, which includes the subcategories of sexual dissatisfaction, girls' dependence on the family, inability to fulfill the roles of a wife, not being understood in life, remaining in the world of childhood, emotional divorce, limiting progress and preventing the achievement of goals, betrayal, and chaotic life.

Conclusion

Young couples problems can be solved by measures such as giving sex education and teaching skills necessary for married life, such as problem solving skills and anger control, to adolescent men and girls, as well as training families on how to properly support adolescent couples.

Nurturing care among adolescent mothers

Many studies show the impact of adolescent mothers on child development. To prevent the impact of adolescent pregnancy, nurturing care is needed to support optimal children's development. This study aims to identify comprehensive nurturing care among adolescent mothers. This study used secondary data in the integration of the 2018 National Socioeconomic Survey and Basic Health Survey. To measure nurturing care, 5 components were used: health, adequate nutrition, security and safety, responsive caregiving, and opportunities for early learning with latent class analysis. The results of the analysis showed that 62% of adolescent mothers provided uncompleted nurturing care. About 21% of adolescent mothers need assistance in improving nurturing care related to adequate nutrition and learning opportunities, and 17% need assistance to improve health, nutrition, responsive caregiving, and opportunities for early learning. Adolescent mothers are in need of comprehensive nurturing care for their children. Practice is needed in order to enhance nurturing care initiatives, particularly for teenage mothers.

Status of Contraceptive Use for Birth Spacing After a Teenage Pregnancy: Where Do We Stand?

BACKGROUND

Adolescence is the most complex stage of reproductive health. The knowledge and awareness of adolescent-related reproductive issues are limited, particularly in lower-middle-income countries. Adolescent pregnancies are associated with major maternal and neonatal complications. Effective contraception use can prevent teenage pregnancy and subsequent complications.

METHODS

It was a cross-sectional study conducted in a tertiary care hospital and teaching institute over a period of one year. Through this study, we aimed to assess the prevalence of postpartum use of approved standard methods of contraception for birth spacing among teenage mothers and to assess the reasons for their non-acceptance. A total of 133 consecutive consenting postpartum teenage mothers were recruited in the study. Participants were asked about their age at the time of marriage and delivery, marital status, parity, education and economic status, the number of antenatal visits, mode of delivery, and antenatal complications. Compliance with postpartum contraception was noted, and reasons for its non-acceptance were asked in detail.

RESULTS

Among the 133 participants, contraceptive users were categorized into Group A and non-users into Group B. The mean age at the time of marriage was 17.6±0.4 and 17.5±0.6 years in Group A and Group B, respectively. Mothers in Group A were more educated than their counterparts in Group B (82.2% of mothers were educated up to 12th standard in Group A compared to 46.6% in Group B). Among the contraception users, 70% had four or more antenatal visits compared to 7.9% of the non-users. Reasons for non-acceptance of postpartum contraception were elicited in Group B: 42.0% had fear of becoming infertile, 38.6% feared that contraceptives interfere with breastfeeding and quality of breastmilk, 13.6% had opposition from family members, and 5.8% did not mention any reason.

CONCLUSION

Teenage pregnancy is associated with increased feto-maternal complications. It also accounts for an increased incidence of unsafe abortions and maternal mortality. So it is crucial to make the adolescent group aware of effective methods of postpartum contraceptives to prevent adolescent pregnancies. Collaborative larger multicentric studies from different countries will help to reach a better, generalized conclusion regarding the same.

What explains the large disparity in child stunting in the Philippines? A decomposition analysis

OBJECTIVE

About one-third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children.

DESIGN

Using the 2015 Philippine National Nutrition Survey, we conducted a linear probability model to examine the determinants of child stunting and then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children.

SETTING

Philippines.

PARTICIPANTS

1881 children aged 6-23 months participated in this study.

RESULTS

The overall stunting prevalence was 38·5 % with a significant gap between poor and non-poor (45·0 % v. 32·0 %). Maternal height, education and maternal nutrition status account for 26 %, 18 % and 17 % of stunting inequality, respectively. These are followed by quality of prenatal care (12 %), dietary diversity (12 %) and iron supplementation in children (5 %).

CONCLUSIONS

Maternal factors account for more than 50 % of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children.

Analysis of Unmarried Adolescents and Modern Contraceptives Initiation in Nigeria: Evidence from 2018 NDHS

Nigeria is one of Africa’s most populous countries. Nigeria’s population is expected to exceed 400 million by 2050, putting it among the top five most populous countries in the world. High birth rates, limited contraception use, and early marriage are the main causes of this rapid increase. In Nigeria, adolescents play a substantial role in these issues, with 117 births per 1000 girls aged 15–19 years. Data for this article comes from the 2018 Nigerian Demographic and Health Survey (NDHS). Our sample consisted of 1014 sexually active unmarried adolescents aged 15–19 years. Kaplan Meier’s curve, Log Rank Test, and Cox proportional hazards model were modeled to estimate the parameters at p > 0.05. Findings show that the average time to the first use of modern contraceptives after sexual initiation is two years. Initiating sex at age 15 or later, belonging to the richest household wealth quintile, and use of the internet is associated with the early initiation of modern contraceptive methods, while residing in the northwest region and being older are associated with a low incidence of modern contraceptive use. Results indicate a deferred initiation of modern contraceptives after first sexual encounter. It has become imperative for tailored interventions to improve the time of initiation of contraceptives, so as to reduce the associated burdens and consequences.

Reproductive health status of adolescent mothers in an Iranian setting: a cross-sectional study

Background

In low and middle-income countries (LMICs), where millions of women give birth before the age of 18, the reproductive health status of married adolescent mothers, including family planning, sexual, psychosocial, and maternal health, remains a significant and recurring phenomenon. As a result, the purpose of this study was to assess the reproductive health status of married adolescent mothers who sought treatment at Ardabil health care centers in 2019.

Methods

A cross-sectional study was carried out in five health centers in Ardabil, Iran. This research included 312 married adolescent mothers who were under 19 years old. Health workers who asked questions of each participant completed a demographic questionnaire and the Reproductive Health Assessment Scale for Married Adolescent Women, and all data were self-reported. Univariate and multivariate linear regressions were used to determine risk factors associated with reproductive health scores. The data was examined using statistical software (SPSS version 20).

Results

The mean age (years) of the respondents was 16.41 ± 0.85, the mean age of their husbands was 24.18 ± 2.29, and the mean age of their marriage was 15.06 ± 1.15. In this study, adolescent mothers had an average reproductive health score of 63.78 ± 11.06. There was a significant association between reproductive health status and age, education, husband’s age and education, and contraceptive methods among married adolescent mothers (p < 0.05).

Conclusion

The research findings indicated that adolescent mothers had an average level of reproductive health. Several socio-demographic characteristics, including age, education, gravida, and contraception, were linked to reproductive health scores. Programmers and policymakers should prioritize improving the reproductive health of adolescent mothers through education and increasing women’s and spouses’ knowledge and awareness.

Modern contraceptive use among adolescent girls and young women in Benin: a mixed-methods study

OBJECTIVES

The study aimed to assess the determinants of modern contraceptive method use among young women in Benin.

DESIGN

A mixed-methods design.

SETTING AND PARTICIPANTS

We used the Benin 2017-2018 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals in Benin. The participants were purposively selected.

OUTCOMES

Contraceptive prevalence rate, unmet need for modern method and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilisation of modern methods were assessed in the qualitative part.

RESULTS

Overall, 8.5% (95% CI 7.7% to 9.5%) among young women ages 15-24 were using modern contraceptives and 13% (12.1% to 14.0%) among women ages 25 or more. Women 15-24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared with women ages 25 or more. 60.8% (56.9% to 64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women's fertility, spousal consent and the use of non-modern contraceptives.

CONCLUSION

Contraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by sociodemographic factors and social norms. Appropriate interventions might promote comprehensive sexuality education, increase community engagement, provide youth-friendly services and address gender inequalities.

Contraception for married adolescents (15-19 years) in India: insights from the National Family Health Survey-4 (NFHS-4)

PURPOSE

Despite the fact that marriage below the age of 18 years is illegal in India, a considerable number of females get married and start childbearing during their adolescent years. There is low prevalence of contraceptive methods and high unmet need for family planning (FP). Realizing this, new government programs have been launched to increase the uptake of sexual and reproductive health services among adolescents. However, evidence specific to this age group remains scarce.

AIM AND OBJECTIVES

The present study was conducted to assess the prevalence of modern contraceptives among married adolescents, and to determine its association with sociodemographic variables, health worker outreach, and media exposure to FP messages in India.

METHODS

Data for this analysis was drawn from the fourth round of the National Family Health Survey (NFHS-4) conducted in India during 2015-16. The sample size is restricted to 13,232 currently married adolescent girls aged 15-19 years, who were not pregnant at the time of the survey. Bivariate and multivariate analysis were conducted to assess the levels of contraceptive use and its predictors among married adolescents.

RESULTS

The use of modern contraceptives among married adolescents increased from 4 to 10% between 1992-93 and 2015-16. The uptake of modern contraceptives was found to be low among the uneducated, those residing in rural areas, among backward classes, those practising Hindu religion, women in the poorest wealth quintile, women without children, and those with no exposure to FP messages via media or health care workers. Among those who met health care workers and discussed FP issues with them, 34.11% were using modern contraceptives as compared to 11.53% of those who did not have discussions with health care workers.

CONCLUSIONS

The evidence suggests that contact with health care workers significantly influences the use of modern contraceptives. Further focus on increasing contact between married adolescents' and health care workers, and improving the quality of counselling will protect adolescents from early marriage and pregnancy.

Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model

OBJECTIVES

This study aimed to identify the multilevel factors that influence contraceptive use and childbearing decisions in Nepal and examine relationships among these factors.

DESIGN

The study drew on qualitative data collected through in-depth interviews (IDIs) and key informant interviews (KIIs) and triangulated results.

SETTING

An urban municipality and a rural municipality in Bara district, Nepal.

PARTICIPANTS

We recruited a total of 60 participants (e.g., 20 married adolescent girls aged 15-19, 20 husbands, 20 mothers-in-law) for IDIs and 10 (e.g., four healthcare providers, three health coordinators, three female community health volunteers) for KIIs.

RESULTS

Married adolescent girls faced a range of barriers that are inter-related across different levels. Patriarchal norms and power imbalances between spouses limited their decision-making power regarding contraception. Social pressures to give birth soon after marriage drove the fear of infertility, abandonment and the stigmatisation of childless married couples, which leads to lack of women's autonomy in making decisions about family planning. Mothers-in-law and religion exerted considerable influence over couples' decisions regarding contraception. Limited access to information about the benefits and methods of family planning contributed to fear of the side effects of contraceptives and low awareness about the risks involved in adolescent pregnancy.

CONCLUSIONS

The convergent results from triangulation confirm that the decision to postpone childbearing is not merely the personal choice of an individual or a couple, highlighting the importance of targeting families and communities. The study underscores the need to challenge restrictive sociocultural norms so that adolescent girls become empowered to exercise greater control over contraceptive use.

Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: a qualitative study

BACKGROUND

The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15-19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15-19 years old) leaving out the young adolescents (10-14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years.

METHODS

This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10-14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis.

RESULTS

Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents' perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies.

CONCLUSION

The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.

Developing and Psychometric Evaluation of a Reproductive Health Assessment Scale for Married Adolescent Women: An Exploratory Mixed-Method Study

Background

Adolescent women's reproductive health is often neglected despite the high prevalence of early marriage. Since no appropriate scales were found to assess the health status of adolescent women, this study aimed to develop a reproductive health scale in married adolescent women in Iran and investigate its psychometric properties.

Materials and Methods

An exploratory mixed-methods study was conducted in Ardabil healthcare centers (Ardabil City, Iran) between May 2017 and December 2018. In the qualitative phase, 14 semi-structured in-depth interviews were conducted with married adolescent women, and two focus group discussions were held with 12 key informants. In the quantitative phase, the initial scales were validated using face, content, and construct validities. In a cross-sectional study among 300 women, Exploratory Factor Analysis (EFA) was used to assess the construct validity. Internal consistency and test-retest methods were used to review. The initial scale was designed with 45 items, but only 30 items reached the construct validity stage. EFA revealed five factors that explained 50.96% of the variance. Cronbach's alpha coefficient of 0.75 estimates the reliability of the scale.

Results

The qualitative study identified 76 items that reached 88 items through literature confirmed its reliability, and test-retest with a two-week interval confirmed its consistency (ICC = 0.99, p < 0.001). Finally, the scale was approved with 27 items and four domains: sexual, pregnancy and childbirth, psychosocial, and family planning.

Conclusions

This valid and reliable scale with cultural sensitivity can be used to help health professionals to improve the reproductive health of married adolescent women.

Identifying the causal effect of child marriage on unmet needs for modern contraception and unintended pregnancy in Nepal: a cross-sectional study using propensity score matching

OBJECTIVES

This study aimed to investigate whether child marriage had causal effects on unmet needs for modern contraception, and unintended pregnancy, by estimating the marginal (population-averaged) treatment effect of child marriage.

DESIGN

This study used secondary data from the Nepal Demographic and Health Survey 2016. Applying one-to-one nearest-neighbour matching with replacement within a calliper range of ±0.01, 15-49 years old women married before the age of 18 were matched with similar women who were married at 18 or above to reduce selection bias.

SETTING

Nationally representative population survey data.

PARTICIPANTS

The sample consisted of 7833 women aged 15-49 years who were married for more than 5 years.

OUTCOME MEASURES

Unmet needs for modern contraception and unintended pregnancy.

RESULTS

The matching method achieved adequate overlap in the propensity score distributions and balance in measured covariates between treatment and control groups with the same propensity score. Propensity score matching analysis showed that the risk of unmet needs for modern contraception, and unintended pregnancy among women married as children were a 14.3 percentage point (95 % CI 10.3 to 18.2) and a 10.1 percentage point (95 % CI 3.7 to 16.4) higher, respectively, than among women married as adults. Sensitivity analysis indicated that the estimated effects were robust to unmeasured covariates.

CONCLUSIONS

Child marriage appears to increase the risk of unmet needs for modern contraception and unintended pregnancy. These findings call for social development and public health programmes that promote delayed entry into marriage and childbearing to improve reproductive health and rights.

Drivers and consequences of child marriage in a context of protracted displacement: a qualitative study among Syrian refugees in Egypt

Background

Child marriage is a human rights violation disproportionately impacting girls in low- and middle-income countries. In the Middle East region, conflict and displacement have prompted concerns that families are increasingly resorting to child marriage to cope with economic insecurity and fears from sexual violence. This study set out to examine child marriage among Syrian refugees residing in Egypt with the aim of understanding drivers of child marriage in this context of displacement as well as how child marriage affects refugee girls’ wellbeing.

Methods

This analysis draws from 15 focus group discussions (FGD) conducted with married and unmarried girls, as well as parents of adolescent girls in three governorates in Egypt. FGDs included a participatory ranking exercise and photo-elicitation. Additionally, we conducted 29 in-depth interviews with girls and mothers, as well as 28 key informant interviews with health providers, community leaders, and humanitarian actors. The data was thematically analyzed using a combination of inductive and deductive coding.

Results

A prevalent phenomenon in pre-war Syria, child marriage has been sustained after the influx of Syrian refugees into Egypt by pre-existing cultural traditions and gender norms that prioritize the role of girls as wives and mothers. However, displacement into Egypt engendered different responses. For some families, displacement-specific challenges such as disruptions to girls’ education, protection concerns, and livelihood insecurity were found to exacerbate girls’ vulnerability to child marriage. For others, however, displacement into urban areas in Egypt may have contributed to the erosion of social norms that favored child marriage, leading to marriage postponement. Among girls who were married early, we identified a range of negative health and social consequences, including lack of family planning use, disruption to schooling and curtailment of girls’ mobility as well as challenges with marriage and birth registration which accentuated their vulnerability.

Conclusion

Efforts to address child marriage among Syrian refugees must acknowledge the different ways in which displacement can influence child marriage attitudes and practices and should capitalize on positive changes that have the potential to catalyze social norm change. Moreover, targeted, focused and contextualized interventions should not only focus on preventing child marriage but also on mitigating its impacts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10718-8.

Linking Female Adolescents' Knowledge, Attitudes and Use of Contraceptives to Adolescent Pregnancy in Ghana: A Baseline Data for Developing Sexuality Education Programmes

(1) Background: Nearly one out of ten Ghanaian female adolescents aged 15–19 has experienced childbearing in urban settlements compared to twice this number in the rural populations due to unintended pregnancies. This study assessed the linkages between knowledge, attitudes, and use of contraceptives and adolescent pregnancy in one of the highly affected Municipalities (i.e., Komenda-Edina-Eguafo Abrem [KEEA]) in Ghana. (2) Methods: Employing a facility-based sampling method, 378 female adolescents aged 15–19 were selected. Unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CI) and p-values were used for significant variables at p < 0.05. (3) Results: Pregnant adolescents were 2 times more likely to indicate that the procedure of procuring contraceptives is quite uncomfortable (aOR = 2.42, 95% CI = [1.29–4.55]; p = 0.006). Also, pregnant adolescents were 5 times more likely to have ever used traditional contraceptive methods than their non-pregnant counterparts (aOR = 5.02, 95% CI = [2.60–9.71]; p < 0.001). On the contrary, pregnant adolescents had lower odds of indicating that contraceptives are for only married people (aOR = 0.38, 95% CI = [0.20–0.70]; p = 0.002) and that it feels bad to receive contraceptive information from parents and relatives than non-pregnant adolescents (aOR = 0.42, 95% CI = [0.24–0.74]; p = 0.003). Pregnant adolescents were less likely to use modern contraceptives than their non-pregnant adolescents (aOR = 0.18, 95% CI = [0.11–0.31]; p < 0.001). (4) Conclusions: The findings indicate that female adolescents’ use of traditional contraceptives is associated with the risk of pregnancy in KEEA Municipality within the Central Region of Ghana. However, adolescents who had the perception that contraceptives are for married people and those who used modern contraceptives were less likely to get pregnant. Government and non-governmental organizations in Ghana should implement educational policies and programmes aimed at educating sexually-active female adolescents on modern contraceptives and the need to use them to prevent pregnancies. The basis for such policies and programmes should be based on evidence that compared to traditional contraceptives, modern contraceptives are more effective. In addition, there is the need to provide accurate information regarding the use of contraceptives to adolescents that will help change their attitudes towards the use of contraceptives.

Low contraceptive utilization among young married women is associated with perceived social norms and belief in contraceptive myths in rural Ethiopia

Introduction

Despite the increasingly wider availability of contraceptives and the high levels of unmet need for family planning in rural Ethiopia, contraceptive utilization among young married women is low. Studies on associated factors in Ethiopia so far have been focused on individual factors with little emphasis on socio-cultural factors. This study aimed to assess the association between contraceptive utilization and socio-cultural factors among young married women in Eastern Ethiopia.

Methods

A community-based survey was conducted among young married women aged 14–24 years. A total of 3039 women were interviewed by trained data collectors using a structured questionnaire. Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was used to identify factors associated with contraceptive utilization using multivariable logistic regression analysis.

Results

The current contraceptive prevalence rate was 14.1% (95% CI: 12.8–15.5). Perceived social approval (AOR = 1.90; 95% CI = 1.60–2.30) and perception of friends’ contraceptive practice (AOR = 1.34; 95% CI: 1.20–1.54) were significantly and positively associated with contraceptive utilization. On the contrary, increased score of belief in contraceptive myths was significantly and negatively associated with contraceptive use (AOR = 0.60; 95% CI: 0.49–0.73). Moreover, recent exposure to family planning information (AOR = 1.67; 95% CI: 1.22–2.28), ever-mother (AOR = 9.68; 95% CI: 4.47–20.90), and secondary and above education level (AOR = 1.90; 95% CI: 1.38–2.70) were significantly associated with higher odds of contraceptive utilization.

Conclusion

Only about one-in-seven young married women were using contraceptive methods. Socio-cultural factors significantly influence young married women’s contraceptive utilization. Interventions to address social norms and pervasive myths and misconceptions could increase the use of contraceptive methods in young married women.

'It is this which is normal' A qualitative study on girl child marriage and health in conakry, Guinea

Guinea has the eighth highest rate of girl child marriage, as 1 in 2 girls marry before age 18. The aim of this study was to qualitatively explore how women married as children in Conakry, Guinea see their marriage as related to their health and their children's health. This study draws from grounded theory. The primary data sources were in-depth interviews collected from August 2016 to January 2017; during that time, we also conducted brief ethnographic interviews, observation, and participant observation. Purposive sampling was used to identify 19 participants who first married before age 18. We used open coding for data analysis. At the first level of coding, key categories were identified. At the second level of coding, categories were grouped. We secured ethical board approval for all study procedures. Through this study, a new picture emerges about health experiences within girl child marriage. We found that most women perceived health disadvantages of their early marriages (n = 16), captured through themes of poor sexual and reproductive health, intimate partner violence and long-term consequences, poor mental health and psychosocial well-being, and other physical health conditions. Most women also perceived health advantages of their early marriages (n = 15), captured through themes of having children, "good health for me and my children," access to health care, delaying first pregnancy and birth spacing, and positive mental health and psychosocial well-being. Sixty-three percent of participants articulated both disadvantages and advantages of their early marriages as related to health outcomes. These findings could be considered in many marital experiences in several contexts, yet women's reflections point toward the importance of the timing of their early marriages in their experiences. Change in preventing this practice and addressing its full set of consequences will not happen effectively without incorporating the voices and experiences of women affected.

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

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.

To keep or not to keep? Decision making in adolescent pregnancies in Jamestown, Ghana

BACKGROUND

Jamestown, an urban coastal slum in Accra, Ghana, has one of the highest adolescent pregnancy rates in the country. We sought to understand the decision (to keep or terminate) factors and experiences surrounding adolescent pregnancies.

METHODS

Thirty semi-structured indepth interviews were carried out among adolescents (aged 13-19 years) who had been pregnant at least once. Half of these were adolescent mothers and the other half had at least one past experience of induced abortion. A pretested and validated questionnaire to assess the awareness and use of contraception in adolescent participants was also administered. To aid social contextualization, semi-structured in depth interviews were carried out among 23 purposively selected stakeholders.

RESULTS

The main role players in decision making included family, friends, school teachers and the partner, with pregnant adolescents playing the most prominent role. Adolescents showed a high degree of certainty in deciding to either abort or carry pregnancies to term. Interestingly, religious considerations were rarely taken into account. Although almost all adolescents (96.1%) were aware of contraception, none was using any prior to getting pregnant. Of the 15 adolescents who had had abortion experiences, 13 (87.0%) were carried out under unsafe circumstances. The main barriers to accessing safe abortion services included poor awareness of the fairly liberal nature of the Ghanaian abortion law, stigma, high cost and non-harmonization of safe abortion service fees, negative abortion experiences (death and bleeding), and distrust in the health care providers. Adolescents who chose to continue their pregnancies to term were motivated by personal and sociocultural factors.

CONCLUSION

Decision-making in adolescent pregnancies is influenced by multiple external factors, many of which are modifiable. Despite legal access to services, options for the safe termination of pregnancy or its prevention are not predominantly taken, resulting in a high number of negative experiences and outcomes. Including safe abortion care within the sexual and reproductive health package, could diminish barriers to safe abortion services. Given the vulnerability of the Jamestown setting, a comprehensive sexual education package that addresses the main decision factors is recommended. Interventions aiming to reduce adolescent pregnancy rates should also recognize that adolescent pregnancies are culturally acceptable in some settings, and under certain circumstances, are desired by the adolescents themselves.

Modern contraceptive use among sexually active women aged 15-19 years in North-Western Tanzania: results from the Adolescent 360 (A360) baseline survey

OBJECTIVES

To describe differences in modern contraceptive use among adolescent women aged 15-19 years according to their marital status and to determine factors associated with modern contraceptive use among sexually active women in this population.

DESIGN

Cross-sectional analysis of Adolescent 360 evaluation baseline survey.

SETTING

The 15 urban and semiurban wards of Ilemela district, Mwanza region, North-Western Tanzania.

PARTICIPANTS

Adolescent women aged 15-19 years who were living in the study site from August 2017 to February 2018 and who provided informed consent. Women were classified as married if they had a husband or were living as married. Unmarried women were classified as sexually active if they reported having sexual intercourse in the last 12 months.

OUTCOME MEASURE

Prevalence of modern contraceptive among adolescent women aged 15-19 years.

RESULTS

Data were available for 3511 women aged 15-19 years, of which 201 (5.7%) were married and 744 (22.5%) were unmarried-sexually active. We found strong evidence of differences in use of modern contraceptive methods according to marital status of adolescent women. Determinants of modern contraception use among unmarried-sexually active women were increasing age, increasing level of education, being in education, hearing of modern contraception from interpersonal sources or in the media in the last 12 months, perceiving partner and/or friends support for contraceptive use, as well as higher knowledge and self efficacy for contraception.

CONCLUSIONS

Sexual and reproductive health programmes aiming to increase uptake of modern contraceptives in this population of adolescent women should consider the importance of girl's education and social support for contraceptive use particularly among unmarried-sexually active women.

Pattern and determinants of contraceptive usage among women of reproductive age in the United Arab Emirates

Introduction:

Women in the UAE and Muslim countries are a largely understudied population with significant disparities in knowledge to most basic health concerns and family planning. Our objective was to identify UAE contraceptive knowledge similarities and variances to other world regions, and to inform efforts to improve contraceptive care at Arab world and Muslim countries.

Methods:

Structured questionnaire consisting of socio-demographic characteristics, knowledge, beliefs and attitudes related to contraception methods.

Results:

The use of effective contraception methods was associated with higher educational levels of UAE national women who desired to conceive. These women had knowledge of contraception that was associated with an identified impact of their spouse on their choice of contraception. Religion plays an essential role in knowledge on the risk of contraception and safe type of contraceptive methods in the UAE. Statistically significant predictors of having knowledge on different methods of contraception were nationality, P < 0.002; education level, P < 0.03; number of marriages P < 0.002; monthly income, P < 0.04; and the number of children, P < 0.015.

Conclusions:

Our results demonstrate that higher education and communication of the benefits and risks of different types of contraceptive methods are needed to improve the use of contraception in the UAE population. We recommend additional training in this area for healthcare providers. The involvement of the spouse in the mutual understanding of contraception and its choice coupled with third party insurance coverage may decrease knowledge and utilization gaps further assisting in providing a best contraceptive method.

The Need for A Training Software among Iranian Infertile Couples: A Qualitative Study

Background

Training needs are multidimensional requirements affected by social and cultural background, level of knowledge and personal and health conditions. This study was conducted to explain the needs for a training software among Iranian infertile couples.

Materials and Methods

In this qualitative study, we used content analysis to examine the need among ten infertile participants (four men and six women) and six health care professionals (including two gynecologists, two reproduc- tive health specialists and two midwives). The present research was carried out from January 2017 to July 2018 at Rouyesh and Ibn Sina infertility treatment centers in Karaj, Iran. The participants were selected through purposive sampling with maximum variation. Four focus group discussions with the health care professionals and twelve semi- structured, in-depth interviews with the infertile participants were held for data collection. Data were analyzed using conventional content analysis in MAXQDA-10.

Results

Data analysis led to the extraction of a central theme of “a multidimensional training application” and its four main categories, including "pre-treatment training", "diagnostic training", "mid- and post-treatment training" and “continuous psychological training". These main categories also had 20 subcategories.

Conclusion

Based on the results of this study, infertile women and men have multidimensional training needs before and after treatment and during the process of diagnosis; psychological aspects should also be considered.The inter- viewed health care professionals helped to explain these training needs. A training software thus needs to be designed based on the real needs of the infertile community.

Long-Term Trends in Reproductive Behavior Among Young Women in Four Countries, 1995-2009

PURPOSE

Identification of trends in the ability of young single women to protect themselves from unwelcome pregnancy is essential for evaluation and development of policies and programs. We document trends over a 15-year period in sexual activity, contraceptive use, and reproductive outcomes in four countries for single women aged 15-24 years.

METHODS

Using retrospective month-by-month reproductive and contraceptive calendars, we constructed annual sexual, contraceptive, and reproductive profiles. The analysis was applied to all four countries (Colombia, Kenya, Peru, and Zimbabwe) that had collected complete reproductive calendars in three consecutive Demographic and Health Surveys. Women-years were classified as sexually inexperienced (i.e., virgin), sexually experienced but using contraception, and sexually experienced without contraception. Conception rates were calculated and those ending in live births were classified as wanted or unwanted.

RESULTS

While virginity decreased over time in the Latin American countries, it increased in the African settings. The contribution of condom to the sexually active time protected by contraception use increased in all countries. While the percentage of conceptions ending in spontaneous or induced abortion increased in Colombia and Peru to around 15% of the total pregnancy outcomes, it decreased in the African countries to less than 6%.

CONCLUSIONS

Delayed sexual debut remains the major restraint on pregnancy in these four countries with the result that conception rates are very low. Condoms remain the most common method of contraception even in the two countries without severe HIV risks and efforts to displace condoms by nonbarrier methods should be pursued with caution.