1
|
Alam MB, Rana MS, Kabir MA, Khanam SJ, Khan MN. Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019. Disabil Health J 2024:101651. [PMID: 38866623 DOI: 10.1016/j.dhjo.2024.101651] [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: 08/31/2023] [Revised: 04/16/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Contraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being. OBJECTIVE The objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh. METHODS We analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding. RESULTS The prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65-0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47-0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities. CONCLUSIONS The study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.
Collapse
Affiliation(s)
- Md Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Shohel Rana
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Awal Kabir
- Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh.
| |
Collapse
|
2
|
Namusisi P, Yeh PT, Ssekubugu R, Chang LW, Lutalo T, Zimmerman L, Grabowski MK. The intersection between migration, HIV, and contraceptive use in Uganda: a cross-sectional population-based study. Reprod Health 2024; 21:65. [PMID: 38760855 PMCID: PMC11100193 DOI: 10.1186/s12978-024-01796-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Low use of modern methods of contraception has been linked to HIV seropositivity and to migration, but few studies have evaluated the intersection of both risk factors with contraceptive use. METHODS We analyzed cross-sectional data from sexually active female participants aged 15 to 49 years in the Rakai Community Cohort Study (RCCS) between 2011 and 2013. The RCCS is an open population-based census and individual survey in south-central Uganda. Recent in-migrants (arrival within approximately 1.5 years) into RCCS communities were identified at time of household census. The primary outcome was unsatisfied demand for a modern contraceptive method (injectable, oral pill, implant, or condom), which was defined as non-use of a modern contraceptive method among female participants who did not want to become pregnant in the next 12 months. Poisson regression models with robust variance estimators were used to identify associations and interactions between recent migration and HIV serostatus on unsatisfied contraceptive demand. RESULTS There were 3,417 sexually active participants with no intention of becoming pregnant in the next year. The mean age was 30 (± 8) years, and 17.3% (n = 591) were living with HIV. Overall, 43.9% (n = 1,500) were not using any modern contraceptive method. Recent in-migrants were somewhat more likely to have unsatisfied contraceptive demand as compared to long-term residents (adjusted prevalence risk ratio [adjPRR] = 1.14; 95% confidence interval [95%CI]: 1.02-1.27), whereas participants living with HIV were less likely to have unsatisfied contraceptive demand relative to HIV-seronegative participants (adjPRR = 0.80; 95%CI = 0.70-0.90). When stratifying on migration and HIV serostatus, we observed the highest levels of unsatisfied contraceptive demand among in-migrants living with HIV (48.7%); however, in regression analyses, interaction terms between migration and HIV serostatus were not statistically significant. CONCLUSIONS Unsatisfied contraceptive demand was high in this rural Ugandan setting. Being an in-migrant, particularly among those living with HIV, was associated with higher unsatisfied contraceptive demand.
Collapse
Affiliation(s)
- Prossy Namusisi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Kawempe National Referral Hospital, Kampala, Uganda.
| | - Ping Teresa Yeh
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Larry William Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Linnea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Hellwig F, Wado Y, Barros AJD. Association between women's empowerment and demand for family planning satisfied among Christians and Muslims in multireligious African countries. BMJ Glob Health 2024; 9:e013651. [PMID: 38724069 PMCID: PMC11085792 DOI: 10.1136/bmjgh-2023-013651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Although the levels of demand for family planning satisfied (DFPS) have increased in many countries, cultural norms remain a significant barrier in low- and middle-income countries. In the context of multireligious African countries, our objective was to investigate intersectional inequalities in DFPS by modern or traditional contraceptives according to religion and women's empowerment. METHODS Analyses were based on Demographic and Health Surveys carried out between 2010 and 2021 in African countries. Countries with at least 10% of Muslims and Christians were selected to analyse inequalities in family planning. The religious groups were characterised by wealth, area of residence, women's age and women's empowerment. The mean level of empowerment was estimated for each religious group, and multilevel Poisson regression was used to assess whether DFPS varied based on the level of women's empowerment among Muslims and Christians. RESULTS Our study sample of 14 countries comprised 35% of Muslim and 61% of Christian women. Christians had higher levels of empowerment across all three domains compared with Muslims and women with no/other religion. DFPS was also higher among Christians (57%) than among Muslims (36%). Pooled analysis indicated a consistent association between DFPS and women's empowerment, with higher prevalence ratios among Muslims than Christians, especially in the decision-making domain. CONCLUSIONS The gap between Muslims and Christians in DFPS significantly reduced as the level of empowerment increased. It highlights the importance of understanding and addressing cultural factors sensibly and respectfully to satisfy the demand for family planning services.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Posgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Yohannes Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Posgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| |
Collapse
|
4
|
Opiro K, Opee J, Sikoti M, Pebalo PF, Ayikoru JH, Akello H, Manano P, Bongomin F. Utilization of modern contraceptives among female health care workers at Gulu university teaching hospitals in Northern Uganda. Contracept Reprod Med 2024; 9:13. [PMID: 38582918 PMCID: PMC10998388 DOI: 10.1186/s40834-024-00274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND The global high rate of unintended pregnancy is a direct result of underutilization of contraceptives methods. Healthcare workers (HCWs) play a pivotal role in promoting and facilitating access to modern family planning services. By examining the extent to which healthcare providers practice what they preach, this research aimed to shed light on the prevalence and factors associated with modern contraceptive use among female HCW at two university teaching hospitals in northern Uganda. METHODS A cross-sectional survey was conducted among qualified female healthcare workers (FHCWs) at Gulu Regional Referral Hospital (GRRH) and St. Mary's Hospital-Lacor in Gulu, Uganda. Convenient consecutive sampling was used to enroll study participants. Linear regression analysis was employed to determine factors independently associated with modern contraceptive use. P < 0.005 was considered statistically significant. RESULTS We enrolled 201 female HCWs, with a median age 31 (interquartile range: 27-38) years. Overall, 15 (7.5%, 95% Confidence Interval [CI]: 4.4 -11.1) participants utilized modern methods of family planning in the last 3 months while lifetime use was at 73.6% (n = 148, 95%CI: 67.3 - 79.4%). Most common method utilized was intra-uterine devices [IUDs] (51%, n = 76), followed by sub-dermal implants (15.4%, n = 23). Eighty-five (42.3%, n = 85) participants had desire to get pregnant. Factors independently associated with utilization of modern methods contraceptives were working at GRRH (adjusted odds ratio (aOR): 5.0, 95% CI: 1.59 - 10.0, p = 0.003), and being single (aOR: 3.3, 9%CI: 1.02 -10.57, p = 0.046). CONCLUSIONS Utilization of modern methods of contraceptive among female HCWs in this study is lower than the Uganda national estimates for the general female population. Most utilized method is IUDs followed by sub-dermal implants. More studies are recommended to see if this finding is similar among FHCWs in other regions of Uganda and the rest of Africa while also considering Male Healthcare Workers.
Collapse
Affiliation(s)
| | - Jimmy Opee
- Gulu University, Gulu, P. O. Box 166, Uganda
| | | | | | | | | | | | | |
Collapse
|
5
|
Odjesa E, Okonofua FE. An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique. PLoS One 2024; 19:e0300744. [PMID: 38512904 PMCID: PMC10956820 DOI: 10.1371/journal.pone.0300744] [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: 01/01/2023] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Given the health and economic benefits of family planning (FP), Nigeria's very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria. MATERIALS AND METHODS A multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities. RESULTS The mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women's husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women's empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of '1', signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities. CONCLUSIONS Our study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.
Collapse
Affiliation(s)
- Emomine Odjesa
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Edo State, Nigeria
| | - Friday Ebhodaghe Okonofua
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Edo State, Nigeria
- Department of Obstetrics and Gynaecology, University of Benin, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
- Women’s Health and Action Research Centre (WHARC), Benin City, Edo State, Nigeria
| |
Collapse
|
6
|
Azure SA, Budu E, Okyere J, Mensah F, Ahinkorah BO, Seidu AA, Ameyaw EK. Assessing the inequalities in demand for family planning satisfied in Ghana: evidence from the 1993-2014 Demographic and Health Surveys. Int Health 2024; 16:61-67. [PMID: 36964694 PMCID: PMC10759287 DOI: 10.1093/inthealth/ihad019] [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: 12/11/2022] [Revised: 02/11/2023] [Accepted: 03/02/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Family planning is essential in promoting the well-being of women and their families and communities and ensuring quality of care in contraceptive use. This study sought to assess the trend and inequalities in the demand for family planning satisfied (DFPS) in Ghana from 1993 to 2014. METHODS The World Health Organization's Health Equity Assessment Toolkit was employed to analyse the data. We disaggregated DFPS by five equity stratifiers: age, economic status, education, residence and region. Inequality was measured using difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF). RESULTS The study showed an increment in DFPS from 17.8% to 38.7% between 1993 and 2014. With respect to age, we noted substantial inequality in 2003 (D=21.9 [95% confidence interval {CI} 15.2 to 28.7]), 1993 (D=4.8 [95% CI -1.8 to 11.4]) and 2014 (D=15 [95% CI 3 to 26.9]). The greatest economic inequality occurred in 1993 (PAF=69.7 [95% CI 50.8 to 88.6]; D=20.1 [95% CI 14.8 to 25.4]). Regarding education, significant inequality existed in 1993 (PAF=112 [95% CI 100.8 to 123.2]; D=29.7 [95% CI 21.9 to 37.4]). Ashanti and the Upper West regions reported significant inequalities (PAF=55.6 [95% CI 33.1 to 78.2]; D=16.1 [95% CI 8.9 to 23.3]). CONCLUSIONS There are age-, education-, wealth-, residence- and region-related inequalities with respect to DFPS. Policymakers will have to prioritize the needs of women with no formal or low educational attainment in order to improve DFPS coverage. Special attention needs to be given to adolescent girls since they suffer greater inequalities than adult women.
Collapse
Affiliation(s)
- Simon Agongo Azure
- Population and Reproductive Health Division, School of Public Health, University of Port Harcourt, Choba, Nigeria
- Department of Community Health, College of Health, Yamfo, Ghana
| | - Eugene Budu
- Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Felix Mensah
- Department of Data Science and Economic Policy, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- L&E Research, Wa, Upper West Region, Ghana
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, Hong Kong
| |
Collapse
|
7
|
Tekakwo A, Nabirye RC, Nantale R, Oguttu F, Nambozo B, Wani S, Musaba MW, Mukunya D, Epuitai J. Enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda: a qualitative study. Contracept Reprod Med 2023; 8:49. [PMID: 37845730 PMCID: PMC10577923 DOI: 10.1186/s40834-023-00251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Male involvement plays a critical role in the utilization of various sexual and reproductive health services. We explored enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda. METHODS This was a qualitative study in Mbale, Eastern Uganda done between November and December 2022. We conducted three group discussions comprising of four participants each, with male partners and eight key informant interviews with midwives. We followed a group discussion guide during the group discussions and an interview guide during the key informant interviews to explore enablers and barriers of male involvement in the use of modern family planning methods. All the interviews and group discussions were audio-recorded with permission from the participants, transcribed verbatim, and analyzed following thematic content analysis approach. RESULTS Two sub-themes emerged from the analysis; perceived enablers and barriers. The perceived enablers included positive attitude, subjective norms, need to support the woman, mutual consent, limited resources and expected benefits of reducing gender-based violence and sexually transmitted infections. Lack of male partner consent, busy work engagement, social stigma, religious prohibition, desire for many children and gender roles incompatibility hindered male partner involvement in family planning. Fear of side effects and misconceptions, unconducive hospital environment in form of mistreatment, family planning considered a female's issue, and lack of consideration of male partner needs in family planning clinic were additional barriers to male involvement. CONCLUSION Male involvement in family planning was related to positive attitude and subjective norms towards family planning, mutual consent, and recognition for limited resources to support a large family size. Lack of male partner approval, fear of side effects and misconceptions, unconducive hospital environment and social, cultural and religious prohibitions discouraged male partner involvement in family planning. Community based approaches to family planning sensitization, such as community education campaigns, may be an important step toward reducing barriers to male involvement in the use of modern family planning methods.
Collapse
Affiliation(s)
- Atkinson Tekakwo
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Rose Chalo Nabirye
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda.
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda.
| | - Faith Oguttu
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
| | - Brendah Nambozo
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
| | - Solomon Wani
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Joshua Epuitai
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| |
Collapse
|
8
|
Araújo FG, Abreu MNS, Felisbino-Mendes MS. [Contraceptive mix and factors associated with the type of method used by Brazilian women: a population-based cross-sectional study]. CAD SAUDE PUBLICA 2023; 39:e00229322. [PMID: 37820236 PMCID: PMC10566557 DOI: 10.1590/0102-311xpt229322] [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: 12/01/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 10/13/2023] Open
Abstract
This study aims to describe the contraceptive mix and analyze the factors associated with the type of contraceptive used by Brazilian women of reproductive age. This is a cross-sectional, population-based study with data from 19,962 women aged 15 to 49 years. The outcomes were use and type of contraceptive, classified as: short-acting reversible contraceptives (SARC), long-acting (LARC), and permanent. The explanatory variables were characteristics of reproductive history, sociodemographic history, and access to health services. Multinomial logistic regression was used for odds ratio (OR) estimates, with SARC being the reference category. The analyses were performed in the Survey module of the Stata software, which considered the effect of the complex sampling plan of the 2019 Brazilian National Health Survey. The prevalence of contraceptive use was 83.7%. Of the total number of users, 72% used SARC, 23.2% permanent methods, and 4.8% LARC. Women with higher education, health insurance, who had deliveries, and who participated in reproductive planning groups had a higher chance of using LARC when compared with the use of SARC, while registration at the basic health unit was associated with a lower chance of use. Still, the higher the age and parity, in addition to living with the partner, the greater the chance of using permanent methods in relation to the use of SARC. Despite the high coverage of contraception, the contraceptive mix remains obsolete, with a predominance of the use of SARC. In addition, important inequalities in access were observed, with LARC being accessible only to women with better socioeconomic conditions, while permanent methods were associated with a profile of greater social vulnerability.
Collapse
|
9
|
Namusisi P, Yeh PT, Ssekubugu R, Chang LW, Lutalo T, Zimmerman LA, Grabowski MK. The intersection between migration, HIV, and family planning in Uganda: a cross-sectional population-based study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.05.23293691. [PMID: 37609347 PMCID: PMC10441507 DOI: 10.1101/2023.08.05.23293691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Low use of modern methods of contraception has been linked to HIV seropositivity and to migration, but few studies have evaluated the intersection of both risk factors with contraceptive use. Methods We analyzed cross-sectional data from sexually active female participants aged 15 to 49 years in the Rakai Community Cohort Study (RCCS) between 2011 and 2013. The RCCS is an open population-based census and individual survey in south-central Uganda. Recent in-migrants (arrival within approximately 1.5 years) into RCCS communities were identified at time of household census. The primary outcome was unsatisfied demand for a modern contraceptive method (injectable, oral pill, implant, or condom), which was defined as non-use of a modern contraceptive method among female participants who did not want to become pregnant in the next 12 months. Poisson regression models with robust variance estimators were used to identify associations and interactions between recent migration and HIV serostatus on unsatisfied contraceptive demand. Results There were 3,417 sexually active participants with no intention of becoming pregnant in the next year. The mean age was 30 (±8) years, and 17.3% (n=591) were living with HIV. Overall, 43.9% (n=1,500) were not using any modern contraceptive method. Recent in-migrants were somewhat more likely to have unsatisfied contraceptive demand as compared to long-term residents (adjusted prevalence risk ratio [adjPRR]=1.14; 95% confidence interval [95%CI]: 1.02-1.27), whereas participants living with HIV were less likely to have unsatisfied contraceptive demand relative to HIV-seronegative participants (adjPRR=0.80; 95%CI=0.70-0.90). When stratifying on migration and HIV serostatus, we observed the highest levels of unsatisfied contraceptive demand among in-migrants living with HIV (48.7%); however, in regression analyses, interaction terms between migration and HIV serostatus were not statistically significant. Conclusions Unsatisfied contraceptive demand was high in this rural Ugandan setting. Being an in-migrant, particularly among those living with HIV, was associated with higher unsatisfied contraceptive demand.
Collapse
|
10
|
Pillai VK, Nagoshi JL. Unmet Family Planning Need Globally: A Clarion Call for Sharpening Current Research Frame Works. Open Access J Contracept 2023; 14:139-147. [PMID: 37492186 PMCID: PMC10364818 DOI: 10.2147/oajc.s378042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Vijayan K Pillai
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Julieann Lynn Nagoshi
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, Arizona, USA
| |
Collapse
|
11
|
Srivastava S, Mohanty P, Muhammad T, Kumar M. Socio-economic inequalities in non-use of modern contraceptives among young and non-young married women in India. BMC Public Health 2023; 23:797. [PMID: 37127678 PMCID: PMC10150497 DOI: 10.1186/s12889-023-15669-w] [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: 05/18/2022] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities. METHODS The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study. RESULTS The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p < 0.001). Women from non-young age group had 39% significantly lower odds of non-use of modern contraceptive use than women from young age group (15-24 years) [AOR: 0.23; CI: 0.23, 0.23]. The value of concentration quintile was -0.022 for young and -0.058 for non-young age groups which also confirms that the non-use of modern contraceptives was more concentrated among women from poor socio-economic group and the inequality is higher among non-young women compared to young women. About 87.8 and 55.5% of the socio-economic inequality was explained by wealth quintile for modern contraceptive use in young and non-young women. A higher percent contribution of educational status (56.8%) in socio-economic inequality in non-use of modern contraceptive use was observed in non-young women compared to only -6.4% in young women. Further, the exposure to mass media was a major contributor to socio-economic inequality in young (35.8%) and non-young (43.2%) women. CONCLUSION Adverse socioeconomic and cultural factors like low levels of education, no exposure to mass media, lack of or limited knowledge about family planning, poor household wealth status, religion, and ethnicity remain impediments to the use of modern contraceptives. Thus, the current findings provide evidence to promote and enhance the use of modern contraceptives by reducing socioeconomic inequality.
Collapse
Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Parimala Mohanty
- Institute of Medical Sciences & Sum Hospital, Siksha "O" Anusandhan Deemed to Be University, Bhubaneswar, Odisha, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Manish Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| |
Collapse
|
12
|
Hellwig F, Saad GE, Wendt A, Barros AJD. Women's marital status and use of family planning services across male- and female-headed households in low- and middle-income countries. J Glob Health 2023; 13:04015. [PMID: 36862138 PMCID: PMC9980282 DOI: 10.7189/jogh.13.04015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background As more households are being led by women, who are often seen as disadvantaged, more attention is being given to the potential association of female household headship with health. We aimed to assess how demand for family planning satisfied by modern methods (mDFPS) is associated with residence in female or male headed households and how this intersects with marital status and sexual activity. Methods We used data from national health surveys carried out in 59 low- and middle-income countries between 2010 and 2020. We included all women aged 15 to 49 years in our analysis, regardless of their relationship with the household head. We explored mDFPS according to household headship and its intersectionality with the women's marital status. We identified households as male-headed households (MHH) or female-headed households (FHH), and classified marital status as not married/in a union, married with the partner living in the household, and married with the partner living elsewhere. Other descriptive variables were time since the last sexual intercourse and reason for not using contraceptives. Results We found statistically significant differences in mDFPS by household headship among reproductive age women in 32 of the 59 countries, with higher mDFPS among women living in MHH in 27 of these 32 countries. We also found large gaps in Bangladesh (FHH = 38%, MHH = 75%), Afghanistan (FHH = 14%, MHH = 40%) and Egypt (FHH = 56%, MHH = 80%). mDFPS was lower among married women with the partner living elsewhere, a common situation in FHH. The proportions of women with no sexual activity in the last six months and who did not use contraception due to infrequent sex were higher in FHH. Conclusions Our findings indicate that a relationship exists between household headship, marital status, sexual activity, and mDFPS. The lower mDFPS we observed among women from FHH seems to be primarily associated with their lower risk of pregnancy; although women from FHH are married, their partners frequently do not live with them, and they are less sexually active than women in MHH.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Ghada E Saad
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Andrea Wendt
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Aluísio JD Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| |
Collapse
|
13
|
Moreira LR, Blumenberg C, Caicedo Velasquez BE, Ewerling F, Balandrán A, Vidaletti LP, Varela AR, Hellwig F, Ponce de Leon RG, Barros AJ, Silveira MF, Wehrmeister FC. The role of gender inequality and health expenditure on the coverage of demand for family planning satisfied by modern contraceptives: a multilevel analysis of cross-sectional studies in 14 LAC countries. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100435. [PMID: 36950033 PMCID: PMC10025422 DOI: 10.1016/j.lana.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023]
Abstract
Background Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. Methods Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. Findings DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman's education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. Interpretation Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population's reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. Funding Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO).
Collapse
Affiliation(s)
- Laísa Rodrigues Moreira
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Corresponding author. Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil.
| | - Cauane Blumenberg
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Beatriz Elena Caicedo Velasquez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación Epidemiología y Bioestadística, Universidad CES, Medellín, Colombia
| | - Fernanda Ewerling
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Alejandra Balandrán
- Inter-american Conference on Social Security, Direction of Health Systems Evaluation & Research, San Ramón s/n, San Jerónimo Lídice, 10200, Mexico City, Mexico
| | - Luis Paulo Vidaletti
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | | | - Franciele Hellwig
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/ WHO), Montevideo, Uruguay
| | - Aluisio J.D. Barros
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Mariangela Freitas Silveira
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Fernando C. Wehrmeister
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Institute for Global Public Health (IGPH), Rady Faculty of Health Sciences, Community Health Sciences, R070 Med Rehab Bldg, 771 McDermot Avenue, University of Manitoba (Bannatyne Campus), Winnipeg, Manitoba, R3E 0T6, Canada
| |
Collapse
|
14
|
Makumbi FE, Nabukeera S, Tumwesigye NM, Namanda C, Atuyambe L, Mukose A, Ssali S, Ssenyonga R, Tweheyo R, Gidudu A, Sekimpi C, Hashim CV, Nicholson M, Ddungu P. Socio-economic and education related inequities in use of modern contraceptive in seven sub-regions in Uganda. BMC Health Serv Res 2023; 23:201. [PMID: 36855140 PMCID: PMC9972732 DOI: 10.1186/s12913-023-09150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 10/17/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Advocacy for equity in health service utilization and access, including Family Planning (FP) continues to be a cornerstone in increasing universal health coverage. Inequities in Family planning are highlighted by the differences in reproductive health outcomes or in the distribution of resources among different population groups. In this study we examine inequities in use of modern contraceptives with respect to Socio-economic and Education dimensions in seven sub-regions in Uganda. METHODS The data were obtained from a baseline cross-sectional study in seven statistical regions where a program entitled "Reducing High Fertility Rates and Improving Sexual Reproductive Health Outcomes in Uganda, (RISE)" is implemented in Uganda. There was a total of 3,607 respondents, half of whom were women of reproductive age (15-49 years) and the other half men (18-54 years). Equity in family planning utilization was assessed by geography, wealth/economic and social-demographics. The use of modern family planning was measured as; using or not using modern FP. Concentration indices were used to measure the degree of Inequality in the use of modern contraceptives. Prevalence Ratios to compare use of modern FP were computed using modified Poisson regression run in STATA V15. RESULTS Three-quarters (75.6%) of the participants in rural areas were married compared to only 63% in the urban. Overall use of modern contraceptives was 34.2% [CI:30.9, 37.6], without significant variation by rural/urban settings. Women in the higher socio-economic status (SES) were more advantaged in use of modern contraceptives compared to lower SES women. The overall Erreygers Concentration Index, as a measure of inequity, was 0.172, p<0.001. Overall, inequity in use of modern contraceptives by education was highest in favor of women with higher education (ECI=0.146, p=0.0001), and the concentration of use of modern contraceptives in women with higher education was significant in the rural but not urban areas CONCLUSION: Inequities in the use of modern contraceptives still exist in favor of women with more education or higher socio-economic status, mainly in the rural settings. Focused programmatic interventions in rural settings should be delivered if universal Family Planning uptake is to be improved.
Collapse
Affiliation(s)
- Fredrick E Makumbi
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Sarah Nabukeera
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Cissie Namanda
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Lynn Atuyambe
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Aggrey Mukose
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Sarah Ssali
- School of Women and Gender studies, Makerere University, Makerere Hill, P.O. Box 7062, Kampala, Uganda
| | - Ronald Ssenyonga
- School of Public Health, Makerere University, New Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda
| | - Ritah Tweheyo
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| | - Andrew Gidudu
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| | - Carole Sekimpi
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| | | | - Martha Nicholson
- Marie Stopes International, 1 Conway Street, Fitzroy Square, London, W1T 6LP UK
| | - Peter Ddungu
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.o. Box 10431, Kampala, Uganda
| |
Collapse
|
15
|
Getting Up to Date with What Works: A Systematic Review on the Effectiveness and Safety of Task Sharing of Modern Methods in Family Planning Services. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8735563. [PMID: 36817856 PMCID: PMC9936454 DOI: 10.1155/2023/8735563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
Objective This systematic review was conducted to provide up-to-date evidence on the safety and effectiveness of task sharing in the delivery of modern contraceptives. Study Design. The review followed the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. We searched Medline, Embase, Cochrane CENTRAL, and Google Scholar for peer-reviewed studies that reported on effectiveness and/or safety outcomes of task sharing of any modern contraceptive method. Only Cochrane Effective Practice of Organizations of Care (EPOC) study designs were eligible, and quality assessment of the evidence was performed using the Cochrane risk of bias (RoB) tools. Meta-analyses, where possible, were carried out using Stata, and certainty of the evidence for outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool (GRADE). Results Six studies met the inclusion criteria: five reported on self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to administered by trained health providers; and one assessed tubal ligation performed by associate clinicians compared to advanced-level associate clinicians. Self-injection improved contraceptive continuation, with no increase in unintended pregnancy and no difference in side effects compared to provider administered. In tubal ligation, the rate of adverse events, time to complete procedure, and participant satisfaction were similar among associate clinicians and advanced clinicians. Conclusion The evidence suggests that self-injection of DMPA-SC and tubal ligation performed by associate clinicians are safe and effective. These findings should be complemented with the evidence on the feasibility and acceptability of task sharing of these methods. The review protocol was registered with PROSPERO CRD42021283336.
Collapse
|
16
|
Hellwig F, Barros AJD. What are the sources of contraceptives for married and unmarried adolescents: Health services or friends? Analysis of 59 low- and middle-income countries. Front Public Health 2023; 11:1100129. [PMID: 36815169 PMCID: PMC9939762 DOI: 10.3389/fpubh.2023.1100129] [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: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Background Despite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status. Methods We used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15-19, 20-34, or 35-49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union. Results mDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions. Conclusions Our findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil,*Correspondence: Franciele Hellwig ✉
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| |
Collapse
|
17
|
Belachew TB, Asmamaw DB, Negash WD. Short birth interval and its predictors among reproductive age women in high fertility countries in sub-Saharan Africa: a multilevel analysis of recent Demographic and Health Surveys. BMC Pregnancy Childbirth 2023; 23:81. [PMID: 36717811 PMCID: PMC9885595 DOI: 10.1186/s12884-023-05403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In developing countries, short birth interval is one of the major public health issues. It is one of the leading cause's adverse birth outcomes in the worldwide. Despite the fact that ending maternal and perinatal morbidity and mortality is one of the Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including high fertility countries. Thus, this study aimed to determine the short birth interval and its predictors in ten high fertile sub-Saharan African countries. METHODS Data for this study was obtained from the most recent Demographic and Health Surveys (DHS). A total of weighted sample of 303,979 women of childbearing age group (15- 49) who had at least two alive consecutive children was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the associated factors of short birth interval. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance. RESULTS Overall prevalence of short birth interval in high fertile sub Saharan Africa was 58.74% (52.32%, 65.17%).The factors significantly associated with the short birth interval were women's educational status; primary education (AOR = 0.88; 95% CI: 0.86,0 .91), secondary and higher (AOR = 0.10; 95% CI: 0.09, 0.11), working (AOR = 0.91; 95% CI: 0.88, 0 .93), classified as rich wealth index level (AOR = 0.90; 95% CI: 0.88, 0.93),having six and above ideal number of children (AOR = 2.25; 95% CI: 2.22, 2.30), preferred waiting time two years and above to give birth (AOR = 0.83; 95% CI: 0.76, 0.89), contraceptive non users (AOR = 3.01; 95% CI: 2.93, 3.07), community level education (AOR = 1.97; 95% CI: 1.54, 2.08), rural residency (AOR = 2.17; 95% CI: 2.13, 2.22), and country Chad (AOR = 1.37; 95% CI: 1.22, 1.54). CONCLUSION The prevalence of short birth interval in the top ten high fertile sub Saharan African countries is still optimally high. Therefore, the government of each country should work on the access to family planning and education in rural parts of the countries.
Collapse
Affiliation(s)
- Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia
| |
Collapse
|
18
|
Hellwig F, Barros AJD. Learning from success cases: ecological analysis of pathways to universal access to reproductive health care in low- and middle-income countries. Gates Open Res 2023; 6:59. [PMID: 36726686 PMCID: PMC9873636 DOI: 10.12688/gatesopenres.13570.1] [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] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more vulnerable groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most vulnerable in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,
| | - Aluisio JD Barros
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| |
Collapse
|
19
|
Hellwig F, Barros AJD. Learning from success cases: ecological analysis of pathways to universal access to family planning care in low- and middle-income countries. Gates Open Res 2023; 6:59. [PMID: 36726686 PMCID: PMC9873636 DOI: 10.12688/gatesopenres.13570.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more vulnerable groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most vulnerable in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,
| | - Aluisio JD Barros
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| |
Collapse
|
20
|
Hellwig F, Barros AJD. Learning from success cases: ecological analysis of potential pathways to universal access to family planning care in low- and middle-income countries. Gates Open Res 2023; 6:59. [PMID: 36726686 PMCID: PMC9873636 DOI: 10.12688/gatesopenres.13570.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced an important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more disadvantaged groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most disadvantaged in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,
| | - Aluisio JD Barros
- International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil,Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| |
Collapse
|
21
|
Negash WD, Belachew TB, Asmamaw DB, Bitew DA. Four in ten married women demands satisfied by modern contraceptives in high fertility sub-Saharan Africa countries: a multilevel analysis of demographic and health surveys. BMC Public Health 2022; 22:2169. [PMID: 36434551 PMCID: PMC9700937 DOI: 10.1186/s12889-022-14610-x] [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: 09/03/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Demand satisfied with modern contraceptive can be seen on both a health and economic level. Additionally, family planning helps to regulate fertility, prevent unintended pregnancies and their consequences. Thus, the aim of this study was to identify the magnitude of demand satisfied with modern contraceptive among married/in-union women in ten high fertility sub Saharan African countries. METHODS Recent Demographic and Health Surveys that included a weighted sample of 43,745 women of reproductive age provided the data for this study. All statistical analyses were conducted once the data had been weighted, and Stata version 16.0 was used. A multilevel mixed-effect binary logistic regression model was fitted. To determine statistically significant individual and community-level factors associated with demand satisfied for modern contraceptive, odds ratios with a 95% confidence interval was generated. A p-value less than 0.05 was declared as statistical significance. RESULTS Overall, demand satisfied to use modern contraceptive in high fertility sub-Saharan Africa countries was 39.53% (95%CI: 39.06, 39.98). Women aged 25-34 (AOR: 1.34, 95%CI: 1.26, 1.42) and 35-49 (AOR: 1.28, 95%CI: 1.20, 1.38), women education: primary (AOR: 1.35, 95%CI: 1.27, 1.44) and secondary (AOR: 2.05, 95%CI: 1.90, 2.21), husband education: primary (AOR: 1.26, 95%CI: 1.18, 1.35) and secondary (AOR: 1.54, 95%CI: 1.43, 1.66), husband residence (AOR: 1.75, 95%CI: 1.60, 1.91), media exposure (AOR: 1.22, 95%CI: 1.15, 1.29), wealth index: poorer (AOR: 1.1, 95%CI: 1.02, 1.19), middle (AOR: 1.18, 95%CI: 1.08, 1.28), richer (AOR: 1.37, 95%CI: 1.26, 1.49) and richest (AOR: 1.34, 95%CI: 1.56, 1.89), number of children: 4-6 (AOR: 0.48, 95%CI: 0.43, 0.55) and above 6 (AOR: 0.39, 95%CI: 0.29, 0.59), perceived distance to the health facility not big problem (AOR: 1.11, 95%CI: 1.04, 1.15), urban residence (AOR: 1.18, 95%CI: 1.10, 1.27), high community level poverty (AOR: 0.85, 95%CI: 0.74, 0.97) were significantly associated with demand satisfied for modern contraceptives. CONCLUSION Only four in ten married reproductive age women demands satisfied with modern contraceptives in high fertility Sub Saharan African countries. Modern contraceptives should therefore be more widely available, especially in rural areas and for those living away from health facilities. Also, increasing media exposure and education, providing financial support, and making contraceptive access easier for married women from poor households are important interventions that need to be put in place.
Collapse
Affiliation(s)
- Wubshet Debebe Negash
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
22
|
Biswas RK, Farzana M, Bhar S, Bhowmik J. Contraceptive use in South and South-East Asian region: assessment of sustainable development goal 3.7 through indicator 3.7.1. J Public Health (Oxf) 2022:6754760. [PMID: 36214514 DOI: 10.1093/pubmed/fdac105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) 3.7 concerns modern contraception use among women of reproductive ages. This study evaluated the progress of indicator 3.7.1 in 11 selected countries in South and South-East Asia and assessed the contribution of women's education to modern contraceptive use. METHODS Generalized linear models for complex surveys were fitted to Demographic and Health Survey (DHS) data from 40 surveys conducted in Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor Leste between 1990 and 2017, followed by a meta-analysis through forest plots. RESULTS Modern contraceptive coverage in most of the selected countries climbed or remained stationary over the past decades. In four countries, <50% of women used contraception. In no country was contraception used by ≥80% women. Higher education was associated with 13% higher odds of modern contraceptive use (95% confidence interval: 1.07, 1.18) among women compared to primary level or no education. DISCUSSION Completion of primary education is insufficient to broaden the coverage of modern contraceptive use. Greater national level effort from the selected countries is needed to lift the education levels of women to meet SDG 3.7 by 2030.
Collapse
Affiliation(s)
- Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, 2052, Australia.,Charles Perkin Centre, School of Health Sciences, The University of Sydney, Camperdown, New South Wales 2006, Australia
| | - Maysha Farzana
- Department of Sociology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Sunil Bhar
- School of Health Sciences, Department of Department of Psychological Sciences, Swinburne University of Technology, 3122, Australia
| | - Jahar Bhowmik
- School of Health Sciences, Department of Health Science and Biostatistics, Swinburne University of Technology, 3122, Australia
| |
Collapse
|
23
|
Fataar K, Zweigenthal V, Harries J. Providers' approaches to contraceptive provision in Cape Town. Front Glob Womens Health 2022; 3:917881. [PMID: 36188423 PMCID: PMC9515548 DOI: 10.3389/fgwh.2022.917881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Health care providers can play a significant role in empowering women to make informed decisions when selecting suitable contraceptive methods during contraceptive counseling. This study explores primary care providers' perspectives and approaches to contraceptive service provision for women attending public sector clinics in South Africa, with the intention of ascertaining established practices and training needs. Methods Ten in-depth interviews were conducted at five primary health care facilities in urban areas in Cape Town, South Africa. Eligible participants included nurses providing contraceptive services and willing to participate in the study. The qualitative software package NVivo was used to sort and manage data. Data was analyzed using a thematic analysis approach. Results Overall, providers emphasized supporting women in contraceptive decision-making. Sexual and reproductive health training increased providers confidence to deliver appropriate contraceptive services. Contraceptive prescribing practices were influenced by women's medical history and preferred bleeding patterns. Providers' concerns about adherence to methods for younger women and suspected adverse events for older women impacted on prescribing. Challenges experienced when providing contraceptive services included: contraceptive stockouts; time constraints of employed women accessing the service; and their work pressure due to providing other health services. Discussion Health care providers play a critical role in facilitating women's right to access high quality contraceptive services. Providers saw themselves as negotiators during contraceptive counseling. They considered both women's preferences and their own recommendations for contraception, to provide information that would enable women to make informed contraceptive decisions. By reinforcing this approach to contraceptive counseling and focusing on shared decision-making, should encourage autonomy in method selection and limit the influence of provider's contraceptive method selection.
Collapse
|
24
|
Mobile phones, women's physical mobility, and contraceptive use in India. Soc Sci Med 2022; 305:115074. [PMID: 35665688 DOI: 10.1016/j.socscimed.2022.115074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
Abstract
Women's economic and social empowerment is facilitated by their ability to move around independently and safely. However, in many developing countries women's physical mobility is restricted by social norms, structural impediments related to poor quality of roads and transport systems, and security issues. Restrictions on female physical mobility and low levels of empowerment can also have negative implications for women's access to healthcare services. Mobile phones could help connect women to information and social networks and thus also strengthen their bargaining power within the household. Here, we use nationally representative data from 39,523 women in India collected in 2011-12 to analyse associations between women's use of mobile phones and selected indicators of female autonomy and empowerment. Results indicate that women's mobile phone use is positively associated with their physical mobility range and use of non-surgical contraceptives, whereas it is negatively associated with surgical contraceptive methods. We also analyse to what extent these associations are influenced by other socioeconomic and cultural factors. Our findings suggest that mobile phones can play an important positive role for women's empowerment in India.
Collapse
|
25
|
Hormonal contraceptives as disruptors of competitive behavior: Theoretical framing and review. Front Neuroendocrinol 2022; 66:101015. [PMID: 35835214 DOI: 10.1016/j.yfrne.2022.101015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
Emerging evidence suggests that hormonal contraceptives (HCs) impact psychological outcomes through alterations in neurophysiology. In this review, we first introduce a theoretical framework for HCs as disruptors of steroid hormone modulation of socially competitive attitudes and behaviors. Then, we comprehensively examine prior research comparing HC users and non-users in outcomes related to competition for reproductive, social, and financial resources. Synthesis of 46 studies (n = 16,290) led to several key conclusions: HC users do not show the same menstrual cycle-related fluctuations in self-perceived attractiveness and some intrasexual competition seen in naturally-cycling women and, further, may show relatively reduced status- or achievement-oriented competitive motivation. However, there a lack of consistent or compelling evidence that HC users and non-users differ in competitive behavior or attitudes for mates or financial resources. These conclusions are tentative given the notable methodological limitations of the studies reviewed. Implications and recommendations for future research are discussed.
Collapse
|
26
|
Sreeramareddy CT, Acharya K, Tiwari I. Inequalities in demand satisfied with modern methods of family planning among women aged 15-49 years: a secondary data analysis of Demographic and Health Surveys of six South Asian countries. BMJ Open 2022; 12:e049630. [PMID: 35688601 PMCID: PMC9189818 DOI: 10.1136/bmjopen-2021-049630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To estimate educational and wealth inequalities in demand satisfied with modern methods of family planning (mDFPS). DESIGN A secondary data analyses of Demographic and Health Surveys. SETTING Six South Asian countries, Afghanistan (2015), Bangladesh (2014), India (2015-2016), Maldives (2016-2017), Nepal (2016) and Pakistan (2017-2018). PARTICIPANTS Women aged 15-49 years. Primary and secondary outcome measures mDFPS was defined as married women aged 15-49 years or their partners, who desired no child, no additional children or to postpone the next pregnancy and who are currently using any modern contraceptive method. We estimated weighted and age-standardised estimates of mDFPS. We calculated the slope index of inequality (SII) and relative index of inequality (RII) as the measures of socioeconomic inequalities. RESULTS A total of 782 639 women were surveyed. The response rate was 84.0% and above. The prevalence of mDFPS was below 50% in Maldives (22.8%, 95% CI 20.7 to 25.0), Pakistan (42.0%, 95% CI 39.9 to 44.0) and Afghanistan (39.1%, 95% CI 36.9 to 41.3), whereas Bangladesh had achieved 76% (75.8%, 95% CI 74.2 to 77.3). Both wealth and educational inequalities varied in magnitude and direction between the countries. Except in Nepal and Bangladesh, mDFPS wealth inequalities showed a trend of increasing mDFPS as we moved towards richer, and richest wealth quintiles that is, pro-poor (RII (0.5 to 0.9); SII (-4.9 to -23.0)). In India and Nepal, higher versus no education was in favour of no education (higher mDFPS among not educated women) (RII 1.1 and 1.4; SII 4.1 and 15.3, respectively) and reverse in other countries ((RII (0.4 to 0.8); SII (-10.5 to -30.3)). Afghanistan, Maldives and Pakistan fared badly in both educational and wealth inequalities among the countries. CONCLUSIONS South Asia region still has a long way ahead towards achieving universal access to mDFPS. Diverse patterns of socioeconomic inequalities between the countries call for national governments and international development agencies to target the population subgroups for improving the mDFPS coverage.
Collapse
Affiliation(s)
| | | | - Ishwar Tiwari
- School of Public Health, University of Alberta, Alberta, Edmonton, Canada
- RTI International, Kathmandu, Nepal
| |
Collapse
|
27
|
Bietsch K, LaNasa K, Sonneveldt E. Identifying inequity in family planning: The Track20 equity tool. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13642.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: With increases in contraceptive use in most countries in the world, within country inequities persist. Equity in family planning does not mean an equal level of contraceptive use among all groups; differences in use of contraception could reflect variation in cultural beliefs and values and therefore not inequity. Methods: Focusing on demand satisfied for modern methods and five dimensions (age, education, geography, parity, and wealth), we map inequities within 15 sub-Saharan African countries and across time. We create a “Concentration of Inequity” to highlight the intersectionality of inequities in family planning and allows for more data informed programming. Results: Inequities exist in all countries included in this analysis, though the range varies substantially. Over 85% of the countries included in this analysis had at least 1 subgroup in the population with demand satisfied 30% or more below the national level of demand satisfied. To help visualize inequities and stimulate discussion, we create an online tool to display multiple aspects of inequity. Conclusions: Using demand satisfied with modern methods to measure inequity for family planning allows us to focus attention on women with desire to delay or limit childbearing. Studying the intersections of demographic factors is fundamental for a deeper understanding of family planning equity.
Collapse
|
28
|
Hellwig F, Ewerling F, Coll CVN, Barros AJD. The role of female permanent contraception in meeting the demand for family planning in low- and middle-income countries. Contraception 2022; 114:41-48. [PMID: 35568087 DOI: 10.1016/j.contraception.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Our aim was to describe the reliance on female permanent contraception among women with demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries (LMICs) and to describe socio-economic and demographic patterns of permanent contraception in countries with high use. METHODS Using data from the latest national health survey carried out in LMICs we estimated mDFPS and the share of each contraceptive method used. Countries with a share of more than 25% of female permanent contraception were further explored for differences by wealth, number of living children, woman's age, and by the intersection of woman's age and number of living children. RESULTS In the 20 countries studied, between 6% and 94% of the contracepting population used modern methods. Female permanent contraception accounted for more than half of women using modern contraceptives in India, Dominican Republic, El Salvador, Mexico, and Colombia. In India and Tonga, more than 20% of women using contraceptives with fewer than two living children were using female permanent contraception. Among women with two living children, countries with the highest reliance on permanent contraception were India (79%), El Salvador (61%), Cuba (55%), Colombia (52%), and Thailand (51%). Dominican Republic, El Salvador, India, and Mexico presented high levels of permanent contraception among younger women, with reliance higher than 30% among women aged 25 to 29 and 50% or more among women aged 30 to 34. CONCLUSIONS Reliance on permanent contraception was high in several countries and among women aged less than 35 years.
Collapse
Affiliation(s)
- Franciele Hellwig
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil; Federal University of Pelotas; Post-graduation Program in Epidemiology; Pelotas Brazil.
| | - Fernanda Ewerling
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil
| | - Carolina V N Coll
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil; Federal University of Pelotas; Post-graduation Program in Epidemiology; Pelotas Brazil
| |
Collapse
|
29
|
Rahaman M, Rana MJ, Roy A, Chouhan P. Spatial heterogeneity and socio-economic correlates of unmet need for spacing contraception in India: Evidences from National Family Health Survey, 2015-16. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
30
|
Memon ZA, Reale S, Ahmed W, Spencer R, Lashari TH, Bhutta Z, Soltani H. Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study. JMIR Res Protoc 2022; 11:e35291. [PMID: 35258461 PMCID: PMC8941439 DOI: 10.2196/35291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background The uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services. Objective The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs. Methods A quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate. Results The intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022. Conclusions This project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context. Trial Registration ClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599 International Registered Report Identifier (IRRID) DERR1-10.2196/35291
Collapse
Affiliation(s)
- Zahid Ali Memon
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Sophie Reale
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Wardah Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rachael Spencer
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | | | - Zulfiqar Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hora Soltani
- Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| |
Collapse
|
31
|
Tsehay CT. Factors associated with modern contraceptive demands satisfied among currently married/in-union women of reproductive age in Ethiopia: a multilevel analysis of the 2016 Demographic and Health Survey. BMJ Open 2022; 12:e049341. [PMID: 35110305 PMCID: PMC8811575 DOI: 10.1136/bmjopen-2021-049341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Regardless of the local and international initiatives, excluding exempting services, demand satisfied for contraceptives remains low in Ethiopia. This circumstance is supposed to be attributed to different level factors; however, most were not well addressed in the previous studies. Therefore, this study aimed at assessing the magnitude and individual, household and community-level factors associated with demand satisfied for modern contraceptive (DSFMC) methods among married/in-union women of reproductive age. DESIGN Cross-sectional study. SETTING A community-based study across the country. PARTICIPANTS Randomly selected 9126 married/in-union women had participated using a structured questionnaire. OUTCOME DSFMC methods among married/in-union women of reproductive age. RESULTS DSFMC methods in Ethiopia was 39.5% (95% CI 38.5% to 40.5%). Women aged 35-49 years (adjusted OR (AOR): 0.43, 95% CI 0.32 to 0.58), Muslim religion (AOR: 0.58, 95% CI0.43 to 0.78), husband lived elsewhere (AOR: 0.42, 95% CI 0.29 to 0.60), joint decision making to use (AOR: 1.30, 95% CI 1.04 to 1.62), good knowledge (AOR: 1.57, 95% CI 1.32 to 1.86) and wealth status of poorer (AOR: 1.56, 95% CI 1.17 to 2.06), middle (AOR: 1.77, 95% CI 1.33 to 2.35), richer (AOR: 1.96, 95% CI 1.49 to 2.59), and richest (AOR: 1.49, 95% CI 1.05 to 2.08), pastoralist regions (AOR: 0.28, 95% CI 0.18 to 0.42), and agrarian regions (AOR: 1.72, 95% CI 1.21 to 2.44) and rural residency (AOR: 0.56, 95% CI 0.37 to 0.82) were factors significantly associated. CONCLUSIONS Women's age, religion, the current living place of husbands and women's knowledge were individual-level factors. Household wealth status and mutual decision making to use were household-level factors. Region and residency were households and community-level factors associated with DSFMCs. Increasing the accessibility of modern contraceptive methods to women in rural areas and pastoralist regions, those living separately, engaging religious leaders and men in the programme, would increase their satisfying demand.
Collapse
Affiliation(s)
- Chalie Tadie Tsehay
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
32
|
Kamuyango A, Yu T, Ao CK, Hu SC, Hou WH, Tseng CC, Li CY. The public-sector family planning program impact scores in association with long acting reversible contraceptive use among young women in 22 Sub-Saharan African countries; A pooled multi-level analysis. Contraception 2022; 108:44-49. [PMID: 35031303 DOI: 10.1016/j.contraception.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the role of public-sector family planning program impact scores and other country-level factors on LARC use among young women aged 15-24. STUDY DESIGN We conducted this research using a large population database covering several decades' worth of multi-wave cross-sectional samples of the demographic health survey (DHS) and the World Bank website data. We carried out a multi-level analysis on data from 1990 to 2019 from 22 Sub-Saharan African countries, with 163,242 participants. RESULTS We found LARC use was at 3.1% of all young women under study. Sierra Leone, 2019 survey had the highest LARC use at 21,961 per 100,000. A 10% increase in public-sector family planning program impact scores was positively associated with LARC use with odds ratio of 1.44, 95% CI, 1.43- 1.45). We also noted that a 1% increase in HIV prevalence was associated with a reduced odds ratio of LARC use at 0.75 (95% CI, 0.70-0.81). CONCLUSIONS Findings from this study provide empirical evidence highlighting the importance of country-level factors in influencing LARC use among young women in sub-Saharan Africa IMPLICATIONS: For young women in Africa, policymakers need to increase their effort on national family planning programs especially in the public sector. Broader societal level interventions to improve LARC use are required. Specific interventions must address the complexities of HIV prevention and LARC use to benefit young women living in countries with a high HIV prevalence.
Collapse
Affiliation(s)
- Asantesana Kamuyango
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chon-Kit Ao
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Healthy Cities Research Center, Research and Services Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Hsuan Hou
- School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Cheng Tseng
- Department of Obstetrics and Gynecology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| |
Collapse
|
33
|
Anik AI, Islam MR, Rahman MS. Association between socioeconomic factors and unmet need for modern contraception among the young married women: A comparative study across the low- and lower-middle-income countries of Asia and Sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000731. [PMID: 36962420 PMCID: PMC10021951 DOI: 10.1371/journal.pgph.0000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
Modern contraceptive methods are effective tools for controlling fertility and reducing unwanted pregnancies. Yet, the unmet need for modern contraception (UNMC) remains high in most of the developing countries of the world. This study aimed to compare the coverage of modern contraceptive usage and the UNMC among the young married women of low- and lower-middle-income countries (LMICs) of Asia and Sub-Saharan Africa, and further examined the likelihood of UNMC across these regions. This cross-sectional study used Demographic and Health Survey (DHS) data on family planning from 32 LMICs of South Asia (SA), Southeast Asia (SEA), West-Central Africa (WCA), and Eastern-Southern Africa (ESA). Multilevel logistic regression models were used to investigate the relationship between UNMC and women's socioeconomic status. Out of 1,00,666 younger married women (15-24 years old), approximately 37% used modern contraceptives, and 24% experienced UNMC. Regionally, women from SA reported higher modern contraceptive usage (44.7%) and higher UNMC (24.6%). Socioeconomic factors like- higher education (in SA and WCA), unemployment (in SA and ESA), no media exposure (in SA and ESA), and higher decision-making autonomy (except SEA) showed positive and significant association with UNMC. Poorest households were positively associated with UNMC in SA and ESA, while negatively associated with UNMC in SEA. UNMC was highly reported among the SA young married women, followed by WCA, SEA, and ESA regions. Based on this study findings, versatile policies, couples counseling campaigns, and community-based outreach initiatives might be undertaken to minimize UNMC among young married women in LMICs.
Collapse
Affiliation(s)
- Asibul Islam Anik
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Rashedul Islam
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Division of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Hamamatsu, Japan
| |
Collapse
|
34
|
Olakunde BO, Pharr JR. The demand for family planning to limit childbearing satisfied with female permanent contraception in Sub-Saharan Africa: a meta-analysis of demographic and health surveys. EUR J CONTRACEP REPR 2021; 27:189-198. [PMID: 34906028 DOI: 10.1080/13625187.2021.2012760] [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: 10/19/2022]
Abstract
OBJECTIVE To assess the percentage of the demand for family planning to limit childbearing satisfied with female permanent contraception (FPC) in sub-Saharan Africa (SSA) and the disparities by sociodemographic characteristics (educational status, wealth, religion, and area of residence). STUDY DESIGN This study was a secondary data analysis of Demographic and Health Surveys conducted in SSA. Countries with a standard DHS conducted between 2010 and 2019 were eligible for inclusion. We performed a meta-analysis with a random-effects model to estimate the percentage of the demand for family planning to limit childbearing satisfied with FPC and differences by sociodemographic characteristics. RESULTS Demographic and Health Surveys (2010-2018) of 33 countries, with a total of 67,476 women with a demand for family planning to limit childbearing were included in this study. The pooled percentage of the demand for family planning to limit childbearing satisfied with FPC was 4.13% (95%CI = 2.43-6.23%, I = 99.36%, p = 0.001). The percentage ranged from 0.26% (95%CI = 0.10-0.67) in Angola to 26.85% (95%CI = 25.86-27.85%) in Malawi. The demand for family planning to limit childbearing satisfied with FPC was significantly higher in women from rich households (PR = 1.41, 95%CI = 1.21-1.65, p < 0.001). However, the differences by educational status, religion, or area of residence were not statistically significant. CONCLUSIONS The uptake of FPC among women with a demand for family planning to limit childbearing is low in many countries in SSA. Multilevel interventions are needed to address the barriers that may be limiting informed and voluntary uptake of FPC in SSA.
Collapse
Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria.,Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
35
|
Hellwig F, Coll CVN, Blumenberg C, Ewerling F, Kabiru CW, Barros AJD. Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries. Front Glob Womens Health 2021; 2:674227. [PMID: 34816227 PMCID: PMC8594043 DOI: 10.3389/fgwh.2021.674227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries. Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage. Results: mDFPS among urban women ranged from 27% (95% CI: 23–31%) in Chad to 87% (95% CI: 84–89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3–15%) among the poorest and 52% (95% CI: 49–56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3–11%) among the poorest and 46% (95% CI: 41–51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7–18%) among the poorest and 47% (95% CI: 41–53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities. Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health.
Collapse
Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Fernanda Ewerling
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Caroline W Kabiru
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| |
Collapse
|
36
|
Alhassan N, Madise NJ. Demand for Family Planning Satisfied With Modern Methods in Urban Malawi: CHAID Analysis to Identify Predictors and Women Underserved With Family Planning Services. Front Glob Womens Health 2021; 2:652902. [PMID: 34816208 PMCID: PMC8594021 DOI: 10.3389/fgwh.2021.652902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Family planning progress under the SDGs is measured with a novel indicator, demand for family planning satisfied with modern methods (mDFPS), which provides a better indication of modern contraceptive coverage than unmet need and contraceptive prevalence rate. Yet, few studies have examined the predictors of mDFPS and the sub-groups of women with unsatisfied mDFPS in urban Saharan Africa. The objective of this study was to examine the predictors of mDFPS in urban Malawi and to identify the sub-groups of urban women underserved with modern contraceptives. Methods: The study analysed data from the 2015–16 Malawi Demographic and Health survey. The sample was comprised of 2,917 women in urban Malawi who had a demand for family planning services. We used a Chi-square (χ2) Automatic Interaction Detector (CHAID) model to address the study objectives. Results: The results show that the number of living children a woman had was the most significant predictor of mDFPS. Women with one or more children, who were of Chewa, Lomwe, or Tumbuka ethnic origin and who resided in the central region had the highest mDFPS (87%). On the other hand, women with no children, and who were not exposed to FP information on television, had the lowest mDFPS (41%). Among women in union, ethnicity was the best predictor of mDFPS. Ngoni, Yao, and other ethnic minority women in union who were aged 15–19 and 40 years and above and those who were Catholic, SDA/Baptist, or Muslim had the lowest mDFPS (36%). Conclusion: This study demonstrates significant intra-urban disparities in demand for FP satisfied with modern contraceptives in Malawi. There is a need for policymakers and reproductive health practitioners to recognise these disparities and to prioritise the underserved groups identified in this study.
Collapse
|
37
|
Machado AKF, Gräf DD, Höfs F, Hellwig F, Barros KS, Moreira LR, Crespo PA, Silveira MF. Prevalence and inequalities in contraceptive use among adolescents and young women: data from a birth cohort in Brazil. CAD SAUDE PUBLICA 2021; 37:e00335720. [PMID: 34787284 DOI: 10.1590/0102-311x00335720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/12/2021] [Indexed: 11/22/2022] Open
Abstract
Monitoring trends of contraceptive use and identifying the groups with less coverage are needed to guide public policies and make them more efficient. But, in Brazil, recent data about these aspects are limited. This study aimed to investigate the prevalence of contraceptive use and its inequalities during adolescence and early adulthood. Data from the 1993 Pelotas birth cohort, Rio Grande do Sul State, Brazil, were used. At 15, 18 and 22 years, respectively, 335, 1,458 and 1,711 women reported having started their sexual lives and were included in analysis. Prevalence and 95% confidence intervals were obtained to describe the most used contraceptive methods. Inequalities in modern contraceptive use were evaluated according to wealth index, scholastic backwardness and ethnicity. In all follow-ups, more than 80% of women used at least one modern method. The use of barrier methods decreased with age; at 22 this prevalence was 36.3%. Such use concomitant with other modern methods was lower than 50% in all follow-ups. We observed inequalities in the use of modern contraceptive methods, mainly in barrier methods used with other modern methods. These findings may contribute and improve the public policies in family planning.
Collapse
Affiliation(s)
| | | | - Fabiane Höfs
- Universidade Federal de Pelotas, Pelotas, Brasil
| | | | | | | | | | | |
Collapse
|
38
|
Hazel E, Mohan D, Gross M, Kattinakere Sreedhara S, Shrestha P, Johnstone M, Marx M. Comparability of family planning quality of care measurement tools in low-and-middle income country settings: a systematic review. Reprod Health 2021; 18:215. [PMID: 34717686 PMCID: PMC8557007 DOI: 10.1186/s12978-021-01261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low-and-middle income countries (LMICs), accurate measures of the elements of quality care provided by a health worker through family planning services (also known as process quality) are required to ensure family's contraceptives needs are being met. There are many tools used to assess family planning process quality of care (QoC) but no one standardized method. Those measuring QoC in LMICs should select an appropriate tool based the program context and financial/logistical parameters, but they require data on how well each tool measures routine clinical care. We aim to synthesize the literature on validity/comparability of family planning process QoC measurement tools through a quantitative systematic review with no meta-analysis. METHODS We searched six literature databases for studies that compared quality measurements from different tools using quantitative statistics such as sensitivity/specificity, kappa statistic or absolute difference. We extracted the comparative measure along with other relevant study information, organized by quality indicator domain (e.g. counseling and privacy), and then classified the measure by low, medium, and high agreement. RESULTS We screened 8172 articles and identified eight for analysis. Studies comparing quality measurements from simulated clients, direct observation, client exit interview, provider knowledge quizzes, and medical record review were included. These eight studies were heterogenous in their methods and the measurements compared. There was insufficient data to estimate overall summary measures of validity for the tools. Client exit interviews compared to direct observation or simulated client protocols had the most data and they were a poor proxy of the actual quality care received for many measurements. CONCLUSION To measure QoC consistently and accurately in LMICs, standardized tools and measures are needed along with an established method of combining them for a comprehensive picture of quality care. Data on how different tools proxy quality client care will inform these guidelines. Despite the small number of studies found during the review, we described important differences on how tools measure quality of care.
Collapse
Affiliation(s)
- Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Diwakar Mohan
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | | | | | - Prakriti Shrestha
- Formerly of Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maia Johnstone
- Formerly of Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Marx
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| |
Collapse
|
39
|
Meherali S, Ali A, Khaliq A, Lassi ZS. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000Res 2021; 10:790. [PMID: 34527219 PMCID: PMC8411274 DOI: 10.12688/f1000research.55204.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In developing countries, pregnancy and childbirth are the leading causes of death among women. In this context, family planning and access to contraceptives are crucial for reducing pregnancy-related morbidity and mortality. Therefore, we aimed to look into the trends of contraception and determinants of contraceptive use in Pakistan. Methods: This study used data for women of reproductive age from four Pakistan Demographic and Health Surveys datasets. Contraception was the outcome variable, whereas, women’s and partner’s education, occupation, wealth quintile, region, place of residence, and exposure to family planning messages were the explanatory variables. Pooled prevalence was estimated using SUMARI and regression analysis was undertaken using SPSS to produce an adjusted prevalence ratio with 95% confidence intervals. Results: Data of 40,259 ever-married women of reproductive age (EMWRA) was analysed. Of the total EMWRA, 30% were using contraception. Of these, 26% were using traditional methods and 74% were using modern methods. The most common method of contraception was condoms (30.5%). The pooled prevalence of contraception used was 29.5% (95% CI 29.1 to 30.0). Through multivariate analysis, women's age, place of residence, region, wealth index, women’s education, their working status, and exposure to family planning messages were found to be significant determinants of contraception usage. Conclusions: There is a noticeable gap regarding awareness and uptake of contraception leading to low contraceptive use among women in Pakistan. In the light of our results, it is important to highlight the importance of girl’s education for building awareness and empowerment.
Collapse
Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, Canada, Alberta, T6G 1C9, Canada
| | - Anna Ali
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Austria
| | - Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
40
|
Trindade RED, Siqueira BB, Paula TFD, Felisbino-Mendes MS. Contraception use and family planning inequalities among Brazilian women. CIENCIA & SAUDE COLETIVA 2021; 26:3493-3504. [PMID: 34468645 DOI: 10.1590/1413-81232021269.2.24332019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Brazil has shown a considerable decline in fertility rates in recent decades. However, sociodemographic differences still have a direct impact on access to family planning in the country. OBJECTIVE To estimate the prevalence of contraceptive use according to sociodemographic variables among Brazilian women in reproductive age. METHODS A cross-sectional study conducted with 17,809 women who have responded to the National Health Survey. We estimated the prevalence as well as the 95% confidence intervals and we used Pearson's chi-square test at a significance level of 5% to analyze differences between groups. RESULTS More than 80% of the women reported to use some contraception method, the most used method was oral contraceptive (34.2%), followed by surgical (25.9%) and condoms (14.5%). Black/Brown, northerly, and low-educated women are more frequently sterilized, while white women, with higher schooling and those living in the south and southeast are the ones who use oral contraception and double protection the most. CONCLUSION Despite the observed improvements, there was no decrease in the prevalence for not using any CM and there are inequalities in access to contraception in the country.
Collapse
Affiliation(s)
- Raquel Elias da Trindade
- Curso de Graduação em Enfermagem, Departamento de Enfermagem Materno- Infantil e Saúde Pública. Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Bárbara Barrozo Siqueira
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Thayane Fraga de Paula
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Mariana Santos Felisbino-Mendes
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| |
Collapse
|
41
|
Ewerling F, McDougal L, Raj A, Ferreira LZ, Blumenberg C, Parmar D, Barros AJD. Modern contraceptive use among women in need of family planning in India: an analysis of the inequalities related to the mix of methods used. Reprod Health 2021; 18:173. [PMID: 34419083 PMCID: PMC8379729 DOI: 10.1186/s12978-021-01220-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level. METHODS Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities. RESULTS The majority (71.8%; 95% CI 71.4-72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1-25.2) in Manipur to 93.6% (95% CI 92.8-94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7-43.7) were sterilized before age 25, 61.5% (95% CI 61.0-62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3-21.3) were not informed that sterilization prevented future pregnancies. CONCLUSION Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.
Collapse
Affiliation(s)
- Fernanda Ewerling
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil.
- , Marechal Deodoro 1160, 3rd floor, Pelotas, RS, Brazil.
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Divya Parmar
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Aluisio J D Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| |
Collapse
|
42
|
Some SYM, Pu C, Huang SL. Empowerment and use of modern contraceptive methods among married women in Burkina Faso: a multilevel analysis. BMC Public Health 2021; 21:1498. [PMID: 34344339 PMCID: PMC8336087 DOI: 10.1186/s12889-021-11541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso. METHODS We analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors. RESULTS Overall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS. CONCLUSIONS Empowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights. TRIAL REGISTRATION No clinical trial has been performed in this study.
Collapse
Affiliation(s)
- Sylvain Y. M. Some
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Christy Pu
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| | - Song-Lih Huang
- International Health Program, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. 11221, Taipei City, Taiwan, Republic of China
| |
Collapse
|
43
|
Saya GK, Premarajan KC, Roy G, Sarkar S, Kar SS, Krishnamoorthy Y, Ulaganeethi R, Olickal JJ. Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India. Health Care Women Int 2021; 45:86-100. [PMID: 34323672 DOI: 10.1080/07399332.2021.1953500] [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: 10/03/2020] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.
Collapse
Affiliation(s)
- Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kariyarath Cheriyath Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Yuvraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Revathi Ulaganeethi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
44
|
Mulubwa C, Munakampe MN, Namakula H, Hernandez A, Ssekamatte T, Atuyambe LM, Birabwa C, Chemonges D, Namatovu F, Makumbi F, Tetui M. Framing Contraceptive Use Motivations Among Adolescents and Young Adults Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda. Front Glob Womens Health 2021; 2:658515. [PMID: 34816215 PMCID: PMC8594010 DOI: 10.3389/fgwh.2021.658515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/31/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: The use of contraceptives among adolescents and young adults is one of the most cost-effective strategies to address many sexual and reproductive health (SRH) challenges, including unintended pregnancies, early marriages, and sexually transmitted infections. Despite a high burden of SRH challenges, uptake and unmet needs of modern contraceptives remain low in Uganda, especially among adolescents and young adults in informal settlement settings. This study aimed to explore the motivations of adolescents and young people to use modern contraceptives (or not). Methods: We analysed qualitative data from eight focus group discussions with 88 adolescents and young people aged 18-24 years residing in informal settlements of urban communities in Kira Municipality of Wakiso district, Uganda. Results: Motivations for use (or not) of modern contraceptives were framed by two interrelated constructs, sources of information on contraception and the unacceptable use of contraceptives among adolescents widespread in the community. These two, in turn, formed the scope of knowledge upon which adolescents and young people based their decision on whether or not to access and use modern contraceptives. Conclusion: To be more effective, sexual and reproductive health programs and interventions that aim to motivate the use of modern contraceptives among adolescents and young people in informal settings should be more comprehensive and focused on alleviating individual, health systems, social, religious factors that reinforce negative health-seeking behaviours towards contraceptive use. In addition, there is a need to support adolescents and young people with socio-economic empowering strategies that equip them with sufficient resources to choose contraceptives of their choice.
Collapse
Affiliation(s)
- Chama Mulubwa
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Margarate Nzala Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Hilda Namakula
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Alison Hernandez
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Lynn M. Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences New Mulago Hospital Complex, Kampala, Uganda
| | - Catherine Birabwa
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Denis Chemonges
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
- Department of Programs, Population Services International, Kampala, Uganda
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Moses Tetui
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
45
|
Mutua MK, Wado YD, Malata M, Kabiru CW, Akwara E, Melesse DY, Fall NA, Coll CVN, Faye C, Barros AJD. Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa. Reprod Health 2021; 18:116. [PMID: 34134700 PMCID: PMC8210345 DOI: 10.1186/s12978-021-01076-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.
Collapse
Affiliation(s)
- Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya.
| | - Yohannes D Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Monica Malata
- Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | | | | | - Dessalegn Y Melesse
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Ndèye Awa Fall
- African Population and Health Research Center, Nairobi, Kenya
| | - Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cheikh Faye
- African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| |
Collapse
|
46
|
Sánchez-Franco S, González-Uribe C. Age disparities in unmet need for contraception among all sexually active women in Colombia: Demographic Health Survey 2015. Women Health 2021; 61:562-571. [PMID: 34102958 DOI: 10.1080/03630242.2021.1936350] [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: 10/21/2022]
Abstract
The Unmet need for contraception increases unintended pregnancies and jeopardizes women's health and reproductive rights. Social determinants are associated with an unmet need for contraception. Still, it is unclear if age is a social determinant of disparities in reproductive health-related outcomes in all Colombian women regardless of marital status. This study used the 2015 Colombian Demographic and Health Survey to determine the unmet need for contraception among 24,245 sexually active women aged 13-49. Age was associated with the unmet need for contraception using a multivariate analysis. Absolute and relative inequalities were estimated using differences in prevalence and odds ratios, respectively. The prevalence of unmet need for contraception was significantly higher in married women aged 13-19 years old (19.8%) than their unmarried counterparts (16.8%), and all older age groups either married or unmarried. Women 13-19 years old [OR = 2.98 (2.49-3.57)] and 20-29 years old [OR = 1.71(1.48-1.97)] are more likely to have an unmet need for contraception than those 40-49 years old. Age disparities are barriers to attaining the Sustainable Development Goals for sexual and reproductive health. Cultural, social, and access barriers demand societies to tailor health care services to meet younger women's needs to narrow the age gap.
Collapse
|
47
|
Gichangi P, Waithaka M, Thiongo M, Agwanda A, Radloff S, Tsui A, Zimmerman L, Temmerman M. Demand satisfied by modern contraceptive among married women of reproductive age in Kenya. PLoS One 2021; 16:e0248393. [PMID: 33836006 PMCID: PMC8034745 DOI: 10.1371/journal.pone.0248393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Demand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs. Materials and methods Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014–2018 was used. PMA2020 surveys are cross-sectional including women 15–49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15. Results Of the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15–19 and 45–49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0–13.8% over the 5-years, p<0.001. Married adolescent 15–19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7–79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9–37.2% and decrease in short acting methods from 49.9–42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence. Conclusions Results show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.
Collapse
Affiliation(s)
- Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- International Centre for Reproductive Health, Mombasa, Kenya
- * E-mail: , ,
| | | | - Mary Thiongo
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Alfred Agwanda
- Population Services Research Institute (PSRI), University of Nairobi, Nairobi, Kenya
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Linea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg school of public Health, Baltimore, Maryland, United States of America
| | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya
- Aga Khan University, Kenya, Nairobi, Kenya
| |
Collapse
|
48
|
Yaya S, Idriss-Wheeler D, Uthman OA, Bishwajit G. Determinants of unmet need for family planning in Gambia & Mozambique: implications for women's health. BMC WOMENS HEALTH 2021; 21:123. [PMID: 33757514 PMCID: PMC7989084 DOI: 10.1186/s12905-021-01267-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022]
Abstract
Background In low-middle-income countries, unmet need for family planning (FP) constitutes a major challenge for prevention of unintended pregnancies and associated health and psychological morbidities for women. The factors associated with unmet need for family planning have been studied for several countries in sub-Saharan Africa, but not much is known about the situation in Gambia and Mozambique. The purpose of this study was to perform a comparative analysis of the prevalence of unmet need for FP, and its sociodemographic correlates in Gambia and Mozambique to better inform FP policies and programs aimed at reducing associated negative health outcomes for women and their families. Methods In this analysis we used nationally representative data from Demographic and Health Surveys in Gambia (2013) and Mozambique (2011). Sample population were 23,978 women (n = 10,037 for Gambia and 13,745 for Mozambique) aged 15–49 years. Women who want to stop or delay childbearing but were not using any contraceptive method were considered to have unmet need for FP. Association between unmet need for FP and the explanatory variables was measured using binary logistic regression models Results Prevalence of unmet need for FP was 17.86% and 20.79% for Gambia and Mozambique, respectively. Having employment in professional/technical/managerial position showed an inverse association with unmet need both in Gambia [OR = 0.843, 95% CI 0.730, 0.974] and Mozambique [OR = 0.886, 95% CI 0.786, 0.999]. Education and household wealth level did not show any significant association with unmet need. The only positive association was observed for rural [OR = 1.213, 95% CI 1.022, 1.441] women in the richer households in Gambia. Having access to electronic media [OR = 0.698, 95% CI 0.582, 0.835] showed a negative effect on having unmet need in Mozambique. Women from female headed households in Gambia [OR = 0.780, 95% CI 0.617, 0.986] and Mozambique [OR = 0.865, 95% CI 0.768, 0.973] had lower odds of unmet need for FP. Conclusion The situation of unmet need for FP in Gambia and Mozambique was better than the Sub-Saharan African average (25%). Nonetheless, there is room for improvement in both countries. Significant assocations with lower unmet need for family planning and women’s occupational status (more education & higher skilled employment), access to mass media communication, and female-headed households provide possible areas for intervention for improved FP opportunities in the region. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01267-8.
Collapse
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
| | | | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Ghose Bishwajit
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada
| |
Collapse
|
49
|
Hasan MM, Magalhaes RJS, Ahmed S, Ahmed S, Biswas T, Fatima Y, Islam MS, Hossain MS, Mamun AA. Meeting the Global Target in Reproductive, Maternal, Newborn, and Child Health Care Services in Low- and Middle-Income Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:654-665. [PMID: 33361233 PMCID: PMC7784071 DOI: 10.9745/ghsp-d-20-00097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/26/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Improving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Many low- and middle-income countries (LMICs) are striving to achieve RMNCH-related Sustainable Development Goals (SDGs). We monitored progress, made projections, and calculated the average annual rate of change needed to achieve universal (100%) access of RMNCH service indicators by 2030. METHODS We extracted Demographic and Health Survey (DHS) data of 75 LMICs to estimate the coverage of RMNCH indicators and composite coverage index (CCI) to measure health system strengths. Bayesian linear regression models were fitted to predict the coverage of indicators and the probability of achieving targets. RESULTS The projection analysis included 64 countries with available information for at least 2 DHS rounds. No countries are projected to reach universal CCI by 2030; only Brazil, Cambodia, Colombia, Honduras, Morocco, and Sierra Leone will have more than 90% CCI. None of the LMICs will achieve universal coverage of all RMNCH indicators by 2030, although some may achieve universal coverage for specific services. To meet targets for universal service access by 2030, most LMICs must attain a 2-fold increase in the coverage of indicators from 2019 to 2030. Coverage of RMNCH indicators, the probability of target attainments, and the required rate of increase vary significantly across the spectrum of sociodemographic disadvantages. Most countries with poor historical and current trends for RMNCH coverage are likely to experience a similar scenario in 2030. Countries with lower coverage had higher disparities across the subgroups of wealth, place of residence, and women's/mother's education and age; these disparities are projected to persist in 2030. CONCLUSION None of the LMICs will meet the SDG RMNCH 2030 targets without scaling up essential RMNCH interventions, reducing gaps in coverage, and reaching marginalized and disadvantaged populations.
Collapse
Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Australia.
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
| | - Ricardo J Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sayem Ahmed
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
| | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Australia
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Md Saimul Islam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Shahadut Hossain
- Department of Statistics, College of Business & Economics, United Arab Emirates University, United Arab Emirates
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
| |
Collapse
|
50
|
Sidibé S, Delamou A, Camara BS, Dioubaté N, Manet H, El Ayadi AM, Benova L, Kouanda S. Trends in contraceptive use, unmet need and associated factors of modern contraceptive use among urban adolescents and young women in Guinea. BMC Public Health 2020; 20:1840. [PMID: 33261605 PMCID: PMC7706031 DOI: 10.1186/s12889-020-09957-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/22/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Guinea, high fertility among adolescents and young women in urban areas remains a public health concern. This study describes trends in contraceptive use, unmet need, and factors associated with the use of modern family planning (FP) methods among urban adolescents and young women in Guinea. METHODS We used four Guinea Demographic and Health Surveys (DHS) conducted in 1999, 2005, 2012, and 2018. Among urban adolescents and young women (15-24 years), we examined trends over time in three key indicators: 1. Modern Contraceptive use, 2. Unmet need for FP and 3. Modern contraceptive use among those in need of FP (demand satisfied). We used multivariable logistic regression to examine association between socio-demographic factors and modern FP use on the most recent DHS dataset (2018). RESULTS We found statistically significant changes over the time period examined with an increase in modern contraceptive use (8.4% in 1999, 12.8% in 2018, p < 0.01) and demand satisfied (29.0% in 1999, 54.1% in 2018, p < 0.001), and a decrease in unmet need for FP (15.8% in 1999, 8.6% in 2018, p < 0.001). Factors significantly associated with modern FP use were; young women aged 20-24 years (AOR 2.8, 95% CI: 1.9-4.1), living in urban areas of Faranah (AOR: 2.6, 95% CI: 1.1-6.5) and Kankan (AOR: 3.6, 95% CI: 1.7-7.8), living in households in the middle (AOR: 7.7, 95% CI: 1.4-42.2) and richer wealth quintiles (AOR: 6.3, 95% CI: 1.0-38.1). Ever-married women (AOR: 0.5, 95% CI: 0.3-0.9) were less likely to use modern FP methods than never married as were those from the Peulh (0.3, 95% CI: 0.2-0.4) and Malinke (0.5, 95% CI: 0.3-0.8) ethnic groups compared to Soussou ethnic group. CONCLUSION Despite some progress, efforts are still needed to improve FP method use among urban adolescent and young women. Age, administrative region, wealth index, marital status, and ethnic group are significantly associated with modern FP use. Future policies and interventions should place emphasis on improving adolescents' reproductive health knowledge, increasing FP availability and strengthening provision. Efforts should target adolescents aged 15-19 years in particular, and address disparities between administrative regions and ethnic groups, and health-related inequalities.
Collapse
Affiliation(s)
- Sidikiba Sidibé
- Institut Africain de Santé Publique (IASP/USTA) of the University Saint Thomas D’Aquin, Ouagadougou, Burkina Faso
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alexandre Delamou
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea
| | - Bienvenu Salim Camara
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea
| | - Nafissatou Dioubaté
- National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea
| | - Hawa Manet
- National Training and Research Centre in Rural Health of Maferinyah, Forecariah, Guinea
| | - Alison M. El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, CA USA
| | - Lenka Benova
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Seni Kouanda
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| |
Collapse
|