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Bøje RB, Bardou M, Mensah K, Rico Berrocal R, Giorgi Rossi P, Bonvicini L, Auzzi N, Taut D, Jiboc N, Tisler A, Reintamm K, Uusküla A, Teixeira M, Firmino-Machado J, Amorim M, Baia I, Lunet N, Michaylova R, Panayotova Y, Kotzeva T, Andersen B, Kirkegaard P. What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries. BMJ Open 2024; 14:e079921. [PMID: 38760040 PMCID: PMC11103196 DOI: 10.1136/bmjopen-2023-079921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/31/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES The aim of this study was to map and compare stakeholders' perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. DESIGN In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. SETTING The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. PARTICIPANTS Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. METHODS Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. RESULTS 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers' lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women's fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. CONCLUSION The study provides an overview of stakeholders' perceived barriers towards vulnerable women's cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women's psychological barriers had several similarities.
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Affiliation(s)
- Rikke Buus Bøje
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Marc Bardou
- CIC-P INSERM 1432, Institut national de la santé et de la recherche médicale, Paris, France
| | - Keitly Mensah
- Early Detection, Prevention and Infections Branch, IARC, Lyon, France
| | - Raquel Rico Berrocal
- Centre d'Etudes des Mouvements Sociaux, Ecole des Hautes Etudes en Sciences Sociales, Paris, France
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Laura Bonvicini
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Noemi Auzzi
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Osservatorio Nazionale Screening, Florence, Italy
| | - Diana Taut
- Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kerli Reintamm
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Margarida Teixeira
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Mariana Amorim
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Ines Baia
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Nuno Lunet
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | | | | | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Olorunsaiye CZ, Brunner Huber LR, Degge HM, Yada FN, Yusuf KK. Assessing the Contraceptive Attitudes of US-Born and Foreign-Born Black Women Living in the USA: a Descriptive Cross-Sectional Study. J Racial Ethn Health Disparities 2024; 11:874-884. [PMID: 36952122 DOI: 10.1007/s40615-023-01569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Racially and ethnically marginalized US women experience unintended pregnancy at twice the rate of White women. Understanding contraceptive attitudes can help identify women at increased risk of contraceptive non-use and unintended pregnancy. We assessed the contraceptive attitudes of US-born and foreign-born Black women and examined differences by nativity. METHODS We used an electronic survey, implemented by Lucid LLC, a consumer research firm, to collect cross-sectional data from 657 reproductive-aged women. Analysis was limited to 414 Black women aged 18-44 years. The exposure variable was nativity (US-born or foreign-born), and the outcome variable was cumulative score on the 32-item Contraceptive Attitude Scale (CAS). Analysis included multivariable linear regression, adjusted for confounders. We also estimated separate models, stratified by nativity to identify predictors of contraceptive attitude among US-born Black women and foreign-born Black women, respectively. RESULTS Three in four participants were US-born (76.6%). The average cumulative CAS score was 118.4 ±20.4 out of 160 indicating favorable contraceptive attitudes. In pooled analysis, foreign-born Black women had significantly lower contraceptive attitude scores compared to US-born women (adjusted regression coefficient (β)= -6.48, p=0.036). In nativity-stratified analysis, income, education, and perceived control over pregnancy timing were significant predictors of contraceptive attitudes for both US-born and foreign-born women. Other significant predictors of contraceptive attitude among US-born women were older maternal age, multi-parity, and perceived pregnancy risk; whereas, for foreign-born women, other significant predictors included marital status (married/cohabiting), language spoken predominantly at home (French), and perceived ability to have a baby and still achieve life goals (agree, neither agree nor disagree). CONCLUSION In addressing the contraceptive needs of Black women, it is important to recognize the differences in attitudes towards contraception by nativity and provide culturally sensitive information and education.
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Affiliation(s)
- Comfort Z Olorunsaiye
- Department of Public Health, Arcadia University, 450 S Easton Road, Glenside, PA, USA.
| | - Larissa R Brunner Huber
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Hannah M Degge
- Department of Health and Education, Coventry University, Scarborough, YO11 2JW, UK
| | - Farida N Yada
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Korede K Yusuf
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
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Oh J. Patient navigation in women's health care for maternal health and noncancerous gynecologic conditions: a scoping review. WOMEN'S HEALTH NURSING (SEOUL, KOREA) 2024; 30:26-40. [PMID: 38650325 PMCID: PMC11073553 DOI: 10.4069/whn.2024.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study investigated the scope of patient navigation studies on women's health care for maternal health and noncancerous gynecologic conditions and aimed to report the characteristics of the identified patient navigation programs. METHODS A scoping review was conducted following Arksey and O'Malley's framework. Five electronic databases were searched for relevant studies published in English: PubMed, Embase, Cochrane Library, CINAHL, and PsycInfo. There were no restrictions on the publication date and the search was completed in July 2023. RESULTS This scoping review included 14 studies, which collectively examined seven patient navigation programs. All selected studies were related to maternal health issues (e.g., perinatal health problems and contraception for birth spacing). Close to two-thirds of the patient navigation services were provided by women (n=9, 64.3%) and half by lay navigators (n=7, 50.0%). The majority incorporated the use of mobile health technologies (n=11, 78.6%). All of the patient navigation programs included in the review coordinated the necessary clinical and social support services to improve women's access to care. CONCLUSION Patient navigation appears to be in its nascent phase in the field of maternal health. The results of this study suggest that the implementation of patient navigation services could potentially improve access to care for socially disadvantaged women and families. Furthermore, providing patient navigation services that are specifically tailored to meet women's needs could improve the quality of maternity care.
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Affiliation(s)
- Jiwon Oh
- College of Nursing, Sungshin Women’s University, Seoul, Korea
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Adrian Parra C, Stuardo Ávila V, Contreras Hernández P, Quirland Lazo C, Bustos Ibarra C, Carrasco-Portiño M, Belmar Prieto J, Barrientos J, Lisboa Donoso C, Low Andrade K. Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review. Public Health 2024; 227:54-62. [PMID: 38118243 DOI: 10.1016/j.puhe.2023.11.031] [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: 07/14/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years. STUDY DESIGN Scoping review. METHODS The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework. RESULTS A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identified-structural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints, racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors. CONCLUSION The most relevant dimensions identified as barriers to access to health services were "culture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.
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Affiliation(s)
- C Adrian Parra
- PhD in Biomedical Research Methodology and Public Health, Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain
| | - V Stuardo Ávila
- Institute of Public Health, Universidad Andrés Bello, Santiago de Chile, Chile.
| | | | - C Quirland Lazo
- PhD in Biomedical Research Methodology and Public Health, Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain; Health Technology Assessment Unit, Arturo López Pérez Foundation, Chile
| | - C Bustos Ibarra
- Department of Social Work, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - M Carrasco-Portiño
- Department of Obstetrics and of Childcare, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - J Belmar Prieto
- School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - J Barrientos
- Faculty of Psychology, Universidad Alberto Hurtado, Chile
| | - C Lisboa Donoso
- School of Dentistry, Faculty of Health Sciences, Universidad Autonoma de Chile, Chile
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Abdi B, Okal J, Serour G, Were V, Temmerman M, Gichangi P. Pattern and determinants of contraceptive use among the muslim women in Wajir and Lamu counties in Kenya: a cross-sectional study. BMC Womens Health 2024; 24:53. [PMID: 38238713 PMCID: PMC10795387 DOI: 10.1186/s12905-024-02892-9] [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: 10/14/2022] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Improving access to family planning (FP) is associated with positive health benefits that includes averting nearly a third of all maternal deaths and 10% of childhood deaths. Kenya has made great strides in improving access to family planning services. However, amid this considerable progress, regional variation has been noted which begs the need for a clearer understanding of the the patterns and determinants that drive these inconsistencies. METHODS We conducted a cross-sectional study that involved 663 Muslim women of reproductive age (15-49 years) from Wajir and Lamu counties in Kenya between March and October 2018.The objective of this study was to understand patterns and determinants of contraceptive use in two predominantly Muslim settings of Lamu and Wajir counties that have varying contraceptive uptake. Eligible women were interviewed using a semi-structured questionnaire containing socio-demographic information and history of family planning use. Simple and multiple logistic regression were used to identify determinants of family planning use. The results were presented as Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) ratios at 95% confidence interval. A p-value of 0.05 was considered statistically significant. RESULTS Of the 663 Muslim women of reproductive age consenting to participate in the study, 51.5%, n = 342 and 48.5%, n = 321 were from Lamu and Wajir County, respectively. The prevalence of women currently using contraceptive was 18.6% (n = 123). In Lamu, the prevalence was 32.8%, while in Wajir, it was 3.4%. The determinants of current contraceptive use in Lamu include; marital status, age at marriage, employment status, discussion with a partner on FP, acceptability of FP in culture, and willingness to obtain information on FP. While in Wajir, determinants of current contraceptive use were education, and the belief that family planning is allowed in Islam. CONCLUSIONS Our study found moderately high use of contraceptives among Muslim women of reproductive age in Lamu county and very low contraceptive use among women in Wajir. Given the role of men in decision making, it is critical to design male involvement strategy particularly in Wajir where the male influence is very prominent. It is critical for the government to invest in women and girls' education to enhance their ability to make informed decisions; particularly in Wajir where FP uptake is low with low education attainment. Further, our findings highlight the need for culturally appropriate messages and involvement of religious leaders to demystify the myths and misconception around family planning and Islam particularly in Wajir.
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Affiliation(s)
- Batula Abdi
- United Nations Population Fund, Uganda Country Office, Kampala, Uganda.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Gamal Serour
- International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt
| | - Vincent Were
- Data Synergy and Evaluation unit, African Population and Health Research Center Nairobi, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - 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
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Barrio-Ruiz C, Ruiz de Viñaspre-Hernandez R, Colaceci S, Juarez-Vela R, Santolalla-Arnedo I, Durante A, Di Nitto M. Language and Cultural Barriers and Facilitators of Sexual and Reproductive Health Care for Migrant Women in High-Income European Countries: An Integrative Review. J Midwifery Womens Health 2024; 69:71-90. [PMID: 37531180 DOI: 10.1111/jmwh.13545] [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] [Revised: 04/26/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Dealing with intercultural communicative barriers in European countries' national health services is an increasing and necessary challenge to guarantee migrant women's right to health care. This integrative review describes the communication barriers and facilitators that migrant women encounter to access and use sexual and reproductive health (SRH) services in Europe. METHODS A literature search was performed to identify original studies in PubMed, CINAHL, PsycINFO, Web of Science, and Scopus, using keywords associated with migrant women and SRH services. This was supplemented by scanning the reference lists from relevant studies and similar reviews. Studies exploring the perspective of migrant women about communication barriers and facilitators to the access and use of SRH services were included, whereas those that solely explored health professional's experiences were excluded. Findings were organized into 4 themes: (1) verbal-linguistic barriers, (2) nonverbal language barriers, (3) cultural barriers, and (4) communication facilitators. RESULTS Nineteen studies met the inclusion criteria. Results showed that when women had problems understanding or being understood by health professionals, they experienced feelings of anxiety, fear, insecurity, and discrimination that discouraged them from using SRH services. The most requested facilitators by women were health education, access to professional interpreters and translation of written information, and increasing the practitioners' cultural competence. DISCUSSION Communication barriers undermine migrant women's right to benefit from preventive SRH programs and to make informed decisions concerning their health. It is necessary to establish tailored plans in each health care center to improve intercultural communication that integrate facilitators proposed by women. Future research should provide solid evidence on the effectiveness of each facilitator implemented.
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Affiliation(s)
| | | | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Raul Juarez-Vela
- GRUPAC, Predepartment Unit of Nursing, University of La Rioja, La Rioja, Spain
| | | | - Angela Durante
- GRUPAC, Predepartment Unit of Nursing, University of La Rioja, La Rioja, Spain
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro,", Novara, Italy
| | - Marco Di Nitto
- Azienda Usl Di Bologna, Bologna, Italy
- Center for Clinical Excellence and Quality of Care, Istituto Superiore Di Sanità, Rome, Italy
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Khan MN, Khalif IY, Rana MS, Khan MMA, Khanam SJ, Alam MB. Improving the uptake of contraception, Somalia. Bull World Health Organ 2024; 102:75-76. [PMID: 38164329 PMCID: PMC10753273 DOI: 10.2471/blt.23.290299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/17/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh-2220, Bangladesh
| | | | - Md Shohel Rana
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh-2220, Bangladesh
| | | | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh-2220, Bangladesh
| | - Md Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh-2220, Bangladesh
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Alomair N, Alageel S, Davies N, Bailey JV. Muslim women's views and experiences of family planning in Saudi Arabia: a qualitative study. BMC Womens Health 2023; 23:625. [PMID: 38007464 PMCID: PMC10675866 DOI: 10.1186/s12905-023-02786-2] [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: 05/05/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Islamic beliefs are associated with decreased contraceptive use compared to other religions, and Muslim women's contraceptive needs are often unmet. Research is needed to provide an in-depth understanding of the complex set of barriers to Muslim women's contraceptive use. Therefore, we aimed to explore Muslim women's awareness and experiences with family planning in Saudi Arabia and investigate barriers to contraceptive use and access to family planning. METHODS A qualitative study using semi-structured interviews with women in a public hospital, in Riyadh, Saudi Arabia, between January and June 2019. Data was analysed using reflexive thematic analysis. RESULTS Twenty-eight women participated in the study. Women's contraceptive awareness was limited to two methods. Women expressed positive attitudes towards family planning and did not believe it is forbidden in Islam. Barriers to contraception use included lack of knowledge, misconceptions, fear of side effects, family and community and social norms. Many women expressed that they have the right to use contraception, even if their husbands disapprove. Our findings show that healthcare providers rarely offered contraceptive advice, even when requested. Healthcare providers often prescribe oral contraceptives without offering information on other methods available. CONCLUSION Our findings suggest that education plays a fundamental role in reproductive autonomy. Men's role in family planning should be encouraged through sharing reproductive responsibility and supporting women's contraceptive choices. Efforts should be directed towards improving women's awareness of different methods of contraception.
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Affiliation(s)
- Noura Alomair
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Samah Alageel
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
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Yeboah D, Issah AN, Kpordoxah MR, Akiti C, Boah M. Prevalence and factors associated with the intention to use contraception among women of reproductive age who are not already using a contraceptive method in Liberia: findings from a secondary analysis of the 2019-2020 Liberia Demographic Health Survey. BMJ Open 2023; 13:e072282. [PMID: 37802625 PMCID: PMC10565247 DOI: 10.1136/bmjopen-2023-072282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Contraception constitutes a vital aspect of sexual and reproductive healthcare. However, the high prevalence of non-use has become a great public health concern globally. This study examined the intention to use contraceptives and its associated factors among women of reproductive age who were not using any method in Liberia. DESIGN AND SETTING A cross-sectional population-based study was conducted. We used data from the 2019-2020 Liberia Demographic and Health Survey. The research framework used the theory of planned behaviour to identify the factors that influence women's intention to use contraception. PARTICIPANTS The study analysed a weighted sample of 4504 women aged 15-49 who were not currently using any form of contraception. DATA ANALYSIS The outcome variable was the intention to use a contraceptive method. A binary logistic regression was used to identify factors associated with the intention to use contraceptives in Stata V.13.0. RESULTS Of the 4504 women, 39.42% intended to use contraception. Contraception intention was significantly lower in married women than in never married women (adjusted OR (aOR) 0.78; 95% CI 0.62 to 0.98). Additionally, women aged 25-34 (aOR 0.434; 95% CI 0.339 to 0.556) and 35-49 (aOR 0.120; 95% CI 0.088 to 0.163) had a reduced intent to use contraceptives than those aged 15-24. However, women with at least one child, those with prior contraception experience and those who had their first sexual encounter at the age of 13 or older were more likely to intend to use contraception. Notably, Muslim and wealthy women displayed a lower likelihood of intending to use contraception. CONCLUSION These findings highlight that attitudes, subjective norms and perceived behavioural control significantly influence women's intentions to use contraception. Understanding and addressing these factors are crucial for promoting effective contraceptive use among women, facilitating informed reproductive choices.
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Affiliation(s)
- Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Policy, Planning Management, and Economics, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, University for Development Studies, Tamale, Ghana
| | - Caselia Akiti
- Department of Bilogical Sciences, University of Liberia, Monrovia, Liberia
- Monitoring and Evaluation Unit, Ministry of Health, Congo Town, Monrovia, Liberia
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, University for Development Studies, Tamale, Ghana
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Sawadogo PM, Sia D, Onadja Y, Beogo I, Sangli G, Sawadogo N, Gnambani A, Bassinga G, Robins S, Tchouaket Nguemeleu E. Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review. PLoS One 2023; 18:e0291486. [PMID: 37708137 PMCID: PMC10501608 DOI: 10.1371/journal.pone.0291486] [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: 07/10/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Migrant, internally displaced, asylum seeking and refugee women experience ongoing risks of having their reproductive healthcare rights violated. This ever-increasing population also has limited access to sexual and reproductive health services. We conducted a scoping review to identify the barriers and facilitating factors when accessing sexual and reproductive health services for this specific population. METHODS We searched the grey literature and queried eight bibliographic databases (Embase, Medline, Cinahl, Scopus, Science Direct, Web of Science, Hinari, and Cochrane Library) to extract articles published between January, 2000, and October, 2021. The extracted data were organized in a framework adapted from Peters et al. and then categorized as facilitators or barriers. We followed the Arksey and O'Malley framework and wrote the report according to the PRISMA-Scr recommendations. RESULTS The search identified 4,722 records of which forty-two (42) met eligibility criteria and were retained for analysis. Ten (10) groups of factors facilitating and/or limiting access to sexual and reproductive health care emerged from the synthesis of the retained articles. The main barriers were lack of knowledge about services, cultural unacceptability of services, financial inaccessibility, and language barriers between patients and healthcare providers. Facilitators included mobile applications for translation and telehealth consultations, patients having a wide availability of information sources, the availability health promotion representatives, and healthcare providers being trained in cultural sensitivity, communication and person-centered care. CONCLUSION Ensuring the sexual and reproductive rights of migrant, internally displaced, asylum-seeking and refugee women requires that policymakers and health authorities develop intervention strategies based on barriers and facilitators identified in this scoping review. Therefore, considering their mental health in future studies would enable a better understanding of the barriers and facilitators of access to sexual and reproductive health services.
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Affiliation(s)
- Pengdewendé Maurice Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Drissa Sia
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Idrissa Beogo
- École des Sciences Infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Sangli
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Assé Gnambani
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Gaëtan Bassinga
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Stephanie Robins
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Eric Tchouaket Nguemeleu
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
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11
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Greenley R, Bell S, Rigby S, Legood R, Kirkby V, McKee M. Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature. Front Public Health 2023; 11:1144674. [PMID: 37304105 PMCID: PMC10247980 DOI: 10.3389/fpubh.2023.1144674] [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: 01/14/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to cervical cancer screening for underserved populations, and (2) identify and describe the effectiveness of interventions aimed at improving participation in cervical cancer screening among underserved groups in Europe. Methods Qualitative, quantitative, and mixed methods studies focusing on barriers and facilitators to cervical screening participation and interventions to improve uptake undertaken in Europe and published after 2000 were included. Four electronic databases were searched to identify relevant papers. Titles and abstracts were screened, full text reviewed, and key findings extracted. Data were extracted and analyzed according to different health system strata: system-wide (macro), service specific (meso) and individual/community specific (micro). Within these categories, themes were identified, and the population groups impacted were recorded. All findings are presented in accordance with (PRISMA) guidelines. Results 33 studies on barriers and facilitators and eight intervention studies met the inclusion criteria. Collectively, the findings of these studies presented a wide array of screening uptake barriers, facilitators, and interventions, predominantly related to screening service and individual/community factors. However, although diverse, certain core themes around information provision, prompts for participation and the need for inclusive spaces were apparent. Implementation of screening programs should focus on: (1) reducing identifiable barriers, (2) increasing public awareness, and (3) providing patient reminders and measures to promote engagement by healthcare providers. Conclusion There are many barriers to uptake of cervical cancer screening and this review, nested within a larger study, will inform work to devise a solution alongside groups identified in three European countries.
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Affiliation(s)
- Rachel Greenley
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sadie Bell
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samuel Rigby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosa Legood
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Kirkby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Kilander H, Sorcher R, Berglundh S, Petersson K, Wängborg A, Danielsson KG, Iwarsson KE, Brandén G, Thor J, Larsson EC. IMplementing best practice post-partum contraceptive services through a quality imPROVEment initiative for and with immigrant women in Sweden (IMPROVE it): a protocol for a cluster randomised control trial with a process evaluation. BMC Public Health 2023; 23:806. [PMID: 37138268 PMCID: PMC10154759 DOI: 10.1186/s12889-023-15776-8] [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: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Immigrant women's challenges in realizing sexual and reproductive health and rights (SRHR) are exacerbated by the lack of knowledge regarding how to tailor post-partum contraceptive services to their needs. Therefore, the overall aim of the IMPROVE-it project is to promote equity in SRHR through improvement of contraceptive services with and for immigrant women, and, thus, to strengthen women's possibility to choose and initiate effective contraceptive methods post-partum. METHODS This Quality Improvement Collaborative (QIC) on contraceptive services and use will combine a cluster randomized controlled trial (cRCT) with a process evaluation. The cRCT will be conducted at 28 maternal health clinics (MHCs) in Sweden, that are the clusters and unit of randomization, and include women attending regular post-partum visits within 16 weeks post birth. Utilizing the Breakthrough Series Collaborative model, the study's intervention strategies include learning sessions, action periods, and workshops informed by joint learning, co-design, and evidence-based practices. The primary outcome, women's choice of an effective contraceptive method within 16 weeks after giving birth, will be measured using the Swedish Pregnancy Register (SPR). Secondary outcomes regarding women's experiences of contraceptive counselling, use and satisfaction of chosen contraceptive method will be evaluated using questionnaires completed by participating women at enrolment, 6 and 12 months post enrolment. The outcomes including readiness, motivation, competence and confidence will be measured through project documentation and questionnaires. The project's primary outcome involving women's choice of contraceptive method will be estimated by using a logistic regression analysis. A multivariate analysis will be performed to control for age, sociodemographic characteristics, and reproductive history. The process evaluation will be conducted using recordings from learning sessions, questionnaires aimed at participating midwives, intervention checklists and project documents. DISCUSSION The intervention's co-design activities will meaningfully include immigrants in implementation research and allow midwives to have a direct, immediate impact on improving patient care. This study will also provide evidence as to what extent, how and why the QIC was effective in post-partum contraceptive services. TRIAL REGISTRATION NCT05521646, August 30, 2022.
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Affiliation(s)
- Helena Kilander
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Rachael Sorcher
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Sofia Berglundh
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Kerstin Petersson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Anna Wängborg
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell- Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Brandén
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Center for Epidemiology and Social Medicine, Region Stockholm, Sweden
| | - Johan Thor
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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13
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Winters A, Jakeman B, Aragon KG, Kasten Z, Bos A, Snyder J, Herman A. Contraceptive Use and Missed Opportunities for Family Planning Discussions in Women Living with Human Immunodeficiency Virus at an HIV Clinic. J Int Assoc Provid AIDS Care 2022; 21:23259582221144449. [PMID: 36536987 PMCID: PMC9772939 DOI: 10.1177/23259582221144449] [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] [Indexed: 12/24/2022] Open
Abstract
The objective of this study was to examine contraception use and family planning discussions (FPD) in female people living with HIV (PLWH). A retrospective cohort study was conducted. Female PLWH were included if they were 18-44 years and received care in 2019 at an HIV clinic. 74 patients met inclusion; mean age was 35 years, 53% were white. All patients were prescribed antiretroviral therapy. 48.6% of patients had documented FPD. 64.9% of patients were using contraception; sterilization was most common (41.7%). Only five patients had a contraindication to hormonal contraception. No differences in contraception use were observed based on age, race, HIV viral load, number of visits, or past pregnancies. However, patients with documented FPD were more likely to use contraception (OR 4.55; 95% CI 1.35-15.29). Routine FPD and contraception use in female PLWH were low. Rates of sterilization were high in female PLWH. Providing quality family planning services is critical to increase contraception use and selection of the most appropriate contraception form.
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Affiliation(s)
- Ashley Winters
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Bernadette Jakeman
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA,Truman Health Services, University of New Mexico Medical Group, Albuquerque, NM, USA
| | - Kelsea Gallegos Aragon
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA,Truman Health Services, University of New Mexico Medical Group, Albuquerque, NM, USA
| | - Zoe Kasten
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Alexander Bos
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Jeremy Snyder
- Truman Health Services, University of New Mexico Medical Group, Albuquerque, NM, USA
| | - Alexandra Herman
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA,Alexandra Herman, Department of Pharmacy Practice & Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico MSC 09 5360, USA.
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14
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Carlsson E. The Realization of Short-Term Fertility Intentions Among Immigrants and Children of Immigrants in Norway and Sweden. INTERNATIONAL MIGRATION REVIEW 2022. [DOI: 10.1177/01979183221107930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Immigrant fertility and the realization of fertility intentions are two topics of considerable interest in contemporary demographic research. Yet very few studies have explored the relationship between intended and actual fertility among immigrants and their children. Using data from the Norwegian and Swedish Generations and Gender Surveys, this article analyzes how both positive and negative short-term fertility intentions stated by men and women at Wave 1 in 2007/08 (Norway) or 2012/13 (Sweden) had been realized at register-based follow-ups three years after the initial interview. Results show that second-generation women of non-Western origin were significantly less likely than native women (defined here as Swedish-born women with two Swedish-born parents) to realize a positive fertility intention, whereas first-generation men of Western origin were significantly more likely than native men to realize a positive fertility intention. Western-origin men were also significantly less likely than native men to have an unintended birth. These findings are robust to controlling for demographic and socioeconomic characteristics at interview. Possible reasons for these intergroup realization differences include group differences in the ability to predict future changes to demographic and socioeconomic status and in the motivation to pursue the realization of a reported fertility intention. This article demonstrates that exploring immigrant-native differences in realization patterns can provide information about immigrants’ ideational and behavioral adaptation to the destination country’s fertility regime that cannot be attained by studying intended or actual fertility alone.
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15
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Omar B, Larsson EC, Calza S, Osman F. Perceptions of family planning among some Somali men living in Sweden: A phenomenographic study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100732. [PMID: 35490478 DOI: 10.1016/j.srhc.2022.100732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A growing body of research in Sweden has focused on migration and reproductive health, particularly on women's perspectives, including family planning and contraception. However, knowledge is limited on how immigrant men perceive family planning. The topic is important because women's use of family planning has been shown to be influenced by their partners and community. Therefore, this study aims to explore perceptions of family planning among Somali men living in Sweden. METHODS A qualitative phenomenographic approach was used. Four focus group discussions were conducted with 41 men aged 28-59 years. Data were analysed using phenomenographic analysis. FINDINGS The following four categories were identified in the analysis: 1) a happier and more sustainable family; 2) ideal family size versus cultural commitment; 3) fears of using modern family planning methods; and 4) a need to be included in family planning. The findings illuminated the complexities of perceptions of family planning. Although Somali men understood the benefits of family planning, they seemed to prefer a large family. However, due to their new social context in Sweden, they had also changed their views on having as large a family as in their home country. CONCLUSION Our findings suggest that Somali men living in Sweden want to be involved in family planning counselling, which may increase women's use of contraception. However, healthcare providers must ensure that the woman desires her partner's involvement and be culturally sensitive about couples' needs.
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Affiliation(s)
- Bakar Omar
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Viale Europa, 11 25123 Brescia, Italy; School of Public Health and Research, Somali National University. Columbia Rd, Hamar Weyne, P.O Box 15, Mogadishu, Somalia.
| | - Elin C Larsson
- Department of Global Public Health and Department of Women's and Children's Health, Karolinska Institutet, GPH Ekström, 171 77 Stockholm, Sweden.
| | - Stefano Calza
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Viale Europa, 11 25123 Brescia, Italy.
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Falun 791 88, Falun, Sweden.
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16
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Mohamed AF, Sundberg LR. "Using contraceptives is abandoning our culture": A qualitative study of contraceptive use among Somali women in Finland. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100718. [PMID: 35354115 DOI: 10.1016/j.srhc.2022.100718] [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: 06/15/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Several studies have reported that Somalis have negative attitudes about using modern contraceptives. However, little attention has been paid to the differences in Somali women's attitudes toward contraceptives across generations and the attitude change happening overtime in Somali women's attitudes toward contraception. This study explores attitudes toward contraceptives and factors influencing contraceptive use, among first- and second-generation Somali women living in Finland. METHODS The study follows a qualitative design with data collection using in-depth interviews. Sixteen women were interviewed regarding their knowledge of, attitude toward, and use of contraceptives. Eight of the study participants were first-generation and eight were second-generation Somali women living in Finland. The data were analyzed using a thematic approach guided by a cultural anthropology framework. RESULTS Three main themes emerged in the data analysis: (1) Culture influencing Somali women's attitudes toward contraceptives; (2) information sources can work differently within the same cultural group; and (3) Somali women's perspectives on contraceptives change over time. Cultural, religion, taboo, and knowledge resources are used to understand the whole concept of Somali women's attitude toward and use of contraceptives. Hence, the study shows the diverse opinions of Somali women. According to the informants the main underlying factors influencing Somali women's attitudes toward contraceptives were education, culture, misinterpreted religion, and social pressure. CONCLUSIONS According to the Finish resident women interviewed for this study, Somali culture do not support the use of modern contraceptives. Even though attitudes towards contraceptives are slowly changing, there is a need for SRH education, particularly among first-generation Somalis. Second-generation women are generally more open to the use of modern contraceptives. The study also draws attention to the need to improve the training of health care professionals regarding the handling of culturally sensitive topics such as contraception use.
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Affiliation(s)
- Amal Farah Mohamed
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Agbemenu K, Mencia JJ, de Rosa C, Aidoo-Frimpong G, Ely G. Family Planning Research in African Immigrant and Refugee Women: A Scoping Review. J Transcult Nurs 2022; 33:416-426. [PMID: 35135387 DOI: 10.1177/10436596211072891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States. METHODS Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020. RESULTS The small number of retrieved studies for the literature review clearly highlights a dearth of research. Available evidence indicates stark disparities in health care access, unmet individual needs, and unacknowledged preferences. DISCUSSION Ignoring cultural considerations for the growing African immigrant population perpetuates the divide in family planning practices.
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Gele AA, Shrestha M, Sheikh NS, Qureshi SA. Pregnant and Powerless: Exploring Barriers to Contraceptive use among Women in Mogadishu, Somalia. Health Serv Res Manag Epidemiol 2022. [DOI: 10.1177/23333928221117057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background With a maternal mortality ratio of 692 per 100 000 live births and modern contraception prevalence of 1%, understanding factors hindering Somali women from using modern contraception is key to developing and implementing locally adopted public health responses. The purpose of this qualitative study was to explore factors impeding Somali women in Mogadishu from using modern contraception Methods We conducted a qualitative study using semi-structured, in-depth interviews with 21 married women aged >18 years, living in different neighborhoods in Mogadishu between July—December 2018. We recruited the participants using a convenience sampling method. Results The findings show that health communication messages and contraceptive information provided by health providers (medical barriers) constitute a significant obstacle to women’s access to modern contraception services. Other barriers included prevalent religious fallacies among women and fear of permanent infertility upon modern contraception. Conclusion Training health providers in the principles of modern contraception, in addition to the medical ethics that govern their responsibility to provide correct and relevant information to their patients, is vital for increasing modern contraception use among Somali women. The findings of this study may be used for designing public health interventions that promote acceptance and the use of modern contraception among both women and men in Somalia.
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Affiliation(s)
- Abdi A Gele
- Department of Health Service Research, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Naima Said Sheikh
- Department of Health Service Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Samera A Qureshi
- Department of Health Service Research, Norwegian Institute of Public Health, Oslo, Norway
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Wulandari RD, Laksono AD, Matahari R. The Barrier to Contraceptive Use among Multiparous Women in Indonesia. Indian J Community Med 2021; 46:479-483. [PMID: 34759492 PMCID: PMC8575210 DOI: 10.4103/ijcm.ijcm_902_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background The lack of perception related to the risk of pregnancy and contraceptive use's side effects is the main reason for not using contraceptives. Objective This study aimed to analyze barriers to contraceptive use among multiparous women in Indonesia. Methods This study employed the 2017 Indonesia Demographic and Health Survey. The analysis unit was multiparous women aged 15-49 years old, and the sample was 25,543 women. The contraceptive use was the dependent variable, while the independent variables analyzed were residence, age, education, employment, wealth, and insurance. The study used a binary logistic regression to determine the barriers. Results Women in urban areas were 1.100 times more likely not to use contraceptives than women in rural areas. All categories of age group are more likely to use contraception than the 45-49 age group. Multiparous women who had low education had a higher possibility of not using contraceptives. Unemployed multiparous women were 1.008 times more likely not to use contraceptives than employed multiparous women. In terms of wealth status, women with all wealth status tended not to use contraceptives than the richest. Conclusions Multiparous women in Indonesia had five barriers to not using contraceptives. These included living in urban, being at younger ages, having no education, being unemployed, and having low wealth status.
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Affiliation(s)
- Ratna Dwi Wulandari
- Department of Administration and Health Policy, Faculty of Public Health, Universitas Airlangga, Surabaya, India
| | - Agung Dwi Laksono
- Center of Research and Development for Humanities and Health Management, National Institute of Health Research and Development, Indonesia Ministry of Health, Jakarta, India
| | - Ratu Matahari
- Department of Reproductive Health, Faculty of Public Health, Ahmad Dahlan University, Yogyakarta, Indonesia
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Al-Sheyab NA, Al Nsour M, Khader YS, Yousif H, Alyahya MS, Taha H, Bardus M, Al Kattan M, Amiri M. Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics. Heliyon 2021; 7:e07810. [PMID: 34458635 PMCID: PMC8379452 DOI: 10.1016/j.heliyon.2021.e07810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/02/2021] [Accepted: 08/12/2021] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES This study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan. METHODS Explorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis. RESULTS Two themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality. CONCLUSIONS This study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.
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Affiliation(s)
- Nihaya A. Al-Sheyab
- Allied Medical Sciences, Department/Faculty of Applied Medical Sciences, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan
| | - Mohannad Al Nsour
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Yousef S. Khader
- Department of Community Medicine, Public Health and Family Medicine/ Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Hind Yousif
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Mohammad S. Alyahya
- Faculty of Medicine, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan
| | - Hana Taha
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
| | - Marco Bardus
- Department of Health Promotion & Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, P.O. Box (11-0236), Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Malika Al Kattan
- Department of Health Promotion & Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, P.O. Box (11-0236), Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mirwais Amiri
- Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan
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Aziz Ali S, Feroz A, Abbasi Z, Aziz Ali S, Allana A, Hambidge KM, Krebs NF, Westcott JE, McClure EM, Goldenberg RL, Saleem S. Perceptions of women, their husbands and healthcare providers about anemia in rural Pakistan: Findings from a qualitative exploratory study. PLoS One 2021; 16:e0249360. [PMID: 33905421 PMCID: PMC8078764 DOI: 10.1371/journal.pone.0249360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. METHODS A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women's health behavior. We analyzed the data through thematic analysis using NVivo 10 software. RESULTS Most community members were not aware of the term anemia but described anemia as a condition characterized by 'blood deficiency' in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia. CONCLUSION The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Savera Aziz Ali
- Department of Nursing, University of Alberta, Edmonton, Canada
| | - Ahreen Allana
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K. Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jamie E. Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Elizabeth M. McClure
- Regional Triangulate Institute International, Research Triangle Park, North Carolina, United States of America
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, New York, United States of America
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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22
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Lukasse M, Baglo MCG, Engdal E, Lassemo R, Forsberg KE. Norwegian women's experiences and opinions on contraceptive counselling: A systematic textcondensation study. Eur J Midwifery 2021; 5:4. [PMID: 33554056 PMCID: PMC7856575 DOI: 10.18332/ejm/132224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Contraception plays a pivotal role in most women's lives, from teenage years to the menopause. Contraception and sexual wellbeing are closely related. Ideally, women should be able to access contraception and discuss issues concerning their sexual life during a contraceptive counselling session. Previously, only doctors conducted contraceptive consultations. Increasingly, other healthcare workers are providing contraceptive care. The aim of this study is to explore women's experiences and opinions related to contraceptive counselling. METHODS An electronic questionnaire was distributed in 2017-2018. The texts of 308 women's written responses to open-ended questions were analyzed using systematic text-condensation. RESULTS The analysis resulted in four themes: 1) Women-centered care, 2) Side-effects of hormonal contraceptives, 3) Non-hormonal methods and male involvement, and 4) Counsellors' professional background. Women wished for a consultation that would lead to the best choice of contraception for them, taking into account their medical history, personal preference and living circumstances. Side-effects of hormonal products were under-communicated, as were non-hormonal methods. Respondents had contradicting opinions about midwives as contraceptive counsellors and were unfamiliar with them in this role. CONCLUSIONS The quality of contraceptive counselling in Norway needs to be improved. Women require individualized follow-up, sufficient information and a choice of methods to find the most suitable alternative for them. A good relationship with a health provider they trust could improve contraceptive consultation. Midwives' knowledge and competence in this area need to be made more widely known.
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Affiliation(s)
- Mirjam Lukasse
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Marie Christine G. Baglo
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Maternity Unit, Tønsberg Hospital, Tønsberg, Norway
| | - Eldri Engdal
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Maternity Unit, Lillehammer Hospital, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ragnhild Lassemo
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Maternity Unit, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Kristin E. Forsberg
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Community Health Services, Horten, Norway
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