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Wood SN, Thomas HL, Guiella G, Mosso R, Gichangi P, Kibira SP, Makumbi F, Akilimali PZ, OlaOlorun FM, Omoluabi E, Decker MR. Longitudinal impact of past-year reproductive coercion on contraceptive use dynamics in Sub-Saharan Africa: evidence from eight population-based cohorts. EClinicalMedicine 2025; 80:103056. [PMID: 39877258 PMCID: PMC11773259 DOI: 10.1016/j.eclinm.2024.103056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 12/17/2024] [Accepted: 12/23/2024] [Indexed: 01/31/2025] Open
Abstract
Background Reproductive coercion (RC) is a type of abuse where a partner intentionally attempts to interfere with fertility through deception or violence, often by manipulating one's contraceptive use or reproductive decision-making. Cross-sectional studies on the magnitude of RC across sub-Saharan Africa have noted associations with contraceptive use. No studies have longitudinally examined RC experiences as related to future contraceptive dynamics, including discontinuation or forgoing use altogether. Methods Two rounds of longitudinal population-based cohorts across eight sites in sub-Saharan Africa, from November 2020 to January 2023, were used to prospectively examine past-year RC's impact on future contraceptive dynamics (discontinuation and switching vs. continuation for contraceptive users at baseline; adoption vs. continued non-use for contraceptive non-users at baseline) using bivariate and multivariable multinomial and logistic regression. Findings Minimal differences in women's past-year RC experiences were observed over a two-year period. In many settings, RC prevalence decreased. Only in Uganda did past-year RC increase between rounds (15.8% to 17.8%). RC's impact on contraceptive dynamics over one year differed by setting. In Burkina Faso, women with past-year RC had a three-fold increased risk of discontinuing contraception, as compared to continuing (RRR = 2.63; 95% CI = 1.28-5.42; p<0.01). In Uganda, past-year RC was marginally associated with reduced odds of contraceptive adoption, compared to continued non-use (p<0.1). Interpretation In this first longitudinal study of RC, trajectories varied across settings, as did RC's impact on contraception, affirming the importance of context. Future work should clarify RC trajectories and drivers thereof. Providers must be aware of RC leading to potential discontinuation. Contraceptive provision must be flexible and reflect women's life circumstances, including partner dynamics. Funding This work was supported, in whole, by the Bill & Melinda Gates Foundation [INV-046501 and INV-009639]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.
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Affiliation(s)
- Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Haley L. Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Rosine Mosso
- Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Cote d’Ivoire
| | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | | | | | - Pierre Z. Akilimali
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Elizabeth Omoluabi
- Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins School of Nursing, Baltimore, USA
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Pearson E, Paul D, Menzel J, Shakhider MAH, Konika RA, Uysal J, Silverman JG. Effectiveness of the Addressing Reproductive Coercion in Health Settings (ARCHES) intervention among abortion clients in Bangladesh: a cluster-randomized controlled trial. EClinicalMedicine 2024; 73:102699. [PMID: 39040882 PMCID: PMC11260591 DOI: 10.1016/j.eclinm.2024.102699] [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] [Received: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/24/2024] Open
Abstract
Background The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention trains existing providers to address reproductive coercion (RC) and intimate partner violence (IPV) within routine family planning counseling. This study evaluated the effectiveness of a single ARCHES counseling session as adapted for use with abortion clients in Bangladesh. Methods In this cluster-randomized controlled trial conducted between January 2019 and January 2021, health facilities with an abortion clinic with infrastructure for private counseling and onsite violence support services were eligible. Six facilities in Bangladesh met inclusion criteria, and matched pairs randomization with parallel assignment and a 1:1 allocation ratio was used to randomize three facilities to ARCHES and three facilities to control, which implemented standard counseling. Blinding was not possible as providers in intervention facilities participated in a three-day ARCHES training. Participants were abortion clients aged 18-49 years who could provide safe recontact information and be interviewed privately. The primary outcome was past three-month modern contraceptive use without interruption or interference. The trial was registered on clinicaltrials.gov (NCT03539315) on 29 May 2018. Findings A total of 1492 intervention participants and 1237 control participants were enrolled. Available data were analyzed at each follow-up period: 1331 intervention and 1069 control participants at the three-month follow-up, and 1269 intervention and 1050 control participants at the twelve-month follow-up. ARCHES was associated with higher likelihood of modern contraceptive use at the three-month follow-up (adjusted RR = 1.08, 95% CI: 1.06-1.10) and the twelve-month follow-up (adjusted RR = 1.06, 95% CI: 1.02-1.10). ARCHES was also associated with decreased incident pregnancy, decreased IPV, and increased knowledge of IPV support services. Interpretation The ARCHES intervention is effective in increasing post-abortion modern contraceptive use and decreasing incident pregnancy and IPV among abortion clients in Bangladesh. Implementation of ARCHES should be considered in facilities with sufficient privacy for counseling. Funding Society of Family Planning (#SFPRF11-07) and Ipas.
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Affiliation(s)
- Erin Pearson
- Ipas, Chapel Hill, NC, USA
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
| | | | - Jamie Menzel
- Ipas, Chapel Hill, NC, USA
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
| | | | | | - Jasmine Uysal
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Jay G. Silverman
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
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Montt-Maray E, Adamjee L, Horanieh N, Witt A, González-Capella T, Zinke-Allmang A, Cislaghi B. Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2023; 4:1149632. [PMID: 37674903 PMCID: PMC10478786 DOI: 10.3389/fgwh.2023.1149632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.
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Affiliation(s)
- Eloisa Montt-Maray
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lamiah Adamjee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nour Horanieh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alice Witt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thaïs González-Capella
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Boydell V, Smith RD, Global LARC Collaborative (GLC). Hidden in plain sight: A systematic review of coercion and Long-Acting Reversible Contraceptive methods (LARC). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002131. [PMID: 37594941 PMCID: PMC10437997 DOI: 10.1371/journal.pgph.0002131] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/12/2023] [Indexed: 08/20/2023]
Abstract
In recent years there has been extensive promotion of long-acting reversible contraceptives (LARC) globally to increase access to what is widely considered a highly effective contraceptive method. Yet, despite these efforts, evidence points towards the worrying propensity for LARCS to be associated with coercion. Hence, we undertook a meta-narrative review across nine databases to draw together the heterogeneous and complex evidence on the coercive practices associated with LARC programs. A total of 92 papers were grouped into three metanarratives: (1) law, (2) public health and medicine, and (3) the social sciences. Across disciplines, the evidence supports the conclusion that coercive practices surrounding LARC programs always target marginalized, disadvantaged and excluded population(s). Looking at coercion across disciplines reveals its many forms, and we present a continuum of coercive practices associated with LARC programming. We found that each discipline provides only a partial picture of coercion, and this fragmentation is a knowledge practice that prevents us from collecting accurate information on this subject and may contribute to the perpetuation of these suspect practices. We present this review to address longstanding silences around coercion and LARCs, and to encourage the development of clinical and programmatic guidance to actively safeguard against coercion and uphold reproductive rights and justice.
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Affiliation(s)
- Victoria Boydell
- School of Health and Social Care, University of Essex, Colchester Campus, Colchester, United Kingdom
| | - Robert Dean Smith
- Department of Anthropology and Sociology, Geneva Graduate Institute, Geneva, Switzerland
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Muluneh MD, Francis L, Agho K, Stulz V. The association of intimate partner violence and contraceptive use: a multi-country analysis of demographic and health surveys. Int J Equity Health 2023; 22:75. [PMID: 37101283 PMCID: PMC10134549 DOI: 10.1186/s12939-023-01884-9] [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: 03/17/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause of poor health, disability, and death among women of reproductive age. However, the existing studies about the association between IPV and contraceptive use have been found to be conflicting and relatively less studied, particularly in low and middle income countries, including Eastern Sub Saharan Africa (SSA). This study examines the relationship between IPV and contraceptive use in Eastern SSA countries. METHODS The Demographic and Health Surveys (DHS) from 2014 to 2017 were a multi-stage cluster sample survey of 30,715 ever married (or cohabitating) women of reproductive age from six countries. The six Eastern SSA datasets were pooled and multivariable logistic regression using a hierarchical approach was performed to examine the association between IPV and contraceptive use after adjusting for women, partners, and household and health facility factors. RESULT Two thirds of women 67% [66.55, 67.88] were not using any modern contraceptive methods and almost half (48%) of the women had experienced at least one form of IPV from their partners. Our analysis showed a strong association with decreased odds of physical violence [adjusted odds ratios (aOR) = 0.72, 95%CI: 0.67, 0 0.78] among women not using any contraceptive methods. Other factors associated with women not using any contraceptive methods were older women (35-49 years), illiterate couples and women from poorest households. Women who had no access to any form of communication [aOR = 1.12, 95%CI: 1.08, 1.36], unemployed partner [aOR = 1.55, 95%CI: 1.23, 1.95] and women who travelled long distances to access health services [aOR = 1.16, 95%CI: 1.06, 1.26] significantly reported increased odds of not using any contraceptive methods. CONCLUSION Our study indicated that physical violence was negatively associated with not using any contraceptive method among married women in Eastern SSA countries. Tailored intervention messages to reduce IPV including physical violence among women not using contraceptive methods in East Africa should target those from low-socioeconomic groups especially, older women with no access to any form of communication, unemployed partners, and illiterate couples.
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Affiliation(s)
- Muluken Dessalegn Muluneh
- Amref Health Africa in Ethiopia, Addis Ababa 17022, Bole Sub, Ethiopia.
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, 2751, Australia.
| | - Lyn Francis
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, 2751, Australia
| | - Kingsley Agho
- School of Health Sciences, Western Sydney University, Locked Bag1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Virginia Stulz
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Nazarbegian M, Averbach S, Johns NE, Ghule M, Silverman J, Lundgren R, Battala M, Begum S, Raj A. Associations between Contraceptive Decision-Making and Marital Contraceptive Communication and use in Rural Maharashtra, India. Stud Fam Plann 2022; 53:617-637. [PMID: 36193029 PMCID: PMC10695302 DOI: 10.1111/sifp.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Women's contraceptive decision-making control is crucial for reproductive autonomy, but research largely relies on the Demographic and Health Survey (DHS) measure which asks who is involved with decision-making. In India, this typically assesses joint decision-making or male engagement. Newer measures emphasize female agency. We examined three measures of contraceptive decision-making, the DHS and two agency-focused measures, to assess their associations with marital contraceptive communication and use in rural Maharashtra, India. We analyzed follow-up survey data from women participating in the CHARM2 study (n = 1088), collected in June-December 2020. The survey included the DHS (measure 1), Reproductive Decision-Making Agency (measure 2), and Contraceptive Final Decision-Maker measures (measure 3). Only Measure 1 was significantly associated with contraceptive communication (adjusted odds ratio [AOR]: 2.75, 95 percent confidence interval [CI]: 1.69-4.49) and use (AOR: 1.73, 95 percent CI: 1.14-2.63). However, each measure was associated with different types of contraceptive use: Measure 1 with condom (adjusted relative risk ratio [aRRR]: 1.99, 95 percent CI: 1.12-3.51) and intrauterine device (IUD) (aRRR: 4.76, 95 percent CI: 1.80-12.59), Measure 2 with IUD (aRRR: 1.64, 95 percent CI: 1.04-2.60), and Measure 3 with pill (aRRR: 2.00, 95 percent CI: 1.14-3.52). Among married women in Maharashtra, India, male engagement in decision-making may be a stronger predictor of contraceptive communication and use than women's agency, but agency may be predictive of types of contraceptives used.
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Affiliation(s)
- Melody Nazarbegian
- University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, La Jolla, CA, 92037, USA
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Nicole E Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Jay Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Madhusudana Battala
- Population Council, Zone 5A, Ground Floor, India Habitat Center, New Delhi, 110003, India
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
- Department of Education Studies, University of California, San Diego, CA, 92161, USA
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Dozier JL, Zimmerman LA, Ejigu BA, Shiferaw S, Seme A, Yihdego M, Yirgu R, Wood SN. Pregnancy coercion and partner knowledge of contraceptive use among Ethiopian women. Contracept X 2022; 4:100084. [PMID: 36193281 PMCID: PMC9525805 DOI: 10.1016/j.conx.2022.100084] [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: 08/02/2021] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the relationship between pregnancy coercion and partner knowledge of contraceptive use. Study design Cross-sectional Performance Monitoring for Action-Ethiopia data were collected in October-November 2019 from a nationally representative sample of women ages 15 to 49. The analytical sample (n = 2,469) included partnered women using contraception in the past year. We used multinomial logistic regression to examine associations between past-year pregnancy coercion (none, less severe, more severe) and partner knowledge/couple discussion of contraceptive use (overt use with couple discussion before method initiation (reference group), overt use with discussion after method initiation, and covert use of contraception). Results Most women reported their partner knew they were using contraception and had discussed use prior to method initiation (1,837/2,469, 75%); 16% used overtly and discussed use after method initiation, and 7% used contraception covertly. The proportion of covert users increased with pregnancy coercion severity (4%none, 14%less severe, 31%more severe), as did the proportion of overt users who delayed couple contraceptive discussions, (14%none, 23%less severe, 26% more severe); however, overt use with couple discussion before method initiation decreased with pregnancy coercion severity (79%none, 60%less severe, 40%more severe). The risk of covert use among women experiencing less severe pregnancy coercion was four times greater than women who experienced no pregnancy coercion (adjusted relative risk ratio, (aRRR) = 3.95, 95% confidence interval (CI) 2.20-7.09) and ten times greater for women who experienced the most severe pregnancy coercion (aRRR = 10.42, 95% CI 6.14-17.71). The risk of overt use with delayed couple discussion also increased two-fold among women who experienced pregnancy coercion compared to those who did not (less severe aRRR = 2.05, 95% CI 1.39-2.99; more severe aRRR = 2.89, 95% CI 1.76-4.73). Conclusion When experiencing pregnancy coercion, women may avoid or delay contraceptive conversations with their partners. Increased pregnancy coercion severity has the greatest association with covert use and couple contraceptive discussions. Implications The presence and timing of couple discussions about contraception are critical for ensuring safety for women experiencing pregnancy coercion. Screening for pregnancy coercion must be included within contraceptive counseling so that women can choose methods that maximize their reproductive autonomy.
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Affiliation(s)
- Jessica L. Dozier
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Linnea A. Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Bedilu A. Ejigu
- Department of Statistics, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahari Yihdego
- Performance Monitoring for Action Ethiopia, Addis Ababa, Ethiopia
| | - Robel Yirgu
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shannon N. Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Dey AK, Dehingia N, Bhan N, Thomas EE, McDougal L, Averbach S, McAuley J, Singh A, Raj A. Using machine learning to understand determinants of IUD use in India: Analyses of the National Family Health Surveys (NFHS-4). SSM Popul Health 2022; 19:101234. [PMID: 36203476 PMCID: PMC9529578 DOI: 10.1016/j.ssmph.2022.101234] [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: 01/25/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022] Open
Abstract
Intra-uterine devices (IUDs) are a safe and effective method to delay or space pregnancies and are available for free or at low cost in the Indian public health system; yet, IUD uptake in India remains low. Limited quantitative research using national data has explored factors that may affect IUD use. Machine Learning (ML) techniques allow us to explore determinants of low prevalence behaviors in survey research, such as IUD use. We applied ML to explore the determinants of IUD use in India among married women in the 4th National Family Health Survey (NFHS-4; N = 499,627), which collects data on demographic and health indicators among women of childbearing age. We conducted ML logistic regression (lasso and ridge) and neural network approaches to assess significant determinants and used iterative thematic analysis (ITA) to offer insight into related variable constructs generated from a series of regularized models. We found that couples’ shared family planning (FP) goals were the strongest determinants of IUD use, followed by receipt of FP services and desire for no more children, higher wealth and education, and receipt of maternal and child health services. Findings highlight the importance of male engagement and family planning services for IUD uptake and the need for more targeted efforts to support awareness of IUD as an option for spacing, especially for those of lower SES and with lower access to care. Prevalence of IUD use has remained extremely low in India for the past two decade. This paper used machine learning models with iterative thematic analysis to explore potential predictors of IUD use among currently married women in India. The strongest predictor of IUD use was shared marital family planning goals between the male and female partners. Prior access to Family Planning services and couples' desire for no more children were also found to be predictive of IUD use in India. Findings also highlight the importance of male engagement and family planning services for IUD uptake.
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Upadhyay AK, Kumar K, James KS, Mcdougal L, Raj A, Singh A. Association between Intimate Partner Violence and Contraceptive Use Discontinuation in India. Stud Fam Plann 2022; 53:5-21. [PMID: 35032028 PMCID: PMC8957512 DOI: 10.1111/sifp.12184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap using microdata collected from women aged 15-49 in the 2015-2016 National Family Health Survey (NFHS). Analyses used multivariable multinomial logistic regressions stratified by long-acting reversible contraceptive methods (LARC)/non-LARC and condom/pill to examine the association between experience of IPV and contraceptive use discontinuation while still in need (DWSIN). Experience of physical violence was associated with DWSIN among LARC/IUD users (RRR: 3.73, 95 percent CI [1.55-8.95]) Among condom users, DWSIN was higher among women who experienced emotional violence compared with women who did not experience any violence (RRR: 4.16, 95 percent CI [1.59-10.90]). Although we did not find an association between IPV and overall contraceptive use discontinuation, we did find compelling evidence of an association between IPV and IUD and condom use discontinuation in India. There is a need to understand women's experience of IPV as a part of a broader strategy to provide high-quality family planning services to all women while considering individual circumstances and reproductive aspirations to support the uninterrupted use of contraception in India.
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Affiliation(s)
- Ashish Kumar Upadhyay
- Research Coordinator, GENDER ProjectInternational Institute for Population SciencesMumbai400 088India
| | - Kaushalendra Kumar
- Assistant Professor, Department of Public Health & Mortality StudiesInternational Institute for Population SciencesMumbai400 088India
| | - K. S. James
- Director and Senior ProfessorInternational Institute for Population SciencesMumbai400 088India
| | - Lotus Mcdougal
- Associate Project Scientist, Center on Gender Equity and HealthUniversity of California San DiegoLa JollaCA92093USA
| | - Anita Raj
- Tata Chancellor Professor of Medicine and Director, Center on Gender Equity and HealthUniversity of California San DiegoLa JollaCA92093USA
| | - Abhishek Singh
- Professor, Department of Public Health & Mortality StudiesInternational Institute for Population SciencesMumbai400 088India
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Dey AK, Acharya R, Tomar S, Silverman JG, Raj A. How does the sex composition of children affect men's higher ideal family size preference relative to women and contraceptive use patterns among couples? A cross-sectional analysis of dyadic couple's data in India. SSM Popul Health 2021; 15:100835. [PMID: 34159248 PMCID: PMC8193613 DOI: 10.1016/j.ssmph.2021.100835] [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: 01/18/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Son preference, an ongoing concern in India, is a known driver of ideal family size preferences and contraceptive use among couples. These associations can vary substantially with parity and can influence men and women differently. This study assesses the association of sex composition of children by parity and a) men's higher ideal family size preference relative to women and b) use of modern contraceptives by couples. Methods We used the Couples Recode dataset from National Family Health Survey (NFHS) 2015-16 and identified couples who had at least one child and had complete responses for variables used in the study (N = 56,731 couples). We developed multivariable linear and logistic regression models to study the association between sex composition of children by parity and our dependent variables. Results Our findings indicate that the sex composition of children is associated with men's higher ideal family size preference, relative to women, among couples with four or more children. We also find that couples with less than four children are less likely to use modern contraceptives when they have an equal or a greater number of daughters than sons compared to those who have no daughters. Findings suggest that couples with four or more children are more likely to use modern contraceptives when they have at least one son and one daughter and are less likely to use contraceptives when they have all daughters and no sons, than couples who have no daughters. Conclusion This study contributes to existing research on the relationship between sex composition of children with ideal family size preferences and contraceptive use by highlighting meaningful differences between higher and lower parity couples. Findings from the study can be used by family planning programs in India to customize family planning counselling messages by both sex composition and parity. Men do not have a higher ideal family size preference, relative to women among couples with less than four children. Men's higher ideal family size preferenceobserved only among couples with four or more children. Couples with less than four children are less likely to use modern contraceptives when they have more daughters than sons. Couples with four or more children are less likely to use contraceptives if they have all daughters and no sons.
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Affiliation(s)
- Arnab K Dey
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | | | - Shweta Tomar
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA.,Department of Education Studies, Division of Social Sciences, University of California, San Diego School of Medicine, La Jolla, CA, USA
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