Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City

Prevalence of unintended pregnancy in the MENA region: a systematic review and meta-analysis

BACKGROUND

Unintended pregnancies pose significant public health challenges globally, particularly in the Middle East and North Africa (MENA) region, where cultural, religious and societal factors play the most substantial role. This systematic review and meta-analysis investigated the pooled prevalence and factors associated with unintended pregnancies in the MENA region.

METHODS

We conducted a systematic review to identify relevant studies in Medical Literature Analysis and Retriaval System (MEDLINE), Embase and Scopus published on unintended pregnancies until July 2024. We included studies that were conducted on unintended pregnancy prevalence within MENA countries and employed suitable measurement tools. We analysed data from 40 studies involving 34 837 participants across the region, including Egypt, Iran, Saudi Arabia and Qatar. We used a random-effects model to estimate the pooled prevalence of unintended pregnancy.

RESULTS

In this meta-analysis, we found that the overall prevalence of unintended pregnancy was 27.0% (95% CI 25.0% to 30.0%) in the MENA region, and the certainty of the evidence was moderate. Saudi Arabia had the highest prevalence of unintended pregnancy at 32.0% (95% CI 27.0% to 38.0%). A lower prevalence, 10.0% (95% CI 8.0% to 14.0%), was found in the studies that used validated tools compared with non-validated tools to measure unintended pregnancy. Between 2006 and 2010, the prevalence was 34.0% (95% CI 28.0% to 40.0%), the highest compared to other time periods . Age, rural areas, education, employment, economic status, parity, gravidity, history of miscarriage, previous pregnancies or abortion, non-use or failure of contraception methods, limited antenatal care, were associated with unintended pregnancies.

CONCLUSION

Our findings suggest that the MENA region faces a substantial burden of unintended pregnancies, with variations among countries and over time. The results emphasise the need for evidence-based interventions to address this issue, focusing on factors associated with unintended pregnancy.

Factors associated with male acceptance of modern contraceptive methods. A descriptive cross-sectional study in a peri-urban municipality

BACKGROUND

Male knowledge and acceptance of modern contraceptive use play a significant role in uptake. This study assessed the factors associated with male acceptance of modern contraceptive methods in Ho Municipality.

METHODS

A cross-sectional study with a quantitative approach was employed. Systematic random sampling was used to select 503 participants from households with married men and women. A structured pre-tested questionnaire, including open-ended and closed-ended questions, was researcher assistant administered. Data analysis was conducted using STATA version 17.

RESULTS

The majority of the respondents identified that contraceptives are used to prevent pregnancy (91.19%), and also identified the following as birth control commodities: birth control pills (64.94%), female condoms (15.71%), intrauterine devices - IUDs (4.79%), and implants (4.21%). Factors such as affordability, employment status, income, and access significantly influenced male acceptance of contraceptives. The study revealed that men (84.67%) agreed with their partner to use contraceptives after sexual intercourse while only 37% agreed to use contraceptives before sexual intercourse. Among those who did not accept the use of modern contraceptives, the reason provided was the fear of side effects (65.13%). Men who find modern contraceptives affordable were more likely to use them (AOR = 8.15; 95%CI:3.49-19.02; p-value < 0.001). Also, unemployed men were less likely to use modern contraceptives (AOR = 0.14; 95%CI:0.044-0.44; p-value = 0.001). Men with lower income (50-900 cedis average monthly income level) were less likely to use modern contraceptives (AOR = 0.28; 95%CI:0.07-1.02; p-value = 0.05).

CONCLUSION

Increasing interventions aimed at continuously reducing the cost of modern contraceptives is essential for improving male acceptance and the overall success of modern contraceptive use in other communities with low male involvement. The government, Healthcare agencies, community leaders, and family planning organizations should work together to actively intervene in lowering the cost of modern contraceptives to improve access by men.

Breaking the silence - systematic review of the socio-cultural underpinnings of men's sexual and reproductive health in Middle East and North Africa (MENA): A handful of taboos?

Background

Sociocultural aspects can impact sexual and reproductive health (SRH). Despite this, no study appraised the socio-cultural underpinnings impacting men's SRH in MENA (Middle East and North Africa). The current systematic review undertook this task.

Methods

We searched PubMed and Scopus electronic databases for original articles on socio-cultural aspects of men's SRH published from MENA. Data were extracted from the selected articles and mapped out employing McLeroy's socioecological model. Analyses and data synthesis identified the factors impacting men's experiences of and access to SRH.

Results

A total of 53 articles were included. Five related socio-cultural underpinnings intertwined with taboos were observed that affect three main SRH topics, HIV, reproduction and sexuality across three broad population groups: HCP/health services, school/university students, and the general public/patients. These underpinnings included 1) Challenges to gender equality; 2) Religious prohibitions and misinterpretations; 3) Sexual rights and taboos; 4) Masculinity and manhood ideals; and 5) Large families and consanguinity. In terms of research, a paradox exists, as we found virtually no research on four socio-cultural underpinnings of men's SRH in MENA pertaining to: a) other STI, despite being common; b) other features of reproduction, despite that religio-cultural factors play a critical role; c) sexuality, despite the high prevalence of sexual disorders, and, d) gender-based violence, despite the widespread partner violence.

Conclusions

Socio-cultural underpinnings are deeply rooted across MENA population groups including HCPs, students, general public, and patients with negative impact on the perceptions and dealings pertaining to men's SRH issues including HIV, reproduction and sexuality. The findings call for concerted widespread efforts to enhance the socio-cultural acceptance of these population groups while highlighting any misinterpretations of religious rules pertaining to men's SRH. Moreover, breaking the silence on such issues necessitates more enthusiasm across MENA health systems, with future research examining the effects of such efforts on the socio-cultural aspects of men's SRH in MENA.

Correction: Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City

[This corrects the article DOI: 10.1371/journal.pone.0249292.].

"Even when you write with a pencil there is an eraser to clean it": Examining men's conceptualisations of and involvement in emergency contraceptive use in Accra, Ghana

Emergency contraceptive pills are an essential and unique post-coital method to avoid a pregnancy, with evidence showing the significant role men can have in procurement and decisions to use. Global Health recommendations specify that emergency contraceptive pills be used sparingly and under specific conditions. This increasingly misaligns with the myriad conceptualisations and rationales among the public for why they choose to use emergency contraceptive pills. There has been a paucity of research aiming to understanding men's involvement and how they shape women's access, choice, and autonomy. This study interrogates how emergency contraceptive pills are conceptualised by men in James Town, Ghana, and how this intersects with their motivations to be involved in its use. Mixed method data from a survey (n = 270) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The analysis examines men's framings of emergency contraceptive pills and how these shape their involvement in its use. Men's knowledge of post-coital contraceptives was high, while knowledge of the specific term 'emergency contraception' was lower. While some men understood the pills in ways that aligned to Global Health framings, many more men saw emergency contraceptive pills as another means of pregnancy prevention in line with other contraceptives. This included its conceptualisation as a contraceptive that facilitates pleasurable (condomless) and spontaneous sex. Gendered perceptions of women who use emergency contraceptive pills were bound in sexual stigma, and men indicated that emergency contraceptive pills were a directly observable form of contraception that they could pressure their partner into using. Understanding plural conceptualisations away from 'emergency' are necessary to create policies and programmes that account for men's involvement. This includes understanding how emergency contraceptive pills are located within people's sexual and reproductive lives and gendered power dynamics, to reflect the public's own rationales for and experiences using post-coital contraceptives.

Immigrant men 's perceptions and experiences of accompanying their partner for contraceptive counselling provided by midwives in Sweden- a qualitative study

BACKGROUND

Male involvement in maternal health care has proven to be beneficial for improving maternal and child health and is often crucial in areas of family planning and contraceptive use. However, compared to male involvement in maternal health care, male involvement in contraceptive counselling is complex and controversial and thus faces certain challenges. Immigrant men in Sweden are often accompanying their partner for contraceptive counselling. Little is known about their presence and role.

AIM

To explore how immigrant men from the Middle East and Afghanistan perceive and experience accompanying their partner for contraceptive counselling provided by midwives in Sweden.

METHODS

Inductive qualitative content analysis guided the interpretation of data based on 21 individual in-depth interviews.

FINDINGS

Balancing conflicting values and norms about sexual and reproductive health and rights including family planning was challenging and confusing when living in Sweden. Contraceptive counselling was perceived as a joint visit, and men were often acting as decision makers. The midwife's role as a contraceptive counsellor was perceived as trusted, but knowledge was lacking about the Swedish midwifery model and the Swedish healthcare system. Providers' ways of communicating sensitive information were crucial. Without marriage contraceptive counselling was unthinkable.

CONCLUSION

Highlighting male engagement and including men's sexual and reproductive health at policy levels are necessary for improving women's sexual and reproductive health and rights. Additional and new ways of contraceptive counselling and midwifery services, such as outreach work and joint visits, are needed in order to reach both men and women.

Emergency Contraception Knowledge, Attitudes, and Barriers Among Men: A Cross-Sectional Study

Background Emergency contraception (EC) plays a pivotal role in the prevention of unintended pregnancies following unprotected sexual intercourse. Men's awareness regarding emergency contraception is pivotal for informed decision-making and for enhancing reproductive health in this context. This study investigated Syrian men's awareness and perspectives on emergency contraception to inform diverse reproductive health initiatives. Methods We conducted a cross-sectional study in Syria, from June 2022 and April 2023. Our study included male participants aged 18 years or older who held Syrian nationality and volunteered to participate. The data collection involved administering a questionnaire comprising three sections (knowledge, attitude, and barrier assessment), encompassing a total of 30 questions. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY). Results Most participants were aged 18-25 (65.7%) and single (75.4%) and held a university degree (79.3%). The knowledge of emergency contraception was low (36.1%), with the Internet and social media (77.5%) being the primary sources of information. While 89% held positive attitudes toward emergency contraception, only 37.3% supported nonprescription availability. Age, income, and desire for children were associated with knowledge, attitudes, and the use of emergency contraception. Men aged 26-35 exhibited the highest positive attitude (8.11±1.83). Those desiring no children showed higher attitude scores (7.42±2.04). Income was positively associated with knowledge (adjusted odds ratio {AOR}=1.75 and confidence interval {CI}=1.02-2.99) and emergency contraception use (AOR=2.87 and CI=1.27-6.48). Conclusion This study underscores the knowledge gap regarding emergency contraception in Syrian men. Despite positive attitudes, awareness remains limited, particularly among those of childbearing age. Targeted education and improved accessibility to emergency contraception can enhance its use among men, particularly in those with low socioeconomic status and younger age groups.

Scoping review of sexual and reproductive healthcare for men in the MENA (Middle East and North Africa) region: a handful of paradoxes?

BACKGROUND

No study appraised the knowledge gaps and factors impacting men's sexual and reproductive health (SRH) in MENA (Middle East and North Africa). The current scoping review undertook this task.

METHODS

We searched PubMed and Web of Science (WoS) electronic databases for original articles on men's SRH published from MENA. Data was extracted from the selected articles and mapped out employing the WHO framework for operationalising SRH. Analyses and data synthesis identified the factors impacting on men's experiences of and access to SRH.

RESULTS

A total of 98 articles met the inclusion criteria and were included in the analysis. The majority of studies focused on HIV and other sexually transmissible infections (67%); followed by comprehensive education and information (10%); contraception counselling/provision (9%); sexual function and psychosexual counselling (5%); fertility care (8%); and gender-based violence prevention, support/care (1%). There were no studies on antenatal/intrapartum/postnatal care and on safe abortion care (0% for both). Conceptually, there was lack of knowledge of the different domains of men's SRH, with negative attitudes, and many misconceptions; as well as a deficiency of health system policies, strategies and interventions for SRH.

CONCLUSION

Men's SRH is not sufficiently prioritized. We observed five 'paradoxes': strong focus on HIV/AIDS, when MENA has low prevalence of HIV; weak focus on both fertility and sexual dysfunctions, despite their high prevalence in MENA; no publications on men's involvement in sexual gender-based violence, despite its frequency across MENA; no studies of men's involvement in antenatal/intrapartum/postnatal care, despite the international literature valuing such involvement; and, many studies identifying lack of SRH knowledge, but no publications on policies and strategies addressing such shortcoming. These 'mismatches' suggest the necessity for efforts to enhance the education of the general population and healthcare workers, as well as improvements across MENA health systems, with future research examining their effects on men's SRH.

A systematic review and meta-analysis of attitude and knowledge involving emergency oral contraceptive use in patients and healthcare providers

BACKGROUND

Levonorgestrel and ulipristal acetate are common emergency oral contraceptives (EOCs). Lack of knowledge and negative attitude toward EOCs pose barriers to the EOCs access and utilization.

AIM

This study aimed to summarize the studies on the knowledge and attitudes of healthcare providers and patients on the use of EOCs.

METHOD

A systematic search was conducted from conception to April 2022 using the following databases: CINAHL Complete, MEDLINE, ScienceDirect, Scopus, and Thai Journal Online. Data were extracted independently and were meta-analyzed using DerSimonian and Laird method for the binary random-effects model.

RESULTS

121 articles with a total number of 92,484 participants were included. The awareness of levonorgestrel as an EOC was 66.7% while the awareness of ulipristal acetate as an EOC was 36.9%. EOCs users received EOC information mainly from the internet, media, and friends. We found that 32.2% of EOCs users and providers agreed that EOCs acted post-fertilization, and 39.8% of the prescribers know the correct time to take the pill postcoital. Negative attitudes toward EOC use were found in 25.4% of the participants. For example, 39.4% of the participants agreed that EOCs users had increased sexual activity.

CONCLUSION

The awareness of EOCs was low and misunderstandings or negative attitudes towards the use or prescription of EOCs were still prevalent. Educating healthcare providers, using media as educational tools, and improving education and economics can be useful in improving EOC users' awareness, knowledge, and attitude towards EOCs.