Women’s decision-making power regarding family planning use and associated factors in Ethiopia: A systematic review and meta-analysis

Objective:

Although emphasis is placed on women’s decision-making power regarding family planning use in Ethiopia, the utilization of contraceptives is low. There are studies conducted in different parts of the country on women’s decision-making power regarding family planning use; however, there are inconsistent findings. Thus, this study aimed to determine the pooled prevalence of women’s decision-making power regarding family planning use and associated factors in Ethiopia.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to develop the systematic review and meta-analysis. All observational studies were retrieved from online databases, including PubMed, CINAHL, Google Scholar, African Journal Online and gray literature. The data search was performed from 1 December to 16 May 2022. The quality of the studies was critically assessed using the Joanna Briggs Institute checklist. Heterogeneity among studies was examined using the I2 statistic. RevMan version 5.3 and STATA version 14 software were used for analysis.

Results:

A total of 852 studies were retrieved, and 8 studies were included in the final meta-analysis. The pooled prevalence of women’s decision-making power regarding family planning use was 57 (95% confidence interval: 37, 77). Good knowledge of family planning methods (odds ratio: 2.46, 95% confidence interval: 1.65, 3.67), a positive attitude toward family planning methods (odds ratio: 2.04, 95% confidence interval: 1.3, 3.2), and having primary or higher education (odds ratio: 9.76, 95% confidence interval: 4.36, 21.99) were associated with increased odds of women’s decision-making power regarding family planning use.

Conclusion:

Nearly three in five married women made decisions regarding family planning use in Ethiopia. Women with good knowledge of family planning methods, a positive attitude toward family planning methods, and women having primary or higher education were associated with increased odds of women’s decision-making power regarding family planning use.

Women's decisions regarding family planning use and its determinants in Ethiopia: A systematic review and meta-analysis protocol

BACKGROUND

Low use of contraceptives has many consequences. Despite this effect, less emphasis is given to women's decision-making on family planning use in Ethiopia. Although there are studies conducted in different parts of the country on women's decision-making regarding family planning use, there are inconsistent findings and a lack of national representative data. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of women's decision-making regarding family planning use and its determinants in Ethiopia.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed to develop the review protocol. All observational studies will be retrieved using Medical Subject Heading (MeSH) terms or keywords from the online databases PubMed, CINAHL, Google Scholar, African Journal online, and gray literature. The quality of the studies will be critically assessed using the Joanna Briggs Institute checklist. Heterogeneity among studies will be examined using I-squared statistics. Funnel plots and Egger's test will be used to examine publication bias. The meta-analysis will be performed using STATA version 14 software. Statistical significance will be determined at 95% CI.

DISCUSSION

Improving women's autonomy in decision-making on reproductive health services, including contraceptive use, has a substantial advantage. There are studies on women's decision-making in family planning use; however, there are inconsistent findings. Therefore, this review protocol aims to determine the pooled prevalence of women's decision-making regarding family planning use and its determinants in Ethiopia. The findings from this systematic review and meta-analysis will help inform policy makers to develop appropriate interventions to improve women's decision making regarding family planning use.

Knowledge, Attitude and Practices of Postpartum Females Regarding the Acceptance of Immediate Postpartum Contraception: A Cross-Sectional Study From North India

The immediate postpartum period is a great time to encourage the acceptance of contraceptive methods; the time is influenced by both emotional and physical factors. At this stage, the administration of intrauterine contraceptives is relatively easier with lesser complications due to the prior obstetric event. A single-center cross-sectional study was conducted using a self-constructed questionnaire-based interview on 331 women in their immediate postpartum period who had delivered a healthy live-born infant. The majority (59.8%) of study participants had unplanned pregnancies. We conducted behavior change communication sessions for postpartum family planning which resulted in 89% of participants accepting the methods with the prime reasons for acceptance being temporary child spacing (41%) and a definitive desire for no more children (34%). The odds were higher in women with more than five pregnancies [adjusted odds ratio (AOR) = 1.951, 95% CI = 1.389-2.925] and women whose last pregnancy was planned [AOR = 1.248, 95% CI = 1.002-3.215].The hindrance to adopt and adhere to postpartum contraception stems from a variety of socio-economic factors which are unique to low-income countries. Individually tailored behavior change communication/counseling approaches may help overcome misconceptions and meet the heterogeneous needs for family planning in the immediate postpartum phase.

Factors associated with decision-making power on family planning utilization among HIV-positive women attending public health facilities in Eastern Ethiopia

BACKGROUND

Family planning for HIV-positive women has numerous advantages. However, the need of family planning utilization is challenged by women's nonautonomous decision-making power. Therefore, this study aimed to examine the level and associated factors of decision-making power to utilize family planning among HIV-positive married women.

METHODS

A facility-based cross-sectional study was conducted from March to June 2020 among 363 HIV-positive married women on ART, using systematic random sampling technique. Logistic regression analysis was used to identify variables that affect women's decision-making power on family planning utilization. Statistical significance was declared at p-value < 0.05 with 95% confidence interval and strength of association was reported by adjusted odds ratio.

RESULTS

Overall 55.2% (95% CI: 49.9-60.5) of the women had decision-making power on family planning utilization. Women's having good knowledge (AOR: 2.87, 95% CI: 1.52-5.40), favorable attitude (AOR: 1.96, 95% CI: 1.13-3.38), women's getting family planning counseling in ART clinics (AOR: 2.04, 95% CI: 1.16-3.59), women who get integration service of FP and ART (AOR: 1.83, 95% CI:1.07-3.12) were factors independently associated with women decision-making power on family planning utilization.

CONCLUSION

Decision-making power to utilize family planning among married HIV-positive women was low. Factors like poor knowledge about family planning, dissatisfaction with family planning service, not getting counseling about family planning in ART clinics, and not receiving family planning service in ART clinics were independently associated with women's decision-making power on family planning. Infrastructure linked with the health facility, knowledge, and attitudinal factors should all be combined in future family planning programs.

Factors affecting men's involvement in maternity waiting home utilization in North Achefer district, Northwest Ethiopia: A cross-sectional study

Background

Maternity waiting home (MWH) is a direct strategy to improve newborn and maternal survival. The utilization of MWH, however, remains very low in Ethiopia. Men involvement in maternal health programs is a key strategy to increase utilization of maternal health services, including MWH. This study defines men involvement in-terms of men’s participation in deciding to admit their spouse to an MWH, accompanying their spouse to an MWH, providing financial support, availing food at an MWH, and taking care of the home or children. Thus, the current study aims to identify factors affecting men’s involvement in MWH utilization.

Methods

A community-based cross-sectional study was conducted from October 1st to December 30th, 2018. Four hundred three men were involved in the study. Data were analyzed by the statistical package for social science (SPSS) version 23. Independent predictors were identified by a multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Results

Men’s involvement in MWH was 55.6% (50.71, 60.45). Age (AOR = 0.86, 95% CI = 0.82–0.94), knowledge about MWH (AOR = 4.74, 95% CI = 2.65–8.49), decision-making power (AOR = 4.00, 95% CI = 1.38–11.57), and receiving counseling about MWH during spousal antenatal care visits (AOR = 9.15, 95% CI = 3.34–25.03) had statistically significant associations with men’s involvement in MWH utilization.

Conclusions

Nearly, half of the male partners were involved in MWH utilization. Men’s age, MWH knowledge, decision-making power, and receiving counseling were factors affecting their involvement in MWH utilization. Interventions targeting to improve male involvement in MWH utilization should focus on building men’s knowledge about MWH, increasing male involvement in ANC with an appropriate level of counseling about MWH, and changing patriarchal thinking in society with appropriate behavioral interventions such as community-based health education.

What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys

Introduction

Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA).

Materials and methods

We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05.

Results

The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17–1.24). We also found that women aged 45–49 (AOR = 5.54, 95% CI = 5.11–6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20–1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04–1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02–1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27–1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39–1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18–1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20–1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04–1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54–0.60) of terminating a pregnancy.

Conclusion

We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA.

Associated Factors of Postpartum Modern Contraceptive Use in Burie District, Amhara Region, Ethiopia

Methods

A community-based cross-sectional study was employed among 686 mothers in Burie District from March 16 to March 25, 2017. A multistage sampling technique was used to select the study participants. Data were collected using face to face interviewer administered structured questionnaires. Then, the collected data was entered, coded, and cleaned into EPI Data version 3.1 and exported to SPSS version 20.0 for data analysis. Bivariate and multivariate logistic regression was done to assess the association of factors with postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p values <0.05 were considered to indicate statistical significance.

Result

This study revealed that postpartum modern contraceptive use was found to be 20.7%. Postpartum modern contraceptive use was significantly associated with women's level of education (AOR = 0.15, 95% CI (0.03-0.71)), discussing FP methods with partner (AOR = 0.60, 95% CI (0.40-0.90)), knowing menses return after birth (AOR = 0.39, 95% CI (0.25-0.59)), ever heard about modern FP methods (AOR = 0.06, 95% CI (0.01-0.43)), and contacting health professionals (AOR = 1.85, 95% CI (1.19-2.88)). Conclusion and Recommendations. Postpartum modern contraceptive use was found to be low. Therefore, health professionals should work on improvements in women's educational status, making awareness of the women and counseling of their husbands about the use of postpartum contraception, when fertility returned and risky timing for becoming pregnant.

Structural equation modeling of psychosocial determinants of health for the empowerment of Iranian women in reproductive decision making

BACKGROUND

Women's empowerment is a process wherein females are afforded power over their own lives as well as their participation in the communities and larger societies to which they belong. An important aspect of such empowerment is the right to make decisions regarding fertility-an entitlement affected by the social health determinants that contribute to the social conditions under which humans live and work throughout their lives. As one such determinant, psychosocial factors play an essential role in the development of women's empowerment. Correspondingly, this study conducted a structural equation modeling of these determinants to examine the empowerment of Iranian women in reproductive decision making.

METHODS

This cross-sectional study involved 400 women who were referred to clinical centers of the Shahid Beheshti University of Medical Sciences in Tehran, Iran. Data were collected using six questionnaires, namely, demographic, socioeconomic, and social support questionnaires, the Rosenberg self-esteem scale, a marital satisfaction questionnaire, and an empowerment survey. The data were analyzed using SPSS software version 17, and the structural equation modeling was carried out using EQS software version 6.1.

RESULTS

The Iranian women had an average level of empowerment with respect to reproductive decision making, and such empowerment was related to all the psychosocial factors examined (p = 0.001). The final model appropriately fit the data (comparative fit index = 0.92, root mean square error of approximation = 0.06). The psychosocial factors served as intermediate social determinants of the women's empowerment in reproductive decision making (β = 0.78, p = 0.001). This empowerment was indirectly affected by socioeconomic situation as a structural factor (β = 0.44, p = 0.001).

CONCLUSIONS

Socioeconomic factors, through the mechanism of psychosocial determinants, may significantly affect women's empowerment in making decisions regarding reproductive health. Conditions associated with these factors should be improved to ensure that women claim and exercise their right to have mastery over their reproductive health.

Predictors of postpartum contraceptive use in rural Tigray region, northern Ethiopia: a multilevel analysis

Background

Postpartum family planning services is one of the recommended public health intervention aimed at reducing maternal and child morbidity and mortalities. However, there is a paucity studies in rural Tigray region. Therefore, determining the level and associated factors of contraceptive use among postpartum women has the potential to contribute in achieving the Ethiopian Health Sector Transformation Plan and to the Sustainable Development Goals on maternal and infant survival.

Methods

A community-based cross-sectional study was done among 1109 postpartum women from March 29, 2017 to April 29, 2017. Face –to–face interview was used for data collection. The collected data were entered and cleaned using EPI - INFO version 7statistical software and later exported to and analyzed using STATA version 12. Mixed-effects multilevel logistic regression analysis was used to identify the individual and community-level factors associated with contraception adoption. A two side p-value< 0.05 was considered to be statistically significant.

Results

The level of contraceptive use was 38.3%. Individual-level variables such as women belong to fourth (AOR = 1.2; 95% CI: 1.1–3.2) and fifth (AOR = 1.5; 95% CI: 1.3–2.5) wealth quintiles were identified as key predictors of contraception use. In addition, partner secondary (AOR = 2.3; 95% CI: 1.8–3.5) and diploma (AOR = 1.2; 95% CI, 1.1–2.6) educational-level and postnatal care (AOR = 2.0; 95% CI: 1.9, 4.3) were also significantly affected contraception use. Community-level variables such as high community-level antenatal care services use (AOR = 2.1; 95% CI: 1.9–4.2) and proximity of women to health facility (AOR = 3.0; 95% CI: 2.7–4.6) were also determinants of contraception uptake.

Conclusions

The status of contraceptive use in rural Tigray region was found to be low. It was found that both individual and community-level variables showed a marked determinant on postpartum contraception use. This study suggested that in order to increase contraceptive use the government should focus on increasing postnatal care, antenatal care services use and reduction of poverty level are important avenues for intervention.