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Askew I, Raney L, Kerrigan M, Sridhar A. Family planning saves maternal and newborn lives: Why universal access to contraception must be prioritized in national maternal and newborn health policies, financing, and programs. Int J Gynaecol Obstet 2024; 164:536-540. [PMID: 37740702 DOI: 10.1002/ijgo.15127] [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: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
SynopsisWe highlight why integrating contraceptive services within maternal and newborn health programs is essential for improving outcomes. We offer effective, actionable recommendations that can be implemented easily.
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Affiliation(s)
- Ian Askew
- FIGO Committee on Contraception, FIGO, London, UK
| | - Laura Raney
- Family Planning 2030, Washington, District of Columbia, USA
| | | | - Aparna Sridhar
- FIGO Committee on Contraception, FIGO, London, UK
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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Shiferaw Y, Jisso M, Fantahun S, Eshetu B, Assefa AA, Gebretsadik A. Acceptance, utilization, and factors associated with immediate postpartum intrauterine contraceptive device among mothers delivered at public health facilities in Hawassa city, Ethiopia: Institution-based study. Reprod Health 2023; 20:39. [PMID: 36890509 PMCID: PMC9996894 DOI: 10.1186/s12978-023-01586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Immediate postpartum intra-uterine contraceptive device (IPPIUCD) placement within 10 min after the expulsion of the placenta following vaginal delivery is a safe and effective method when provided after comprehensive counseling. Studies on its acceptance and utilization are scarce in the study area. This study aims to assess the acceptance and utilization of IPPIUCD. METHODS A cross-sectional study was conducted from January 1st up to February 31st, 2020, among 392 mothers who delivered at public health facilities in Hawassa city. EPI-Data version 7.2 was used for data entry and STATA 14 for analysis. Data were collected using an interviewer administered structured questionnaire. A binary logistic regression and a multivariable logistic regression model were used to assess association. Statistical significance was determined at a p-value of less than 0.05 with a 95% confidence interval. RESULTS Of the 392 mothers enrolled, 16.3% (95% CI: 12.7-20.0) of them accepted immediate post-partum IUCD. However, only 10% (95%CI: 7.0, 12.9) utilized immediate post-partum IUCD. Counseling about IPPIUCD, Attitude, plan to have another child, and birth intervals were associated with acceptance of immediate PPIUCD while husband support for family planning use, delivery time, and the number of children had a significant association with utilization of immediate PPIUCD. CONCLUSIONS The study found a relatively low proportion of acceptors and utilizers of immediate post-partum IUCD in the study area. To improve the acceptance and utilization of immediate PPIUCD among mothers, all stakeholders concerned with family planning need to mitigate and promote the challenges and facilitating factors, respectively.
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Affiliation(s)
- Yemisrach Shiferaw
- Hawassa University College of Medicine and Health Science School of Public Health, Hawassa, Ethiopia.
| | - Meskerem Jisso
- Hawassa University College of Medicine and Health Science School of Public Health, Hawassa, Ethiopia
| | - Selam Fantahun
- Hawassa University College of Medicine and Health Science School of Public Health, Hawassa, Ethiopia
| | - Betelhem Eshetu
- Hawassa University College of Medicine and Health Science School of Public Health, Hawassa, Ethiopia
| | - Abiyu Ayalew Assefa
- Department of Public Health, Hawassa College of Health Science, P. O. Box: 84, Hawassa, Ethiopia
| | - Achamyelesh Gebretsadik
- Hawassa University College of Medicine and Health Science School of Public Health, Hawassa, Ethiopia
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Nyaboe E, Larsen A, Sila J, Kinuthia J, Owiti G, Abuna F, Kohler P, John-Stewart G, Pintye J. Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:667413. [PMID: 36304017 PMCID: PMC9580727 DOI: 10.3389/frph.2021.667413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics. Methods: From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15-24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5-15% HIV incidence) defined "high" HIV risk. Results: Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20-23], median completed education was 12 years (IQR 10-12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09-1.29, p < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09-2.10, p = 0.012); injectable use was not associated with HIV risk scores ≥5. Conclusions: Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.
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Affiliation(s)
| | - Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Child, Family, and Population Health, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
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Tomar S, Dehingia N, Dey AK, Chandurkar D, Raj A, Silverman JG. Associations of intimate partner violence and reproductive coercion with contraceptive use in Uttar Pradesh, India: How associations differ across contraceptive methods. PLoS One 2020; 15:e0241008. [PMID: 33064775 PMCID: PMC7567561 DOI: 10.1371/journal.pone.0241008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Intimate partner violence (IPV) and reproductive coercion (RC)-largely in the form of pressuring pregnancy-appear to contribute to low use of contraceptives in India; however, little is known about the extent to which these experiences differentially affect use of specific contraceptive methods. The current study assessed the association of IPV and RC with specific contraceptive methods (Intrauterine Devices [IUDs], pills, condoms) among a large population-based sample of currently married women (15-49 years, n = 1424) living in Uttar Pradesh. Outcomes variables included past year modern contraceptive use and type of contraceptive used. Primary independent variables included lifetime experience of RC by current husband or in-laws, and lifetime experiences of physical IPV and sexual IPV by current husband. Multivariate logistic regression models were developed to determine the effect of each form of abuse on women's contraceptive use. Approximately 1 in 7 women (15.1%) reported experiencing RC from their current husband or in-laws ever in their lifetime, 37.4% reported experience of physical IPV and 8.3% reported experience of sexual IPV by their current husband ever in their lifetime. Women experiencing RC were less likely to use any modern contraceptive (AOR: 0.18; 95% CI: 0.9-0.36). Such women also less likely to report pill and condom use but were more likely to report IUD use. Neither form of IPV were associated with either overall or method specific contraceptive use. Study findings highlight that RC may influence contraceptive use differently based on type of contraceptive, with less detectable, female-controlled contraceptives such as IUD preferred in the context of women facing RC. Unfortunately, IUD uptake remains low in India. Increased access and support for use, particularly for women contending with RC, may be important for improving women's control over contraceptive use and reducing unintended pregnancy.
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Affiliation(s)
- Shweta Tomar
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
- * E-mail:
| | - Nabamallika Dehingia
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | - Arnab K. Dey
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | | | - Anita Raj
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Jay G. Silverman
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
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Soriano-Moreno DR, Soriano-Moreno AN, Mejia-Bustamante A, Guerrero-Ramirez CA, Toro-Huamanchumo CJ. Factors associated with highly effective contraceptive use among reproductive-age women in Peru: Evidence from a nationwide survey. Eur J Obstet Gynecol Reprod Biol 2020; 245:114-120. [PMID: 31891894 DOI: 10.1016/j.ejogrb.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to assess the factors associated with highly effective contraceptive (HEC) use among reproductive-age women in Peru, using evidence from a nationwide survey. STUDY DESIGN We analyzed the data corresponding to a national representative sample of 30,169 Peruvian women aged 15-49 years, surveyed during the Demographic and Family Health Survey, 2017. Usage of HEC methods included pills, IUD, injections, sterilization and implant. We assessed the factors associated with its use using Poisson regression models, reporting the crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95 % confidence intervals (95 % CI). RESULTS The prevalence of HEC use was 29.9 %. Factors related to a more likely use of HEC methods were having one (aPR: 4.03; 95 % CI: 3.19-5.09) or more children (aPR: 5.60; 95 % CI: 4.42-7.09), and having a health insurance children (aPR: 1.14; 95 % CI: 1.05-1.24). Women from the highlands (aPR: 0.74; 95 % CI: 0.67-0.81), aged ≥35 years (aPR: 0.78; 95 % CI: 0.67-0.90), not currently married or cohabiting (aPR: 0.52; 95 % CI: 0.47-0.58), and who considered it really hard to have to take transportation when they need medical help or advice (aPR: 0.92; 95 % CI: 0.86-0.99) were less likely to use highly effective contraception. CONCLUSION Quality and access to reproductive health is still a challenge in Peru. Family planning programs should be better disseminated and integrated. Similarly, promotion of educational campaigns and easy access to HEC methods are needed.
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Affiliation(s)
| | | | | | | | - Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru; Association for the Study of Medical Education, Edinburgh, UK.
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Steele SJ, Sugianto H, Baglione Q, Sedlimaier S, Niyibizi AA, Duncan K, Hill J, Brix J, Philips M, Cutsem GV, Shroufi A. Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho. Trop Med Int Health 2018; 24:2-10. [PMID: 30365204 PMCID: PMC7379625 DOI: 10.1111/tmi.13175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co‐payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho. Methods We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives. Results Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% — from 1547 to 2308 — and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital. Conclusion Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries.
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Affiliation(s)
- Sarah Jane Steele
- Médecins Sans Frontières South Africa and Lesotho, Cape Town, South Africa
| | - Hartini Sugianto
- Médecins Sans Frontières South Africa and Lesotho, Cape Town, South Africa
| | - Quentin Baglione
- Agence Européenne pour le Développement et la Santé, Brussels, Belgium
| | | | | | - Kristal Duncan
- Médecins Sans Frontières South Africa and Lesotho, Cape Town, South Africa
| | - Julia Hill
- Médecins Sans Frontières South Africa and Lesotho, Cape Town, South Africa
| | - Jesper Brix
- Médecins Sans Frontières South Africa and Lesotho, Roma, Lesotho
| | - Mit Philips
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - Gilles Van Cutsem
- Médecins Sans Frontières South Africa and Lesotho, Cape Town, South Africa.,University of Cape Town, Cape Town, South Africa
| | - Amir Shroufi
- Médecins Sans Frontières South Africa and Lesotho, Cape Town, South Africa
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Hodgins S. Modeling Outputs Can Be Valuable When Uncertainty Is Appropriately Acknowledged, but Misleading When Not. GLOBAL HEALTH, SCIENCE AND PRACTICE 2017; 5:530-533. [PMID: 29284692 PMCID: PMC5752600 DOI: 10.9745/ghsp-d-17-00444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While modeling approaches seek to draw on the best available evidence to project health impact of improved coverage of specific interventions, uncertainty around the outputs often remains. When the modeling estimates are used for advocacy, these uncertainties should be communicated to policy makers clearly and openly to ensure they understand the model's limits and to maintain their confidence in the process.
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Affiliation(s)
- Steve Hodgins
- Editor-in-Chief, Global Health: Science and Practice, and Associate Professor, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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