1
|
Aventin Á, Robinson M, Hanratty J, Keenan C, Hamilton J, McAteer ER, Tomlinson M, Clarke M, Okonofua F, Bonell C, Lohan M. Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries. Campbell Syst Rev 2023; 19:e1296. [PMID: 36911859 PMCID: PMC9837728 DOI: 10.1002/cl2.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important. OBJECTIVES The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions. SEARCH METHODS We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists. SELECTION CRITERIA Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review. DATA COLLECTION AND ANALYSIS Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of 'effectiveness-plus' reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved 'best fit' framework synthesis. RESULTS We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I 2 = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research. AUTHORS' CONCLUSIONS FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls.
Collapse
Affiliation(s)
- Áine Aventin
- Queen's University BelfastBelfastNorthern Ireland
| | | | | | - Ciara Keenan
- Queen's University BelfastBelfastNorthern Ireland
| | | | | | - Mark Tomlinson
- Queen's University BelfastBelfastNorthern Ireland
- Stellenbosch UniversityStellenboschSouth Africa
| | - Mike Clarke
- Queen's University BelfastBelfastNorthern Ireland
| | | | - Chris Bonell
- London School of Hygiene and Tropical MedicineLondonUK
| | - Maria Lohan
- Queen's University BelfastBelfastNorthern Ireland
| |
Collapse
|
2
|
Tobey E, Jain A, Mozumdar A. Differences in Quality of Care of Family Planning Services Received by Age and Contraceptive Continuation Among Young Mothers in India. J Adolesc Health 2023; 72:88-95. [PMID: 36253196 DOI: 10.1016/j.jadohealth.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Youth face barriers that affect their use of family planning (FP) services, including low quality of care and provider bias. Although young women have the highest unmet need for FP in India, little is known about the effect of age on quality of care received. Additionally, although youth have higher contraceptive discontinuation than older women, the factors associated with continuation, including the effect of quality of care, are not well known. This study aims to assess differences in quality of care received by young mothers aged 15-24 and mothers aged 25-48, and to examine factors associated with modern contraceptive continuation 6 months after initiation among young mothers. METHODS Data come from a 12-month longitudinal study of married reversible contraceptive users in India. Multinomial logistic regression was conducted to examine adjusted associations of age and reported receipt of low, medium, or high quality of care. Logistic regression was used to assess factors associated with modern contraceptive continuation after 6 months. RESULTS Results showed that young mothers were less likely to receive high quality of care than older mothers, and that among young mothers, motivation to prevent pregnancy was significantly associated with continued use after 6 months. DISCUSSION As India aims to improve quality of care and increase access to services for youth, special attention should be paid to care received by young mothers, as well as options to support them in continuing to use contraceptive methods as long as they desire to prevent pregnancy.
Collapse
Affiliation(s)
| | - Aparna Jain
- Population Council, Washington, District of Columbia
| | | |
Collapse
|
3
|
Bula A, Kopp DM, Maman S, Chinula L, Tsidya M, Tang JH. Family planning knowledge, experiences and reproductive desires among women who had experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study. Contracept Reprod Med 2018; 3:22. [PMID: 30349736 PMCID: PMC6192333 DOI: 10.1186/s40834-018-0075-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background Perinatal mortality is unacceptably high in low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, the reproductive desires and family planning knowledge of women who have experienced a stillbirth or neonatal death in resource-poor settings are not well understood. Methods We examined family planning knowledge, contraceptive practices and barrier to contraceptive use among women who had experienced a poor obstetric outcome at Bwaila Hospital in Lilongwe, Malawi. We performed individual in-depth interviews or through focus group discussion with women who had experienced a stillbirth or early neonatal death, 4–8 weeks after their delivery. NVivo software was used to analyze data for recurrent patterns and themes, and central ideas were extracted to identify the data’s core meanings. Results We interviewed 46 women who had experienced a poor obstetric outcome. Overall, women were aware of both modern and traditional family planning methods, and the majority were in favour of modern versus traditional methods. They also had knowledge about risks for future complications if they have a short inter-pregnancy interval. However, they faced conflict about whether to use family planning methods for their health, as suggested by their relatives and friends, or to have another child to fulfil their husband’s desire, especially among those with no living child. Some had fear about side effects, while others were concerned that use of family planning methods without involving the husband could bring misunderstandings within the family. A number of women had misconceptions about family planning methods, which also served as a barrier to their use. Conclusion Although women with a poor obstetric outcome are aware of modern family planning and its health benefits after their delivery, their decision to use a method is complicated by their own desire to protect their own health and the husband’s desire for a child, particularly among those women with no living children coupled with fear of side effects and misconceptions. These findings suggest the importance of counselling both the affected woman and her husband about the benefits of family planning use, even after a poor obstetric outcome, to jointly choose the method they feel comfortable to use and dispel any misconceptions. Trial registration Clinicaltrials.gov NCT02674542.
Collapse
Affiliation(s)
- Agatha Bula
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Dawn M Kopp
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.,2UNC Department of Obstetrics & Gynecology, Chapel Hill, NC USA.,3Kamuzu Central Hospital, Lilongwe, Malawi
| | - Suzanne Maman
- 4UNC Department of Health Behavior, Chapel Hill, NC USA
| | - Lameck Chinula
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.,2UNC Department of Obstetrics & Gynecology, Chapel Hill, NC USA.,3Kamuzu Central Hospital, Lilongwe, Malawi.,5Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| | - Mercy Tsidya
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Jennifer H Tang
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.,2UNC Department of Obstetrics & Gynecology, Chapel Hill, NC USA.,3Kamuzu Central Hospital, Lilongwe, Malawi.,5Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| |
Collapse
|
4
|
Kopp DM, Bula A, Maman S, Chinula L, Tsidya M, Mwale M, Tang JH. Influences on birth spacing intentions and desired interventions among women who have experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study. BMC Pregnancy Childbirth 2018; 18:197. [PMID: 29855296 PMCID: PMC5984328 DOI: 10.1186/s12884-018-1835-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 05/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirth and neonatal mortality are very high in many low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, reproductive desires and influences on birth spacing preferences of women who have experienced a stillbirth or neonatal death in low-resource settings are not well understood. METHODS We conducted a qualitative study using 20 in-depth interviews and four focus group discussions with women who had experienced a stillborn baby or early neonatal death to explore attitudes surrounding birth spacing and potential interventions to promote family planning in this population. Qualitative data were analyzed for recurrent patterns and themes and central ideas were extracted to identify their core meanings. RESULTS Forty-six women participated in the study. After experiencing a stillbirth or neonatal death, most women wanted to wait to become pregnant again but women with living children wished to wait for longer periods of time than those with no living children. Most women preferred birth spacing interventions led by clinical providers and inclusion of their spouses. CONCLUSIONS Many influences on family size and birth spacing were noted in this population, with the most significant influencing factor being the spouse. Interventions to promote birth spacing and improve maternal and neonatal health in this population need to involve male partners and knowledgeable health care providers to be effective. TRIAL REGISTRATION Clinicaltrials.gov NCT02674542 Registered February 1, 2016 (retrospectively registered).
Collapse
Affiliation(s)
- Dawn M Kopp
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi. .,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA. .,Kamuzu Central Hospital, Lilongwe, Malawi.
| | - Agatha Bula
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi
| | - Suzanne Maman
- UNC Department of Health Behavior, Chapel Hill, NC, USA
| | - Lameck Chinula
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.,Kamuzu Central Hospital, Lilongwe, Malawi.,Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| | - Mercy Tsidya
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi
| | - Mwawi Mwale
- Bwaila Hospital, Lilongwe District Health Office, Lilongwe, Malawi
| | - Jennifer H Tang
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.,Kamuzu Central Hospital, Lilongwe, Malawi.,Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| |
Collapse
|
5
|
Affiliation(s)
- Jack Stevens
- Jack Stevens is with the Research Institute at Nationwide Children's Hospital and the Ohio State University Department of Pediatrics, Columbus. Robyn Lutz and Ngozi Osuagwu are with the OhioHealth Research and Innovation Institute, Columbus
| | - Robyn Lutz
- Jack Stevens is with the Research Institute at Nationwide Children's Hospital and the Ohio State University Department of Pediatrics, Columbus. Robyn Lutz and Ngozi Osuagwu are with the OhioHealth Research and Innovation Institute, Columbus
| | - Ngozi Osuagwu
- Jack Stevens is with the Research Institute at Nationwide Children's Hospital and the Ohio State University Department of Pediatrics, Columbus. Robyn Lutz and Ngozi Osuagwu are with the OhioHealth Research and Innovation Institute, Columbus
| |
Collapse
|
6
|
Paul M, Essén B, Sariola S, Iyengar S, Soni S, Klingberg Allvin M. Negotiating Collective and Individual Agency: A Qualitative Study of Young Women's Reproductive Health in Rural India. Qual Health Res 2017; 27:311-324. [PMID: 26531879 PMCID: PMC5302084 DOI: 10.1177/1049732315613038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.
Collapse
Affiliation(s)
- Mandira Paul
- Uppsala University, Uppsala, Sweden
- Mandira Paul, Department of Women’s and Children’s health/IMCH, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden.
| | | | | | - Sharad Iyengar
- Action Research & Training for Health, Udaipur, Rajasthan, India
| | - Sunita Soni
- Action Research & Training for Health, Udaipur, Rajasthan, India
| | - Marie Klingberg Allvin
- Karolinska Institutet/Karolinska University Hospital, WHO collaborating Centre, Stockholm, Sweden
- Dalarna University, Falun, Sweden
| |
Collapse
|
7
|
Chandra A, Sarkar S, Adinarayanan S, Balajee KL. Impact of Health Awareness Campaign in Improving the Perception of the Community about Palliative Care: A Pre- and Post-intervention Study in Rural Tamil Nadu. Indian J Palliat Care 2016; 22:467-476. [PMID: 27803570 PMCID: PMC5072240 DOI: 10.4103/0973-1075.191832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background and Objective: The only way to provide palliative care to a huge number of people in need in India is through community participation, which can be achieved by improving the awareness of the people about palliative care. We conducted a study to assess the impact of health awareness campaign in improving the awareness of people about palliative care. Materials and Methods: This was a pre- and post-intervention study conducted in Kadaperikuppam village of Vanur Taluk in Villupuram district, Tamil Nadu. One respondent each from 145 households in the village was interviewed regarding the knowledge and attitude on palliative care before and after the health awareness campaign using a pretested questionnaire. Health awareness campaign consisted of skit, pamphlet distribution, poster presentation, giving door-to-door information, and general interaction with palliative team in the village. Results: The awareness regarding palliative care during the preintervention was nil. After the intervention, it increased to 62.8%. However, there was a decline in the attitude and the interest of the people toward palliative care. Interpretation and Conclusions: Health awareness campaigns can increase the awareness of people in the rural parts of the country about palliative care. However, to improve the attitude of the community about delivery of palliative care services, more sustained efforts are required to make them believe that palliative care can be provided by community volunteers also and not necessarily only by professionals.
Collapse
Affiliation(s)
- Ankit Chandra
- MBBS Student, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S Adinarayanan
- Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Karthik Laksham Balajee
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
8
|
Rimal RN, Sripad P, Speizer IS, Calhoun LM. Interpersonal communication as an agent of normative influence: a mixed method study among the urban poor in India. Reprod Health 2015; 12:71. [PMID: 26265221 PMCID: PMC4533786 DOI: 10.1186/s12978-015-0061-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although social norms are thought to play an important role in couples' reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India. METHODS Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain more in-depth knowledge about decision-making processes related to modern contraceptive use. RESULTS Spousal influence and interpersonal communication emerged as key factors in decision-making, waning in the later years of marriage, and they also moderated the influence of descriptive norms on behaviors. Norms around contraceptive use, which varied by parity, are rapidly changing with the country's urbanization and increased access to health information. CONCLUSION Open interpersonal discussion, community norms, and perspectives are integral in enabling women and couples to use modern family planning to meet their current fertility desires and warrant sensitivity in the design of family planning policy and programs.
Collapse
Affiliation(s)
- Rajiv N Rimal
- Department of Prevention and Community Health, George Washington University, Washington, D.C., USA.
| | - Pooja Sripad
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Ilene S Speizer
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lisa M Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
9
|
Vélez LF, Sanitato M, Barry D, Alilio M, Apfel F, Coe G, Garcia A, Kaufman M, Klein J, Kutlesic V, Meadowcroft L, Nilsen W, O'Sullivan G, Peterson S, Raiten D, Vorkoper S. The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence. J Health Commun 2014; 19 Suppl 1:89-121. [PMID: 25207449 PMCID: PMC4205911 DOI: 10.1080/10810730.2014.939313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.
Collapse
Affiliation(s)
| | - Mary Sanitato
- Bureau for Global Health, U.S. Agency for International Development
,
Washington
,
District of Columbia
,
USA
| | - Donna Barry
- Center for American Progress
,
Washington
,
District of Columbia
,
USA
| | - Martin Alilio
- U.S. Agency for International Development
,
Washington
,
District of Columbia
,
USA
| | - Franklin Apfel
- World Health Communication Associates
,
Somerset
,
United Kingdom
| | - Gloria Coe
- U.S. Agency for International Development
,
Washington
,
District of Columbia
,
USA
| | - Amparo Garcia
- U.S. Forest Service
,
Washington
,
District of Columbia
,
USA
| | - Michelle Kaufman
- Center for Communication Programs
, Johns Hopkins Bloomberg School of Public Health
,
Baltimore
,
Maryland
,
USA
| | - Jonathan Klein
- American Academy of Pediatrics
,
Elk Grove Village
,
Illinois
,
USA
| | - Vesna Kutlesic
- National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| | | | - Wendy Nilsen
- Office of Behavioral and Social Sciences Research
, National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| | | | | | - Daniel Raiten
- National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| | - Susan Vorkoper
- National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| |
Collapse
|
10
|
Affiliation(s)
- Christine Dehlendorf
- Corresponding author at: Department of Family and Community Medicine, UCSF, 995, Potrero Avenue Ward 83, San Francisco, CA 94110, USA. Tel.: +1 415 206 8712; fax: +1 415 206 8387 (C. Dehlendorf)
| | | |
Collapse
|