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Gebrekidan H, Alemayehu M, Debelew GT. Determinants of unmet need for modern contraceptives in Ethiopia. BMJ Open 2024; 14:e079477. [PMID: 38692721 PMCID: PMC11086180 DOI: 10.1136/bmjopen-2023-079477] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To identify the determinants of the unmet need for modern contraceptives in Ethiopia. DESIGN Community-based cross-sectional study. SETTING Ethiopia. PARTICIPANTS A group of 6636 women of reproductive age (15-49 years) who were sexually active were included in the study. OUTCOME Unmet need for modern contraceptives METHOD: The study used data from the 2019 Performance Monitoring for Action-Ethiopia survey, which was community-based and cross-sectional. The sample consisted of women aged 15-49 from households randomly selected to be nationally representative. Multinomial logistic regression and spatial analysis were performed to determine the factors influencing unmet needs for modern contraceptives. The descriptive analysis incorporated svy commands to account for clustering. RESULTS The proportion of unmet need for modern contraceptives was 19.7% (95% CI: 18% to 21.5%). Women with supportive norms towards family planning had a lower risk of unmet need for spacing (relative risk ratio (RRR)=0.92, 95% CI: 0.86 to 0.99). Older age lowered the risk of unmet need for spacing 40-44 (RRR=0.28, 95% CI: 0.13 to 0.59) and 45-49 (RRR=0.11, 95% CI: 0.04 to 0.31). Being married increased the unmet need for spacing (RRR=1.9, 95% CI: 1.36 to 2.7) and limiting (RRR=3.7, 95% CI: 1.86 to 7.4). Increasing parity increases the risk of unmet need for spacing (RRR=1.27, 95% CI: 1.16 to 1.38) and limiting (RRR=1.26, 95% CI: 1.15 to 1.4). Contrarily, older age increased the risk of unmet need for limiting 40-44 (RRR=10.2, 95% CI: 1.29 to 79.5), 45-49 (RRR=8.4, 95% CI: 1.03 to 67.4). A clustered spatial unmet need for modern contraceptives was observed (Global Moran's I=0.715: Z-Score=3.8496, p<0.000118). The SaTScan identified 102 significant hotspot clusters located in Harari (relative risk (RR)=2.82, log-likelihood ratio (LLR)=28.2, p value<0.001), South Nations Nationalities and People, Oromia, Gambella and Addis Ababa (RR=1.33, LLR=15.6, p value<0.001). CONCLUSIONS High levels of unmet need for modern contraceptives were observed in Ethiopia, showing geographical variations. It is essential to address the key factors affecting women and work towards reducing disparities in modern contraceptive unmet needs among different regions.
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Affiliation(s)
- Hailay Gebrekidan
- Population and Family Health, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Oromia, Ethiopia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mussie Alemayehu
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gurmesa Tura Debelew
- Population and Family Health, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Oromia, Ethiopia
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Zepro NB, Medhanyie AA, Probst-Hensch N, Chernet A, Tschopp R, Abongomera C, Paris DH, Merten S. Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach. BMJ Open 2024; 14:e080654. [PMID: 38658003 PMCID: PMC11043775 DOI: 10.1136/bmjopen-2023-080654] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES The study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia. DESIGN A qualitative exploratory design with the key informant approach. SETTING AND PARTICIPANTS The study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women. RESULTS Eritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women. CONCLUSIONS A complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.
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Affiliation(s)
- Nejimu Biza Zepro
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- College of Health Sciences, Samara University, Afar, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Afona Chernet
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rea Tschopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Charles Abongomera
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel H Paris
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Moyo RC, Nkhoma D. Association of migration and family planning use among women in Malawi: Evidence from 2019/2020 Malawi Multiple Indicators Survey. Contracept Reprod Med 2023; 8:52. [PMID: 37891691 PMCID: PMC10604777 DOI: 10.1186/s40834-023-00254-8] [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] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Family planning (FP) is known to bring multiple benefits to people both individually and collectively. Individually, FP has been associated with reduction in risk of unintended pregnancy which also correlates with low child mortality rates. Child mortality rates in women with child spacing of less than two years are 45% higher compared to their counterparts with child spacing of more than two years. Several factors that predict FP utilisation among women of childbearing age have been identified but there is limited literature on how migration impacts FP utilisation in Malawi. Our current study aimed at assessing the association between migration and modern contraceptive use among women of childbearing age in Malawi. METHODS Data for this study came from a nationally representative 2019/20 Malawi multiple cluster indicator survey (MICS). At total of 24,543 women aged 15 to 49 participated in the survey. Contraceptive prevalence rate (CPR) analyses were conducted separately on all women of childbearing age and married women. The data was analysed using the complex survey data approach by applying sampling weights to correct unequal representation of participants at cluster, district, and regional level. We used binary logistic regression to assess association between migration status and modern contraceptive use among all women of childbearing age and married women separately. We included age, age at first sex, age at marriage, region of residence, education, residence wealth index and presence of disability as confounders in our final multivariable models. RESULTS The overall CPRs for married women and for all women of childbearing age were 64.7% and 40.5% respectively. The CPRs for all women of childbearing age were 40.5% for non-migrants and 33.0% for migrant women. For married women, CPRs were 51.5% for migrant women and 65.5% for non-migrant women. The fully adjusted odds ratios for the association between migration status and modern contraceptive use were 0.62 (0.49-0.78) for married women and 0.65 (0.52-0.80) for all women of childbearing age. CONCLUSIONS We conclude from our findings that migrant women were significantly less likely to utilize modern contraceptive methods for both married women and all women of childbearing age. Deliberate efforts are required to ensure that migrant women of childbearing age have equal access to sexual and reproductive health services which includes family planning.
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Affiliation(s)
- Reuben Christopher Moyo
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Ministry of Health, Nkhatabay District Health Office, Stellenbosch University, Nkhatabay, Cape Town, Malawi.
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Kebede SD, Mamo DN, Adem JB, Semagn BE, Walle AD. Machine learning modeling for identifying predictors of unmet need for family planning among married/in-union women in Ethiopia: Evidence from performance monitoring and accountability (PMA) survey 2019 dataset. PLOS Digit Health 2023; 2:e0000345. [PMID: 37847670 PMCID: PMC10581455 DOI: 10.1371/journal.pdig.0000345] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/11/2023] [Indexed: 10/19/2023]
Abstract
Unmet need for contraceptives is a public health issue globally that affects maternal and child health. Reducing unmet need reduces the risk of abortion or childbearing by preventing unintended pregnancy. The unmet need for family planning is a frequently used indicator for monitoring family planning programs. This study aimed to identify predictors of unmet need for family planning using advanced machine learning modeling on recent PMA 2019 survey data. The study was conducted using secondary data from PMA Ethiopia 2019 cross-sectional household and female survey which was carried out from September 2019 to December 2019. Eight machine learning classifiers were employed on a total weighted sample of 5819 women and evaluated using performance metrics to predict and identify important predictors of unmet need of family planning with Python 3.10 version software. Data preparation techniques such as removing outliers, handling missing values, handling unbalanced categories, feature engineering, and data splitting were applied to smooth the data for further analysis. Finally, Shapley Additive exPlanations (SHAP) analysis was used to identify the top predictors of unmet need and explain the contribution of the predictors on the model's output. Random Forest was the best predictive model with a performance of 85% accuracy and 0.93 area under the curve on balanced training data through tenfold cross-validation. The SHAP analysis based on random forest model revealed that husband/partner disapproval to use family planning, number of household members, women education being primary, being from Amhara region, and previously delivered in health facility were the top important predictors of unmet need for family planning in Ethiopia. Findings from this study suggest various sociocultural and economic factors might be considered while implementing health policies intended to decrease unmet needs for family planning in Ethiopia. In particular, the husband's/partner's involvement in family planning sessions should be emphasized as it has a significant impact on women's demand for contraceptives.
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Affiliation(s)
- Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Daniel Niguse Mamo
- Department of Health Informatics, College of Medicine and health sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Jibril Bashir Adem
- Department of Public Health, College of Medicine and Health Science, Arsi University, Asella, Ethiopia
| | - Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science College, Debre Berhan University, Debre Berhan, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, Mettu University, Mettu, Ethiopia
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Terefe G, Abebe F, Teka B. Unmet Need for Family Planning Service and Associated Factors Among Homeless Women of Reproductive Age Group in Jimma Zone Administrative Towns, Ethiopia. Open Access J Contracept 2022; 13:83-93. [PMID: 35702259 PMCID: PMC9188778 DOI: 10.2147/oajc.s363258] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background The majority of homeless women (75%) do not wish to have or delay a pregnancy during this difficult time, yet many do not use contraception in developing countries. In Ethiopia, there is limited evidence of unmet need for family planning in settings where homelessness is on the increase. This study aims to assess the unmet need for family planning services among homeless women and identify associated factors in Jimma Town, southwestern, Ethiopia. Methods A community-based cross-sectional study was conducted on May 3rd and 4th, 2021. The complete enumeration was done to include 206 homeless women. Epidata version 3.1 data entry and exported to SPSS version 20 were used for analysis. Bivariate and multivariable logistic regressions were used to identify factors associated with the unmet need for family planning. Associated factors were determined by a 95% confidence interval of AOR and P-value <0.05 in the multivariable model. Results The unmet need for family planning among homeless women was 47.3% [95% CI (38.2, 49.7)]. Being with a disability; [(AOR: 4.10, 95% CI (1.73–9.56), visited by a health care provider in the last 12 months; [(AOR: 0.25, CI (0.09–0.65)], and a number of living children; [(AOR: 0.42, CI (0.18–96)] were significantly associated with an unmet need for family planning. Conclusion The unmet need for family planning methods among homeless women was high compared to the national standard of unmet need for family planning, being with a physical disability, visited by a health care provider in the last twelve months, and having a number of living children contributed to the unmet need for family planning. Therefore, health care professionals should focus on providing health education on family planning among these women at the grass-root level to reduce the unmet need for family planning among these women.
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Affiliation(s)
- Gemechu Terefe
- Department of Midwifery, Jimma University, Jimma Town, Oromia, Ethiopia
| | - Fikadu Abebe
- Department of Midwifery, Jimma University, Jimma Town, Oromia, Ethiopia
| | - Bekelu Teka
- Department of Population and Family Health, Jimma University, Jimma Town, Oromia, Ethiopia
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Mourtada R, Melnikas AJ. Crisis upon crisis: a qualitative study exploring the joint effect of the political, economic, and pandemic challenges in Lebanon on Syrian refugee women's fertility preferences and behaviour. Confl Health 2022; 16:35. [PMID: 35705985 PMCID: PMC9199315 DOI: 10.1186/s13031-022-00468-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Starting in October 2019, Lebanon experienced overlapping crises that caused a significant deterioration of the living conditions for Syrian refugees and the host community. Previous studies have shown that difficult living conditions and refugee status alone do not impact the fertility preferences of Syrian refugees. This study seeks to explore the effect of the overlapping crises on the fertility preferences and behaviour of Syrian refugees in Lebanon.
Methods In this qualitative study, we carried out focus group discussions (FGDs) with married female Syrian refugees recruited purposively from two cities in West Bekaa (Bar Elias and Saad Nayel) and from inside and outside the Informal Tented Settlements (ITS). Transcripts were analysed using thematic analysis.
Results The overlapping crises (political, economic, and Covid-19) in Lebanon influence Syrian refugee women’s reported desire for fewer children. Two themes emerged that explained the change in Syrian refugees’ fertility preferences towards limiting their number of children or delaying having children, and potentially a change in their fertility practices: the sudden deterioration in their living conditions triggered by the effect of inflation on their daily needs, and decreased support and changes in the job market that led to more women working to support their families. Consequently, refugees expressed a preference towards limiting their number of children due to concern about the consequences of the crisis on their children’s physical and mental well-being. This was combined with decreased pressure on women from men and in-laws to have (additional) children and concern over the effect of Covid-19 on pregnant women. Conclusions The sudden deterioration in living conditions due to the overlapping crises may have influenced Syrian refugees’ preferences towards limiting their number of children or delaying having children until the situation improves. The potential shift in power dynamics in households caused by more women working outside the home also may have increased women’s autonomy in making decisions regarding family size and use of modern contraception. These findings have implications for developing programs that focus on female livelihoods and engagement in work outside the home to influence family size and other reproductive health outcomes and gender equity indicators.
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Affiliation(s)
| | - Andrea J Melnikas
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Anik AI, Islam MR, Rahman MS. Association between socioeconomic factors and unmet need for modern contraception among the young married women: A comparative study across the low- and lower-middle-income countries of Asia and Sub-Saharan Africa. PLOS Glob Public Health 2022; 2:e0000731. [PMID: 36962420 PMCID: PMC10021951 DOI: 10.1371/journal.pgph.0000731] [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] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
Modern contraceptive methods are effective tools for controlling fertility and reducing unwanted pregnancies. Yet, the unmet need for modern contraception (UNMC) remains high in most of the developing countries of the world. This study aimed to compare the coverage of modern contraceptive usage and the UNMC among the young married women of low- and lower-middle-income countries (LMICs) of Asia and Sub-Saharan Africa, and further examined the likelihood of UNMC across these regions. This cross-sectional study used Demographic and Health Survey (DHS) data on family planning from 32 LMICs of South Asia (SA), Southeast Asia (SEA), West-Central Africa (WCA), and Eastern-Southern Africa (ESA). Multilevel logistic regression models were used to investigate the relationship between UNMC and women's socioeconomic status. Out of 1,00,666 younger married women (15-24 years old), approximately 37% used modern contraceptives, and 24% experienced UNMC. Regionally, women from SA reported higher modern contraceptive usage (44.7%) and higher UNMC (24.6%). Socioeconomic factors like- higher education (in SA and WCA), unemployment (in SA and ESA), no media exposure (in SA and ESA), and higher decision-making autonomy (except SEA) showed positive and significant association with UNMC. Poorest households were positively associated with UNMC in SA and ESA, while negatively associated with UNMC in SEA. UNMC was highly reported among the SA young married women, followed by WCA, SEA, and ESA regions. Based on this study findings, versatile policies, couples counseling campaigns, and community-based outreach initiatives might be undertaken to minimize UNMC among young married women in LMICs.
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Affiliation(s)
- Asibul Islam Anik
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Rashedul Islam
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Division of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Hamamatsu, Japan
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Ahinkorah BO, Budu E, Aboagye RG, Agbaglo E, Arthur-Holmes F, Adu C, Archer AG, Aderoju YBG, Seidu AA. Factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa: evidence from cross-sectional surveys of 29 countries. Contracept Reprod Med 2021; 6:22. [PMID: 34332644 PMCID: PMC8325798 DOI: 10.1186/s40834-021-00165-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. This study sought to determine the factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa. METHODS This study used data from the Demographic and Health Surveys of 29 countries in sub-Saharan Africa. A total of 87,554 women aged 15-49 with no fertility intention and who had completed information on all the variables of interest were considered in this study. Using a multilevel logistic regression analysis, four models were used to examine the individual and contextual factors associated with modern contraceptive use. The results were presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p< 0.05. RESULTS The prevalence of modern contraceptive use was 29.6%. With the individual-level factors, women aged 45-49 had lower odds of using modern contraceptives (aOR = 0.33, 95% CI = 0.28, 0.39). Women who had their first sex at age 15-19 (aOR = 1.12, 95% CI = 1.07, 1.17), those with higher education (aOR = 1.93, 95% CI = 1.75, 2.13), and women who were exposed to newspaper (aOR = 1.15, 95% CI = 1.10, 1.20) and radio (aOR = 1.21, 95% CI = 1.17, 1.26) had higher odds of modern contraceptive use. In terms of the contextual factors, women living in urban areas (aOR = 1.06, 95% CI = 1.02, 1.11), women in the richest wealth quintile (aOR = 1.55, 95% CI = 1.43, 1.67), and those in communities with medium literacy level (aOR = 1.11, 95% CI = 1.06, 1.16) and medium community socio-economic status (aOR = 1.17, 95% CI = 1.10, 1.23) had higher odds of modern contraceptive use. Across the geographic regions in sub-Saharan Africa, women in Southern Africa had higher odds of modern contraceptive use (aOR = 5.29, 95% CI = 4.86, 5.76). CONCLUSION There is a relatively low prevalence of modern contraceptive use among women with no fertility intention in sub-Saharan Africa, with cross-country variations. Women's age, age at first sex, level of education, mass media exposure, place of residence, community literacy level and community socio-economic status were found to be associated with modern contraceptive use. It is, therefore, important for policy makers to consider these factors when designing and implementing programmes or policies to increase contraceptive use among women who have no intention to give birth. Also, policymakers and other key stakeholders should intensify mass education programmes to address disparities in modern contraceptive use among women.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anita Gracious Archer
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Yaa Boahemaa Gyasi Aderoju
- Department of Adult Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Australia
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Gage AJ, Wood FE, Akilimali PZ. Perceived norms, personal agency, and postpartum family planning intentions among first-time mothers age 15-24 years in Kinshasa: A cross-sectional analysis. PLoS One 2021; 16:e0254085. [PMID: 34242267 DOI: 10.1371/journal.pone.0254085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Unintended pregnancy is an important global health problem and frequently occurs during the immediate postpartum period. However, few studies have examined postpartum family planning (PPFP) intentions among adolescent girls and young women. This study assessed whether perceived norms and personal agency predicted PPFP intentions among first-time mothers age 15–24 in Kinshasa, the Democratic Republic of Congo. Data were derived from the 2018 Momentum Project baseline survey. Analysis was based on 2,418 nulliparous pregnant women age 15–24 who were approximately six months pregnant with their first child in six health zones of Kinshasa. Overall PPFP intentions were low and ten to thirteen percent of women stated they were very likely to discuss PPFP next month with (a) their husband/male partner and (b) a health worker, and to (c) obtain and (d) use a contraceptive method during the first six weeks following childbirth. The results of multivariable linear regression models indicated that the PPFP intention index was predicted by description norms, perceptions of the larger community’s approval of PPFP, normative expectations, perceived behavioral control, self-efficacy, and autonomy. Rejection of family planning myths and misconceptions was also a significant predictor. Interaction terms suggested that the association of normative expectations with PPFP intentions varied across ethnic groups and that the positive association of injunctive norms with PPFP intentions was significantly increased when the larger community was perceived to disapprove of PPFP use. Normative expectations and PPFP-related self-efficacy accounted for two-thirds of the variance in PPFP intentions. The results suggested that understanding different normative influences may be important to motivate women to use contraception in the immediate postpartum period. In addition to addressing institutional, individual, and social determinants of PPFP, programs should consider integrating norm-based and empowerment strategies.
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Kettema WG, Aynalem GL, Yismaw AE, Degu AW. Modern Contraceptive Utilization and Determinant Factors among Street Reproductive-Aged Women in Amhara Regional State Zonal Towns, North West Ethiopia, 2019: Community-Based Study. Int J Reprod Med 2020; 2020:7345820. [PMID: 33354561 DOI: 10.1155/2020/7345820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/04/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Reproductive-aged women living on the street, with no doubt, are with lesser benefits of exercising their reproductive rights. Pregnancies from this marginalized population are likely to be unplanned, unwanted, and unsupported. The aim of this study, therefore, was to assess modern contraception utilization and associated factors among street reproductive-aged women in Amhara regional state zonal towns. Method A community-based cross-sectional study was conducted among street reproductive-aged women in Amhara regional state zonal towns. A single population proportion formula was used to calculate the sample size, a similar literature-based tool adaptation was done, and a semistructured, pretested sectioned questionnaire was used. Cluster sampling technique was used to reach the study participants. Data was entered into Epi Info version 7 and exported to SPSS version 23 for analysis. A multivariable logistic regression model was fitted to control the possible effect of confounders, and finally, the independent variables were identified on the basis of OR, with 95% CI and p values less than 0.05. Results 604 street reproductive-aged women were interviewed in the study which make the response rate 94.2%. The study revealed that current modern contraceptive utilization among the study participants was found to be 38.9%. Having history of pregnancy in street life (AOR = 1.70, 1.1-2.7), having three or more live children (AOR = 6.4, 2.0-20.4), undesiring to have additional children in the future (AOR = 2.7, 1.4-5.1), mentioning three to four (AOR = 2.2, 1.5-3.3) and five or more modern contraceptive types (AOR = 5.5, 1.4-21.0), and discussion with sexual partners for contraceptive use (AOR = 6.6, 4.3-10.1) were variables significantly associated with modern contraceptive utilization. Modern contraceptive utilization among the street reproductive-aged women was low. Authors suggest that awareness creation and male partner involvement in the maternal services may be important to increase contraceptive utilization.
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Chand S, Chamroonsawasdi K, Vatanasomboon P, Chansatitporn N. Assessing the unmet need for modern contraceptives among reproductive-aged women in rural Nepal. JHR 2020. [DOI: 10.1108/jhr-06-2020-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this research was to determine the extent of the unmet need for modern contraceptives (MC) and its associated factors.
Design/methodology/approach
This community-based cross-sectional survey was conducted via interview among 306 women. Percentages, means, standard deviations, Chi-square tests and multiple logistic regression were completed for data analysis.
Findings
In total, 46.7% of respondents had total unmet need (24.8% spacing and 21.9% limiting). Multiple logistic regression for spacing showed the number of living children (AOR = 40.893, 95% CI = 6.930–241.292), no previous experience of MC (AOR = 30.149, 95% CI = 11.572–78.548) and level of knowledge (AOR = 5.587, 95% CI = 1.366–22.851). With regard to limiting pregnancies, respondent's age (AOR = 12.470, 95% CI = 1.264–86.734), number of living children (AOR = 21.257, 95% CI = 4.825–93.639) and no previous experience of MC (AOR = 120.542, 95% CI = 31.044–486.062) were recorded. Findings revealed that no previous experience of MC (AOR = 714.511, 95% CI = 160.646–3177.955) was a significant predictor of total unmet need.
Research limitations/implications
As this is a community-based cross-sectional study, it cannot establish causal relationships and was conducted in a limited rural area of mid-western Nepal and may limit the generalization of results to other settings.
Practical implications
This research supports health authority to develop need-based action to increase family planning service in the local context.
Originality/value
Experience and knowledge of MC play a vital role in the unmet need of MC use. A comprehensive education program to promote decision-making on MC choice and integrated family planning services at local communities by capacity building of service providers should be scaled up.
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Worku SA, Mittiku YM, Wubetu AD. Unmet need for family planning in Ethiopia and its association with occupational status of women and discussion to her partner: a systematic review and meta-analysis. Contracept Reprod Med 2020; 5:21. [PMID: 33292648 PMCID: PMC7678115 DOI: 10.1186/s40834-020-00121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/01/2019] [Accepted: 09/06/2020] [Indexed: 11/11/2022] Open
Abstract
Background Unmet need refers to fecund women who either wish to postpone the next birth (spacers) or who wish to stop childbearing (limiters) but are not using a contraceptive method. Many women who are sexually active would prefer to avoid becoming pregnant but are not using any method of contraception. These women are considered to have an unmet need for family planning. Therefore, the objective of this systematic review and meta-analysis is to estimate the pooled prevalence of unmet need for family planning and its association to occupational status of women and discussion to her partner among fecund women in Ethiopia. Method A systemic review and meta-analysis was conducted using published and unpublished research on the prevalence of unmet need for family planning and its association to occupational status of women and discussion to her partner among fecund women in Ethiopia. Data extraction was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, CINAHL, and Embase. All statistical analysis were done using STATA version 14 software using random effects model. The pooled prevalence was presented in forest plots. Results A total of 9 studies with 9785 participants were included, and the overall pooled estimated prevalence of unmet need for family planning among fecund women in Ethiopia was 34.90% (95% CI: 24.52, 45.28%). According to subgroup analysis the estimated prevalence of unmet need for family planning in studies conducted in Amhara was 32.98% (95% CI: 21.70, 44.26%), and among married women was 32.84% (95% CI: 16.62, 49.07%). Additionally, housewife women were 1.6 times more likely have unmet need for family planning compared to government employed women (OR: 1.6, 95% CI: 1.29, 1.99). Moreover, women who don’t discuss to partner were 1.87 times more likely to have unmet need for family planning compared to women who had discussion to her partner (OR 1.87; 95% CI: 1.52, 2.31). Conclusion The analysis revealed that the overall prevalence of unmet need for family planning among fecund women in Ethiopia was high. Family planning programs should identify strategies to improve communication in family planning among couples and to ensure better cooperation between partners.
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Affiliation(s)
- Solomon Adanew Worku
- Department of Midwifery, College of Health Science, Debre Berhan University, P.O.Box 445, Debre Berhan, Ethiopia.
| | - Yohannes Moges Mittiku
- Department of Midwifery, College of Health Science, Debre Berhan University, P.O.Box 445, Debre Berhan, Ethiopia
| | - Abate Dargie Wubetu
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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Getaneh T, Negesse A, Dessie G, Desta M, Moltot T. Predictors of unmet need for family planning in Ethiopia 2019: a systematic review and meta analysis. ACTA ACUST UNITED AC 2020; 78:102. [PMID: 33088503 PMCID: PMC7566059 DOI: 10.1186/s13690-020-00483-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/06/2020] [Indexed: 11/13/2022]
Abstract
Background unmet need for family planning is a common cause of uninteded pregnancy which mostly end up with abortion. Many studies were conducted on predictors of unmet need of family planning in Ethiopia. But, up until now, single evidence has not been synthesized and various point prevalence estimates of unmet need for family planning have been reported. Therefore, this sytematic review and meta analysis was established to identify the predictors of unmet need for family planning in Ethiopia. Methods search engines including PubMed, Embase, CINAHL, Google Scholar, HINARI portal, and Cochrane Library were used to retrieve included articles and reported using the preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) checklist guidelines. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was applied for critical appraisal. All observational studies done on reproductive age women and reported on unmet need for family planning were included. Unmet need for family planning is the percentage of women of reproductive age, either married or in a union, who have an unmet need for family planning to stop or delay childbearing. Random effect model was done to estimate the pooled prevalence of unmet need for family planning. Odds ratio with 95% confidence interval was considered to determine the association of identified variables with unmet need of family planning. Cochran’s Q statistic, Egger’s and Begg’s test were carried out to assess heterogeneity and publication bias. Results Fifteen articles and 17, 585 reproductive aged women were included to estimate the pooled prevalence of unmet need for family planning and its predictors in Ethiopia. The prevalence of unmet need for family planning in Ethiopia ranges from 26.52 to 36.39%. Age at first marriage < 18 yrs. with OR = 2.3 (95% CI: 1.08, 4.87), women with no formal education with OR = 1.9 (95%CI: 1.19, 3.04), partner with no formal education with OR = 1.78 (95%CI: 1.18, 2.68) and absence of discussion with their partner about family planning with OR = 3.52 (95%CI, 2.56, 4.87) were predictors of unmet need of family planning in Ethiopia. Conclusion This meta analysis revealed that, the prevalence of unmet need for family planning in Ethiopia was high as compared with the United Nations sphere standard of unmet need for planning, considered to be high if it is greater than 25%. Early marriage, no formal eduaction and lack of discussion with partner on family planning were predictors of unmet need for family planning. Therefore, efforts are needed to empower women through eduaction, avoiding early marriage and facilitating dicussion of partners about family planning in order to improve family planning usage.
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Affiliation(s)
- Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Center of excellence in Human Nutrition, School of Human Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Getenet Dessie
- Department of Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Tebabere Moltot
- Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Zhang Y, McCoy EE, Scego R, Phillips W, Godfrey E. A Qualitative Exploration of Somali Refugee Women's Experiences with Family Planning in the U.S. J Immigr Minor Health 2020; 22:66-73. [PMID: 30941615 DOI: 10.1007/s10903-019-00887-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of our study was to explore the knowledge, attitudes, and experiences of Somali refugee women with family planning in the U.S. We conducted focus groups of Somali refugee women and used grounded theory methodology to identify emergent themes. Fifty-three women, aged 18-49 years, participated. Somali refugee women's cultural and religious beliefs and social identities strongly influence their conceptualization of family planning. Participants agreed that a woman's fertility is ultimately decided by Allah and identified environmental changes after immigration and the desire to optimize maternal health as facilitators to modern contraceptive use. Misconceptions about and fear of side effects of modern contraceptive methods, including a fear of infertility, were identified as barriers to use. To deliver patient-centered family planning counseling to Somali refugee women, it is essential that healthcare providers approach these discussions with cultural humility and consider employing community partners or cultural brokers to help provide family planning education.
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