Client-Centeredness of Family Planning Services in a Resource Limited Setting

Early discontinuation of the IMPLANON® and associated factors in Ethiopia, systematic review and meta-analysis

Background

Implanon® is a commonly used effective long-acting reversible contraceptive method. It provides contraception for up to three years. Its early discontinuation was associated with an unwanted pregnancy, abortion, and socioeconomic burden. Thus, the main aim of this systematic review and meta-analysis is to determine the rate of early discontinuation of Implanon® and associated factors in Ethiopia.

Method

This Systematic review and meta-analysis was performed by using online databases including PubMed, Google Scholar, Cochrane, HINARI, Web of Science, and other gray and online repositories of Ethiopian Universities. The JOANNA Briggs Institute standard data extraction and appraising sheet format was used for the extraction of all included studies. To test the heterogeneity of the studies the Cochran Q test and I² statistics test were used. The Funnel plot and Egger's tests were used to detect possible publication biases of the included studies. The forest plots were used to present the finding of the overall prevalence of the early Implanon® discontinuation and the odds ratio (OR) along with a 95% CI.

Result

In this systematic review and meta-analysis seven studies with a total population of 3161 women using Implanon® were included. The overall pooled early Implanon® discontinuation rate was 31.34% (95%CI: 19.20, 43.47). Early discontinuation of Implanon® was associated with lack of counseling during service delivery 2.55times (OR: 2.55, 95%CI: 1.99, 3.25), the experienced side effect 3.25 times (OR: 3.25, 95%CI: 2.48, 4.24), absence of appointment after insertion 6.06 times (OR: 6.06, 95%CI: 2.15, 17.05), others decision on the women's choice 3.30 times (OR = 3.30, 95%CI: 2.52, 4.32), and lack the satisfaction of provided service 2.68 times (OR: 2.68, 96%CI: 1.61, 4.45).

Conclusion

About one-third of the women in Ethiopia discontinue the use of Implanon® within one year of the insertion. This is high compared to findings from other countries. Lack of counseling about the service, women's experience of the side effect, absence of the appointment following the service provision, other decisions on the method chosen, and lack of satisfaction were factors associated with the discontinuation of Implanon®. Hence, efforts should be made to reduce the rate of early discontinuation of Implanon® through drafting national guidelines and strategies accompanied by appropriate implementation, follow-up to foster adequate counseling, arrangement of appointments, helping women to decide on the choice, and increase the quality of care provision to enhance the satisfaction of the service.

Quality of care in sterilization services at the public health facilities in India: A multilevel analysis

Female sterilization is the most popular contraceptive method among Indian couples, and the public sector is the major source of sterilization services in the country. However, concerns remain on the quality of services provided, deaths, failures, and complications following sterilization. In this paper, we study the complexities around the quality of care in female sterilization services at public health facilities and identify strategies for improving the measurement of such quality. A better understanding of these issues could inform pragmatic strategies for enhancing quality. This study uses data from the National Family Health Survey (NFHS) 2015–16 and District Level Household and Facility Survey (DLHS) 2012–13. The study is limited to only districts whose data are available in both DLHS 2012–13 and NFHS 2015–16. The methods of analysis include bivariate statistics, Pearson’s chi-square test, and two-level mixed-effects logistic regression. We found that the quality of care (QoC) in sterilization service at the public health facilities in India is associated with facility readiness and the socio-economic characteristics of the clients. There is a significant association between household wealth and the QoC received. Our study provides empirical shreds of evidence on the role of structural attributes in delivering quality sterilization services. The spatial analyses revealed the geographies in the country where the QoC and facility readiness are low. Quality should be an overriding priority to establish the credibility of any health care delivery system. It is essential to provide safeguards against adverse events to develop the client’s confidence in the services, which is the key to success for any voluntary family planning program like in India.

Factors influencing women's decisions regarding birth planning in a rural setting in Kenya and their implications for family planning programmes

Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper explores factors influencing women's decisions regarding contraceptive uptake, switching and discontinuation, and the implications of those decisions for family planning programmes. Data were from in-depth interviews that were conducted in 2018 with 42 women who participated in a longitudinal research project implemented in Homa Bay County of Kenya. Participants comprised women who were aged 15-39 years at the time of recruitment into the study and who discontinued using injectables or implants between the first and second rounds of data collection. Data were analysed using an exploratory inductive content analytic approach. The findings show that uptake of contraception was largely driven by concerns about the negative consequences of frequent childbirth on individual health and household socioeconomic well-being. Most women discontinued methods because of dissatisfaction but, instead of abandoning contraception altogether, switched to alternative methods, albeit sometimes less-effective ones. However, some women had difficulties in identifying an appropriate new method after experiencing side-effects, contraceptive failure or stock-out of their current method. Securing the cooperation of sexual partners was an additional problem especially for women whose partners did not support contraception. The findings suggest that concerns about the negative consequences of frequent childbirth outweigh challenges associated with contraceptive use. This presents an opportunity for family planning programmes to improve contraceptive uptake and continuation by addressing the health system challenges related to commodity stock-out and poor quality of care, as well as the concerns of men.

Disparities in Long-Acting Reversible Contraceptive Utilization among Married Women in Ethiopia: Findings of the Ethiopian Demographic and Health Survey

Background

Long-acting contraceptive methods, subdermal implants, and intrauterine devices are reliable, safe, and cost-effective family planning methods. However, these methods are not widely used in Ethiopia despite government effort to increase access. The study is aimed at assessing the rate of utilization of long-acting contraceptive methods among married women and associated factors.

Method

We analyzed the 2016 Ethiopian Demographic and Health Survey dataset. A total of 2045 married women of reproductive age group, who were using any modern contraceptive method at the time of the survey, were included in the study. Descriptive statistics were computed to characterize the study participants. Bivariate and multivariable logistic regression analyses were performed to identify associated factors, reporting odds ratios (ORs) and 95% confidence intervals (95% CIs).

Result

The multivariable analyses showed that women educational status, parity, religion, previous history of abortion, desire for more child, and region where the respondents reside were significantly the factors that determine the utilization of long-acting contraceptive. There is a significant regional disparity in long-acting contraceptive utilization. Compared to women residing in Tigray region, those who live in other regions (Afar-Somali, Oromia, Amhara, Benishangul Gumz-Gambela, and Southern Nations Nationalities and People) have low likelihood of using long-acting contraceptive methods.

Conclusion

Utilization of long-acting family planning method is low in Ethiopia. There is a significant regional disparity in utilizing these methods. Policy makers should promote culture-sensitive and tailored interventions to improve the utilization of long-acting family planning methods.