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Van Eekert N, Biegel N, De Kort L, Verhoeven V, Gehrmann T, Masquillier C, Ahannach S, Lebeer S. Relationship between classic indicators of health behaviour and contraceptive choices in women in Flanders. BMC Womens Health 2024; 24:275. [PMID: 38706007 PMCID: PMC11070100 DOI: 10.1186/s12905-024-03079-y] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/07/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND In this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours. METHODS Using the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women). RESULTS Higher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method. DISCUSSION The fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies. CONCLUSION The results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women's contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way.
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Affiliation(s)
- Nina Van Eekert
- Research Foundation Flanders (FWO), Brussels, Belgium.
- Centre for Population, Family & Health, Research Foundation Flanders (FWO), Antwerp, Belgium.
| | - Naomi Biegel
- Centre for Population, Family & Health, Research Foundation Flanders (FWO), Antwerp, Belgium
| | - Leen De Kort
- Centre for Population, Family & Health, Research Foundation Flanders (FWO), Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Thies Gehrmann
- Department of Bioscience Engineering, Research Group Environmental Ecology and Applied Microbiology, University of Antwerp, Antwerp, Belgium
| | - Caroline Masquillier
- Centre for Population, Family & Health, Research Foundation Flanders (FWO), Antwerp, Belgium
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Sarah Ahannach
- Department of Bioscience Engineering, Research Group Environmental Ecology and Applied Microbiology, University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Department of Bioscience Engineering, Research Group Environmental Ecology and Applied Microbiology, University of Antwerp, Antwerp, Belgium
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Adiputri L, Gutman LM. Using the behaviour change wheel to examine facilitators and barriers to assertive contraception-use conversations for Indonesian women. Cult Health Sex 2024; 26:671-686. [PMID: 37489998 DOI: 10.1080/13691058.2023.2238014] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia.
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Affiliation(s)
- Levina Adiputri
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
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Borges ALV, Roman Lay AA, Duarte LS, Chofakian CBDN, Hall JA, Barrett G. Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey. Contraception 2024; 131:110359. [PMID: 38159791 DOI: 10.1016/j.contraception.2023.110359] [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] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We assessed contraceptive use changes during the second lockdown due to COVID-19 in Brazil and their associated factors. STUDY DESIGN This was a longitudinal web-based study in which 725 non-pregnant Brazilian women aged 18 to 49 completed an online structured survey about their contraceptive practices in two rounds in 2021. Multivariate multinomial logistic regression was used to analyze factors associated with contraceptive use changes during COVID-19. RESULTS Sixty percent reported they changed their contraceptive use during COVID-19, especially starting to use a method or switching to a more effective one (32%). In adjusted analysis, women who were ambivalent about a future pregnancy were more likely to switch to a more effective method (adjusted odds ratio [aOR] 2.33, 95% CI 1.42-3.83) and to stop using contraceptive (aOR 3.64, 95% CI 1.91-6.91). Women with a partner were less likely to switch to a more effective method (aOR 0.61, 95% CI 0.39-0.93) and to stop using contraceptive (aOR 0.53, 95% CI 0.31-0.93), but more likely to switch to a less effective method (aOR 2.25, 95% CI 1.16-4.34). Age was also associated with contraceptive use changes. CONCLUSIONS Contraceptive use among Brazilian women during COVID-19 depended on their age and partnership status. During the period of the highest peak in the number of cases and deaths in the country, ambivalence towards a future pregnancy increased changes in contraceptive use. IMPLICATIONS Contraceptive changes were observed during a two-wave web-survey in Brazil depending on women's age and partnership status. Ambivalence towards a future pregnancy increased changes in contraceptive use and should be considered in future studies regarding sexual and reproductive health and COVID-19 as well as in family planning program implementation.
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Affiliation(s)
| | | | | | | | | | - Geraldine Barrett
- EGA Institute for Women's Health, University College London, London, UK
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GBD Local and Small Area Estimation Family Planning Collaborators. Mapping heterogeneity in family planning indicators in Burkina Faso, Kenya, and Nigeria, 2000-2020. BMC Med 2024; 22:38. [PMID: 38297381 DOI: 10.1186/s12916-023-03214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Family planning is fundamental to women's reproductive health and is a basic human right. Global targets such as Sustainable Development Goal 3 (specifically, Target 3.7) have been established to promote universal access to sexual and reproductive healthcare services. Country-level estimates of contraceptive use and other family planning indicators are already available and are used for tracking progress towards these goals. However, there is likely heterogeneity in these indicators within countries, and more local estimates can provide crucial additional information about progress towards these goals in specific populations. In this analysis, we develop estimates of six family indicators at a local scale, and use these estimates to describe heterogeneity and spatial-temporal patterns in these indicators in Burkina Faso, Kenya, and Nigeria. METHODS We used a Bayesian geostatistical modelling framework to analyse geo-located data on contraceptive use and family planning from 61 household surveys in Burkina Faso, Kenya, and Nigeria in order to generate subnational estimates of prevalence and associated uncertainty for six indicators from 2000 to 2020: contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), traditional contraceptive prevalence rate (tCPR), unmet need for modern methods of contraception, met need for family planning with modern methods, and intention to use contraception. For each country and indicator, we generated estimates at an approximately 5 × 5-km resolution and at the first and second administrative levels (regions and provinces in Burkina Faso; counties and sub-counties in Kenya; and states and local government areas in Nigeria). RESULTS We found substantial variation among locations in Burkina Faso, Kenya, and Nigeria for each of the family planning indicators estimated. For example, estimated CPR in 2020 ranged from 13.2% (95% Uncertainty Interval, 8.0-20.0%) in Oudalan to 38.9% (30.1-48.6%) in Kadiogo among provinces in Burkina Faso; from 0.4% (0.0-1.9%) in Banissa to 76.3% (58.1-89.6%) in Makueni among sub-counties in Kenya; and from 0.9% (0.3-2.0%) in Yunusari to 31.8% (19.9-46.9%) in Somolu among local government areas in Nigeria. There were also considerable differences among locations in each country in the magnitude of change over time for any given indicator; however, in most cases, there was more consistency in the direction of that change: for example, CPR, mCPR, and met need for family planning with modern methods increased nationally in all three countries between 2000 and 2020, and similarly increased in all provinces of Burkina Faso, and in large majorities of sub-counties in Kenya and local government areas in Nigeria. CONCLUSIONS Despite substantial increases in contraceptive use, too many women still have an unmet need for modern methods of contraception. Moreover, country-level estimates of family planning indicators obscure important differences among locations within the same country. The modelling approach described here enables estimating family planning indicators at a subnational level and could be readily adapted to estimate subnational trends in family planning indicators in other countries. These estimates provide a tool for better understanding local needs and informing continued efforts to ensure universal access to sexual and reproductive healthcare services.
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Hossain S, Akter T, Mohsin M, Islam MM, Chowdhury PB, Khudri MM. Contraceptive uses among married women in Bangladesh: a systematic review and meta-analyses. J Health Popul Nutr 2024; 43:10. [PMID: 38233954 PMCID: PMC10795415 DOI: 10.1186/s41043-024-00502-w] [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] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Although Bangladesh's economy has shown significant improvement over the past two decades, the high population growth rate has hindered development efforts. This study aimed to review the prevalence of different contraceptive methods used among women of reproductive age in Bangladesh, which could help control the population growth rate. METHODS We conducted an extensive literature review and meta-analysis of 82 articles, identifying 20 articles for analysis. The analyses included heterogeneity and publication bias in published papers. RESULTS The pooled prevalence of various contraceptive methods was as follows: condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices (IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage, while traditional methods constituted 8.79%. On average, only 1.95% of women opted for the implant method. The overall prevalence of contraceptive method usage was 59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically significant heterogeneity for all contraceptive methods used by women in Bangladesh. The funnel plot and Egger's test showed no publication bias for any of the contraceptive methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by women in rural areas also showed publication bias (Z = -3.04, P = 0.0024). CONCLUSION A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies to ensure adherence to and provision of the most appropriate contraceptive method for couples.
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Affiliation(s)
- Sorif Hossain
- Department of Statistics, Noakhali Science and Technology University, Noakhali, Bangladesh.
| | - Tahmina Akter
- Department of Statistics, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Md Mohsin
- Interdisciplinary Health Sciences, The University of Texas at El Paso, El Paso, USA
| | - Md Momin Islam
- Department of Meteorology, University of Dhaka, Dhaka, 1000, Bangladesh.
| | | | - Md Mohsan Khudri
- Department of Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, USA
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Gelaw KA, Atalay YA, Gebeyehu NA. Unintended pregnancy and contraceptive use among women in low- and middle-income countries: systematic review and meta-analysis. Contracept Reprod Med 2023; 8:55. [PMID: 37993927 PMCID: PMC10666441 DOI: 10.1186/s40834-023-00255-7] [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: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Unintended pregnancy is a leading cause of maternal mortality associated with abortion, inadequate contraceptive use, contraceptive failure, and contraceptive discontinuation in low- and middle-income countries. Most unintended pregnancies occur in regions with limited availability of maternal health services, resulting in a significant number of maternal deaths. Therefore, this review aimed to assess the overall prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries. METHOD PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University Online Library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked using forest plot, Begg rank test, and Egger regression test. To check for heterogeneity, I2 was calculated and an overall estimation analysis was performed. Subgroup analysis was conducted by study setting, study design, and publication. The Joanna Briggs Institute quality assessment tool was used to assess the quality of each study. We performed a one-time sensitivity analysis. RESULTS Of the 1304 articles retrieved, 23 studies (involving 40,338 subjects) met the eligibility criteria and were included in this study. The pooled prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries was 44.68% (95% CI: 35.16-54.20; I2 = 99.7%, P < 0.001). Based on subgroup analysis, the pooled prevalence of unintended events was 43.58% (CI: 32.99, 54.173) and 49.93% (CI: 28.298, 71.555) for cross-sectional and cohort studies, respectively. Based on the study design, it was 34.47% (CI: 27.012, 41.933) for community studies and 55.85% (CI: 33.364, 78.339) for institutional studies. CONCLUSION The overall prevalence of unintended pregnancy was high among women using contraceptives in low- and middle-income countries. Therefore, it is better to pay attention to prevention strategies for unintended pregnancy, such as information and education accessibility and contraceptive utilization.
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Affiliation(s)
- Kelemu Abebe Gelaw
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Amsalu M, worku K, Ayalew M, Alamneh AA. Contraceptive use and associated factors among women of reproductive age on antiretroviral therapy in Awabel Woreda health centers, Northwest Ethiopia. SAGE Open Med 2023; 11:20503121231190275. [PMID: 38020801 PMCID: PMC10640806 DOI: 10.1177/20503121231190275] [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: 09/23/2022] [Accepted: 07/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The family planning options for reproductive-age women who are in antiretroviral therapy should consider different types of contraceptive methods including condom use. There is a high unmet need and unplanned pregnancies in Ethiopia among HIV-positive women. Attention was not given towards contraceptive use for HIV women in Ethiopia including the study area. The study aimed to assess contraceptive use and associated factors among women of reproductive age (15-49 years) on Antiretroviral therapy in Awabel Woreda, Northwest Ethiopia. Methods A facility-based cross-sectional study was conducted among 572 women of reproductive age who were receiving HIV care and treatment. Data were collected using interviewer-administered questionnaire, entered by Epidata3.1 and exported to IBM SPSS for statistics version 20 for analysis.Multivariable logistic regression was used to identify factors associated with contraceptive use and the presence of significant association was declared at p-value <0.05 and 95% confidence level. Result A total of 526 out of 572 women have responded, with a response rate of 91.9%. Two-thirds (66.5% (95% CI: 63.5, 69.5)) of the study participants were using contraceptive methods at the time of the survey. Women living in areas (Adjusted Odds Ratio = 1.95; 95% CI: 1.16, 3.72), and those who disclosed their HIV status to their partner (Adjusted Odds Ratio = 2.61; 95% CI: 1.37, 4.95) were more likely to use contraceptives. While Women (Adjusted Odds Ratio = 0.41; 95% CI: 0.24, 0.69) and their partners (Adjusted Odds Ratio = 0.57; 95% CI: 0.34, 0.97) who had desire to have a child were less likely to use contraceptives. Conclusions The prevalence of contraceptive use among reproductive-age women who were on antiretroviral therapy (ART) was lower than a systematic review done in Ethiopia and higher than the national target. Intervention targeting on implementation of contraceptive methods, and counseling about contraceptives to address their question of fertility desire and knowledge were recommended.
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Affiliation(s)
- Menichil Amsalu
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Kalkidan worku
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mulugeta Ayalew
- Federal Police Hospital Department of Disease Prevention, Addis Ababa, Ethiopia
| | - Alehegn Aderaw Alamneh
- Department of Human Nutrition, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Chola M, Hlongwana K, Ginindza TG. Understanding adolescent girls' experiences with accessing and using contraceptives in Zambia. BMC Public Health 2023; 23:2149. [PMID: 37924036 PMCID: PMC10623822 DOI: 10.1186/s12889-023-17131-3] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Globally, the unmet need for contraception among adolescent girls is high and is driven by barriers to access and utilisation of contraceptives. Understanding adolescent girls' experiences with accessing and using contraceptives is crucial because it influences their decision to use and willingness to continue using health products and services. While determinants of contraceptive use have been extensively researched globally, few studies explore how adolescent girls experience contraceptive use in Zambia using qualitative methods. Therefore, this study aimed to understand Zambian adolescent girls' experiences using contraceptives. METHODS Thematic analysis was used to analyse data generated from 7 focus group discussions and three in-depth interviews with adolescent girls aged 15 to 19 years in 4 districts in Zambia. NVivo version 12 pro (QSR International) software was used to manage and organise the data. RESULTS Results revealed that adolescents' experiences concerning contraceptives across the continuum of care are shaped by various factors, including knowledge of contraceptives which comprises sources of information and contraceptives; experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives; perspectives about existing contraceptives; and preferred types of contraceptives. CONCLUSION The multifactorial interaction relating to adolescents' personal experience, their community and the environment in which they access contraceptive services all contribute to their overall experience and influence their contraceptive decisions. Therefore, qualitative studies exploring adolescents' experiences with accessing and using contraceptives are vital for tailoring interventions responsive to the contraceptive needs of this age group.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa.
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, 10101, Zambia.
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
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Tampah-Naah AM, Yendaw E, Sumankuuro J. Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis. BMC Womens Health 2023; 23:550. [PMID: 37875940 PMCID: PMC10594689 DOI: 10.1186/s12905-023-02684-7] [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] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Modern contraceptive refers to "a product or medical procedure that interferes with reproduction from acts of sexual intercourse". The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana. METHODS We examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15-49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05. RESULTS In the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097-1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065-1.289), middle (AOR = 1.24; 95% CI = 1.118-1.385), and fourth (AOR = 1.25; 95% CI = 1.113-1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042-1.830), rural-middle (AOR = 1.45; 95% CI = 1.084-1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128-2.059), and rural-high (AOR = 1.42; 95% CI = 1.019-1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20-24 (AOR = 2.33; 95% CI = 2.054-2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981-1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385-1.736), Central (AOR = 1.48; 95% CI = 1.296-1.682) and Eastern (AOR = 1.48; 95% CI = 1.289-1.695) regions significantly predicted modern contraceptive use. CONCLUSION Modern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.
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Affiliation(s)
- Anthony Mwinilanaa Tampah-Naah
- Department of Geography, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Post Office Box WA64, Ghana.
| | - Elijah Yendaw
- Department of Governance and Development Management, Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
- Centre for Environment, Migration and International Relations, Simon Diedong Dombo, University of Business and Integrated Development Studies, Wa, Ghana
| | - Joshua Sumankuuro
- Department of Public Policy and Management, Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Allied Health, Exercise and Sports Sciences, Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Bwalya BB, Kasonde ME, Mulenga JN, Mapoma CC, Wamunyima N, Siamianze B, Onukogu O. The association between contraceptive use and desired number of children among sexually active men in Zambia. BMC Public Health 2023; 23:1833. [PMID: 37730599 PMCID: PMC10512645 DOI: 10.1186/s12889-023-16750-0] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Contraceptive methods have been used to space births, but also to limit a couple's desired number of children. Efforts of family planning programmes have mainly concentrated on females, even though males tend to have large say on the desired number of children a couple should have. In our study, we sought to determine linkages between contraceptive use and desired number of children, as well as associated demographic and socio-economic characteristics, among sexually active males in Zambia. METHODS The main outcome variable of interest was desired number of children as measured by ideal number of children which is a count variable. Data for this paper was the male dataset from the 2018 Zambia Demographic and Health Survey, a cross-sectional national survey. Binary logistic regression was performed to determine odds ratios of contraceptive use by selected characteristics of sexually active males. Multivariate Poisson Regression Model was used to establish factors associated with desired number of children. RESULTS Age of men (20-29, 30-39 and 40-49 years), residence in rural areas, wealth quintile, Protestant or Muslim religious affiliation, media exposure, and having discussed family planning with a health worker in the last few months prior to the survey were associated with contraceptive use. Sexually active males who reported using any contraception method reported 3% less desired number of children compared to those who were not using any method. Older males (age group 30-49 years), resident in rural areas, with primary education, married, employed, Protestant religion, and those labelling women who use contraceptives "as promiscuous" had more desired number of children. CONCLUSIONS There were minimal differences in the desired number of children among males who reported using and not using any contraceptive method. Strategies aimed at encouraging contraception use should cover all categories of males to achieve universal involvement of men in family planning in Zambia. Future research may consider combining both qualitative and quantitative methods to look holistically at the demographic, socio-economic and cultural factors associated with non-contraception use and desired number of children among sexually active men in Zambia.
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Affiliation(s)
- Bwalya Bupe Bwalya
- Mulungushi University, Kabwe, Zambia.
- Department of Economics, School of Social Science, Mulungushi University, Kabwe, Zambia.
| | - Mwewa E Kasonde
- Department of Population Studies, School of Humanities and Social Sciences, The University of Zambia, Lusaka, Zambia
| | - James Nilesh Mulenga
- Department of Economics, School of Social Science, Mulungushi University, Kabwe, Zambia
| | - Chabila Christopher Mapoma
- Department of Population Studies, School of Humanities and Social Sciences, The University of Zambia, Lusaka, Zambia
| | - Nayunda Wamunyima
- Department of Political and Administrative Studies, School of Humanities and Social Sciences, The University of Zambia, Lusaka, Zambia
| | - Billy Siamianze
- Department of Economics, School of Social Science, Mulungushi University, Kabwe, Zambia
| | - Obinna Onukogu
- Department of Social Development Studies, School of Social Science, Mulungushi University, Kabwe, Zambia
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Adebowale AS, Palamuleni ME. Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors. BMC Womens Health 2023; 23:492. [PMID: 37715218 PMCID: PMC10504785 DOI: 10.1186/s12905-023-02640-5] [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] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria. METHODS This cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05). RESULTS Mean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40-49 years compared to the younger women in age group 20-29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14-1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63-2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women. CONCLUSIONS A high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.
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Affiliation(s)
- A S Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria.
- Population and Health Research Entity, Faculty of Humanities, North-West University, Mafikeng, South Africa.
| | - M E Palamuleni
- Population and Health Research Entity, Faculty of Humanities, North-West University, Mafikeng, South Africa
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Steyn PS, Cordero JP, Nai D, Shamba D, Fuseini K, Mrema S, Habib N, Nguyen MH, Kiarie J. The impact of community and provider-driven social accountability interventions on contraceptive use: findings from a cohort study of new users in Ghana and Tanzania. Int J Equity Health 2023; 22:167. [PMID: 37641059 PMCID: PMC10464246 DOI: 10.1186/s12939-023-01928-0] [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] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/30/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Although contraceptive use has increased over 15 years, discontinuation rates remain high. Contraceptive use is becoming more important when addressing unmet need for family planning. Social accountability, defined here as collective processes for holding duty bearers to account for their actions, is a rights-based participatory process that supports service provision and person-centred care, as well as, informed decision-making among community members regarding their health. A study implemented in Ghana and Tanzania was designed to understand and evaluate how social accountability and participatory processes influences quality of care and client satisfaction and whether this results in increased contraceptive uptake and use. We report here on the relationship between social accountability and the use of modern contraceptives, i.e., contraceptive method discontinuation, contraceptive method switching, and contraceptive discontinuation. METHODS As part of Community and Provider driven Social Accountability Intervention (CaPSAI) Project, a cohort of women aged 15 to 49 years who were new users of contraception and accessing family planning and contraceptives services at the study facilities across both intervention and control groups were followed-up over a 12-month period to measure changes contraceptive use. RESULTS In this cohort study over a one-year duration, we did not find a statistically significant difference in Ghana and Tanzania in overall method discontinuation, switching, and contraceptive discontinuation after exposure to a social accountability intervention. In Ghana but not in Tanzania, when stratified by the type of facility (district level vs. health centre), there were significantly less method and contraceptive discontinuation in the district level facility and significantly more method and contraceptive discontinuation in the health centres in the intervention group. In Ghana, the most important reasons reported for stopping a method were fear of side-effects, health concerns and wanting to become pregnant in the control group and fear of side-effects wanting a more effective method and infrequent sex in the intervention group. In Tanzania, the most important reasons reported for stopping a method were fear of side-effects, wanting a more effective method, and method not available in the control group compared to wanting a more effective method, fear of side-effects and health concerns in the intervention group. CONCLUSIONS We did not demonstrate a statistically significant impact of a six-month CaPSAI intervention on contraceptives use among new users in Tanzania and Ghana. However, since social accountability have important impacts beyond contraceptive use it is important consider results of the intermediate outcomes, cases of change, and process evaluation to fully understand the impact of this intervention. TRIAL REGISTRATION The CaPSAI Project has been registered at Australian New Zealand Clinical Trials Registry (ACTRN12619000378123, 11/03/2019).
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Affiliation(s)
- Petrus S Steyn
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland.
| | - Joanna Paula Cordero
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Dela Nai
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar Es Salaam, Tanzania
| | - Kamil Fuseini
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Sigilbert Mrema
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar Es Salaam, Tanzania
| | - Ndema Habib
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - My Huong Nguyen
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - James Kiarie
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
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Daniel AK, Casmir E, Oluoch L, Micheni M, Kiptinness C, Wald A, Mugo NR, Roxby AC, Ngure K. "I was just concerned about getting pregnant": Attitudes toward pregnancy and contraceptive use among adolescent girls and young women in Thika, Kenya. BMC Pregnancy Childbirth 2023; 23:493. [PMID: 37403049 DOI: 10.1186/s12884-023-05802-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) have a high incidence of unplanned pregnancies, especially in low-resource settings. AGYW assess the overlapping risks of pregnancy, contraception, and STIs as they navigate relationships. Few studies have examined how AGYW consider the comparative risks of their decisions around sexual and reproductive health in this context or how risk perception influences contraceptive use. METHODS Twenty in-depth interviews (IDIs) and 5 focus group discussions (FGDs) were conducted with a subset of sexually active AGYW enrolled in the Girls Health Study (GHS), a longitudinal cohort study in Thika, Kenya, assessing HSV-2 incidence in a cohort of AGYW aged 16-20. Interview questions were focused on perspectives and decision-making around sexual and reproductive health. Interviews were conducted in both English and Kiswahili, transcribed, and coded using inductive and deductive approaches to identify emerging themes. RESULTS Misconceptions about long-acting reversible contraceptives (LARCs), injectables, and daily oral contraceptive pills strongly disincentivized their use among AGYW. Participants described pregnancy as undesirable, and AGYW reported prioritizing contraceptive methods that were effective and reliable in pregnancy prevention, even if not effective in preventing STI/HIV infection. Participants reported that AGYW relied heavily on emergency contraceptive (EC) pills for pregnancy prevention. CONCLUSIONS Though the goal of avoiding unintended pregnancy was common, this did not suffice to motivate the uptake of long-term contraceptives among AGYWs. Given the convenience, cost-effectiveness, and lower perceived risk of side effects, EC pills were more likely to be accepted as a form of contraception. Understanding the reasons for AGYW's acceptance of certain contraceptive methods over others can help future interventions better target communication and counseling about contraception and influence key drivers of AGYW behavior and decision-making around sexual and reproductive health.
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Affiliation(s)
| | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Partners in Health Research and Development, Thika, Kenya
| | - Lynda Oluoch
- Partners in Health Research and Development, Thika, Kenya
| | - Murugi Micheni
- National Syndemic Disease Control Council, Nairobi, Kenya
| | | | - Anna Wald
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nelly Rwamba Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- University of Washington, Seattle, WA, USA
| | - Alison C Roxby
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Box 19704-00202, Nairobi, Kenya.
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Ilori T, Adewale BA, Obembe TA, Morakinyo OM. Sexual autonomy and the use of modern contraceptives in Nigeria: Evidence from the 2018 demographic and health survey. Ann Afr Med 2023; 22:352-358. [PMID: 37417025 PMCID: PMC10445701 DOI: 10.4103/aam.aam_86_22] [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] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/23/2022] [Accepted: 01/04/2023] [Indexed: 07/08/2023] Open
Abstract
Objective The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Methods Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15-49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Results Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25-1.46). Conclusion There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.
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Affiliation(s)
- Temitope Ilori
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Taiwo A. Obembe
- Department of Health Policy and Management, University of Ibadan, Ibadan, Nigeria
| | - Oyewale Mayowa Morakinyo
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Panda A, Parida J, Jena S, Pradhan A, Pati S, Kaur H, Acharya SK. Perception, practices, and understanding related to teenage pregnancy among the adolescent girls in India: a scoping review. Reprod Health 2023; 20:93. [PMID: 37344890 DOI: 10.1186/s12978-023-01634-8] [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: 02/12/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Teenage pregnancy is a concerning public health problem in India. Misperception and misunderstanding about pregnancy and its preventive methods lead to pregnancy when adolescents are involved in unsafe sexual intercourse. This scoping review aims to discuss the evidence on the perception, practices, and understanding related to teenage pregnancy among adolescent girls in the Indian context. METHOD The Arksey and O'Malley scoping review framework and Joanna Briggs Institute Reviewers' Manual were used for the scoping review. The Population, Concept, and Context strategy (PCC) ensured the review questions, eligibility criteria, and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) was used. A literature search was done using electronic databases by specific keywords such as "teenage", "adolescences", "pregnancy", "perception", "knowledge", "awareness", etc. Relevant grey literature was identified through further searching. The review included studies that fulfil inclusion criteria having female adolescent groups aged from 10 to 19 years in the Indian context between the years 2000 and 2021. RESULT We found 40 eligible studies; more than half of these were from southern (35%) and northern (27.5%) regions, and studies from the rest of India were very sporadically distributed. Most studies (72.5%) were published in the last 10 years. The relevant extracted data from individual studies were synthesized and presented in the two major sections, perception, practices, and the second one, understanding and experiences among teenage girls. The understanding of pregnancy and teenage pregnancy-related preventive methods was detailed analysis in about 72% of papers whereas other aspects, such as perception (22.5%), practices (25%), and experiences (7.5%) were discussed in the remaining papers related to pregnancy among adolescent girls. CONCLUSION Evidence in the selected studies shows that understanding and practices are the major areas that were primarily explored, where perception, practices and experiences are the topics that are relatively less investigated. Literature synthesis derives misconception, lack of understanding, and practices without knowing the consequences are the key factors responsible for early pregnancies. Future interventions like increasing awareness, providing comprehensive reproductive knowledge, convenient health care aids, and proper counselling are adequate measures for minimalising the problem. The present analysis showed that studies are limited in their scope concerning various aspects of teenage pregnancy in India, so this scoping review gives essential perspectives on future research and implementation plans and policies in this field.
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Affiliation(s)
- Arpita Panda
- ICMR-Regional Medical Research Center, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Jayashree Parida
- ICMR-Regional Medical Research Center, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Susangita Jena
- ICMR-Regional Medical Research Center, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Abinash Pradhan
- ICMR-Regional Medical Research Center, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Center, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Harpreet Kaur
- Division of Epidemiology and Communicable Diseases (ECD-Tribal Health), ICMR Head Quarters, New Delhi, India
| | - Subhendu Kumar Acharya
- ICMR-Regional Medical Research Center, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
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Amoak D, Konkor I, Mohammed K, Saaka SA, Antabe R. Exposure to mass media family planning messages among men in Nigeria: analysis of the Demographic and Health Survey data. PeerJ 2023; 11:e15391. [PMID: 37273544 PMCID: PMC10237178 DOI: 10.7717/peerj.15391] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/19/2023] [Indexed: 06/06/2023] Open
Abstract
Background Family planning (FP) is essential for improving health and achieving reproductive goals. Although men are important participants in FP decision-making within households in Nigeria, a country with one of the highest rates of maternal mortality, we know very little about their exposure to mass media FP messages. Methods Drawing theoretical insights from the structural influence model of health communication and using the 2018 Nigeria Demographic and Health Survey (n = 13,294), and applying logistic regression analysis, we explored the factors associated with men's exposure to mass media FP messages in Nigeria. Results A range of socioeconomic, locational, and demographic factors were associated with men's exposure to mass media FP messages. For example, wealthier, more educated, and employed men were more likely to be exposed to mass media FP messages than their poorer, less educated, and unemployed counterparts. In addition, compared to those in rural areas and other regions, men in urban areas as well as South East Region, were more likely to be exposed to mass media FP messages. Finally, younger men and those who belong to the traditional religion were less likely to be exposed to mass media FP messages, compared to their older and Christian counterparts. Conclusions Based on these findings, we discuss implications and recommendations for policymakers as well as directions for future research.
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Affiliation(s)
- Daniel Amoak
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | - Roger Antabe
- University of Toronto, Scarborough, Ontario, Canada
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Khan GR, Baten A, Azad MAK. Influence of contraceptive use and other socio-demographic factors on under-five child mortality in Bangladesh: semi-parametric and parametric approaches. Contracept Reprod Med 2023; 8:22. [PMID: 36864535 PMCID: PMC9983207 DOI: 10.1186/s40834-023-00217-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/03/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The under-five child mortality rate is a widely accepted indicator of the development of a country as well as reflects the country's health care system and quality of life. Although the child mortality rate is decreasing over time in Bangladesh, the rate is still high among South Asian countries. The target of the Sustainable Development Goal-3.2 is to reduce the under-five mortality rate in all countries of the world to 25 or fewer per 1000 live births by 2030. The purpose of this study is to identify the socio-demographic factors which have an influence on under-five child mortality in Bangladesh as well as to examine whether contraceptive use has any effect on under-five mortality in Bangladesh. Finally, a comparison has been made between the results obtained from the Cox proportional Hazard Model and Weibull model to find out which model is more efficient for the study data. METHODS For the study, data was extracted from Bangladesh Demographic Health Surveys 2017-2018 (BDHS 2017-2018). The Kaplan-Meier survival function has been used to demonstrate the survival probabilities of under-five children. While multivariate analyses of the Cox Proportional Hazard model and Weibull model are used to estimate the under-five mortality risks for various predictors. RESULTS The study results show consistently higher survival probabilities for children of mothers who used modern contraceptives during survival periods. Other significant predictors for under-five child mortality include mother's education level (higher education), mother's age (> 20), wealth index (rich), source of drinking water (tube well), and division (Chittagong, Khulna, Mymensingh). Weibull model has given more efficient results than the Cox Proportional Hazard model except for one covariate (water source). CONCLUSION Contraceptives use significantly improves the survival chances of children under-five age. This underscores the importance of contraceptive use in the pursuit of a sustainable reduction in under-five mortality in Bangladesh. It also intensifies the need to address the present level of contraceptive use in the country. This may not be due to the use of contraceptives in itself but may be due to the substantial biological and socioeconomic benefits that are concomitant with contraceptive use which may promote both maternal and child health. So, Extra effort should be given by the policymakers to ensure the use of modern contraceptive methods to improve the under-five survival in Bangladesh.
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Affiliation(s)
- Golam Rabbi Khan
- grid.443016.40000 0004 4684 0582Department of Statistics, Jagannath University, Dhaka-1100, Bangladesh
| | - Abdul Baten
- Department of Statistics, Jagannath University, Dhaka-1100, Bangladesh.
| | - Md. Abul Kalam Azad
- grid.443016.40000 0004 4684 0582Department of Statistics, Jagannath University, Dhaka-1100, Bangladesh
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Laksono AD, Wulandari RD, Rohmah N, Matahari R. Unmarried Women and Unintended Pregnancy: An Indonesian Cross-Sectional Study. Indian J Community Med 2023; 48:361-363. [PMID: 37323749 PMCID: PMC10263027 DOI: 10.4103/ijcm.ijcm_325_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 02/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background Indonesia has moral norms consider pregnancy among unmarried women a disgrace. The study analyzes the factors influencing unintended pregnancies among unmarried women in Indonesia. Material and Methods The study examined 1,050 women. The author analyzed unintended pregnancy and six other variables (residence, age, education, employment, wealth, and parity). Multivariate analysis used binary logistic regression. Results 15.5% of unmarried women in Indonesia have experienced an unintended pregnancy. Women living in urban areas are more likely to experience unintended pregnancies than women in rural areas. The 15-19 have the highest chance of experiencing an unintended pregnancy. Education is a protective factor from unintended pregnancy. Employed women are 1.938 times more likely than unemployed. Poverty is a risk factor for experiencing an unintended pregnancy. Multiparous is 4.095 times more likely than primiparous. Conclusion The study identified six variables that affect unintended pregnancy among unmarried women in Indonesia: residence, age, education, employment, wealth, and parity.
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Affiliation(s)
- Agung D. Laksono
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | | | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia
| | - Ratu Matahari
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
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Bell SO, Karp C, Moreau C, Gemmill A. "If I use family planning, I may have trouble getting pregnant next time I want to": A multicountry survey-based exploration of perceived contraceptive-induced fertility impairment and its relationship to contraceptive behaviors. Contracept X 2023; 5:100093. [PMID: 37114162 PMCID: PMC10127128 DOI: 10.1016/j.conx.2023.100093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/29/2023] Open
Abstract
Objectives We aim to assess women's perceptions regarding contraceptive effects on fertility across a diversity of settings in sub-Saharan Africa and how they vary by women's characteristics. We also aim to examine how such beliefs relate to women's contraceptive practices and intentions. Study design This study uses cross-sectional survey data among women aged 15 to 49 in nine sub-Saharan African geographies from the Performance Monitoring for Action project. Our main measure of interest assessed women's perceptions of contraceptive-induced fertility impairment. We examined factors related to this belief and explored the association between perceptions of contraceptive-induced fertility impairment and use of medicalized contraception (intrauterine device, implant, injectable, pills, emergency contraception) and intention to use contraception (among nonusers). Results Between 20% and 40% of women across study sites agreed or strongly agreed that contraception would lead to later difficulties becoming pregnant. Women at risk of an unintended pregnancy who believed contraception could cause fertility impairment had reduced odds of using medicalized contraception in five sites; aORs ranged from 0.07 to 0.62. Likewise, contraceptive nonusers who wanted a/another child and perceived contraception could cause fertility impairment were less likely to intend to use contraception in seven sites, with aORs between 0.34 and 0.66. Conclusions Our multicountry study findings indicate women's perception of contraceptive-induced fertility impairment is common across diverse sub-Saharan African settings, likely acting as a deterrent to using medicalized contraceptive methods. Implications Findings from this study can help improve reproductive health programs by addressing concerns about contraception to help women achieve their reproductive goals.
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Affiliation(s)
- Suzanne O. Bell
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Corresponding author.
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
| | | | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Lee JK, Gutin SA, Getahun M, Okiring J, Neilands TB, Akullian A, Ssali S, Cohen CR, Maeri I, Eyul P, Kamya MR, Bukusi EA, Charlebois ED, Camlin CS. Condom, modern contraceptive, and dual method use are associated with HIV status and relationship concurrency in a context of high mobility: A cross-sectional study of women of reproductive age in rural Kenya and Uganda, 2016. Contraception 2023; 117:13-21. [PMID: 36115610 PMCID: PMC9984206 DOI: 10.1016/j.contraception.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/08/2021] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Mobility (international/internal migration, and localized mobility) is a key driver of the HIV epidemic. While mobility is associated with higher-risk sexual behavior in women, a possible association with condom, modern contraceptive, and dual method use among women living with HIV (WLHIV), is unknown. In addition, HIV status and sexual behaviors such as relationship concurrency may also affect condom, modern contraceptive, and dual method use. STUDY DESIGN We surveyed sexually active women (N = 1067) aged 15 to 49 in 12 communities in Kenya and Uganda participating in a test-and-treat trial in 2015 to 2016. Generalized (unordered) multinomial logistic regression models accounting for community clustering examined associations between mobility (overnight travel away from home in past 6 months and any migration within past 2 years) and condom, modern contraceptive (i.e., oral contraceptive pills, injectables, intrauterine devices, implants, vasectomy, tubal ligation; excluding male/female condoms), and dual method use within past 6 months, adjusting for key covariates such as HIV status and relationship concurrency. RESULTS WLHIV relative to HIV-negative women (ratios of relative risk [RRR] = 3.76, 95% confidence interval [CI]: 2.40-5.89), and women in concurrent relative to monogamous relationships (RRR = 4.03, 95% CI 1.9-8.50) had higher odds of condom use alone. In contraceptive use models, WLHIV relative to HIV-negative women were less likely to use modern contraceptive methods alone (RRR = 0.51, 95% CI 0.36-0.73). Relationship concurrency (RRR = 4.51, 95% CI 2.10-9.67) and HIV status (RRR = 3.97, 95% CI 2.43-6.50) were associated with higher odds of dual method use while mobility was marginally associated with higher odds of dual method use (RRR = 1.65, 95% CI 0.99-2.77, p = 0.057). CONCLUSIONS Mobility had a potential impact on dual method use in Kenya and Uganda. In addition, our findings highlight that WLHIV were using condoms and dual methods more, but modern contraceptives less, than HIV-negative women. Those in concurrent relationships were also more likely to use condoms or dual methods. These findings suggest that in a context of high mobility, women may be appropriately assessing risks and taking measures to protect themselves and their partners from unintended pregnancies and acquisition and transmission of HIV. IMPLICATIONS Our findings point to a need to strengthen accessibility of sexual and reproductive health services for both mobile and residentially stable women in settings of high mobility and high HIV prevalence.
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Affiliation(s)
- Joi K. Lee
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA,Corresponding author: Joi Lee, , Advancing New Standards in Reproductive Health (ANSIRH) Program, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), 1330 Broadway, Suite 1100, Oakland, CA 94512
| | - Sarah A. Gutin
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Torsten B. Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
| | - Adam Akullian
- Institute for Disease Modeling (IDM), Seattle, Washington, USA
| | - Sarah Ssali
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda,School of Women and Gender Studies, Makerere University College of Health Sciences, Kampala, Uganda
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA,Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Edwin D. Charlebois
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA,Division of Prevention Science, Department of Medicine, University of California, San Francisco, USA
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Prusty RK, Begum S. Missing men in family planning: understanding the socio-spatial differentials in male sterilization and male spacing methods of contraception in India. J Biosoc Sci 2023; 55:116-30. [PMID: 34927580 DOI: 10.1017/S0021932021000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated. Recent media reports have indicated a rapid decline in male sterilization use in the past few years. This study aimed to assess the trends in, patterns of and factors associated with the use of male sterilization and male spacing methods in India using data from four rounds of the National Family Health Survey, conducted from 1992 to 2016. Bivariate analysis was done to see the trends in, and patterns of, male sterilization and spacing methods, while multinomial logistic regression was used to understand the factors associated with male spacing methods and sterilization. The results show a marked decline in the prevalence of male sterilization from 1992-93 (3.5%) to 2015-16 (0.3%) in India. Of the 640 districts, only 21 had a more than 2% prevalence of male sterilization. Scheduled tribe couples were two times more likely to use male sterilization than other (upper/no caste) groups. Couples from the northern region were significantly more likely to use male sterilization (aOR: 1.68, 95% CI: 1.43-1.97) compared with those from the south. There was a regional disparity in male condom use, with a very small proportion of couples in the southern (1.1%), north-eastern (2.4%) and eastern (3.3%) regions using the method compared with couples from the northern region (9.7%). Couples from the northern (aOR: 8.89, 95% CI: 8.44-9.38), north-eastern (aOR: 11.37, 95% CI: 10.62-12.18), eastern (aOR: 6.96, 95% CI: 6.60-7.34), western (aOR: 4.65, 95% CI: 4.40-4.92) and central (aOR: 10.89, 95% CI: 10.35-11.46) regions were also significantly more likely to use male spacing methods than those from southern India. Therefore, a greater focus on increasing the use of male sterilization and condoms is required in India to reduce the gender disparity in the use of family planning methods.
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Seidu AA, Ahinkorah BO, Armah-Ansah EK, Dadzie LK, Aboagye RG, Ameyaw EK, Budu E, Zegeye B, Yaya S. Women's household decision-making power and contraceptive use in Mali. Reprod Health 2022; 19:232. [PMID: 36578012 PMCID: PMC9798590 DOI: 10.1186/s12978-022-01534-3] [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] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/22/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Utilization of contraceptives remains low in several countries in sub-Saharan Africa despite evidence of its benefits. Several factors are associated with contraceptive use. However, little is known about the association between women's decision-making capacity and the utilization of contraceptives in Mali. This study sought to determine the effect of women's household decision-making power on contraceptive use in Mali. METHODS This study involved a cross-sectional analysis of data from the 2018 Mali Demographic and Health Survey. A total of 7893 married women were included in the final analysis. A binary logistic regression analysis was conducted with statistical significance set at p < 0.05. RESULTS Contraceptive use among married women in Mali was 17.1%. The odds of using contraceptives were higher among women with joint decision-making with their husbands on how to spend respondent's earnings [aOR = 1.79; 95% CI = 1.12, 2.85], joint decision-making with their husbands on what to do with their husband's earnings [aOR = 1.43; 95% CI = 1.12, 1.83], and joint decision-making with husband on large household purchases [aOR = 1.32; 95% CI = 1.10, 1.59]. Deciding alone on a visit to family or relatives was associated with lower odds of contraceptive use [AOR = 0.72; 95% CI = 0.58, 0.89]. CONCLUSION The study has revealed that joint household decision-making is positively associated with contraceptive use. Therefore, to achieve Sustainable Development Goal 3, the ministry for the advancement of women, children and families and related stakeholders must unearth strategies to empower women in joint decision-making and encourage men's involvement in contraceptive decision-making.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- L & E Research Consult Limited, Wa, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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23
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Jonas K, Lombard C, Chirinda W, Govindasamy D, Appollis TM, Kuo C, Gray G, Beauclair R, Cheyip M, Mathews C. Participation in an HIV prevention intervention and access to and use of contraceptives among young women: A cross sectional analysis in six South African districts. Contraception 2022; 116:51-58. [PMID: 35882358 PMCID: PMC9691588 DOI: 10.1016/j.contraception.2022.07.005] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study investigated whether young women's participation in a combination HIV-prevention intervention was associated with accessing and using condoms and other contraceptives. STUDY DESIGN A cross-sectional household survey was conducted from 2017 to 2018 among a representative sample of young women aged 15-24 years old living in six South African districts in which the intervention was implemented. Cross-tabulations and multivariate regression analyses of weighted data were performed to examine access to and use of condoms and other contraceptives. RESULTS In total 4399 young women participated, representing a 60.6% response rate. Of participants, 61.0% (n = 2685) reported accessing condoms and other contraceptives in the past year. Among those who ever had sex (n = 3009), 51.0% used condoms and 37.4% other contraceptives at last sex. Among 15-19 year old, participation in the combination intervention was positively associated with reporting contraceptive use other than condoms at last sex (Prevalence Ratio (PR): 1.36; 95% CI: 1.21-1.53) and reporting use of both condoms and other contraceptives at last sex (PR: 1.45; 95% CI: 1.26-1.68). No associations were observed in the age group 20-24. CONCLUSION Our findings suggest that combination HIV prevention interventions may lead to increased access and use of condoms and other methods of contraception among adolescent women, but this needs to be confirmed in experimental studies. We need to test different or more intensive interventions to increase contraceptive use in young women aged 20-24. IMPLICATIONS Participating in combination HIV prevention interventions that are delivered via multiple approaches may promote access to, and use of condoms and other methods of contraceptives among adolescent women, and thereby help reduce unintended pregnancies.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Unit, Cape Town, South Africa; Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Glenda Gray
- South African Medical Research Unit, Cape Town, South Africa
| | - Roxanne Beauclair
- Department of Science and Innovation (DSI)-National Research Foundation (NRF) Center of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Mireille Cheyip
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Unit, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Bornstein M, Norris A, Shaba G, Huber-Krum S, Gipson JD. "I know my body and I just can't get pregnant that easily" - Women's use and non-use of the injection to manage fertility. SSM Qual Res Health 2022; 2:100071. [PMID: 37021076 PMCID: PMC10069985 DOI: 10.1016/j.ssmqr.2022.100071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately one-third of contraceptive users in Malawi use the Depo-Provera injection, a method that must be re-injected every three-months to prevent pregnancy and may reduce fecundity for a time after discontinuation. Little is known about how women use the injection to achieve their desired family size. In 2018, we conducted 20 in-depth interviews with women who were part of a cohort study in rural Malawi. Interviews focused on contraceptive decision-making. Data were indexed (summarized) and coded using narrative, process, and thematic codes. Women described the importance of knowing about their "natural" fertility by having children prior to ever using contraception because women considered contraception to have a potential negative effect on fertility. Women then applied what they learned about their fertility (i.e., how easy/difficult it was to become pregnant) to manage their fertility over their reproductive life-course. As part of fertility management, women frequently described using the injection less frequently than clinically recommended, using signs from their body (e.g., menstruation) to determine when to reinject. Managing fertility through subclinical injection use was viewed as a way to optimize women's' chances of preventing unintended pregnancy while maintaining their ability to become pregnant when they wanted to. Women wanted to play an active role in managing their fertility and were not passive consumers of contraception. It is therefore critical that family planning programs provide contraceptive counseling to women that engages their desire to manage their fertility, acknowledges their concerns about fertility, and helps them choose a method that best fits their needs.
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Affiliation(s)
- Marta Bornstein
- The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA
- University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA
| | - Alison Norris
- The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA
| | | | - Sarah Huber-Krum
- Harvard T.H. Chan School of Public Health, Cambridge, MA, 02115, USA
| | - Jessica D. Gipson
- University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA
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25
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Envall N, Wallström T, Gemzell Danielsson K, Kopp Kallner H. Use of contraception and attitudes towards contraceptive use in Swedish women: an internet-based nationwide survey. EUR J CONTRACEP REPR 2022; 27:409-417. [PMID: 36004625 DOI: 10.1080/13625187.2022.2094911] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Explore contraceptive use, unmet need of and attitudes towards contraceptive use in Sweden. Secondly, to investigate knowledge of contraceptives, prevalence and outcomes of unintended pregnancies. MATERIALS AND METHODS Internet based e-survey of Swedish women aged 16-49. The e-survey contained 49 questions with both spontaneous and multi-choice character on demographics, contraceptive use, knowledge of and attitudes towards contraception, importance of monthly bleeding, and experience of unintended pregnancy. The e-survey was closed when reaching the estimated sample size of 1000 respondents. RESULTS A total of 1016 women participated, whereof 62.4% used contraception, 31.8% did not and 5.8% had stopped in the last 12 months. Unmet need for contraception was estimated at 17.2%. At least one unintended pregnancy was experienced by 19.9%. All women rated effectiveness as the most important characteristic of a contraceptive method. CONCLUSIONS Use of contraception in Swedish women remains low, 62.4%, and the unmet need for contraception has increased to 17.2%. Method effectiveness and health benefits of hormonal contraception should be emphasised during contraceptive counselling, and actions are needed to target groups with low use of effective contraception as well as to reach those who never seek contraception.KEY MESSAGEClose to one third of Swedish women do not use contraception and one fifth have experienced at least one unintended pregnancy. Unmet need for contraception is high despite easy access and subsidies for young women.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wallström
- Department of Clinical Science and Education, South General Hospital Stockholm, Stockholm, Sweden.,Department of Obstetrics and Gynecology, South General Hospital Stockholm, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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26
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Kasonde ME, Bwalya BB, Nyirenda ET, Mapoma CC, Sikaluzwe M, Chimpinde K, Songolo GI. Association between sexual violence and unintended pregnancy among married women in Zambia. BMC Public Health 2022; 22:1491. [PMID: 35927643 PMCID: PMC9354302 DOI: 10.1186/s12889-022-13881-8] [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: 03/14/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background One of the outcomes of sexual violence is unintended pregnancy. In Zambia, 15% of married women age 15—49 years had experienced sexual violence from their husband or partner. The prevalence of unintended pregnancies among women age 15—49 years has risen from 33% in 1992 to 38% in 2018. The link between sexual violence and unintended pregnancy in Zambia was investigated in this study. Methods This study used the women's dataset from the 2018 Zambia Demographic and Health Survey, a cross-sectional survey. The study looked at a weighted sample size of 4,465 women age 15 – 49 years. Unintended pregnancy was measured by combining response categories of mistimed and unwanted pregnancy. Multivariate binary logistic regression was performed to establish the net effects of sexual violence and each explanatory variable on unintended pregnancy. Results The findings suggest that sexual violence does have a role in unintended pregnancies (AOR 1.74; CI 1.38—2.19). Ever use of contraception is also a significant predictor of unintended pregnancy (AOR 1.48; CI 1.16—1.88), even when other characteristics are taken into account. Results have shown that a woman who had ever used contraception and had experienced sexual violence was more likely to have an unintended pregnancy. Conclusion Spousal sexual violence is highly associated with unintended pregnancies in Zambia. Addressing intimate partner sexual violence is among the ways to prevent unintended pregnancies. It is also important to sensitize women on reporting acts of sexual violence to relevant authorities as this will not only prevent reoccurrence of sexual violence but also reduce unintended pregnancies and associated long-term effects.
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Affiliation(s)
- Mwewa E Kasonde
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
| | - Bwalya Bupe Bwalya
- Directorate of Research and Postgraduate Studies, Mulungushi University, Kabwe, Zambia
| | - Elizabeth T Nyirenda
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Chabila Christopher Mapoma
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Milika Sikaluzwe
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Kafiswe Chimpinde
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Gloria I Songolo
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Rajkhowa P, Qaim M. Mobile phones, women's physical mobility, and contraceptive use in India. Soc Sci Med 2022; 305:115074. [PMID: 35665688 DOI: 10.1016/j.socscimed.2022.115074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
Abstract
Women's economic and social empowerment is facilitated by their ability to move around independently and safely. However, in many developing countries women's physical mobility is restricted by social norms, structural impediments related to poor quality of roads and transport systems, and security issues. Restrictions on female physical mobility and low levels of empowerment can also have negative implications for women's access to healthcare services. Mobile phones could help connect women to information and social networks and thus also strengthen their bargaining power within the household. Here, we use nationally representative data from 39,523 women in India collected in 2011-12 to analyse associations between women's use of mobile phones and selected indicators of female autonomy and empowerment. Results indicate that women's mobile phone use is positively associated with their physical mobility range and use of non-surgical contraceptives, whereas it is negatively associated with surgical contraceptive methods. We also analyse to what extent these associations are influenced by other socioeconomic and cultural factors. Our findings suggest that mobile phones can play an important positive role for women's empowerment in India.
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Agyekum MW, Henry EG, Kushitor MK, Obeng-Dwamena AD, Agula C, Opoku Asuming P, Toprah T, Agyei-Asabere C, Shah I, Bawah AA. Partner support and women's contraceptive use: insight from urban poor communities in Accra, Ghana. BMC Womens Health 2022; 22:256. [PMID: 35752803 PMCID: PMC9233795 DOI: 10.1186/s12905-022-01799-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/13/2021] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Despite the benefits associated with contraceptive use, there is a low prevalence of contraceptive use in sub-Saharan Africa and Ghana. Previous studies have partly and consistently attributed the low prevalence of contraceptive use to partner opposition. However, little is known about the influence of men in contraceptive related choices of their partners, particularly within the context of urban poverty. This study examines the influences of partners on women’s contraceptive choices.
Methods The study utilized a cross-sectional household survey data of 1578 currently married women and women in a union of reproductive ages 16–44 years. Women who were pregnant and those trying to be pregnant were excluded from the analysis. The dependent variables for the study were current use of any contraceptive method, types of contraceptive methods and types of modern contraceptive methods. The independent variable for the study was a woman’s report of partner support in contraceptive related choices. A binary logistic regression model was used to examine the associations between partner support in contraceptive related choices and contraceptive use of women.
Results The results of the study show that partner support of contraceptive related choices has a significant influence on contraceptive use of women. Women who indicated support from their partners were more likely to be current users of any contraceptive method, yet were less likely to use modern contraceptive methods.
Conclusion The study highlights the need to involve men in family planning programs and research, as well as educating them on the various contraceptive modern methods and the side effects.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Iqbal Shah
- Harvard TH Chan School of Public Health, Boston Massachusetts, USA
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Mohamed AF, Sundberg LR. "Using contraceptives is abandoning our culture": A qualitative study of contraceptive use among Somali women in Finland. Sex Reprod Healthc 2022; 32:100718. [PMID: 35354115 DOI: 10.1016/j.srhc.2022.100718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/15/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Several studies have reported that Somalis have negative attitudes about using modern contraceptives. However, little attention has been paid to the differences in Somali women's attitudes toward contraceptives across generations and the attitude change happening overtime in Somali women's attitudes toward contraception. This study explores attitudes toward contraceptives and factors influencing contraceptive use, among first- and second-generation Somali women living in Finland. METHODS The study follows a qualitative design with data collection using in-depth interviews. Sixteen women were interviewed regarding their knowledge of, attitude toward, and use of contraceptives. Eight of the study participants were first-generation and eight were second-generation Somali women living in Finland. The data were analyzed using a thematic approach guided by a cultural anthropology framework. RESULTS Three main themes emerged in the data analysis: (1) Culture influencing Somali women's attitudes toward contraceptives; (2) information sources can work differently within the same cultural group; and (3) Somali women's perspectives on contraceptives change over time. Cultural, religion, taboo, and knowledge resources are used to understand the whole concept of Somali women's attitude toward and use of contraceptives. Hence, the study shows the diverse opinions of Somali women. According to the informants the main underlying factors influencing Somali women's attitudes toward contraceptives were education, culture, misinterpreted religion, and social pressure. CONCLUSIONS According to the Finish resident women interviewed for this study, Somali culture do not support the use of modern contraceptives. Even though attitudes towards contraceptives are slowly changing, there is a need for SRH education, particularly among first-generation Somalis. Second-generation women are generally more open to the use of modern contraceptives. The study also draws attention to the need to improve the training of health care professionals regarding the handling of culturally sensitive topics such as contraception use.
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Affiliation(s)
- Amal Farah Mohamed
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Abdelaziz W, Nofal Z, Al-Neyazy S. Factors affecting contraceptive use among currently married women in Iraq in 2018. J Biosoc Sci 2022;:1-14. [PMID: 35264272 DOI: 10.1017/S0021932022000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Level of contraceptive use is one of the primary proximate determinants of fertility level. Among Arab countries, Iraq experiences high fertility rates, especially among adolescents. According to the 2018 Iraq Multiple Indicator Cluster Survey (IMICS 2018), 52.8% of currently married Iraqi women used a contraceptive method (36.1% used modern methods, and 16.7% used traditional methods). A multiple multinomial logistic regression model was adopted to investigate the demographic, socioeconomic, fertility, and cultural determinants of contraceptive use among currently married, nonpregnant Iraqi women based on the 2018 Iraq Multiple Indicator Cluster Survey data. The main findings indicated that women using modern contraceptive methods had more children, did not experience the death of a child, and had no desire for more children. Moreover, they were married before age 21, had at least an upper secondary education, had access to mass media, used the internet, belonged to a low or middle wealth category, and lived in urban Kurdistan. Kurdish women prefer to use traditional methods. The results suggest that family planning programmes should target women who live in southern/central areas of Iraq, as they were the least likely to use contraceptives, and motivate Kurdish women to use modern contraceptives rather than traditional contraceptives.
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Raj A, Ghule M, Johns NE, Battala M, Begum S, Dixit A, Vaida F, Saggurti N, Silverman JG, Averbach S. Evaluation of a gender synchronized family planning intervention for married couples in rural India: The CHARM2 cluster randomized control trial. EClinicalMedicine 2022; 45:101334. [PMID: 35274093 PMCID: PMC8902598 DOI: 10.1016/j.eclinm.2022.101334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite calls for gender transformative family planning interventions to increase male engagement and female reproductive agency, there is limited research involving rigorous evaluation of the integration of these approaches. CHARM2 (counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) builds upon a prior three-session male engagement intervention by integrating female-focused sessions emphasizing women's choice and agency (i.e., gender synchronization). We hypothesized that CHARM2 participants will be more likely to report marital contraceptive use and communication and women's contraceptive agency, and less likely to report unintended pregnancy, relative to participants in the control condition. METHODS We conducted a two-armed cluster randomized controlled trial evaluating the effects of CHARM2 on marital contraceptive use, communication, decision-making; women's contraceptive agency, and pregnancy among young married couples in rural Maharashtra, India (ClinicalTrials.gov #NCT03514914, complete). 40 geographic clusters, defined based on the catchment areas of subcenter health facilities (the most proximal level of community health care within India's public health system) were randomized to control (n = 20) and intervention (n = 20). We assigned all participants within that geographic cluster to the corresponding cluster treatment condition; participants, investigators, and study staff were not masked to treatment assignment. Eligibility criteria included wife aged 18-29, couple residing together for at least six months with no plan for migration, and neither spouse sterilized or infertile. The CHARM2 intervention included five provider-delivered sessions on gender equity and family planning, two delivered in parallel to husbands and wives separately by gender-matched providers, and one final joint session, delivered within the four months subsequent to baseline survey. We conducted surveys and pregnancy testing at baseline and 9-month and 18-month follow-up. We used difference-in-differences multilevel mixed effects logistic regressions to assess CHARM2 effects on marital contraceptive use and communication, and women's contraceptive agency; we used single time point mixed effects logistic regressions for pregnancy outcomes. All analyses used an intention-to-treat approach. FINDINGS 1201 couples were recruited between September 2018 and June 2019; 600 intervention and 601 control. All couples were included in outcome analyses. Full couple retention was 90·2% (n = 1083) at 9-month follow-up and 90·5% (n = 1087) at 18-month follow-up. Modern contraceptive use was higher among intervention participants at 9-month but not 18-month follow-up (9-month adjusted ratio of odds ratio [AROR] 1·5, 95% CI 1·03-2·3; 18-month AROR 0·8, 95% CI 0·4-1·4). Communication (9-month AROR 1·9, 95% CI 1·0-3·6; 18-month AROR 2·7, 95% CI 1·5-4·8) and agency (9-month AROR 5·1, 95% CI 1·2-22·4; 18-month AROR 8·1, 95% CI 1·4-48·2) both improved at both time points. There was no significant difference in pregnancy between groups over the 18-month period (AOR 0·8, 95% CI 0·7-1.1) However, for women who expressed fertility ambivalence at baseline, unintended pregnancy was marginally less likely among intervention participants (47% vs 19%) (p = 0·07). There were no reported adverse events. INTERPRETATION The CHARM2 intervention offers a scalable model to improve contraceptive use, communication, and agency and possibly decrease unplanned pregnancies for couples in rural India.
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Affiliation(s)
- Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Department of Education Studies, University of California, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
- Corresponding author at: Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States.
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
| | - Nicole E. Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
| | - Madhusudana Battala
- Population Council, Zone 5A, Ground Floor, India Habitat Center, Lodi Road, New Delhi 110003, India
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive Health, J.M Street, Parel, Mumbai 400012, India
| | - Anvita Dixit
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Joint Doctoral Program in Public Health (Global Health Track), University of California San Diego/San Diego State University, UC San Diego 9500 Gilman Dr., La Jolla, CA 92093-0725, USA
| | - Florin Vaida
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Niranjan Saggurti
- Population Council, Zone 5A, Ground Floor, India Habitat Center, Lodi Road, New Delhi 110003, India
| | - Jay G. Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
| | - Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, 9300 Campus Point Drive #7433, La Jolla, CA 92037, USA
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Seidu AA, Ameyaw EK, Ahinkorah BO, Baatiema L, Dery S, Ankomah A, Ganle JK. Sexual and reproductive health education and its association with ever use of contraception: a cross-sectional study among women in urban slums, Accra. Reprod Health 2022; 19:7. [PMID: 35033115 PMCID: PMC8760577 DOI: 10.1186/s12978-021-01322-5] [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: 06/03/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had sexual and reproductive health education would likely utilize contraception. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. Methods A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691, made up of respondents who provided responses to the question on ever used contraception, sex education as well as those with complete information on all the other variables of interest was considered in this study. Binary logistic regression models were fitted to examine association between sexual and reproductive health education and ever use of contraception. Crude odds ratios (cOR) and adjusted odds ratios (aOR) at p-value less than 0.05 were used to assess the strength of the association between the outcome and independent variables. Results More than half (56.73%) of the women have never received sexual and reproductive health education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sexual and reproductive health education had lower odds of ever using contraception (OR = 0.641, 95% CI 0.443, 0.928) and this persisted after controlling for the effect of demographic factors (AOR = 0.652, 95% CI 0.436, 0.975] compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. Conclusion The study revealed a relatively low prevalence of sex education among women in urban slums in Accra. However, sex education was found to increase the odds of ever use of contraception. These findings call for intensified sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms. Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had some form of sex education would likely utilize contraception more than those who have not. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691 girls/women aged 15–49 was considered. More than half (56.73%) of the women had never received some form of sex education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sex education had lower odds of ever using contraception and this persisted after controlling for the effect of demographic factors compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. In sum, the study revealed that while prevalence of sex education was relatively low among urban slum women, sex education generally increased the chances of ever use of contraception. These findings call for more and targeted sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms.
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Affiliation(s)
- Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | - John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, P. O. Box LG 13, Accra, Ghana.
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Huber-Krum S, Miedema SS, Shortt JW, Villaveces A, Kress H. Associations between adverse childhood experiences and contraceptive use among young adults in Honduras. Child Abuse Negl 2022; 123:105381. [PMID: 34753054 PMCID: PMC9511159 DOI: 10.1016/j.chiabu.2021.105381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 04/13/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men. METHODS We used data from 810 women and 753 men aged 18-24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use. FINDINGS Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22). CONCLUSION The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.
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Affiliation(s)
- Sarah Huber-Krum
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephanie Spaid Miedema
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joann Wu Shortt
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés Villaveces
- Field Epidemiology and Prevention Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Field Epidemiology and Prevention Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Akonor PY, Ayanore MA, Anaman-Torgbor JA, Tarkang EE. Psychosocial factors influencing contraceptive use among adolescent mothers in the Volta Region of Ghana: application of the Health Belief Model. Afr Health Sci 2021; 21:1849-1859. [PMID: 35283963 PMCID: PMC8889796 DOI: 10.4314/ahs.v21i4.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Globally, complications arising from pregnancy and childbirth are the leading cause of death among pregnant women aged 15 to 19 years. This study investigated the psychosocial factors influencing contraceptive use among adolescent mothers in the Volta Region using the Health Belief Model (HBM). Methods This was a cross-sectional study conducted among 422 adolescent mothers. An interviewer-administered structured questionnaire was used to collect data. Binary logistic regression was used to determine the strength of association between the independent and the dependent variables at a p-value less than 0.05. Results The prevalence of contraceptive use was 18.7%. Concerning perceived susceptibility, there was a significant association between contraceptive use and the perception of being at risk of pregnancy complications (p<0.001). Perceived barriers showed a significant association between fear of side-effects of contraceptives and contraceptive use (p=0.007). Concerning perceived self-efficacy, there was a significant association between contraceptive use and confidence to suggest to a partner to use contraceptives (p=0.003); confidence to ask for contraceptives from health facilities (p<0.001) and confidence to use contraceptives (p<0.001). Conclusion Programmes to increase contraceptive use should aim at heightening the perception of risk of pregnancy complications, reduce barriers to contraceptive use and increase the skills in negotiating contraceptive use.
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Affiliation(s)
- Paa Yeboah Akonor
- School of Public Health, University of Health and Allied Sciences PMB 31 Ho, Ghana
| | - Martin A Ayanore
- School of Public Health, University of Health and Allied Sciences PMB 31 Ho, Ghana
| | | | - Elvis E Tarkang
- School of Public Health, University of Health and Allied Sciences PMB 31 Ho, Ghana
- HIV/AIDS Prevention Research Network Cameroon PO Box 36 Kumba, Cameroon
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Wulandari RD, Laksono AD, Matahari R. The Barrier to Contraceptive Use among Multiparous Women in Indonesia. Indian J Community Med 2021; 46:479-483. [PMID: 34759492 PMCID: PMC8575210 DOI: 10.4103/ijcm.ijcm_902_20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background The lack of perception related to the risk of pregnancy and contraceptive use's side effects is the main reason for not using contraceptives. Objective This study aimed to analyze barriers to contraceptive use among multiparous women in Indonesia. Methods This study employed the 2017 Indonesia Demographic and Health Survey. The analysis unit was multiparous women aged 15-49 years old, and the sample was 25,543 women. The contraceptive use was the dependent variable, while the independent variables analyzed were residence, age, education, employment, wealth, and insurance. The study used a binary logistic regression to determine the barriers. Results Women in urban areas were 1.100 times more likely not to use contraceptives than women in rural areas. All categories of age group are more likely to use contraception than the 45-49 age group. Multiparous women who had low education had a higher possibility of not using contraceptives. Unemployed multiparous women were 1.008 times more likely not to use contraceptives than employed multiparous women. In terms of wealth status, women with all wealth status tended not to use contraceptives than the richest. Conclusions Multiparous women in Indonesia had five barriers to not using contraceptives. These included living in urban, being at younger ages, having no education, being unemployed, and having low wealth status.
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Affiliation(s)
- Ratna Dwi Wulandari
- Department of Administration and Health Policy, Faculty of Public Health, Universitas Airlangga, Surabaya, India
| | - Agung Dwi Laksono
- Center of Research and Development for Humanities and Health Management, National Institute of Health Research and Development, Indonesia Ministry of Health, Jakarta, India
| | - Ratu Matahari
- Department of Reproductive Health, Faculty of Public Health, Ahmad Dahlan University, Yogyakarta, Indonesia
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McGregor F, Paisi M, Robinson A, Shawe J. Improving the sexual health of young people experiencing homelessness. Br J Community Nurs 2021; 26:560-566. [PMID: 34731038 DOI: 10.12968/bjcn.2021.26.11.560] [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] [Indexed: 11/11/2022]
Abstract
The sexual health needs of young people experiencing homelessness in the UK have not been researched adequately. This study aimed to examine knowledge and attitudes around sexual health and contraceptive use amongst this vulnerable group to develop suitable models of care in the community. A qualitative ethnographic case-study following Burawoy's extended case method was used. Semi-structured interviews with 29 young people experiencing homelessness and five key workers in London hostels were carried out together with ethnographic observations and analysis of documentary evidence. Thematic analysis was undertaken. Demographic data were collected. Three significant themes were identified: risks and extreme vulnerability, relationships and communication difficulties and emergence of a culture of homelessness. Young people experiencing homelessness require specialist delivery of sexual health care in safe surroundings. Initial care should focus on assessment of basic needs and current state of being. Establishing trusting relationships and considering ongoing vulnerability, can help promote meaningful and personalised sexual healthcare both at policy and practice level.
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Affiliation(s)
- Fiona McGregor
- Research Fellow, School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey
| | - Martha Paisi
- Senior Research Fellow, Faculty of Health, University of Plymouth
| | - Ann Robinson
- Senior Teaching Fellow, Midwifery, School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey
| | - Jill Shawe
- Professor in Midwifery and Family Health, Faculty of Health, University of Plymouth
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Afolabi RF, Fagbamigbe AF, Palamuleni ME. A comparative analysis of the influence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries. BMC Womens Health 2021; 21:346. [PMID: 34600521 PMCID: PMC8487107 DOI: 10.1186/s12905-021-01486-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. METHODS We analysed cross-sectional data on women aged 15-49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. RESULTS The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89-0.97), Ethiopia (aHR = 0.64; CI: 0.61-0.67) and South Africa (aHR = 0.51; CI: 0.47-0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. CONCLUSION Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.
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Affiliation(s)
- Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Population Studies and Demography Programme and Population and Health Research Entity, North-West University, Mmabatho, South Africa.
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Martin Enock Palamuleni
- Population Studies and Demography Programme and Population and Health Research Entity, North-West University, Mmabatho, South Africa
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Silverstein RG, Fitz V, Thornton M, Carter A, Morse JE. Contraceptive use and counseling in patients with systemic lupus erythematosus. Contraception 2021; 105:46-50. [PMID: 34492256 DOI: 10.1016/j.contraception.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/04/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES (1) Describe contraception use in women with systemic lupus erythematosus (SLE); (2) characterize the types of contraception used by this population; (3) determine factors affecting the documentation of contraception use; (4) identify if contraception counseling was received in this population at risk for adverse pregnancy outcomes. STUDY DESIGN This cross-sectional study analyzed data from clinic visits from 2016 - 2018 among 453 women of reproductive age who have SLE. Documentation of contraception use, contraception method, contraception counseling, and other medication use were abstracted from the medical record and analyzed with percentage based statistics, chi-squared test, t-test, and logistic regression. RESULTS Of the 453 women included in the analysis, 71% had a method of contraception documented within 2 years of the study period. Only 37% were using highly effective contraception. 78% had documentation of contraception counseling. Half (50%) were using teratogenic medications; patients on teratogenic medications had higher odds of having a contraceptive method documented (OR 1.56, 95% CI 1.04 - 2.36) however 24% did not have any contraception documented. 28% of patients were using contraception for which they had a possible or absolute contraindication. CONCLUSIONS Given a substantial proportion of women with SLE did not have any contraception or contraceptive counseling documented, these findings suggest the need to improve universal reproductive health counseling in patients with SLE. IMPLICATIONS There is room to improve reproductive health care in patients with SLE through provider training to help optimize pregnancy outcomes in this high-risk population.
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Affiliation(s)
- R Gina Silverstein
- Department of OB/GYN, University of North Carolina Hospitals, Chapel Hill, NC, United States.
| | - Victoria Fitz
- Department of OB/GYN, University of North Carolina Hospitals, Chapel Hill, NC, United States
| | - Madeline Thornton
- Department of OB/GYN, University of North Carolina Hospitals, Chapel Hill, NC, United States
| | - Allison Carter
- Department of OB/GYN, University of North Carolina Hospitals, Chapel Hill, NC, United States
| | - Jessica E Morse
- Department of OB/GYN, University of North Carolina Hospitals, Chapel Hill, NC, United States
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Admassu M, Tegegne AS. Factors Affecting Contraceptive Use in Ethiopian: A Generalized Linear Mixed Effect Model. Ethiop J Health Sci 2021; 31:457-466. [PMID: 34483602 PMCID: PMC8365491 DOI: 10.4314/ejhs.v31i3.2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ethiopia is the second most populous nations in Africa. Family planning is a viable solution to control such fast-growing population. This study aimed to assess the prevalence of contraceptive use and its predictors in Ethiopia. Methods About 4,563 women were drawn randomly by Central Statistics Agency from its master sampling frame. The survey was conducted from January, 2014 to March, 2016 within six months' interval for the study period. The study was conducted using secondary data collected by PMA2020/Ethiopia project. Negative Binomial regression model was employed for data analysis. The model was selected using information criterion. Results Predictors like easy access of health service, residence area, level of health institutions, regions, availability of community health volunteers, experience sharing, support from husbands, level of education and employment status of women as well as residence area significantly affected the performance of contraceptive use in Ethiopia. From the interaction effects of health centers with region and health post with number of opening days per a week were significant predictors of the contraceptive use. Conclusion The performance of contraceptive use was different from one individual to another because of their experience sharing, support from their husbands, employment status and education level. A woman who got encouragement to use birth control from her husband had good performance to be effective for her contraceptive use. There should be an experience sharing/orientation, about use of birth control to protect women from unwanted pregnancy. Hence, rural women should get experience from urban women.
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Struffolino E, Zagel H. Limited detraditionalization of intimacy: Growing socioeconomic differences in contraceptive use at first intercourse in Italy. Adv Life Course Res 2021; 49:100416. [PMID: 36695121 DOI: 10.1016/j.alcr.2021.100416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 06/17/2023]
Abstract
This paper investigates links between social inequality and reproductive behavior. It complements the extensive research on the stratification of young adults' life chances in education and the labor market by considering changes over time in the stratification of contraceptive use at first intercourse by parental background. We seek to understand detraditionalization trends in young people's sexually intimate behavior by investigating whether these trends were driven by particular social groups and how they were supported by policy initiatives. We study Italy from 1950 to 2006, which shows strong regional and socioeconomic disparities, and comparatively slow changes in religiosity and gender norms. Data from the "Survey on Italians' Sexual Behavior" (2006) and macro indicators on family planning centers are used. The findings show a steep increase in contraceptive use at first sexual intercourse over time, stratified by parental background, but only for condom use. We did not find that family planning centers intervened in these relationships.
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Affiliation(s)
- Emanuela Struffolino
- Institute of Social Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Hannah Zagel
- Institute of Social Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
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Huber-Krum S, Rohr J, Kurutas S, Karadon D, Baykal SS, Okcuoglu BA, Esmer Y, Canning D, Shah I. Does cosmopolitan culture weaken ethnic and regional diversity: contraceptive behaviours of women in Istanbul, Turkey. EUR J CONTRACEP REPR 2021; 26:479-485. [PMID: 34420465 DOI: 10.1080/13625187.2021.1964466] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The primary aim of the study was to examine the relationship between self-reported ethnic identity, region of birth and contraceptive use, in Istanbul, Turkey. METHODS Cross-sectional data from a random sample of 3038 married women of reproductive age living in two urban districts of Istanbul were used in a series of logistic regression models to assess key relationships. RESULTS Kurdish ethnic minority women were less likely than Turkish ethnic majority women to use traditional contraceptive methods over no method (relative risk ratio [RRR] 0.69; 95% confidence interval [CI] 0.50, 0.96). However, there were no significant differences between ethnicities (i.e., Turkish, Kurdish and other) and modern method use. Among Turkish women, those born in regions farther away from the western region were more likely to use traditional methods (RRRnorthern 2.06; 95% CI 1.31, 3.22). CONCLUSION While Kurdish ethnic minority women were less likely to use traditional methods, compared with Turkish ethnic majority women, the difference might have been due to the length of time living in a neighbourhood. Regional variations in contraceptive use were concentrated only among Turkish ethnic majority women and for traditional methods. Regional norms of traditional method use may be a barrier to modern contraceptive use in Turkey.
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Affiliation(s)
- Sarah Huber-Krum
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julia Rohr
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sebahat Kurutas
- Department of Political Science and International Relations, Bahcesehir University, Istanbul, Turkey
| | - Duygu Karadon
- Department of Political Science and International Relations, Bahcesehir University, Istanbul, Turkey
| | - Simay Sevval Baykal
- Department of Political Science and International Relations, Bahcesehir University, Istanbul, Turkey
| | - Bahar Ayca Okcuoglu
- Department of Political Science and International Relations, Bahcesehir University, Istanbul, Turkey
| | - Yilmaz Esmer
- Department of Political Science and International Relations, Bahcesehir University, Istanbul, Turkey
| | - David Canning
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Iqbal Shah
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Ewerling F, McDougal L, Raj A, Ferreira LZ, Blumenberg C, Parmar D, Barros AJD. Modern contraceptive use among women in need of family planning in India: an analysis of the inequalities related to the mix of methods used. Reprod Health 2021; 18:173. [PMID: 34419083 PMCID: PMC8379729 DOI: 10.1186/s12978-021-01220-w] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level. METHODS Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities. RESULTS The majority (71.8%; 95% CI 71.4-72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1-25.2) in Manipur to 93.6% (95% CI 92.8-94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7-43.7) were sterilized before age 25, 61.5% (95% CI 61.0-62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3-21.3) were not informed that sterilization prevented future pregnancies. CONCLUSION Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.
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Affiliation(s)
- Fernanda Ewerling
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil.
- , Marechal Deodoro 1160, 3rd floor, Pelotas, RS, Brazil.
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Divya Parmar
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Aluisio J D Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
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Newmann SJ, Zakaras JM, Dworkin SL, Withers M, Ndunyu L, Gitome S, Gorrindo P, Bukusi EA, Rocca CH. Measuring Men's Gender Norm Beliefs Related to Contraception: Development of the Masculine Norms and Family Planning Acceptance Scale. Arch Sex Behav 2021; 50:2691-2702. [PMID: 33821378 PMCID: PMC8416878 DOI: 10.1007/s10508-021-01941-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Male partner resistance is identified as a key factor that influences women's contraceptive use. Examination of the masculine norms that shape men's resistance to contraception-and how to intervene on these norms-is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measure men's contraceptive acceptance-the Masculine Norms and Family Planning Acceptance (MNFPA) scale. We developed draft scale items based on qualitative research and administered them to partnered Kenyan men (n = 150). Item response theory-based methods were used to reduce and psychometrically evaluate final scale items. The MNFPA scale had a Cronbach's α of 0.68 and loaded onto a single factor. MNFPA scores were associated with self-efficacy and intention to accept a female partner's use of contraception; scores were not associated with current contraceptive use. The MNFPA scale is the first rigorously developed and psychometrically evaluated tool to assess men's contraceptive acceptance as a function of male gender norms. Future work is needed to test the MNFPA measure in larger samples and across different contexts. The scale can be used to evaluate interventions that seek to shift gender norms to increase men's positive engagement in pregnancy spacing and prevention.
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Affiliation(s)
- Sara J Newmann
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Unit 6D-14, San Francisco, CA, 94110, USA.
| | - Jennifer Monroe Zakaras
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Mellissa Withers
- University of Southern California Institute On Inequalities in Global Health, Los Angeles, CA, USA
| | - Louisa Ndunyu
- Kenya Medical Research Institute, Nairobi, Kenya
- The Department of Public Health, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Phillip Gorrindo
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, Oakland, CA, USA
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Rana MJ, Goli S. The road from ICPD to SDGs: Health returns of reducing the unmet need for family planning in India. Midwifery 2021; 103:103107. [PMID: 34358778 DOI: 10.1016/j.midw.2021.103107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/09/2019] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study attempts to estimate the impact of reducing the unmet need for family planning on the key maternal and child health indicators in India from 1993 to 2016, and projecting this for the period from 2016 to 2030. DATA AND METHODS The data have been compiled from various sources such as the United Nations' World Population prospects, national family health surveys and the sample registration system. The family planning and demographic projection modules of 'Spectrum', a modular computer simulation program, were used to estimate the impact of family planning programmes on reproductive, maternal and child health outcomes in India from 1993 to 2030. RESULTS Reduction of the unmet need for family planning averted approximately 56 million unintended pregnancies, 7 million unsafe abortions and 167,000 maternal deaths between 1993 and 2016. It is expected that an additional 41 million unintended pregnancies, 5 million unsafe abortions and 124,000 maternal deaths can be avoided by reducing the unmet need for family planning to 5% by 2030. Similarly, the declining unmet need for family planning between 1993 and 2016 led to a reduction in the pregnancy rate, abortion rate, and risk-adjusted infant and under-five mortality rates by 27 per 1000 married women, 1.8 per million married women, 10 per 1000 live births and 15 per 1000 live births, respectively. It is expected that approximately 24 pregnancies per 1000 married women, 1.6 abortions per million married women, 10 risk adjusted infant deaths per 1000 live births, and 14 under-five deaths per 1000 live births can be avoided by reducing the unmet need for family planning to 5% by 2030. CONCLUSIONS The findings of this study advocate that family planning is one of the best return on-investment strategies for India to achieve several targets under the reproductive, maternal and child health-related sustainable development goals.
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Affiliation(s)
- Md Juel Rana
- International Institute for Population Sciences, Govandi Station Road Deonar, Mumbai 400088, India; Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
| | - Srinivas Goli
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India; UWA Public Policy Institute and Australia India Institute, University of Western Australia, Crawley WA, Australia
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Dixit A, Johns NE, Ghule M, Battala M, Begum S, Yore J, Saggurti N, Silverman JG, Reed E, Benmarhnia T, Averbach S, Raj A. Male-female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India. Reprod Health 2021; 18:139. [PMID: 34193214 PMCID: PMC8244175 DOI: 10.1186/s12978-021-01187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Women's involvement in contraceptive decision-making increases contraceptive use and reduces unmet need, but study of this has been limited to women's self-reports. Less research is available examining couple concordance and women's involvement in contraceptive decision-making as reported by both men and women. STUDY DESIGN We carried out a cross-sectional study using data from rural India (N = 961 young married couples). Using multivariable regression we examined the association between concordance or discordance in spousal reports of wife's involvement in contraceptive decision-making and modern contraceptive use, adjusting for demographics, intimate partner violence, and contraceptive use discussion. RESULTS More than one third (38.3%) of women reported current modern contraceptive use. Report of women's involvement in contraceptive decision-making showed 70.3% of couples agreed that women were involved, jointly or alone (categorized as Concordant 1), 4.2% agreed women were not involved (categorized at Concordant 2), 13.2% had women report involvement but men report women were uninvolved (categorized as Discordant 1), and 12.2% had women report uninvolvement but men report that women were involved (categorized as Discordant 2). Discordant 2 couples had lower odds of modern contraceptive use relative to Concordant 1 couples (adjusted RR = 0.61, 95% CI 0.45-0.83). No other significant differences between Concordant 1 couples and other categories were observed. CONCLUSION One in four couples indicated discordance on women's involvement in contraceptive decision making, with Discordant 2 category having lower odds of contraceptive use. Couples' concordance in women's involvement in contraceptive decision-making offers a target for family planning research and interventions to better meet their needs. Trial registration ClinicalTrial.gov, NCT03514914. https://clinicaltrials.gov/ct2/show/NCT03514914.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA. .,Joint Doctoral Program in Public Health (Global Health Track), University of California San Diego/San Diego State University, San Diego, USA.
| | - Nicole E Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | | | - Jay G Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | - Elizabeth Reed
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA.,Division of Health Promotion and Behavior, San Diego State University, San Diego, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, USA.,Scripps Institution of Oceanography, University of California, San Diego, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, La Jolla, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA.,Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
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Hussain R, Kavanaugh ML. Changes in use of emergency contraceptive pills in the United States from 2008 to 2015. Contracept X 2021; 3:100065. [PMID: 34136798 PMCID: PMC8176291 DOI: 10.1016/j.conx.2021.100065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/30/2020] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe changes in use and receipt of emergency contraceptive (EC) pills among women in the United States during a period of key EC policy changes, from 2008 to 2015. STUDY DESIGN Using data from the 2006 to 2010 and 2013 to 2017 National Surveys of Family Growth, we present changes in the percent of women who ever used EC between 2008 and 2015 by select sociodemographic and sexual and reproductive health characteristics, and we examine multivariable relationships of these characteristics with EC ever use in 2015. We also examine changes in repeat EC use, receipt of EC counseling, reasons for EC use and source of EC between the time periods. RESULTS Among sexually experienced women ages 15 to 44, EC ever use increased from 11% in 2008 to 23% in 2015 overall and among nearly all groups of women. In 2015, age 20 to 29, non-Hispanic other or Hispanic race, at least a high school education, working part-time, income at least 100% of the federal poverty level, ever having been married, and having received EC counseling in the prior year all represent characteristics associated with higher odds of having ever used EC. In 2015, a smaller share of women last obtained EC with a prescription or at a health facility than in 2008. CONCLUSIONS Increases in EC use occurred as access to EC was broadened through regulatory changes that moved some forms of EC from behind-the-counter to fully over-the-counter between 2008 and 2015. IMPLICATIONS Over-the-counter provision of many forms of EC pills may have increased access and introduced more flexibility in how EC is obtained, but these changes may have come with tradeoffs, both in the form of cost barriers and decreased opportunities for clinicians to discuss EC with their patients. Despite improved access to contraception more broadly through the Affordable Care Act, EC remains a necessary component of the overall contraceptive method mix, and clinicians can play a key role in discussing EC as one option among many during contraceptive counseling sessions.
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Abstract
Infertility and unintended pregnancy are dual burdens in Malawi, where 41% of pregnancies are unintended and approximately 20% of people report infertility. Although preventing unintended pregnancy has been a focus in public health, infertility has rarely been explored as a factor that may be associated with contraceptive use. Using cross-sectional survey data (2017-2018; N = 749), we report on the prevalence of and sociodemographic characteristics associated with infertility and certainty of becoming pregnant among women in Malawi. We conducted multivariable logistic regressions examining the relationship between infertility, certainty of becoming pregnant, and contraceptive use. Approximately 16% of women experienced infertility, and three-quarters (78%) were certain they could become pregnant within one year. Women who experienced infertility had lower odds of contraceptive use than women who did not (Adjusted Odds Ratio [AOR]: 0.56; 95% Conficence Interval [CI]: 0.39-0.83). Women who said there was "no chance" or they were "unlikely" to become pregnant also had lower odds of contraceptive use compared to women who were certain they would become pregnant (AOR: 0.30; 95% CI: 0.10-0.92). Our findings indicate that experiences and perceptions surrounding fertility are associated with contraceptive use, underscoring their importance in understanding how people manage their fertility to reach their reproductive goals.
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Affiliation(s)
- Marta Bornstein
- Marta Bornstein, Jessica D. Gipson, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,California Center for Population Research, University of California, Los Angeles, CA, USA
| | - Sarah Huber-Krum
- Sarah Huber-Krum, Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alison H Norris
- Alison H. Norris, College of Public Health and College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jessica D Gipson
- Marta Bornstein, Jessica D. Gipson, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,California Center for Population Research, University of California, Los Angeles, CA, USA
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Lindberg LD, Firestein L, Beavin C. Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019. Contracept X 2021; 3:100064. [PMID: 33997764 PMCID: PMC8102179 DOI: 10.1016/j.conx.2021.100064] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 08/19/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study examines changes over time in the prevalence of select sexual behaviors and contraceptive use measures in a national sample of U.S. adolescents. STUDY DESIGN We used data on adolescents aged 15-19 from the 2006-2010 (n=4,662), 2011-2015 (n=4,134), and 2015-2019 (n=3,182) National Surveys of Family Growth. We used logistic regression to identify changes between periods in sexual behaviors and contraceptive use by gender, and for some measures by age. We estimated probabilities of age at first penile-vaginal intercourse with Kaplan-Meier failure analysis. RESULTS Over half of adolescents have engaged in at least one of the sexual behaviors measured. Males reported declines in sexual behaviors with a partner of a different sex. Adolescent males reported delays in the timing of first penile-vaginal intercourse. Adolescent females reported increases from 2006-2010 to 2015-2019 in use at last intercourse of any contraceptive method (86%, 95%CI 83-89; 91%, 95%CI 88-94), multiple methods (26%, 95%CI 22-31; 36%, 95%CI 30-43), and IUDs or implants (3%, 95%CI 1-4; 15%, 95%CI 11-20). Adolescent males reported increases in partners' use of IUDs or implants use from <1% to 5% and recent declines in condom use at last intercourse (78%, 95%CI 75-82, 2011-2015; 72%, 95%CI 67-77, 2015-2019). Condom consistency declined over time. Males were more likely than females to report condom use at last intercourse and consistent condom use in the last 12 months. CONCLUSIONS These findings identify declines in male adolescent sexual experience, increased contraceptive use overall, and declines in consistent condom use from 2006 to 2019. IMPLICATIONS This analysis contributes a timely update on adolescent sexual behavior trends and contraceptive use, showing that adolescent behaviors are complex and evolving. Sexual health information and services must be available so that young people have the resources to make healthy and responsible choices for themselves and their partners.
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Affiliation(s)
| | - Lauren Firestein
- Formerly with the Guttmacher Institute, New York, NY, United States
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Humphrey KN, Horn PS, Olshavsky L, Reebals L, Standridge SM. Features of Menstruation and Menstruation Management in Individuals with Rett Syndrome. J Pediatr Adolesc Gynecol 2021; 34:144-153. [PMID: 33186698 DOI: 10.1016/j.jpag.2020.11.002] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE To describe features of menstruation, menstrual-related symptoms, and menstrual management in females with Rett syndrome (RTT) to help develop a clinical approach to these parameters in RTT. DESIGN Retrospective cross-sectional chart review and prospective survey. SETTING Cincinnati Children's Hospital Medical Center, Rett Syndrome and Related Spectrum Disorders Clinic. PARTICIPANTS Females with RTT (12-55 years of age) and their caregivers. MAIN OUTCOME MEASURES Descriptive data on features of menstruation and menstrual-related symptoms in individuals with Rett syndrome; prevalence, types, reason for use/discontinuation, and efficacy of hormonal treatment in females with RTT. RESULTS Age at menarche, menstrual cycle length, and menstrual period length in females with RTT are comparable to those in typically developing females and females with other neurodevelopmental disabilities. Dysmenorrhea and emotional lability are common menstrual cycle-related changes among females with RTT; 22.1% of participants also reported catamenial seizures. Oral progestin, combined oral contraceptive pill, and depot-medroxyprogesterone acetate (DMPA) were effectively used to suppress or regulate menstruation and to manage menstrual-related symptoms. CONCLUSIONS Characteristics of menstruation in females with RTT are comparable to those of typically developing females, with the exception of increase in catamenial seizure activity. Hormonal treatments are used for management of menstruation, dysmenorrhea, and seizures. Choice of hormonal treatment is influenced by bone health and immobility in females with RTT.
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Affiliation(s)
| | - Paul S Horn
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Lisa Reebals
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shannon M Standridge
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Bula AK, Hatfield-Timajchy K, Chapola J, Chinula L, Hurst SA, Kourtis AP, Tang JH. Motivations to use hormonal contraceptive methods and condoms among HIV-positive and negative women randomized to a progestin contraceptive in Malawi: a qualitative study. BMC Womens Health 2021; 21:114. [PMID: 33743659 PMCID: PMC7981805 DOI: 10.1186/s12905-021-01236-1] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although many countries have been promoting hormonal contraceptives to prevent unintended pregnancy and condom use to prevent HIV transmission, little is known about how women targeted by these messages have interpreted and internalized them. We describe HIV-positive and negative women's understanding of the benefits of contraception and condoms and their motivations to use them. METHODS This is a qualitative sub-study from a clinical trial evaluating the effects of progestin contraception on HIV-positive and negative women aged 18-45 years randomly assigned to depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant. We purposively recruited 41 women to participate in in-depth interviews (IDIs) and focus group discussions (FGDs) after randomization into the main study. We conducted a total of 30 IDIs and 6 FGDs comprised of 4-7 women (N = 32). All women were counselled about potential risks for HIV acquisition/transmission with progestin-only contraception, drug-drug interactions between the implant and efavirenz-based ART, and the need to use condoms with their assigned contraceptive to help prevent pregnancy and HIV acquisition and transmission. RESULTS All women understood that HIV is transmitted through unprotected sex and that HIV transmission can be prevented through condom use but not DMPA injection or LNG implant use. Nearly all HIV-positive women knew or suspected that their partners were also HIV-positive and were most interested in using condoms to prevent infection with a drug-resistant HIV strain to keep their HIV viral load low. Almost all reported that their partners agreed to condom use, but few used them consistently. Most women believed that condoms were effective at preventing both HIV and pregnancy if used consistently. Nearly all women considered contraception and condom use as important in preventing unintended pregnancy and HIV because partner disclosure of HIV status is low. CONCLUSION Our results showed that both HIV-positive and negative women understood modes of HIV transmission and prevention and were aware that hormonal contraceptives are only effective for preventing pregnancy and not HIV. Although both HIV-negative and positive women were motivated to use condoms to prevent both HIV acquisition and infection with other HIV strains respectively, they all faced challenges from their partners in using condoms consistently.
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Affiliation(s)
- Agatha K Bula
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.
| | | | - John Chapola
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - L Chinula
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.,Department of OB-GYN, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Stacey A Hurst
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Athena P Kourtis
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J H Tang
- Department of OB-GYN, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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