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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 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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Das L, Shekhar C. Contraceptive behavior of women in India after induced abortion. Reprod Health 2024; 21:60. [PMID: 38693522 PMCID: PMC11064373 DOI: 10.1186/s12978-024-01802-4] [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: 06/21/2023] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.
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Affiliation(s)
- Labhita Das
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Chander Shekhar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
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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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Mann ES, Bertotti AM. The biomedicalization of pregnancy prevention, neoliberal feminism, and college women's experiences of the contraceptive paradox. Soc Sci Med 2024; 348:116825. [PMID: 38569286 DOI: 10.1016/j.socscimed.2024.116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/10/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
Research examining the "contraceptive paradox" has illuminated how contraception can be a source of empowerment for some and oppression for others. This study advances theorizing of the contraceptive paradox by illustrating how 45 young women experience contraception as both liberating and constraining due to a confluence of biomedicalization processes, gender inequality, and neoliberal feminism. Drawing on focus group data, we find that the biomedicalization of pregnancy prevention and neoliberal feminist discourse, in combination with experiences of social and economic privilege and gender inequality in fertility work, shape participants' interpretation of contraceptive technology as a key resource for individually liberating themselves from undesired pregnancy. At the same time, their experiences indicate prescription contraception plays an oppressive role in their lives. In addition to blaming themselves and their bodies for negative contraceptive side effects, participants take for granted that assuming sole responsibility for contraceptive use in their relationships with men is the price they must pay to feel free. The findings indicate that addressing a social problem using an individualized biomedical solution obscures the power that structural inequalities exert over pregnancy-capable people, including relatively privileged young women. As an expression of biopower, these dynamics prompted participants to emphasize distributive justice over social justice, foreclosing their engagement in collective action.
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Affiliation(s)
- Emily S Mann
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; Department of Women's and Gender Studies, University of South Carolina, Columbia, SC 29208, USA.
| | - Andrea M Bertotti
- Department of Sociology and Criminology, Gonzaga University, Spokane, WA 99258, USA
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O'Hara CA, Shan TW, Yau JNS. Knowledge of non-contraceptive benefits of and willingness to consider taking oral contraceptive pills among a low-risk female population: a cross-sectional study. EUR J CONTRACEP REPR 2024; 29:53-60. [PMID: 38284986 DOI: 10.1080/13625187.2023.2300944] [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: 10/17/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND In addition to its widely-appreciated contraceptive applications, the oral contraceptive pill (OCP) conveys both oncological and non-oncological benefits. Oncological benefits include a decreased risk of endometrial, ovarian, and colorectal cancer. Non-oncological benefits include reducing androgenic effects and alleviating menstruation-related problems. This study aimed to ascertain knowledge levels of non-contraceptive benefits and risks of OCP use among participants without contraindications to OCPs. This study also assessed factors associated with participants being more likely to consider taking OCPs. METHODS 263 women aged 21 to 40 years old with no contraindications for OCP usage participated in this study. An anonymous questionnaire collected sociodemographic information and assessed participants' knowledge of the non-contraceptive benefits and risks associated with OCP use. Multivariate linear regression was used to assess factors associated with knowledge levels. Multivariate logistic regression was used to investigate factors associated with being more likely to consider taking OCPs among women who did not presently take them. RESULTS Multivariate logistic regression revealed that participants who were more knowledgeable overall about the non-contraceptive benefits of OCPs were more likely to consider taking OCPs (coefficient = 0.184, p-value = 0.00). Knowledge of both oncological and non-oncological benefits of OCP use was relatively poor, especially among older women. Current OCP users were found to be more knowledgeable about their benefits. CONCLUSIONS As women with greater knowledge of non-contraceptive benefits of OCPs are more likely to consider taking them, knowledge gaps regarding OCPs should be filled, so that more women may reap the non-contraceptive benefits of OCPs.
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Affiliation(s)
| | - Teoh Wei Shan
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - Joseph Ng Soon Yau
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
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Kvalem IL, Dahr Nygaard IM, Træen B, Ivanova A, Dahlgren CL. Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness. Womens Health (Lond) 2024; 20:17455057241249553. [PMID: 38682834 PMCID: PMC11060024 DOI: 10.1177/17455057241249553] [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: 08/25/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being. OBJECTIVES This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness. STUDY DESIGN A cross-sectional online survey. METHOD A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates. RESULTS Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image. CONCLUSION Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.
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Affiliation(s)
| | | | - Bente Træen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Anna Ivanova
- Department of Psychology, University of Oslo, Oslo, Norway
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Manze MG, Srinivasulu S, Jones HE. Patient perspectives of using reproductive autonomy to measure quality of care: a qualitative study. BMC Womens Health 2023; 23:647. [PMID: 38049782 PMCID: PMC10696671 DOI: 10.1186/s12905-023-02804-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Current measures of reproductive health care quality, such as rates of "unintended" pregnancies, neglect to incorporate patients' desires and center their reproductive autonomy. This study explores patients' perspectives on and receptivity to alternative metrics for measuring quality of such care. METHODS An online research recruitment firm identified eligible participants living in New York, ages 18-45, self-identifying as women, and having visited a primary care provider in the last year. We conducted five virtual focus groups and eight in-depth interviews with participants (N = 30) in 2021. Semi-structured guides queried on ideal clinic interactions when preventing or attempting pregnancy and their perspectives on how to measure the quality of such encounters, including receptivity to using our definition of reproductive autonomy to develop one such metric: "whether the patient got the reproductive health service or counseling that they wanted to get, while having all the information about and access to their options, and not feeling forced into anything." We employed an inductive thematic analysis. RESULTS Participants wanted care that was non-judgmental, respectful, and responsive to their needs and preferences. For pregnancy prevention, many preferred unbiased information about contraceptive options to help make their own decisions. For pregnancy, many desired comprehensive information and more provider support. There was considerable support for using reproductive autonomy to measure quality of care. CONCLUSIONS Patients had distinct desires in their preferred approach to discussions about preventing versus attempting pregnancy. Quality of reproductive health care should be measured from the patient's perspective. Given participants' demonstrated support, future research is needed to develop and test a new metric that assesses patients' perceptions of reproductive autonomy during clinical encounters.
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Affiliation(s)
- Meredith G Manze
- City University of New York, Graduate School of Public Health & Health Policy, 55 W 125th Street, New York, NY, 10027, USA.
| | - Silpa Srinivasulu
- City University of New York, Graduate School of Public Health & Health Policy, 55 W 125th Street, New York, NY, 10027, USA
| | - Heidi E Jones
- City University of New York, Graduate School of Public Health & Health Policy, 55 W 125th Street, New York, NY, 10027, USA
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Jackson TE, Graveline VL, Murphy AM, Rodericks ES. 'That just sounds bizarre': factors affecting heterosexual college students' perceptions of new sperm-targeting contraceptives. Cult Health Sex 2023; 25:1498-1514. [PMID: 36602875 DOI: 10.1080/13691058.2022.2162972] [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: 07/13/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
Contraceptive responsibility has historically fallen on women in the context of heterosexual relationships, often resulting in a perceived burden on their emotional and reproductive health. We conducted in-depth, individual interviews with women and men in college to investigate factors influencing the choices they make regarding contraceptive use and more specifically their perceptions and willingness to try new sperm-targeting contraceptives. Thematic analysis revealed factors at a societal, interpersonal, and individual level affecting participants' perceptions and imagined decisions. Societally, a perceived gendered divide continues to exist placing primary responsibility for contraceptive use on women. Interpersonally, the context of a relationship increased partners' feelings of empathy and willingness to try alternative contraceptive methods; and individually participants remained concerned about their own sexual and reproductive safety. Findings indicate that societal level norms need to be shifted towards the acceptability of sperm-targeting contraceptives or other versions of contraceptives that act on male bodies, in addition to a greater focus on their development. It is proposed that this would help to ease the continued undue burden placed on women for reproductive health.
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Affiliation(s)
- Theresa E Jackson
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | - Valerie L Graveline
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | - Alicia M Murphy
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
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Yang L, Allen RH, Catherine Cambou M, Nielsen-Saines K, Brown BP. Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners. J Midwifery Womens Health 2023; 68:719-727. [PMID: 37903728 PMCID: PMC10872909 DOI: 10.1111/jmwh.13575] [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] [Revised: 08/13/2023] [Indexed: 11/01/2023]
Abstract
People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug-drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best-practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.
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Affiliation(s)
- Lanbo Yang
- Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rebecca H. Allen
- Department of Obstetrics and Gynecology, Women and Infants Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary Catherine Cambou
- Division of Infectious Diseases, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Benjamin P. Brown
- Department of Obstetrics and Gynecology, Women and Infants Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Calhoun LM, Mandal M, Onyango B, Waga E, McGuire C, van den Akker T, Beňová L, Delvaux T, Zulu EM, Speizer IS. "So let me give you money, you give me what I want": decision-making priorities around contraceptive method and source choice among young women in Kenya. Reprod Health 2023; 20:96. [PMID: 37365630 PMCID: PMC10294346 DOI: 10.1186/s12978-023-01641-9] [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: 10/30/2022] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Many factors influence young women's choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya. METHODS In August-September 2019, 30 in-depth interviews were conducted with women ages 18-24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically. RESULTS The majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method. CONCLUSIONS This study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women's needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care.
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Affiliation(s)
- Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
| | | | - Erick Waga
- African Institute for Development Policy, Nairobi, Kenya
| | - Courtney McGuire
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eliya M. Zulu
- African Institute for Development Policy, Nairobi, Kenya
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Bornstein M, Huber-Krum S, Gipson JD, Norris AH. Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi. Stud Fam Plann 2023; 54:63-74. [PMID: 36721055 PMCID: PMC10913817 DOI: 10.1111/sifp.12223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contraceptive counseling protocols tend to focus narrowly on pregnancy intentions, which may overlook other factors that contribute to whether an individual wants or needs contraception. In this report, we demonstrate the potential of two measures of individual contraceptive need that could be assessed as part of contraceptive counseling: (1) a composite score constructed from pregnancy intentions, sexual frequency, and perceived fecundity and (2) a direct measure of contraceptive need ("do you feel it is necessary for you to be using contraception right now?") We compare the two measures using data from Umoyo wa Thanzi, a cohort study in Central Malawi (N = 906; 2017-2018). More frequent sex, perceptions of being more fecund, and a stronger desire to avoid pregnancy were associated with directly reporting contraceptive need (p < 0.001). Women who directly reported contraceptive need had a higher average composite score than women who directly reported they had no need (mean = 7.4 vs. 6.3; p < 0.01), but nearly all participants had scores indicating some risk of unintended pregnancy. Contraceptive counseling protocols should consider assessing women's direct report of contraceptive need, along with risk factors for unintended pregnancy, such as sexual frequency, perceived fecundity, and desire to avoid pregnancy, to better counsel clients.
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Affiliation(s)
- Marta Bornstein
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Sarah Huber-Krum
- The Ohio State University College of Social Work, Columbus, OH, USA
| | | | - Alison H Norris
- The Ohio State University College of Public Health, Columbus, OH, USA
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12
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Stevens R, Machiyama K, Mavodza CV, Doyle AM. Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. Stud Fam Plann 2023; 54:309-321. [PMID: 36753058 DOI: 10.1111/sifp.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.
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Affiliation(s)
- Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Kazuyo Machiyama
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Department of Public Health and Policy, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Simmons RG, Baayd J, Waters M, Diener Z, Turok DK, Sanders JN. Assessing contraceptive use as a continuum: outcomes of a qualitative assessment of the contraceptive journey. Reprod Health 2023; 20:33. [PMID: 36793112 PMCID: PMC9930211 DOI: 10.1186/s12978-023-01573-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Contraceptive use is often a multi-decade experience for people who can become pregnant, yet few studies have assessed how this ongoing process impacts contraceptive decision-making in the context of the reproductive life course. METHODS We conducted in-depth interviews assessing the contraceptive journeys of 33 reproductive-aged people who had previously received no-cost contraception through a contraceptive initiative in Utah. We coded these interviews using modified grounded theory. RESULTS A person's contraceptive journey occurred in four phases: identification of need, method initiation, method use, and method discontinuation. Within these phases, there were five main areas of decisional influence: physiological factors, values, experiences, circumstances, and relationships. Participant stories demonstrated the ongoing and complex process of navigating contraception across these ever-changing aspects. Individuals stressed the lack of any "right" method of contraception in decision-making and advised healthcare providers to approach contraceptive conversations and provision from positions of method neutrality and whole-person perspectives. CONCLUSIONS Contraception is a unique health intervention that requires ongoing decision-making without a particular "right" answer. As such, change over time is normal, more method options are needed, and contraceptive counseling should account for a person's contraceptive journey.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Megan Waters
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Zoë Diener
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jessica N. Sanders
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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Thornton M, Ascha MS, Arora KS. Addressing fluidity in contraceptive decision-making: a key component of patient-centered contraceptive counseling. Am J Obstet Gynecol 2022; 227:99-100. [PMID: 35248572 DOI: 10.1016/j.ajog.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Madeline Thornton
- Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, NC
| | | | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina Hospitals, 101 Manning Dr., Chapel Hill, NC 27514.
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Mutumba M. Mass media influences on family planning knowledge, attitudes and method choice among sexually active men in sub-Saharan Africa. PLoS One 2022; 17:e0261068. [PMID: 35085245 PMCID: PMC8794141 DOI: 10.1371/journal.pone.0261068] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
Men are underrepresented in family planning (FP) research, and despite the widespread promotion of FP through mass media, there is no systematic evaluation on how mass media exposure influences their FP knowledge, attitudes and behavior. Using Demographic and Health Survey (DHS) data from 31 countries in Sub-Saharan Africa (SSA), collected between 2010 and 2019, this paper examines the associations between three types of traditional mass media (radio, television and print) with FP knowledge, attitudes and method choices among reproductive age men in SSA, relative to other socio-cultural factors. Estimates to quantify the relative contribution of each type of mass media, relative to other evidence-based socio-cultural influences on FP outcomes, were derived using the Shorrocks-Shapley decomposition. Radio exposure had the largest impact on FP knowledge, attitudes and method choice, accounting for 26.1% of the variance in FP knowledge, followed by Television (21.4%) and education attainment (20.7%). Mass media exposure had relatively minimal impact on FP method choice, and between the three types of mass media, television (8%) had the largest influence on FP method choice. Print media had comparatively lesser impact on FP knowledge (8%), attitudes (6.2%) and method choice (3.2%). Findings suggest that mass media exposure has positive influences on FP knowledge, attitudes and method choice but its influence on FP knowledge, attitudes and method choice is smaller relative to other socio-cultural factors such as education, household wealth and marital status. As such, efforts to increase FP uptake in Sub-Saharan Africa should take into consideration the impact of these socio-cultural economic factors.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
- * E-mail:
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16
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Shagaro SS, Gebabo TF, Mulugeta BT. Four out of ten married women utilized modern contraceptive method in Ethiopia: A Multilevel analysis of the 2019 Ethiopia mini demographic and health survey. PLoS One 2022; 17:e0262431. [PMID: 35030213 PMCID: PMC8759669 DOI: 10.1371/journal.pone.0262431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background
Modern contraceptive method is a product or medical procedure that interferes with reproduction from acts of sexual intercourse. Globally in 2019, 44% of women of reproductive age were using a modern method of contraception but it was 29% in sub-Saharan Africa. Therefore, the main aim of this analysis was to assess the prevalence of modern contraceptive utilization and associated factors among married women in Ethiopia.
Method
The current study used the 2019 Ethiopia mini demographic and health survey dataset. Both descriptive and multilevel mixed-effect logistic regression analysis were done using STATA version 14. A p-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were used to report statistically significant factors with modern contraceptive utilization.
Result
The overall modern contraceptive utilization among married women in Ethiopia was 38.7% (95% CI: 37.3% to 40.0%). Among the modern contraceptive methods, injectables were the most widely utilized modern contraceptive method (22.82%) followed by implants (9.65%) and pills (2.71%). Maternal age, educational level, wealth index, number of living children, number of births in the last three years, number of under 5 children in the household, religion, and geographic region were independent predictors of modern contraceptive utilization.
Conclusion
In the current study only four out of ten married non-pregnant women of reproductive age utilized modern contraceptive methods. Furthermore, the study has identified both individual and community-level factors that can affect the utilization of modern contraceptive methods by married women in the country. Therefore, concerned bodies need to improve access to reproductive health services, empower women through community-based approaches, and minimize region wise discrepancy to optimize the utilization.
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Affiliation(s)
- Sewunet Sako Shagaro
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Teshale Fikadu Gebabo
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Be’emnet Tekabe Mulugeta
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Yeshaneh A, Lencha A, Aweke AM, Dessalew Y, Wale T, Mekuriya E, Abdulahi T, Workineh A, Yitayew M, Dinku H, Asfaw G. Consistent condom utilization and associated factors among HIV positive clients attending ART clinic at Pawi general hospital, North West Ethiopia. PLoS One 2021; 16:e0261581. [PMID: 34932611 PMCID: PMC8691638 DOI: 10.1371/journal.pone.0261581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020. Methods An institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. Results A total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2–56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization. Conclusion Consistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.
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Affiliation(s)
- Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Adugna Lencha
- Department of Midwifery, Institute of health science, Pawi Health Science College, Pawi, Ethiopia
| | - Amlaku Mulat Aweke
- Department of Midwifery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
| | - Yaregal Dessalew
- Department of Midwifery, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| | - Tegegne Wale
- Department of Midwifery, College of Medicine and Health Science, Debretabor University, Debretabor, Ethiopia
| | - Esubalew Mekuriya
- Department of Midwifery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
| | - Temkin Abdulahi
- Department of Midwifery, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| | - Alemu Workineh
- Department of Reproductive Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Meseret Yitayew
- Department of Nursing, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| | - Hirut Dinku
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Genet Asfaw
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Kayi EA, Biney AAE, Dodoo ND, Ofori CAE, Dodoo FNA. Women's post-abortion contraceptive use: Are predictors the same for immediate and future uptake of contraception? Evidence from Ghana. PLoS One 2021; 16:e0261005. [PMID: 34932576 PMCID: PMC8691597 DOI: 10.1371/journal.pone.0261005] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
This study seeks to identify the socio-demographic, reproductive, partner-related, and facility-level characteristics associated with women’s immediate and subsequent use of post-abortion contraception in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were utilized in this study. The weighted data comprised 1,880 women who had ever had an abortion within the five years preceding the survey. Binary logistic regression analyses were performed to examine the associations between the predictor and outcome variables. Health provider and women’s socio-demographic characteristics were significantly associated with women’s use of post-abortion contraception. Health provider’s counselling on family planning prior to or after abortion and place of residence were associated with both immediate and subsequent post-abortion uptake of contraception. Among subsequent post-abortion contraceptive users, older women (35–49), women in a union, and women who had used contraception prior to becoming pregnant were strong predictors. Partner-related and reproductive variables did not predict immediate and subsequent use of contraception following abortion. Individual and structural/institutional level characteristics are important in increasing women’s acceptance and use of contraception post abortion. Improving and intensifying family planning counselling services at the health facility is critical in increasing contraceptive prevalence among abortion seekers.
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Affiliation(s)
- Esinam Afi Kayi
- Department of Adult Education and Human Resource Studies, School of Continuing and Distance Education, University of Ghana, Legon, Ghana
- * E-mail:
| | | | - Naa Dodua Dodoo
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | | | - Francis Nii-Amoo Dodoo
- Department of Sociology, Pennsylvania State University, State College, Pennsylvania, United States of America
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Merga J, Wirtu D, Bekuma TT, Regasa MT. Unintended pregnancy and the factors among currently pregnant married youths in Western Oromia, Ethiopia: A mixed method. PLoS One 2021; 16:e0259262. [PMID: 34735534 PMCID: PMC8568197 DOI: 10.1371/journal.pone.0259262] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unintended pregnancy is a global concern affecting both developed and developing countries. Some young women who had unintended pregnancies obtain an abortion while others carry their pregnancies to term, incurring the risk of morbidity and mortality higher than those for adult women. Despite the availability of highly effective methods of contraception, different studies in Ethiopia revealed that there is a high level of unintended pregnancy. OBJECTIVE To assess the magnitude of unintended pregnancy and associated factors among currently pregnant married youths in Kiremu district. METHODS A community-based cross-sectional study was conducted among currently pregnant married 15-24 years women. Multi-stage stratified sampling technique was used to select 434 study units. Ten kebeles were randomly selected and samples were selected from each of ten kebeles by simple random sampling using kebeles household identification numbers as the sampling frame. Quantitative data was entered with SPSS version 20 and crude and adjusted odds ratio together with their 95%CI were computed and interpreted accordingly. A p-value<0.05 was considered to declare a result as statistically significant in this study. In-depth interviews and transcripts of the recorded discussions were coded and analyzed thematically. The results were finally presented in texts, tables, and graphs. RESULT Unintended pregnancies among currently pregnant married young women in the study area were 31.1%. Educational status (AOR = 3.195,95%CI = 1.757,5.811),being Gov't employee (AOR = 0.039, 95% CI = 0.002,0.988), ever heard contraceptives(AOR = 0.260, 95%CI = 0.077, 0.876), ever used contraceptives (AOR = 0.348,95%CI = 0.168,0.717),discussion about contraceptives with husband(AOR = 0.027,95%CI = 0.015, 0.050),fear of side effect of contraceptives (AOR = 5.819,95% CI = 1.438,23.422), autonomy on health (AOR = 0.122,95%CI = 0.035,0.431), age at first marriage (AOR = 3.195, 95%CI = 1.757,5.811), age first pregnancy(AOR = 23.660,95%CI = 12.573,44.522), being visited by health care providers (AOR = 0.202,95%CI = 0.073,0.566) and average birth interval (AOR = 3.472,95%CI = 1.392,8.61) were the factors associated with unintended pregnancy. CONCLUSION AND RECOMMENDATION Significant proportion of women had an unintended pregnancy in the study area. Therefore, emphasis should be given to married youths especially on women empowerment, encouraging partner discussions, and providing appropriate counseling on contraceptive side effects by giving due attention to those marred at younger ages (<18 years).
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Affiliation(s)
- Jaleta Merga
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Desalegn Wirtu
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tariku Tesfaye Bekuma
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- * E-mail:
| | - Misganu Teshoma Regasa
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Lun CN, Aung T, Mya KS. Utilization of modern contraceptive methods and its determinants among youth in Myanmar: Analysis of Myanmar Demographic and Health Survey (2015-2016). PLoS One 2021; 16:e0258142. [PMID: 34614023 PMCID: PMC8494330 DOI: 10.1371/journal.pone.0258142] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Abstract
Reproductive health service is crucial for youth to reduce maternal and child mortality. However, many young women face unintended pregnancies and pregnancy-related complications due to insufficient knowledge of contraceptive methods and low contraceptive utilization. This study aims to assess the modern contraceptive prevalence rates among youth and identify factors influencing modern contraceptive utilization among youth. We used Myanmar Demographic and Health Survey (2015-2016) data. This study included 1,423 men and 3,677 women aged 15-24 years from all states and regions of Myanmar. We used multivariable binary logistic regression analysis and reported the results using adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). Data analysis was done by STATA software (version 15.1). Ever-married youth used mainly injectable contraception, followed by oral contraceptive pills. Never-married male youth mainly used oral contraceptive pills; however, almost all never-married female youth did not use contraception. The modern contraceptive prevalence rates were 14.9% among total youth, 10% among males, 16.8% among females, 1.5% among never-married males, 44.7% among ever-married males, and 54% among ever-married female youth. The knowledge on modern contraceptive methods favored the utilization. Sexually active youth utilized more contraception than sexually inactive youth. We also found geographical variation and low utilization among rural youth. The desire for more children was also a significant predictor of contraceptive utilization among married youth. The utilization of modern contraception was low among Myanmar youth. Reproductive health program needs to be emphasized on the youth population especially in the area with low utilization to have equitable access to quality reproductive health services. Moreover, the revitalization of Youth Information Corner and youth-friendly reproductive health education programs should be implemented to increase reproductive health knowledge and prevent unsafe sex, unintended pregnancies, and abortions which might help in reducing maternal and child mortality. We warranted conducting mixed method studies to explore the barriers and challenges of contraceptive utilization and male involvement in the choice of contraception among youth.
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Affiliation(s)
- Ciin Ngaih Lun
- Mingalar Taung Nyunt Township Public Health Department, Yangon, Myanmar
| | - Thida Aung
- Department of Population and Family Health, University of Public Health, Yangon, Myanmar
| | - Kyaw Swa Mya
- Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
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Aguessivognon TA. Negotiation of the use of medical contraception: Levers and obstacles within married couples in Benin. PLoS One 2021; 16:e0253438. [PMID: 34292962 PMCID: PMC8297886 DOI: 10.1371/journal.pone.0253438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
In developing countries, millions of married women who want to use medical contraception are unable to do so for various reasons. To address this gap in access to contraception international development actors are emphasizing, among other things, the implementation of empowerment programs for women to enable them to take ownership of issues related to their sexual and reproductive health. Nevertheless, studies show that beyond their socio-demographic characteristics, negotiating contraception as a couple is the essential determinant of medical contraception usage among married women in developing countries. Thus, some authors suggest that this aspect be considered in the strategies of national family planning programs. However, we do not know much about the reasons underlying the negotiation or silence around contraception in Beninese married couples. To fill this gap, we conducted semi-structured interviews with women and men living as married couples in Benin. The results show that this type of negotiation is mainly influenced by specific factors that can act as levers or obstacles. These data could help family planning service providers in Benin and possibly other developing countries to ensure greater contraceptive use among married women.
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Affiliation(s)
- Togla Aymard Aguessivognon
- Health and Society Institute, Faculty of Human Sciences, University of Quebec in Montreal, Montreal, Canada
- * E-mail: ,
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22
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Odwe G, Wado YD, Obare F, Machiyama K, Cleland J. Method-specific beliefs and subsequent contraceptive method choice: Results from a longitudinal study in urban and rural Kenya. PLoS One 2021; 16:e0252977. [PMID: 34143804 PMCID: PMC8213138 DOI: 10.1371/journal.pone.0252977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Evidence from sub-Saharan Africa, including Kenya, shows that negative beliefs about contraceptive methods are associated with non-use. However, little is known about the relationship between contraceptive beliefs and subsequent method choice. Methodology We used data from a two-year longitudinal survey of married women aged 15–39 years at enrollment from one urban site (Nairobi) and one rural site (Homa Bay) in Kenya. Analysis entails descriptive statistics and estimation of a conditional logit analysis to examine associations between method-specific beliefs and choice of injectables, implants or pills among women who were not using any method or were pregnant at baseline (round 1) but adopted these methods at 12-month follow-up (Nairobi, n = 221; Homa Bay n = 197). Results Beliefs about pills, injectables and implants among non-users were generally negative. With the partial exception of the pill in Nairobi, the majority thought that each method was likely to cause serious health problems, unpleasant side effects, menstrual disruption, and would be unsafe for long-term use. In both sites, satisfied past use of a method and the perception that a method is easy to use had a major influence on method choice. Concerns about menstrual disruption and safety for long-term use were unimportant in both sites. There were some marked differences between the two sites. Beliefs about long-term fertility impairment and perceived husband approval had strong influences on choice of injectables, implants or pills in the urban site but not in the rural site. Conclusion The relative importance of beliefs, some erroneous, in predisposing women to choose one method over another appears to be conditioned by the social context. There is need for family planning counseling programmes to pay attention to erroneous beliefs and misconceptions about contraceptives.
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Affiliation(s)
| | | | | | - Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Higgins JA, Kramer RD, Everett B, Wright KQ, Turok DK, Sanders JN. Association Between Patients' Perceptions of the Sexual Acceptability of Contraceptive Methods and Continued Use Over Time. JAMA Intern Med 2021; 181:874-876. [PMID: 33900361 PMCID: PMC8077038 DOI: 10.1001/jamainternmed.2021.1439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/06/2021] [Indexed: 12/05/2022]
Affiliation(s)
- Jenny A. Higgins
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison
- Collaborative for Reproductive Equity, University of Wisconsin-Madison, Medical Sciences Center 4245, Madison
- Department of Gender and Women’s Studies, University of Wisconsin-Madison, Madison
| | - Renee D. Kramer
- Department of Gender and Women’s Studies, University of Wisconsin-Madison, Madison
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison
| | | | - Kelsey Q. Wright
- Department of Gender and Women’s Studies, University of Wisconsin-Madison, Madison
- Department of Sociology, University of Wisconsin-Madison, Madison
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City
| | - Jessica N. Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City
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Berglas NF, Kimport K, Mays A, Kaller S, Biggs MA. "It's Worked Well for Me": Young Women's Reasons for Choosing Lower-Efficacy Contraceptive Methods. J Pediatr Adolesc Gynecol 2021; 34:341-347. [PMID: 33359316 PMCID: PMC8096642 DOI: 10.1016/j.jpag.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To understand the diverse reasons why some young women choose contraceptive methods that are less effective at preventing pregnancy, including condoms, withdrawal, and emergency contraception pills, even when more effective contraceptive methods are made available to them. DESIGN In-depth interviews with young women at family planning clinics in July-November 2016. Interview data were thematically coded and analyzed using an iterative approach. SETTING Two youth-serving family planning clinics serving predominantly Latinx and African American communities in the San Francisco Bay Area, California. PARTICIPANTS Twenty-two young women ages 15-25 years who recently accessed emergency contraception to prevent pregnancy. INTERVENTIONS None. MAIN OUTCOME MEASURES Young women's experiences using different methods of contraception, with specific attention to methods that are less effective at preventing pregnancy. RESULTS Young women reported having previously used a range of higher- and lower-efficacy contraceptive methods. In interviews, they described affirmative values that drive their decision to use lower-efficacy methods, including: a preference for flexibility and spontaneity over continual contraceptive use, an emphasis on protecting one's body, and satisfaction with the method's effectiveness at preventing pregnancy. Some young women described using a combination of lower-efficacy methods to reduce their pregnancy risk. CONCLUSION Young women make contraceptive decisions on the basis of preferences and values that include, but are not limited to, effectiveness at preventing pregnancy. These reasons are salient in their lives and need to be recognized as valid by sexual health care providers to ensure that young women receive ongoing high-quality care.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California.
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - Aisha Mays
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
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Furman L, Pettit S, Balthazar MS, Williams K, O’Riordan MA. Barriers to post-placental intrauterine device receipt among expectant minority women. EUR J CONTRACEP REPR 2021; 26:91-97. [PMID: 33295807 PMCID: PMC9088240 DOI: 10.1080/13625187.2020.1852398] [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: 09/21/2020] [Revised: 11/01/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to identify barriers to breastfeeding-compatible post-placental intrauterine devices (IUDs) for expectant predominantly non-Hispanic African-American women. MATERIALS AND METHODS This cross-sectional survey study, conducted at 3 Cleveland community partner locations, enrolled 119 expectant predominantly unmarried but partnered non-Hispanic African-American women. The survey assessed contraceptive, IUD-specific and breastfeeding attitudes and intentions. Survey responses were described with percentages and frequencies, and compared by feeding intention using 2-sided Chi-Square tests. Factor analysis with Varimax rotation identified 2 potential measures of reluctance to post-placental IUD acceptance. The relationship of factors scores to maternal characteristics was assessed. RESULTS Feeding intention (breastfeeding versus not) was not related to perceived barriers to post-placental IUD receipt among expectant minority women. A "Personal Risks Reluctance" factor included low risk IUD events (migration and expulsion), misconceptions (delayed fertility return), menstrual changes and partner preference: a higher score was significantly associated with younger age group but no other maternal characteristics. A "Not Me Reasons" factor included provider and insurance barriers, and was not related to any maternal characteristics. CONCLUSIONS Expectant minority women's perceived barriers to post-placental IUDs are not related to prenatal feeding intentions. We identified two clinically relevant factors that appear to measure barriers to post-placental IUD acceptance.
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Affiliation(s)
- Lydia Furman
- Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shannon Pettit
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Mary Ann O’Riordan
- Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
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Berlan ED. Implant and adolescents. BMJ Sex Reprod Health 2021; 47:150-151. [PMID: 32611545 DOI: 10.1136/bmjsrh-2020-200631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Elise D Berlan
- Pediatrics/Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Whidden C, Keita Y, Treleaven E, Beckerman J, Johnson A, Cissé A, Liu J, Kayentao K. Women's empowerment, intrahousehold influences, and health system design on modern contraceptive use in rural Mali: a multilevel analysis of cross-sectional survey data. Reprod Health 2021; 18:55. [PMID: 33658054 PMCID: PMC7931535 DOI: 10.1186/s12978-020-01061-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent challenges in meeting reproductive health and family planning goals underscore the value in determining what factors can be leveraged to facilitate modern contraceptive use, especially in poor access settings. In Mali, where only 15% of reproductive-aged women use modern contraception, understanding how women's realities and health system design influence contraceptive use helps to inform strategies to achieve the nation's target of 30% by 2023. METHODS Using household survey data from the baseline round of a cluster-randomized trial, including precise geolocation data from all households and public sector primary health facilities, we used a multilevel model to assess influences at the individual, household, community, and health system levels on women's modern contraceptive use. In a three-level, mixed-effects logistic regression, we included measures of women's decision-making and mobility, as well as socio-economic sources of empowerment (education, paid labor), intrahousehold influences in the form of a co-residing user, and structural factors related to the health system, including distance to facility. RESULTS Less than 5% of the 14,032 women of reproductive age in our study used a modern method of contraception at the time of the survey. Women who played any role in decision-making, who had any formal education and participated in any paid labor, were more likely to use modern contraception. Women had three times the odds of using modern contraception if they lived in a household with another woman, typically a co-wife, who also used a modern method. Compared to women closest to a primary health center, those who lived between 2 and 5 km were half as likely to use modern contraception, and those between 5 and 10 were a third as likely. CONCLUSIONS Despite chronically poor service availability across our entire study area, some women-even pairings of women in single households-transcended barriers to use modern contraception. When planning and implementing strategies to expand access to contraception, policymakers and practitioners should consider women's empowerment, social networks, and health system design. Accessible and effective health systems should reconsider the conventional approach to community-based service delivery, including distance as a barrier only beyond 5 km.
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Affiliation(s)
- Caroline Whidden
- Muso, Route de 501 Lodgements SEMA, Bamako, Mali.
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Emily Treleaven
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Ari Johnson
- Muso, Route de 501 Lodgements SEMA, Bamako, Mali
- Institude for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Aminata Cissé
- Sub-Direction of Reproductive Health, General Directorate of Health and Public Hygiene, Bamako, Mali
| | - Jenny Liu
- Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Kassoum Kayentao
- Muso, Route de 501 Lodgements SEMA, Bamako, Mali
- Malaria Research & Training Centre, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Coutinho RZ, Montalvo AV, Weitzman A, Marteleto LJ. Zika virus public health crisis and the perpetuation of gender inequality in Brazil. Reprod Health 2021; 18:40. [PMID: 33588891 PMCID: PMC7883759 DOI: 10.1186/s12978-021-01067-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015-2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. METHODS We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18-40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. RESULTS Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. CONCLUSION Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.
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Affiliation(s)
- Raquel Zanatta Coutinho
- Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais and Center for Development and Regional Planning (Cedeplar), Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
| | - Aida Villanueva Montalvo
- Department of Sociology, University of Massachusetts-Amherst, 910 Thompson Hall, Amherst, MA, 01003, USA
| | - Abigail Weitzman
- The College of Liberal Arts, University of Texas at Austin and Population Research Center, 116 Inner Campus Dr Stop G6000, Austin, TX, 78712, USA
| | - Letícia Junqueira Marteleto
- The College of Liberal Arts, University of Texas at Austin and Population Research Center, 116 Inner Campus Dr Stop G6000, Austin, TX, 78712, USA
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Jain M, Caplan Y, Ramesh BM, Isac S, Anand P, Engl E, Halli S, Kemp H, Blanchard J, Gothalwal V, Namasivayam V, Kumar P, Sgaier SK. Understanding drivers of family planning in rural northern India: An integrated mixed-methods approach. PLoS One 2021; 16:e0243854. [PMID: 33439888 PMCID: PMC7806122 DOI: 10.1371/journal.pone.0243854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Family planning is a key means to achieving many of the Sustainable Development Goals. Around the world, governments and partners have prioritized investments to increase access to and uptake of family planning methods. In Uttar Pradesh, India, the government and its partners have made significant efforts to increase awareness, supply, and access to modern contraceptives. Despite progress, uptake remains stubbornly low. This calls for systematic research into understanding the 'why'-why people are or aren't using modern methods, what drives their decisions, and who influences them. METHODS We use a mixed-methods approach, analyzing three existing quantitative data sets to identify trends and geographic variation, gaps and contextual factors associated with family planning uptake and collecting new qualitative data through in-depth immersion interviews, journey mapping, and decision games to understand systemic and individual-level barriers to family planning use, household decision making patterns and community level barriers. RESULTS We find that reasons for adoption of family planning are complex-while access and awareness are critical, they are not sufficient for increasing uptake of modern methods. Although awareness is necessary for uptake, we found a steep drop-off (59%) between high awareness of modern contraceptive methods and its intention to use, and an additional but smaller drop-off from intention to actual use (9%). While perceived access, age, education and other demographic variables partially predict modern contraceptive intention to use, the qualitative data shows that other behavioral drivers including household decision making dynamics, shame to obtain modern contraceptives, and high-risk perception around side-effects also contribute to low intention to use modern contraceptives. The data also reveals that strong norms and financial considerations by couples are the driving force behind the decision to use and when to use family planning methods. CONCLUSION The finding stresses the need to shift focus towards building intention, in addition to ensuring access of trained staff, and commodities drugs and equipment, and building capacities of health care providers.
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Affiliation(s)
- Mokshada Jain
- Surgo Foundation, Washington, District of Columbia, United States of America
| | - Yael Caplan
- Surgo Foundation, Washington, District of Columbia, United States of America
| | - B. M. Ramesh
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shajy Isac
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, New Delhi, Delhi, India
| | - Preeti Anand
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, Lucknow, Uttar Pradesh, India
| | - Elisabeth Engl
- Surgo Foundation, Washington, District of Columbia, United States of America
| | - Shiva Halli
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hannah Kemp
- Surgo Foundation, Washington, District of Columbia, United States of America
| | - James Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vikas Gothalwal
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- India Health Action Trust, Lucknow, Uttar Pradesh, India
| | - Vasanthakumar Namasivayam
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Sema K. Sgaier
- Surgo Foundation, Washington, District of Columbia, United States of America
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Gonsalves L, Martin Hilber A, Wyss K, Say L. Potentials and pitfalls of including pharmacies as youth-friendly contraception providers in low- and middle-income countries. BMJ Sex Reprod Health 2021; 47:6-8. [PMID: 32788181 PMCID: PMC7815634 DOI: 10.1136/bmjsrh-2020-200641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 05/20/2023]
Affiliation(s)
- Lianne Gonsalves
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Adriane Martin Hilber
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Gallimore A, Irshad T, Cooper M, Cameron S. Influence of culture, religion and experience on the decision of Pakistani women in Lothian, Scotland to use postnatal contraception: a qualitative study. BMJ Sex Reprod Health 2021; 47:43-48. [PMID: 32299825 DOI: 10.1136/bmjsrh-2019-200497] [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: 10/07/2019] [Revised: 01/28/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling. METHODS Qualitative research including focus groups and 1:1 semi-structured interviews with women and staff. Participants were first- and second-generation Pakistani women with a child/children aged up to 5 years, or pregnant; community and hospital midwives, obstetric doctors who counsel or provide PNC. Data were coded and categorised using QSR NVIVO10. Inductive thematic analysis was carried out. RESULTS Women were receptive to discussion of contraception, including antenatally, and welcomed translated information. Some said the decision on PNC was theirs or made jointly with their husband; however, they acknowledged that in some marriages the husband will take the decision. Women stated they may face family expectation to have a baby early in marriage. Language was identified as a challenge by maternity staff, who utilised translation services to ensure women received the information they needed on contraception. CONCLUSIONS Pakistani women value antenatal discussion about PNC. Maternity staff have an important role in providing quality information on contraception and should be supported with translated resources in a range of formats. Most importantly, staff should adopt a tailored approach to identify the individual woman's needs and preferences.
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Affiliation(s)
| | - Tasneem Irshad
- Medical Research Council (MRC) Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | | | - Sharon Cameron
- Medical Research Council (MRC) Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
- Chalmers Sexual Health Clinic, NHS Lothian, Edinburgh, UK
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Wasswa R, Kabagenyi A, Atuhaire L. Determinants of unintended pregnancies among currently married women in Uganda. J Health Popul Nutr 2020; 39:15. [PMID: 33287906 PMCID: PMC7722439 DOI: 10.1186/s41043-020-00218-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda. METHODS In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15-49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model. RESULTS The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman's age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies. CONCLUSION Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.
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Affiliation(s)
- Ronald Wasswa
- Department of Statistical Methods and Actuarial Science, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Allen Kabagenyi
- Department of Population Studies, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Leonard Atuhaire
- Department of Planning and Applied Statistics, School of Statistics & Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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Sato R, Elewonibi B, Msuya S, Manongi R, Canning D, Shah I. Why do women discontinue contraception and what are the post-discontinuation outcomes? Evidence from the Arusha Region, Tanzania. Sex Reprod Health Matters 2020; 28:1723321. [PMID: 32178594 PMCID: PMC7888019 DOI: 10.1080/26410397.2020.1723321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 12/18/2022] Open
Abstract
In Africa, high discontinuation of contraceptive use is thwarting goals for healthy birth spacing or limiting childbearing. This paper investigates how well the contraception program is addressing the needs of women and couples in the Arusha region, Tanzania by studying contraceptive use continuation. We measured the overall and method-specific discontinuation rate, reasons for discontinuation, post-discontinuation reproductive behaviours/outcomes, and examined the determinants of contraceptive discontinuation. We used data from a household survey conducted in Arusha from January to May 2018. Information on contraceptive use during the 31 months preceding the survey was recorded in a monthly calendar. Using the single- and multiple-decrement life-table approach, we calculated the overall and cause-specific discontinuation of contraceptive methods. Logistic regression was used to evaluate the determinants of discontinuation. The 12-month overall discontinuation of contraceptive use was 44.6%. Discontinuation was lowest for implants (12.3%) and highest for male condoms (60.1%), the most common reason being side effects (11.7%). 59.8% of women who discontinued did not switch to another method within 3 months following discontinuation and 20.9% experienced pregnancy. Longer distance to a health facility is associated with higher discontinuation of hormonal methods such as injectables, but lower discontinuation of non-hormonal methods such as condoms. Discontinuation due to side effects is not explained by most of the women's background characteristics other than the method they used. Discontinuation of contraception is high among Arusha women. Effective contraception programs, especially improved counselling, need to address the reasons for the discontinuation of contraceptive use.
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Affiliation(s)
- Ryoko Sato
- Research Associate, Harvard TH Chan School of Public Health, Boston, MA, USA. Correspondence: ,
| | - Bilikisu Elewonibi
- Research Associate, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sia Msuya
- Associate Professor, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rachel Manongi
- Associate Professor, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - David Canning
- Professor, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Iqbal Shah
- Principal Research Scientist, Harvard TH Chan School of Public Health, Boston, MA, USA
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Abelman SH, Cron J. Contraception Counseling and Use Among Adolescent and Young Adult Female Patients Undergoing Cancer Treatment: A Retrospective Analysis. J Pediatr Adolesc Gynecol 2020; 33:652-657. [PMID: 33010464 PMCID: PMC7527283 DOI: 10.1016/j.jpag.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Adolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study aimed to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes. DESIGN Retrospective chart review. SETTING Yale New Haven Hospital from 2013 to 2018. PARTICIPANTS Female patients 15-25 years of age receiving cancer treatment, excluding those treated with surgery only. INTERVENTIONS None. MAIN OUTCOME MEASURES Outcomes of documented sexual health counseling and contraception use were assessed for frequency. Associations between patient factors and these outcomes were assessed using Pearson χ2 and Fisher exact tests, and multivariate logistic regression was used to identify predictors of these outcomes. RESULTS In this cohort (n = 157), the median age was 20.5 years, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Of the patients, 33.1% were documented as receiving sexual health counseling, and 48.4% used contraception. Younger patients (15-20 years of age) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P = .005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P = .009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P = .001) were significantly associated with contraception use. CONCLUSIONS Sexual health counseling was documented infrequently during oncologic care for AYA women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a need to improve rates of counseling in this high-risk setting, in which adolescents may be more vulnerable with regard to sexual health.
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Affiliation(s)
| | - Julia Cron
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
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Mekonnen BD, Wubneh CA. Prevalence and associated factors of contraceptive discontinuation among reproductive-age women in Ethiopia: using 2016 Nationwide Survey Data. Reprod Health 2020; 17:175. [PMID: 33160392 PMCID: PMC7648969 DOI: 10.1186/s12978-020-01032-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contraceptive discontinuation for reasons other than the desire for pregnancy is associated with mistimed and unwanted pregnancies, unwanted births and unsafe abortions which has increased risks of maternal morbidity and mortality. However, research on the identification of factors that are associated with contraceptive discontinuation in Ethiopia is limited. Therefore, this study aimed to determine the prevalence of contraceptive discontinuation and associated factors among reproductive-age women in Ethiopia, using recent national survey data. METHODS A population-based cross-sectional study was conducted using secondary data analysis from of 2016, Ethiopian Demographic Health Survey. A total of 10,871 reproductive-age women were included. The analysis was performed using SPSS version 20 statistical package. Bivariate and multivariate logistic regression analysis was conducted to examine significant factors of contraceptive discontinuation, and statistical significance was declared at p-value < 0.05. RESULTS The prevalence of discontinuation for all contraceptives methods among reproductive-age women was 32.2% (95% C.I 31.2, 33.1). Rural residence (AOR = 1.94, 95% C.I 1.65, 2.28), women with no formal education (AOR = 1.68, 95% C.I 1.30, 2.17), women having no children (AOR = 1.95, 95% C.I 1.19, 3.58), husband desire for children (AOR = 2.57, 95% C.I 2.03, 3.26), women self-decision when using a contraceptive (AOR = 0.54, 95% C.I 0.38, 0.77), joint decision when using a contraceptive (AOR = 0.38, 95% C.I 0.29, 0.48), didn't discuss about FP with healthcare worker (AOR = 1.28, 95% C.I 1.06, 1.54) and didn't get information about side effects (AOR = 2.01, 95% C.I 1.59, 2.52) were factors significantly associated with contraceptives discontinuation. CONCLUSION The prevalence of contraceptive discontinuation among reproductive-age women was high and multiple factors determined it. Thus, counseling on side effects, availability of other contraceptive methods, and partner involvement in decision-making process by health care providers are strongly recommended. In addition, women empowerment should be promoted so that women are able to liberally decide on when and how many children they wish to have.
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Affiliation(s)
| | - Chalachew Adugna Wubneh
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia
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Ahinkorah BO, Ameyaw EK, Seidu AA, Agbaglo E, Budu E, Mensah F, Adu C, Yaya S. Sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa: Evidence from demographic and health surveys. PLoS One 2020; 15:e0240556. [PMID: 33141830 PMCID: PMC7608905 DOI: 10.1371/journal.pone.0240556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Contraception plays a significant role in fertility regulation and determines the reproductive health rights of women. Studies in other parts of the world have found that sexual violence has negative effects on unmet need for contraception. There has not been any study on the association between these two phenomena in sub-Saharan Africa using current nationally-representative survey data. We investigated the association between sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa. MATERIALS AND METHODS This study was based on secondary datasets from 26 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A sample of 101,968 women in sexual unions (married and cohabiting) with complete information on sexual violence and all the variables of interest were included in the analyses. Both bivariate and multilevel logistic regression analyses were carried out to examine the association between sexual violence and unmet need for contraception. Other individual and contextual level socio-economic and demographic variables were considered as covariates. Crude odds ratios [cOR] and adjusted odds ratios [aOR] with their corresponding 95% confidence intervals [CI], signifying precision, were presented. Level of statistical significance was declared at p<0.05. RESULTS The overall prevalence of sexual violence and unmet need for contraception in the 26 sub-Saharan African countries were 8.7% and 28.7% respectively. Experience of sexual violence within the last 12 months resulted in 10% increase in unmet need for contraception [OR = 1.10, CI = 1.03-1.14] and 5% increase in unmet need for contraception after controlling for individual and contextual level factors [aOR = 1.05, CI = 1.01-1.11]. With the individual level factors, women with 4 or more births [aOR = 4.85, CI = 4.41-5.33], those cohabiting [aOR = 1.43, CI = 1.37-1.47], those in female headed households [aOR = 1.22, CI = 1.18-1.27] and those who watched television at least once a week [aOR = 1.12, CI = 1.07-1.16] had higher odds of unmet need for family planning. However, those aged 30-34 [aOR = 0.56, CI = 0.52-0.61], those with secondary/higher level of education [AOR = 0.80, CI = 0.77-0.84], those who read newspaper less than once a week [aOR = 0.75, CI = 0.71-0.79] and those who listened to radio at least once a week [aOR = 0.94, CI = 0.90-0.97] had lower odds of unmet need for contraception. In terms of the contextual factors, women in rural areas [aOR = 0.87, CI = 0.84-0.91] and those in the richest wealth quintile households [aOR = 0.80, CI = 0.75-0.85] had lower odds of unmet need for contraception. CONCLUSION Our study has shown an association between sexual violence and unmet need for contraception in sub-Saharan Africa. Experiencing sexual violence increases the likelihood of unmet need for contraception in sub-Saharan Africa. It is also worthy to note that having four or more children, cohabiting with a male partner, and living in female-headed households are some of the key variables associated with unmet need for contraception in sub-Saharan Africa. Our study recommends that, successful contraceptive initiatives should focus on reducing sexual violence, while taking into consideration other significant factors that increase unmet need for contraception. Meanwhile, in doing this, contextual factors ought to be prioritised.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - 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, Queensland, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Felix Mensah
- Fr. Thomas Alan Rooney Memorial Hospital, Asankrangwa, Western Region, Ghana
| | - Collins Adu
- Department of Health Promotion, and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanni Yaya
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
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Xu F, Bu K, Chen F, Jin S, Zhang H, Zhang D, Sun C, Wang N, Han M, Wang L. Structural equation modeling test of the pre-intentional phase of the health action process approach (HAPA) model on condom use intention among senior high school students in Tianjin, China. Medicine (Baltimore) 2020; 99:e22776. [PMID: 33126316 PMCID: PMC7598788 DOI: 10.1097/md.0000000000022776] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Based on the Theory of Health Action Process Approach (HAPA) Model, this study aimed to investigate factors associated with condom use intention in Chinese adolescents.In 2017, we conducted a cross-sectional study using stratified cluster, convenience sampling method to assess condom use intention among senior high school students in Tianjin, China. One thousand eighty two senior high school students were anonymously surveyed through self-administered questionnaires. Structural equation modelling was used to assess the pre-intentional phase of HAPA model.Among the participants, 41.5% (449/1082) were male, 54.1% (585/1082) were female, 4.4% (48/1082) were gender-deficient. The average age was 16.7 years. The final pre-intentional phase of HAPA model was acceptable (CFI = 0.95; GFI = 0.94; RMSEA = 0.06). Action self-efficacy (r = 0.60) had a strong direct effect on condom use intention.The pre-intentional phase of HAPA model is valid to assess condom use intention among Chinese senior high school students. The pre-intention phase of the HAPA model could be applied to guide AIDS health educations of students, and further research is needed to evaluate the effect.
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Affiliation(s)
- Fang Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
- Department of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Kai Bu
- School of Health Humanities, Peking University
| | - Fangfang Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | | | - Hanxi Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Dong Zhang
- Dongli Center for Disease Control and Prevention, Tianjin
| | - Caixia Sun
- Qinghai Of Health Sciences, Qinghai, Beijing, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Mengjie Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Lu Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
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Kanakuze CA, Kaye DK, Musabirema P, Nkubito P, Mbalinda SN. Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study. BMC Pregnancy Childbirth 2020; 20:650. [PMID: 33109097 PMCID: PMC7590736 DOI: 10.1186/s12884-020-03337-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital. METHODS A concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data. RESULTS The prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017-6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018-4.218) as compared to those who didn't receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485-4.492); as compared to those who didn't receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472-3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477-2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD. CONCLUSION The acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD.
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Grants
- D43 TW010132 FIC NIH HHS
- R25 TW011213 FIC NIH HHS
- D43TW010132 by Office of the Director, National Institutes of Health (OD), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Neurological Disorders And Stroke (NINDS), National Heart, Lung, And Blood Institute (NHLBI), Fogarty Interna
- 1R25TW011213. Fogarty International Center of the National Institutes of Health.
- by Office of the Director, National Institutes of Health (OD), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Neurological Disorders And Stroke (NINDS), National Heart, Lung, And Blood Institute (NHLBI), Fogarty Interna
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Affiliation(s)
- Chris Adrien Kanakuze
- Faculty of Health Sciences, Kibogora Polytechnic, P.O. Box: 31, Rusizi, Rwanda
- Department of Nursing, Makerere University, College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Dan Kabonge Kaye
- Department of Obstetrics and Gynecology, Makerere University, College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Priscilla Musabirema
- Midwifery department, Faculty of Nursing Science, University of Rwanda, Kigali, Rwanda
| | - Pascal Nkubito
- Department of Obstetrics and Gynecology, Muhima Hospital, Kigali, Rwanda
| | - Scovia Nalugo Mbalinda
- Department of Nursing, Makerere University, College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Arikawa S, Dumazert P, Messou E, Burgos-Soto J, Tiendrebeogo T, Zahui A, Horo A, Minga A, Becquet R. Childbearing desire and reproductive behaviors among women living with HIV: A cross-sectional study in Abidjan, Côte d'Ivoire. PLoS One 2020; 15:e0239859. [PMID: 33085671 PMCID: PMC7577483 DOI: 10.1371/journal.pone.0239859] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Evidence on childbearing desire and reproductive behaviors in women living with HIV on antiretroviral therapy (ART) is scarce, particularly in West Africa. We investigated the prevalence and associated factors of childbearing desire in HIV-infected women in care in Abidjan, Côte d’Ivoire and explored whether such desires were translated into behaviors related to contraceptive use and communication with health personnel. Methods A cross-sectional survey was conducted in two HIV-care facilities in Abidjan, Côte d’Ivoire in 2015. Eligible women were non-pregnant, non-menopausal, aged 18–49 years and diagnosed as HIV-infected. The outcomes were childbearing desire, prevalence of modern contraceptive use, unmet needs for family planning and intention of the last pregnancy since HIV diagnosis. Women wishing to conceive immediately were asked whether they had discussed their desire with HIV healthcare workers. Logistic regression models were used to assess the associations between the outcomes and women’s characteristics. Results Of 1,631 women, 80% declared having childbearing desire. No association was found between women’s childbearing desire and ART status or its duration. In multivariate models, younger age, being in a stable relationship and having no or only one child were significantly associated with increased childbearing desire. Of the women wishing to conceive immediately (n = 713), only 43% reported having had fertility-related dialogue with healthcare provider. Among sexually active women wanting to avoid or delay pregnancy (n = 650), unmet needs for family planning was 40%. Regarding the last pregnancy since HIV diagnosis, one in three women reported not having wanted a baby at that time. Conclusions Pregnancy desire in women living with HIV in Abidjan was extremely high. Integration of safe conception strategies as well as improvement of contraceptive uptake among women in need of family planning are of utmost importance to ensure optimal conception and to avoid transmission of HIV to the male partner or to the forthcoming child.
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Affiliation(s)
- Shino Arikawa
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- * E-mail:
| | - Patricia Dumazert
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre de Prise en charge de Recherche et de Formation (CePReF-Aconda-VS), Abidjan, Côte d'Ivoire
| | - Juan Burgos-Soto
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Thierry Tiendrebeogo
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
| | - Angèle Zahui
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Albert Minga
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre Médical de Suivi de Donneurs de Sang (CMSDS), Abidjan, Côte d’Ivoire
| | - Renaud Becquet
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
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Gashaye KT, Tsegaye AT, Abebe SM, Woldetsadik MA, Ayele TA, Gashaw ZM. Determinants of long acting reversible contraception utilization in Northwest Ethiopia: An institution-based case control study. PLoS One 2020; 15:e0240816. [PMID: 33079973 PMCID: PMC7575092 DOI: 10.1371/journal.pone.0240816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Though long-acting reversible contraceptives (LARCs) are highly effective, have minimal side effects, require minimal follow-up, and are low cost, only 10% of contraceptives used in Ethiopia are LARCs. The reason for this low uptake is not understood at the country or regional level. Therefore, this study identified determinants of LARC utilization in Northwest Ethiopia. METHODS A facility-based unmatched case control study, using LARC users as cases and short- acting reversible contraception (SARC) users as controls, had been conducted at fourteen public health institutions in Northwest Ethiopia. A systematic random sampling technique was used to select participants with a 1:2 case to control ratio (n = 1167). Binary logistic regression analysis was used to identify determinants of LARC utilization among family planning service users. RESULTS Wealth status [AOR:1.87, 95%CI (1.08, 3.24)], history of abortion [AOR:2.69, 95%CI (1.41, 5.12)], limiting family size [AOR: 2.38, 95%CI (1.01, 5.62)], good knowledge about LARCs [AOR: 2.52, 95%CI (1.17, 5.41)], method convenience [AOR: 0.23, 95%CI (0.16, 0.34)], good availability of method [AOR:0.10 (0.05, 0.19)], less frequent visits to health facility [AOR:2.95, 95% CI(1.89, 4.62)], health care providers advice [AOR:10.69, 95%CI (3.27, 34.87)], partner approval [AOR:0.66, 95%CI (0.45, 0.97)], and favorable attitude towards LARCs [AOR:13.0, 95%CI (8.60, 19.72)] were significantly associated with LARC utilization. CONCLUSION Professional support, favorable attitude towards LARC use, high economic status, history of abortion, advantage of less frequent visits, having good knowledge towards LARC and interest of limiting births were significantly associated with LARC Utilization. On the other hand, perceived method convenience, and contraception availability were inversely associated with it. Family planning education about the benefits of LARC should be done by health providers and media. Male involvement in the counselling and decision making about the advantage of using LARC may improve the negative influence of partners on LARC utilization. It is also recommended that, future qualitative research further explore perceptions of LARC use.
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Affiliation(s)
- Kiros Terefe Gashaye
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris Woldetsadik
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mengistu Gashaw
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
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Tomar S, Dehingia N, Dey AK, Chandurkar D, Raj A, Silverman JG. Associations of intimate partner violence and reproductive coercion with contraceptive use in Uttar Pradesh, India: How associations differ across contraceptive methods. PLoS One 2020; 15:e0241008. [PMID: 33064775 PMCID: PMC7567561 DOI: 10.1371/journal.pone.0241008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Intimate partner violence (IPV) and reproductive coercion (RC)-largely in the form of pressuring pregnancy-appear to contribute to low use of contraceptives in India; however, little is known about the extent to which these experiences differentially affect use of specific contraceptive methods. The current study assessed the association of IPV and RC with specific contraceptive methods (Intrauterine Devices [IUDs], pills, condoms) among a large population-based sample of currently married women (15-49 years, n = 1424) living in Uttar Pradesh. Outcomes variables included past year modern contraceptive use and type of contraceptive used. Primary independent variables included lifetime experience of RC by current husband or in-laws, and lifetime experiences of physical IPV and sexual IPV by current husband. Multivariate logistic regression models were developed to determine the effect of each form of abuse on women's contraceptive use. Approximately 1 in 7 women (15.1%) reported experiencing RC from their current husband or in-laws ever in their lifetime, 37.4% reported experience of physical IPV and 8.3% reported experience of sexual IPV by their current husband ever in their lifetime. Women experiencing RC were less likely to use any modern contraceptive (AOR: 0.18; 95% CI: 0.9-0.36). Such women also less likely to report pill and condom use but were more likely to report IUD use. Neither form of IPV were associated with either overall or method specific contraceptive use. Study findings highlight that RC may influence contraceptive use differently based on type of contraceptive, with less detectable, female-controlled contraceptives such as IUD preferred in the context of women facing RC. Unfortunately, IUD uptake remains low in India. Increased access and support for use, particularly for women contending with RC, may be important for improving women's control over contraceptive use and reducing unintended pregnancy.
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Affiliation(s)
- Shweta Tomar
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
- * E-mail:
| | - Nabamallika Dehingia
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | - Arnab K. Dey
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | | | - Anita Raj
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Jay G. Silverman
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
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Mahande MJ, Shayo E, Amour C, Mshana G, Msuya S. Factors associated with modern contraceptives use among postpartum women in Bukombe district, Geita region, Tanzania. PLoS One 2020; 15:e0239903. [PMID: 33052975 PMCID: PMC7556445 DOI: 10.1371/journal.pone.0239903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/15/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Modern contraceptive use during the first year postpartum potentially prevents unplanned pregnancies and help to improve maternal and child health. Therefore, identifying factors associated with contraceptive utilization among women of reproductive age during extended postpartum period is essential. OBJECTIVE This study aimed to assess factors associated with modern contraceptives use among postpartum women in Bukombe District, Geita region. METHOD A community-based cross-sectional study was conducted among women who were in their first year after child birth in Bukombe district. A total of 511 women were included using multistage sampling techniques. Data were collected using a structured questionnaire. Data analysis was performed using Stata 15 (College Station, Texas, USA). RESULTS The prevalence of postpartum modern contraceptive was 11.9%. The most frequently used method was implant (6.5%). Most women started to use the contraceptive during the first three months after delivery. Living in urban (AOR = 1.85, 95% CI: 1.20-3.79), having business (AOR = 2.35, 95% CI: 1.31-2.28), last born aged 3-4 months (AOR = 3.31, 95% CI: 1.11-9.85) and menses resumption (AOR = 9.24, 95% CI: 3.60-23.72) were predictors for postpartum contraceptive use. However, fear of side effects, poor knowledge about contraceptives, husband restrictions, distance to health facility and contraceptive availability were reported as barriers for postpartum modern contraceptive use. CONCLUSION Prevalence of postpartum modern contraceptive use in the study area is still low. Numerous factors were reported as barriers for postpartum contraceptive use. A strategy such as health education on befits of post-partum modern contraceptive use and counseling women about side effects may help to improve its uptake.
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Affiliation(s)
- Michael Johnson Mahande
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emmanuel Shayo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Caroline Amour
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gerry Mshana
- National Institute of Medical Research, MITU- Mwanza, Mwanza, Tanzania
| | - Sia Msuya
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Boydell V, Nulu N, Hardee K, Gay J. Implementing social accountability for contraceptive services: lessons from Uganda. BMC Womens Health 2020; 20:228. [PMID: 33046065 PMCID: PMC7549211 DOI: 10.1186/s12905-020-01072-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/13/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women's barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care. METHODS This exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated. RESULTS The case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue. CONCLUSION The study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.
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Affiliation(s)
- Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Chemin Rigot 2, 1202, Geneva, Switzerland.
| | - Nanono Nulu
- Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Jill Gay
- MIA, What Works Association, Washington, DC, USA
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Rezel-Potts E, Palmer MJ, Free C, Baraitser P. A cohort study of the service-users of online contraception. BMJ Sex Reprod Health 2020; 46:287-293. [PMID: 32371501 PMCID: PMC7569369 DOI: 10.1136/bmjsrh-2020-200610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In January 2017, the first free service providing oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark - ethnically and socioeconomically diverse areas with high rates of unplanned pregnancy. There are concerns that online services can increase health inequalities; therefore, we aimed to describe service-users according to age, ethnicity and Index of Multiple Deprivation (IMD) quintile of area of residence and to examine the association of these with repeated use. METHODS We analysed routinely collected data from January 2017 to April 2018 and described service-users using available sociodemographic factors and information on patterns of use. Logistic regression analysis examined factors associated with repeat ordering of OCPs. RESULTS The service was accessed by 726 individuals; most aged between 20 and 29 years (72.5%); self-identified as being of white ethnic group (58.8%); and residents of the first and second most deprived IMD quintiles (79.2%). Compared with those of white ethnic group, those of black ethnic group were significantly less likely to make repeat orders (adjusted OR 0.53, 95% CI 0.31 to 0.89; p=0.001), as were those of Asian and mixed ethnic groups. CONCLUSIONS These are the first empirical findings on free, online contraception and suggest that early adopters broadly reflect the population of the local area in terms of ethnic diversity and deprivation as measured by IMD. Ongoing service development should prioritise the identification and removal of barriers which may inhibit repeat use for black and minority ethnic groups.
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Affiliation(s)
- Emma Rezel-Potts
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paula Baraitser
- School of Population Health & Environmental Sciences, King's College London, London, UK
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Moore AM, Blades N, Ortiz J, Whitehead H, Villarreal C. What does informal access to misoprostol in Colombia look like? A mystery client methodology in Bogotá and the Coffee Axis. BMJ Sex Reprod Health 2020; 46:294-300. [PMID: 32624479 PMCID: PMC7569367 DOI: 10.1136/bmjsrh-2019-200572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them. METHODS A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews. RESULTS Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications. CONCLUSIONS As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.
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Affiliation(s)
- Ann M Moore
- Division of Research, Guttmacher Institute, New York, New York, USA
| | - Nakeisha Blades
- Division of Research, Guttmacher Institute, New York, New York, USA
| | | | - Hannah Whitehead
- Division of Research, Guttmacher Institute, New York, New York, USA
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Crow M, Walker V, Braunholtz-Speight J, Singh M. Improving the provision of postnatal contraception within inpatient wards: a UK pilot study. BMJ Sex Reprod Health 2020; 46:313. [PMID: 31948948 DOI: 10.1136/bmjsrh-2019-200518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Madeleine Crow
- Leeds Sexual Health, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Victoria Walker
- Leeds Sexual Health, Leeds Community Healthcare NHS Trust, Leeds, UK
| | | | - Manisha Singh
- Leeds Sexual Health, Leeds Community Healthcare NHS Trust, Leeds, UK
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Cavallaro FL, Benova L, Owolabi OO, Ali M. A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't? BMJ Sex Reprod Health 2020; 46:254-269. [PMID: 31826883 PMCID: PMC7569400 DOI: 10.1136/bmjsrh-2019-200377] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 04/19/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 05/21/2023]
Abstract
AIM The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages. METHODS Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered. RESULTS A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types. CONCLUSIONS The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.
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Affiliation(s)
| | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Moazzam Ali
- World Health Organization, Geneva, Switzerland
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Imran M, Yasmeen R. Barriers To Family Planning In Pakistan. J Ayub Med Coll Abbottabad 2020; 32:588-591. [PMID: 33225672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
According to the last census conducted in Pakistan in 2017, Pakistan's population reach up to 207.7 million and a growth rate of 2.4. Currently. Researchers and policymakers estimated that if the growth rate of Pakistan remains the same, then up till 2050, Pakistan becomes 5th most populous country in the world. Pakistan has a commitment of FP2020 that Pakistan will achieve a CPR rate of 55% at the national level, but it seems difficult to achieve as Pakistan Demographic Health Survey conducted during 2017-18 shows that overall contraceptive prevalence rate of Pakistan is 34%. In this review, we have identified barriers that can restrict the use of family planning, which includes: lack of knowledge and motivation, lack of agency, communication gap and limited availability and accessibility. There is a need to increase awareness and understanding of contraceptive methods, change negative attitudes and help couples to change their behaviours. The decision-maker should make such policies that can help in improving family planning usage and helps in population control.
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Affiliation(s)
- Muhammad Imran
- College of Physician & Surgeon Pakistan, The Indus Hospital, Karachi, Pakistan
| | - Rehana Yasmeen
- College of Physician & Surgeon Pakistan, The Indus Hospital, Karachi, Pakistan
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Yadav K, Agarwal M, Shukla M, Singh JV, Singh VK. Unmet need for family planning services among young married women (15-24 years) living in urban slums of India. BMC Womens Health 2020; 20:187. [PMID: 32883262 PMCID: PMC7469334 DOI: 10.1186/s12905-020-01010-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND NFHS-4 stated high unmet need for family planning (FP) among married women in Uttar Pradesh. Unmet need is highest among age groups: 15-19 and 20-24 years. Currently few data is available about unmet need for FP among vulnerable section of the community, i.e.15-24 year's age group living in the urban slums. Therefore this study was conducted to assess the unmet need for FP services and its determinants among this under-privileged and under-served section of society residing in urban slums of Uttar Pradesh, India. METHODS Cross sectional study was conducted in the slums of Lucknow, India. One Urban-Primary Health Centre (U-PHC) was randomly selected from each of the eight Municipal Corporation zones in Lucknow and two notified slums were randomly selected from each U-PHC. All the households in the selected slums were visited for interviewing 33 young married women (YMW) in each slum, with a pre-structured and pre tested questionnaire, to achieve the sample size of 535. Analysis of the data was done using logistic regression. RESULTS The unmet need for family planning services among YMW was 55.3%. About 40.9% of the unmet need was for spacing methods and 14.4% for limiting methods. Important reasons cited for unmet need for family planning services were negligent attitude of the women towards family planning, opposition by husband or others, embarrassment / hesitation / shyness for contraceptive use, poor knowledge of the FP method or availability of family planning services. Among method related reasons health concerns and fear of side effects were frequently cited reasons. On multiple logistic regression: age, educational status, duration of marriage, number of pregnancies, knowledge of contraceptive methods, opposition to contraceptive use and contact with Auxiliary Nurse Midwife (ANM) showed independently significant association with unmet need for family planning services. CONCLUSIONS Unmet need for family planning services is very high among the YMW of urban slums. The findings stress that program managers should take into cognizance these determinants of high level of unmet need for family planning among YMW and make intense efforts for addressing these issues in a holistic manner.
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Affiliation(s)
- Kriti Yadav
- Assistant Professor, Vir Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand India
| | - Monika Agarwal
- Department of Community Medicine & Public Health, K.G. Medical University, Lucknow, UP India
| | - Mukesh Shukla
- Assistant Professor, Vir Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand India
| | - Jai Vir Singh
- Principal, Hind Institute of Medical Sciences, Lucknow, UP India
| | - Vijay Kumar Singh
- Department of Community Medicine & Public Health, K.G. Medical University, Lucknow, UP India
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Harris ML, Coombe J, Forder PM, Lucke JC, Bateson D, Loxton D. Young Women's Complex Patterns of Contraceptive Use: Findings from an Australian Cohort Study. Perspect Sex Reprod Health 2020; 52:181-190. [PMID: 33191577 DOI: 10.1363/psrh.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/27/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Unintended pregnancy is common among young women. Understanding how such women use contraceptives- including method combinations-is essential to providing high-quality contraceptive care. METHODS Data were from a representative cohort of 2,965 Australian women aged 18-23 who participated in the 2012-2013 Contraceptive Use, Pregnancy Intention and Decisions baseline survey, had been heterosexually active in the previous six months, and were not pregnant or trying to conceive. Latent class analysis was employed to characterize women's contraceptive choices; multinomial logistic regression was used to evaluate correlates of membership in the identified classes. RESULTS The vast majority of women (96%) reported using one or more contraceptives, most commonly short-acting hormonal methods (60%), barrier methods (38%), long-acting contraceptives (16%) and withdrawal (15%). In total, 32 combinations were reported. Four latent classes of method use were identified: no contraception (4% of women); short-acting hormonal methods with supplementation (59%, mostly the pill); high-efficacy contraceptives with supplementation (15%, all long-acting reversible contraceptive users); and low-efficacy contraceptive combinations (21%); supplementation usually involved barrier methods or withdrawal. Class membership differed according to women's characteristics; for example, women who had ever been pregnant were more likely than other women to be in the no-contraception, high-efficacy contraceptive or low-efficacy contraceptive combination classes than in the short-acting hormonal contraceptive class (odds ratios, 2.0-3.0). CONCLUSIONS The complexity of women's contraceptive choices and the associations between latent classes and such characteristics as pregnancy history highlight the need for individualized approaches to pregnancy prevention and contraceptive care.
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Affiliation(s)
- Melissa L Harris
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
| | - Jayne C Lucke
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | | | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
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