Knowledge, Attitude, Practice, and Effect of COVID-19 Lockdown on Family Planning among Married Women

Impact of subgroup analysis on estimates of infertility

Purpose The purpose of this paper is to determine the socio-religious factors associated with unmet need for family planning among married Rwandan women, and examine individual and contextual characteristics of married fecund women influencing their contraceptive use and future intentions to use contraception. Design/methodology/approach This study employed merge data, which were extracted from 2005, 2010, 2014–2015 Rwanda Demographic And Health Survey’s individual women data sets. Characteristics of married fecund women with unmet need for family planning were compared using Pearson’s χ2 test. A binary logistic regression analysis was applied to examine the influence of socio-religious factors on contraceptive use, and future intentions to use contraception among married fecund women. Findings Unmet need for family planning among married Rwandan women has significantly decreased over the past decade, from 39.9 percent in 2005 to 19.5 percent in 2010 and 17.5 percent in 2015. Women who are Protestants, residing in rural area, and having five or more children were significantly more likely to have an unmet need for family planning. Overall, the likelihood of having unmet need for family planning, not using contraceptives and future intentions for not using contraception was found statistically high among Protestant women compared to Catholics and low-educated women. Research limitations/implications Unmarried women and men are not included to examine their role play and characteristics influences on family planning use in Rwanda. Investing in education of girls should be a priority for the future, without that there will not be equality in reproductive health and rights. Factors behind the recent slow motion of family planning initiatives need to be addressed in order to meet the reproductive needs and rights of all women. Practical implications Public-religious collaboration to promote nationally Natural Family Planning in all healthcare facilities is extremely needed. Since the family planning initiatives have been recently very slow, investing in behavioral change programs through mass communication seems deliberately prudent. Social implications Investing in behavioral change programs and promoting sexual and reproductive health education would improve women’s social well-being. Originality/value This is the first-ever effort to examine the influence of the socio-religious values on family planning use among Rwandan fecund women.

Background: Family planning services have traditionally targeted women. However, there is recognition that reproductive health is the joint responsibility of men and women. Given that men often have significant influences on a couple‘s contraceptive use, male participation is crucial to the success of family planning programs and associated with better outcomes in reproductive health. While there are many possible factors affecting male participation in contraceptive, there is a lack of empirical studies supporting it in Indonesia. This study aimed to investigate the perception and attitude of husbands toward male participation in family planning in Colomadu, Karanganyar, Central Java, Indonesia. Subjects and Method: This was a qualitative study with phenomenology approach, conducted at Bolon Village, Colomadu, Surakarta, Central Java. A total of 5 husbands was selected purposively. The dependent variable was male participation in using contraceptive. The independent variables were perception and attitude. The data were collected by indepth interview and direct observation. The data were analyzed descriptively. Results: Generally, there were differences in perception and attitude based on the knowledge of husband. Most husbands felt sorry for the side effects of contraceptive use that their wives experienced. Husbands had positive attitude towards male participation in contraceptive use if it were offered voluntarily without coercion. Husbands had positive perception on male participation in family planning program as it might reduce the inadvertent risk of wives posed by contraceptive use. Conclusion: Husbands have positive perception and attitude towards male participation in family planning, although there actual participation in contraceptive use remains low. Keywords: male participation, family planning, contraceptive use, perception, attitude

This scoping review aimed to understand the extent and type of evidence in relation to sexual and reproductive health needs of women with severe mental illness (SMI) in low- and middle-income countries (LMIC) and to summarise those needs. Inclusion criteria were 1) focus on sexual and reproductive health needs 2) women or girls with SMI, professionals, caregivers of women with SMI and community members 3) study set in a LMIC 4) peer reviewed literature (no restriction on study date or design). Studies were identified from comprehensive searches of Medline, EMBASE, CINAHL and PsycINFO (to July 2023). The review included 100 papers. Most studies were cross-sectional and set in hospital outpatient departments. Only 20 of 140 LMIC countries were included in this review and only 15 studies were set-in low-income countries (LIC). Included studies often had multiple focus areas and were grouped by frequency of topic into categories of HIV (prevalence, risk behaviour and knowledge), other sexually transmitted infections (STIs), sexual function, contraception use and family planning, sexual violence, fertility, pregnancy and postpartum. Included studies indicated women with SMI have worse outcomes and worse sexual and reproductive health compared to both women without SMI and men with SMI. Women with SMI were shown to have higher rates of HIV and low levels of contraception knowledge and use, with little advice offered by professionals. This review highlights the need for a greater diversity of study methodology, robustness of ethical and consensual reporting when researching vulnerable populations and for further research on interventions and models of care aimed at addressing stigma, discrimination and improving the sexual and reproductive health of women with SMI. Future research should better represent the breadth of LMIC, investigate cultural adaptability of interventions and consider sexual health needs across the life course.

CONTEXT: Rwanda is the most densely populated country in Africa, with substantial annual population growth. The current government seeks new policies for family limitation as a way to facilitate more sustainable development. METHODS: Data from the 2005 Rwanda Demographic and Health Survey were used for a two-step analysis; binary logistic regression was used to identify factors associated with desiring to stop childbearing and having unmet need. RESULTS: Eighty-seven percent of women aged 15-49 approve of family planning, but only 64% believe that their partner approves of it. There is a high level of unmet need for family limitation; 58% of women who want to stop child-bearing do not use modern contraceptives. Demand was lower among women who did not approve of family planning, those who did not know their partner's attitude toward family planning and those who had discussed family planning with their partner fewer than three times. Unmet need was higher among women who did not approve of family planning, those who believed their partner did not approve of family planning or who did not know his attitude, and those who had never discussed family planning with their partner or had done so only once or twice. CONCLUSIONS: Negative attitudes toward family planning and failing structures of provision are the dominant constraints on the use of modern contraceptives in Rwanda. Community-based family planning services could greatly expand access, especially in underserved provinces. International Perspectives on Sexual and Reproductive Health, 2009,35(3):122-130 ********** Rwanda faces serious development problems. A high population growth rate--2.5% a year in the period 2000-2005--is one of them. The vast majority of the country's nine million inhabitants live in rural areas, and 90% of the population work in agriculture. The country has the highest population density in Africa (350 persons per square km) and, with a gross domestic product of USS250 per capita in 2005, it belongs to the group of very low-income countries. (1) The country's high population growth contributes to continuing pressure on natural resources, particularly land, which is thought to be one of the underlying causes of the ethnic tensions that contributed to the killing of 800,000 Rwandans in 1994. (2) The country achieved an impressive economic growth rate (6%) in 2000-2006; however, during the same period, the number of poor people increased by half a million. (1) Population issues have been on the government's agenda since 1981, when the National Office of Population (ONAPO) was created. Between 1981 and 1990, ONAPO focused on improving access to family planning services and promoting family planning through trained communicators known as abakangurambaga (awakeners of the people). (3) In 1990, ONAPO's activities were intensified when it began to provide modern contraceptives throughout the country; at this time, family planning became part of a broader national development policy that was aimed at increasing agricultural production, improving public health, and promoting the education, employment and empowerment of women. Development efforts in these fields were expected to create an environment favorable to behavioral changes that would result in lower fertility; (4) the aim was to reduce the total fertility rate from 8.6 to 4.0 and to raise the contraceptive prevalence rate from 2% to 48% by 2000. (5) Implementation of the various policies facilitated a significant increase in the use of contraceptives: In 1983, only 11% of the population used contraceptives, while in 1992 the figure was 21% (Table l). (6-9) TABLE 1. Trends in fertility and demand for contraception among all fecund women in Rwanda, 1983, 1992, 2000 and 2005 Indicator 1983 1992 2000 2005 Total fertility rate 8.5 6.2 5.8 6.1 Ideal no. …

Impressive reductions of up to 29% in maternal deaths may be expected from satisfying unmet need for contraception as shown in a recent analysis covering 172 countries (Ahmed et al. 2012). Despite the cost-effectiveness of family planning (Prata et al. 2010) investments remain low (Osotimehin 2012) a concern declared under Goal 5 on the UN Millennium Development Goals website ‘Inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health.’ Alongside investment and political commitment clear indicators for the coverage and quality of family planning services are required to design and implement strategies to improve family planning. However the evidence used in planning and monitoring of family planning is often suboptimal and poses a serious problem for effective efficient responses to scale up these services. The 2012 London Summit on Family Planning signalled renewed interest in this important intervention by the global community. Large investments were pledged and ambitious targets of access to contraception for 120 million women and girls by 2020 were set. This has also prompted the Alliance for Reproductive Maternal and Newborn Health to work with WHO and development partners to facilitate a prioritisation of the family planning research agenda. With a view to informing these discussions we were commissioned by the Australian Agency for International Development (AusAID) to identify the key knowledge gaps for evidence-based planning and budgeting for family planning. As part of a multicountry initiative working with policy makers to effect a more rational use of resources for reproductive maternal newborn and child health (Jimenez-Soto et al. 2012) we collated the data necessary to inform local decision-making on scaling up family planning services. Our work highlighted major evidence gaps that have the potential to undermine efforts to plan and invest in family planning and interfere with monitoring progress. The seven leading knowledge gaps identified are outlined in this short paper and provide an essential ‘front-line’ perspective to inform research priorities for effective scaling-up of family planning. We draw on examples from our study sites in four countries: two districts and two cities in Indonesia two provinces and one city in the Philippines three clusters of districts in Nepal two districts in the Indian state of Orissa and two districts in the state of Uttar Pradesh. We believe that this view from the front line provides a much-needed link between global agendas and the realities of implementation at a local level. (excerpt)

During the COVID-19 pandemic, all activities are carried out online. One of them is the provision of information on Family Planning and Reproductive Health which must be provided to supervise family planning acceptors so that they do not experience discontinuation of contraceptive use. This study aimed to evaluate the provision of information on Family Planning and Reproductive Health provided online to the public. This study used a One-Shot Case Study design. The intervention given was the provision of contraceptive information through the WhatsApp group. The research sample was married women aged 15-49 years who used the pill and injection contraception in Lebak District. The number of samples in this study was 94 respondents. In this study, about 11% of married women stated that they had difficulty accessing contraceptive services during the COVID-19 pandemic. After being given information on Family Planning and Reproductive Health through WhatsApp groups, 66% of respondents stated that the intervention provided increased knowledge about contraception, 18% complained about the use of quotas, 6.4% stated that they could not understand because they were used to face-to-face. This study also explored information about suggestions for contraceptive service programs, namely 14.9% expects services and providing information on Family Planning and Reproductive Health to be carried out face-to-face and 12.8% recommended free contraceptive services. Conclusion. Providing information on Family Planning and Reproductive Health online is an alternative during the COVID-19 pandemic. However, during contraceptive services, health workers still directly provide information as needed. Information on payment for contraceptive services using health social security agency must be provided to acceptors and contraceptive service activities funded by the national family planning coordinating board must also be informed to increase the coverage of contraceptive use.

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

Canadian Contraception Consensus (Part 2 of 4).

Canadian Contraception Consensus (Part 1 of 4).

This AIDS supplement brings to the forefront the latest advances in family planning/HIV integration research programs and policy. It also offers insights into strategic directions for future investments in this area. Topics include: biomedical and basic science research on the relationship between reproductive health and HIV transmission and disease behavioral research examining contraceptive practices and fertility choices among women and couples affected by HIV implementation science evaluating integrated service delivery innovations and evidence-based recommendations for programming.

The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth. The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols.

Implementing a Natural Family Planning Program: The Case of The Metropolitan Archdiocese of Cagayan De Oro

The COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the pandemic has been viewed as a homogenous event without recognising its troughs and waves or disentangling effects of response measures such as lockdowns from the pandemic itself. As the pandemic continues, neglected SRH services like those targeting GBV need to be urgently scaled up, and those being implemented with any adaptations should be rigorously tested.

Nigeria has played significant role in the economy for sustainability growth and development in Africa. However, the outbreak and spread of the Covid-19 has affected the small and Medium Scale Enterprises (SMEs), the basic unit of economic expansion. As the pandemic continues to ravage the country, SMEs are struggling to survive due to decline in the volumes of production and harsh market condition increase with its severe effects on the population. This study intends to investigate the sound effects of the COVID-19 lockdown on small business owners in Akoko South West Local Government Area of Ondo State, Nigeria. The research method employed is a descriptive research design of the survey type. The choice of this method is based on the fact that it focuses on people, event or phenomenon. The population for this study consisted of small business owners and simple random sampling techniques was used to select the respondents from five (5) communities under Akoko South West Local Government Area of Ondo State, Nigeria. The study area is given academic attention due to strategic location for socio-economic advancement. The data collected were analysed using descriptive and inferential statistics. Frequency counts and percentage were used on the three research questions raised while chi-square was used on the two hypotheses. The findings of this study revealed that in hypothesis one, there are no significant effects of the Covid-19 lockdown on small business owner, because the p-value of each of the items is less than 0.05 (p&lt;0.05) and, therefore, rejected. To inferred that there is a significant effect of the Covid-19 lockdown on small business owner, the hypotheses two revealed that there was no significant difference in the opinion of male and female business owners on the effects of the Covid-19 lockdown on small business owners (t (148) = 1.103; p&gt;0.05). Therefore, the effects of the Covid-19 lockdown on small business owners were not rejected.