Multivariate Adaptive Regression Splines for Contraceptive Use

Trends and predictors of modern contraceptive use among married women: Analysis of 2000–2016 Ethiopian Demographic and Health Surveys

Changes in contraceptive method use, access, and experiences of care during a statewide contraceptive initiative.

Despite its documented benefits, contraceptive use among adolescents remains low, particularly in low-and middle-income countries. This study aimed to decompose the main factors contributing to the changes in contraceptive use among adolescent girls in Zambia over the period 1996 to 2014. Data on adolescent girls aged 15-19 years from Zambia Demographic and Health Survey data were analysed using multivariate decomposition analysis of change. Stata 15/MP (Stata-Corp LLC) was used for analysis, at a 95% confidence level. A P-value of 0.05 was used to determine statistical significance. The sample included 9,072 adolescent girls. Contraceptive use increased by 3% from 7.6% in 1996 to 10.6% in 2013/14. Change in modern contraceptive use among adolescents was mainly due to differences in coefficients (changes in population behaviour). Increases in age contributed to the change in contraceptive use, resulting in 2.94 and 9.33% increases for 17- and 18-year-olds respectively. Marriage or living with a partner contributed the largest change (44%) while living in a rural area accounted for approximately 20%. Interventions targeting improving contraceptive use in adolescents should be responsive to the needs of various age groups, places of residence, and educational levels for maximum benefits.

The 2012 implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive coverage mandate removed financial barriers to contraception access for many insured women. Since that time, increases in sexually transmitted disease (STD) rates have been noted, particularly among Black adolescent and young adult women aged 15 to 24 years. It is unclear whether changes in dual-method contraception use (simultaneous use of nonbarrier contraceptive methods and condoms) are associated with the increase in STD rates. A repeated cross-sectional analysis was conducted among adolescent and young adult women to compare pre-ACA data from the 2006-2010 cohort and post-ACA data from the 2013-2015 cohort of the National Survey for Family Growth. A significant decrease in short-acting reversible contraception use (SARC; 78.2% vs. 67.5%; p < .01) and a significant increase in long-acting reversible contraception use (LARC; 8.9% vs. 21.8%; p < .01) were found, but no significant change in dual-method contraception use was found among pre- versus post-ACA SARC users and SARC nonusers (odds ratio [OR]: 1.88, 95% confidence interval [CI]: 0.64-5.46, p = .25), LARC users and LARC nonusers (adjusted odds ratio [AOR]: 1.62, 95% CI: 0.42-6.18, p = .48), or White and Black women (AOR: 1.45, 95% CI: 0.66-3.18, p = .35). There was no direct association between changes in contraception use and decreased condom use and therefore no indirect association between changes in contraception use and increased STD rates. Health care providers should continue promoting consistent condom use. Additional research is needed to understand recent increases in STD rates among Black women in the post-ACA era.

This paper examines changes in young women's contraceptive use over nine years in relation to a range of reproductive life events using longitudinal data from the Australian Longitudinal Study on Women's Health (ALSWH). Little previous research has examined changes in young women's contraceptive use after significant reproductive or health life events. Some research has examined the reasons that women might discontinue contraceptive use in general and there has been some work investigating contraceptive use after the birth of a child and after the termination of a pregnancy. However other events may also cause a woman to re-evaluate her contraception, for example, the diagnosis of an STD, or having an abnormal pap test. The Australian Longitudinal Study on Women's Health is a broad-ranging project which examines relationships between many biological, physiological, social and lifestyle factors and women's physical health, emotional well-being, and use of and satisfaction with health services. Women were selected from the Medicare database which includes all citizens and permanent residents using stratified random sampling, with systematic over-sampling of women from rural and remote areas. This paper presents data from 6716 women who completed a self-report survey in 1996 when they were aged 18-23, and again in 1999, 2002 and 2005. Multinomial analysis is used to explore patterns of contraceptive use before and after events related to pregnancy and birth (pregnancy, live birth, miscarriage and termination of pregnancy) and health (diagnosis with a sexually-transmitted infection and abnormal Pap test) and the factors associated with changes in contraceptive use. The ALSWH provides an exciting opportunity to examine patterns of contraceptive use over time among women of reproductive age.

Despite a vigorous national family planning program and such innovations as the Continuous Motivation System, there has been little change in contraceptive use in Pakistan in recent years. Data from the 1968-69 National Impact Survey and the 1975 World Fertility Survey for Pakistan show that, while use rates increased by a small amount in urban areas, the rates in rural areas seem to have declined. Even in urban areas contraceptive use is low in comparison with other developing countries that began family planning programs around the same time. Although this is probably due to differences in economic development, further investigation of program structure and inputs is recommended.

IntroductionAccessing family planning can reduce a significant proportion of maternal, infant, and childhood deaths. In Ethiopia, use of modern contraceptive methods is low but it is increasing. This study aimed to analyze the trends and determinants of changes in modern contraceptive use over time among young married women in Ethiopia.MethodsThe study used data from the three Demographic Health Surveys conducted in Ethiopia, in 2000, 2005, and 2011. Young married women age 15–24 years with sample sizes of 2,157 in 2000, 1,904 in 2005, and 2,146 in 2011 were included. Logit-based decomposition analysis technique was used for analysis of factors contributing to the recent changes. STATA 12 was employed for data management and analyses. All calculations presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance.ResultsAmong young married women, modern contraceptive prevalence increased from 6% in 2000 to 16% in 2005 and to 36% in 2011. The decomposition analysis indicated that 34% of the overall change in modern contraceptive use was due to difference in women’s characteristics. Changes in the composition of young women’s characteristics according to age, educational status, religion, couple concordance on family size, and fertility preference were the major sources of this increase. Two-thirds of the increase in modern contraceptive use was due to difference in coefficients. Most importantly, the increase was due to change in contraceptive use behavior among the rural population (33%) and among Orthodox Christians (16%) and Protestants (4%).ConclusionsModern contraceptive use among young married women has showed a remarkable increase over the last decade in Ethiopia. Programmatic interventions targeting poor, younger (adolescent), illiterate, and Muslim women would help to maintain the increasing trend in modern contraceptive use.

Family planning is an important service for preventing maternal deaths. A 3-year project on children and maternal health was conducted in suburban areas of the Diyarbakir province of Turkey. In this project, volunteer women told women resident in the area about family planning as well as other maternal and child health-related subjects. Within 3 years, all women were visited at least five times and changes in contraceptive use were recorded. A cross-sectional study was planned to understand the factors affecting contraceptive use in grand multiparous women. A total of 200 grand multiparous women were selected from visit cards and various characteristics of these women were evaluated. Odds ratios and 95% confidence intervals were calculated using logistic regression analyses. The use of contraceptives had increased from 33.5% to 59.5% by the end of the 3 years in the 200 women. The main factors affecting contraceptive use were misconceptions and concerns about health-related risks, having a child younger than 14 years working outside the home to contribute to the household income, religious opposition, a gap between the desired and actual number of sons, number of previous deaths of children and discussion with the husband about family planning.

Effect of US policies on women's health worldwide

IntroductionKenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.MethodsWe use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.ResultsThere was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993–1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.ConclusionThe narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.

One strategy for meeting the contraceptive needs of HIV-positive women is to integrate family planning into HIV services. In 2008 in Cross River State, Nigeria,family planning was integrated into antiretroviral (ART) services in five local government areas. A basic family planning/HIV integration model was implemented in three of these areas, and an enhanced model in the other two. We conducted baseline interviews in 2008 and follow-up interviews 12-14 months later with 274 female ART clients aged 18-45 in 2009 across the five areas. Unmet need for contraception was high at baseline (28-35 percent). We found that modern contraceptive use rose in the enhanced and basic groups; most of the increase was in consistent condom use. Despite an increase in family planning counseling by ART providers, referrals to family planning services for noncondom methods were low. We conclude by presenting alternative strategies for family planning/HIV integration in settings where large families and low contraceptive use are normative.

In July 2012, the London Summit on Family Planning reenergized the reproductive health field by establishing a new commitment to bring modern contraception to women and girls with an unmet need for family planning—those who say they do not want a child soon or at all but are not currently using contraception. At that time, it was estimated that 222 million women in the developing world had an unmet need for modern contraception.1 Most of these women were concentrated in the world's 69 poorest countries.2 The family planning community committed at the Summit to enabling an additional 120 million women in these 69 countries to use modern contraception by 2020.2–4 The community felt that designating a single number would help rally the community and push forward a renewed focus on family planning.3 Nearly 5 years later, the widely recognized “120 by 20” goal supported by the Family Planning 2020 (FP2020) global partnership can be credited for galvanizing renewed commitment to family planning. However, the new metric of “additional users”—an aggregate metric that estimates how many more modern contraceptive users there are now compared with the estimated 2012 baseline number—has created confusion about the definition and meaning of several other related family planning metrics, including “new users,” “acceptors,” “first-time users,” and “adopters.” It has also raised the question of how service-level metrics collected by programs can be linked to the aggregate concept of “additional users” to assess progress of individual programs toward population changes in contraceptive use at the country level. In this article, which follows from a panel discussion among the 4 coauthors held during the 2016 International Conference on Family Planning, we outline several of the metrics currently used to measure family planning program progress and propose a preferred set of service-level metrics to inform contributions to the FP2020 aggregate-level goal of reaching “additional users.” We also describe 2 approaches—Track20's Family Planning Estimation Tool (FPET) and Marie Stopes International's Impact 2 model—for bridging the gap between service-level measures available in programs' routine service statistics and the aggregate metric of additional users. Finally, we draw attention to the need for more robust data collection systems that allow for the collection of harmonized routine longitudinal metrics rather than focusing solely on visit-based service statistics or cross-sectional household surveys.

BackgroundPrevious literature suggests that men reporting more gender-equitable attitudes are more likely to use condoms, but there is a paucity of data evaluating whether these attitudes are associated with contraceptive communication and use. The objective of this study is to test the hypothesis that men reporting more gender-equitable attitudes will be more likely to (a) engage in contraceptive communication with their wives and (b) that they and/or their wives will be more likely to use all forms of family planning, compared to men with less equitable attitudes. MethodsUsing cross-sectional dyadic survey data from young married couples from rural Maharashtra, India (N = 989), we assessed the associations between men's gender role attitudes and a) spousal contraceptive communication and b) contraceptive use by type (none, traditional, condoms, pills, or IUD). The contraceptive use outcome is based on wives' report. We assessed these associations via bivariate t-test (communication outcome) or ANOVA test (contraceptive type outcome), as well as unadjusted and adjusted logistic (communication outcome) and multinomial logistic (contraceptive type outcome) regression models. Adjusted models included sociodemographic factors selected a priori based on established associations with gender-equitable attitudes and/or our assessed outcomes. FindingsMen with more gender-equitable attitudes were more likely to discuss family planning with their wives (AOR = 1·05, 95%CI 1·03-1·07, p < 0·001) and to use condoms (ARRR = 1·03, 95%CI 1·00-1·06, p = 0·07). There was no association between gender-equitable attitudes and use of other types of contraception. InterpretationWhile gender-equitable attitudes among men may facilitate condom use and family planning communication in marriage, they do not appear to be linked with greater likelihood of use of more effective types of contraceptive use. This suggests that males supportive of gender equity may take greater responsibility for family planning vis a vis a less effective contraceptive, condoms, in the absence of more effective short-acting contraceptives for men. FundingThe National Institutes of Health [Grant number 5R01HD084453-01A1] and the Bill & Melinda Gates Foundation, Seattle, WA [grant number INV-002967].

Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey

Family planning is an important service for preventing maternal deaths. A 3-year project on children and maternal health was conducted in suburban areas of the Diyarbakir province of Turkey. In this project,volunteer women told women resident in the area about family planning as well as other maternal and child health-related subjects. Within 3 years, all women were visited at least five times and changesin contraceptive use were recorded. A cross-sectional study was planned to understand the factors affecting contraceptive use in grand multiparous women. A total of 200 grand multiparous women were selectedfrom visit cards and various characteristics of these women were evaluated. Odds ratios and 95% confidence intervals were calculated using logistic regression analyses. The use of contraceptives had increasedfrom 33.5% to 59.5% by the end of the 3 years in the 200 women. The main factors affecting contraceptive use were misconceptions and concerns about health-related risks, having a child younger than 14 yearsworking outside the home to contribute to the household income, religious opposition, a gap between the desired and actual number of sons, number of previous deaths of children and discussion with the husbandabout family planning.