Adoption Of Modern Contraception Research Articles

Barriers to modern contraceptive utilization in Ethiopia.

Contraception is a critical service for women to control their reproductive health, allowing them to determine the number and spacing of their children prevent unintended pregnancies, reduce the risk of morbidity and mortality from associated with childbirth, and reduce the likelihood of abortions. Despite its benefits, the utilization of modern contraceptive methods remains low in certain regions of Ethiopia, Particularly in Afar and Somali, which are also experiencing high fertility rates. However, there is a substantial gap in understanding the sociocultural barriers that hinder the adoption of modern contraception in these regions. This study aims to explore these barriers to contraceptive use among women of reproductive age in Afar and Somali regions, providing qualitative insights that are essential for designing effective strategies to improve contraceptive service utilization. Asequential mixed method approach was employed, including scoping review and qualitative interviews. Scoping review focused on qualitative or mixed-methods studies conducted in Ethiopia and published between 2013 and 2023 in English, Selecting 14 articles Additionally, qualitative data were collected from Afar and Somali regions through In-depth interviews with women aged 15-49 who are married or in consensual union, and key informant interviews with health extension workers and contraception providers at health center. A total of 20 in-depth interviews and 07 key informants were conducted. Thematic analysis was used to analyze the data. The integrated findings from the scoping review and qualitative study reveal various barriers and determinants influencing contraceptive use among women in Ethiopia. Barriers includes religious or cultural beliefs, myths and misconceptions, fear of side effects, lack of knowledge and misinformation, negative attitude towards contraceptives, partner opposition, socio-cultural factors, fear of being judged by family and friends, and lack of communication between husband and wife, husband altitude, distance from health facility, availability of service and different contraceptive choice, separate room for family planning services, and cost of contraceptive method and transportation. The scoping review corroborates these findings, emphasizing on the role of socio-demographic, economic, cultural, religious, health service, and knowledge-related factors. Higher education, urban residence, higher income, mass media exposure, spousal communication, family size, and access to quality health services were associated with increased utilization, while lack of awareness, misconceptions, myths, side effects, fear of infertility, partner opposition, social stigma, and cultural norms decreased utilization. The study recommended promoting contraceptive use, challenging socio-cultural norms through Social Behavioural Communication and Counselling (SBCC), engaging partners and community members, and improving the quality of care.

Examining the linkages between maternity services and postpartum modern contraceptive adoption among young women in India: Insights from the 2015-16 and 2019-21 National Family Health Survey.

The adoption of maternity services and postpartum modern contraception are the two most crucial components that help in reducing maternal and infant mortality; still, India is consistently struggling with it. This paper, therefore, aimed to examine the linkages between use of maternity services and postpartum modern contraceptive adoption. The required reproductive calendar data were extracted from the 2015-16 and 2019-21 National Family Health Survey (NFHS) datasets. The assessment was made based on a sample of currently married women aged 15-24 years who had given most recent childbirth in five years preceding the survey. For the analysis, a time-to-event approach was applied using the Kaplan-Meier survival statistic, Log-Rank Chi-square test and Cox-Proportional Hazard (Cox-PH) models. The results revealed that the proportion of postpartum modern contraceptive uptake among young users increased by 9%, from 33% in 2015-16 to 42% in 2019-21. The Cox-PH models revealed that, in both NFHS waves, the associations between various components of maternity services and postpartum modern contraceptive uptake were strongly significant, even after controlling for selected socio-economic and demographic correlates. The findings of this study reinforced urgent need for implementing integrated maternal-child health and family planning programmes and for boosting effective family planning counselling by health professionals to promote and motivate young women with a desire to early adoption of modern contraception in subsequent months after a recent childbirth.

Service delivery point and individual characteristics associated with the adoption of modern contraceptive: A multi-country longitudinal analysis.

BackgroundWomen who start using contraception (“adopters”) are a key population for family planning goals, but little is known about characteristics that predict the adoption of contraception as opposed to current use. We used prospective data from women and facilities for five countries, (Democratic Republic of Congo, India, Kenya, Nigeria, and Burkina Faso) and identified baseline characteristics that predicted adoption of modern contraception in the short term.MethodsWe used data from the Performance Monitoring for Action (PMA) Agile Project. PMA Agile administered service delivery point (SDP) client exit interview (CEI) surveys in urban sites of these five countries. Female clients responding to the CEI were asked for phone numbers that were used for a phone follow-up survey approximately four months later. For our analysis, we used data from the SDP and CEI baseline surveys, and the phone follow up to compare women who start using contraception during this period with those who remain non-users. We used characteristics of the facility and the woman at baseline to predict her contraception adoption in the future.ResultsDiscussing FP with a partner at baseline was associated with greater odds of adoption in DRC (OR 2.34; 95% CI 0.97–5.66), India (OR 2.27; 95% CI 1.05–4.93), and Kenya (OR 1.65; 95% CI 1.16–2.35). Women who discussed family planning with any staff member at the health facility had 1.72 greater odds (95% CI 1.13–2.67) of becoming an adopter in Nigeria. The odds of adoption were lower in Nigerian facilities that had a stockout (OR 0.66 95% CI 0.44–1.00) at baseline. Other characteristics associated with contraception adoption across settings were education, age, wealth, parity, and marital status.ConclusionsCharacteristics of both the woman and the health facility were associated with adoption of modern contraception in the future. Some characteristics, like discussing family planning with a spouse, education, and parity, were associated with contraceptive adoption across settings. Other characteristics that predict contraceptive use, such as health facility measures, varied across countries.

Women’s bargaining power and contraception use in post-Soviet Tajikistan

ABSTRACT This article aims to examine the relationship between women’s household bargaining power and their adoption of modern contraception in post-Soviet Tajikistan using the 2012 Demographic and Health Survey. The study uses direct measures of bargaining weights: a woman’s ability to make decisions about her own health care; visits to her family or relatives; and contraceptive use. An additional measure defining a woman’s financial capability to receive medical treatment for herself is added in the analysis to understand its correlation to women’s contraceptive-use behaviour. The probability of using contraception is 187 percentage points higher for a woman who has both control over her own health care and financial means to get medical help than a woman who does not have these choices. Having a say in the decision to control births increases the probability of using contraception by 98 percentage points. Our findings reveal that certain aspects of a woman’s household decision-making and financial freedom are relevant to explain her contraceptive-use behaviour.

Effect of integrating postpartum family planning into the health extension program in Ethiopia on postpartum adoption of modern contraception.

Ethiopia has large unmet need for contraception among postpartum women. Community-level services may improve postpartum contraceptive use in Ethiopia and other contexts where home childbirth is common. This study estimated the additional effect of systematically integrating messages on postpartum family planning (PPFP) into community contacts with pregnant and postpartum women, on top of integrated facility contacts. The quasi-experimental study was conducted in two districts in Oromia Regional State and used a controlled trial design with random assignment of primary health care units-a health center and surrounding health posts-to intervention and comparison arms. We used the log-rank test and fitted a multivariate Cox proportional hazards regression model to estimate the adjusted hazard ratio (adjHR) and 95% confidence interval (95% CI) for differences in contraceptive uptake by arm. Time from delivery to uptake of modern contraception was the outcome variable. We separately analyzed subsets of women by place of delivery, as this variable interacts with the study arm. A total of 772 pregnant women were enrolled February-March 2017 and re-interviewed 15 months later (May 2018). Loss to follow-up was 10% in intervention, 7% in comparison areas. Among women who delivered at home, there was higher PPFP adoption by one year postpartum in the intervention arm (35.2%, 95% CI: 28.8-42.4%) versus comparison arm (27.8%, 95% CI: 22.2-34.4%). In the adjusted Cox regression model, women who delivered at home in the intervention arm were 45% more likely to adopt contraception (adjHR1.45, CI: 1.01-2.07). There was no difference by arm for women who delivered in a facility. Integrating PPFP into community-level services for pregnant and postpartum women and infants may have additional benefit on top of PPFP services at facilities. The intervention benefited women who delivered at home, an important target population in countries like Ethiopia, where many women do not deliver in a facility. This study, implemented under real world conditions, informs the PPFP body of evidence and fills a gap in research on the contribution of community-based PPFP in contexts where services are integrated within maternal, newborn, and child health care in facilities.

The predictive utility of unmet need on time to contraceptive adoption: a panel study of non-contracepting Ugandan women

ObjectiveThe predictive utility of the unmet contraceptive need indicator is not well known, despite being recognized as a key family planning indicator for showing the extant demand for birth control. This study assesses the dynamic influence of unmet need on time to contraceptive adoption, as compared with that of contraceptive intentions and their concordance. Study designThis observational study analyzed survey data, including a contraceptive calendar, reported by a panel of 747 non-contracepting, fecund and sexually active Ugandan women, first interviewed in a 2014 national survey and re-interviewed in 2018. We conducted descriptive, survival and multivariate Cox regression analysis of the influence of women's baseline measures of unmet need, self-reported intention to contracept and their concordance with time to adoption of modern contraception over 36 months. ResultsThe study found women classified as having unmet need were slower to adopt contraception than those without unmet need, after adjustment for background covariates (aHR=0.79, 95% CI=0.57–1.10). Women intending future contraceptive use were significantly faster to adopt (aHR=1.45, 95% CI=1.22–1.73) than those not intending. Women with no unmet need but intending to use had the highest rate of adoption compared to those with no need and no intention to use (aHR=2.78, 95% CI=1.48–5.25). ConclusionsThe unmet need indicator underperforms in predicting future contraceptive adoption compared to contraceptive intentions, which merits further consideration as a complementary predictor of future use. Non-contracepting women with unmet need but no intention to use contraception in particular warrant programmatic attention. ImplicationsA non-contracepting woman wanting to limit or space her births is defined as having unmet need, but little is known if she subsequently adopts contraception. By contrasting a woman's unmet need with her expressed intention to use, we offer reasons to further consider self-reported contraceptive intentions as a better predictor of adoption and the underlying latent demand for volitional regulation of fertility.

Are stage-based health information messages effective and good value for money in improving maternal newborn and child health outcomes in India? Protocol for an individually randomized controlled trial

BackgroundEvidence is limited on the effectiveness of mobile health programs which provide stage-based health information messages to pregnant and postpartum women. Kilkari is an outbound service that delivers weekly, stage-based audio messages about pregnancy, childbirth, and childcare directly to families in 13 states across India on their mobile phones. In this protocol we outline methods for measuring the effectiveness and cost-effectiveness of Kilkari.MethodsThe study is an individually randomized controlled trial (iRCT) with a parallel, partially concurrent, and unblinded design. Five thousand pregnant women will be enrolled from four districts of Madhya Pradesh and randomized to an intervention or control arm. The women in the intervention arm will receive Kilkari messages while the control group will not receive any Kilkari messages as part of the study. Women in both arms will be followed from enrollment in the second and early third trimesters of pregnancy until one year after delivery. Differences in primary outcomes across study arms including early and exclusive breastfeeding and the adoption of modern contraception at 1 year postpartum will be assessed using intention to treat methodology. Surveys will be administered at baseline and endline containing modules on phone ownership, geographical and demographic characteristics, knowledge, practices, respectful maternity care, and coverage for antenatal care, delivery, and postnatal care. In-depth interviews and focus group discussions will be carried out to understand user perceptions of Kilkari, and more broadly, experiences providing phone numbers and personal health information to health care providers. Costs and consequences will be estimated from a societal perspective for the 2018–2019 analytic time horizon.DiscussionKilkari is the largest maternal messaging program, in terms of absolute numbers, currently being implemented globally. Evaluations of similar initiatives elsewhere have been small in scale and focused on summative outcomes, presenting limited evidence on individual exposure to content. Drawing upon system-generated data, we explore linkages between successful receipt of calls, user engagement with calls, and reported outcomes. This is the first study of its kind in India and is anticipated to provide the most robust and comprehensive evidence to date on maternal messaging programs globally.Trial registrationClinicaltrials.gov, 90075552, NCT03576157. Registered on 22 June 2018.

‘Two children to make ends meet’: the ideal family size, parental responsibilities and costs of children on two sides of the Iron Curtain during the post-war fertility decline

One of the major corollaries of the post-war fertility boom and decline is that two-child families became common across Europe after the 1970s. Despite the general agreement on the convergence of fertility trends, there is still little understanding of how this change took place in a comparative perspective of Western and Eastern Europe, which at that time were characterised by Cold War tensions of different ideological regimes. This study addresses this aspect by focusing on individual decisions around childbearing, child-rearing and family size. Based on 104 oral histories from Switzerland and Ukraine, this study illuminates that the urban setting provided parents with a similar set of constraints and opportunities, which eventually resulted in strikingly similar perceptions of the costs of childrearing on two sides of the Iron Curtain. Individuals’ motives to postpone first birth in Switzerland and second birth in Ukraine rested on a similar aspiration to invest in the well-being of children by ensuring material security for the family. This aim was increasingly achieved through female labour-force participation and adoption of modern contraception – the pill in Switzerland and abortion in Ukraine. While the timing of returning to the labour market and the share of women working after entering parenthood might have varied across the two contexts, a good mother became increasingly defined in both contexts in terms of providing emotionally and financially for her children. Although the introduction of modern birth control methods allowed couples to plan family size more carefully, it also made Swiss and Ukrainian women increasingly carry the major costs and actual burden of birth control. Altogether, this study challenges the common assumption around the persistence of strikingly different demographic realities in post-war Western and Eastern Europe by uncovering the mechanisms behind the stabilisation of family size around the two-child family ideal.

Religion, Contraceptive Method Mix, and Son Preference Among Bengali-Speaking Community of Indian Subcontinent

This paper examines the influence of religion on contraceptive method mix in the context of son preference among Bengali-speaking population of eastern India (i.e., West Bengal and Tripura) and Bangladesh. In spite of cultural similarity and parallel programmatic approach to family planning in these two distinct geopolitical spaces, differential use of contraception is evident. Using National Family Health Survey (2005–2006) and Bangladesh Demographic Health Survey (2007) and by employing sequential logit model, the paper finds evidence of latent son preference in adoption of modern contraception in Bengali-speaking Hindu and Muslim communities of eastern India. However, such practice is observed only among Hindus in Bangladesh. The paper further argues that although diffusion of the culture of son preference cuts across religious groups among Bengali-speaking community in eastern India, religious identity dominates over region in Bangladesh, encouraging minority Hindus to adopt a distinct pattern of contraceptive behavior with reference to sons. Such finding calls for further research in understanding the pros and cons of behavioral diffusion in majority–minority population mix in similar tradition and culture.

Contraception and the Fertility Transition

Three profound changes -- the mortality, fertility and contraception transitions -- characterized the Victorian era in England. Economists, following Becker (1960), focus on the first two and underplay the third by assuming couples can achieve their fertility target at no cost. The historical experience from Victorian England is at odds with this view of costless fertility regulation. We incorporate costly fertility limitation into the Becker paradigm: in our story, the mortality transition spurs on a contraception revolution which, in turn, makes it possible for the fertility transition to arrive. In the model, generationally-linked households with heterogeneous income choose between two contraception strategies, one traditional, the other modern. The modern comes with a higher fixed cost (reflecting social opposition and informational barriers characteristic of the times), but has a lower variable cost when it comes to averting childbirths. While the initial adopters of the modern technology are the rich -- those unfazed by the higher fixed cost -- eventually everyone switches so as to economize on the variable cost. What hastens theswitch is the decline in child mortality. Increased adoption of modern contraception unleashes a social diffusion process causing more people to switch, lowering fertility further and across all socioeconomic groups. The model is consistent with broad time-series and cross-sectional patterns ofthe English fertility transition.

Contraceptive social marketing in Albania – The NESMARK story

ABSTRACTObjectives To present the history of social marketing of modern contraceptives in Albania.Methods We review documentation and activity of NESMARK, an Albanian non-governmental social marketing organisation, and national data on adoption of modern contraception.Results During 15 years of awareness raising, sales of affordable products, and provider training, NESMARK has impacted the introduction and adoption of modern contraception in Albania. NESMARK is the country’s main distributor of emergency contraception (EC) and complements the public sector in the distribution of condoms and oral contraceptives. NESMARK has made major efforts to overcome prevalent taboos and misinformation held by medical and nursing personnel, pharmacists and the general public, regarding the effectiveness and safety of condoms, oral contraceptives, and EC.Conclusions NESMARK has contributed to increasing the choices for modern contraception methods in Albania by providing affordable contraceptives, training providers, and educating the general population. However, widespread use of withdrawal coupled with the belief that it is as or more effective than modern contraception, continues to limit uptake of new methods and is a significant challenge to comprehensive and sustained social marketing programmes.

Fertility, parental investment, and the early adoption of modern contraception in rural ethiopia

What triggers initial shifts to fertility limitation as populations undergo socioeconomic development remains poorly understood. Alternative models emphasize the social contagion of low fertility ideals, or the individual perception of economic and/or fitness benefits to fertility limitation. Few micro-level studies in communities experiencing the earliest stages of the demographic transition are available. In a previous study, we found little support for the role of social transmission through friendships and spatial networks in explaining contraceptive uptake in rural Ethiopia, where contraceptive prevalence is low (<20%). Here, using data from the same population, we investigate the possibility that early contraceptive uptake is best understood as a manipulation of parental investment in response to local environmental change. We used data on >800 women which recorded fertility, birth spacing and offspring survivorship. We first investigated whether ever-users and non-users differ in their reproductive behavior and success prior to contraception use. We then conducted a within-women analysis to investigate the impact of contraceptive uptake on reproduction and child survivorship. Women who have experienced higher fertility and higher child survival adopt modern contraception sooner rather than later, and contraceptive use among early adopters is predictive of greater birth spacing. However, contraceptive uptake does not have an impact on offspring survivorship. Our data provide support for the idea that preferences for low fertility emerge in response to increasing competition between offspring. The study has implications for our understanding of the emergence of local fertility norms and the spread of modern birth control.

Social transmission and the spread of modern contraception in rural Ethiopia.

Socio-economic development has proven to be insufficient to explain the time and pace of the human demographic transition. Shifts to low fertility norms have thus been thought to result from social diffusion, yet to date, micro-level studies are limited and are often unable to disentangle the effect of social transmission from that of extrinsic factors. We used data which included the first ever use of modern contraception among a population of over 900 women in four villages in rural Ethiopia, where contraceptive prevalence is still low (<20%). We investigated whether the time of adoption of modern contraception is predicted by (i) the proportion of ever-users/non ever-users within both women and their husbands' friendships networks and (ii) the geographic distance to contraceptive ever-users. Using a model comparison approach, we found that individual socio-demographic characteristics (e.g. parity, education) and a religious norm are the most likely explanatory factors of temporal and spatial patterns of contraceptive uptake, while the role of person-to-person contact through either friendship or spatial networks remains marginal. Our study has broad implications for understanding the processes that initiate transitions to low fertility and the uptake of birth control technologies in the developing world.

MEN’S SOCIAL NETWORKS AND CONTRACEPTION IN GHANA

In this paper, longitudinal data from northern Ghana is used to assess the effects of encouragement to use family planning that men receive from their personal network partners on the adoption of modern contraception by their wives. The study tests a conceptual model that, in addition to the effect of men's network encouragement, incorporates the effect of encouragement to use family planning that women receive from their respective network partners and the effect of spousal communication on reproductive matters and approval of family planning. Results show that encouragement received by men from their social networks significantly increases the likelihood of subsequent contraceptive use by their wives but this effect operates primarily by galvanizing spousal communication on reproductive matters. The effect of encouragement received by women from their respective network partners is largely independent from the effect of male network encouragement but it influences contraceptive adoption both directly and through spousal communication.

Contraceptive practices in Armenia: Panel evaluation of an Information-Education-Communication Campaign

Induced abortion remains the major form of birth control among Armenian women, contributing to their excess mortality and preventable morbidity. Reliance on abortion is attributed to limited access to information concerning modern methods of contraception and to widely held misinformation among women regarding family planning and reproductive health. Based on the Steps to Behavior Change model, the Green Path Campaign for Family Health, an information-education-communication (IEC) campaign, was launched in June 2000. This multimedia campaign promoted greater awareness, knowledge, acceptance, and adoption of modern contraception through increased utilization of counseling and related services provided at underutilized family planning centers. A representative panel of 1088 married women aged 18–35 were surveyed on reproductive health/family planning knowledge, attitudes, and practices immediately prior to and immediately following the 6-month national campaign. Exposure to the campaign was associated with significant increases in factors associated with contraceptive behavior change: knowledge, favorable attitudes toward modern methods, favorable attitudes toward family planning services, and information seeking and utilization of family planning services. Women who were more educated, more affluent, and slightly older were more likely to use family planning services as well as modern contraceptive methods. New visits to family planning centers increased by 84%. Despite the usual 25% turnover among those using modern methods at the start of the study, use of modern contraceptive methods increased by 4.6%, significantly exceeding the projected 3% increase. The results document changes in underlying behavioral predictors consistent with the Steps to Behavior Change model and highlight the relatively untapped potential of media-based health promotion efforts in post-Soviet Republics.

Domestic Violence and Contraceptive Adoption in Uttar Pradesh, India

This study examines the association between domestic violence and the subsequent adoption of modern contraception in North India. Matched data on married couples who were not practicing contraception are analyzed from companion surveys of married husbands and wives in five districts of Uttar Pradesh. By means of hazard modeling, a significant negative association was found between a husband's reporting of using physical domestic violence against his wife and the couple's adoption of a modern method of contraception. Community norms that were more tolerant of domestic violence were, in contrast, not a significant predictor of subsequent method adoption. The results highlight the need to address the issue of support for women experiencing domestic violence within existing family planning services and to sensitize service providers to the specific needs of women experiencing such violence.

Mobilizing demand for contraception in rural Gambia.

A community trial was conducted in rural Gambia in order to determine whether a community-based intervention designed to mobilize latent demand for contraception would increase use of modern contraceptives, even in the absence of improved availability of family planning services. Analysis of trial data indicates that the demand-mobilization intervention had a statistically significant positive effect on nonusers' adoption of modern contraception and that coterminous implementation of an intervention designed to improve access to services offered no additional benefit. The program component found to have the greatest impact was the "kabilo approach," in which village women provide basic health and family planning counseling to other women in their extended families. These results suggest that the principal barriers to increased contraceptive use in rural Gambia are psychosocial and that these barriers can be overcome through village-based interventions designed to provide socially appropriate counseling to potential contraceptive users.

Traditional child spacing practices of women: Experiences from a primary care project in Lagos, Nigeria

The study carried out within the target population of a Primary Care Project in Lagos, Nigeria, found that some changes had occurred. The traditional length of abstinence has decreased, and more women now resume sex before termination of breast-feeding. This should give rise to some concern especially if the level of adoption of modern contraception does not rise correspondingly. Other changes regarding the opinion of mothers about some of the practices, and the danger of the current trend of starting infant formula earlier in the post partum period are discussed.