Contraceptive Prevalence Rate Research Articles

Prevalence and associated factors of family planning among students of health training institutes in Juba: A cross sectional descriptive study

Introduction: Family planning (FP) is less prevalent in South Sudan yet information on the subject is scarce and varied from one source to another. This study assessed the prevalence and associated factors in family planning among students at health science training institutes in Juba City. Method: This was a cross-sectional survey of students’ self-reported utilisation of FP methods. Four hundred randomly selected students from five health training institutes (HTIs) in Juba City participated. Data collection was done using a pretested structured questionnaire. IBM SPSS 23 software was used for data analysis. Chi squared tests and regression analyses were performed to determine the associated factors. Results: Among the 400 participants, the lifetime prevalence of FP methods was 77.3%, of which modern contraceptive use was 22%. FP was more prevalent among participants aged 45-50 (85.7%) and females (80.7%). Eighty-seven percent of divorced couples and 91.3% of traditional believers reported practicing FP. More nursing/midwifery cadres within the professional category reported practicing FP, as well as 90.4% of rural respondents. Eighty-three percent of respondents working in pharmacies said they practice FP, compared to 68.1% of those working in clinics. FP practice was similar among participants who were aware (78.9%) and those who denied being aware (72.5%). Marital status (p < 0.001), religion (p < 0.001), residence (p < 0.001), and place of work (p = 0.037) were significantly associated with FP. Conclusion: The prevalence of family planning among students at Health Training Institutes in Juba City is high compared to national estimates, but the contraceptive overall prevalence rate is still low. It is significantly associated with marital status, religion, residence, and place of work. There is a need to continue the effort.

National Policy Influences of Contraceptive Prevalence and Method Mix Strategy: A Longitudinal Analysis of 59 Low- and Middle-Income Countries, 2010-2021.

Understanding the impact of family planning policy and actions is essential for building effective strategies to increase contraceptive use. This study identifies policies that correlate with modern contraceptive prevalence rate (mCPR) and private-sector contraceptive method mix strategies (the number of contraceptive methods offered in the private sector) in low-income and middle-income countries. While education, contraceptive choices, and economic growth are known determinants of contraceptive prevalence, many national policies intended to increase contraceptive prevalence in the short term to medium term have ambiguous evidence that they indeed do so. By developing beta and Poisson regression models using 12 years of reported Contraceptive Security Indicators Survey data (2010-2021) from 59 countries, this study investigated the effect of 20 independent variables on mCPR or method mix strategies. Furthermore, to help interpret the potential consequences of economic status, separate models segmented by gross national income (low, low-middle, and upper-middle) were assessed. Of 20 independent variables, 10 are implicated with mCPR and 6 with a method mix strategy. Of these, increasing the share of domestic financing (versus donor funding) for contraceptives had the broadest and strongest contribution. mCPR is also predicted by the existence of national insurance systems that cover contraceptive costs, contraceptive security committees, family planning logistics management information systems, and, inversely, by client fees. A comprehensive private-sector method mix strategy-which itself influences mCPR-is also driven by these, as well as the inclusion of more contraceptives on the national essential medicines list. These findings have implications for countries seeking to expand access to and use of contraceptives through policy initiatives.

IJCM_14A: Contraceptive use and its determinents among women in field practice area of rural health and training center of tertiary care hospital -a Cross-Sectional study

Background: In reproductive health services contraceptive prevalence rate serves as a proxy measure and is an indicator of health, population, development, and women’s empowerment which is essential for meeting many of Sustainable Development Goals, especially child mortality and maternal related goals. There is increase the use of contraceptive methods in rural area which is influenced by various factors. Objectives: 1) To estimate the prevalence of use of contraception among reproductive age women in rural area 2) To examine the determinants of contraceptive used of reproductive age women. Methodology: This is community based cross sectional study among reproductive age women in field practice area of rural health training center. The sample size was calculated as 208 using 67 percentage prevalence of contraceptive prevalence rate according to NFHS 5 data at 95% confidence interval and 6% error. The study were conducted using prevalidated and pretested questionnaire on sociodemographic variables. The data was analysed using SPSS trial version. Univariate analysis is done and binary logistic regression is applied p value Results: The prevalence of contraceptive use was 73.1%. Most commonly used methods among study participant was condom followed by intra uterine device and oral contraceptive pills. In the adjusted analysis of binary logistic regression, contraceptives use was significantly lower (OR=0.21,95%CI=0.07-0.26, P=0.001) upon respondent age 36-49years compaired to those aged 15-35 years. Contraceptive use was significantly lower among migrants (OR=0.34;95%CI=0.13-0.48; p=0.03) compared with non-migrant. Conclusion: The contraceptive prevalence was found to be higher in this study population and multiple factors were influencing the contraception use. In addition, family planning programs should target migrants to increase use of contraception in rural areas.

IJCM_90A: Knowledge about newer contraceptives among health care personnel working in primary health centres in north coastal district of Andhra Pradesh- a Cross sectional analytical study

Background: According to NFHS -5 the contraceptive prevalence rate has 67%. The unmet need for contraception is two-pronged: a spacing method and a permanent method. A Newer Oral contraceptive pill Chhaya is suitable for both of these purposes. Another newer injectable contraceptive available as Antara. Both are having less side effects. Government of India supplies free of cost. But its current acceptance rates are lower than expected. Health Care Personnel are the key persons to educate, promote and create awareness on contraceptive acceptance in the community especially, Eligible Couple. Hence this study was conducted to assess the knowledge of grassroot level of Health Care Personnel. Objectives: 1. To assess the knowledge of field Health Care Personnel on Newer Contraceptives. 2. To compare the knowledge among Health Care Personnel in Urban and Rural PHCs. Methodology: A cross-sectional analytical study was conducted among 100 Health care personnel (5 Urban & 5 Rural PHCs) of North coastal district, Andhra Pradesh during November 2023 by simple random sampling with prevalence 50% and with allowable error 10%. Those who are willing, included in the study after taking written informed consent. Knowledge was categorized as Poor, Fair, Good. Data was collected by using pretested semi-structured questionnaire. Data was entered and analyzed using MS Excel and SPSS 21. Prior approval from institutional educational committee was obtained. Results: Mean age of study population is 38 ± 17 years. Mean service was 8.4 ± 9 years. 72% of study population were =10th standard.39.8% of the health care personnel have fair knowledge and 60.2% of health care personnel have poor knowledge on newer contraceptives. Fair Knowledge was more among urban study subjects. Conclusion: Knowledge about contraceptive was inadequate in majority of health care personnel. It should be enhanced by conducting scrupulous training programs.

Women alone modern contraceptive use decision making and its correlates, evidence from PMA CS 2021 survey

BackgroundWomen alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners’ effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health.MethodsNationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance.ResultsThis study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use.Conclusion59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.

A Study to Determine the Quality of Life among the Permanent Contraceptive Adopters and Non-adopters at Selected Rural Areas of Dadra and Nagar Haveli

INTRODUCTION Contraceptive information and services are fundamental to the health and human rights of all individual, prevention of unintended pregnancies helps to lower maternal ill-health and the number of pregnancy-related deaths (According to WHO). Between 2000 and 2020, the contraceptive prevalence rate (percentage of women aged 15-49 who use any contraceptive method) increased from 47.7 to 49.0% and 77.5% globally in 2022. In Dadra and Nagar Haveli and Daman and Diu, total modern methods used is 59.8%, female sterilization is 41.6% male sterilization is 0.2%, IUD usage is 2.2%, pill usage is 3.1%, condom usage is 11.7%, and injectables contraceptive usage is 0.9%. AIM The aim of the study is to determine the quality of life among the permanent contraceptive adopters and non-adopters at selected rural areas of Dadra & Nagar Haveli. METHODOLOGY Non-experimental two group comparative descriptive design with non- probability, purposive sampling technique was used to select 100 samples, who fulfilled inclusion criteria. WHO quality of life scale (BREF), that is self-administered scale was used to assess the level of quality of life. RESULT The result of the study showed that the adopters mean value was 70.3450 and the standard deviation was 8.55458, non-adopters mean value was 60.4000 and the standard deviation was 6.76406, ‘t’ value was 6.448 which was higher than the table value and ‘P’ value was 0.000. So there was a highly significant difference between the quality of life among the permanent contraceptive adopters and non-adopters. Hence research hypothesis was accepted. CONCLUSION The study proved that the quality of life among the permanent contraceptive adopters is much better than non-adopters. Hence there is a need to create awareness and provide health education on Family planning methods to the non-adopters.

Understanding Multifaceted Determinants of Contraceptive Utilization among Adolescent Females: Insights from Wakiso District, Uganda

Despite global efforts to enhance contraceptive utilization, adolescent females in Uganda face persistent challenges accessing and utilizing modern contraceptive methods, resulting in high fertility rates and maternal mortality. This cross-sectional study investigated the intricate factors influencing contraceptive usage among adolescent females attending Kasangati Health Center IV in Wakiso District, Uganda. Employing questionnaire-based surveys, the study targeted adolescent females attending the health center, utilizing simple random sampling to select 220 participants, as determined by Fisher's formula. Data analysis was conducted using Microsoft Excel and SPSS version 20, presenting comprehensive findings through tables, pie charts, bar graphs, and narratives. The study uncovered a concerning contraceptive prevalence rate (CPR) of 19% among adolescent females, despite existing awareness of family planning methods. Key determinants of contraceptive usage included limited knowledge about contraception, constrained access to services, entrenched societal norms, and gender dynamics. The findings highlight the urgent need to address these multifaceted barriers to enhance contraceptive utilization and mitigate unmet needs among adolescent females. The study's recommendations encompass targeted educational campaigns, improved accessibility of family planning services, and fostering the engagement of both genders in reproductive health decision-making processes. Ethical considerations were meticulously observed, with informed consent obtained from participants and ethical approval secured from relevant authorities. This study contributes seminal insights into the complex landscape of contraceptive utilization among adolescent females in Uganda, offering critical guidance for policy formulation and programmatic interventions aimed at improving reproductive health outcomes and curtailing maternal mortality rates. Keywords: Contraceptive utilization, Adolescent females, Reproductive health, Family planning, Wakiso District and Uganda

Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study

IntroductionUganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda.MethodsA comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed.ResultsWe found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27–2.16], acquired skills [AOR = 2.28, 95% CI: 2.11–2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3–5 years [AOR = 2.24, 95% CI: 1.46–3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods.ConclusionOur findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.

Prevalence and Factors Associated with Contraceptive Use Among Females Living with HIV at Moi Teaching and Referral Hospital, Eldoret, Kenya

Objective: To assess the prevalence of, and the factors associated with, contraceptive use among females living with HIV at Moi Teaching and Referral Hospital, Eldoret, Kenya. Methods: A cross-sectional study with a sample including a total of 375 females living with HIV aged 15–49 years undergoing follow-up. Data were collected using a semi-structured questionnaire. Bivariate and multivariate analysis was done to check for association and predictors of contraceptive use. Results: The contraceptive prevalence rate was 64%. Factors associated with contraceptive utilisation included parity (crude odds ratio [COR]: 2.33; 95% confidence interval [CI]: 1.22–4.45; P=0.010), marital status (COR: 1.75; 95% CI: 1.04–2.97; P=0.036), and availability of information on the side effects of the contraception methods (COR: 29.93; 95% CI: 14.26–70.58; P=0.001). Multivariate analysis showed a significant association between contraceptive use and whether information on the side effects of the current contraception method was provided (adjusted OR: 34.98; 95% CI: 16.72–83.33; P=0.001).The odds of meeting the contraceptive needs of females living with HIV was 34 times higher among females who had information on side effects of the contraceptives than their counterparts who had no information. Conclusions: The contraceptive prevalence rate was 64% among females living with HIV, higher than latest national value of 61%. Females living with HIV had a high unmet need for contraceptive use at 28.4%. Key factors associated with contraceptive utilisation included awareness of side effects.

Mapping heterogeneity in family planning indicators in Burkina Faso, Kenya, and Nigeria, 2000–2020

BackgroundFamily planning is fundamental to women’s reproductive health and is a basic human right. Global targets such as Sustainable Development Goal 3 (specifically, Target 3.7) have been established to promote universal access to sexual and reproductive healthcare services. Country-level estimates of contraceptive use and other family planning indicators are already available and are used for tracking progress towards these goals. However, there is likely heterogeneity in these indicators within countries, and more local estimates can provide crucial additional information about progress towards these goals in specific populations. In this analysis, we develop estimates of six family indicators at a local scale, and use these estimates to describe heterogeneity and spatial–temporal patterns in these indicators in Burkina Faso, Kenya, and Nigeria.MethodsWe used a Bayesian geostatistical modelling framework to analyse geo-located data on contraceptive use and family planning from 61 household surveys in Burkina Faso, Kenya, and Nigeria in order to generate subnational estimates of prevalence and associated uncertainty for six indicators from 2000 to 2020: contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), traditional contraceptive prevalence rate (tCPR), unmet need for modern methods of contraception, met need for family planning with modern methods, and intention to use contraception. For each country and indicator, we generated estimates at an approximately 5 × 5-km resolution and at the first and second administrative levels (regions and provinces in Burkina Faso; counties and sub-counties in Kenya; and states and local government areas in Nigeria).ResultsWe found substantial variation among locations in Burkina Faso, Kenya, and Nigeria for each of the family planning indicators estimated. For example, estimated CPR in 2020 ranged from 13.2% (95% Uncertainty Interval, 8.0–20.0%) in Oudalan to 38.9% (30.1–48.6%) in Kadiogo among provinces in Burkina Faso; from 0.4% (0.0–1.9%) in Banissa to 76.3% (58.1–89.6%) in Makueni among sub-counties in Kenya; and from 0.9% (0.3–2.0%) in Yunusari to 31.8% (19.9–46.9%) in Somolu among local government areas in Nigeria. There were also considerable differences among locations in each country in the magnitude of change over time for any given indicator; however, in most cases, there was more consistency in the direction of that change: for example, CPR, mCPR, and met need for family planning with modern methods increased nationally in all three countries between 2000 and 2020, and similarly increased in all provinces of Burkina Faso, and in large majorities of sub-counties in Kenya and local government areas in Nigeria.ConclusionsDespite substantial increases in contraceptive use, too many women still have an unmet need for modern methods of contraception. Moreover, country-level estimates of family planning indicators obscure important differences among locations within the same country. The modelling approach described here enables estimating family planning indicators at a subnational level and could be readily adapted to estimate subnational trends in family planning indicators in other countries. These estimates provide a tool for better understanding local needs and informing continued efforts to ensure universal access to sexual and reproductive healthcare services.

A randomized controlled study of the effects of targeted health education on uptake of contraceptives among women of reproductive age in Nnewi City, South-East Nigeria.

There is a need for contraception uptake among people to enable them to fulfil their right to determine the timing, number and spacing of their children. In regions with poor contraceptive prevalence rates, lack of effective education has been largely implicated, and Nigeria falls among such regions. Thus, the present study is designed to examine the impact of an educational intervention on uptake of contraceptives among women aged 18-49 years seeking care at the Nnamdi Azikiwe University Teaching Hospital Nnewi. Being an interventional study to underscore the effect of targeted health education on uptake of contraceptives, a randomized controlled trials design was adopted. A total of 275 women were randomly recruited and allocated into two groups-140 in intervention group and 135 in the control group. Data was collected by trained research assistants using a pretested structured interviewer-administered questionnaire and analyzed using Statistical Package for Social Sciences version 25. The level of significance was set at p < 0.05. At baseline, the level of uptake of contraceptives was similar in both the control and the intervention group (control = 2.48 points; intervention = 2.55 points). Overall, there were no statistically discernible differences between the two groups at baseline. The level of awareness and knowledge on contraceptives as well as the uptake of contraceptives significantly increased in both groups at the end of the study period. A statistically significantly higher increase was noted in the intervention group when compared to the control in level of awareness (t = 3.235; p < 0.05) and uptake of contraceptives (t = 2.628; p < 0.05). Significant positive changes in perceptions of contraceptives were observed more among the intervention group when compared to the control. Logistic regression analysis showed uptake of contraceptives was significantly influenced by occupation, monthly income, source of information, time of first use of contraceptives, level of knowledge on contraceptives as well as the targeted educational intervention. The targeted health educational intervention had a significant and positive effect on the level of awareness and uptake of contraceptives, as displayed in the intervention group. A significant and positive change in perception of contraceptives was also noted among the intervention group in almost all the questions. Certain factors were found to significantly impact the uptake of contraceptives. There is a need for studies with longer follow-up to ascertain sustained impact of health education on uptake of contraceptives. Further studies should be carried out in the other facilities in Nnewi to ensure a better coverage and representation of the target population. Finally, related studies should be carried out among men.

CONFRONTING PAKISTAN'S OVERPOPULATION ISSUE FOR LONG-TERM SOLUTIONS

CONFRONTING PAKISTAN'S OVERPOPULATION ISSUE FOR LONG-TERM SOLUTIONS

Unmet Need for Contraceptive among Tribal Married Women of Rangamati District, Bangladesh

Background: The unmet need for contraceptives refers to the discrepancy between some women's objectives towards conception and their use of contraception, which has been a central indicator for monitoring the progress of family planning programs. Objective: This study set out to identify and evaluate the unmet need for contraceptives among married tribal women between the ages of 15 to 49. Materials and Methods: A descriptive cross-sectional study was carried out between January 2022 to December 2022 in Belaichari Upazilla of the Rangamati district. Two hundred and six married indigenous women (15–49 years old) were surveyed house–to–house. Data on the characteristics of contraceptive uses, unmet needs, and correlations were collected by interviewing the participants using a pre-designed, semi-structured questionnaire. Results: The mean age of the participants was 28.07 ± 6.09 years, and most were Buddhist (63.6%). The contraceptive prevalence rate was found to be 41.3%. Overall, unmet need for family planning was 16.5%, and the age of the woman, religion, and profession of the husband were found to be significantly associated with the unmet need for contraceptive. Apprehension of side effects and difficulty in using were reported as two common reasons for unmet needs. Conclusion: Contraceptive services should place priority on improving the information and counseling they provide and the range of methods they offer. All sexually active women need information about their risk of becoming pregnant and about the choices of methods that could meet their needs.

Quantitative and qualitative assessment of maternal and child health services among hard-to-reach communities in Adamawa State, Nigeria

Background: Recent global reports highlighted the significance of improving the quality of healthcare delivery in all settings, including rural and hard-to-reach communities, as a central strategy for attaining sustainable development goals in universal health coverage. Objectives: This study aimed to assess and document relevant data associated with delivering qualitative Maternal and Child health services in the HTR communities using carefully selected indicators. Methods: The study used a mixed-design approach of quantitative and qualitative methods. Results: This study report high performance on the first antenatal visit (ANC 1), use of modern contraceptives (CPR), Penta 3, measles vaccination coverage, and, Low dropout rate also noticed in Penta 3, thus signifying a generally good performance in all the Local Government areas. Furthermore, Yola South, Fufore, Toungo, Ganye and Michika LGA were found to be the best performing LGAs on the selected maternal and Child indicators, namely: (ANC1), ANC4, ANC8, Institutional delivery rate, and Contraceptive Prevalence Rate (CPR), while Gombi, Guyuk and Madagali LGAs were the poorest performing LGAs. The poor performance of the fore mentioned LGAs was associated with human and environmental interferences: ongoing security challenges, high HTR communities due to mountains and riverine, low level of education, inadequate outreach services during the period under review, poverty, lack of adequate emergency transport system, inadequate HRH, inadequate and poor infrastructure, many communities lack a comprehensive PHC. Conclusion: The assessment highlights LGAs with low utilization of MCH services in HTR communities in Adamawa State, the reasons for the low coverage, and the possible strategies for increased utilization of these services.

Is Pakistan’s fertility transition stalling?

ABSTRACT This study examines the question as to whether Pakistan’s fertility transition is stalling. The paper reviews the trajectories of fertility and its various determinants and compares Pakistan’s trends with those of India and Bangladesh. Countries in the South Asia region share features such as cultural similarities (e.g. the low status of women and son preference) and high poverty levels. However, while Bangladesh and India are near replacement fertility today with modern contraceptive prevalence rates well above 50 per cent, Pakistan still has one of the highest fertility and lowest contraceptive prevalence levels in Asia. Our main conclusion is that Pakistan’s fertility transition is close to stalling in mid-transition. The key causes of this stall are a high and unchanging desired family size, stalling demand for contraception and relatively low satisfaction of this demand. These are important obstacles to future decline in fertility.

Contraceptive use and discontinuation among women aged 15-24 years in Kenya.

The 15-24-year-old age group of young women make up about 15% of the population of 47 million Kenyans which comes to 7 million. Addressing the reproductive health goals of this cohort is thus a policy priority because of the high potential they pose for unintended pregnancy through incorrect and intermittent use of contraception. The study sought to present evidence on contraceptive use among women aged 15-24 in Kenya between 2012 and 2014 using Kenya Demographic and Health Survey (KDHS) 2014 Contraceptive calendar data and make recommendations on enhancing the correct and consistent use of contraception. The data used was obtained from the Choices and Challenges tool developed by Population Reference Bureau (PRB) and visualized innovatively using Sankey Diagrams that show contraceptive use/non-use, continuation, switching/discontinuation, and pregnancy. The use of contraceptives went up by about 30% during the study period while the use of modern methods went up by 83%. The uptake of Long-Acting Reversible Contraception (LARC) went up by 87% while that of Short Acting Methods (SAM) went up by 70% but the progress was clouded by discontinuation rates of 35% with side effects being the leading reason for the abandonment of contraception. For Kenya to achieve transformative results in ending the unmet need for contraception and preventable maternal deaths, it is critical to sustaining the current gains in contraceptive prevalence rate (CPR) by promoting the retention of youth users and encouraging new users.

The Effect of a Decade Implemented Project in Improving the Uptake of Comprehensive Contraception: Difference-In-Difference Analysis.

Promotion and use of family planning in countries with high birth rates have the potential to avert a third of all maternal deaths and nearly a tenth of childhood deaths. To support government efforts in creating wider access to comprehensive contraceptive methods, EngenderHealth has contributed to the government of Ethiopia's long-term goal of improving maternal health outcomes through its Access to Better Reproductive Health Initiative project. Difference-in-Difference approach is the main methodology in this analysis to estimate the "contribution" or "effect" of the ABRI intervention by comparing the changes in family planning outcomes from 2005 to 2016 between the ABRI and non-ABRI areas. This analysis was based on pooled data from the 2005 and 2016 Ethiopian Demographic and Health Surveys. To track temporal changes in the family planning indicators in the ABRI and non-ABRI areas, we employed simple trend analysis. The results show that overall contraceptive prevalence rate, use of injectables, women's knowledge of Long-Acting Reversible Contraception (LARC) methods, and their exposure to family planning information/messages from health workers all significantly improved in the ABRI intervention areas beyond what occurred in the non-ABRI areas. The greatest increase in the use of modern contraception was among adolescents aged 15-19 years, with a DID estimate of 22.4% (p=0.007), ABRI areas compared to no-ABRI areas. In the ABRI areas, family planning indicators recorded positive and significant changes. EngenderHealth has contributed its part in improving access to the uptake of comprehensive contraception and supporting government programs.

Association of migration and family planning use among women in Malawi: Evidence from 2019/2020 Malawi Multiple Indicators Survey

BackgroundFamily planning (FP) is known to bring multiple benefits to people both individually and collectively. Individually, FP has been associated with reduction in risk of unintended pregnancy which also correlates with low child mortality rates. Child mortality rates in women with child spacing of less than two years are 45% higher compared to their counterparts with child spacing of more than two years. Several factors that predict FP utilisation among women of childbearing age have been identified but there is limited literature on how migration impacts FP utilisation in Malawi. Our current study aimed at assessing the association between migration and modern contraceptive use among women of childbearing age in Malawi.MethodsData for this study came from a nationally representative 2019/20 Malawi multiple cluster indicator survey (MICS). At total of 24,543 women aged 15 to 49 participated in the survey. Contraceptive prevalence rate (CPR) analyses were conducted separately on all women of childbearing age and married women. The data was analysed using the complex survey data approach by applying sampling weights to correct unequal representation of participants at cluster, district, and regional level. We used binary logistic regression to assess association between migration status and modern contraceptive use among all women of childbearing age and married women separately. We included age, age at first sex, age at marriage, region of residence, education, residence wealth index and presence of disability as confounders in our final multivariable models.ResultsThe overall CPRs for married women and for all women of childbearing age were 64.7% and 40.5% respectively. The CPRs for all women of childbearing age were 40.5% for non-migrants and 33.0% for migrant women. For married women, CPRs were 51.5% for migrant women and 65.5% for non-migrant women. The fully adjusted odds ratios for the association between migration status and modern contraceptive use were 0.62 (0.49–0.78) for married women and 0.65 (0.52–0.80) for all women of childbearing age.ConclusionsWe conclude from our findings that migrant women were significantly less likely to utilize modern contraceptive methods for both married women and all women of childbearing age. Deliberate efforts are required to ensure that migrant women of childbearing age have equal access to sexual and reproductive health services which includes family planning.

Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies.

Around half of adolescent pregnancies in low- and middle-income countries are unintended, contributing to millions of unsafe abortions per year. Adolescents 360 (A360), a girl-centred initiative, aimed to increase voluntary uptake of modern contraceptives among adolescents in Nigeria, Ethiopia and Tanzania. We evaluated the effectiveness and cost-effectiveness of A360 in increasing modern contraceptive use in selected geographies. We used before-and-after cross-sectional studies of adolescent girls in four settings. Two Nigerian settings had purposefully selected comparison areas. Baseline and endline household surveys were conducted. The primary study outcome was modern contraceptive prevalence rate (mCPR). Secondary outcomes mapped onto the A360 Theory of Change. Interpretation was aided by a process evaluation along with secular mCPR trends and self-reported A360 exposure data. Incremental design and implementation costs were calculated from implementer systems, site visits, surveys, and interviews. mCPR change was modelled into maternal disability-adjusted life years (DALY) averted to calculate incremental cost-effectiveness ratios. In Oromia, Ethiopia, mCPR increased by 5% points (95% CI 1-10; n = 1,697). In Nigeria, there was no evidence of an effect of A360 on mCPR in Nasarawa (risk ratio: 0·96, 95% CI: 0·76-1·21; n = 5,414) or in Ogun (risk ratio: 1·08, 95% CI: 0·92-1·26; n = 3,230). In Mwanza, Tanzania, mCPR decreased by 9% points (-17 to -0.3; n = 1,973). Incremental cost per DALY averted were $30,855 in Oromia, $111,416 in Nasarawa, $30,114 in Ogun, and $25,579 in Mwanza. Costs per DALY averted were 14-53 times gross domestic product per capita. A360 did not lead to increased adolescent use of modern contraceptives at a population level, except in Oromia, and was not cost-effective. This novel adolescent-centred design approach showed some promise in addressing the reproductive health needs of adolescents, but must be accompanied by efforts to address the contextual drivers of low modern contraceptive use.

Factors affecting practices of recently delivered women on maternal and neonatal health care in selected rural areas of Bangladesh

Bangladesh has made laudable progress in maternal and child health (MCH). Maternal and child mortalities have reduced substantially accompanied by stellar rise in immunization and contraceptive prevalence rate (CPR). However, such success is distributed unevenly throughout and the country is among one of the top ten countries with highest number of neonatal and under-five children mortalities. Rural Bangladesh is home to more than half of the country’s total population. Yet, disparity in access to healthcare services and information are overt in these areas. Utilization of maternal health services (MHS) is low whereas maternal and child mortalities are high in the rural areas. Thus, this cluster randomized cross sectional study was conducted with the aim to observe the practices that rural women followed in regards to maternal and child health and factors that affected these practices. Primary data was collected from 550 respondents using a structured questionnaire within the time period September—October 2019. All our participants were recently delivered women (RDW), defined in our study as women of reproductive age (15–49 years) who had delivered a child recently, i.e. 12 months prior (September 2018 – August 2019) the data collection. We conducted logistic regression and multivariate analysis to analyze data. Results from this study depict that while 96.3% of RDW opted for ANC visits and 99.1% fed colostrum to their newborn, fewer have had institutional deliveries and the number of RDW who had PNC was only 64.7%. Education was found to be the most prominent factor that affected practices employed by RDW. The more educated a respondent was, the greater the chance was of her engaging in appropriate maternal and child health practices. The RDW preferred and visited private facilities the most to obtain healthcare services with private medical doctors being one of the prime sources of healthcare information for the respondents. On the contrary, monthly expenditure exerted no statistically significant impact on the aforementioned practices. Thus, results of our study imply that interventions enhancing education and health knowledge of women and engaging private sector be designed for improving maternal and neonatal health care in rural areas of Bangladesh.