Contraceptive Prevalence Research Articles

How well are Indonesia's urban poor being provided access to quality reproductive health services?

Accommodating the needs of Indonesia’s rapidly growing urban population is essential to reaching national reproductive health goals and international commitments. As in other rapidly urbanizing low- and middle-income countries, satisfying the needs of Indonesia’s urban poor is both a high priority and a significant challenge. In this study, we assessed both how being from urban poor or near-poor households affects the quantity and quality of family planning and maternal health services received and the extent to which differentials had narrowed during the 2012–2017 period. This time interval is significant due to the introduction of a national social health insurance scheme in 2014, establishing the foundation for universal health care in the country. Data from the 2012 and 2017 Indonesian Demographic and Health Surveys were analyzed using logistic and multinomial logit regression. Poverty status was measured in terms of urban household wealth quintiles. For family planning, although urban poor and near-poor women made different method choices than non-poor women, no substantial 2017 differences in contraceptive prevalence, unmet need for family planning or informed choice were observed. However, urban poor women and to a lesser extent near-poor women systematically lagged non-poor urban women in both the quantity and quality of maternal health services received in connection with recent pregnancies. Significant maternal health service gains were observed for all urban women during the study reference period, with gains for poor and near poor urban women exceeding those for non-poor on several indicators. While the deployment of pro-poor interventions such as the national social health insurance scheme is likely to have contributed to these results, evidence suggesting that the scheme may not be influencing consumer health-seeking behaviors as had been anticipated along with continued limitations in public health sector supply-side readiness resulting in service quality issues suggest that more will have to be done.

The power of women\u2019s and men\u2019s Social Networks to catalyse normative and behavioural change: evaluation of an intervention addressing Unmet need for Family Planning in Benin

BackgroundIn Benin, despite good knowledge and availability, modern contraceptive prevalence remains relatively low, and the unmet need for family planning is relatively high. This is partly due to insufficient attention to socio-normative barriers that influence need and method use. Applying social network theory, Tékponon Jikuagou (TJ) aims to reduce socio-normative barriers preventing modern contraceptive use in rural Benin. After community identification, TJ trains influential network actors who encourage critical dialogue about unmet need, family planning, gender, and other social norms within their networks, complemented by radio and services linkages. This paper evaluates TJ's effectiveness and how intervention components affect intermediate and primary FP outcomes.MethodsWe report findings from pre/post-intervention cross-sectional research with a comparison group conducted at baseline with 1,043 women and 1,030 men, and 14 months later at endline with 1,046 women and 1,045 men. Using sex-stratified models, we assessed balance across intervention and comparison groups on background characteristics using Pearson's chi-square tests of independence; performed bivariate tests of independence to assess differences between baseline to endline on intermediate outcomes and primary FP outcomes; used logistic regression to examine the effect of intervention components on intermediate and primary FP outcomes.ResultsStatistically significant improvements in primary outcomes: women's intentions to use modern contraception, achieve met need, and reduce perceived met need. The fourth primary outcome, actual use, showed substantial gains, although not statistically significant. Men's achievement of met FP need and reduced perceived met need were also statistically significant. Assessing intermediate outcomes at individual, couple, normative-network levels, TJ led to statistically significant increases in couple and network communication on fertility desires and family planning use and self-efficacy and confidence to access services. Both women and men showed significant shifts in the acceptability of discussing FP in public. Results for other indicators of norms change were inconsistent.ConclusionsAn easy-to-implement, short-duration, gender-equitable social network intervention with a limited set of network actors, TJ effectively decreases social and normative barriers preventing women and men from seeking and using FP services. Results support the broader use of innovative social and behaviour change strategies that diffuse family planning ideas through social networks, diminish normative and communication barriers, and catalyse modern family planning use.

Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms

Between 2005 and 2020, total contraceptive use among married women in Rwanda increased from 17% to 64%. The aim of this study is to better understand how the Rwandan government's mobilization and demand generation efforts have impacted community norms and interpersonal discourse surrounding family planning. Eight focus group discussions with family planning providers and 32 in-depth interviews with experienced modern contraceptive users were conducted in 2018 in the two Rwandan districts with the highest and the lowest contraceptive prevalence rates. Results suggest that outspoken government support, mass media, and community meetings were valuable sources of information about family planning. Information received through these channels generated interpersonal dialogue about contraceptives through both conversation and observation; however, rumors and misinformation remained a significant barrier to use. A once taboo subject is now normative among married couples. Continuing to address common fears and misinformation through communication channels such as mass media and community meetings may help to further increase contraceptive uptake in Rwanda.

Dinamika fertilitas dan prevalensi kontrasepsi di Indonesia

The fertility dynamics are related to the direction of population policies and socio-economic conditions of the community. From the 1970s to 1990, Soeharto had succeeded in reducing fertility rates. Unfortunately, population control had weakened in 2000 when the government adopted regional autonomy. Consequently, population control was no longer a priority due to the merger of institutions with the full authority of population and family planning. In addition, improving the socio-economic conditions of society poses challenges to population control efforts. This paper aims to analyze fertility and contraceptive prevalence rate trend in Indonesia based on the 2017 Indonesia Demographic and Health Survey data. The data were analyzed using inferential statistics. The results indicate socio-economic conditions affect people’s mindset in deciding the use of contraception and pregnancy. People are aware of birth control but tend not to use modern contraception and move to traditional contraception. The socio-economic improvement of women, which causes negative child value, is sufficiently a sufficient condition to maintain or reduce fertility. Other factors such as improvement of maternal education, maternal participation in work, and increased family welfare that is important to keep fertility at a low level.

Exploring the Individual and Interpersonal Obstructive Factors Affecting Contraceptive Usage among Married Fertile Women in Rural Vicinities of Multan District, Pakistan

Family Planning is the most effective tool to reduce maternal morbidity and mortality during pregnancy. Contraceptive usage is the widely accepted method for birth spacing among married women in reproductive age span. In Pakistan, contraceptive prevalence is low in rural areas as compared to urban milieus. For exploring the present research phenomenon, the ethnographic research design was used to determine the subjective meaning-making of participants about the study phenomenon. Informal Discussions (IDs), N=20 In-Depth Interviews (IDIs), and N=6 Focus Group Discussions (FGDs) were conducted in two adjacent villages X and Y of Multan, Pakistan. Interview guide and discussion guide were used to explore the responses of the participants through thematic analysis. The present research results illustrated that the causes behind disinclination for contraceptive usage prevailed at two major levels, i.e. individual and interpersonal. The individual-level obstructive factors comprised of age of the married women, education level of husband, the economic cost of contraceptive usage, and adverse effects of contraceptives on the health of married females. Furthermore, the inter-personal level factors comprehended of husband opposition towards contraception usage, and discussion about contraception usage with husband as an anti-normative act. In conclusion, the orthodox, misogynistic, and gender-biased normative structure snatched the reproductive autonomy of married women. Resultantly, the women changed their fertility preferences and avoided birth spacing through contraceptive usage. Government intervention through social media awareness campaigns, provision of monthly incentives, and facilitation of “health card” could be used to ensure high prevalence of contraceptive usage among married women in the study locale.

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

ObjectivesAccessing family planning is a key investment in reducing the broader costs of health care and can reduce a significant proportion of maternal, infant, and childhood deaths. In Ethiopia, use of modern contraceptive methods is still low but it is steadily increasing. Identifying the contributing factors to the changes in contraceptive use among women helps to improve women’s contraceptive use and helps to plan strategies for family planning programs. Thus, the current study aimed to analyze the trends and predictors of changes in modern contraceptive use over time among married women in Ethiopia. Data source and study designSecondary data analysis of the national representative data of 2000–2016 Ethiopian Demography and Health Survey was employed. MethodsThis secondary data analysis was considered using 2000 through 2016 Ethiopian Demographic and Health Surveys. The study used data from the four DHSs conducted in Ethiopia (2000–2016). The data from all EDHS was collated so as to follow the trends throughout the period considered for the survey. Married women aged 15–49 years with sample sizes of 36,721 (9,203 in 2000, 8,438 in 2005, 9,478 in 2011, and 9,602 in 2016) were included. The analysis involved three levels, including trend analysis (to see changes from 2000 to 2005, 2005–2011, 2011–2016 and 2000–2016). Bivariate and multivariate analysis were also considered to identify predictors of modern contraceptive use. Data was extracted from the EDHS datasets for which authorization was obtained from the DHS Program/ICF International using a data extraction tool. SPSS 24 was employed for data management and analysis. ResultsAmong married women of reproductive age, modern contraceptive prevalence increased from 6.2% in 2000 to 35.2% in 2016. This 5-fold increment in modern contraceptive use was due to being in the age group of 25–29 years (AOR = 1.4; 95%CI (1.1, 1.7)), having two children (AOR = 1.3; 95%CI (1.1, 1.6)), the richest wealth category (AOR = 3.0; 95% CI (2.5, 3.5)), currently working (AOR = 1.3; 95%CI (1.2, 1.5)) and attending secondary and above education (AOR = 1.2; 95%CI (1.1, 1.6)) were found to be predictors. ConclusionsOver the past 15 years, an annual average of a 1.9% point increment has been observed in modern contraceptive use, but the country lags behind the SDGs's 2030 target of achieving zero unmet needs for contraception. Program interventions, and continued education of women, are mandatory, as education is one of the major factors contributing to increasing contraceptive use.

Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study.

BackgroundThe uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services.ObjectiveThe main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs.MethodsA quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate.ResultsThe intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022.ConclusionsThis project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context.Trial RegistrationClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599International Registered Report Identifier (IRRID)DERR1-10.2196/35291

Modern contraceptive use among young women aged 15–24 years in selected municipalities of Western Nepal: results from a cross-sectional survey in 2019

ObjectiveTo estimate the modern contraceptive prevalence rate (mCPR) and its predictors among young women aged 15–24 years.DesignCross-sectional analysis of Adolescent Youth Project baseline survey.Setting29 municipalities within Lumbini Province and Sudurpaschim...

Impact of family planning logistic management models on uptake of contraceptives in selected states in Nigeria: A comparative retrospective analysis

Background: Use of contraceptives improves individual and national health outcomes and indices as it prevents maternal mortality and morbidity, child mortality, incidence of sexually transmitted infections and retains adolescents and young girls in school with improvement in the economic earning power. Contraceptive Logistics is the supply of contraceptives in the right quantity and quality at the right place at the right time for the right cost to the right people. The Contraceptive Logistics Management System in Nigeria stipulates that to ensure uninterrupted product availability and minimal stock out, Family Planning Service Delivery Points (SDPs) are to be re-supplied on a bi-monthly basis to bring their stock level to a maximum of 4 months of stock at any given time. Method: A retrospective analysis of the impacts of the three logistic models operational in six southern states in Nigeria under the auspice of UNFPA funded family planning logistics supply chain. Three outcomes of interest used to assess the impacts were stock out rates, gaps in supply and proportion of new users of contraceptives. The three models of family planning logistics reviewed were direct government last mile distribution with external funding, direct government last mile distribution without external funding and a third party private logistic company last mile distribution Result: The stock out rates for the direct government logistics with external funding was 6-20%, the direct government logistics last mile distribution (LMD) without external funding had a stock out rate of 20-58% and the private logistic company last mile distribution had a stock out rate of 10-30%. In terms of the gap in supply, the supply gap with the direct government LMD with external funding model was 48%, while the direct government LMD with no external funding model had a supply gap of 73% and the private company LMD logistics model had a low supply gap of 28%. The proportion of FP users who were new users was 19% in the direct government LMD with external funding, 8% in direct government LMD without external funding, and 16% in private logistic company LMD. Discussion: Direct government last mile distribution (LMD) with external funding reached the highest number of new FP users followed by private logistic company LMD and therefore contributed the greatest to the reduction of unmet need in family planning and increasing the contraceptive prevalence rates. The highest stock out rate of contraceptives was associated with direct government LMD without external funding and the least stock out rate was associated with same direct government LMD but with external funding. The greatest gap in supply of contraceptives was seen with direct government LMD without external funding followed by direct government LMD with external funding. Private company LMD had the least supply gap in contraceptives.

What Distinguishes Women Who Choose to Self-Inject? A Prospective Cohort Study of Subcutaneous Depot Medroxyprogesterone Acetate Users in Ghana.

Depot medroxyprogesterone acetate administered subcutaneously (DMPA-SC) is an all-in-one injectable contraceptive administered every 3 months, either by a trained health care provider or community health worker or by training a client to self-inject. Using a prospective cohort of family planning (FP) clients in Ghana, this study explores patterns of DMPA-SC use and mode of injection administration over a 6-month period. This study also examines the predictors of self-injection adoption 6 months after initiating DMPA-SC. Our analysis focuses on 378 women who were using DMPA-SC at the 6-month interview. Adjusted odds ratios accounting for clustering show that clients who were new FP users, never married, or attended high school/attained higher education were significantly more likely to self-inject by the third injection. Results of this study suggest that in Ghana, adding DMPA-SC to the method mix may improve access to FP, especially among new users. Results of this study may inform FP projects and programs aiming to improve access to contraceptive methods and increase contraceptive prevalence by introducing or scaling up DMPA-SC self-injection. The findings also provide a sociodemographic profile of FP clients most likely to adopt DMPA-SC self-injection over time, which could serve as an evidence base for social marketing strategies.

Norms, Trust, and Backup Plans: U.S. College Women’s Use of Withdrawal with Casual and Committed Romantic Partners

ABSTRACT This study integrates research on contraceptive prevalence with research on contraceptive dynamics in hookup culture to examine college women’s use of withdrawal with sexual partners. Drawing on in-depth interviews with 57 women at a midwestern U.S. university, we analyzed women’s explanations for using withdrawal for pregnancy prevention and framed our study within the research on gender norms, sexual scripts, and power dynamics. Findings showed withdrawal was normalized within collegiate hookup culture, and that women frequently relied on withdrawal as a secondary or backup method or when switching between methods. Women often followed up with emergency contraceptives if using withdrawal alone. With casual partners, women advocated for their own preferences, including for partners to withdraw. In committed relationships, women prioritized their partner’s desires for condomless sex, but also linked withdrawal with trust and love. Thus, women in relationships may be disadvantaged by hookup culture norms suggesting sex is freely available, putting pressure on them to acquiesce to withdrawal. Many women used withdrawal despite acknowledging it was not the most desirable or effective method, emphasizing the need for a sexual health approach that acknowledges these tensions and strives to help women and their partners safely meet their sexual and contraceptive preferences.

Post Partum Contraception: Awareness and Willingness to Use by Antenatal Attendees in A Third Level Health Facility, Southern Nigeria

Background: The contraceptive prevalence of Nigeria is low. Post partum contraception (PPC), especially in the immediate post period, may improve our contraceptive prevalence rate. Objective: To determine the level of awareness and willingness to use post partum contraception by antenatal attendees of the University of Port Harcourt Teaching Hospital (UPTH). Methods: This is a cross-sectional questionnaire-based prospective study in consented antenatal attendees of the UPTH between the 1st of June and 31st of August 2020. Pretested questionnaires were administered on the respondents by trained assistants. Their socio-demographic data and information on their awareness and willingness to use post partum contraception were entered into excel spread sheet and analyzed with SPSS version 20.0. Chi-square test of variables were done and P<0.05 was taken as significant. The results were presented in tables of frequencies and percentages. Result: Two hundred and seventy-one antenatal attendees of the UPTH participated in this study. Their mean parity was 2.65 with a standard deviated of 1.25. Of the total number of respondents, 299(99.26%) had at least a secondary education, 156 were aware of post partum contraception; giving a prevalence of 57.56%. Two hundred and six (76.01%) expressed willingness to use post partum contraception if counseled and offered. Husbands support for the use of contraception was 69.37%. Conclusion: There was poor awareness of post partum contraception in the UPTH antenatal attendees. However, the expression of willingness to use this method of contraception was high.

Building social accountability to improve reproductive, maternal, newborn and child health in Nigeria

BackgroundLike many places in Nigeria, Niger, a predominantly rural and poor state in the north of the country, has high fertility, low contraceptive prevalence, and high maternal mortality. This paper presents a descriptive, contextualized case study of a social accountability campaign run by the nongovernmental organization White Ribbon Alliance Nigeria to strategically mobilize collective action to demand quality maternal health care and improve government responsiveness to those demands. We treat maternal health as a component of reproductive health, while recognizing it as a less contested area.MethodsData come from more than 40 interviews with relevant actors in Niger State in 2017 and 2018 during the initial phase of the campaign, and follow-up interviews with White Ribbon Alliance Nigeria staff in 2019 and 2021. Other data include White Ribbon Alliance Nigeria’s monthly reports. We analyzed these data both deductively and inductively using qualitative techniques.ResultsDuring its first phase, the campaign used advocacy techniques to convince the previously reticent state government to engage with citizens, and worked to amplify citizen voice by hosting community dialogues and town halls, training a cadre of citizen journalists, and shoring up ward health development committees. Many of these efforts were unsustainable, however, so during the campaign’s second phase, White Ribbon Alliance Nigeria worked to solidify state commitment to durable accountability structures intended to survive beyond the campaign’s involvement. Key challenges have included a nontransparent state budget release process and the continued need for significant support from White Ribbon Alliance Nigeria.ConclusionThese findings reveal the significant time and resource inputs associated with implementing a strategic social accountability campaign, important compromises around the terminology used to describe “accountability,” and the constraints on government responsiveness posed by unrealistic budgeting procedures. The campaign’s contributions towards increased social accountability for maternal health should, however, also benefit accountability for reproductive health, as informed and empowered woman are better prepared to demand health services in any sector.

No one left behind: has the pursuit of FP2020's 120 million additional users goal left some women behind?

Background: An important question is whether the FP2020's "120 million additional users" goal exacerbated inequities and led to a prioritization of populations within countries where substantial gains towards the goal could be made. We examine FP2020 country data for signs of inequity in gains in modern contraceptive prevalence (MCP). Methods: We selected 11 countries (Bangladesh, Burundi, Ethiopia, Haiti, Malawi, Mali, Nepal, Pakistan, Senegal, Sierra Leone, Uganda, and Zimbabwe) to conduct a bivariate analysis. We evaluated if MCP growth had been equitable by assessing MCP between two surveys stratified by residence, levels of education, age groups, marital status, and wealth. Results: In most countries, MCP increased among rural women and in seven African countries these gains were significant. In six countries, MCP gains were significant both among women with no education and in the lowest wealth group. MCP gains among young women aged 15-19 and 20-24 were seen in four African countries: Malawi, Senegal, Sierra Leone, and Uganda. Conclusions: Our findings suggest that between two surveys since 2010 many countries saw MCP gains across different dimensions of equity and do not suggest a focus on expanded coverage at the expense of equity. As the family planning community begins to look ahead to the next partnership, this analysis can help inform the emerging FP2030 framework, which includes equity as a guiding principle.

Unmet need for family planning among rural married women in Ethiopia: What is the role of the health extension program in reducing unmet need?

BackgroundEthiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia.MethodsThis paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP.ResultsThe overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37–0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67–0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67–2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01–1.48) were associated with a higher likelihood of an unmet need for FP.ConclusionThe unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women.

Assessing the cost-effectiveness of contraceptive methods from a health provider perspective: case study of Kiambu County Hospital, Kenya

BackgroundKenya’s contraceptive prevalence rate at 53% is low, with wide disparity among the 47 counties that make up the country (2–76%). Significant financial investment is required to maintain this level of contraceptive use and increase it to levels seen in more developed countries. This is in the context of a growing population, declining donor funding, limited fiscal space and competing health challenges. Studies have shown that long-term contraceptive methods are more cost-effective than short-term methods. However, it is unclear if this applies in Sub-Saharan Africa; with limited financial resources, lower social economic status among users, and publicly managed commodity supply chains, in vertical programs largely dependent on donor funding. This study assessed the cost-effectiveness of contraceptive methods used in Kenya.MethodsA cross-sectional study was undertaken in a county referral hospital in mid-2018. Purposive sampling of 5 family planning clinic providers and systematic sampling of 15 service delivery sessions per method was done. Questionnaire aided interviews were done to determine inputs required to provide services and direct observation to measure time taken to provide each method. Cost per method was determined using activity based costing, effectiveness via couple year protection conversion factors, and cost-effectiveness was expressed as cost per couple year protection.ResultsThe intra-uterine copper device was most cost-effective at 4.87 US dollars per couple year protection followed by the 2-Rod Implant at 6.36, the 1-Rod Implant at 9.50, DMPA at 23.68, while the combined oral contraceptive pills were least cost-effective at 38.60 US dollars per couple year protection. Long-term methods attracted a higher initial cost of service delivery when compared to short-term methods.ConclusionLong-term contraceptive methods are more cost-effective. As such, investing in long-term contraceptives would save costs despite higher initial cost of service delivery. It is recommended, therefore, that Sub-Saharan Africa countries allocate more domestic financial resources towards availability of contraceptive services, preferably with multi-year planning and budget commitment. The resources should be invested in a wide range of interventions shown to increase uptake of long-term methods, including reduction of cost barriers for the younger population, thereby increasing contraceptive prevalence rates.

Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study

BackgroundMultiple contraindications to combined hormonal contraceptives (CHC) use exist. The impact of these factors on contraceptive choice, particularly among women living with HIV (WLWH), is not well understood. We measured and compared the prevalence of contraceptive use and contraindications among WLWH and women not living with HIV (controls).MethodsWe examined cross-sectional survey and medical chart data from 83 WLWH and 62 controls, aged 16–49 and sexually active, from 2013–2017. We compared the age-adjusted prevalence and types of contraceptives used in the last month and the proportion of women with CHC contraindications, including drug interactions, medical comorbidities, and smoking at ≥ 35 years old. All WLWH received care at an interdisciplinary, women-centred HIV clinic.ResultsCompared to controls, WLWH were older (median [IQR)] 39 [34–43] vs 31 [23–41] years; p = 0.003), had less post-secondary education (37% vs 73%; p < 0.001), and more often had household income < $15,000/year (49% vs 30%; p = 0.006). WLWH trended to higher contraceptive prevalence than controls (80% vs 63%; p = 0.06 adjusted for age). Overall hormonal contraceptive use was similar. However, despite controlling for age, WLWH used CHC less (4% vs 18%; p = 0.006) than controls, and had more frequently undergone tubal ligation (12% vs 2%; p = 0.03). WLWH also experienced more CHC contraindications (54% vs 13%; p = 0.0001), including smoking at ≥ 35 years old (30% vs 6%; p = 0.0003) or a CHC-related drug interaction (all antiretroviral related) (25% vs 0%; p = 0.0001).ConclusionsWLWH attending our interdisciplinary clinic used hormonal contraception at similar rates as controls, though with different types. Differences may reflect different distributions of CHC contraindications. CHC contraindications present barriers to accessing the full range of contraceptive choices for WLWH. Guidelines and education for care providers and WLWH regarding contraceptive choices and drug interactions are needed, especially when care is provided without the benefit of an interdisciplinary women-centered healthcare team.

Determinants of Unmet Need Family Planning Among Married Woman of Reproductive Age in North Sumatra (Susenas March 2019)

Unmet need is one of the obstacles of the family planning programs that can reduce contraceptive prevalence. The percentage of total unmet need in North Sumatra Province is 12.1 and comparable to the total national unmet need in 2019. This study aims to determine the factors that influence family planning needs and the tendency of married women of reproductive age in North Sumatra Province in 2019 with multinomial logistic regression. The data used is sourced from the Susenas KOR 2019. Results show that married women of reproductive age having a greater tendency to experience the unmet need for limiting are characterize as 35-49 years old, living in urban areas, and with junior high/equivalent levels. Meanwhile, the characteristics of married women of reproductive age (WUS) who have a greater tendency to experience the unmet need for spacing such as aged 15-24 years, Age at First Marriage more than 18 years, and with a higher education level. Therefore, a more optimal commitment and support from family planning field workers in family planning counselling are needed and increase equitable access and quality of family planning services.

Introduction of DMPA-SC and Self-injection (AI) in the City of Conakry (Guinea) in Time of COVID-19 in 2021

<i>Context:</i> The maternal mortality rate in Guinea remains high at 550/100,000 live births. Contraceptive prevalence is still low with 11% for women in union, unmet need was 22% with a fertility rate of 4.8. With this in mind, the DMPA-SC was introduced in Guinea in 2018 and then scaled up to 2020. The objective was to study the supply of DMPA- SC and AI services in the health districts of Conakry in the time of COVID-19. <i>Methods:</i> This was a descriptive, cross-sectional, prospective recruitment study, from March 1 to November 30, 2021 in public health facilities and from June 1 to November 30, 2021 in private health facilities; it involved new users of DMPA SC and AI in these facilities, the review and validation of FP data from the facilities, and post-training follow-up was carried out by telephone or in person. The data were collected in a whatsAPP platform and processed using Excel software. <i>Results: </i>We counted 2279 new users, including 1474 for DMPA-SC and 271 DMPA-SC AI in 28 public health facilities and 383 DMPA-SC and 151DPMA-SC AI in 30 private clinics. The practice of self-injection was more dominant in private clinics (70%) than in public facilities (36%). <i>Conclusion:</i> Private clinics appear to be an opportunity to increase contraceptive prevalence in Guinea.

Prevalence, pattern and determinants of contraceptive use among pregnant women attending antenatal clinic (ANC) in a secondary health facility in Kebbi State: a cross-sectional study.

Introductionrapidly rising population in Africa is of great concern, especially in Nigeria because of its impact on social stability. Nigeria has been unable to meet the set targets in respect of scaling up access to contraception, and increasing contraceptive prevalence. Thus, being projected to be the third most populous country by 2050 amidst a rising unemployment rate and a shrinking economy.Methodsa cross-sectional study was conducted among 350 pregnant women attending antenatal clinic (ANC) in General Hospital Argungu, Kebbi State, and data were obtained using an interviewer-administered questionnaire and analyzed using IBM SPSS version 22.Resultsmost 318 (90.9%) of the 350 respondents were aware of contraception. The prevalence of previous use of contraceptives among the respondents was 59.4%, while 70% of them intend to use contraception in the future. Concerns about the return of fertility 56 (50.9) after contraceptive use was a major reason given by respondents who had never used any form of contraceptive. Educational attainment, age at marriage, and occupation were the factors that were associated with awareness, previous use, and future use of contraception.Conclusionthis study underscores the need to promote girl-child education as a cardinal strategy in increasing the level of contraception among the populace.