Contraceptive Prevalence Research Articles

Profile of unobservant women regarding contraception in Sousse (Tunisia)

Abstract Background The contraceptive prevalence rate in Tunisia is estimated around 62.5%meanwhile the rate of voluntary termination of pregnancy is constantly increasing. The aim of this study was to define the profile of unobservant women regarding contraception and to assess their knowledge about oral contraception. Methods A cross-sectional study was conducted during the month of March 2018 at the Obstetrics and Gynecology Service in Sousse (Tunisia). This study included 100 women who had undergone voluntary termination of pregnancy. All the participants were using contraceptive means. Results Roughly 49% of participants were aged between 30 and 38 years, 64% came from an urban environment, 68% had low socio-economic status and 34% had a secondary level of education. Most of them (98%) were using progestin-only pills. Approximately 40 % did not know what ‘back-up' measures they should take after missing a dose of the contraceptive pill. Conclusions We cannot extrapolate these results to the whole Tunisian women but we are facing a lack of minimal knowledge about contraception among at least this category of women. Those patients should be more educated and monitored by the prescribers of contraception such as midwives. Key messages The rate of voluntary termination of pregnancy is constantly increasing. Patients should be more educated and monitored by the prescribers of contraception such as midwives.

Use of modern contraceptives in Lagos Nigeria during the COVID-19 pandemic

We estimated modern contraceptive prevalence rate (mCPR) and examined predictors of modern contraceptives utilization amongst 1,445 sampled reproductive age women in Lagos (Nigeria’s epicenter) during the devastating COVID-19 pandemic. Estimated mCPR was 30.8%. Women aged 20–29 years were 50% (95%CI:0.37–0.71) less likely to use modern contraceptives during the pandemic than those 30–39 years. Married and divorced women were about three (95%CI:1.37–5.25) and over three (95%CI:1.32–7.79) times more likely to use modern contraceptives compared to single women. Though mCPR has not reduced, sustained contraceptive needs assessment of sometimes obscure sub-populations is required, especially if outbreaks like COVID-19 become our ‘new normal’.

Utilization of modern contraceptive methods and its determinants among youth in Myanmar: Analysis of Myanmar Demographic and Health Survey (2015-2016).

Reproductive health service is crucial for youth to reduce maternal and child mortality. However, many young women face unintended pregnancies and pregnancy-related complications due to insufficient knowledge of contraceptive methods and low contraceptive utilization. This study aims to assess the modern contraceptive prevalence rates among youth and identify factors influencing modern contraceptive utilization among youth. We used Myanmar Demographic and Health Survey (2015-2016) data. This study included 1,423 men and 3,677 women aged 15-24 years from all states and regions of Myanmar. We used multivariable binary logistic regression analysis and reported the results using adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). Data analysis was done by STATA software (version 15.1). Ever-married youth used mainly injectable contraception, followed by oral contraceptive pills. Never-married male youth mainly used oral contraceptive pills; however, almost all never-married female youth did not use contraception. The modern contraceptive prevalence rates were 14.9% among total youth, 10% among males, 16.8% among females, 1.5% among never-married males, 44.7% among ever-married males, and 54% among ever-married female youth. The knowledge on modern contraceptive methods favored the utilization. Sexually active youth utilized more contraception than sexually inactive youth. We also found geographical variation and low utilization among rural youth. The desire for more children was also a significant predictor of contraceptive utilization among married youth. The utilization of modern contraception was low among Myanmar youth. Reproductive health program needs to be emphasized on the youth population especially in the area with low utilization to have equitable access to quality reproductive health services. Moreover, the revitalization of Youth Information Corner and youth-friendly reproductive health education programs should be implemented to increase reproductive health knowledge and prevent unsafe sex, unintended pregnancies, and abortions which might help in reducing maternal and child mortality. We warranted conducting mixed method studies to explore the barriers and challenges of contraceptive utilization and male involvement in the choice of contraception among youth.

DETERMINANTS OF FAMILY PLANNING AMONG MYANMAR WOMEN: SYSTEMATIC REVIEW

Background: Family planning is achieved by using contraceptive methods and the treatment of involuntary infertility. In Myanmar, although the contraceptive prevalence rate is increasing, it still needs to reach 60% in family planning 2020 commitment. This review is aimed to explore the determinants that can improve or inhibit contraceptive usage among Myanmar women. Methods: 88 articles are found through searching in PubMed, Scopus, EBSCO and ProQuest. Nine articles which meet inclusion and exclusion criteria are selected. Results: Four main themes emerged. These are socio-demographic factors (age, level of education, marital duration, number of living children, religion, occupation, income), cognitive factors (knowledge), affective factors (attitude and motivation including support from health care providers, family, friend as well as husband and health education) and availability of service (distance form health care place, service available for 24 hours, cost). Conclusion: The findings will be supported to information about the needs and gaps in implementing family planning. It is recommended that knowledge on determinants of family planning is helpful to improve family planning program in both urban and rural communities.

Prevalence of Contraceptive Methods among Women of Reproductive Age Attending Family Planning Clinic in Adeoyo Maternity Teaching Hospital, Ibadan, Oyo State

The 2008 Nigeria demographic and health survey showed that maternal mortality in Nigeria is currently estimated at 545 per 100,000 live births. This burden of maternal health can be alleviated through effective modern family planning measures (Singh, 2008). The contraceptive prevalence in Nigeria is still very low, about 15% (NDHS, 2008). This study aimed at examine the prevalence of contraceptive methods among women of reproductive age attending family planning clinic in Adeoyo, Ibadan, Oyo State. A descriptive cross sectional study design was used for this study. The study was carried out in Adeoyo Maternity Hospital, Yemetu located at Ibadan, Oyo State. Oyo State is one of the 36 states of Nigeria and is located in the South Western region of the country. Purposive sampling was used for the distribution of the questionnaires to the women attending Infant Welfare Clinic at General Hospital Adeoyo Maternity, Yemetu, Ibadan Oyo State. Participants were interviewed as they came into the hospital. The process continued until the required number of sample size (100) was obtained. Data was collected using an interviewer administered questionnaire which consists of the following. Section A consist of Socio demographic characteristics. Section B consist of data on Perceived reasons for choice of contraceptive method, perception about contraceptive choice. Section C consist of data on Perceived satisfaction with chosen contraceptive method and explore factors that influence satisfaction. Section D consist of data on Compliance with contraceptive methods and factor that influence compliance. Data was entered, edited, and analyze with SPSS statistical software (version 15). This included the analysis of participants socio-demographics data such as age, marital status, occupation, educational level, ethnicity. Frequency table diagrams and graph for these data was computed. Chi-square test was used for bivariate analyses to test the significance of the association between selected independents and dependents variables. findings from this study show that (96%) women of reproductive age that participated in this study have heard of contraceptive and understand it importance also (58% ) were satisfied with the contraceptive method they choose because of the level of convenience, also (82%) of the respondents also used the contraceptive method of their choice regularly also (60% ) pf the respondents said they have confidence in the use of the method they went for .805) of the respondent their source of information on their currents method on the type of contraceptive to used was through the health worker. Only (19%) pf the respondents experienced side effect from their choice of contraceptive method they choose. Among the selected socio-demographic variable tested, it was discovered in this study that religion is the only factor that influence the use of contraceptive method among and this show statistically significant with P-value of 0.004. It is recommended that Increase effort in modern contraceptive method promotion and education is needed to be intensify to improve knowledge among women so that they can make a proper and informed choice. It is also recommended that health care providers should effectively play their role by making sure that their clients have sufficient knowledge on contraceptives which can help them make a correct choice.

Socio-economic and demographic determinants of fertility in six selected Pacific Island Countries: An empirical study.

In this study, we seek to perform macro analysis of fertility in a panel of 6 selected Pacific Island Countries (PICs, hereafter). The macro analysis with secondary data, mostly obtained from World Bank database, stretched over the period 1990-2019 was stacked randomly in a balanced panel set-up, within which the most preferred fixed effect model is used for multivariate analysis. Pooled OLS and Random effect estimation techniques were applied for comparing results. Categories such as women's empowerment, health, connectivity and cost of living were used to classify proxy variables as regressors for fertility determination. The results indicate variables such as contraceptive prevalence rate, female labour force participation rate and consumer price index (inflation) are negatively correlated with fertility at 1% level, while urbanisation is negatively correlated with fertility rate only at 10% significance level. Real GDP has negative relationship with fertility, however it is not statistically significant. Variables that are positively correlated with fertility but hold limited to no significance effects are female secondary enrolment, female population, mobile subscription and infant mortality rate. It is implied that those variables that are negatively associated with fertility, as well as Real GDP will be the major drivers for achieving replacement level fertility in the long run.

The family planning "know-do" gap among married women of reproductive age in urban Pakistan.

To examine the prevalence and predictors of family planning (FP) know-do gaps among married women of reproductive age (MWRA) in low socio-economic urban areas of Karachi, Pakistan. This was a cross-sectional survey of randomly selected 7288 MWRA (16-49 years) to identify predictors of the know-do gap in FP using a logistic regression model. More than one third (35.5%) of MWRA had FP know-do gap, i.e., despite having a knowledge of contraceptives and desire to limit or delay childbearing, they were not using contraceptives. Women were less likely to use FP if they were getting older (25-35 years: OR 1.45, 95% CI 1.09-1.94; >35 years: OR 3.02, 95% CI 1.90-4.80), from certain ethnicities (Sindhi: OR 1.64, 95% CI 1.11-2.42; Saraiki: OR 1.66, 95% CI 1.01-2.71; other minorities: OR 2.37, 95% CI 1.63-3.44); did not receive FP counselling: OR 1.43, 95% CI 1.13-1.80; and had not made a joint decision on FP: OR 1.44, 95% CI 1.06-1.98). Conversely, women were more likely to use contraceptives if they had >10 years of schooling (OR 0.66, 95% CI 0.46-0.94), with each increasing number of a living child (OR 0.68, 95% CI 0.62-0.75) and each increasing number of contraceptive method known (OR 0.93, 95% CI 0.88-0.98). The predictors associated with the FP know-do gap among MWRA should be considered when planning future strategies to improve the contraceptive prevalence rate in Pakistan.

Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria

BackgroundHealth system financing presents a challenge in many developing countries. We assessed two reform packages, performance-based financing (PBF) and direct facility financing (DFF), against each other and business-as-usual for maternal and child healthcare (MCH) provision in Nigeria.MethodsWe sampled 571 facilities (269 in PBF; 302 in DFF) in 52 districts randomly assigned to PBF or DFF, and 215 facilities in 25 observable-matched control districts. PBF facilities received $2 ($1 for operating grants plus $1 for bonuses) for every $1 received by DFF facilities (operating grants alone). Both received autonomy, supervision, and enhanced community engagement, isolating the impact of additional performance-linked facility and health worker payments. Facilities and households with recent pregnancies in facility catchments were surveyed at baseline (2014) and endline (2017). Outcomes were Penta3 immunization, institutional deliveries, modern contraceptive prevalence rate (mCPR), four-plus antenatal care (ANC) visits, insecticide-treated mosquito net (ITN) use by under-fives, and directly observed quality of care (QOC). We estimated difference-in-differences with state fixed effects and clustered standard errors.ResultsPBF increased institutional deliveries by 10% points over DFF and 7% over business-as-usual (p<0.01). PBF and DFF were more effective than business-as-usual for Penta3 (p<0.05 and p<0.01, respectively); PBF also for mCPR (p<0.05). Twenty-one of 26 QOC indicators improved in both PBF and DFF relative to business-as-usual (p<0.05). However, except for deliveries, PBF was as or less effective than DFF: Penta3 immunization and ITN use were each 6% less than DFF (p<0.1 for both) and QOC gains were also comparable. Utilization gains come from the middle of the rural wealth distribution (p<0.05).ConclusionsOur findings show that both PBF and DFF represent significant improvements over business-as-usual for service provision and quality of care. However, except for institutional delivery, PBF and DFF do not differ from each other despite PBF disbursing $2 for every dollar disbursed by DFF. These findings highlight the importance of direct facility financing and decentralization in improving PHC and suggest potential complementarities between the two approaches in strengthening MCH service delivery.Trial registrationClinicalTrials.gov NCT03890653; May 8, 2017. Retrospectively registered.

Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews.

BackgroundAvailable evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya.MethodsWe conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services.ResultsThe Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15–24 years (aOR = 0.69, 95% CI = 0.56–0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33–0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44–0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65–0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42–2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03–1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively.ConclusionThe quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.

Heterogeneity of Modern Contraceptive Use among Urban Slum and Nonslum Women in Kinshasa, DR Congo: Cross-Sectional Analysis.

Urban populations have been increasing at an alarming rate, with faster growth in urban slums than that in nonslums over the past few decades. We examine the association between slum residence and the prevalence of contraceptive use among women of reproductive age, and assess if the effect was modified by household wealth. We conducted cross-sectional analysis comprising 1932 women in slums and 632 women in nonslums. We analyzed the moderating effect through an interaction between household wealth and neighborhood type, and then conducted stratified multivariable logistic-regression analysis by the type of neighborhood. Fewer women living in nonslum neighborhoods used modern methods compared to those living in slum neighborhoods. Within slum neighborhoods, the odds of using modern contraceptive methods were higher among women visited by community health workers than among those who had not been visited. Parity was one of the strong predictors of modern contraceptive use. Within nonslum neighborhoods, women from the wealthiest households were more likely to use modern contraceptives than those from the poorest households. Household wealth moderated the association between the type of neighborhood and modern contraceptive use. The study findings suggested heterogeneity in modern contraceptive use in Kinshasa, with a surprisingly higher contraceptive prevalence in slums.

Barrier to contraceptive use among childbearing age women in rural Indonesia.

The contraceptive prevalence rate in Indonesia has not experienced much improvement, which has led to an increase in the number of pregnancies. This study aimed to analyse the barriers to contraception use among women of childbearing age in rural Indonesia. This study used a cross-sectional design with data from the Indonesian Demographic and Health Survey (IDHS) of 2017. The independent variables were age, employment status, education, marital status, wealth status, health insurance and parity. The dependent variable was the use of contraception. The statistical significance was set at p <0.05 using bivariate analysis and binary logistic regression. The study showed that the age group of 45-49 years (OR 0.199; 95% CI 0.149-0.266), secondary education (OR 2.227; 95% CI 2.060-2.514), women married/living with their partner (OR 43.752; 95% CI: 35.484-53.946), wealth status: middle (OR 1.492; 95% CI 1.400-1.589) and multipara (OR 2.524; 95% CI: 2.328-2.737) exhibited the increased use of contraception among women of childbearing age in rural Indonesia. The variables proven to represent obstacles to contraceptive use among women of childbearing age in rural Indonesia include old age, no education, no husband/partner, poverty and already having one child.

Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys

ObjectiveWe examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries.DesignWe included a weighted...

701To estimate contraceptive prevalence rate and unmet need for family planning in rural Shimla

Abstract Background The utilization of family planning services has improved over the decade, but still the SDG’s health target to ensure universal access to sexual and reproductive health care services is yet to be achieved. Methods A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent. Results The mean age of the participants was 28.9 ± 5.9 years. The modern contraceptive prevalence rate (mCPR) was found to be 67.7% among women of reproductive age group (15-49 years). Male condom (36%), followed by female sterilisation (30%) were the most common methods preferred. Conclusions Besides male condoms and female sterilisation, other methods of contraception were adopted by meagre number of women. Though, the unmet need for family planning was lesser in this study, still, efforts are needed to plunge it, for ameliorating the contraceptive prevalence rate. Also, the availability of basket of contraceptive choices in government sector need sheer assiduity. Key messages The continuing IEC activity related to family planning methods need to be upsurged, so that the available contraceptives reach the community by and large. The government system of provision of contraceptives may be made accessible and convenient, so that the beneficiaries are inclined to utilise these services.

Unmet need for family planning in Pakistan: prevalence and factors influencing unmet need among women of reproductive age.

Introduction: Despite government efforts, the contraceptive prevalence rate is low in Pakistan. UMNFP still exists in Pakistan like other low-middle income countries. Our study aims to determine the prevalence and factors affecting the unmet need for family planning in Pakistan.&#x0D; Methods: The analysis was performed using PDHS 2017-18 data set. In our study, 11847 women of reproductive age were included out of 14498.&#x0D; Result: In binary logistic regression, age, wealth index, and the number of living children found statistically significant. UMNFP was lower in women of older age (45-49) in contrast to younger women of age between 15-19 years. Regarding the women's socioeconomic status, those who belong to the middle socioeconomic class had a lower UNMFP in contrast to the poorest. UMNFP was 1.7 times more in women having more than three children in contrast to women who had less than or equal to three children. However, women's age, women socioeconomic status, and working status of women were found to be statistically significant with an unmet need for spacing in the multinomial model. In addition, the age of women, region, number of living children, socioeconomic status, and knowledge of family planning was found to be statistically significant with an unmet need for limiting.&#x0D; Conclusion: In the light of our study, overall unmet need is lower in older age and richer wealth quintile while UNMFP is high in women who had more than three children. Policymakers should design interventions to target high-risk populations to overcome the issue of rapid population growth.

FACTORS INFLUENCING CONTRACEPTIVE USE AMONG MARRIED WOMEN OF PRODUCTIVE AGE IN INDONESIA

Indonesia is facing a serious health issue as the total fertility rate (TFR) has significantly increased in the period of 2000-2017. Contraceptive Prevalence Rate (CPR) is stagnant in the same period. This study aims to assess the use of contraception in reproductive age-married women in Indonesia focusing on Contraceptive Use Mix (CUM) and other related factors. This cross-sectional study used raw data from the Indonesian National Socio-Economic Survey (INSES). The sample was 15-49 years married women with contraceptive use in 34 provinces in Indonesia. Total sample were 19,991 women. The results show that modern contraceptive use was 97.2% as opposed to traditional methods (2.8%). The Short-Acting Reversible Contraceptive (SARC) preferred was injectable methods (55.2%) and pills (21.0%). Factors influenced the use of modern contraceptive use was the number of children with OR = 1.864 (50%CI: 1.534-2.266). This research argues that contraceptive use among married women of productive age is still low in Indonesia, especially rural areas. Therefore, government must increase contraceptive financing and the village midwife program.

IDENTIFYING FACTORS ASSOCIATED WITH THE USE OF A SCALED-UP POSTPARTUM FAMILY PLANNING PROJECT IMPLEMENTED IN PUNJAB, PAKISTAN

Pakistan has one of the highest unmet needs for family planning among low and middle-income countries. Postpartum family planning (PPFP) is considered to have the potential of significantly improving the contraceptive prevalence rate and reducing the unmet need for family planning. Jhpiego (John Hopkins Affiliate) implemented a PPFP pilot project in the district headquarter hospital of Mandi Bahauddin. The key interventions of the Jhpiego pilot were to improve services pertinent to PPFP. Based on the successes of the pilot, the interventions were scaled up to other health facilities. The present study aims to identify the factors associated with the utilization of the postpartum family planning health project implemented in the health facilities once the scale-up activities ended and comparing it with the pilot facility. A cross-sectional survey with a sample of 410 women using postpartum care services in the facilities was conducted using a structured questionnaire. The findings indicated that the complete set of interventions were not present in the facilities. Postpartum family planning method uptake was low (26%) along with the shortage of contraceptives supplies. Multivariate logistic regression was conducted to identify the predictors for the current use of postpartum family planning. The predictors identified that women with the age of 25 years and above with 3 or more children, who attended antenatal care visits and were counselled on PPFP were more likely to adopt/use PPFP in the postpartum period. The findings indicated scale-up was limited and the interventions were not sustained once the donor support ended.

Exploring barriers to family planning service utilization and uptake among women in Iraq.

Family planning helps to avoid unwanted pregnancy and reduce maternal mortality and morbidity. Contraceptive prevalence is still relatively low (58%) in Iraq compared with other countries in the Eastern Mediterranean Region, and the unmet need (12%) and total fertility (4.2 children per woman) rates are still high. Services are available free of charge or heavily subsidized in many public and private health facilities, yet many women may still not use them due to social, cultural, financial or health care services constraints. This scoping review explores barriers to family planning services utilization and uptake among women in Iraq. The review uses an adapted conceptual framework from quality of care and human rights-based frameworks to analyse published scientific studies. At policy level, the government has supported family planning but not enough resources were allocated. At the service level, low family planning promotion from health care providers (especially during antenatal care visits) along with provider bias for certain types of contraception, have contributed to inaccurate information and misconceptions. At the community and individual level, women's choice is still largely influenced by the husband's position on contraception as men are still considered the key decision-makers in regard to fertility. Valuing a large family is still a barrier to family planning services utilization and uptake whereas religion was found to support the use of family planning. There is a need to provide promotional messages and encouraging mutual fertility decisions.

Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018

Background: In developing countries, pregnancy and childbirth are the leading causes of death among women. In this context, family planning and access to contraceptives are crucial for reducing pregnancy-related morbidity and mortality. Therefore, we aimed to look into the trends of contraception and determinants of contraceptive use in Pakistan.Methods: This study used data for women of reproductive age from four Pakistan Demographic and Health Surveys datasets. Contraception was the outcome variable, whereas, women’s and partner’s education, occupation, wealth quintile, region, place of residence, and exposure to family planning messages were the explanatory variables. Pooled prevalence was estimated using SUMARI and regression analysis was undertaken using SPSS to produce an adjusted prevalence ratio with 95% confidence intervals.Results: Data of 40,259 ever-married women of reproductive age (EMWRA) was analysed. Of the total EMWRA, 30% were using contraception. Of these, 26% were using traditional methods and 74% were using modern methods. The most common method of contraception was condoms (30.5%). The pooled prevalence of contraception used was 29.5% (95% CI 29.1 to 30.0). Through multivariate analysis, women's age, place of residence, region, wealth index, women’s education, their working status, and exposure to family planning messages were found to be significant determinants of contraception usage.Conclusions: There is a noticeable gap regarding awareness and uptake of contraception leading to low contraceptive use among women in Pakistan. In the light of our results, it is important to highlight the importance of girl’s education for building awareness and empowerment.

Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda. Implications for Urban Health.

Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality.Methods: A cross-sectional study conducted among 626 women in the reproductive age (15–49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0.Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women's education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48–0.97) and high decision-making power (PR 0.64, 95% CI: 0.50–0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01–1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24–2.34).Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.

Use of community-based interventions to promote family planning use among pastoralist women in Ethiopia: cluster randomized controlled trial

BackgroundAfar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia.MethodsThe study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women’s education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI).ResultsThe proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women’s education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women’s education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women’s education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm.ConclusionThe present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP.Trial registrationClinicalTrials.gov, NCT03450564, March, 2018.