Contraceptive Prevalence Research Articles

Predictors of modern contraceptive usage among sexually active rural women in Ethiopia: A\xa0multi-level analysis

BackgroundEthiopia is one of the Sub-Saharan Africa countries with the lowest modern contraceptive prevalence rate and the highest fertility rate. This study aimed to assess individual and community-level predictors of modern contraceptive use among sexually active rural women in Ethiopia.Data and methodsA sample of 9450 sexual active rural women aged 15-49 was extracted from the 15, 683 nationally representative samples of 2016 Ethiopian Demographic and Health Survey (EDHS). Multi-level logistic regression model was considered to identify determinant factors of modern contraceptive use among sexually active rural women in Ethiopia.ResultThe prevalence of modern contraceptive use among respondents was 20% in rural Ethiopia. Injection (66.35%) was the most common type of modern contraceptive use. In the last full model of the multilevel analysis, individual and community-level factors accounted for 86.69% of the variation in the use of modern contraceptive methods. Secondary and above-educated women (AOR = 1.39, 95%CI: 1.06, 2.81), having 1-4 living children (AOR = 2.70, 95%CI: 2.07, 3.53), rich wealth status (AOR = 2.26, 95%CI: 1.96, 2.60), married women (AOR = 17.31, 95%CI: 10.72, 27.94), having primary educated husband (AOR = 1.45, 95%CI: 1.27, 1.67) and being working husband (AOR = 2.26, 95%CI: 1.96, 2.60) were significantly positively associated with individual-level factors of the use of modern contraceptive methods. Besides, modern contraceptive use was negatively associated with Muslim women (AOR = 0.29, 95%CI: 0.25, 0.33). Compared to the Tigray region, women living in the Afar, Somali, Harari, and Dire Dawa regions had lower use of modern contraceptive methods. Women who had access to mass media (AOR = 1.35, 95%CI: 1.16, 1.57) were more likely to use contraceptives than their counterparts.ConclusionThe prevalence of modern contraceptive use among rural women has very low. Both individual and community-level factors were significant predictors of modern contraceptive use. Consequently, the government and other stakeholders need to address educational opportunities; creating awareness about modern contraception and valuable counseling would increase modern contraceptive methods utilization.

The Impact of Contraceptive use on Women Health: A Study of Rural Area, Minia, Egypt

Background: Women’s health concerns are associated with the female reproductive system, breast and otherphysiological structures. Contraception was a deliberate and willful selection of contraceptive methods. InEgypt, there is an increasing trend of using contraception to regulate births due to recent awareness ofcontraception. However; having insufficient knowledge about use of contraceptives would be more riskyand its prolonged use sometimes results in various health problems. Aim was to reveal the prevalence ofcontraception use in rural area of Minia governorate and study the most common health problems amonguser as compared to non-users. Methodology: cross sectional community based study conducted among 564rural married women in reproductive age during the period from November 2018 to May 2019. Results:Nearly 69.1% of women were currently using a contraceptive method, 142 (25.2%) never previouslyuse contraception and 32 (5.7%) discontinued. There were significant increase of health problem amongcurrently contraception user a compared to currently non user, majority (90.3%) of user complain menstrualirregularities compared to 24.1% of non-user (p=0.003* RR=29.1), 64.1% had nausea compared to 28.1%among non-user with RR =6.3, hypertension (RR=5.5) Headache (RR=2.6) Heart burn (RR=3.3) hadsignificant increased relative risk. Conclusion: The present study illustrates that contraceptive methodshave important health impacts. Health states decrease the effectiveness of any method. Awareness should beenhanced by health education using mass media and counseling, male contraceptives should be introduced,medical free camps and contraceptive availability.

Contraceptive prevalence rate and associated factors among reproductive age women in four emerging regions of Ethiopia: a mixed method study

BackgroundEthiopia is the second most populous country in Africa, known for its high fertility and low contraceptive use. The magnitude of contraceptive use in the emerging regions of the country is below the national average. However, there is a paucity of evidence regarding the reasons for low contraceptive use in these regions. Therefore, this study aimed to assess contraceptive use and associated factors in the emerging regions of Ethiopia.MethodsFor the quantitative part, a community based cross-sectional study was conducted among 2891 reproductive age women who were selected by multistage sampling technique. Data were collected face to face using an open data kit software, and STATA version 14 was used for data analysis. Frequencies, percentages, summary measures and tables were used to summarize and present the data. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with contraceptive use, by computing odds ratio with 95% confidence interval. Level of significance was considered at p-value < 0.05. For the qualitative part, phenomenological study was conducted among 252 health care workers and community members who were selected purposely. The data were collected by focused group discussions, in-depth interviews and key informant interviews. The data were audio-recorded in the local languages, and then translated to English verbatim. NVivo version 11 was used to analyze the data through a thematic analysis method.ResultsThe overall contraceptive prevalence rate was 22.2%; with 11.7, 38.6, 25.5 and 8.8% for Afar, Benshangul Gumuz, Gambela and Somali Regions, respectively. Age, religion, education, marital status, family size, ideal children, knowledge and attitude were significantly associated with contraceptive use. Additionally, the qualitative study identified three themes as barriers to contraceptive use: individual, health care system and sociocultural factors.ConclusionsContraceptive prevalence rate was low in this study compared to the national average. Age, religion, education, marital status, family size, ideal children, knowledge and attitude were significantly associated with contraceptive use. From the qualitative aspect, individual, health care system and sociocultural factors were identified as barriers to contraceptive use. Therefore, the emerging regions of Ethiopia need special focus in increasing contraceptive use through behavioral influence/change.

Demand for Family Planning Satisfied With Modern Methods in Urban Malawi: CHAID Analysis to Identify Predictors and Women Underserved With Family Planning Services.

Introduction: Family planning progress under the SDGs is measured with a novel indicator, demand for family planning satisfied with modern methods (mDFPS), which provides a better indication of modern contraceptive coverage than unmet need and contraceptive prevalence rate. Yet, few studies have examined the predictors of mDFPS and the sub-groups of women with unsatisfied mDFPS in urban Saharan Africa. The objective of this study was to examine the predictors of mDFPS in urban Malawi and to identify the sub-groups of urban women underserved with modern contraceptives.Methods: The study analysed data from the 2015–16 Malawi Demographic and Health survey. The sample was comprised of 2,917 women in urban Malawi who had a demand for family planning services. We used a Chi-square (χ2) Automatic Interaction Detector (CHAID) model to address the study objectives.Results: The results show that the number of living children a woman had was the most significant predictor of mDFPS. Women with one or more children, who were of Chewa, Lomwe, or Tumbuka ethnic origin and who resided in the central region had the highest mDFPS (87%). On the other hand, women with no children, and who were not exposed to FP information on television, had the lowest mDFPS (41%). Among women in union, ethnicity was the best predictor of mDFPS. Ngoni, Yao, and other ethnic minority women in union who were aged 15–19 and 40 years and above and those who were Catholic, SDA/Baptist, or Muslim had the lowest mDFPS (36%).Conclusion: This study demonstrates significant intra-urban disparities in demand for FP satisfied with modern contraceptives in Malawi. There is a need for policymakers and reproductive health practitioners to recognise these disparities and to prioritise the underserved groups identified in this study.

The Effect of Reframing the Goals of Family Planning Programs from Limiting Fertility to Birth Spacing: Evidence from Pakistan.

Contraceptive prevalence in Pakistan has plateaued near 34 percent for over a decade, suggesting that fertility levels are likely to stay high unless effective interventions are designed. We evaluate the Family Advancement for Life and Health 2007–2012 (FALAH), a family planning project implemented in 31 districts of Pakistan. Deviating from previous programs, FALAH emphasized birth spacing—as opposed to limiting family size—as the primary purpose of contraceptive use. We use Pakistan Demographic and Health Survey to evaluate FALAH's impact on continuous and binary measures of birth intervals. To estimate the causal effects of the project, we compare the outcomes for multiple children born to the same mother before and after the project. We find that FALAH increased interbirth intervals by 2.4 months on average and reduced the proportion of short birth intervals by approximately 7.1 percentage points. This finding suggests that birth spacing as a goal of contraceptive use may resonate better with Pakistani couples than limiting family size. The project's effects were more pronounced for women with high education, in rural areas, and in the middle of the wealth distribution.

The effect of women's bargaining power within couples on contraceptive use in Cameroon.

The prevalence of contraception among married women, evaluated at 23%, is low in Cameroon. Maternal death rates, estimated at 782 deaths per 100,000 live births, are very worrying. The National Strategic Plan for Reproductive, Maternal, Newborn and Child Health (2015-2020) and the Health Sector Strategy (2016-2027) focuses on increasing modern contraceptive prevalence as a means to reduce maternal death. This paper identifies women's bargaining power as a factor that may stimulate contraceptive use. The objective of this study is to analyze the association between women's bargaining power within couples and modern contraceptive use. The data used come from the fifth Demographic and Health Survey (DHS) conducted in 2018. Women's bargaining power within couple is measured by a Woman Bargaining Power Composite Index (WBPCI) built through a multiple correspondence analysis. The logistic regression model was used to analyze the relationship between WBPCI and modern contraceptive use. The results of the descriptive statistics show that women's bargaining power is higher among women who use contraception than for those who do not. The results of the logistic regression model show that an increase of WBPCI was significantly associated with higher chances of using a modern contraceptive method (OR = 1.352; 95% CI: 1.257, 1.454; p <0.01). The education of women is also a key determinant since educated women were at least two times more likely to use a modern contraceptive method than uneducated women. To reduce high maternal death rates in Cameroon, public health policies should not only focus on the health system itself, but should also focus on social policies to empower women in the household.

Yam Daabo interventions\u2019 effects on postpartum family planning use in Burkina Faso at 24\u2009months after childbirth

IntroductionAfter testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventions’ effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention.MethodsYam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12 months post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics.ResultsTwelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12 months, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratio = 1.21; 95% confidence interval [CI] = [0.91–1.61], p = 0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratio = 1.35; 95% CI = [1.08–1.69], p = 0.008).ConclusionTwelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group.Trial registrationThe trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334. The date of the first registration is 27/09/2016.

Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant

ObjectivesReproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce...

Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi

BackgroundWith a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members.MethodsAn explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n = 132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes.ResultsThe overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09–10.27 p = 0.038), those that have completed secondary school and having four or less children were significantly associated with use of family planning (aOR 1.72 (95%1.35–2.01) p = 0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning.ConclusionGiven that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.

Spatiotemporal Patterns and Determinants of Reproductive Health Care Utilization in Nigeria: 2008–2018

This study examined the spatiotemporal variations and determinants of reproductive health care (RH) indicators in Nigeria- contraceptive prevalence rate, antenatal care by skilled provider, institutional delivery, skilled attendant at birth, and postnatal care, for the period 2008–2018. Data were obtained from Demographic and Health Surveys conducted in 2008, 2013, and 2018. Moran’s I indices and multivariable logistic regression analysis were employed. Wide spatial variations exist in RH utilization at regional, urban/rural and district levels, and among different socio-economic groups. Reproductive healthcare utilization was high in the South-West and South-East zones, urban areas, among women with post-secondary education, richest households, women aged 20–34 years and first birth order but low in the North-West and North-East zones, rural areas, among women with no education, poorest households and those aged 15–19 years. All the RH indicators exhibited a clustered pattern nationally. Locally, hotspot clusters were located in the South-West and South-East while cold spots concentrated in the North-West and North-East zones. Educational level and wealth were the most consistent determinants of utilization of all the RH indicators. Other factors include region, place of residence, partner/husbands educational level and ethnicity. Strengthening of health interventions and educational campaigns are required especially in rural areas.

Where are Women Getting Contraceptives in Conflict-Affected Settings?: Analysis of Demographic and Health Survey Data From 30 African Countries

Background: Most populations affected by conflict still lack adequate reproductive health (RH) care. This study examined the association between conflict and modern contraceptive use, unmet need, and provision in 30 sub-Saharan African (SSA) countries. Objectives were to compare outcomes in conflict-affected, post-conflict and non-affected countries, and quantify the effect of conflict status on where women sourced their contraception. Methods: We used Demographic and Health Survey datasets to estimate our primary outcome of contraceptive use, within which we examined unmet need and type of contraceptive used. To examine where women accessed care, we categorised health services into public and non-public sectors. We classified countries as non-conflict, conflict-affected, or post-conflict using Uppsala criteria. Bivariate and multivariable logistic regression models were used to examine the association between outcomes and conflict. Findings: Among 344,394 women, unmet need was 53∙9%, 64∙3% and 66∙0% in non-, conflict-affected, and post-conflict settings, respectively. Use of modern contraceptives was 15∙1% overall, highest in non-conflict (21∙3%) and lowest in conflict-affected countries (10∙5%). Women in conflict-affected countries had 2∙35 times higher adjusted odds (95%CI 2∙10-2∙62) of seeking contraceptive services in the non-public sector than women in non-conflict affected countries. Interpretation: Contraceptive prevalence in conflict-affected SSA countries was low with a skew toward short-acting methods in conflict-affected countries. Women in conflict areas were more likely to seek services in the non-public sector. MCPR could potentially be increased through engagement with non-public sector entities, as women are already accessing contraceptive services there. Funding Information: Funding for this work came from MSD, through MSD for Mothers. Declaration of Interests: None declared. Ethics Approval Statement: Informed consent and ethical approval is obtained in every country the DHS is conducted. Ethical approval for this analysis was obtained from the London School of Hygiene and Tropical Medicine ethics committee.

The scale-up and integration of contraceptive service delivery into nursing school training in the Democratic Republic of the Congo.

In Kinshasa, Democratic Republic of the Congo (DRC), modern contraceptive prevalence is low by international standards: 29.6% as of 2020. A 2015 pilot study demonstrated the feasibility and acceptability of using medical and nursing students to administer DMPA-SC (the subcutaneous injection) among other methods at the community level. The more far-reaching discovery was the potential of clinically trained students to increase access to low-cost contraception in the short-run, while improving the quality of service delivery for future generations of healthcare providers. Scale-up involved integrating the family planning curriculum into the training of nursing students, including classroom instruction in contraceptive technology and service delivery, coupled with a year-long field practicum in which students offered a range of contraceptive methods during intermittent outreach events, door-to-door distribution or sales from their homes. Starting in 2015, a multi-agency team consisting of an international non-governmental organizations (NGO), several Ministry of Health directorates and a local NGO used the ExpandNet/WHO framework to guide this scale-up. This article details the nine steps in the scale-up process. It presents results on increases in contraceptive uptake, feedback from participating nursing school personnel and the employment experience of the graduates from this programme. Between 2015 and 2019, the family planning curriculum was incorporated into 30.8% of the 477 nursing schools in 7 of the 26 provinces in the DRC. Students delivered 461 769 couple-years of protection (the key output indicator for family planning programmes). Nursing school personnel were strongly favourable to the approach, although they needed continued support to adequately implement a set of additional interventions related to the service delivery components of the new training approach. Post-graduation, only 40.1% of graduates had paid employment (reflecting the staggering unemployment in the DRC); among those, over 90% used their family planning training in their work. We describe the multiple challenges faced during the scale-up process and in planning for expansion to additional schools.

FAKTOR YANG MEMPENGARUHI PEMILIHAN IUD PASCA PLASENTA PADA WUS DI PUSKESMAS WILAYAH KOTA MATARAM

The use of the Kb method is expressed by the Contraceptive Prevalence Rate (CPR). Based on Riskesdas (2013), the proportion of family planning use in risk groups, namely the group of married women aged 15-19 years, is 46%, this figure is still lower than the 2014 RPJM target of 60.1%. Younger married women use more modern short-term contraceptives such as injections and birth control pills, while older women use more long-term contraceptives such as IUD and sterile (BKKBN et al., 2012). The purpose of this study was to determine the description of the user profile and what factors influence the selection of post-placental IUDs in fertile aged women in the PKM, Mataram City area. This research is a descriptive analytic study. With a case control research design which is an analytic survey (survey) that concerns how risk factors are studied using a retrospective approach. The sample in this study was 40 respondents who were divided into 2 groups, namely 20 respondents for the user group and 20 respondents for the control group. The user profile of the respondents in this study is the post-placenta IUD which is most widely used in respondents with the age group of 20 - 35 years, namely a number of 19 respondents (95%). Most of them came from high school education level with a number of 15 respondents (75%). Most of them came from unemployed mothers / housewives, namely 17 respondents (85%). With the highest number of parity is multiparous, namely 12 respondents (60%). And all respondents 20 respondents (100%) have the goal of family planning is to delay pregnancy. There is a significant relationship between perceptions and attitudes with the use of the Post Placenta IUD in women in the working area of ??Puskesmas in Mataram City

Evaluating the Demographic and Health Surveys Mode Switch From PAPI to CAPI: An Experiment From Turkey

The Demographic and Health Surveys (DHS) have been carried out in over 90 countries since 1984, as interviewer administered household surveys conducted initially by paper and pencil interviews (PAPI). Computer assisted personal interviews (CAPI) were introduced in the 2004 Peru DHS, and since then numerous countries have also switched. However, DHS randomized mode comparisons have been limited. The 2018 Sixth Turkey DHS was conducted using CAPI but allocated one household from 21 in each of 754 clusters to PAPI. This analysis examines a wide range of potential differences between modes: interviewer attitudes toward modes; response rates, underreporting and misreporting of persons or events, number of selections to “check all that applies” questions, respondents' attitudes towards modes reflected by responses to sensitive questions, satisficing behavior such as age heaping, straight-line response patterns, and use of don’t know options; and some operational aspects of modes such as retrospective monthly contraceptive prevalence rates, presence of others during interview, and interview length. Findings show that, despite strong interviewer CAPI preference, CAPI and PAPI were on average almost identical in terms of responses. CAPI took 11 min less (total duration of 33 min). Analysis of retrospective monthly contraception use indicated potential underreporting by CAPI for past use, an issue highlighted before in DHS literature. Overall, the switch to computer technology in DHS surveys does not appear to change estimates or levels of nonsampling errors, although some differences with respect to PAPI mode may need DHS designer attention.

Adolescents Living With HIV: Contraceptive Services and Uptake in General Primary Healthcare Clinics and Stand-Alone Youth Clinics.

To investigate whether current contraceptive uptake, unmet need for contraception, and unintended pregnancy among female adolescents living with HIV (ALHIV) vary with the model of access sites for HIV-related services, that is, stand-alone youth clinics (YCs) versus general primary health clinics (PHC). Exit interviews. Multi-center, primary healthcare facilities. Female adolescents living with HIV (ALHIV) aged 14-19 years and interviewed between March 1, 2017 and July 31, 2017. Structured exit paper-based survey. Participants were divided into stand-alone YC and general PHC groups. Uptake of contraceptive counseling and products were compared between the 2 clinic groups. A total of 303 female ALHIV completed the exit interviews. For female ALHIV, contraceptive prevalence was high among both general PHCs (84.2%) and stand-alone YCs (82.9%). Contraceptive method mix was similar between both groups of female ALHIV. Compared to stand-alone YCs, the general PHCs had similar likelihood of contraceptive counseling provision (aOR 0.84 95% CI [0.55, 1.26]) and provision of contraceptive products, including condoms (aOR 0.54 95% CI [0.26, 1.16]) and dual-method (aOR 1.80 95% CI [0.81, 3.99]) for female ALHIV. Also, there were no significant differences in the likelihood of contraceptive prevalence (aOR 0.99 95% CI [0.59, 1.67], unmet need for contraception (aOR 1.64 95% CI [0.90, 2.98]), and unintended pregnancy (aOR 1.06 95% CI [0.57, 1.98]) between clinic groups. Mainstreaming youth-friendly services into existing health facilities could achieve similar contraceptive service provision, uptake and outcomes for ALHIV as stand-alone youth clinics.

Donor Commitments and Disbursements for Sexual and Reproductive Health Aid in Kenya, Tanzania, Uganda and Zambia.

Background: Sexual and Reproductive Health and Rights (SRHR) investments are critical to people's well-being. However, despite the demonstrated returns on investments, underfunding of SRHR still persists. The objective of this study was to characterize donor commitments and disbursements to SRH aid in four sub-Saharan countries of Kenya, Tanzania, Uganda and Zambia and to compare trends in donor aids with SRH outcome and impact indicators for each of these countries.Methods: The study is a secondary analysis of data from the Organization for Economic Co-operation and Development's Assistance creditor reporting system and SRH indicator data from the Global Health Observatory and country demographic health surveys for a 16-year period (2002–2017). We downloaded and compared commitments to disbursements of all donors for population policies, programs and reproductive health for the four African countries. SRH indicators were stratified into health facility level process/outcome indicators (modern contraceptive prevalence rate, unmet need for family planning, antenatal care coverage and skilled birth attendance) and health impact level indicators (maternal mortality ratio, newborn mortality rate, infant mortality rate and under five mortality rate).Results: Donor commitments for SRH aid grew on average by 20% while disbursements grew by 21% annually between 2002 and 2017. The overall disbursement rate was 93%. Development Assistance Cooperation (DAC) countries donated the largest proportion (79%) of aid. Kenya took 33% of total aid, followed by Tanzania 26%, Uganda 23% and then Zambia (18%). There was improvement in all SRH outcome and impact indicators, but not enough to meet targets.Conclusion: Donor aid to SRH grew over time and in the same period indicators improved, but improvement remained slow. Unpredictability and insufficiency of aid may be disruptive to recipient country planning. Donors and low- and middle-income countries should increase funding in order to meet global SRHR targets.

Knowledge and Utilization of Family Planning Services among Women of Reproductive Age in Ilishan Community Health Center, Ogun State

Nearly one in ten women of reproductive age worldwide has an unmet need for family planning. Although contraceptive usage has increased globally, sub-Saharan Africa has recorded the lowest usage of contraceptives worldwide, with Nigeria, the country with the highest population in Africa still recording a low prevalence of contraceptive usage. This descriptive survey assessed the knowledge and utilization of family planning services among 85 women attending a comprehensive health centre in Ogun State. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 26 and hypotheses were tested using chi-square. Findings revealed the level of knowledge on family planning was above average as 55.8% demonstrated good knowledge; however, utilization of family planning services was below average as 55.8% showed inadequate utilization. While significant association was found between the utilization of family planning and the number of children per household, (χ2=8. 649, p = 0.034), no significant association was found between knowledge of the respondents and their utilization of family planning services (χ2=0.828, p = 0.730), and also between knowledge of the respondents and their educational level (χ2=4.303, p = 0.116). Although the level of knowledge in this study was above average, there is still room for improvement even as the knowledge did not translate into adequate utilization of family planning services. This calls for more advocacy and interventions to combat this trend. This will hopefully improve contraceptive prevalence while aligning Nigeria with the Sustainable Development Goal of providing universal access to reproductive health services by 2030.

An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda

BackgroundSupportive male involvement is strongly correlated with contraceptive use. In Rwanda, where the contraceptive prevalence rate among married women increased from 17 to 52% from 2005 to 2010, and stagnated at 53% in 2015, understanding the role of male partners in collaborative couple contraceptive use can help inform programs designed to further increase the use of contraception in Rwanda.MethodsThis study utilized qualitative methods in 2018, specifically 32 in-depth interviewers with mostly current users of modern contraceptive methods and eight focus group discussions with family planning providers—both family planning nurses and community health workers (CHWs). Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively, to explore the role of couple collaboration in family planning use in Rwanda. Data were analyzed using the thematic content approach in Atlas.ti (8).ResultsFindings demonstrate that some men are opposed to use of male methods of contraception, and some are opposed to any contraceptive use, which can lead to covert use. Women and providers prefer collaborative couple contraceptive use—as a result, providers advocate for and encourage male partner participation in contraceptive use. Women are most often burdened with seeking out information, initiating discussions, and sharing information discovered about contraceptive use with partners. Decision-making about contraceptive use, once discussed, can be collaborative and motivated by financial considerations. When couple contraceptive use is collaborative, benefits range from marital harmony to husband’s support of sustained use through reminders about appointments, joint counseling, and support in managing side effects.ConclusionFamily planning providers at the community and clinic levels encourage collaborative contraceptive use among couples and some Rwandan couples communicate well about family planning use. Despite the positives, women are expected to source family planning information, share that information with their male partners, seek out family planning services, and use family planning. If more Rwandan male partners accepted use, used male methods of contraception, and participated even more in the work it takes to use family planning, the potential for sustained, and even enhanced, contraceptive use in Rwanda could be realized.

Implementing a Novel Facility-Community Intervention for Strengthening Integration of Infant Nutrition and Family Planning in Mara and Kagera, Tanzania.

Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.

Demand satisfied by modern contraceptive among married women of reproductive age in Kenya.

BackgroundDemand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs.Materials and methodsPerformance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014–2018 was used. PMA2020 surveys are cross-sectional including women 15–49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15.ResultsOf the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15–19 and 45–49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0–13.8% over the 5-years, p<0.001. Married adolescent 15–19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7–79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9–37.2% and decrease in short acting methods from 49.9–42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence.ConclusionsResults show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.