Contraceptive Utilization Research Articles

INFLUENCE OF SUBSTANCE ABUSE ON CONTRACEPTIVE USE AMONG UNDERGRADUATE STUDENTS

Studies have shown a relationship betweendrinking and ineffective contraception and condom use. The rate of binge drinking and ineffective contraception or ineffective condom use among college women was proved to be high. This article examined the influence of addictive behavior on utilization of contraceptives among undergraduate students. Addictive factors that were compared with utilization included attending club and parties, alcohol consumption, and smoking. The data used in analysis was based on stratified probability sample of 453 respondents interviewed in 2017 from Masinde Muliro University of Science and Technology (MMUST). Quantitative and qualitative data was analyzed using descriptive statistics. The study revealed that there was a statistical significant relationship between respondent who frequently attended clubs and parties and contraceptives utilization (OR=0.48 95%CI 0.27-0.84, p=0.01). However, patronizing clubs and parties frequently reduced the probability of using contraceptives by 48% compared to those who did not frequent clubs or parties. Also, alcohol consumption was significantly associated with contraceptives utilization (OR=0.33: 95%CI 0.18-0.59, p=0.00). This result also revealed that respondents who consumed alcohol were 0.33 times less likely to use contraceptives than those who did not indulge in alcohol. Smoking was not statistically significantly associate with contraceptive utilization (p=0.85). The article recommends that HIV and AIDS peer educators should be tasked with educating on sexual and reproductive health and the importance of implementing specific programs in institutions of higher learning to limit the risks of addiction and partying, not only in terms of alcohol abuse, but also addictive behavior such as smoking.

The significant influence of history of induced abortion on the utilisation of long-acting reversible contraceptive methods in the immediate post abortion period, Northern Ethiopia

Background Rapid population growth, untended pregnancy, and related consequences remain the concern of Sub-Saharan African countries, including Ethiopia. Despite this, long-acting reversible contraceptives methods are still underutilised and no studies have sought the factors in this study setting. Therefore, this study conducted to assess the prevalence and determining factors of long-acting reversible contraceptives utilisation following an abortion in Northern Ethiopia. Method Facility-based cross-sectional study design was employed. A total of340 post aborted women selected by a systematic sampling method from August 1 to October 30, 2018. Data were entered into Epi-Info version 7 software and exported to SPSS version 20 for analysis. Both bivariate and multivariate logistic regression models were used to identify factors associated with the outcome variable. Results The overall post-abortion long-acting reversible contraceptives utilisation was 57(16.76%) with 47(82.46%) implantand 10 (17.54%) intrauterine devices. Age range 20–29 years (AOR = 0.09, 95% CI 0.02–0.37), employed (AOR = 5.22, 95% CI 1.99–13.67), had ≥2 alive children (AOR = 7.02, 95% CI 1.58–31.23), induced abortion (AOR = 8.41, 95% CI 3.28–21.59), surgical abortion (AOR = 5.99, 95% CI 2.25–15.94), previous awareness (AOR = 3.18, 95% CI 1.14–8.82) and history of prior utilisation (AOR = 3.59, 95% CI 1.08–11.97) were the factors significantly associated with utilisation of post-abortion long-acting reversible contraceptives. Conclusion Long-acting reversible contraceptive methods level of utilisation following an abortion in this study was low. Advocating and raising awareness should always consider on benefits and effectiveness of long-acting reversible contraceptives for all type of abortion and methods of termination as an integral part of reproductive health care services.

Contraceptive Method Utilization and Determinant Factors among Young Women (15-24) in Ethiopia: A Mixed-Effects Multilevel Logistic Regression Analysis of the Performance Monitoring for Action 2018 Household Survey.

Despite highly effective modern contraceptive methods (both short and long acting) are made widely available and accessible globally, their utilization remains low among young women in low- and middle-income countries, including Ethiopia. Hence, this study is aimed at determining its status and identifying the determinant factors by using nationally representative data. A multilevel analysis of the nationwide Performance Monitoring for Action 2018 of Ethiopia round 6 data, collected from June to July, 2018, was conducted. A total of 982 both married and unmarried young women (15-24) were included in the analysis. Descriptive statistics was used to describe the status of contraceptive method utilization and unmet need across regions. A mixed-effects multilevel logistic regression model was used to identify the determinants of the contraceptive method utilization. Adjusted odds ratios with corresponding 95% confidence intervals were used to show the significance of the associations at p < 0.05. The status of contraceptive method utilization was 54.8% (95% CI: 51.7%, 57.9%), and 18.6% (95% CI: 16.3%, 21.2%) had unmet need. Afar (12.3%), Harari (12.5%), and Ethiopian Somali (20.0%) regions had the lowest contraceptive method utilization. Wealth quintiles and religion were the higher level variables affecting contraceptive method utilization among the young women. Age, marital status, parity, future birth intention, and knowledge of contraceptive methods were the individual level factors identified as determinants of contraceptive method use among the young women. In conclusion, the status of contraceptive method utilization among the young women in Ethiopia is promising as compared to the national target of 55% for 2020; however, still high unmet need exists. The factors also exist both at the contextual and at individual levels. Hence, multilevel interventions need to be in place giving special emphasis to the low performing regions. Besides, region-specific behavioral interventions and family planning services that will be able to reach the young women need to be designed.

Association between media exposure and family planning in Myanmar and Philippines: evidence from nationally representative survey data

BackgroundAlthough women in South Asia and South-east Asia have developed their knowledge regarding modern contraceptive and other family planning techniques, limited information exists on the influence of mass media exposure on the utilization of contraceptives and family planning. The current study examined the association between media exposure and family planning in Myanmar and Philippines.MethodsThe study analyzed data from the 2017 Philippines National Demographic and Health Survey (NDHS) and 2015–16 Myanmar Demographic and Health Survey (MDHS). Three family planning indicators were considered in this study (i.e., contraceptive use, demand satisfied regarding family planning and unmet need for family planning). A binary logistic regression model was fitted to see the effect of media exposure on each family planning indicator in the presence of covariates such as age group, residence, education level, partner education level, socio-economic status, number of living children, age at first marriage, and working status.ResultsThe prevalence of contraception use was 57.2% in the Philippines and 55.7% in Myanmar. The prevalence of demand satisfied regarding family planning was 70.5 and 67.1% in the Philippines and Myanmar respectively. Unmet need regarding family planning was 16.6% and 19.9% in the Philippines and Myanmar respectively. After adjusting for the covariates, the results showed that women who were exposed to media were more likely to use contraception in Philippines (aOR = 2.24, 95% CI = 1.42–3.54) and Myanmar (aOR 1.39, 95% CI = 1.15–1.67). Media exposure also had a significant positive effect on demand satisfaction regarding family planning in the Philippines (aOR = 2.19, 95% CI = 1.42–3.37) and Myanmar (aOR = 1.34, 95% CI = 1.09–1.64). However, there was no significant association between media exposure and unmet need in both countries.ConclusionsThe study established a strong association between mass media exposure and the use and demand satisfaction for family planning among married and cohabiting women in Philippines and Myanmar. Using mass media exposure (e.g., local radio, television- electronic; newspapers) to increase both access and usage of contraceptives as well as other family planning methods in these countries could be pivotal towards the attainment of United Nations Sustainable Development Goal 3 (SDG 3) of improving maternal health.

Determinants of short birth intervals among married women: a cross-sectional study in Karachi, Pakistan

IntroductionBirth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our...

The intersection of intimate partner violence and substance use among women with opioid use disorder

Background Women with opioid use disorder (OUD) report high rates of intimate partner violence (IPV) and there is limited understanding of how IPV influences substance use behaviors among women with OUD. Methods: Semi-structured qualitative interviews were conducted with a sample of 40 women with OUD participating in an ongoing clinical trial evaluating postpartum contraceptive utilization patterns for this population. Interviews were audio-recorded, transcribed verbatim and lasted approximately 45 min. Interview questions focused on women’s perceptions and experiences with IPV and how these experiences impacted their substance use behaviors. Transcripts were coded independently in Atlas.ti and qualitatively analyzed using a general qualitative inquiry approach for emerging themes. Results: Participants were aged 24–29, and the majority were white, single, unemployed, had Medicaid insurance and a high school degree. Although personal IPV experiences were not necessary to be selected for this qualitative sub-study, all participants reported some lifetime experience with IPV. Four overarching themes emerged: (1) women attributed physical IPV to their partner’s substance use; (2) emotional abuse prevented women from fully engaging in their recovery; (3) financial abuse prevented women from gaining independence from abusive partners; and (4) women coped with IPV experiences through substance use. Conclusions: IPV had a significant influence on women’s substance use behaviors including their perceived risk of relapse and treatment discontinuation. These findings demonstrate the need to integrate assessment, evaluation and management of IPV into substance use treatment settings.

Prevalence and associated factors of adolescent pregnancy (15\u201319 years) in East Africa: a multilevel analysis

BackgroundAdolescent pregnancy is a major public health problem both in developed and developing countries with huge consequences to maternal health and pregnancy outcomes. However, there is limited evidence on the prevalence and associated factors of adolescent pregnancy in East Africa. Therefore, this study aimed to investigate the prevalence and associated factors of adolescent pregnancy in Eastern Africa.MethodThe most recent Demographic and Health Survey (DHS) datasets of the 12 East African countries were used. A total weighted sample of 17, 234 adolescent girls who ever had sex was included. A multilevel binary logistic regression analysis was fitted to identify the significantly associated factors of adolescent pregnancy. Finally, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the factors that are significantly associated with adolescent pregnancy.ResultsThe overall prevalence of adolescent pregnancy in East Africa was 54.6% (95%CI: 53.85, 55.34%). In the multivariable multilevel analysis; being age 18–19 years [AOR = 3.06; 95%CI: 2.83, 3.31], using contraceptive [AOR = 1.41; 95%CI: 1.28, 1.55], being employed girls [AOR = 1.11; 95%CI: 1.03, 1.19], being spouse/head within the family [AOR = 1.62; 95% CI: 1.45, 1.82], and being from higher community level contraceptive utilization [AOR = 1.10; 95%CI:1.02, 1.19] were associated with higher odds of adolescent pregnancy. While adolescent girls attained secondary education and higher [AOR = 0.78; 95%CI: 0.68, 0.91], initiation of sex at age of 15 to 14 years [AOR = 0.69; 95%CI: 0.63, 0.75] and 18 to 19 years [AOR = 0.31; 95%CI: 0.27, 0.35], being unmarried [AOR = 0.25; 95%CI: 0.23, 0.28], having media exposure [AOR = 0.85; 95%CI: 0.78, 0.92], and being girls from rich household [AOR = 0.64; 95%CI: 0.58, 0.71] were associated with lower odds of adolescent pregnancy.ConclusionThis study found that adolescent pregnancy remains a common health care problem in East Africa. Age, contraceptive utilization, marital status, working status, household wealth status, community-level contraceptive utilization, age at initiation of sex, media exposure, educational level and relation to the household head were associated with adolescent pregnancy. Therefore, designing public health interventions targeting higher risk adolescent girls such as those from the poorest household through enhancing maternal education and empowerment is vital to reduce adolescent pregnancy and its complications.

A study on assessment of unmet need and contraceptives practices adopted among currently married females residing at urban slums of Ahmedabad

Background: India is a country where population is rapidly growing, to slow down this growth rate family planning is necessary. Family planning services have the potential to improve the quality of the lives and economic welfare of people. Aim of the study was to assess prevalence of unmet need, knowledge, attitude regarding family planning methods and contraceptive practices, among study participants.Methods: A cross- sectional study was carried out among females of early reproductive age group 18-25 years, Group-1 and late reproductive age group 35-49 years, Group-2Results: Out of 200 women, majority respondents belonged to age group of 22-25 years (44.5%). Females of both age-groups had almost similar (54% and 53%) knowledge “partially correct” type for objectives of family planning and had similar positive attitude (78% and 85%) towards family planning practices. Total 45% of group 1 and 55% of other group females were currently using contraception. Most common method used by group 1 women was Intra Uterine Devices (35.5%), followed by Oral Contraceptive pills (31.2%) and in group 2 women was permanent sterilization (74.5%) followed by barrier and Intra Uterine Devices (9.1% each). Unmet need of family planning was 29% and 18% among early and late reproductive age groups, respectively.Conclusions: Unmet need of family planning was higher among early age group females. In both age groups, utilization of contraceptives were less because of lack of awareness and fear of side effect.

Short-term effects of the COVID-19 state of emergency on contraceptive access and utilization in Mozambique.

The COVID-19 pandemic has increasingly disrupted the global delivery of preventive health care services, as a large number of governments have issued state of emergency orders halting service delivery. However, there is limited evidence on the realized effects of the pandemic and associated emergency orders on access to services in low-income country contexts to date. To address this gap, this paper analyzes administrative data on utilization of contraceptive health services by women referred via community health promoters in two large urban and peri-urban areas of Mozambique. We focus on the period immediately surrounding the national state of emergency declaration linked to the COVID-19 pandemic on March 31, 2020. Data reported for 109,129 women served by 132 unique promoters and 192 unique public health facilities is analyzed using logistic regression, interrupted time series analysis and hazard analysis. The results demonstrate that the imposition of the state of emergency is associated with a modest short-term drop in both service provision and utilization, followed by a relatively rapid rebound. We conclude that in this context, the accessibility of reproductive health services was not dramatically reduced during the first phase of the pandemic-related emergency.

Implementation of Community‑Wide Initiatives Designed to Reduce Teen Pregnancy: Measuring Progress in a 5‑Year Project in 10 Communities.

Community-wide initiatives (CWI) to prevent teen pregnancy were implemented in 10 communities in the USA. The CWI supported the implementation of evidence-based teen pregnancy interventions (EBIs) and implementation of best practices for adolescent reproductive health care. Implementation was supported through mobilizing communities, educating stakeholders, and strategies to promote health equity. We assessed indicators of progress of the CWI for the following five project components (data collected from 2010 to 2015): community mobilization, stakeholder education, working with diverse communities, evidence-based interventions, and increasing access to clinical services and the potential contributions of training and technical assistance. Communities engaged multiple stakeholder groups to contribute to planning, community outreach and education, and partnership development and used multiple dissemination methods to share information on adolescent reproductive health needs and teen pregnancy prevention strategies. The amount of training and technical assistance from state- and community-based organizations was associated with increased numbers of youth receiving EBIs and increased provision of contraceptives. The number of health centers implementing best practices for adolescent reproductive health services increased; conducting sexual health assessments, offering hormonal contraception or IUD, and offering quick start of IUDs were associated with increases in long-acting reversible contraception utilization. These findings demonstrate that scaled prevention efforts can occur with adequate support including training and technical assistance and community awareness and engagement in the process. The findings raise important questions for understanding what factors contribute to successful community-wide implementation of EBIs and health center best practices for contraceptive access and whether these lead to reductions in teen pregnancies in highly impacted communities.

31. Contraception Consistency in Postpartum Adolescents versus Adults and Associated Impact on Short Interval Pregnancy Rate

<h3>Background</h3> An unintended pregnancy for an adolescent may cause complex, lasting challenges for the patient and their community. Once in the peripartum period, there are numerous opportunities to empower a patient to make reproductive choices compatible with their family planning goals regardless of age. In spite of improved counseling, prior studies have revealed that adolescents are less likely to opt for long acting reversible contraception (LARC) than non-adolescents. The objective of this study is to evaluate contraceptive choices between postpartum adolescents and adults, consistency in contraception plans across various peripartum time points, and associated rate of short interval pregnancy (SIP). <h3>Methods</h3> This retrospective, observational study was performed at an urban, tertiary hospital in Chicago, Illinois. The participants were defined as adolescent patients (< 22 years old at the time of delivery) or adults seen on labor and delivery between Jan. 1, 2017 and Dec. 31, 2017. Medical records were reviewed through 18 months postpartum to evaluate for consistency in contraception utilization and occurrence of SIP. Comparison of contraception choice was performed between adolescents and adults. The primary outcome of postpartum contraception consistency and incidence of SIP was compared within the adolescent group. Secondary analysis evaluated patient participation in postpartum visits, use of LARC vs. non-LARC, and the associated risk of SIP. Statistical analysis consisted of Chi Square test of association and logistic regression analysis. This study was approved by the on-site Institutional Review Board. <h3>Results</h3> A total of 207 adolescents and 1077 adults with complete data were included in the study. Prior to delivery, adolescents were significantly more likely to choose LARCs as their contraceptive plan as compared to adults (P=<0.00001). No such difference existed when either reporting no postpartum contraception plan or choosing non-LARCs (P=0.07 and 0.24, respectively). An inconsistent contraceptive plan was found to be an independent and significant predictor of SIP (Odds Ratio [OR] 3.4, 95% CI 1.2-9.4, P = 0.02) even when controlling for lack of a postpartum visit or whether a patient chose a LARC vs. non-LARC as their final contraceptive choice. <h3>Conclusions</h3> Inconsistency of contraception plan was found to confer a greater risk of SIP in the adolescent group than even lack of participation in a postpartum visit or the choice of utilizing a LARC vs. non-LARC as the final form of contraception. Therefore, continuous counseling of adolescents about their choice of contraception and developing a consistent plan in the peripartum period is crucial to reducing the incidence of unintended and short interval pregnancy.

Determinants of obstetric fistula in South-western Ethiopia.

Obstetric fistula, despite improved obstetric care, remains a real threat to poor women in rural Ethiopia. This study aimed to identify the risk factors that predispose women to obstetric fistula in South-western Ethiopia. An unmatched case-control study design was employed in which 48 cases (women with obstetric fistula) and 188 controls (women without obstetric fistula) were included. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Univariate, bivariate, and multivariate analysis was conducted using SPSS version 20.0. Adjusted odds ratio, 95% confidence level, and p-values were used as the main measure of association. The study revealed that age at pregnancy of < 18years (AOR = 5, 95% CI = 2-13), residing in rural areas (AOR = 4, 95% CI 1.6-11), lack of antenatal care (AOR = 5, 95% CI 2-14), no history of modern contraception utilization (AOR = 5, 95% CI = 2-13), post-term pregnancy (AOR = 8, 95% CI 3-22), and duration of labor > 24hours (AOR = 4, 95% CI 2-9) were associated with obstetric fistula. The majority of fistula survivors were teenagers who were living in rural areas. Mothers having no antenatal care, not using modern contraception, having a post-term pregnancy, and having prolonged labor were at increased risk of developing obstetric fistula. Thus, delaying the age of first pregnancy, improving access to basic obstetric care, and advocating the use of modern contraceptive methods are crucial for teenage women residing in rural areas.

Pooled prevalence and determinants of modern contraceptive utilization in East Africa: A Multi-country Analysis of recent Demographic and Health Surveys.

According to the 2017 estimate, around 214 million reproductive-age women in developing regions who want to avoid pregnancy do not use a modern contraceptive method. Although there are studies done on factors associated with modern contraceptive utilization in individual East African countries, as to our search of the literature, there is limited evidence on the pooled prevalence and determinants of modern contraceptive utilization in the East African region. Therefore, this study aimed to estimate the pooled prevalence and determinants of modern contraceptive utilization in the East African region. The pooled prevalence of modern contraceptive utilization and the strength of determinants were estimated using STATA version 14. Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance were used for model fitness and comparison. The multilevel logistic regression model was fitted to identify determinants of modern contraceptive use in the region. Adjusted Odds Ratio with its 95% Confidence Interval was presented, and variables with a p-value ≤of 0.05 were declared significant determinants of modern contraceptive utilization. Overall, about 20.68% (95%CI:-20.46.,20.91)of women used modern contraceptive, ranging from 9.08% in Mozambique to 61.49% in Comoros. In the multilevel logistic regression model; maternal age group 25-34 (AOR: 0.79, 95%CI:0.76,0.82) and 35-49 (AOR:0.49, 95%CI:0.46,0.51). Being married (AOR:0.85, 95%CI:0.82,0.88), mothers with primary education (AOR:1.48, 95%CI:1.43,1.54) and secondary and above education level (AOR:1.60, 95%CI:1.52,1.69), husbands with primary education (AOR:2.43, 95%CI:2.35,2.51) and secondary and above education level (AOR:2.92, 95%CI:2.76,3.05). The mothers who had occupation (AOR:2.11, 95%CI:1.23,1.33), mothers from households with middle wealth index (AOR:1.23, 95%CI:1.19,1.28) and rich wealth index (AOR:1.28, 95%CI:1.23,1.33) were found to be significant determinants of modern contraceptive use. We found that modern contraceptive utilization in the 12 East Africa countries was low compared to SDG target 2030(75%). The governmental and non-governmental organizations should scale up their public health programs to the poor and marginalized communities to scale up modern contraceptive utilization uptake in the region. In addition, reforming the health system and reproductive health education through mass media to create awareness of modern contraceptive use benefits are effective strategies to improve modern contraceptive use among East Africa women.

Utilization of Long Acting and Permanent Contraceptive Methods and Associated Factors among Married Women of Reproductive Age Group in Goba Town, Southeast Ethiopia

Background: Ethiopia is the second most populous country in Africa. The total fertility rate of Ethiopia is 4.8 births per women with population growth rate of 2.13% per year and contraception prevalence rate of 29% while the unmet need for family planning is 25% for spacing 16% and 9% for limiting. Almost all of these users are using modern contraceptive method. The most widely used are injectable (21%) followed by implant (3%) and intrauterine contraceptive device (2%) and female sterilization (<1%) are the least used. Objective: The aim of this study was to assess the utilization of long-acting and permanent family planning methods and associated factors among married women of reproductive age group in Goba town, Bale zone, Oromia region, Ethiopia 2017. Methods: A community based cross sectional study was conducted. Data collection was performed using pre tested structured questionnaire. The households were chosen at regular interval using systematic sampling method. Data was analysed by SPSS version 22and association of dependent and predictors using variable was declared at 95%CI on P<0.05. Result: A total of 354 women during collection period were interviewed. The response rate was 98.9%. The overall prevalence of LAPMs contraceptives was 18.9%; the least used methods were female and male sterilization. Sixty three point six percent of women have knowledge about LAPMs and more than half of respondents (54.5%) have an intention to use LAPMs. The major source of modern contraceptive was governmental health facility (72.5%) and knowledge about LAPMs, support using LAPMs, partner attitude towards LAPMs, intention to use LAPMs, discussion with partner about LAPMs and knowledge about LAPMs have association with utilization of LAPMs. Conclusion: Utilization of LAPMs in Goba town was low. More than half of the respondents know about LAPMs. The majority of respondent support use of LAPMs. Therefore, Goba hospital should increase accessibility of contraceptive especially. Media should increase provision of accurate and continues information on LAPMs.

Determinants of Modern Contraceptive Utilization among Women of Reproductive Age in Cambodia

Background: Contraceptive uptake remains a public health concern in Cambodia. Therefore, the aim ofthis study was to determine the modern contraceptive use pattern and itsassociated factors among women ofreproductive age in Cambodia.Method: A cross-sectional study used the data from the Cambodia Demographic and Health Survey. Thissurvey adopted a two-stage stratified random sampling process to select respondents to respond a structuredquestionnaire interview. The multiple logistic regression was applied to determine the association.Results: Of the total 7,606 women, 51.04% used modern contraceptives.Themultivariable analysis indicatedthe use of modern contraceptives was strongly associated with fertility preferences, ideal number of children,number of living children, husband’s desire for children,age at first marriage, number of induced abortions,and marriage to a first birth interval. Health service factors including sources of family planning information,visited health facilities, inaccessibility to health service as well as sociodemographic factors such as women’sage, occupation, and geographical regions also significantly associated with modern contraceptive use.Conclusions: About half of women in Cambodia used modern contraceptives. Reproductive, health serviceand sociodemographic factorswere essential for modern contraceptive utilization.

Accessibility of federally funded family planning services in South Carolina and Alabama.

This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach's alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P<0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha=0.892) and Acceptability (43 items) (alpha=0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization.

Determinants of Short Birth Interval Among Married Women of Child Bearing Age in Becho Woreda, South West Showa Zone, Oromia Region, Ethiopia

Background: Short Birth interval is the time duration less than 33 months between two consecutive live births. Short birth interval is one of the concerns of different countries of the world, because it can affect the overall economic, political and social aspects of a given country by increasing their fertility. Women in the developing world who have many children in quick succession place themselves and their children at enormous risks.Child bearing patterns-maternal age, birth order, and the interval between births-have an important influence upon the probability that a child will survive infancy and early childhood. Thus the study area has short birth interval below the national and WHO recommendation. Objective: To identify determinants of short birth interval among married women of child bearing age in Becho Woreda. Methods and materials : Community based case control study was conducted from July to October 2019. Cases (n=231) were women with short birth intervals less than 33 months), whereas controls (n=462) were women having history of birth intervals (33 to 59 Months) selected by systematic random sampling. Data were collected using structured interviewer administered questionnaires then cleaned, coded, entered and analyzed by using SPSS version 22. Frequency distributions, measures of central tendency and logistic regression were calculated and interpreted accordingly. Result: Result of this study revealed that 60.3% of respondents had information about short birth interval and 65.4% of respondents have utilized previous pregnancy plan. Age of mother at first child birth, the number of children, her educational level, wealth index, occupation of the mother, and duration of breast feeding and use of modern contraceptive were the determinant of optimum birth interval. Having no formal education [(AOR= 2.04, 95% CI; (1.49-2.78)], duration of breastfeeding for less than 24 months[(AOR=0.62, 95% CI; (0.45-0.84)], preceding child being female [(AOR=7.69, 95% CI; (5.24-11.30)], modern contraceptive use [(AOR=7.07, 95% CI: (5.03-9.94)], poor wealth index [(AOR=3.08, 95% CI; (1.85-5.14)] and Previous pregnancy plan [(AOR= 8.59, 95% CI; (6.02-12.18)] of respondents were independent predictors of short birth interval. Conclusion and recommendation : Educational status, duration of breast feeding, sex of the preceding child, modern contraceptive use and wealth index were markers of unequal distribution of inter birth intervals. Ministry of Health should work on women and their partner on creating awareness about the importance of modern contraceptive utilization, breast-feeding, and optimal birth interval. Keywords : Birth interval; Child bearing age; Determinants; South West Shoa DOI: 10.7176/JHMN/87-01 Publication date: March 31 st 2021

A study of knowledge and practice of contraception in a rural area of Bareilly, Uttar Pradesh

Background: It is very critical to understand that awareness of family planning and proper utilization of contraceptives is an important indicator for reducing maternal and neonatal mortality and morbidity. It also plays an important role in promoting reproductive health of the women in an underdeveloped country. Objective was to assess knowledge and practice of modern contraception in rural area.Methods: A community based cross sectional study. A cross-sectional descriptive study was carried out in the in a rural area of Bareilly, Uttar Pradesh. 458 randomly selected eligible couples were included in the study. A pre-structured questionnaire was used to collect information about family planning methods knowledge, source of knowledge and current practices and reasons of nonuse. The appropriate statistical analysis was done to present the results.Results: 48.03% eligible couples had adopted one or the other current modern contraceptive measure. Female sterilization was the most common method used.Conclusions: Overall usage of postpartum contraception was low need to focus at every step to contact with health facility or health workers.

Low contraceptive utilization among young married women is associated with perceived social norms and belief in contraceptive myths in rural Ethiopia.

Despite the increasingly wider availability of contraceptives and the high levels of unmet need for family planning in rural Ethiopia, contraceptive utilization among young married women is low. Studies on associated factors in Ethiopia so far have been focused on individual factors with little emphasis on socio-cultural factors. This study aimed to assess the association between contraceptive utilization and socio-cultural factors among young married women in Eastern Ethiopia. A community-based survey was conducted among young married women aged 14-24 years. A total of 3039 women were interviewed by trained data collectors using a structured questionnaire. Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was used to identify factors associated with contraceptive utilization using multivariable logistic regression analysis. The current contraceptive prevalence rate was 14.1% (95% CI: 12.8-15.5). Perceived social approval (AOR = 1.90; 95% CI = 1.60-2.30) and perception of friends' contraceptive practice (AOR = 1.34; 95% CI: 1.20-1.54) were significantly and positively associated with contraceptive utilization. On the contrary, increased score of belief in contraceptive myths was significantly and negatively associated with contraceptive use (AOR = 0.60; 95% CI: 0.49-0.73). Moreover, recent exposure to family planning information (AOR = 1.67; 95% CI: 1.22-2.28), ever-mother (AOR = 9.68; 95% CI: 4.47-20.90), and secondary and above education level (AOR = 1.90; 95% CI: 1.38-2.70) were significantly associated with higher odds of contraceptive utilization. Only about one-in-seven young married women were using contraceptive methods. Socio-cultural factors significantly influence young married women's contraceptive utilization. Interventions to address social norms and pervasive myths and misconceptions could increase the use of contraceptive methods in young married women.

Duration of birth interval and its predictors among reproductive-age women in Ethiopia: Gompertz gamma shared frailty modeling.

The World Health Organization recommended a minimum of 33 months between consecutive live births to reduce the incidence of adverse pregnancy outcomes. Poorly spaced pregnancies are associated with poor maternal and child health outcomes such as low birth weight, stillbirth, uterine rupture, neonatal mortality, maternal mortality, child malnutrition, and maternal hemorrhage. However, there was limited evidence on the duration of birth interval and its predictors among reproductive-age women in Ethiopia. Therefore, this study aimed to investigate the duration of birth interval and its predictors among reproductive-age women in Ethiopia. A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11022 reproductive-age women who gave birth within five years preceding the survey was included for analysis. To identify the predictors, the Gompertz gamma shared frailty model was fitted. The theta value, Akakie Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance was used for model selection. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared frailty analysis, the Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to show the strength and statistical significance of the association. The median inter-birth interval in Ethiopia was 38 months (95% CI: 37.58, 38.42). Being living in Addis Ababa (AHR = 0.15, 95% CI: 0.03, 0.70), being rural resident (AHR = 1.13, 95% CI: 1.01, 1.23), being Muslim religious follower (AHR = 6.53, 95% CI: 2.35, 18.18), having three birth (AHR = 0.51, 95% CI: 0.10, 0.83), having four birth (AHR = 0.30, 95% CI: 0.09, 0.74), five and above births (AHR = 0.10, 95% CI: 0.02, 0.41), and using contraceptive (AHR = 2.35, 95% CI: 1.16, 4.77) were found significant predictors of duration of birth interval. The length of the inter-birth interval was consistent with the World Health Organization recommendation. Therefore, health care interventions that enhance modern contraceptive utilization among women in rural areas and Muslim religious followers would be helpful to optimize birth interval.