Demand For Contraception Research Articles

Meeting women’s demand for contraceptives in Ghana: Does autonomy matter?

ABSTRACTThis study addressed a basic conceptual gap in research on the relationship between women’s autonomy and contraceptive behavior and included intention to use while measuring the unmet demand for family planning. The study used data from the 2014 Ghana Demographic and Health Survey. The weighted sample included 2,017 sexually active, non-pregnant, fecund women in unions, aged 15–49 years, who wanted to delay conception for at least 2 years. The relation of household decision-making autonomy to current contraceptive use and intention was assessed, adjusting for women’s socio-demographic, partner, and couple characteristics. About half of the women studied had a met demand for contraception, and over a third had no intention to use a contraceptive method in the future. In adjusted multinomial logistic regression models, household decision-making autonomy was not significantly associated with met contraceptive demand for contraceptives, but was associated with their intentions to use contraception (p = .05). Formal education, age, wealth, and region of residence were significantly associated with having a met demand. In Ghana, women’s household decision-making autonomy appears to have modest relation to contraceptive uptake. Programs to improve meeting contraceptive demand should consider contextual factors and place differences in contraceptive uptake.

Women\u2019s preferences for contraceptive counseling in Mexico: Results from a focus group study

BackgroundClient-centered contraceptive counseling is critical to meeting demand for contraception and protecting human rights. However, despite various efforts to optimize counseling, little is known outside of the United States about what individuals themselves value in counseling. In the present study we investigate women’s preferences for contraceptive counseling in Mexico to inform efforts to improve service quality.MethodsWe conducted applied qualitative research, using six focus group discussions with 43 women in two cities in Mexico with distinct sizes and sociocultural contexts (Mexico City and Tepeji del Río, Hidalgo) to assess contraceptive counseling preferences. We used a framework approach to thematically code and analyze the transcriptions from focus groups.ResultsConsistent with quality of care and human rights frameworks for family planning service delivery, participants expressed a desire for privacy, confidentiality, informed choice, and respectful treatment. They expanded on usual concepts of respectful care within family planning to include avoidance of sexual assault or harassment—in line with definitions of respectful care in maternal health. In contrast to counseling approaches with method effectiveness as the organizing principle, participants preferred counseling centered on personalized assessments of needs and preferences. Many, particularly older, less educated women, highly valued hearing provider opinions about what method they should use, based on those personalized assessments. Participants highlighted the necessity of clinical assessments or physical exams to inform provider recommendations for appropriate methods. This desire was largely due to beliefs that more exhaustive medical exams could help prevent negative contraceptive outcomes perceived to be common, in particular expulsion of intra-uterine devices (IUDs), by identifying methods compatible with a woman's body. Trust in provider, built in various ways, was seen as essential to women's contraceptive needs being met.ConclusionsFindings shed light on under-represented perspectives of clients related to counseling preferences. They highlight specific avenues for service delivery improvement in Mexico to ensure clients experience privacy, confidentiality, informed choice, respectful treatment, and personalized counseling—including around reasons for higher IUD expulsion rates postpartum—during contraceptive visits. Findings suggest interventions to improve provider counseling should prioritize a focus on relationship-building to foster trust, and needs assessment skills to facilitate personalization of decision-making support without imposition of a provider's personal opinions. Trust is particularly important to address in family planning given historical abuses against women’s autonomy that may still influence perspectives on contraceptive programs. Findings can also be used to improve quantitative client experience measures.

Changes in demand for children between 2003 and 2013 in Nigeria: Evidence from survey data

Abstract Nigeria has one of the highest fertility rates in Africa. Data from 2013 Demographic and Health Surveys indicate a virtual stagnation of fertility rate since 2003. Low contraceptive use and pronatalist attitudes are among the factors contributing to the high fertility rate in Nigeria. In this manuscript, we pooled data from three most recent waves of Demographic and Health Surveys to examine trends in demand for children over time and identify the factors associated with change in demand for children. The data show that demand for children has declined since 2003 although not monotonically so. Variables that were positively associated with increased likelihood of desiring no additional children were residence in the South-West (as opposed to residence in the North-Central), exposure to family planning (FP) messages on the mass media, number of children ever born, educational level, and urban residence. In contrast, uncertainty about fertility desire was more widespread in 2008 compared to 2013 although less widespread in 2003 than in 2013. The likelihood of being undecided about fertility desire was positively associated with discrepancies in family size desires between husband and wife, parity and Islamic religious affiliation. Programs should aim to increase access to effective contraceptive methods and promote demand for contraceptives as a way of fostering a sustainable reduction in demand for children. Furthermore, strategies that address uncertainty by fostering women’s understanding of the social and health implications of large family sizes are relevant.

Trends in contraceptive demands and unmet need for family planning in migrant population of Uttarakhand

Background: The knowledge of contraceptive use and unmet need is important to know the constraints for unmet need based on user perspective. The aim of the study was to find the prevalence of Contraceptive use, Contraceptive preferred and the Un-met demand for contraceptives. Methods: Married, non-pregnant women of reproductive age group (15-49 years) from the migrant population were interviewed by Census method using pre-designed and pre-tested instrument by cross-sectional survey. Operational definitions for unmet need for spacing, limiting and unfelt need used in the study were as per NFHS -4 findings and traditional methods of contraception like abstinence, withdrawal were included in Un-met need for contraceptive due to its very high failure rate. Results: 58.44% study subjects had ‘Ever Used FP’ and 56.78% are currently using FP methods. The CPR is 56.7% by ‘Any Method’ and 43.0% by ‘Modern method’. The method which is most popular is ‘Sterlisation 29% and 20.96% and ‘Others’ i.e. highly unreliable methods like coitus interruptus, calendar method etc. found high number of users. The reasons for non use were apprehension of complication/side effects in 39%) and inconvenience or the difficulties with modern contraceptive methods or lack of knowledge by 7.67% and 6.95% respectively, 16% were relied on traditional methods, such as periodic abstinence, withdrawal and herbal mixtures from traditional healers as well as LAM 8% for a FP method, all of which have high failure rate. Only 24.8% Women were decision maker regarding the time and type of contraceptive to be used. The unmet need was 29.7% out of which the unmet needs for spacing and limiting were 9.6 per cent and 20.1 per cent, respectivelyConclusions: The unmet need is high and can be addressed by removing the constraints such as poor accessibility to the knowledge thus removing apprehension for side effects, improve accessibility to resources and low decision-making autonomy.

Demand and Unmet Needs of Contraception Among Sexually Active In-Union Women in Nigeria: Distribution, Associated Characteristics, Barriers, and Program Implications

It is not clear whether the 16% unmet need for contraceptives in Nigeria indicates a success story. This study assessed the contraceptive prevalence rate (CPR), total contraceptive demand, and unmet needs and determined the distribution, determinants, and barriers to contraceptive demands and unmet needs in Nigeria. The fertility, breastfeeding, and contraceptive use information provided by 27,829 women who were either currently married or in a sexual union in the 2013 Nigeria Demographic and Health Survey (NDHS) were extracted. Associations between having unmet needs and the demographic, socioeconomic, and reproductive profiles of the respondents were assessed using bivariate and multiple logistic regression at 5% significance level. Multiple response data analysis techniques were used to assess barriers to nonuse of contraceptives. Data were weighted to reflect differentials in the population of in-union women in each geographical state. The modern CPR was 9.8% while total demand for contraception was 31.2%, consisting of unmet need at 16.1% and met needs at 15.1%. Unmet need for family planning was higher among rural women compared with urban women (16.8% vs. 14.9%); younger women (adjusted odds ratio [aOR] = 4.29; confidence interval [CI] = [3.03, 6.07]), women belonging to poorer economic status (aOR = 2.27, CI = [1.92, 2.68]), and women with no education (aOR = 3.23, CI = [2.60, 4.02]) had higher odds of unmet needs. The low unmet need should not be mistaken for a good progress in family planning programming in Nigeria; the success is better measured using the level of total demand for contraceptives and CPR. Interventions to improve the socioeconomic status of women, increase the knowledge of modern contraceptives, and improve women’s decision-making power should be prioritized.

Awareness and opinions regarding contraception by women of reproductive age in North-West Nigeria

IntroductionNorth-west Nigeria is a traditionally high fertility setting. Increasing attention is being channeled into scaling up the various interventions that can reduce high fertility, including enhancing contraceptive uptake among women of reproductive age. However, in order to improve demand for contraception, understanding the level of awareness, knowledge and perception of WRA to contraceptive use is essential. This study examines the level of knowledge and perception of WRA to contraceptive use.MethodsA descriptive cross-sectional study was carried out in December 2016 in Kebbi and Sokoto states, North-west Nigeria. Semi-structured questionnaires were administered to 500 women between the ages of 15-49 years in 4 randomly selected local government areas across the states. Data analysis included descriptive and bi-variate statistics.ResultsOnly 43.8% claimed to be currently using a modern form of contraception; 82.4% were aware of at least one form of contraception, while health personnel formed the major source of information. The most popular and least common modern contraceptive methods were the male condom (86.8%) and vasectomy (26.6%) respectively. A higher proportion of married respondents (88.8%) than those presently single (68.8%) had good knowledge of contraceptives. Perception of contraceptives was mixed, with majority believing that contraceptives should be made available to every woman, despite stating that it contradicted their religious beliefs.ConclusionThese results underline the need for policy makers to focus on improving the knowledge of younger age groups on contraceptives and include other information channels such as peer-to-peer discussions to increase awareness.

Unmet Need and Nonacceptance of Usage of Contraceptive Devices in a Rural Area of Delhi: An Exploration of Facts.

Background:An important cause of high fertility rates in Delhi is the low availability and use of family planning services. Fostering family planning practice alleviates poverty, accelerates socioeconomic development, increases child schooling, promotes gender equality, and decreases maternal and infant mortality. The study objective was to find out the perception of potential users, health workers, and health professionals on the reasons for nonusage of contraceptive services provided and to recognize possible solutions to the identified barriers.Methods:This cross-sectional study was done using qualitative methods among three groups of people by focus group discussion and in-depth interviews. The study was conducted in the rural health center of Madanpur Khaddar, Department of Community Medicine, Jamia Hamdard Institute of Medical Sciences and Research, from June to August 2016.Results:The median age group of the participants was 27 years, and the participants were majorily less educated and were homemakers. Description of key thematic issues found out that contraceptive nonusage was due to lack of accessibility, lack of availability, as well as issues with privacy and autonomy. Out of 25 women, 3 had never heard the term Copper-T (CuT). Twelve out of the rest 22 women had heard about CuT, but knew no more than that.Conclusion:The findings that have emerged from this study thus provide some recommendations to increase the demand for contraception. Effective information, education, and communication should be promoted continuously with the help of community health workers for better acceptance of CuT because it is believed that no single child should be born into the world unplanned.

The impact of media on behaviour: Evidence from television coverage expansion and declining fertility in Indonesia

AbstractThe media is increasingly recognized as playing an important role in affecting the behaviour of individuals. In this article, we examine the effect of an expansion of private television broadcast on fertility in Indonesia. Our district fixed effects estimation results show that increasing the share of population with access to private television by one‐standard deviation—from a 78% coverage to a universal coverage—reduces crude birth rate by 6.2%, equivalent to 190,000 fewer births. We find evidence that television causes an increase in the use of modern contraceptives, but no change in the use of traditional contraceptives. The finding that expanding television coverage increases the demand for modern contraceptives shows that policy‐makers need to ensure that modern contraceptive is easily accessible.

Lifecycle Contraceptive Choice in Sub-Saharan Africa

Understanding how and why women use contraceptives is essential to understanding the fertility transition in sub-Saharan Africa, a region of the world where high fertility may impede development. However, there has been little examination of African women's lifecycle contraceptive demand. In this descriptive paper, we examine several facets of African women's lifecycle contraceptive demand including: (1) how contraceptive use varies with age; (2) how the probability of stopping contraceptive spells varies with age and method; (3) how use of different methods is affected by marriage and parity; (4) how use of different contraceptive methods relates to use of traditional methods of fertility control at different ages; and (5) how the reasons women provide for terminating contraceptive spells vary by method used and age. To assess these aspects of contraceptive behavior, we estimate individual fixed effects regressions on a unique monthly frequency retrospective panel dataset we create from all available contraceptive calendars collected by the Demographic and Health Surveys in sub-Saharan Africa. We find a collection of results consistent with women using injectables and pills primarily to space births when aged 25-40, using implants and female sterilizations primarily to limit births when aged 40-49, and using condoms primarily when unmarried and having less frequent sex than married counterparts. Together, our results suggest that women's lifecycle contraceptive demand is driven by different fertility needs at different ages of their fertile life.

Unmet need for family planning in Turkey.

Data from the 1988 Turkish Fertility and Health Survey covering 5257 ever-married women were employed to compute the unmet need for family planning for both modern methods and all methods. The method of Westoff (1988) which includes those desiring family limitation or spacing was applied although amenorrheic women were omitted because of insufficient data. The total ummet need was 25.2%; 13% if users of traditional methods are excluded. The need in rural areas was 29% compared to 23% in urban areas. The more industrialized western region of Turkey had the lowest need 20.6% while the eastern region had the highest 26.4%. Younger women had a higher demand for contraception while those under 20 desiring spacing had a need 5 times higher than woman desiring family limitation. Unmet need is inversely related to education. Need for specific methods in Turkey really means need for IUDs since pill failure rates in this population often surpass those of traditional methods. Unmet need for contraception in Turkey is about 25% a fairly high estimate similar to that of Korea and the Philippines.

Unmet need and demand for family planning among married women of Abha, Aseer Region in Saudi Arabia

Abstract Objective To measure the unmet need and demand for family planning among Saudi women; to delineate the major reasons for not using contraceptives and identify the associated factors. Methodology This cross sectional study was conducted in six primary health care centres in Abha city among 402 women of reproductive age ranged between 15 to 49 years, having atleast one child. Face to face interview was conducted by using a validated questionnaire. Results The prevalence of unmet need was 32.6%. The proportion of spacers and limiters among this group was 65.7% and 34.4% respectively. The proportion of spacers among unmet need was significantly high among the younger age group and proportion of limiters were high in the older age group (p = 0.001). The major reasons for not using contraceptives was inaccessibility of family planning methods (68.0%), lack of knowledge (59.5%), religious belief (49.6%), fear of side effects of contraceptives they had suffered in the past, and opposition by husband 42.7%. Unmet need was significantly high amongst the women with lower and older age group. Low level of education is significantly associated with unmet need for contraceptive (p = 0.043). Conclusion Around one third of the women in the present study have an unmet need for family planning and demand for Contraception for this population has been found to be high. All these findings point out the need of action in this regards.

Contraceptive availability leads to increase in use in conflict-affected Democratic Republic of the Congo: evidence from cross-sectional cluster surveys, facility assessments and service statistics

BackgroundHumanitarian assistance standards mandate specific attention to address the sexual and reproductive health (SRH) needs of conflict-affected populations. Despite these internationally recognised standards, access to SRH services is still often compromised in conflict settings. CARE in collaboration with the RAISE Initiative strengthened the Ministry of Health (MOH) to provide contraceptive services in Maniema province, Democratic Republic of the Congo. This study evaluated the effectiveness of this support for MOH health facility provision of contraception.MethodsCross-sectional surveys in 2008 (n = 607) and 2010 (n = 575) of women of reproductive age using a two-stage cluster sampling design were conducted in Kasongo health zone. Facility assessments were conducted to assess the capacity of supported government health facilities to provide contraceptive services in 2007 and 2010. Data on the numbers of clients who started a contraceptive method were also collected monthly from supported facilities for 2008–2014.ResultsCurrent use of any modern contraceptive method doubled from 3.1 to 5.9% (adjusted OR 2.03 [95%CI 1.3–3.2]). Current use of long-acting and permanent methods (LAPM) increased from 0 to 1.7% (p < .001), an increase that was no longer significant after adjustment. All current users except a few condom users reported a health facility as the source of the method. The 2010 facility assessments found that most supported facilities had the capacity to provide short-acting and long-acting methods. Service statistics indicated that the percentage of clients who accepted a long-acting method at supported facilities increased from 8% in 2008 to 83% in 2014 (p < .001).ConclusionsThis study demonstrated that contraceptive prevalence doubled between 2008 and 2010; service statistics indicate that utilization of long-acting methods continued to increase to a majority of new clients after 2010. Strengthening the health system to provide contraceptive services enabled individuals to exercise their right to prevent unintended pregnancies. These results suggest that demand for contraception, including long-acting methods, is present even in humanitarian settings, and that women will use them when they are available and of reasonable quality. It is critical that the humanitarian community ensure that such services are available to women affected by crises.

The Impact of Unanticipated Economic Shocks on the Demand for Contraceptives: Evidence from Uganda.

We investigate the impact of unanticipated economic shocks on the use of contraceptives for childbirth control in Uganda using a nationally representative panel of women. To complement our reduced form analysis, we use both intra-village and inter-village variation in rainfall shocks between 2009 and 2012 to identify the impact of agricultural income on the adoption of contraceptives by Ugandan women and their husbands. Our results indicate that women in Uganda, along with their husbands, use contraceptives strategically to postpone childbirth during negative shocks. Our baseline coefficient estimate reveals that a 0.10 log-point adverse rainfall shock increases the demand for contraceptives by 3.8 percentage points. This translates to a 6.7% increase in the likelihood of contraceptives demand. Results from the two-stage least-square instrumental variable estimation for the impact of income complements the strategic birth control story from the reduced form estimates of this paper. More importantly, we find suggestive evidence-linking preventive childbirth decisions to food insecurity during drought. Copyright © 2017 John Wiley & Sons, Ltd.

Delaying first birth: an analysis of household survey data from rural Southern Tanzania

BackgroundCurrently, family planning metrics derived from nationally-representative household surveys such as the Demographic and Health Surveys (DHS) categorise women into those desiring to space or limit (permanently stop) births, or according to their age in the case of young women. This conceptualisation potentially ignores a large and growing group of young women who desire to delay a first birth. This study uses household survey data to investigate the characteristics and needs for family planning of women who want to delay their first birth.MethodsThe research was conducted in two rural districts in southern Tanzania (Tandahimba and Newala), and nested within the Expanded Quality Management Using Information Power (EQUIP) study. Data were collected as part of a repeated cross sectional household survey conducted between September 2013 and April 2014. The socio-demographic characteristics, including parity, contraceptive practices and fertility intentions of 2128 women aged 13–49 were analysed. The association between women’s life stages of reproduction (delayers of first birth, spacers of subsequent pregnancies and limiters of future birth) and selected contraceptive outcomes (current use, unmet need and demand for modern contraceptives) was assessed using the point estimates and 95% confidence intervals for each indicator, adjusted for the survey design.ResultsOverall, four percent of women surveyed were categorised as ‘delayers of first birth’, i.e. sexually active but not started childbearing. Among this group, the majority were younger than 20 years old (82%) and unmarried (88%). Fifty-nine percent were currently using a modern method of contraception and injectables dominated their contraceptive use. Unmet need for contraception was higher among delayers (41%; 95% CI 32–51) and limiters (41%; 95% CI 35–47) compared to spacers (19%; 95% CI 17–22).ConclusionsDelayers of first birth have very high unmet needs for modern contraceptives and they should be routinely and separately categorised and measured within nationally-representative surveys such as Demographic and Health Survey and Multiple Indicator Cluster surveys. Acknowledging their unique needs could help catalyse a programmatic response.

Contraceptive sales in the setting of the Zika virus epidemic.

STUDY QUESTIONHas there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil?SUMMARY ANSWERContraceptive sales in the 24 months of evaluation showed little variation and no significant change has been observed since the ZIKV outbreak.WHAT IS KNOWN ALREADYTransmission of ZIKV is primarily by Aedes aegypti mosquitoes; however, sexual transmission has also been described. The association of several birth defects and the ZIKV infection during pregnancy has been established, and it was estimated in Bahia, Brazil that the infection rate could range from 10% to 80%. The World Health Organisation (WHO) declared the cluster of microcephaly cases and other neurological disorders a health emergency on 1 February 2016. The Brazilian government also made recommendations for women who were planning to become pregnant and who reside in ZIKV-affected areas to reconsider or postpone pregnancy.STUDY DESIGN, SIZE, DURATIONThe objective of this study was to assess the sales of contraceptive methods in Brazil, tracking it from before and through the ZIKV outbreak. We obtained information from all pharmaceutical companies based in Brazil and from the manufacturers of long-acting reversible contraceptives (LARCs), including the copper-intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants, about contraceptives sales in the public and private sectors between September 2014 and August 2016.PARTICIPANTS/MATERIALS, SETTING, METHODSWe analyzed the data for: (i) oral contraceptives, i.e. combined oral contraceptives (COC) and progestin-only pills (POP), and vaginal and transdermal contraceptives, (ii) injectable contraceptives, i.e. once-a-month and depot-medroxyprogesterone acetate, (iii) LARCs and (iv) emergency contraceptive (EC) pills.MAIN RESULTS AND THE ROLE OF CHANCEMonthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7–13.8 million cycles/units per month (90%). The second largest group of sales was injectables, representing 0.8–1.5 million ampoules per month (9.5%). Following this, are LARC methods with sales of 37 000–41 000 devices per month (0.5%). It is important to note that although the peak months of sales were different for each group of contraceptives, there were no significant differences overall between the months of observation. The EC pill sales were between 1.0 million and 1.3 million of pills per month.LIMITATIONS, REASONS FOR CAUTIONAlthough the use of contraceptive methods was already high and no change was noted, the ZIKV outbreak may have changed the pregnancy intentions of Brazilian women. Consequently, the number of women planning pregnancy may be lower than that recorded. The contraceptive sales figures did not include condoms. Since condoms might not only prevent pregnancies, but also sexual transmission of ZIKV, this lack of information is a limitation.WIDER IMPLICATIONS OF THE FINDINGSThe results from this assessment showed that the sales of contraceptives presented little variation during the ZIKV outbreak in Brazil. Furthermore, it is possible that access to LARC methods was limited. Although we did not investigate the reason for low LARC uptake, we suspect that it is due to lack of availability of LARC in the public sector, the high cost of the methods and the incomplete insurance coverage on contraception for women. Projections estimate millions of additional cases of ZIKV transmission. Thus, a coordinated response is needed to ensure access to a wide range of contraceptive methods for women during the ZIKV outbreak. In conclusion, this assessment of contraceptive sales in Brazil identifies challenges in contraceptive access, especially for LARC methods, and represents an alternative source of data to help us understand the trends in demand for contraception in ZIKV-affected areas.STUDY FUNDING/COMPETING INTEREST(S)This study received partial financial support from Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award # 2015/20504-9 and from an anonymous donor. The funding sources did not play a role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. The authors declare no conflict of interest associated with this study.TRIAL REGISTRATION NUMBERN/A

How User Fees Influence Contraception in Low and Middle Income Countries: A Systematic Review.

Accessible and quality reproductive health services are critical for low‐ and middle‐income countries (LMICs). After a decade of waning investment in family planning, interest and funding are growing once again. This article assesses whether introducing, removing, or changing user fees for contraception has an effect on contraceptive use. We conducted a search of 14 international databases. We included randomized controlled trials, interrupted‐time series analyses, controlled before‐and‐after study designs, and cohort studies that reported contraception‐related variables as an outcome and a change in the price of contraceptives as an intervention. Four studies were eligible but none was at low risk of bias overall. Most of these, as well as other studies not included in the present research, found that demand for contraception was not cost‐sensitive. We could draw no robust summary of evidence, strongly suggesting that further research in this area is needed.

Contraception and Unintended pregnancy: The changing relationship overtime in sub-Saharan Africa

Contraception is hailed as one of the most important health innovation that enables women and couples avoid unintended pregnancies. As such contraceptive prevalence is expected to be negatively associated with unintended pregnancy. However, one study examining the relationship between unintended pregnancy and modern contraceptive use globally has produced counter-intuitive results. This study draws on Demographic and Health Survey data from 206 country surveys to explore if this relationship holds when examined regionally and overtime. I find that the counter-intuitive relationship only holds for Sub-Saharan Africa (SSA). Using selected countries from SSA and other regions I find that the counter-intuitive relationship holds true at the earlier stages of the fertility transition. I conclude that the unexpected relationship between unintended pregnancy and contraception is only temporary in the early stages of fertility transition when the demand for contraception is higher than the ability of the health system to satisfy it

Correlates of unmet need for contraception in Bangladesh: does couples' concordance in household decision making matter?

IntroductionA large body of literature has highlighted that women's household decision-making power is associated with better reproductive health outcomes, while most of the studies tend to measure such power from only women's point of view. Using both husband's and wife's matched responses to decision-making questions, this study examined the association between couples' concordant and discordant decision makings, and wife's unmet need for contraception in Bangladesh. MethodsThis study used couple's data set (n=3336) from Bangladesh Demographic and Health Survey of 2007. Multivariate logistic regression was used to examine the likelihood of unmet need for contraception among married women of reproductive age. FindingsStudy results suggested that couples who support the equalitarian power structure seemed to be more powerful in meeting the unmet demand for contraception. Logistic regression analysis revealed that compared to couple's concordant joint decision making, concordance in husband-only or other's involvement in decision making was associated with higher odds of unmet need for contraception. Wives exposed to family planning information discussed family planning more often with husbands, and those from richest households were less likely to have unmet need for contraception. ConclusionCouple's concordant joint decision making, reflecting the concept of equalitarian power structure, appeared to be a significant analytic category. Policy makers in the field of family planning may promote community-based outreach programs and communication campaigns for family planning focusing on egalitarian gender roles in the household.

Women's fertility desires and contraceptive behavior in three peri-urban communities in sub Saharan Africa.

BackgroundFertility desires and contraceptive behavior often change over time. This study examined the influence of change in fertility desires on change in modern contraceptive use over time in three peri-urban communities in sub-Saharan Africa.MethodsThis multi-site study includes baseline and follow up data from 3 sites in the Family Health and Wealth Study. Following a census in each site, a probability sample of at least 500 households was obtained. Generalized linear models were employed.ResultsModern contraceptive use increased in Ipetumodu, Nigeria (29.4 % to 36.7 %), but declined slightly in Sebeta, Ethiopia (66.9 % to 61.3 %) and Asawase, Ghana (12.6 % to 10.8 %). Across sites, at baseline and follow up, women who wanted no more children reported more contraceptive use, compared with those who wanted more children, and were more likely to shift to being contraceptive users in Ipetumodu [aOR(95 % CI):1.55 (1.07,2.26)].ConclusionsWomen’s fertility desires influenced their contraceptive behavior, although there were cross-site differences. Changing contraceptive demand and program factors will be important to enable peri-urban women to frame and act on their fertility desires.

Trends in direct-to-consumer advertising of prescription contraceptives

ObjectiveDespite much speculation about the role of direct-to-consumer advertising (DTCA) in increasing demand for prescription contraceptives in the United States, there is little published research on this topic. We sought to quantify the prevalence and magnitude of DTCA for prescription contraceptives over the last decade. Study designUsing cross-sectional data from January 2005 through December 2014, we performed descriptive analyses on trends in DTCA expenditure for prescription contraceptives. We also quantified the amount of DTCA according to contraceptive method category and individual brand. ResultsDuring the study period, pharmaceutical companies spent a total of US$1.57 billion in the United States on DTCA of prescription contraceptives. Annual expenditure for contraceptive DTCA reached a peak value of US$260 million in 2008, with a progressive decline to a nadir of US$69 million by 2013. Of the contraceptive methods, oral contraceptive pills (OCPs) have been the most heavily promoted, with Yaz (drospirenone/ethinyl estradiol) — the most advertised brand — accounting for US$347 million of cumulative DTCA expenditure. However, DTCA spending on OCPs peaked in 2007 and was overtaken in 2012 by the DTCA of long-acting reversible contraceptives (LARCs), the contraceptive method now receiving the largest amount of DTCA promotion. ConclusionsDTCA is a major form of promotion for prescription contraceptives. Recent trends in DTCA expenditure indicate a shift from promotion of the OCPs to the LARCs. DTCA's effect on provider and patient utilization of various contraceptive methods has yet to be determined. ImplicationsThis study provides the first quantitative evaluation of DTCA of prescription contraceptive methods and reveals DTCA's importance as a form of promotion. Recent DTCA trends indicate increased promotion of LARCs, coinciding with greater uptake of LARC methods by patients and prescribers.