Use Of Family Planning Methods Research Articles

Impact of Covid-19 Pandemic upon Iraqi women’s Commitment to Family Planning at Primary Health Care Centers in Baghdad City

Objectives: To evaluate the impact of COVID-19 upon Iraqi women's commitment to family planning before and during COVID-19 pandemic Methods: A descriptive design, correlational approach was conducted from November /2021 to July / 2022. The setting of the study including two primary health care centers in Baghdad City. A non-probability 'purposive sample' consists of (200) women at reproductive age (16-49) years old. Descriptive and correlational statistics were used for data analysis. Results: The results of the study shows that regarding commitment to use of family planning methods among women before and during COVID19 pandemic; the “Use family planning methods” among (94.5%) before-COVID19 and (83%) during COVID19. there is high significant relationship between commitment to use of family planning before-COVID19 and during COVID19 at p-value= .001 respectively. Conclusion: The pandemic has affected women’s commitment to family planning methods, as well as its impact on the type of method that used. Despite the pandemic family planning is very important to women’s reproductive health so, it is necessary to improve family planning information, services, and access.

Relationship between reproductive health literacy and components of healthy fertility in women of the reproductive age.

One of the key factors affecting women's behavior with fertility issues is their health literacy, but this topic has been less addressed in the existing studies. We aimed to determine the relationship between reproductive health literacy and components of healthy fertility in women of reproductive age. This cross-sectional study was conducted from March 2019 to September 2014 on 230 married women who were referred to comprehensive health centers in Lordegan city. Data were collected using a reproductive health literacy questionnaire, demographic and fertility information checklist, and components of healthy fertility. Data analysis was done using SPSS software, version 20. Pearson, Spearman, and independent t-tests were used as appropriate. The mean ± SD reproductive health literacy score in the participants was 43.80 ± 18.99 depicting an average literacy level in more than half of the women. Also, the reproductive health literacy score had a statistically significant relationship with the use of low-failure contraceptive methods (P < 0.001) and planned pregnancy (P = 0.03). However, this relationship was not significant regarding pre-pregnancy care (P = 0.88) and observing the interval between pregnancies (P = 0.57). We found a relationship between the level of reproductive health literacy and the use of family planning methods with low failure and planned pregnancy. Hence, it seems that interventions to improve reproductive health literacy are effective in reducing the occurrence of high-risk pregnancies and unwanted and unplanned pregnancies. Therefore, it is suggested that the health system consider and provide education related to reproductive health literacy as a part of healthy reproductive services.

Family planning in the Eastern Democratic Republic of the Congo: personal beliefs, intimate partner negotiations and social pressure

The Democratic Republic of the Congo (DRC) has a low prevalence of family planning use. Recent studies have highlighted the significant role that socio-cultural factors play in the decision to use family planning or not. This qualitative study explored barriers to women’s use of family planning methods in an ongoing conflict region, South-Kivu, DRC. Focus group discussions and individual in-depth interviews were conducted to understand perceptions and habits regarding family planning. An inductive approach was used to analyse the data. Precariousness of life, religious beliefs and fear of side effects were limiting factors to the use of family planning. Power relations within the couple also played an important role in decision-making. Sole provider (‘breadwinner’) women were more likely to use family planning, including hormonal methods. Our findings highlight the continued importance of family planning programmes that respond to socio-cultural factors, personal beliefs, and fear of side effects in parallel with addressing availability and accessibility. This will require including the community in their design and implementation in order to meet unmet family planning needs. Health care providers’ capacity building and training to help women manage family planning side effects will also be beneficial.

Key drivers of hysterectomy among women of reproductive age in three states in India: comparative evidence from NFHS-4 and NFHS-5

PurposeAccording to the 4th and 5th rounds of National Family Health Survey (NFHS), there is high prevalence of hysterectomies in the three states of Andhra Pradesh Telangana and Bihar. The three said states have more than double the number of hysterectomies taking place than the national average. Our purpose is to analyse whether these rates are increasing, decreasing or have stabilized and their reasons thereof. Such an analyses will help the policy makers in recommending good clinical practices within their states.Material and methodsWe used data from NFHS-4 (2015-16) and NFHS-5 (2019-2021) rounds. We calculated the differences in predicted probabilities for various factors, performed a Fairlie Decomposition analyses to quantify the positive and negative contributors in the prevalence of hysterectomy across the three states over two time points, and assessed the association of various socio-demographic characteristics to hysterectomy through a multilevel logistic regression model.Results and conclusionThe results show that out of a total of 80,976 eligible respondents from the states under study, 5826 respondents self-reported that they had a hysterectomy done. It was found that older age, living in rural areas, belonging to other backward classes and higher wealth quintile, and higher parity positively contributed to the increased prevalence of hysterectomies in the three states. Higher educational attainment and previous use of family planning methods acted as protective factors. Characteristics at the household level had the highest intra-class correlation value in the prevalence of hysterectomy among women, followed by the Primary Sampling Unit and District levels, indicating high clustering in the prevalence of hysterectomy at the household level in all three states. Heavy menstrual bleeding/pain was the leading cause of hysterectomies in all three states, followed by fibroids/cysts in Andhra Pradesh and Telangana and Uterine disorder/ prolapse in Bihar. Over 80% of hysterectomies took place in the private hospitals.RecommendationsThe study recommends better, more efficient and accountable hysterectomy surveillance to ensure more sustainable woman’s reproductive health services in India. Government should adopt and implement standard regulatory guidelines to prevent provider-driven avoidable hysterectomies. Moreover, we recommend informing primary care professionals about the long-term health effects of hysterectomy and promoting alternate therapies for treating uterine fibroids and heavy bleeding.

Factors associated with inadequate dietary diversity among adolescent girls in Hurumu Woreda High School, Oromia Region, Southwest Ethiopia.

Inadequate diet among adolescent girls leads to anatomical and physiological disturbances which will contribute to the vicious intergenerational cycle of malnutrition. However, only a few studies are available in Ethiopia on dietary diversity among adolescent girls who are attending school. The objective of this study is to assess factors associated with inadequate dietary diversity among high school adolescent girls in Hurumu Woreda, Southwest Ethiopia, 2022. An institution-based cross-sectional study was conducted among 374 high school adolescent girls from 3 May 2022 to 12 June 2022 and selected by using simple random sampling techniques. Data were collected through face-to-face interviews using structured questionnaires. Epi-data version 4.6.0 was used to enter the data, which were then exported to SPSS version 26 for analysis. Simple binary and multivariable logistic regressions were performed to identify factors associated with inadequate dietary diversity. In this study, the magnitude of inadequate dietary diversity among adolescent girls was 62.6% [95% CI: 57.5-66.5]. Living with more than five family members (AOR = 1.8, 95% CI: 1.16-3.44), consumption of sweet foods/beverages (AOR = 2.2, 95% CI: 1.07-3.41), poor nutritional knowledge (AOR = 2.5, 95% CI: 1.48-3.89), and poor household wealth tercile (AOR = 2.8, 95% CI: 1.44-5.12) were significantly associated with inadequate dietary diversity. Living with more than five family members, poor household wealth status, consumption of sweet foods/beverages, family size, and poor nutritional knowledge were factors significantly associated with inadequate dietary diversity. Hence, nutrition education, the use of family planning methods, and securing income-generating activities should be implemented.

Awareness and Utilisation of Family Planning Among Postpartum Women in Ondo State, Nigeria

This study investigates the awareness and utilisation of family planning among postpartum women attending postnatal clinics in selected health centers in Ifedore Local Government, Ondo State. The objectives include determining sources of information, examining common methods used, and assessing knowledge, utilisation, and perceived attitudes of workers regarding family planning. A descriptive design was employed, and the target population comprised women aged 15 to 49, 1 week–12 months postpartum, accessing child health services from three selected health centers. The sample size of 234 was determined using Cochran’s formula, with data collected through a self-structured questionnaire. Validity and reliability were ensured through expert assessment and a pilot study. Analysis using SPSS 27.0 involved percentages, tables, and chi-square tests. The findings revealed commendable understanding of family planning services among women of reproductive age, although utilisation remained inadequate. Factors contributing to this included low socioeconomic status, religious beliefs, and limited education. Despite these challenges, the study highlights the potential for positive outcomes in the future, emphasizing the importance of comprehensive understanding of family planning services. Recommendations include enhancing community education on the benefits of smaller families and women empowerment, promoting gender balance, and emphasizing immediate initiation of family planning postpartum in healthcare settings. These initiatives aim to address barriers and promote the use of family planning methods among women in the study area.

Knowledge and practice of family planning among pregnant tribal women in Southern India: an observational study

BackgroundThere are over 700 Scheduled Tribes (ST) living in 30 Indian states. As with other indigenous groups across the world, Indian ST have some of the poorest infant and child health outcomes of any communities in India. A child born to an ST family is 19% more likely to die in the first month of life and has a 45 percent risk of dying in their first year compared with other Indian populations. Research suggests that early conception, high fertility, and low use of family planning methods are large contributors to these disparities.MethodsA cross sectional survey in Kannada was conducted among 303 pregnant tribal women in Mysore, India after obtaining informed consent. Univariate and multivariable analyses were carried out to determine the demographic and psychosocial factors associated with knowledge of contraceptive methods using Stata 14.0.ResultsThere was widespread knowledge about female sterilization, while only 39.3% of women reported hearing about one or more forms of temporary contraception, and 36.3% knew where to get them. The largest proportion of women had heard about copper-T (33.0%), followed by oral contraceptive pills (23.8%), condoms (11.9%), and injectables (4.6%). Only 2.7% of women reported ever using any form of temporary contraception. Results from the multivariable logistic regression indicated that knowledge of at least one form of temporary contraception was linked to higher age (adjusted odds ratio[AOR]: 1.09; 95% CI: 1.02, 1.17), greater number of years of marriage (AOR: 0.90; 95% CI: 0.85, 0.96), and last birth in a government facility (AOR: 3.67; 95% CI: 1.99, 6.82).ConclusionsThe study revealed poor knowledge and utilization of temporary contraceptive methods among a tribal population in rural Mysore, India. Interventions aiming to increase knowledge of contraceptive options are important for birth spacing in this population and should target younger women and those without contact with government health facilities.

Use of family planning methods and attitudes of married women aged 15-49 in konya province

Use of family planning methods and attitudes of married women aged 15-49 in konya province

Fertility among Northern Nigeria women and associated factors: Negative binomial regression model approach

Objective: The 2020 sustainable development progress report shows that human population growth is a critical barrier to achieving the Sustainable Development Goals (SDG). There are very few studies on determinants of fertility particularly looking at the northern part of Nigeria that has a relatively high fertility level compared with the southern part of the country. This study therefore is aimed at identifying the factors associated with fertility among women in northern Nigeria. Methods: The data for this study was from the Nigeria Demographic and Health Survey (NDHS) 2018. The number of children ever born by women aged 15 – 49 years and other variables who lived in Northern Nigeria were extracted and analyzed using Negative Binomial Regression, where the level of significance was 0.05. Results: There were variations in factors associated with fertility among the geopolitical zones in Nigeria. Age of the respondents, sex of household head, wealth index, religion, ethnicity, use of family planning (FP) method, and child death experience were among the factors associated with fertility. Women with no/lower education, early marriage, being Muslim and Hausa/Fulani ethnic background experienced high fertility (p&lt;0.05). Conclusion: Attention to the factors mentioned above and intervention programmes designed to reduce fertility are indispensable. Education of female children should be given extra attention as this will empower them to be more informed. Hence, achieving SDGs will become a reality.

The Effect of Women’s Family Planning Method Use on Worry Level

Objectives: The research is aimed to determine the effect of women's family planning method use on worry level.&#x0D; Methods: The sample of this descriptive study was composed of 339 women who applied to the outpatient clinics of a hospital in Trabzon between 15.05.2019-01.10.2019. Data from the study was collected via the personal data form and the Penn State Worry Questionnaire (PSWQ). Descriptive statistical methods, Cronbach Alpha reliability Test, t test in independent groups and ANOVA test were used to evaluate the research data. Before collecting data, permission to use the scale, research permission, ethics committee permission and written consent were obtained from the women participate in the research.&#x0D; Results: The average age of the women involved in the study was 31.51±6.53. %51 of the women were high school graduates and %65.8 were housewives. %12.4 of women expressed concern about the family planning method they used. Women received an average score of 54.16±14.39 from PSWQ. The mean scores of women using oral contraceptives, condoms, intrauterine devices and withdrawal methods from PSWQ are respectively 52.19±9.17, 58.20±15.25, 46.84±14.97 and 59.38±13.82 found to be. The PSWQ mean scores of women 25-32 aged between, 6 Months-1 years married, living in a large family, has a pregnancy and a child, the family planning method he uses negatively affects his sexual life and his relationship with his wife, dissatisfied with the family planning method he and his wife use, not trusting the method, worried about the method, fear of pregnancy it was found to be higher than other women and the difference between groups was statistically significant (p

Sexual and reproductive health problems among women with mental illness attending tertiary care psychiatric outpatient clinic in India: A cross-sectional study.

Sexual and reproductive health (SRH) is a vital concern among women with mental illness (WMI) due to the increased risk for unplanned pregnancy, sexually transmitted infections (STIs), and poor obstetric outcomes. Objective of the study was to explore the current use of family planning (FP) methods, symptoms of STIs and sexual dysfunction among WMI. This descriptive study involved 404 WMI of reproductive age (18-49 years) attending tertiary care psychiatric outpatient clinics in India. During face-to-face interviews, centers for disease control and prevention (CDC)-reproductive health assessment toolkit-FP questionnaire, STI questionnaire and Female sexual function index (FSFI) were used to collect the data. Of 404 WMI, 261(64.6%) were users, and 137 (33.9%) were non-users of FP methods. About 6(1.5%) WMI did not respond FP methods question. Female sterilization was the highest among the users, 244(93%). Among non-users, 100 (73%) were unaware of choosing the effective method of FP. Most of the WMI, 377(93.3%), were unaware of STIs. The symptoms of STI reported include unusual genital discharge 62(15.3%) and genital ulcers/ sores 58(14.4 %). Most of them, 76(63.3%), were not on any treatment. The most common reason for not taking treatment was feeling ashamed 70(92.1%). Female sexual dysfunction was reported in 176(43.6%). Most of the WMI had difficulties in the arousal domain 288(71.3%), followed by low desire 233(57.7%) and dissatisfaction 186(46%). Most WMI underwent sterilization. Non-users of FP methods were not aware of choosing the effective method. Awareness about STIs was poor, and feeling ashamed was the primary reason for not availing of medical help. Nearly half of the WMI reported sexual dysfunction, among which arousal difficulties, low desire and dissatisfaction were common. Health professionals need to increase awareness about FP methods and symptoms of STIs among WMIs. Women require appropriate counselling regarding SRH and treatment for sexual dysfunction.

Determinants of unmet need for family planning: Evidence from the 2018 Turkey Demographic and Health Survey.

Unmet need for family planning is a valuable concept to indicate the discrepancy between women's fertility preferences and contraceptive use. Unmet need may lead to unintended pregnancies and unsafe abortions. These may result in health deterioration and reduced employment opportunities for women. The 2018 Turkey Demographic and Health Survey report indicated that the estimated unmet need for family planning doubled from 2013 to 2018, returning to the high levels of the late 1990s. Considering this unfavourable change, this study aims to investigate the determinants of unmet need for family planning among married women of reproductive age in Turkey by using the 2018 Turkey Demographic and Health Survey data. Logit model estimations revealed that women who were at older ages, more educated, wealthier, and had more than one child were less likely to have unmet need for family planning. Employment statuses of women and their spouses and place of residence were significantly associated with unmet need. Results emphasised that training and counselling to enhance the use of family planning methods should effectively target young, less educated, and poor women.

THE RELATIONSHIP BETWEEN MARITAL ADJUSTMENT AND SEXUAL QUALITY OF LIFE OF WOMEN OF REPRODUCTIVE AGE: EFFECT OF USE FAMILY PLANNING METHODS

The aim of this study is to determine the relationship between women's marital adjustment and sexual quality of life, and their use of family planning methods. This is a descriptive study. The sample size was calculated as 349 women. Data were collected using the personal information form, the Dyadic Adjustment Scale, and the Sexual Quality of Life Questionnaire-Female. The data obtained were analyzed using the SPSS 23.0 software by creating the database. The stat൴st൴cal s൴gn൴f൴cance level was set at 0.05. The mean scores the participants obtained from the Dyadic Adjustment Scale and Sexual Quality of Life Questionnaire-Female were 106.27±22.21 and 77.46±21.85 respectively. Of the participating women, 36.7% used an intrauterine device for birth control, 27.8% used condoms, 13.8% used hormonal drugs. No statistically significant differences were determined between the mean scores obtained from the Dyadic Adjustment Scale and between the mean scores obtained from the Sexual Quality of Life Questionnaire-Female in terms of the family planning methods the participants used (p&gt;0.05). However, differences between the mean scores the participants obtained from the affectional expression subscale of Dyadic Adjustment Scale were found to be statistically significant in terms of the family planning methods they used (p&lt;0.05). While the marital adjustment was high among the participating women their quality of life level was moderate. It was determined that the sexual quality of life increased as the marital adjustment increased. It was also determined that family planning methods the participants preferred affected not their sexual quality of life and marital adjustment but the affectional expression subscale. Family planning methods the participating women used did not affect their marital adjustment and sexual quality, but hormonal drugs and intra uterin device affected their scores for the affectional expression subscale of the DyadicAdjustment Scale.

Gender-based Approach in Family Planning in Practices in Turkey’s Most Fertile Province: Secondary Analysis of Mix Method Two Studies

Objective: To determine the gender-based family planning approaches in the province in Turkey with the highest fertility rate.&#x0D; Methods: This study was carried out with the secondary analysis of the data on family planning of two different studies, which were carried out by the researchers with the mixed method.&#x0D; Results: In total, 56.7% of the women stated that they used any available family planning method, whereas 80.4% chose the method with their spouse. According to their responses, family planning methods used by women were intrauterine devices (41.2%) and withdrawal (28.9%). Furthermore, 10.5% of the men reported using any available family planning method, whereas 91.0% used the method decided by their spouse. According to the responses obtained from the male participants, the family planning methods used were pills (45.5%), intrauterine devices (18.2%), and male condom (18.2%). Factors affecting the use of family planning methods in women included age, duration of marriage, and number of living children, whereas these factors in men were age, income level, and health insurance. &#x0D; Conclusion: The study outcomes revealed that there are gender-based differences between women and men in the use of family planning methods, that men undertook less responsibility in using and selecting family planning methods.

"The phone number tells us good things we didn't know before." Use of interactive voice response calling for improving knowledge and uptake of family planning methods among Maasai in Tanzania.

Maasai living in the Arusha region, Tanzania, face challenges in feeding their children because of decreasing grazing grounds for their cattle. Therefore, they requested birth control methods. Previous studies have shown that lack of knowledge about, and poor access to, family planning (FP) may worsen the situation. We developed an interactive voice response calling (IVRC) platform for Maasai and health care workers (HCW) to create a venue for communication about FP to increase knowledge and access to FP. The objective of this study was to explore the effect of the platform on knowledge, access and use of family planning methods. We applied a participatory action research approach using mixed methods for data collection to develop and pilot-test an mHealth-platform with IVRC using Maa language. We enrolled Maasai-couples and HCW in Monduli District (Esilalei ward), Arusha Region, and followed them for 20 months. A baseline assessment was done to explore knowledge about FP. Furthermore, we abstracted information on FP clinic visits. Based on that, we developed a system called Embiotishu. A toll-free number was provided to interact with the system by calling with their phone. The system offers pre-recorded voice messages with information about FP and reproductive health to educate Maasai. The system recorded the number of calls and the type of information accessed. We measured the outcome by (1) a survey investigating the knowledge of contraceptive methods before and after Embiotishu and (2) counting the number of clinic visits (2018-2020) from medical records and feedback from qualitative data for FP used among Maasai. The acceptability and feasibility were explored through focus group discussions (FGDs) with Maasai and in-depth interviews (IDIs) with HCW. We recruited 76 Maasai couples whom we interviewed during the baseline assessment. The overall knowledge of contraceptives increased significantly (p<0.005) in both men and women. The number of clinic visits rose from 137 in 2018 to 344 in 2019 and 228 in the first six months of 2020. Implants were the most prescribed family planning method, followed by injections and pills, as found in medical records. The number of incoming calls, missed calls, and questions were 24,033 over 20 months. Out of these calls, 14,547 topics were selected. The most selected topics were modern contraceptives (mainly implants, condoms, tubal ligation, and vasectomy). Natural methods of contraception (vaginal fluid observations, calendar, and temperature). Our study has shown that the IVRC system led to an improvement in knowledge about and access to contraceptives. Furthermore, it has potential to increase access to health information as well as improve dialogue between Health workers and Maasai.

Pemberdayaan Masyarakat Dalam Keikutsertaan Pasangan Usia Subur Menjadi Aseptor KB di Kelurahan Ladang Bambu Kecamatan Medan Tuntungan

The use of family planning (KB) methods by couples of childbearing age is an important step in regulating pregnancy and maintaining reproductive health. However, the successful use of family planning relies heavily on the knowledge of PUS about contraceptive methods as well as their participation in using contraceptives consistently. Lack of knowledge and proper participation can lead to unwanted pregnancies and even trigger abortions.To improve the understanding of PUS about family planning, a health education program was implemented in Kelurahan Ladang Bambu, Medan Tuntungan sub-district in 2023. This education provided information on various contraceptive methods and how to use them correctly, so that PUS can make the right decision in family planning.The results of the education activities showed an increase in PUS knowledge about contraceptives. Comparison of test results before and after the intervention showed a significant increase in knowledge by 0.37 (p&lt;0.05). That is, there was a difference in the average pretest and posttest scores after the health education was conducted, indicating the effectiveness of the program in improving the understanding of PUS related to contraceptive methods. In conclusion, this health education program succeeded in increasing the knowledge of PUS about contraceptive methods. With better understanding, PUS can use family planning more effectively and consistently, reducing the risk of unwanted pregnancy and its implications such as abortion. This program contributes positively to family welfare and reproductive health in the community.

Evaluation of Factors that Contribute to Low Utilization of Methods for Family Planning Among Adolescents at Adjumani Hospital, Adjumani District

Globally, approximately 80 million unintended pregnancies worldwide are accounted for low utilization of family planning (FP) methods during adolescent and postpartum period. Young people’s sexual and reproductive health affects their lives and the health of the global community. The purpose of this study was to find out factors that contribute to low utilization of Family Planning Methods among adolescents attending family planning clinic at Adjumani Hospital, Adjumani District. A cross-sectional and descriptive study which employed quantitative method of data collection was used for a period of four weeks and the study was conducted at Family Planning clinic in Adjumani Hospital. A purposive sampling method was used. Only 45 adolescent aged 12 to 20 years old attending Family Planning clinic freely assented/consented to participate in the study. The results showed 25 (56%) of the adolescent were of age range 18-20 years and 5 (11%) who were 12-14 years. 31 (69%) respondents agreed that their culture allowed the use of FP method. Only 14 (31%) participants said that their culture does not allow the use of family planning method and revealed that FP affects their fertility. They also said that the culture considered it as a crime in the community. Nearly 38 (84%) have ever visited family planning clinic while very few 7 (16%) have not visited, most 27 (71%) were attended by Nurse while only few 3 (8%) were attended by Doctor. The results from this study shows that respondents’ family planning use conflict with their cultural/religious belief and majority claimed that family planning encourages cheating in relationship. Keywords: Adolescents, Family Planning, fertility, condoms

Dietary and obstetric correlates of anaemia among pregnant women: a cross-sectional study from the Wa municipality, Ghana

Introduction/Aims Anaemia is the most severe pregnancy-related hematological condition globally and affects approximately 32.4 million pregnant women. This study's aim was to identify factors influencing anaemia in pregnancy at 36 weeks in the Wa municipality. Methods A descriptive cross-sectional study was conducted among 410 pregnant women. The participants' haemoglobin levels and obstetric variables were extracted from antenatal record books. Data were analysed using multivariate binary logistics regression analysis to determine risk factors associated with anaemia in pregnancy at 36 weeks. Results The prevalence of anaemia at 36 weeks was 81.5%. Predictors included no previous use of family planning methods, paragravidity, low dietary diversity and an average monthly income of &lt;1000 Ghanaian Cedi. Conclusions The prevalence of anaemia at 36 weeks was high. Preventive interventions targeting preconception nutrition and promoting regular antenatal care visits throughout pregnancy are urgently required.

Community and Health Care Provider Perspectives on Barriers to and Enablers of Family Planning Use in Rural Sindh, Pakistan: Qualitative Exploratory Study.

Unmet need for family planning in Pakistan is high, with 17% of all married women wanting to avoid or delay pregnancy. However, they cannot owing to a lack of access to modern contraception and sociocultural hindrances. With the modern contraceptive prevalence rate stagnant at approximately 25% over the last 5 years, it is important to explore barriers and enablers to modern contraception uptake to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women. A formative research approach was taken to explore community member and health care provider perspectives on access to and use of family planning methods in 2 rural districts of Sindh, Pakistan. The broader goal of this study was to provide evidence to design and implement a socioculturally appropriate family planning intervention within the existing service delivery platforms to increase modern contraceptive uptake in the context of rural Sindh. A qualitative exploratory design was used. Between October 2020 and December 2020, 11 focus group discussions and 11 in-depth interviews were conducted. Focus group discussions were held with men and women from the community, including adolescents, to build an understanding of community beliefs and concepts regarding modern contraceptive methods. In-depth interviews were conducted with health care workers and explored intersections between family planning and reproductive health service delivery at the facility and outreach levels. The findings revealed that limited financial autonomy, restricted women's mobility, discriminatory gender norms, and cultural practices left women with little opportunity for independent decision-making on the use of modern contraceptive methods. Furthermore, facility-level and supply-side barriers, including frequent stock-outs of modern contraceptives combined with a lack of capacity of health workers to provide quality family planning services and counseling, played an important role in demotivating women from seeking services. In addition, a lack of integration of family planning with maternal and child health service delivery at the health system level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to family planning uptake were also highlighted. These included husbands' or in-laws' disapproval, social stigma, and perceived fear of side effects regarding modern family planning method use. More importantly, a lack of adolescent-friendly reproductive health services and spaces for counseling was identified as a critical intervention area. This study provides qualitative evidence on issues related to the effectiveness of family planning interventions, specifically in the context of rural Sindh. The findings emphasize the need to design socioculturally appropriate and health system-relevant family planning interventions-the effectiveness of which can be improved through their integration with maternal and child health service delivery mechanisms, consistent service provision, and opportunities for the capacity building of the health care workforce. RR2-10.2196/35291.

A Field Test of the NORMAL Job Aid With Community Health Workers in Kenya to Address Contraceptive-Induced Menstrual Changes.

Concerns about contraceptive-induced menstrual changes (CIMCs) contribute to nonuse and discontinuation of family planning (FP). Current counseling materials inadequately address these concerns. After obtaining initial feedback, we field-tested an adapted version of the NORMAL job aid that guides community health workers on how to counsel women about CIMCs. The field test aimed to help understand how the job aid was used, the challenges faced in using it, and recommendations to improve the job aid. Sixteen community health volunteers (CHVs) from 2 subcounties in Kenya were trained on the 2-page job aid and given copies of the job aid to use with clients. Six to 8 weeks after the training, we interviewed the CHVs about their experiences using the job aid. The interviews were audio-recorded, transcribed, and analyzed to identify qualitative themes. All 16 CHVs reported using the job aid each time they counseled. All liked it and said they used it because it gave them new information and made counseling easier. All reported offering the job aid to most clients and that most clients accepted a copy. CHVs noted clients referred their friends and family to them after counseling using the job aid. CHVs said the job aid reduced clients' and their male partners' concerns about CIMCs and helped clients select or switch FP methods. Most CHVs did not have suggestions for improving the job aid. The job aid was highly acceptable to the CHVs who participated in this small assessment. According to the CHVs, it increased counseling effectiveness and may help increase uptake and continued use of FP methods directly through counseling or indirectly through diffusion in the community. Though further research is needed in other settings and to quantify its impact, we recommend this promising job aid be adapted for wider use.