Utilization Of Family Planning Services Research Articles

FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT BABY: A CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL

Objectives: Low birth weight (LBW) is a challenging multifaceted public health problem due to its association with increased risk of morbidity and mortality of infants. Both community and institution-based studies are needed to find out the lacunae regarding the occurrence of LBW babies so that effective strategies which are relevant to the local conditions can be adopted for its prevention. We conducted this study to estimate the prevalence and determine the factors associated with LBW in the live-born infants delivered in a tertiary care hospital. Methods: This was an observational and cross-sectional questionnaire-based study done in the Department of Pharmacology and Department of Gynecology and Obstetrics in this tertiary care hospital. Mothers who gave birth to their baby in the Obstetrics Ward were included in the study. The subjects underwent a face-to-face interview using a suitably designed and validated questionnaire and the data were collected. Results: A total of 360 subjects were interviewed. About 34.7% of mothers were below 20 years of age. The majority of the mothers had education up to secondary level (58.33%) and were housewife (82.22%). About 58.2% of mothers belonged to a family size of 5–10 members. Among the 104 LBW infants, 63.46% were small for date and 36.54% were pre-term. The mean weight of the newborn was 2.54 kg. Maternal age, number of family members, number of anti-natal care visits, anemia and maternal weight gain during pregnancy were associated with LBW (p<0.05). No significant differences were found among the newborns with and without LBW regarding variables such as religion, family type, maternal addiction, previous abortion, and tetanus toxoid taken by the mother. Conclusion: As LBW is the major cause of perinatal morbidity and mortality, every step should be taken for its prevention. In this regard, proper maternal education for antenatal care and regular visits to antenatal care clinics should be done. Field workers may help to impart correct knowledge of diet through proper health education besides providing other advices such as delaying the age of the first child, birth spacing, and family planning services utilization.

Unraveling the Intersection of Socio-Economic Dynamics and Family Planning Accessibility: Insights from Women of Reproductive Age in Kween District, Eastern Uganda

The provision and utilization of Family Planning (FP) services play a pivotal role in not only safeguarding women's health but also significantly enhancing the overall well-being of their partners, children, and the wider societal fabric. Studies have estimated that optimizing FP services could potentially save 32% of maternal lives and 10% of child lives. In light of these critical implications, this research delves into the multifaceted factors hindering women's access to Family Planning Services within the precincts of the Kween district. Employing a cross-sectional descriptive study design, this investigation focuses on women aged between 18-49 years. Data collection involved survey questionnaires administered to a strategically sampled group of 40 women. The quantitative data underwent meticulous analysis utilizing SPSS version 20, while qualitative data was subjected to content and thematic analysis, presenting findings in a verbatim format. The study revealed that while 47.5% of women were utilizing modern FP methods, encompassing pills, implants, and injectables, there existed a notable unmet contraceptive need of 25%, coupled with a 22.5% contraceptive discontinuation rate. The primary deterrent to accessing modern FP methods stemmed from acceptability issues entrenched in prevailing myths, notably the erroneous beliefs associating Family Planning with infertility and the culturally unfavorable birth of twins. Moreover, the discontinuation of modern FP methods predominantly stemmed from reported side effects such as excessive bleeding, backaches, and headaches. Additionally, the research underscored a correlation between the utilization of modern FP methods, women's educational attainment, and demographic factors like the number of living male children and participation in polygamous marriages. Intriguingly, religious affiliations had a limited impact on FP method utilization, as women demonstrated a tendency to contravene religious doctrines to access FP services despite religious opposition. This study illuminates critical barriers obstructing women's access to and sustained use of modern FP methods in the Kween district, emphasizing the urgency for tailored interventions addressing socio-cultural misconceptions, side-effect management, and demographic sensitivities to foster more inclusive and effective FP service delivery in similar contexts. Keywords: Family Planning, Contraceptives, Injectables, Implants.

Barriers to Family Planning Service Utilization in Ethiopia: A Qualitative Study.

The unmet need for family planning (FP) is a major impediment to achieving the sustainable development goal The COVID-19 pandemic and other contextual, individual, and hospital-related problems are major barriers that reduce FP service uptake. However, most of the studies are quantitative and give due focus to individual and community-level barriers. Therefore, this study tends to explore barriers to the utilization of FP in Ethiopia including health care and contextual barriers. A multiple explorative case study design was employed from October to December 2021 and a total of 41 Key-informant interviews, 32 in-depth interviews, and 13 focus group discussions were performed by using the purposive sampling technique. The data were analyzed with a thematic content analysis approach using NVivo software. This study explored barriers to FP in four major teams; individual, community-related, health system, and contextual barriers. It reviled that the community's misconception, fear of side effects, lack of women's decision-making autonomy, existing socio-cultural norms, religious conditions, topography, covid 19 pandemic, and conflict were the major barriers to FP service utilization. Using the four teams mentioned above, this study identified different poor health professional skills, misconceptions, pandemics, functional, and structurally related barriers. As a result, it is recommended that health education for the community and training for health professionals are important. Collaboration between government and non-government organizations is also mandatory for strengthening mentorship and supervision systems and establishing resilient health care that can avoid future pandemics.

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Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study.

The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled "Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas," conducted by the World Health Organization (WHO) Department of Reproductive Health and Research. This study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19-affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services. In-depth interviews will be conducted with clients-women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services-and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19-affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries. Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023. The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs. DERR1-10.2196/43329.

Assessment of Family planning services utilization among women of Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir

Objectives: To determine the percentage of women in Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir who use family planning services, and to determine the relationship between demographic characteristics and family planning service use (AJ&K). Study design and setting: A cross-sectional study was conducted in UC Bangoin (Rawalakot) Azad Jammu and Kashmir over the duration of 6 months, from 5 January to 5 July 2021. Methodology: A sample of 344 married women with the age range 18 to 45 was obtained. The study's assessment instrument was developed from an existing assessment tool (Reproductive health knowledge and services utilization among rural adolescence in Ethiopia 2014). It included 14 questions on demographics and 13 questions about the use of family planning services. Results: High utilization was 52% (n=179) while low utilization was 48% (n=165). Most of them had fear of side effects of using contraception (n=170, 48.9%). Chi-square test showed significant association (p-val =0.05) between fear of side effects of using contraception, decision of using contraception, education level, distance from home to hospital, number of children, exposure to mass media and utilization of family planning services. Conclusion: There was low family planning services utilization in that area. Study showed that there was a strong association between fear of side effects of using contraception, low education and low exposure to mass media with utilization of family planning services in Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir (AJ&K)

Assessing motivators for utilizing family planning services among youth students in higher learning institutions in Dodoma, Tanzania: Protocol for analytical cross sectional study.

Contraceptive services utilization is an important intervention in averting the impact of unwanted and unplanned pregnancy among youth which is an obstacle to the higher learning institutions youth students in attaining their educational goals. Therefore, the current protocol aims to assess the motivators for family planning service utilization among youth student in higher learning institutions in Dodoma Tanzania. This study will be a cross-sectional study with quantitative approach. A multistage sampling technique will be employed in studying 421 youth students aged between 18 to 24 years using structured self-administered questionnaire adopted from the previous studies. The study outcome will be family planning service utilization and independent variables will be family planning service utilization environment, knowledge factors, and perception factors. Other factors such as socio-demographic characteristics will be assessed if they are confounding factors. A factor will be considered as a confounder if it associates with both the dependent and the independent variables. Multivariable Binary logistic regression will be employed in determining the motivators for family planning utilization. The results will be presented using percentages, frequencies, and Odds Ratios and the association will be considered statistically significant at p-value <0.05.

The effects of COVID-19 lockdown measures on health and healthcare services in Uganda.

Many countries across the world instituted lockdowns as a measure to prevent the spread of COVID-19. However, these lockdowns had consequences on health systems. This study explored effects of the COVID-19 lockdown measures on health and healthcare services in Uganda. The qualitative study employed focus group discussions (FGDs), household interviews, and key informant interviews (KIIs) in both an urban (Kampala district) and rural (Wakiso district) setting in central Uganda. Fourteen FGDs were conducted among community members, local leaders, community health workers, and health practitioners. Interviews were conducted among 40 households, while 31 KIIs were held among various stakeholders including policy makers, non-governmental organisations, and the private sector. Data was analysed by thematic analysis with the support of NVivo 2020 (QSR International). Findings from the study are presented under four themes: maternal and reproductive health; child health; chronic disease services; and mental health. Maternal and reproductive health services were negatively affected by the lockdown measures which resulted in reduced utilisation of antenatal, postnatal and family planning services. These effects were mainly due to travel restrictions including curfew, and fear of contracting COVID-19. The effects on child health included reduced utilisation of services which was a result of difficulties faced in accessing health facilities because of the travel restrictions. Patients with chronic conditions could not access health facilities for their routine visits particularly due to suspension of public transport. Depression, stress and anxiety were common due to social isolation from relatives and friends, loss of jobs, and fear of law enforcement personnel. There was also increased anxiety among health workers due to fear of contracting COVID-19. The COVID-19 lockdown measures negatively affected health, and reduced access to maternal, reproductive and child health services. Future interventions in pandemic response should ensure that their effects on health and access to health services are minimised.

Effects of family planning service utilization determinants on unmet need incidents with generalized structural equation modeling

One of the reasons for the lack of optimal achievement in terms of contraceptive use in Indonesia is the unmet need for family planning that has not been fully addressed. This study aimed to determine the direct, indirect, and total effect of the determinants of family planning services utilization on the incidence of unmet need spacing and limiting in Indonesia to provide a basis for appropriate and effective program recommendations. This study used secondary data from the 2017 Indonesian Demographic and Health Survey with a cross-sectional design with 33,635 respondents who were married women aged 14 to 49 years. The results of the generalized structural equation modeling showed that the incidence of unmet need in Indonesia was 11.68%, consisting of unmet need spacing (4.86%) and unmet need limiting (6.82%). The quality of family planning services had a positive indirect effect on the incidence of unmet need spacing. The quality of family planning services also had a positive direct, indirect, and total effect on the incidence of unmet need limiting. Socioeconomic and demographic status variables had a negative direct effect on the incidence of unmet need spacing, whereas the indirect and the total effect were positive. The direct and total effect of socioeconomic and demographic status variables on the incidence of unmet need limiting were positive. The women's autonomy variable had a positive direct, indirect, and total effect on the incidence of unmet need spacing. Women's autonomy had positive indirect and total effect on the incidence of unmet needs limiting. The variable of access problems did not have a significant effect on the incidence of unmet need spacing and unmet need limiting. The ideal number of children had a negative direct and total effect on the incidence of unmet need spacing and unmet need limiting in Indonesia. The variables that have been shown to have a significant effect on the incidence of unmet needs were the quality of family planning services, socioeconomic and demographic status, women's autonomy, and the ideal number of children.

Utilization of Family Planning Services in Africa’s Most Populous Nation, are we at a tipping point

Background Nigeria is the most populous country in Africa, with a population growth rate of 2.53 percent, one of the highest contributors to the global maternal and new born deaths burden. Family planning service utilization has remained low despite efforts by development partners and the government. Hence, the need to examine the utilization of family planning services in order to understand regional preferences, trends, patterns, and utilization associated factors such as accessibility and availability of the services to the populace. Methodology Critical analysis regarding the utilization of family planning in Nigeria was used with source data from NDHS 2003, 2008, 2013, and 2018 and DHIS2. The analysis focused on the utilization of family planning services and most utilized family planning options. Finding Contraceptive use among women of reproductive age is generally higher in the northern region than in the southern region. A five-year trend in the utilization of family planning services by women of reproductive age is showed a slightly declining trend in the utilization of family planning services by women of reproductive age in the country.Injectables and implants were married women’s most utilized family planning options. As reported by health facilities, utilization of family planning services in 2021 showed that condoms and implants were the most utilized family planning options. Conclusion The findings urge the need to intensify sensitization among the rural populace on the benefits of family planning, improve female literacy and empowerment, and make easily accessible family planning services and commodities.

Drivers of Family Planning Services Utilization in Pakistan: A Literature Survey and Recent Trends in Contraceptive Use

Population planning is inevitable for a sustainable and secure future of a lower middle-income economy, like, Pakistan which stands fifth populous economy across the globe and has high population growth rate. Based on Pakistan Demographic and Health Survey 2017-18 data and by covering a sample of 12339 ever-married females, the study intends to investigate the correlates of family planning services use in Pakistan as well as the use of contraceptives across the regions and districts of Pakistan. An exploration of 34 studies (spanning over a time from 1989 to 2021), specifically on Pakistan, with respect to family planning services utilization, have found that the use of family planning services was an outcome of a woman’s education, awareness status, wealth or economic status, religion, husband’s approval, area of residence, number of living children, prevalence of the desired family planning method, desire for more children, subsidized healthcare services and other social or individual factors. In Pakistan, the average contraceptive use rate was recorded as between 19-49 percent across the regions and between 0-71 percent across the districts. The region Islamabad Capital Territory (ICT) had the highest contraceptive usage rate, i.e., 49%, followed by: Punjab (42%), Khyber Pakhtunkhwa (KPK) and Gilgit Baltistan (39% each), Sindh and Azad Jammu and Kashmir (AJK) (34% each), Federally Administered Tribal Areas (FATA) (24%), and Balochistan (19%). Amongst the districts, top three districts with highest contraceptive usage were Jafarabad, Sheikhupura and Jhang whereas the districts of Rajanpur, Tor Ghar and Kohlu were lying at the bottom. Region-wise disaggregation found that in the province of Punjab and Sindh, the range of contraceptive use across the districts was respectively ranged between 0-70 percent and 8-60 percent. Likewise, in KPK and Balochistan provinces, the range of contraceptive use had been recorded between 0-59 percent and between 2-71 percent. While the range of contraceptive use in Gilgit-Baltistan, FATA region, and in AJK had been respectively recorded between 9-48 percent, 11-39 percent, and 17-47 percent.

Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda.

BackgroundCoronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people’s lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda.MethodsA qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes.ResultsFive themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport.ConclusionResults showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.

Assessment of men involvement in family planning services use and associated factors in rural Ghana

BackgroundIn low-and-middle income countries (LMICs) less attention is paid to men’s involvement in Family Planning (FP) programs where public health officials have advocated the involvement of men as a strategy for addressing the dismal performance of FP programs. The study assessed the involvement of men in FP use and the factors which promote or hinder the uptake of FP services among partners in a rural setting of northern Ghana.MethodsA cross-sectional descriptive study was used to collect data from 200 respondents. Study respondents were selected through random cluster sampling.ResultsThe findings showed that male partners’ knowledge (95.5%) and approval (72.8%) of FP services were high. About 48% of men were involved in FP service utilization. Having living children (aOR; 1.71(1.27, 2.15)) and being knowledgeable (aOR; 6.14(1.38, 10.90)) about FP were positively associated men’s involvement in FP service utilization. The findings also indicated that men had a higher propensity (X2 = 4.5534, p = 0.033) of supporting a FP method use. Women who reported that their spouse supported FP method use were more likely to use a contraceptive method (X2 = 9.5223, P = 0.002) if their spouse supported FP method use (X2 = 9.5223, P = 0.002) and if their partners had some education (X2 = 14.1133, P = 0.000). Reasons for low contraceptive use were health risks, side effects, and socio-cultural norms.ConclusionFamily planning programs need to include men at all levels of health promotion and education of FP programs to help reduce misconceptions about contraceptive methods to increase acceptance and use among partners in rural settings of Ghana.

A multi-sectoral intervention model to scale up family planning services utilization at the primary health care level: evidence from a priority district, Fayoum governorate, Egypt

&#x0D; Background: Egypt is one of the most populous countries in the Middle East and Africa. Evidence from developing countries revealed that increasing family planning use is associated with substantial declines in fertility and population growth. The objective of this study was to assess the impact of implementing a multisectoral intervention model on the family planning utilization at the Primary Health Care (PHC) level in a priority district, Fayoum governorate, Egypt. &#x0D; Methods: A quasi-experimental design was conducted from July 2016 to September 2016. The model targeted 10 PHC units out of 23 at Tamia district, with two types of interventions; health sector and non-health sector related interventions carried out in the intervention units and their catchment areas. The family planning utilization of the intervention units (n=10) was compared to the control units (n=13). Additionally, the overall family planning utilization at the district level was measured. &#x0D; Results: Following the implementation of the interventions, the overall family planning utilization at the district level showed a significant increase in mean ± Standard Error of the Mean (SEM) of new family planning clients (44.4±11.0vs. 63.3±13.8; P= 0.006) recording 43% change. The mean ± SEM of intrauterine devices dispensed from the intervention units significantly increased by 391% (3.5±1.0 vs. 17.2±3.3; P=0.002). Findings from the control units didn't reveal significant increase regarding the dispense of any family planning method. &#x0D; Conclusion: Mobilizing and optimizing resources use, empowering district authorities and strengthening collaboration across sectors were key drivers of the success of this model in scaling up family planning services utilization. &#x0D; &#x0D;

Classification of Family Planning Services Utilization for Prediction of Social and Economic Factors

Family planning does more than enable women to limit family size. It enables women to have the number of children they want and subsequently reduces the incidence of maternal and infant mortality. Family planning method was investigated among market traders in Ibadan metropolis, Nigeria. The study revealed that male condom was the most preferred among the family planning methods used by market traders and their spouses in Ibadan metropolis. Vasectomy/Tubal Ligation received the least preference among the family planning methods. However the level of information among the men was low about the different family planning methods and their risk. Also the low contraceptive prevalence rate in Nigeria is associated with high rates of unsafe and induced abortion the results of the analysis of data collected on the prevalence of family planning services utilization revealed that most market traders in Ibadan metropolis used family planning services. Furthermore, the finding showed that among the males of market traders in Ibadan metropolis, 51.7% used family planning services, while among the female market traders, 64.7% used family planning services. These findings showed that female market traders in Ibadan metropolis use family planning service more their male counterparts. The result of the study also showed the factor(s) that determines the choice of most family planning utilization are: accessibility, availability, cost, perceived effectiveness, no side effects, past practices and from health workers. The result revealed that attitude towards family planning services utilization was significant determinant of family planning services utilization.

Health problems and utilization of health services among Forcibly Displaced Myanmar Nationals in Bangladesh

BackgroundAccess to and utilization of health services have remained major challenges for people living in low- and middle-income countries, especially for those living in impaired public health environment such as refugee camps and temporary settlements. This study presents health problems and utilization of health services among Forcibly Displaced Myanmar Nationals (FDMNs) living in the southern part of Bangladesh.MethodsA mixed-method (quantitative and qualitative) approach was used. Altogether 999 household surveys were conducted among the FDMNs living in makeshift/temporary settlements and host communities. We used a grounded theory approach involving in-depth interviews (IDIs), focus group discussions (FGDs), and key informant interviews (KIIs) including 24 IDIs, 10 FGDs, and 9 KIIs. The quantitative data were analysed with STATA.ResultsThe common health problems among the women were pregnancy and childbirth-related complications and violence against women. Among the children, fever, diarrhoea, common cold and malaria were frequently observed health problems. Poor general health, HIV/AIDS, insecurity, discrimination, and lack of employment opportunity were common problems for men. Further, 61.2% women received two or more antenatal care (ANC) visits during their last pregnancy, while 28.9% did not receive any ANC visit. The majority of the last births took place at home (85.2%) assisted by traditional birth attendants (78.9%), a third (29.3%) of whom suffered pregnancy- and childbirth-related complications. The clinics run by the non-governmental organizations (NGOs) (76.9%) and private health facilities (86.0%) were the most accessible places for seeking healthcare for the FDMNs living in the makeshift settlements. All participants heard about HIV/AIDS. 78.0% of them were unaware about the means of HIV transmission, and family planning methods were poorly used (45.2%).ConclusionsOverall, the health of FDMNs living in the southern part of Bangladesh is poor and they have inadequate access to and utilization of health services to address the health problems and associated factors. Existing essential health and nutrition support programs need to be culturally appropriate and adopt an integrated approach to encourage men’s participation to improve utilization of health and family planning services, address issues of gender inequity, gender-based violence, and improve women empowerment and overall health outcomes.

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

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

Are user fees in health care always evil? Evidence from family planning, maternal, and child health services

The effect of introducing or increasing user fees for health services in low- and middle-income countries is controversial. While user fees are advocated as an effective means of generating revenue and enabling health service quality improvement, they constitute a financial barrier to access health services for the poorer. This paper contributes to the literature on the demand-side financing in health by providing evidence on the medium-term effects of introducing user fees on the utilisation of family planning, antenatal care, and delivery care services, women’s access to health care, and child health status in a middle-income country setting. Using a difference-in-differences identification strategy to establish causality, we find that the introduction of user fees in Egypt had no negative effect on the utilisation of family planning and delivery care services. Further, fees did not hinder women’s access to care and did not harm child health outcomes. Positive effects were even observed with respect to the utilisation of antenatal care services. Our findings are compatible with the hypothesis that the potential decrease in demand due to the user fee imposition might have been offset by an increased willingness to pay for a quality of health care that could be, at least partly, perceived as higher.

Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics

ObjectivesThis study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan. MethodsExplorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis. ResultsTwo themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality. ConclusionsThis study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.

Determinants of uterovaginal prolapse in Western Ethiopia.

Uterovaginal prolapse is a significant public health concern in developing countries like Ethiopia where access to health care is limited. It significantly affects women's health and productivity. Thus, it is very important to identify determinant factors and take preventive actions. A hospital-based unmatched case-control study was conducted on 86 cases and 258 controls who attended gynecologic outpatient departments in Nekemte town from May 1 to July 30, 2019. Cases were women with grade II, III and IV uterovaginal prolapse while controls were women free from uterovaginal prolapse but with other gynecologic diseases. Data were collected using pretested interviewer-administered questionnaires, and measurements on height and weight were taken to calculate the women's body mass index. Data were entered using Epi Data version 3.1, and analysis was carried out by SPSS version 20. Descriptive, bivariate and multivariable logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used, and statistical significance was declared at p < 0.05. This study revealed age ≥ 40years (AOR = 10.49; 95% CI: 4.03, 27.35), duration of labor ≥ 24h (AOR = 8.32; 95% CI: 3.58, 19.33), instrumental delivery (AOR = 7.40; 95% CI: 1.21, 45.28), non- utilization of family planning (AOR = 3.14; 95% CI: 1.32, 7.47) and underweight (BMI < 18.5kg/m2) (AOR = 5.30; 95% CI: 1.83, 15.33) were determinants of uterovaginal prolapse. Age ≥ 40years, prolonged labor, instrumental delivery, non-utilization of family planning and underweight were identified as determinant factors of uterovaginal prolapse. Thus, family planning service utilization and appropriate and timely obstetric care are advisable.