Utilization Of Family Planning Services Research Articles

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.

Men\u2019s involvement in family planning service utilization among married men in Kondala district, western Ethiopia: a community-based comparative cross-sectional study

BackgroundMen involvement is one of the important factors in family planning (FP) service utilization. Their limitation in the family planning program causes a decrease in service utilization as well as the discontinuation of the method which eventually leads to failure of the program. Family planning uptake is low but there is no enough study conducted on the parameters of husband involvement in Ethiopia. Hence, this study focused to assess men’s involvement in family planning service utilization in Kondala district, western Ethiopia.MethodsCommunity based comparative cross-sectional study design was employed in urban and rural kebeles of kondala district using quantitative and qualitative data collection tools. The multi-stage sampling method was employed to select 370 participants from each of the four urban and eight rural kebeles. Logistic regression analysis was used to identify variables that affect husbands’ involvement in FP service utilization. Statistical significance was declared at p-value of < 0.05 with 95% confidence interval (CI) and strength of association was reported by odds ratio (OR).ResultsThe study showed that 203(55.6%) men from urban and 178(48.8%) from rural were involved in FP service utilization. The median age of the respondents was 36+ 8.5 years (IQR: 27.5–44.5) in urban and 35 years (IQR: 25–45) in rural parts. Respondents who had four and above current children (AOR = 3.25, 95%CI = 1.51–7.02) in urban and (AOR = 4.20, 95%CI = 1.80–9.79) in rural were positively associated with men’s involvement in FP service utilization. In the urban setting, being government employee (AOR = 2.58, 95%CI = 1.25–5.33), wishing less than two children (AOR = 3.08, 95%CI = 1.80–5.24) and having a better attitude towards FP methods (AOR = 1.86, 95%CI = 1.16–2.99) were positively associated with FP service utilization. While good educational background (AOR = 2.13, 95%CI = 1.02–4.44), short distance from home to health facility (AOR = 2.29, 95%CI = 1.24–4.19) and having better knowledge (AOR = 4.49, 95%CI = 2.72–7.38) were positively associated with men involvement in FP service utilization in the rural area.ConclusionLow involvement of men in family planning service utilization was reported in both settings. Factors associated with husbands’ involvement were varied between the two setups, except for the current number of children. Future FP program should incorporate infrastructure associated with the health facility, knowledge, and attitudinal factors.

Determinants of under-five mortality in the high mortality regions of Ethiopia: mixed-effect logistic regression analysis

BackgroundEven though the global under-five mortality rate substantially decreased over time, Sub-Saharan African (SSA) countries including Ethiopia continue to share the huge burden of under-five mortality. Ethiopia showed a substantial reduction in under-five mortality over time but the rate of reduction has varied across regions. Therefore, this study aimed to investigate determinants of under-five mortality in the high mortality regions of Ethiopia.MethodsA secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 3446 live births were included for this study. For the determinants of under-five mortality, mixed-effect logistic regression was fitted. The Intra-Class Correlation Coefficient (ICC), and Median Odds Ratio (MOR) were done to assess the presence of a significant clustering effect. The standard binary logistic regression and the mixed-effect logistic regression model were fitted and deviance (−2LL) was used for model comparison as the models were nested models. Variables with a p-value less than 0.2 in the bi-variable mixed-effect binary logistic regression analysis were considered for the multivariable analysis. In the multivariable mixed-effect logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to declare the statistical significance and strength of association of under-five mortality and the determinant factors.ResultsOverall, the under-five mortality rate in the high mortality regions of Ethiopia was 74 per 1000 live births and it was highest among twin births (262 per 1000 live births). In the multivariable mixed-effect logistic regression analysis, being having 6 and above births (AOR = 3.66, 95% CI: 1.55, 8.67), preceding birth interval of 2–3 years (AOR = 0.57, 95% CI: 0.41, 0.81) and above 3 years (AOR = 0.35, 95% CI: 0.22, 0.55), being twin (AOR = 5.12, 95% CI: 2.28, 11.46), and being having antenatal care (ANC) visit during pregnancy (AOR = 0.27, 95% CI: 0.16, 0.45) were significant determinants of under-five mortality.ConclusionIn this study, under-five mortality rate was highest in high mortality regions of Ethiopia. Parity, ANC visit, preceding birth interval, and multiple births were significant predictors of under-five mortality. Therefore, public health interventions that increase maternal health service utilization such as ANC and family planning service utilization to increase birth interval are needed to reduce under-five mortality among these regions of Ethiopia.

Access to Contraceptive Services in Puerto Rico: An Analysis of Policy and Practice Change Strategies, 2015-2018.

During the 2016-2017 Zika virus outbreak in Puerto Rico, preventing unintended pregnancy was a primary strategy to reduce Zika-related adverse birth outcomes. The Zika Contraception Access Network (Z-CAN) was a short-term emergency response intervention that used contraception to prevent unintended pregnancy among women who chose to delay or avoid pregnancy. This analysis reports on the identified policy and practice change strategies to increase access to or provision of contraceptive services in Puerto Rico between 2015 and 2018. A policy review was conducted to document federal- and territorial-level programs with contraceptive coverage and payment policies in Puerto Rico and to identify policy and practice change. Semistructured interviews with key stakeholders in Puerto Rico were also conducted to understand perceptions of policy and practice change efforts following the Zika virus outbreak, including emergency response, local, and policy efforts to improve contraception access in Puerto Rico. Publicly available information on federal and territorial programs with policies that facilitate access, delivery, and utilization of contraceptive coverage and family planning services in Puerto Rico to support contraceptive access was documented; however, interview results indicated that the implementation of the policies was often limited by barriers and that policy and practice changes as the result of the Zika virus outbreak were short-term. Consideration of long-term policy and practice changes related to contraceptive access is warranted. Similar analyses can be used to identify policies, practices, and perceptions in other settings in which the goal is to increase access to contraception or reduce unintended pregnancy.

Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana

BackgroundImprovement in maternal healthcare is a public health priority. Unfortunately, in spite of the efforts made over time regarding universal coverage, there remain issues with accessibility and use of healthcare services up to now. In this study, we examined inequalities in out-of-pocket health expenditure among women of reproductive age in Ghana. We analyzed secondary data collected in Ghana Demographic and Health Survey (GDHS) - 2014. A total of 9,002 women of reproductive age were included in this study. Lorenz curves and the concentration index were used to examine neighborhood socioeconomic disadvantage inequalities in out-of-pocket expenditure for maternal healthcare utilizationResultsAbout two thirds (66.0%) of women of reproductive age in Ghana were covered by health insurance. In sum, women of high neighborhood socioeconomic disadvantage status had the least out-of-pocket expenditure for total healthcare utilization, laboratory investigations, antenatal care visits, post-natal care visits, care for new born for up to 3 months, and other healthcare services. The converse was however true for family planning service utilization. Using Concentration Index, we quantified the degree of neighborhood socioeconomic disadvantage inequalities in healthcare service utilizations.ConclusionThis study showed a gap in health insurance coverage among women of reproductive age. There were also inequalities in out-of-pocket expenditure for healthcare services utilization. It is expedient for stakeholders in the healthcare system to make policies targeted at bridging the neighborhood socioeconomic differences in maternal healthcare use and develop programs to improve women’s financial protection. Moreover, enlightenment on health insurance availability and coverage should focus on women at risk of out-of-pocket expenditure.

Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study.

Globally an estimated 55.9 million abortions occur each year. The majority of abortions occur due to unintended pregnancies, which is a result of the non-use of family planning methods. World health organization recommends all clients to utilize modern contraceptive methods after any abortion procedure. However, post-abortion family planning utilization is still low in Ethiopia including the study area. Therefore, this study was expected to determine the utilization of post-abortion family planning and associated factors in Bahir Dar city health facilities in Northwest Ethiopia. Institution based cross-sectional study was conducted among 408 women from March 1 to April 30, 2019. Data were collected through face-to-face interview using a structured and pre-tested questionnaire. Systematic random sampling was used to select the study participants. Data were cleaned, coded, and entered into epi data and exported to SPSS for further analysis. Both bivariable and multivariable logistic regression were employed. Those variables that had a p-value of less than 0.2 during the bivariate analysis were retained for the multivariable analysis. P-value and confidence interval were used to measure the level of significance on multi-variable analysis and those variables whose P-value, less than 0.05 was considered as statistically significant. The finding of this study showed that the magnitude of post-abortion family planning (PAFP) utilization was 61% with 95% CI (55, 65). Secondary education level(AOR, 4.58; 95% CI (1.96, 10.69)), certificate and above education level (AOR, 3.06; 95% CI (1.32, 7.08)), Manual Vacuum Aspiration(MVA) (AOR, 7.05; 95% CI (2.94, 16.90)), both medication and Manual Vacuum Aspiration (AOR, 5.34; 95% CI (2.56, 11.13)) and received Post Abortion Family Planning (PAFP) counseling (AOR, 5.99; 95% CI (3.23, 11.18)) were significantly associated with PAFP utilization. Post-abortion family planning utilization in Bahir Dar health facilities was low compared with the national figure. Secondary and above educational level, respondents who were managed by Manual Vacuum Aspiration (MVA), both Manual Vacuum Aspiration (MVA) and medication and receiving Post Abortion Family Planning (PAFP) counseling were predictors of post-abortion family planning service utilization.

Involvement in family planning service utilization and associated factors among married men at Debre Tabor town, Northwest Ethiopia, 2017.

Introductionmen´s involvement in family planning (FP) can be either as a user of male contraceptive methods and/or support of the male partners. In some developing countries, levels of communication on this issue is low for decision-making. Unmet need for FP suggested that unwanted pregnancy and unsafe abortion are the main causes of maternal mortality in Ethiopia. Men’s involvement in family planning is very important to improve women´s health in particular and reproductive health in general.Methodsthe community based cross-sectional study design was conducted to assess men´s involvement in family planning service and associated factors among married men at Debre Tabor town. A simple random sampling method was used to include 382 married males. Data were collected by face-to-face interview using a structured questionnaire. The data were entered into Epi Info 7 and were analyzed using SPSS version 21 statistical software package.Resultsfrom three hundred and eighty-two participants, 373 participated yielding a 97.6% response rate. The age range of the participants’ was from 20 to 65 years, the mean age was 38.6 with the standard deviation of ±7.8. The majority of the participants were Orthodox followers 358 (96%). About 33.2% of them were greater than secondary education level. The magnitude of male involvement in family planning was 254 (68.1%), 370 (99.2%) of the participants had information on different family planning methods. Adjusting all other factors for the final model, educational status AOR = 2.39 [1.084, 5.260], source of information AOR [95%CI] = 1.88 [1.016, 3.485], men’s approval AOR [95%CI] = 0.07 [0.036, 0.134], ever used contraceptive AOR [95%CI] = 0.21 [0.064, 0.705] were found to be associated with men’s involvement.Conclusionthe level of male involvement was moderate, but their actual utilization is low.

MALE PARTNER INVOLVEMENT IN LONG TERM CONTRACEPTIVE UPTAKE AMONG SELECTED COUPLES IN MURANG’A COUNTY CENTRAL KENYA

Purpose: the main objective of the study was to assess male partner involvement in long term contraceptive uptake among selected couples in Murang’a county central Kenya&#x0D; Methodology: This was a descriptive, cross-sectional study employing both qualitative and quantitative approaches. Data collection tools were Interviewer administered - Semi Structured Questionnaires, Key Informant interviews guide and Focused Group Discussions guide .Pre-test of Instruments was done at Othaya Sub County in Nyeri. Eligible couples were systematically sampled using the EPI spatial sampling methods adopted by WHO for use in low income countries Data was analyzed using SPSS version 20 software. Descriptive statistics, chi square, binary and multiple logistic regressions was computed. Those variables that were significant at P-value ≤ 0.05 were entered into multivariate analysis. The odds ratio was calculated to assess the association and strength of association of variables. P-value &lt; 0.05 was taken as a cut point. Qualitative data was triangulated with the quantitative data to enhance validity and reliability of the study findings.&#x0D; Findings: Majority of couples interviewed (73%) reported being in a long-term relationship Most participants (61%) cited male involvement as male partner participation and contribution, which they believed was important in family planning services utilization. Whereas most women(57%) reported that the partner’s permission was not necessary and the decision to use any family planning method was their own, key informant indicated that despite receiving information about benefits of long-term family planning method, many women remained (53%) reluctant to undergo some procedures without first obtaining their partners permission. Most of the male partners(51%) were not willing to undergo vasectomy as they equated it with castration and the stigma which was to accompany the tag.&#x0D; Unique contribution to theory, practice and policy: There is need to increase the level of knowledge and awareness among male partners on long term family planning methods and their benefits. Future research should explore the feasibility and effectiveness of engaging male partners in utilization of long-term family planning methods

Trends and Contributing Factors to Contraceptive Use in Kenya: A Large Population-Based Survey 1989 to 2014.

Kenya is among the leading nations in family planning in Africa, having the first official nationwide family planning program in sub-Saharan Africa. However, Kenya is still one of the most highly populated countries in Africa with a population of more than 52 million. The objective of this study was to assess the trends and contributing factors of contraceptive use. We conducted a multi-wave cross-sectional study using both the demographic health survey (DHS) and family planning effort index (FPE) datasets, analyzing five-year waves from 1989 to 2014. This study indicates that contraceptive use increased from 24.0% to 42.6%, with a change % of 77.5%. Despite changes in women’s characteristics, these characteristics posed little on the time trend of contraceptive use in Kenya. In addition, the policy component of FPE scores had a positive association with contraceptive use with negligible change after adjusting for social and demographic factors 1.055 (1.046–1.065). There was a fluctuating trend of the additional FPE components throughout the years. Women with lower education, those married to husbands with lower education, unmarried, and rural women remain behind in family planning service utilization. Targeted programs are still needed for these special groups. Policy adherence is vital for continued progress.

EFFECT OF COVID-19 PANDEMIC ON SAFE ABORTION AND CONTRACEPTIVE SERVICES AND MITIGATION MEASURES: A CASE STUDY FROM A TERTIARY FACILITY IN ETHIOPIA

Background: To protect the gains made in sexual and reproductive health in Ethiopia over the past several decades, care for childbearing women and newborn infants needs to continue during the pandemic. The provision of safe abortion and contraceptive services remains critical. When staff and services are under extreme stress there is a real risk of increasing avoidable harm. This case study aims to determine the impact of COVID-19 on contraception and safe abortion care services at a tertiary facility in Ethiopia. Materials and Methods: We collected data on safe abortion and contraception services from service delivery units from March through May 2020. For comparison, and due to seasonal variation in caseload throughout the year, we pulled data from March through May 2019. Results: Deliveries and immediate postpartum family planning have decreased by 27.6% and 66.7% respectively during the pandemic compared to the same months last year. Overall, the number of clients presenting for family planning was reduced by 27%. Safe abortion services and comprehensive abortion care were reduced by 16.4% and 20.31% respectively. Likewise, family planning service utilization among safe abortion and post-abortion clients were reduced by 40.6%, and 39.7% respectively. Conclusion and recommendations: The COVID-19 pandemic is significantly impairing safe abortion and contraception services. Both contraception and abortion services have decreased significantly following the COVID-19 pandemic. These findings underscore that the Ethiopia Federal Ministry of Health (FMOH) and their partners (donors and non-government organizations) must take swift action, including defining abortion care and contraceptive services as essential services to continue during the pandemic. Innovative methods, such as telehealth (voice or video calls), self-care interventions, and utilization of health extension workers, need to be maximized to maintain and increase access to these essential health services.

Factors Associated with Teenage Pregnancy: A Case Control Study

Teenage pregnancy is a major public health problem worldwide. Studies shows that teenage mothers are more likely to experience pregnancy-related complications compared to normal age mothers. This study was conducted to find the associated factors of teenage pregnancy. Hospital based case-control study was adopted among teenage mothers (15-19 years) and non-teenage (20-29 years) postnatal mothers admitted in two medical college teaching hospitals of Pokhara. Systematic random sampling was used to select the respondents. Study sample comprises 432 respondents with 216 cases and 216 controls. The data was collected by using structured interview schedule and collected data were entered in MS excel with validated command and analyzed with SPSS 16 version. The study resulted that teenage pregnancy was associated with disadvantaged ethnicity (AOR: 2.02, 95% CI: 1.14-3.56) agriculture (AOR: 5.37, 95% CI: 1.86-15.49) and labour (AOR: 6.22, 95% CI: 2.56-15.11) family occupation, lower education (AOR: 2.57, 95% CI: 1.39-4.76), nonworking status of women (AOR: 2.87, 95% CI: 1.60-5.14), unplanned pregnancy (AOR: 1.79, 95% CI: 1.101-3.21), incomplete immunization (AOR: 2.32, 95% CI: 1.11-4.84) and preterm gestational age (AOR: 3.23, 95% CI: 1.46-7.15).It is recommended to design and implement health education interventions especially for disadvantaged groups and people with low socio economic to reduce teenage pregnancy; to emphasize on providing opportunities for higher education, employment and empowerment and increasing utilization of family planning and maternal health services among teenagers.&#x0D; Key words: Teenage pregnancy, associated factors, case control study, outcomes, adolescents

Assessment of Socio Cultural Factors Affecting the Utilization of Family Planning Services: The Case of Haramaya town Bate Kebele

In Ethiopia socio cultural factors are highly determine the utilization of family planning services. There are many socio cultural factors that contributes to low contraceptive use, high fertility rate, un meet need of family planning services among these: religion, culture, misconception and social norm as a barriers to universal untaken of contraceptive use in Ethiopia. The objective of the study was to assess socio cultural factors affecting the utilization of family planning services: The case of Haramaya town Bate kebele . This study was used different research methodology like, cross-sectional studies, with in research approach, the study was used mixed research approach, and also the study was obtained information from primary and secondary data sources. In addition to this, study was employed Interview and Survey methods. The study was used non-probability sampling techniques, with these techniques particularly purposive (Judgmental), and through this technique the researcher was selected 98 samples and also the researcher was analyzed the qualitative and quantitative data, that get from interview and questionnaire through narration, percentages and frequency. The Findings of this study was religious fundamentalists who are not take family planning services, and also they condemned individuals who used family planning services and Culture give much value to children. Family planning challenged by tradition it means the mainstream culture toward family planning, society perception, society perceive the concept family planning in a negative sense, it lead to imbalance of ministration, sterilization, over fatty and other negative explanation are given to the services. Both governmental and non-governmental health care institutions should strongly attach each other for the mitigating of socio-cultural factors affecting on family planning services utilization. Key words: Culture , Contraceptive use, Family planning DOI : 10.7176/RHSS/9-21-06 Publication date: November 30 th 2019

Family Planning Utilization Among Model and Non Model Family Women Enrolled in Urban Health Extension Program in Addis Ababa, Ethiopia, 2015

Background : In 2003, the Ethiopian Federal Ministry of Health (FMOH) launched a new health care plan, the “Accelerated Expansion of Primary Health Care Coverage,” through a comprehensive Health Extension Program (HEP).Recognizing the huge gap between need and health care services available, the FMOH has focused on “providing quality promotive, preventive, and selected curative health care services in an accessible and equitable manner to reach all segments of the population, with special attention to mothers and children. Objective: To assess on family planning service utilization among model and non-model family women enrolled in urban health extension program of kirkos sub-city administration. Method: A cross sectional study design using a quantitative method was used .A total of 424 (212 model families and 212 non-model families) participated the study. Adjusted ORs that controls the confounding effects of other covariates were calculated using the multiple logistic regression models of SPSS version 16 statistical programs. Statistical significance was considered at P-value less than 0.05. Result: Large proportion study population 210(81.08%) [109(78.4%)) and 101 (84.1%),) model and non-model respectively] were they prefer to be informed by health professional and followed by other (like friend husband...) were 27(10.42%) [18(12.9%) and 9(7.5%) for model and non-model families respectively], media (radio and TV) were 15(5.79%) [5(3.59) and10 (8.33%) for model and non-model families respectively] with X2 =4.21, p value =0.000021. Conclusion : By this measurement the UHEP programs lacks the aspects expected to be done. FMOH should see the implementation strategies of UHEP on providing and upgrading family planning service. Keywords: Family planning, Urban Health Extension Program (UHEP), Model /Non-model Family DOI : 10.7176/JMPB/59-04 Publication date :September 30 th 2019

Utilization of Maternal Health Care Services among Mothers Residing at Slum Area.

Appropriate utilization of maternal health care services is very important tool to reduce the maternal and child morbidity and mortality rate. This study was conducted to assess the utilization of maternal health care services by the women for their last pregnancy in one year period and to find out it's association with selected variables. Descriptive cross sectional study was conducted for one year by using semi-structured questionnaire among 285 mothers residing at slums area of Dharan sub-metropolitan city after taking written consent from them. Ethical clearance was obtained from Institutional Review Committee, BPKIHS and Dharan Sub-metropolitan city office. Simple random sampling followed by snowball sampling method was used to collect the data by interview method. Majority (95.1%) had one Antenatal visit, 60.4% had initiated antenatal visit at first trimester and 78.99% had completed 4 or more antenatal visits. Only 35.8% had taken complete dose of iron and calcium. Majority 262 (91.92%) respondents have taken Tetanus Toxoid immunization and among them only 74.42% had taken 2 dose of TT injection. Women who delivered in health facility accounted for 70.9% but only 28.8% went for postnatal visit. Majority (65.3%) received health advice during postnatal period. Nearly 40% respondents used family planning after post partum period .There was significant association between utilization of antenatal and delivery services with Educational status of respondents and their husbands and number of pregnancy and between utilization of postnatal services with occupation of husband. Utilization of maternal health care services, antenatal services utilization were satisfactory whereas postnatal services and family planning services utilization were very poor. Utilization of maternal health services should be encouraged by conducting public awareness programmes.

Geographic Inequities in Coverage of Maternal and Child health Services in Haryana State of India

Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12-23months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators - 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals.

My husband will love me more if I give birth to more children: Rural women’s perceptions and beliefs on family planning services utilization in a low resource setting

IntroductionResponsibility for family planning in low resource settings is almost solely delegated to women, with very low male involvement. This study investigated rural Tanzanian women’s perceptions and cultural beliefs of the barriers to family planning services utilization. MethodsThis study used a qualitative descriptive approach drawing on four group discussions with 20 purposively selected married women with two or more children. The study followed COREQ guidelines for reporting qualitative studies. Data were collected from participants at four health facilities in Bagamoyo and Kisarawe districts in Pwani, Tanzania. ResultsParticipants’ occupations included housewives, small-scale farmers, and entrepreneurs. Most women were Muslim and had a primary school education.Five main themes were identified: use of modern and traditional family planning methods; my husband will love me more if I give birth to more children; men’s expected roles in family planning; provide education to dispel myths; and religious barriers. Associated sub-themes covered use of strings, snares and pigis; calendars; breastfeeding linked to family planning; men as heroes for having many children; men not having time to attend clinic; and conflicting sources of health information. ConclusionLack of adequate family planning information; beliefs on and use of traditional/unconventional methods; gender roles expectations that influence decision making and limit women’s choices of family planning methods and; socio-cultural and religious beliefs were main perceived barriers for family planning utilization in this study. Mitigation of these barriers depends on the sustained engagement of key stakeholders including religious and community leaders. Health education must be designed to adapt socio-cultural and religious doctrines with benefits of family planning and health outcomes. Health delivery services must also address women’s’ prevailing perceptions and beliefs with emphasize on the partner communication and their encouragement of men’s’ involvement in reproductive health services utilization.

Socio-Demographic Determinants of Family Planning Service Utilization among Women of Reproductive Age in Urban Communities of Imo State, Nigeria

Introduction: Many developing countries are characterized by rapid population growth, which is partly attributed to high fertility rates, high birth rates, accompanied by steady declines in death rates, low contraceptive use and high but declining mortality rate. AIM: To determine the factors influencing family planning method use among women of reproductive age in urban communities of Imo state, Nigeria. Methodology: The study was a community based descriptive cross-sectional study involving 560 women of reproductive age who met the inclusion criteria and were selected using the multistage sampling technique. The data were collected using a pretested, semi-structured and interviewer administered questionnaire and were analyzed using EPI-INFO version 3.2.1. A p-value ≤ 0.05 was considered significant. Results: The mean age of the respondents was 32.7 ± 7.7 years with most of the women (99.1%) being aware of family planning. The common methods known were; pills (65.2%), injections (62.5%), condoms (61.3%) and natural family planning methods (49.5%). The prevalence of ever use and current use of family planning was 54.1% and 35.1% respectively and the commonest method ever (36%) and currently (26%) used was the condom. The factors found to significantly influence family planning method use in the study were: age of women, religion, family size, number of male children, monthly income, being able to access and pay for family planning services without partners financial support, contraceptive knowledge, prior discussion of family planning with partner, partner being in support of modern family planning methods use and previous use of any form of contraception. Conclusion: Most of the factors found to influence use can be modified by appropriate intervention programs.? Thus there is need to institute these intervention programs by authorities concerned so as to increase utilization of services and reduce consequent problems.

The Increasing access to family planning services through a non-health sector: Technical Integration Coverage and Access (TICA) in Nepal

Background: Family Planning (FP) is a key developmental focus for the government of Nepal. Use of modern contraceptives has stagnated at 43.2% since 2011. Unmet need for family planning (FP) in Nepal remains high at 27%. A factor contributing to this levelling of contraceptive use despite relatively high unmet need is the limited range of methods available to most clients at most sites. To address the FP need among married women of reproductive age (WRA), we tested integration of FP into agricultural programs. &#x0D; Aim: To assess the effectiveness of a FP program integrated into an agriculture (e.g. non-health) sector program.&#x0D; Methods: A cross-sectional interventional study conducted November 2015 to February 2016 among 525 WRA who were participants in an agriculture program.&#x0D; Results: The contraceptives commonly used by women in the study location were Depo Provera and Minilap. After Technical Integration Coverage and Access (TICA) interventions, almost all of the respondents (99.6%) had heard about FP of which 67.8% correctly understood FP as a method to prevent unwanted pregnancy. About 50% of the respondents were found currently using FP. The percentage of WRA aware of long-acting and permanent FP methods increased from 49.0% to 62.0% and 39.0% to 52.0% respectively. Decisions on using a FP method were predominantly made by the husband (68.0%). However, 68.4% women reported that they were motivated by their husband. The proportion of men willing to use FP increased from 5.2% to 15.5% after TICA activities implementation. The main reason identified for not currently using FP devices was that the husband and wife were not living together (88.8%). Most of the women (98.0%) reported that FP utilization improved their quality of life.&#x0D; Conclusion: TICA activities were very successful in both increasing FP knowledge level as well as utilization of FP services among the targeted beneficiaries. The use of FP increased among agriculture program beneficiaries after the integration of TICA activities with a gradual shift from short-acting FP methods to long-acting and permanent FP methods. For easy integration, FP projects should also utilize existing community structures such as cooperatives, women’s groups, men’s groups, and youth clubs.