High Levels Of Contraceptive Use Research Articles

Socio-Economic Determinants of Choosing the Month of Child Birth in the Russian Federation: Statistical Analysis

The results of a statistical analysis of the factors determining the decisions of families regarding the choice of the month of child birth are presented in the article. A review of the literature shows that a wide range of factors – cultural, biological, climatic and socio-economic – can influence these decisions. In the article, the authors focus on socio-economic determinants. In the Russian Federation, as well as throughout the world, there is a steady seasonality of births: between 2000 and 2022 most children were born in July and August. The article formulates a number of hypotheses regarding possible seasonality determinants, which were tested on the basis of Rosstat data from a sample survey of households «Comprehensive observation of living conditions of the population in 2020» and Rosstat data on registered births by month in Russian regions for 2019–2022. Using unordered multiple choice logit model estimates, cluster analysis and correlation analysis the authors obtained results demonstrating that the choice of summer months for the child birth is determined primarily by household, with the increase of which the birth of a child is more often planned for July. In regions characterized by high rates of quality-of-life indicators, predominantly urban population and a high level of contraceptive use, family preferences in choosing the summer months for child birth are also increasing. The influence of mother's age and education was not identified in the work.The results of the study can be used by the authorities to develop an effective strategy in the field of demographic policy.

Women’s Empowerment, Region of Residence, and Contraception among Women in India

Abstract: Despite actions taken by the Indian government to improve national, regional, and village-level sexual and reproductive health, 49 million women still have unmet contraceptive needs. Yet, when granted access, women disproportionately elect for irreversible methods such that India has the highest female sterilization rate in the world. Building on these insights, the present study examines associations between women’s empowerment (e.g., cooking, shopping, and family-planning autonomy), region (e.g., Hills, North, and East), and use of contraception (i.e., any and type). Data for this study comes from ever-married, reproductive aged women in the 2005 and 2012 waves of the India Human Development Survey (n=38,634). Results from multilevel logistic models showed that higher levels of women’s empowerment are associated with greater probability of using contraception, and after disaggregation, relying on female sterilization. Furthermore, region of residence modifies associations such that women residing in the North Central and North are typically less likely to utilize contraception. Across empowerment levels, residents of the West and South consistently have higher levels of contraceptive use. This study highlights the importance of women’s empowerment for contraception as well as regional differences in reproductive healthcare access, views of contraception, and long-term impacts of fertility planning programs.

Abandoning Contraception at the Commune V Reference Health Center in Bamako, Mali

Introduction: A descriptive analysis of contraception discontinuation, based on Demographic and Health Survey data from six countries with high level of contraceptive use, fonds that approximately one-third of couples discontinuous their contraceptive use, method within 12 months and about half cease within 24 months. Aim: Was to study the reasons for abandoning contraception at the Reference Health Center of Commune V of District of Bamako. Material and Methods: We carried out a prospective, descriptive and cross-sectional study on the reasons for abandoning contraceptive methods from January 1, 2020 to December 31, 2020. Results: The frequency of abandonment of contraceptive methods in Commune V was 18.19%. The main reasons mentioned among the 200 former users of contraceptive methods interviewed were side effects with 35% of cases, husband's opposition (10 %), complications (20%), the desire to pregnancy (10%), reception of clients and occasional unavailability of inputs (5%). Conclusion: Inadequate management of side effects and complications related to contraception, the husband's reluctance and rumors had been the determining factors in the abandonment of contraception.

Let's Talk About Sex: Improving Measurement of Contraceptive Use in Cross-Sectional Surveys by Accounting for Sexual Activity Recency.

Standard measures of contraceptive prevalence have known biases given that they do not reflect sexual activity and true exposure to the risk of an unintended pregnancy. In this study, we aim to understand the extent to which women protect themselves against unintended pregnancy, taking into account exposure to sex, by examining contraceptive use patterns by marital status and recent sexual activity. Data come from population-based surveys of reproductive age women in 9 low-resource settings. We estimated contraceptive prevalence using (1) the standard current contraceptive use measure, (2) a new measure of contraceptive use at last sex, and (3) a comprehensive measure that combines current use and use at last sex. Analyses are stratified by site and examine patterns by marital status only, and by both marital status and sexual activity separately. We then examined method mix by each contraceptive measure. Study findings reveal distinct patterns in contraceptive use in relation to marital status and sexual recency across sites. Overall, married women tended to report higher levels of current contraceptive use compared to use at last sex, whereas unmarried women reported higher levels of contraceptive use at last sex. When examining these measures by sexual activity and marital status, results indicate lower levels of contraceptive use among women who had not had sex in the month prior to the survey, for both married and unmarried women. The comprehensive measure of contraceptive use yielded the highest estimates, by design. Method mix varied consistently by contraceptive measure, with current use tending to capture more permanent and long-acting methods and use at last sex more likely to capture short-acting and coital-dependent methods. These findings have important implications for how the family planning field evaluates unintended pregnancy risk and unmet need for contraception within low-resource settings, given different estimates yield discrepant estimates for who is "at risk."

Contraceptive Use Among Adolescents With and Without Disabilities

PurposeThe aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities. MethodsData were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse—including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception—by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive. ResultsGirls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference −2.6%, 95% CI −.26%, −4.9%; adjusted prevalence ratio .97, 95% CI .95–1.00, p = .03). ConclusionsWe observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.

Migration and Contraception among Mexican Women: Assessing Selection, Disruption, and Adaptation.

Despite the sizeable impact of migration on childbearing, less is known about how it shapes contraceptive use undergirding fertility. We utilize binational survey data collected in 2006/7 by the Migration, Gender, and Health among Immigrant Latinos in Durham, NC study to assess how selection, disruption, and adaptation shape contraceptive use among Mexican migrant women. We address selectivity with respect to both socio-demographic and formative sexual initiation characteristics, comparing migrants to non-migrants in Mexico. We examine the disruptive effect of migration on contraception among migrant women sexually initiated in Mexico. Finally, we compare current methods between Mexican migrants and non-migrants to assess adaptation to U.S. contraceptive practices. We find migrant selectivity is less important than context in shaping immigrant women's contraceptive practices, though migrant women sexually initiated in the United States exhibit earlier and higher levels of contraceptive use than their migrant peers initiated in Mexico. Migration also disrupts contraceptive trajectories. Many migrants discontinue contraceptive use pre-migration in response to their husbands' solo migration. Partner separation also reduces contraceptive use immediately after migration. Finally, migrants show numerous signs of adaptation to the U.S. context, mainly via the adoption of oral contraception. The main obstacle for contraceptive use in Durham is lack of information about where to obtain it. Efforts to improve immigrants' reproductive health should recognize the deleterious effect of policies encouraging family separation. Healthcare must reach immigrant women soon after arrival, be attuned to pre-migration contraceptive practices, and recognize the unique vulnerabilities of women migrating at older ages.

Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System

ObjectiveTo examine associations between health insurance coverage, income level and contraceptive use — overall and most/moderately effective method use — among women ages 18–44 at risk of pregnancy, within and across 41 United States jurisdictions in 2017. Study designUsing data from the 2017 Behavioral Risk Factor Surveillance System, we calculated the proportions of women using any contraceptive method and using a most or moderately effective method for each state/territory and across all jurisdictions, categorized by health insurance coverage and income groups. For both contraceptive use outcomes, we ran simple and multivariable logistic regression models to test for significant differences in outcomes between insured and uninsured individuals. ResultsAcross jurisdictions, compared to uninsured women, those who had health care coverage had higher levels of contraceptive use (65% versus 59%; p < .001) and most/moderately effective contraceptive use (43% compared to 35%; p < .001); low-income women with coverage also had higher levels of contraceptive use (64% versus 61%; p < .05) and most or moderately effective contraceptive use (42% versus 36%; p < .01) than their uninsured counterparts. Controlling for individual-level demographic characteristics, health insurance coverage was associated with increased odds of most or moderately effective contraceptive use across jurisdictions (adjusted odds ratio = 1.33, p < .01). In 11 states, insured women had significantly higher odds of at least one contraceptive use metric than their uninsured counterparts. ConclusionsVariation in contraceptive use across the states likely reflects broader demographic, social and structural differences across state and local populations. States' political will and support around contraceptive access likely play a role in individuals' ability to obtain and use contraception. ImplicationsOur key finding that insurance coverage is significantly associated with use of most/moderately effective contraceptive methods across the states but not any contraceptive use underscores the importance of health insurance in aiding access to methods that are more costly and often require a visit to a health care provider.

Insights from outside BJOG

Insights from outside BJOG

Measuring contraceptive prevalence among women who are at risk of pregnancy

ObjectivesThe contraceptive prevalence rate (CPR) is generally reported among in-union women ages 15–49. Here, union status and age serve as proxies for exposure to the risk of pregnancy. As a result of changing dynamics, age and union status proxies may be insufficient for determining the rate of contraceptive use among women at risk of pregnancy. Our objectives are to define a measure of contraceptive use among women at risk, to measure contraceptive use among such women and to compare this rate with conventional CPR. Study designUsing data from the United States 2011–2013 National Survey of Family Growth (NSFG), we explore self-reported data on contraceptive use, sexual recency, pregnancy status and fecundity to develop an alternative CPR (ACPR) measure, contraceptive prevalence among women at risk of pregnancy. After defining and measuring ACPR, we compare ACPR and conventional CPR estimates using NSFG and Demographic and Health Survey data from 48 surveys completed from 2000 to 2015 in low- and middle-income countries. ResultsFor measuring ACPR, it is best to limit sexual activity recency component to “four weeks” to minimize underreport of coital-specific methods. It is best to limit the contraceptive use component to “current use” rather than “use at last sex” to minimize underreport of permanent methods. In the United States, 86% of women at risk of pregnancy are currently using contraception. ConclusionWomen at risk of pregnancy report higher levels of contraceptive use than the conventional CPR indicates. Implications statementDevelopment of ACPR exposed some potential family planning measurement weaknesses. Specifically, because CPR is based on report of “current use,” our analyses show that CPR may underreport coital-specific methods. As a result, CPR estimates may be somewhat deflated, and unmet need estimates may be somewhat inflated.

The New Majority: How Will Latino Youth Succeed in the Context of Low Educational Expectations and Assumptions of Sexual Irresponsibility?

Latino youth are the fastest-growing ethnic group in the USA and will soon comprise a significant portion of our future leadership and workforce. Prejudicial stereotypes about Latino youth—such as the assumption that teen pregnancy will inevitably lead to lower educational attainment—ignore significant advancements in educational and sexual health outcomes and contribute to inequities in health and education policies. A total of 332 Latino-identified youth living in California gave voice to their educational aspirations, challenges, and sexual and reproductive health needs through an exploratory mixed-methods research study. Youth participated in interviews and focus groups (n = 105) and in a statewide survey (n = 227) to explore assets that help youth overcome discriminatory low expectations and improve sexual decision making and educational aspirations. Results indicated most Latino youth desire to attend college. Likelihood of attending college was associated with individual and environmental assets. Lower likelihood of attending college was associated with perceived discrimination from teachers. Sexually active youth reported high levels of contraceptive use. Many youth want to defy the negative stereotypes and are seeking successful futures despite the structural challenges and social bias. There is an urgent need to reframe the negative public discourse about Latino youth, to acknowledge their resilience and to address underlying structural factors creating inequities. Specific policy recommendations are provided to promote positive sexual health and educational outcomes among Latino youth.

Beyond the clinic walls: empowering young people through Youth Peer Provider programmes in Ecuador and Nicaragua

Youth in Latin America experience high rates of teen pregnancy and sexually transmitted infections, but traditional health services are not meeting their health care needs. Youth require access to tailored health care and information to make informed, healthy decisions. To break down barriers to these vital sexual and reproductive health services, Planned Parenthood Global, a division of Planned Parenthood Federation of America, developed a Youth Peer Provider model which has been implemented in Latin America since the early 1990s. The model goes beyond peer education to train Youth Peer Providers under age 20 to provide condoms, oral contraceptive pills, emergency contraception, injectable contraceptives, and sexual and reproductive health information to their peers. Peers with needs beyond Youth Peer Providers' capacity are referred to health professionals offering youth-friendly services. Survey results reveal high levels of contraceptive use among those served by the Youth Peer Providers: 98% of sexually active survey respondents wishing to avoid pregnancy report contraceptive use at least five years after joining the programme. Results of qualitative programme evaluations highlight higher self-esteem, stronger communication and decision-making skills, close relationships with friends and family, more interest in school, understanding of responsibility in relationships, and other positive outcomes among programme participants.

Improving family planning program performance through management training: the 3Cs paradigm.

Action research was conducted in Bangladesh to determine whether a high level of fertility control behavior can be attained in a country of very low socioeconomic status, including very low levels of literacy and women's status, and if management training help can improve the performance of service delivery systems. 20 family planning officials participated in a 14-week, non-degree, management training program conducted in Dhaka. The research found that competently executed determined effort is a far faster and more effective alternative to socioeconomic development-led contraception in a developing population. A carefully designed and executed intervention can achieve a high level of contraceptive use, and thereby control fertility, without waiting for significant improvement in a country's socioeconomic indicators. For example, in the 19 experimental thanas, the contraceptive prevalence rate increased by an average of approximately 10 percentage points within 12 months of training. These findings demonstrate how a task-focused, well-designed, and properly conducted management training, backed by well organized and managed follow-up, can effect major improvement in a system's effectiveness and productivity, even if that system is staffed by a demoralized and apathetic work force.

ACCESS TO CONTRACEPTIVE METHODS AND PREVALENCE OF USE

Survey data on contraceptive use for about 80 countries are related to measures of contraceptive access, by method, from 1999 to 2009. Cross-tabulation and correlational methods are employed, with geographic comparisons and time trends. Total prevalence of use for five modern contraceptive methods correlates well to a variety of access measures. Greater access is also accompanied by a better balance among methods for both access and use. Sub-Saharan African countries show similar patterns though at lower levels. Improved access to multiple methods is consistently associated with higher levels of contraceptive use.

CONTRACEPTION USE AND ASSOCIATIONS WITH INTIMATE PARTNER VIOLENCE AMONG WOMEN IN BANGLADESH

This study examines the association between contraception use and intimate partner violence (IPV) among women of reproductive age in Bangladesh. The observational study of 10,996 women used the chi-squared test and logistic regressions to assess the associations. Almost 80% of all respondents had used contraceptives at some point in their lives. About half of the respondents (48%) were victims of physical violence, while 11% experienced sexual abuse from their husbands. Urban residents, higher educated women and women aged 20-44 were more likely to use contraceptives than their peers in rural areas, those with lower education and those in their late forties (45-49 years). Women exposed to physical violence were almost two times (OR 1.93, CI 1.55-2.41) more likely to use contraceptives compared with their non-abused peers. Sexual abuse had no significant association with contraceptive use. Physical violence is a predictor for higher levels of contraceptive use among women in Bangladesh. The findings emphasize the importance of screening for IPV at health care centres. The differences in urban and rural contraceptive use and IPV exposure identified by the study have policy implications for service delivery and planning.

How Increased Contraceptive Use has Reduced Maternal Mortality

It is widely recognized that family planning contributes to reducing maternal mortality by reducing the number of births and, thus, the number of times a woman is exposed to the risk of mortality. Here we show evidence that it also lowers the risk per birth, the maternal mortality ratio (MMR), by preventing high-risk, high-parity births. This study seeks to quantify these contributions to lower maternal mortality as the use of family planning rose over the period from 1990 to 2005. We use estimates from United Nations organizations of MMRs and the total fertility rate (TFR) to estimate the number of births averted-and, consequently, the number of maternal deaths directly averted-as the TFR in the developing world dropped. We use data from 146 Demographic and Health Surveys on contraceptive use and the distribution of births by risk factor, as well as special country data sets on the MMR by parity and age, to explore the impacts of contraceptive use on high-risk births and, thus, on the MMR. Over 1 million maternal deaths were averted between 1990 and 2005 because the fertility rate in developing countries declined. Furthermore, by reducing demographically high-risk births in particular, especially high-parity births, family planning reduced the MMR and thus averted additional maternal deaths indirectly. This indirect effect can reduce a county's MMR by an estimated 450 points during the transition from low to high levels of contraceptive use. Increases in the use of modern contraceptives have made and can continue to make an important contribution to reducing maternal mortality in the developing world.

Pregnancy and STD Prevention Counseling Using an Adaptation of Motivational Interviewing: A Randomized Controlled Trial

Given levels of unintended pregnancy and STDs, an effective counseling intervention is needed to improve women's consistent use of effective prevention methods. A sample of 764 women aged 16-44 who were at risk of unintended pregnancy were enrolled in a randomized controlled trial in North Carolina in 2003-2004. Intervention participants received pregnancy and STD prevention counseling, adapted from motivational interviewing, both at enrollment and two months later; controls received only a session of general health counseling. Levels of contraceptive use (categorized as high, low or none on the basis of the effectiveness of the method and the consistency of use) and barriers to use were measured at two, eight and 12 months; chi-square tests were used to compare selected outcomes between the groups. Rates of unintended pregnancy and chlamydia infection were assessed over the study period. At baseline, 59% of all participants reported a high level of contraceptive use, 19% a low level and 22% nonuse. At two months, the proportions of intervention and control participants who had improved their level of use or maintained a high level (72% and 66%, respectively) were significantly larger than the proportions who had reported a high level of use at baseline (59% and 58%, respectively). No significant differences were found between the groups at 12 months, or between baseline and 12 months for either group. During the study, 10-11% of intervention and control participants became pregnant, 1-2% received a chlamydia diagnosis and 7-9% had another STD diagnosed. Repeated counseling sessions may be needed to improve contraceptive decision-making and to reduce the risk of unintended pregnancy and STDs.

Do better family planning services reduce abortion in Bangladesh?

Fertility decline is often associated with an increase in contraception and abortion, but the causal relations are difficult to examine with non-experimental data. We aimed to assess the effects of family planning services on abortion rates in two similar areas. We examined trends in overall abortion rates and rates for intended and unintended pregnancies in two similar areas typical of rural Bangladesh. We analysed Matlab Demographic Surveillance System (DSS) data on pregnancy outcomes between 1979 and 1998 in these areas, matching them to survey data on fertility preferences, which enabled us to identify pregnancies as intended or unintended. Abortion rates were significantly lower in the area with better family planning services compared with the comparison area (1984-86, 2.2 vs 5.2; 1996-98, 2.3 vs 6.8). Abortion of unintended pregnancies is similar in both areas, but the higher levels of contraceptive use in the treatment area have led to lower levels of unintended pregnancy and abortion. The likelihood that an unintended pregnancy will be aborted has increased in both areas but the decrease in unintended pregnancies was sufficiently large in the treatment area to offset this increase. Abortion may increase during the fertility transition in less-developed countries as the desire to limit family size increases unless there is widespread availability of quality family planning services.

Empirical assessments of social networks, fertility and family planning programs: nonlinearities and their implications.

Empirical studies of the diffusion of modern methods of family planning have increasingly incorporated social interaction within nonlinear models such as logits. But they have not considered the full implications of these nonlinear specifications. This paper considers the implications of using nonlinear models in empirical analyses of the impact of family programs, modulated by social interaction, on reproductive behavior. Three implications of nonlinear models, in comparison with linear models, are developed. 1) With nonlinear models, there may be both low and high contraceptive-use equilibria (i.e., the ultimate level of use of modern family planning that a population can be expected to reach after the effects of a sustained change in a family planning program have worked through the population) rather than just one equilibrium as in linear models. If there are multiple equilibria, then one striking and important result is that a transitory large program effort may move a community from sustained low- to high-level contraceptive use. 2) With nonlinear models, the extent to which a social interaction multiplies program efforts depends on whether the community is at a low or high level of contraceptive use rather than being independent of the level of contraceptive use as in linear models. 3) With nonlinear models, intensified social interaction can retard or enhance the diffusion of family planning, in contrast to only enhancing diffusion as within linear models. To clarify these implications, for comparison a simple and more transparent linear model is also discussed. Illustrative estimates are presented of simple linear and nonlinear models for rural Kenya that demonstrate that some of these effects may be considerable.

Family Planning Outreach and Credit Programs in Rural Bangladesh

Results of this recent study in rural Bangladesh suggest that programs that draw women out of their homes and reduce their dependence on men are contributing to greater use of contraception. One such program, Grameen Bank, now has female members in nearly half of all Bangladesh villages. Participation in the program was found to be associated with high levels of contraceptive use even among women who have not been exposed to family planning outreach. For nonparticipants in communities where the program works, the combination of home visits by female family planning workers and the presence of Grameen Bank in the village appears to have a dramatic effect on contraceptive use.

Ethnic differences in contraceptive use in Kuwait: A clinic-based study

The Arab, Muslim, oil-rich nation of Kuwait has achieved unusually high levels of knowledge and use of contraception for a developing, high fertility country. Almost all women know of contraceptive pills without prompting, and 57–86% report having ever used a method (usually the oral pill or IUD) in recent studies. Based on a survey of six randomly selected clinics the present study compares the knowledge and use levels of two major ethnic groups—the Beduins and non-Beduins. It also analyses preference for various contraceptive methods and probable reasons for this. While Census or Survey data do not provide information about the size of ethnic groups analyzed in this paper, it is estimated that at least one-third of the population of Kuwait is Beduin. There is a significant difference between the levels of knowledge and use of contraception between the Beduin and non-Beduin women; current use being 42% and 65%, respectively. The differentials between the two groups are particularly marked among women of lower socioeconomic status, and tend to reduce notably once variables such as education and income are controlled. Within the subgroup of non-Beduins, socioeconomic differences in contraceptive use have virtually disappeared; the illiterate and relatively less affluent women are as likely to use a contraceptive method as the university educated, and richer women. However, among the Beduins, the usually expected differences by socioeconomic characteristics still persist. The oral pill is the best known and most commonly used method. Male sterilization is the least known and not practiced at all. Despite the high level of contraceptive use, the total fertility rate is still around 6 per woman. Some of the sociocultural reasons for the lack of a fertility impact are the use of contraceptive methods for spacing rather than limitation purposes, and the persistently large ideal family size which is 7.0 among Beduins and 5.7 among non-Beduins. The latter is consistent with the country's goal to increase the percentage of Kuwaiti nationals who presently comprise less than half of the total population.