Increase In Contraceptive Prevalence Research Articles

Prevalence of and factors associated with contraceptive discontinuation in Kenya.

BackgroundThe overwhelming uptake of contraception in Kenya at 58% suggests huge potential for a continued increase, but discontinuation threatens efforts to achieve new targets. Further increases in contraceptive prevalence will depend more on continuation and re-adoption amongst past users because unintended pregnancies would increasingly result from discontinuation. Eliminating discontinuations from side effects and method failure could increase continuation rates by 10%.AimTo establish the prevalence and factors associated with contraceptive discontinuation.SettingKenya, with a successful family planning programme, but also the challenge of discontinuation rates of 31%.MethodsContraceptive calendar data from the 2014 Kenya Demographic and Health Survey were used in the survival analysis approach.ResultsOverall discontinuation rates were 37% (24 months) and 74% at (36 months), whilst discontinuation in need was 36%. Side effects accounted for 40% of discontinuations, whilst injection and pill recorded the highest rates. Current method emerged as a predictor of discontinuation at 24 months with the following hazard ratio (HR) at 95% confidence interval [CI]; intrauterine device (IUD) (HR = 0.466, CI = 0.254–0.857), injection (HR = 0.801, 95% CI = 0.690–0.930), implants (HR = 0.580, 95% CI = 0.429–0.784) and at 36 months, injection (HR = 0.808, 95% CI = 0.722–0.904) and implants (HR = 0.585, 95% CI = 0.468–0.730). Age (15–24 years) displayed influence only at 36 months (HR = 1.219, 95% CI = 1.044–1.424).ConclusionThe study showed a close link between contraceptive method used and discontinuation and thus the need to address method-related issues in an attempt to minimise discontinuation in Kenya. Expanding contraceptive options and improving the quality of service can scale up switching and thus help reduce discontinuation and unintended births.

Family Planning in Zambia: An Investment Pillar for Economic Development.

Family planning represents a 'best buy' in global efforts to achieve sustainable development and attain improvements in sexual and reproductive health. By meeting contraceptive needs of all women, significant public health impact and development gains accrue. At the same time, governments face the complex challenge of allocating finite resources to competing priorities, each of which presents known and unknown challenges and opportunities. Zambia has experienced a slow but steady increase in contraceptive prevalence, with slight decline in total fertility rate (TFR), over the past 20 years. Drawing from the Zambian context, including a review of current policy solutions, we present a case for making investments in voluntary family planning (FP), underpinned by a human rights framework, as a pillar for accelerating development and socio-economic advancement. Through multilevel interventions aimed at averting unintended pregnancies, Zambia - and other low- and middle-income countries - can reduce their age dependency ratios and harness economic growth opportunities awarded by the demographic dividend while improving the health and quality of life of the population.

Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education.

Since the 1990s some countries in Africa have experienced very rapid increases in contraceptive prevalence (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study aims to shed light on the causes of these different trends which remain controversial. We assess the role of family planning programs vs. socioeconomic development (especially, women's educational attainment). Estimates of the effects of different explanatory factors are obtained by country level regressions in which the prevalence of modern contraception is the dependent variable and women's educational attainment, Gross National Income (GNI) per capita, percent urban and child mortality as well as the family planning program score are the independent variables. The statistical analysis finds no significant effects of GNI per capita, percent urban and child mortality. In contrast, women's educational attainment and program score have highly significant effects and are the dominant drivers of contraceptive prevalence trends. Voluntary family planning programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impact above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even where education levels have risen substantially.

Family Planning in Zambia: An Investment Pillar for Economic Development

Family planning represents a 'best buy' in global efforts to achieve sustainable development and attain improvements in sexual and reproductive health. Ensuring access is amongst key transformative strategies that underpin health and sustainable development. It confers fertility choices on women and couples within a human rights framework. By meeting contraceptive needs of all women, significant public health impact and development gains accrue. At the same time, governments face the complex challenge of allocating finite resources to competing priorities, each of which presents known and unknown challenges and opportunities. As such, there is a need to carefully consider the estimated costs and benefits for each proposed investment in health, education, social welfare, and security. Zambia has experienced a slow but steady increase in contraceptive prevalence, with slight decline in total fertility rate (TFR), over the past 20 years. Increasing voluntary modern contraceptive use among women offers opportunities to reduce unintended pregnancy while effectively harnessing the demographic dividend in order to bolster socioeconomic outcomes for households and communities. Drawing from the Zambian context, we present a case for making investments in voluntary family planning (FP), underpinned by a human rights framework, as a pillar for accelerating development and socio-economic advancement. Through multilevel interventions aimed at averting unintended pregnancies, Zambia - and other low- and middle-income countries - can reduce their age dependency ratios and harness economic growth opportunities awarded by the demographic dividend while improving the health and quality of life of the population.

Trends in Contraceptive Use and Method Mix from Equity Perspective in the Past Two Decades: Evidence from Two East Indian States

mix is a key determinant of the fertility impact of contraceptive practices; the use of effective and right methods by couples can produce a greater decline in fertility than use of less effective methods. The present paper tries to understand contraceptive use with a special focus on spacing methods in the state of Bihar and Odisha during 1992-2014. Indian National Family Health Surveys (NFHS) of 1992-93, 1998-99 and 2005-06 and project Ujjwal Survey data (2014) in Bihar and Odisha were used in the analyses. Data on currently married fecund women were used for the present study. Both bivariate and multivariate analysis was used to understand the changes in different methods and factors associated with the methods. The results show there is an increase in contraceptive prevalence rate both nationally (1992-2006) and in both the states (1992-2014). The share of sterilization has increased in the high fertility state of Bihar whereas it has gone down in moderate fertility state of Odisha. There is a steady increase in short-term modern methods in Odisha largely contributing to its increase in contraceptive prevalence whereas in Bihar the spacing methods don’t show a clear pattern. The multivariate analysis shows the predicated probability of using modern spacing method is lowest among Muslims, Poor and older women in both the states in both the states after adjusting socio-economic variables. This paper brought the significance of method-mix in contraceptive prevalence in the states. The initiatives by NGOs and experiments with public-private partnerships are one of the leading contributors to increase in spacing methods. The social marketing and social franchising of selected reproductive health services by project Ujjwal is one such example. Similar initiatives on prioritizing spacing methods in family planning may be successful in improving access to contraceptive in Bihar.

Prospects for Fertility Decline in Africa

Prospects for Fertility Decline in Africa

Incidence of induced abortion in Malawi, 2015.

BackgroundIn Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates.MethodsWe conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology.ResultsWe estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures.ConclusionsThe estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.

Serving the contraceptive needs of HIV-positive women in Africa: the need for a health systems focus

Research goal Global policy supports service integration to ensure that the contraceptive needs of women using HIV/AIDS services are met. We conducted an intervention study in 5 public sector health facilities in South Africa to test a strategy for serving the reproductive health (RH) needs of postpartum PMTCT clients. We conducted another study in 8 public sector health facilities in Uganda to test an intervention for increasing dual method use (condom + another contraceptive) among clients receiving antiretroviral therapy. Both studies failed to demonstrate increases in contraceptive prevalence. We examined process data to understand why RH-HIV service integration was not successful when tested in routine practice.

Integrating family planning promotion into the work of environmental volunteers: a population, health and environment initiative in Kenya.

Voluntary use of family planning is instrumental to the health and social well-being of women, families and communities.Although contraceptive use in Sub-Saharan Africa is increasing, unmet need for family planning remains high. Even within countries that have achieved increases in contraceptive prevalence, use remains low among some population subgroups. Contraceptive prevalence is generally lower in rural areas than in cities, and is consistently lower among women in the lowest wealth quintile than among those in the highest. Achieving progress in health and social indicators, such as those captured by the Millennium Development Goals, depends on expanding family planning services to poor, remote rural areas in Africa.

Decline in Unmet Need Is Not Main Reason for Rise In Contraceptive Prevalence

Although contraceptive prevalence has increased substantially in Sub-Saharan Africa during the past two decades, for the most part the gains have not been driven by a decline in unmet need, according to an analysis of Demographic and Health Survey (DHS) data. (1) Examining trends in 22 countries that had multiple DHS surveys between 1990 and 2011, the investigators found that, on average, contraceptive prevalence rose by 13 percentage points--from 17% to 30%--between a country's first and most recent surveys. However, the proportion of women with unmet need fell by a mean of only four percentage points, a decline smaller than the simultaneous decrease in the proportion of women with no need (e.g., those wanting more children soon). Few studies have examined longitudinal changes in unmet need and lack of need among cohorts of women. However, Madsen and colleagues note that DHS data offer a useful substitute. Because the surveys in a particular country are typically administered about five years apart, one can use consecutive surveys to track changes in contraceptive use and nonuse among five-year cohorts of women; for example, a random sample of 25-29-year-old woman in a given survey will draw from the same pool of women as a sample of 20-24-year-old women in the previous survey, simulating a longitudinal cohort study. The current study used this approach to analyze DHS data collected between 1990 and 2011 from 22 countries in Sub-Saharan Africa. All countries had at least two surveys during that period, and most had four; in nearly all cases, the earliest survey for a particular country was conducted before 1998 and the most recent after 2005. For each survey, women aged 15-49 who were married or in a union were categorized, according to standard DHS definitions, as either being contraceptive users, having unmet need, having no need or being infecund. The investigators examined trends in these four categories in two ways. First, they performed period analyses to assess changes in the prevalence of the categories among women in each five-year age-group (e.g., whether the prevalence of contraceptive use, unmet need, no need and infecundity among 20-24-year-olds in a country's first survey differed from the prevalence among 20-24-year olds in subsequent surveys). These analyses included both descriptive and regression analyses. Second, as noted earlier, the investigators performed cohort analyses in which women in each five-year age-group were assumed to represent the same population as the next oldest five-year age-group in the following survey. Although the mean interval between surveys was, in fact, about five years, 21% of surveys were either less than four years apart or more than 6.5 years apart. Nonetheless, the authors retained these outliers in order to maintain comprehensive coverage and adequate sample size; supplementary analyses indicated that retention of the full sample did not meaningfully affect the results. Period analyses revealed that, on average, contraceptive prevalence in a given country rose by 13 percentage points (from 17% to 30%) between a country's first and last surveys (mean interval, 14 years). At the same time, countries had mean declines of four percentage points in the proportion of women with unmet need, five points in the proportion with no need and four points in the proportion who were infecund. Consistent with these findings, a multiple linear regression model more closely linked the increase in contraceptive prevalence to a decline in lack of need (coefficient, -1. …

Evaluating the impact a proposed family planning model would have on maternal and infant mortality in Afghanistan

This study aimed to assess the potential impact a proposed family planning model would have on reducing maternal and infant mortality in Afghanistan. Afghanistan has a high total fertility rate, high infant mortality rate, and high maternal mortality rate. Afghanistan also has tremendous socio-cultural barriers to and misconceptions about family planning services. We applied predictive statistical models to a proposed family planning model for Afghanistan to better understand the impact increased family planning can have on Afghanistan's maternal mortality rate and infant mortality rate. We further developed a sensitivity analysis that illustrates the number of maternal and infant deaths that can be averted over 5 years according to different increases in contraceptive prevalence rates. Incrementally increasing contraceptive prevalence rates in Afghanistan from 10% to 60% over the course of 5 years could prevent 11,653 maternal deaths and 317,084 infant deaths, a total of 328,737 maternal and infant deaths averted. Achieving goals in reducing maternal and infant mortality rates in Afghanistan requires a culturally relevant approach to family planning that will be supported by the population. The family planning model for Afghanistan presents such a solution and holds the potential to prevent hundreds of thousands of deaths.

National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis

Expansion of access to contraception and reduction of unmet need for family planning are key components to improve reproductive health, but scarce data and variability in data sources create difficulties in monitoring of progress for these outcomes. We estimated and projected indicators of contraceptive prevalence and unmet need for family planning from 1990 to 2015. We obtained data from nationally representative surveys, for women aged 15-49 years who were married or in a union. Estimates were based on 930 observations of contraceptive prevalence between 1950 and 2011 from 194 countries or areas, and 306 observations of unmet need for family planning from 111 countries or areas. We used a Bayesian hierarchical model combined with country-specific time trends to yield estimates of these indicators and uncertainty assessments. The model accounted for differences by data source, sample population, and contraceptive methods included in the measure. Worldwide, contraceptive prevalence increased from 54·8% (95% uncertainty interval 52·3-57·1) in 1990, to 63·3% (60·4-66·0) in 2010, and unmet need for family planning decreased from 15·4% (14·1-16·9) in 1990, to 12·3% (10·9-13·9) in 2010. Almost all subregions, except for those where contraceptive prevalence was already high in 1990, had an increase in contraceptive prevalence and a decrease in unmet need for family planning between 1990 and 2010, although the pace of change over time varied between countries and subregions. In 2010, 146 million (130-166 million) women worldwide aged 15-49 years who were married or in a union had an unmet need for family planning. The absolute number of married women who either use contraception or who have an unmet need for family planning is projected to grow from 900 million (876-922 million) in 2010 to 962 million (927-992 million) in 2015, and will increase in most developing countries. Trends in contraceptive prevalence and unmet need for family planning, and the projected growth in the number of potential contraceptive users indicate that increased investment is necessary to meet demand for contraceptive methods and improve reproductive health worldwide. United Nations Population Division and National University of Singapore.

Modelling strategic interventions in a population with a total fertility rate of 8.3: a cross-sectional study of Idjwi Island, DRC.

BackgroundIdjwi, an island of approximately 220,000 people, is located in eastern DRC and functions semi-autonomously under the governance of two kings (mwamis). At more than 8 live births per woman, Idjwi has one of the highest total fertility rates (TFRs) in the world. Rapid population growth has led to widespread environmental degradation and food insecurity. Meanwhile family planning services are largely unavailable.MethodsAt the invitation of local leaders, we conducted a representative survey of 2,078 households in accordance with MEASURE DHS protocols, and performed ethnographic interviews and focus groups with key informants and vulnerable subpopulations. Modelling proximate determinates of fertility, we evaluated how the introduction of contraceptives and/or extended periods of breastfeeding could reduce the TFR.ResultsOver half of all women reported an unmet need for spacing or limiting births, and nearly 70% named a specific modern method of contraception they would prefer to use; pills (25.4%) and injectables (26.5%) were most desired. We predicted that an increased length of breastfeeding (from 10 to 21 months) or an increase in contraceptive prevalence (from 1% to 30%), or a combination of both could reduce TFR on Idjwi to 6, the average desired number of children. Increasing contraceptive prevalence to 15% could reduce unmet need for contraception by 8%.ConclusionsTo meet women’s need and desire for fertility control, we recommend adding family planning services at health centers with NGO support, pursuing a community health worker program, promoting extended breastfeeding, and implementing programs to end sexual- and gender-based violence toward women.

The Use of Withdrawal among Birth Limiters in Iran and Turkey

Despite a decline infertility, an increase in contraceptive prevalence, and a wide expansion of family planning programs in Iran and Turkey, a large proportion of "birth limiters" rely on withdrawal to avoid pregnancy. Adopting a comparative approach, this study draws on data from the 2000 Iran DHS and 2003 Turkey DHS to examine the determinants of the practice of withdrawal among birth limiters. Multivariate logistic regression analyses were employed to estimate the likelihood of withdrawal use among two representative samples of birth limiters. Higher education and wealth were associated with greater likelihood of withdrawal use among birth limiters in Iran, while an inverse association was found in Turkey. Older age was positively associated with withdrawal in both countries, whereas having more than four children was inversely related to use. Study results suggest that family planning and reproductive health programs in Iran and Turkey should be aware of the groups that have high rates of withdrawal use, should educate couples in the effective use of withdrawal, and should encourage the use of more effective modern methods and emergency contraceptives when appropriate.

Contraceptive use among Malawian women 1992 – 2004

A comparison of four nationally representative household surveys of Malawian women of reproductive ages indicates a substantial increase in contraceptive prevalence during the twenty-year period 1984 to 2004 (see figure 1). Contraceptive Prevalence Rate (CPR) in Malawi has increased from less than one percent in 1984 to 7%, 12%, 21% and 22% in 1992, 1996, 2000 and 2004, respectively Malawi Medical Journal Vol. 20 (3) 2008: pp. 78-79

Distribution of contraceptive use in a Turkish population

ObjectiveThis study is designed to estimate the distribution of contraceptive use among reproductive age women in a Turkish population (Turkey). Study designWe included 2365 women of reproductive age in this study. Women were given a questionnaire via a face-to-face interview. ResultsDuring the time period just after marriage, 1914 women (80.9%) declared that they did not use any type of contraception. Among 451 women who had used a contraceptive method just after marriage, the most commonly used method was condoms (34.2%), followed by oral contraceptives (31.2%) and coitus interruptus (25.9%). When their history of contraceptive use was asked, 1903 women (80.2%) stated that they used a method of contraception while 462 women (19.5%) had never used any type of contraceptive. Distribution of contraceptive methods among women was analyzed and intrauterine devices were detected to be the most commonly used method (n=1046, 55%). ConclusionA point that should be emphasized is that there is a marked increase in contraceptive prevalence, and expansion of family planning activities in Turkey. This change, we believe, is due to improvements in health services of Turkey, realized in recent years.

The determinants of withdrawal use in Turkey: A husband's imposition or a woman's choice?

This paper seeks to understand why Turkey has one of the highest rates of withdrawal ( coitus interruptus) use in the world. Despite a pronounced fertility decline, a marked increase in contraceptive prevalence, and expansion of family planning activities, in 1998 one in four Turkish couples relied on withdrawal, and this fraction has remained stable since 1983. In contrast to previous research that has focused on women's reports, here we use the husbands’ module of the 1998 Turkish Demographic and Health Survey to examine user characteristics and attitudes, as well as the determinants of withdrawal use among a representative sample of 1950 currently married men in Turkey. Multivariate methods are employed to estimate these effects and the likelihood of using withdrawal rather than other methods. Among other findings, less egalitarian-minded husbands were more likely to select withdrawal over other contraceptive methods, but measures of male authority had only partial predictive power after controlling for other variables. Although withdrawal use typically reflects husbands’ preferences, it is widely practiced as it satisfies user requirements and simplifies womens’ lives. The results of this study are discussed in a broader historical and cultural context and used to provide insight into how Turkey's family planning and reproductive health programs might be improved. In contrast to neighboring countries, there is little sign of withdrawal being displaced in Turkey anytime soon by modern methods.

81. The challenges of global reproductive health

The latest UN estimates of growth rates of global population in the next 150 years point to a decrease, no doubt due in part to the increase in contraceptive prevalence and to socioeconomic development in many countries. Using the medium fertility scenario of two children per family, total world population should level out at about 10 billion by 2050. Compare this to a population of 27 billion by 2150 if the fertility rate rises to 2.5–2.6 per family. However, the estimates are uneven and there is more to the demographic challenge than total population numbers. It is important to consider the reproductive health of individuals and populations. The proportion of adolescents and people over 60 years will increase, requiring special consideration of their reproductive health needs. It is estimated that over 120 million couples do not have access to safe and effective methods of family planning. The burden of maternal and perinatal ill-health remains persistently high in many developing countries, with maternal deaths that could be avoided in excess of 500,000 per annum. It is estimated that 340 million new cases of sexually transmitted infections occur annually and are disproportionately found in adolescents and in developing countries. Many of these STIs are curable, but not in the case of HIV/AIDS, of which there are over 15000 new cases a day. Much of this burden falls on women and children in developing countries. The International Conference on Population and Development held in 1994 articulated a comprehensive approach to population and development including poverty alleviation, provision of health care and education, and preservation of the environment. Its emphasis on gender equality and equity and on meeting individual reproductive health needs remains as pertinent today as it was in 1994.

Greater than expected fertility decline in Ghana: untangling a puzzle.

This study examines fertility decline that is larger than expected on the basis of recorded increases in contraceptive prevalence in Ghana. The primary sources of data are three Demographic and Health Surveys (DHS) conducted in the country in 1988, 1993 and 1998. First, the trend in fertility and contraceptive prevalence in Ghana is considered and compared with the trend that would be expected on the basis of prior research. Next, an attempt is made to uncover the explanation behind this unexpected trend. Measures of the quality of the survey data are looked at, as well as trends in the proximate determinants of fertility: contraceptive use, marriage and sexual activity, postpartum insusceptibility and induced abortion. Finally, evidence is presented that couples adjust their coital frequency in accordance with their fertility preferences, behaviour that would influence fertility rates but would not be captured by conventional measures of the proximate determinants of fertility.

Consequences of the Shift from Domiciliary Distribution to Site-Based Family Planning Services in Bangladesh

Using data from the longitudinal surveillance systems of the Operations Research Project of the International Center for Diarrheal Disease Research Bangladesh a before-and-after analysis of the contraceptive prevalence method mix source mix new acceptance rate and dropout rate was conducted to assess the consequences of the shift in service delivery approach. The shift from domiciliary distribution to clinic-based service delivery appears to have resulted in a slight increase in contraceptive prevalence in the urban study area from 54-56% before the shift to 55-57% afterward. The changeover did not produce any discernable variation in the method mix the proportion of new acceptors of family planning or the contraceptive dropout rate. This apparent lack of change can be explained by increased use of alternative sources with a substantial rise among users in reliance on pharmacies and shops (30-35% before vs. 42-50% after). In two rural study areas the shift from domiciliary distribution to service delivery from static sites known as cluster spots resulted in an increase in the prevalence rate from 52% to 57% in Paira and from 40% to 45-46% in Durgapur. The changeover coincided with greater use of injectable contraceptives and decreased reliance on traditional methods among rural contraceptive users. A notable immediate increase in new acceptors also was evident as was a long-term decline in dropouts. In Paira following the shift 43-44% of current users obtained their contraceptive supplies from cluster spots as did 32-33% in Durgapur. The recent change in the family planning program toward clinic-based delivery of an integrated package of essential health and family planning services appears likely to maintain and perhaps even increase contraceptive prevalence levels in Bangladesh. (authors)