Low Contraceptive Prevalence Rate Research Articles

THE EVOLVING FIELD OF PUBLIC HEALTH, THE GLOBAL DISEASE PATTERNS AND THE NEED FOR CAPACITY BUILDING OF PHYSICIANS FOR HEALTH IN PAKISTAN.

Amongst all its South Asian and Eastern Mediterranean neighbors, Pakistan is still struggling with major public health hurdles, from elevated rates of stillbirths, infant, neonatal and under-five mortality, and maternal mortality compounded with low contraceptive prevalence rates, a surge in infectious diseases, and a notable burden of non-communicable diseases. The question arises: Are we nurturing a sufficiently skilled public health workforce? Complicating matters is a fragmented, unregulated healthcare system marked by non-uniform healthcare delivery and an acute dearth of proficient human resources. WHO’s health system strengthening framework considers the health workforce as one of six critical building blocks, essential for effective public health interventions. Yet, the existing undergraduate MBBS curriculum in Pakistan tends to conflate "community medicine" with "public health," despite the latter's much bigger canvas, applications and centrality in global health in today’s world. The subject of community medicine in medical colleges is still imparting rudimentary health concepts, definitions and an obsolete curriculum. To tackle evolving global health challenges, diseases patterns and cross border nature of infections, it's imperative to re-visit the MBBS curriculum. This would entail integrating scientific domains such as epidemiology, health economics, medical statistics, sociology, psychology, and health management sciences. Emphasis should be placed on cultivating research skills, promoting evidence generation, and fostering the use of information for informed decision-making. Furthermore, innovative methods for student assessment, program evaluation, and practical experiences are indispensable. Collaboration among public health practitioners, academics, and medical educators is indispensable for crafting a comprehensive and technically robust curriculum. Pakistan urgently needs an updated MBBS curriculum to confront the public health exigencies of the present era. Such a curriculum must embrace interdisciplinary subjects and inventive assessment techniques, ensuring that medical graduates are equipped to address contemporary public health emergencies.

Underage girls' pregnancy during schooling in Niger: Socio-demographic aspect, causes, effect and control. A prospective cohort study.

The aim of this study was to determine the frequency, the socio-demographic aspect, the consequences on the schooling of girls and the control measures of underage pregnancy in schooling in Niger. This was a prospective cohort study over a 12-month period. The study concerned pregnant and parturient girls who were minors and in the process of attending school in the city of Niamey in the Republic of Niger. The socio-demographic, obstetric and school data of 184 underage girls admitted to the Issaka Gazobi Maternity Hospital in Niamey during the study period were collected and analysed. At the same time, we conducted interviews in 30 schools and educational inspection services in the city of Niamey, in order to gather qualitative data on the phenomenon of pregnancy and childbirth among minors in schools. The frequency of childbirth among under-age students was 3.06% in our maternity. The average age was 15.7 years. Nine out of 10 minors (90.7%) had become mothers by the end of the study. School drop-out rates were high (53.8%). According to our interviews with school leaders, the factors at the root of pregnancy in Niamey schools are socio-cultural and religious (factors linked to the vulnerability of young girls, the lack of sex education within families and schools, and peer pressure, cultural and religious considerations which encourages early marriage and pregnancy, and the low contraceptive prevalence rate in Niger). Pregnancy in the school environment is common in Niger and has repercussions on the normal progress of schooling. This study recommended adequate parental implication, eradication of street hawking and inculcation of moral values through religious bodies as ways of reducing underage girls' pregnancy in schooling in Niger.

Understanding fertility behavior of the Forcibly Displaced Myanmar Nationals in Bangladesh: A qualitative study.

Rohingya- the Forcibly Displaced Myanmar Nationals (FDMN)- are largely characterized by a high total fertility rate (TFR) and a low contraceptive prevalence rate. This study aimed to explore the reasons behind their high fertility behavior by utilizing the Theory of Planned Behavior. We adopted a cross-sectional qualitative research approach. Fifteen semi-structured, face-to-face in-depth interviews were conducted with the Rohingya husbands, wives, and community leaders (Majhi and Imam/Khatib) living in Camps 1 and 2 of Ukhiya Refugee Camp, Cox's Bazar, Bangladesh. We analyzed the qualitative data using the thematic analysis approach. The Muslim-majority FDMN predominantly constructed the fertility outcome as the will and order of Allah. On the one hand, the Rohingya parents highlighted various religious, political, economic, and social advantages of having more children, especially sons. On the other hand, beliefs about religious restriction, fear of side effects, and community pressure against contraception sustained the reality of the low contraceptive prevalence rate in the community. Alarmingly, the Rohingya religious leaders and mass people were found highly politically motivated to continue the practice of high fertility with a view to 'expanding the Rohingya community' or 'to increase Muslim soldiers', so that they may fight back and take control of their ancestors' place in Myanmar in the future. Furthermore, these pronatalist attitudes and beliefs translated into high TFR through various high-fertility-supportive social norms and practices widely prevalent in the Rohingya community. These include child marriage, gendered division of labor, women's subordinate nature, the Purdah system, and joint-family members' support during childbirth and rearing. Religion, ethnic identity, and the unique political context and experiences of the Rohingya people jointly explain their high fertility behavior. This study warrants the urgency of initiating social and behavior change communication programs to change the religiopolitically-motivated high-fertility notions that prevailed in the Rohingya community.

Trend Analysis of Contraceptive Usage and Reasons of Low Contraceptive Use in Pakistan: A Narrative Review on Available Literature

The Pakistani government has been struggling continuously to slow down the population rise despite making easy accessibility of family planning services. Various factors including economic crisis, poverty, unemployment, and inflation have been identified that influence family planning practices leading to a low contraceptive prevalence rate (CPR). The main aim of this review was to understand the positive and negative predictors and the trends of contraceptive use. Pakistan, currently facing the issues of high morbidity and mortality of mother and child as a consequence of low CPR secondary to the high risk of unplanned and/or teenage pregnancies, abortion, and miscarriages. Low CPR produces a drastic effect on the nation's economy, as a high growth rate causes uncontrolled urbanization. Old age, education, and mothers' employment, wealth, and better lifestyle have positive influences while it is evident rural life, traditional religion, illiteracy, poverty, non-working mothers, and fear of side effects, etc. navigate low CPR. Although contraception in terms of modern contraceptive techniques has increased in Pakistan over the past two decades, still there is a need for efforts to increase CPR among reproductive and fertile age groups. Further, interventions such as the provision of affordable family planning practices and facilitating access to women near their homes, improving awareness must be targeted as a priority.

Contraceptive Experiences of Women of Procreation Age Who Attended Two HealthCenters in the City of Abidjan (Cote d’Ivoire)

Introduction: Maternal mortality, which is estimated at 614 deaths per 100,000 births in Côte d’Ivoire, is associated with a low national contraceptive prevalence rate of 13.9%. In this study, we are interested in the contraceptive experiences of women who attend health centers to estimate their rate of contraceptive use and to assess the factors involved in the use of modern contraceptive methods among women of childbearing age who are exposed to the risk of pregnancy. Method: A descriptive cross-sectional study was conducted from December 2018 to September 2019 among 423 women, who attended two health centers in Abidjan. A bivariate analysis identified factors associated with contraceptive use by these women. A descriptive analysis determined the means for the quantitative variables and the frequencies and percentages of qualitative variables. Interpretation of results was based on significance (α = 5%, 95% CI). Results: Contraceptive prevalence was 37%. There was a significant relationship between contraceptive use and the socio-demographic and reproductive characteristics of women (p < 0.001). Conclusion: Women who were over 35 years age, uneducated, primary school graduates, housewives, unemployed, in the informal sector, Muslims, nulliparous, and lacking information and decision-making power were less likely to use modern contraceptive methods. They are the target population for strategic interventions to improve contraceptive prevalence.

BARRIERS TO USE CONTRACEPTIVE METHODS AMONG POST ABORTION CLIENTS IN SARGODHA, PAKISTAN: A QUALITATIVE STUDY

&#x0D; &#x0D; &#x0D; World Health Organization (WHO) recommends at least 6 months interpregnancy interval after an abortion. Pakistan has a low contraceptive prevalence rate and a high unmet need for contraception. Post-abortion women are the potential clients for contraception but national data reveal low uptake of the contraceptive methods by these clients. This study aimed to explore the barriers to adopting contraception among post-abortion clients in the district of Sargodha, Pakistan. A qualitative research design was used. Study participants were recruited from three private and three public sector hospitals in the district of Sargodha, Pakistan. The study was conducted from July 2018 to November 2018. Ninety-nine in-depth interviews (IDIs) of post-abortion women were conducted using an unstructured interview guide within the period of one month after abortion. Detailed field notes were made. Interviews continued until thematic saturation had reached. The content was organized into a matrix based on themes and sub-themes. A descriptive thematic analysis using both inductive and deductive coding was conducted. Reasons for not adopting contraceptive methods were explored Although many clients expressed a desire to limit fertility, some barriers were found to be hindering the uptake of contraception. Major barriers expressed by clients were the unwillingness of the husband, the resistance of other family members and real or perceived fear of side effects of contraceptive methods. Lack of adequate knowledge about fertility and contraception was another factor which contributed to the decision not to adopt contraception. Socio-cultural norms to have large family sizes were also reported by some clients. Other barriers include religious beliefs, focus on other health issues, financial unaffordability, infrequent intercourse and plan for tubal ligation. The study concluded that without addressing the barriers post-abortion contraceptive uptake is unlikely to improve. Identification of barriers is the first step to addressing the existing unmet need for contraception.&#x0D; &#x0D; &#x0D;

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

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

Determinant Factors Related to the Unmet-Need of Family Planning Program among Married Women in Indonesia

Unmet family planning is one of the common causes of low contraceptive prevalence rates in developing countries, including Indonesia. Contraceptive in family planning is used to monitor family planning. Globally, the unmet for family planning remains high. The population growth rate is due to birth (fertility), death (mortality), and population. The high population growth is one of the problems in Indonesia and other developing countries. One of the population growth efforts is carrying out a family planning program to control fertility because it is critical for managing population growth, especially in Indonesia[1]. Program from the Indonesian government contains population growth, including the Family Planning Program, Reproductive Health, Prosperous family, and family empowerment. Based on the Indonesian Demographic Health Survey, it is evident that the proportion of unmet needs for family planning in 2012 was 11.4%, and in 2017 10.6%. This study aims to factors associated with the family planning program used by married women. Thus, this study is designed to assess the prevalence and associated factors of unmet needs of family planning programs.This study uses secondary data from 2017 IDHS carried out in 34 provinces in Indonesia. The total sample was 34.086 of 49,627 mother’s aged 15-49 years. The dependent variable was the family planning program. The independent variables consisted of socio-demographic and socioeconomic factors, knowledge, discussion with husband, and access to health services. Data analysis was performed through a binary logistic regression test to obtain the adjusted odds ratio of each factor. Data analysis using binary logistic regression STATA. The results showed that determinant factors related to the unmet- need of family planning program were the use of contraception (p=0.000), maternal age (p=0.000), mother’s education (p=0.000), number of children’s ownership (p=0.000), history of child death (p=0.000) 0.000), wealth index (p=0.011), province of residence (p=0.000), knowledge about contraceptive use (p=0.000) and ever used anything to delay getting pregnant (p=0.000). The proportion of unmet needs in this analysis was 61% with p- value= 0.000 OR= 2.49 (95% CI= 2.43- 2.56).The proportion of unmet needs in Indonesia is still high. Programs intervention should be targeted at women to decrease associated factors, especially in the productive period

Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia.

Unmet family planning is one of the common causes for low contraceptive prevalence rates in developing countries, including Ethiopia. Rapid urbanization had profound effect on population health, however, little is known about the unmet need of family planning in settings where there was increased industrializations and internal migrations in Ethiopia. This study aims to determine the unmet need for family planning services among currently married women and identify factors associated with it in Bishoftu town, Eastern Ethiopia. Community-based cross-sectional study was conducted from 1st January to 28th February, 2021 among 847 randomly sampled currently married women of the reproductive age group. Data were collected using semi structured interviewer administered questionnaire. Multivariate logistic regression was used to identify factors associated with the outcome variable and a 95% confidence interval was used to declare the presence of statistical significance associations. Eight hundred twenty-eight women were participated in the study. The prevalence of unmet need for family planning among currently married women was 26% [95% CI: 23,29]. Maternal age [AOR, 3.00, 95% CI:1.51-5.95], educational status [AOR, 2.49, 95% CI:1.22-5.07], occupational status of self-employee [AOR, 1.98, 95% CI:1.15-3.39] and housewife [AOR, 1.78, 95% CI:1.02-3.12], being visited by health care provider in the last 12 months [AOR, 1.81, 95% CI: 1.26-2.60] and desired number of children less than two [AOR, 1.53, 95% CI:1.01-2.30] were significantly associated with unmet need for family planning. Unmet need for family planning was higher in the study area compared with the United Nations sphere standard of unmet need for family planning and the national average, and slightly lower than the regional average. Socio-demographic, economic, and health institution factors were determinants of the unmet need for family planning in the study area. Therefore, health education and behaviour change communication related to family planning services should be strengthened and access to family planning services should be improved.

Use of community-based interventions to promote family planning use among pastoralist women in Ethiopia: cluster randomized controlled trial

BackgroundAfar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia.MethodsThe study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women’s education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI).ResultsThe proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women’s education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women’s education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women’s education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm.ConclusionThe present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP.Trial registrationClinicalTrials.gov, NCT03450564, March, 2018.

Women Deprivation Index and Family Planning Utilisation in Urban Geography of West African Countries.

Inequalities in health care utilisation and outcomes vary significantly across geographies. Though available evidence suggests disparity in contraceptive uptake in favour of urban compared with rural geographies, there are unassessed nuances among women in urban communities. This study examines some of these disparities within the context of socioeconomic deprivations and family planning utilisation among urban women in West Africa. A secondary analysis of the most recent Demographic and Health Survey dataset of five selected West African countries was conducted, using pooled data of 21,641 women aged 15–49 years. Associations between family planning utilisation and women's deprivation status were investigated using a binary logistic regression model. The findings show that more than one-quarter of the women were severely deprived across the countries except Senegal (17.4%), and the severely deprived consistently have relatively low contraceptive prevalence rates (CPR) (16.0–24.3%) compared with women with no/low deprivation across the countries except Senegal (39.8%). The results for long-acting reversible contraceptives (LARC) were not consistent across the five countries: whereas, LARC utilisation was lower among severely deprived women in Nigeria (9.1%), Guinea (9.6%), and Mali (19.3%), utilisation was similar across the deprivation groups in Benin and Senegal. In the multivariable analyses, the log-odds of modern contraceptive utilisation decreases by 0.27 among the moderately deprived (ß = −0.27, SE = 0.05, p < 0.01) and by 0.75 among the severely deprived women (ß = −0.75, SE = 0.05, p < 0.01) compared with those with no/low deprivation, with variations across the countries. Similarly, the log-odds of LARC utilisation decreases by 0.44–0.72 among the severely deprived women compared with those with no/low deprivation across the countries except Senegal. This study concluded that family planning intervention programmes and policies need to underscore the deprivation context of urban geographies, particularly among women living in informal settlements.

Experiences of women, men and healthcare workers accessing family planning services in Malawi: A grounded theory.

BackgroundThe importance of modern contraceptive methods in averting unwanted pregnancies has been acknowledged in Malawi. Currently, the country has registered the highest rates of unsafe abortions, unmet needs for contraception and a low contraceptive prevalence rate. Understanding why these rates exist is important. However, women’s views and experiences regarding uptake of family planning methods in Malawi have not been explored.MethodsA grounded theory methodology was used. Data were gathered through in-depth interviews with women (n = 18), men (n = 10), healthcare workers (n = 10) and non-participant observations of family planning clinic consultations (n = 10). Data were analysed using constant comparative technique. Methods of open, axial and selective coding enabled subsequent conceptualisations until theoretical saturation occurred.ResultsThe core category ‘disenabling environment prevents women’s family planning needs from being met’ provides an understanding of women’s, men’s and healthcare workers’ experiences of contraceptive use and non-use. The disenabling environment contributed to shaping women’s family planning experiences. This was supported by three main categories: navigating the processes, disempowerment of women and learning by chance.ConclusionFindings from this study illuminate contextual issues into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman’s family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman’s family planning needs. At national level, laws that would empower women with decision-making ought to be developed and enforced.

Mapping evidence on decision-making on contraceptive use among adolescents: a scoping review protocol

BackgroundContraceptive use among adolescents remains consistently low globally. Numerous studies have been done investigating factors that contribute to low contraceptive prevalence rates in this special population. It is particularly vital to understand decision-making processes that adolescents undergo when deciding whether or not to use contraceptives. Therefore, this scoping review seeks to map available evidence on decision-making processes in contraceptive use among adolescents.MethodsWe will conduct a scoping review to explore, describe and map literature on the adolescent decision-making regarding contraceptive use. The primary search will include peer-reviewed and review articles. Databases, including PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct and Scopus, will be searched for articles that meet the eligibility criteria. Keyword searches will be used, and for articles included after title screening, abstract and full articles will be screened by two independent reviewers with a third as a decider on any disputes. Content analysis will be used to present the narrative account of the reviews.DiscussionUnderstanding how adolescents make decisions about whether or not to use contraception is essential for improving contraceptive prevalence rates in this special population. It is envisioned that the results from this review will highlight key evidence on how adolescent make decisions regarding contraceptive use as well as gaps and opportunities for future research. It will also be important in enhancing and re-focusing adolescent sexual and reproductive health policies and programmes.

Adaptation of the Training Resource Package to Strengthen Preservice Family Planning Training for Nurses and Midwives in Tanzania and Uganda.

Tanzania and Uganda have high total fertility and maternal mortality rates, and low contraceptive prevalence rates. High-quality preservice family planning education for nurses and midwives can improve the quality of sexual and reproductive health care, thereby improving health outcomes. In 2015, we worked with relevant stakeholders in Tanzania and Uganda through a series of surveys, assessments, and workshops to adapt modules of the Training Resource Package for Family Planning (TRP), an evidence-based global resource, to improve the quality of preservice family planning education for nurses and midwives. With support, a wide range of stakeholders, including policy makers, program managers, educators from nursing and midwifery training institutions, and representatives from professional associations, identified relevant TRP modules and adapted them to each country's context to inform and develop their own lesson plans in accordance with national policies, guidelines, and standardized preservice education templates. Important lessons from the adaptation process include the following: (1) engage relevant ministries of health and education, professional associations, and regulatory councils at each step of the process to increase the acceptability and utility of the TRP; (2) use a context-specific process for adaptation of the TRP, as not one process will fit the needs of all countries; and (3) include nursing and midwifery educators in the adaptation process to create an established pool of trainers who can then cascade the TRP to other educators in their respective schools. Overall, participants in both countries expressed challenges with incorporating competency-based teaching methods into their curricula because they were unfamiliar with such approaches themselves and with reducing the extensive TRP content to fit within the time constraints for preservice education. Adaptation of an evidence-based global family planning training resource in Tanzania and Uganda resulted in substantive changes to the curricula of the reproductive health preservice course unit that will support nurses and midwives to provide quality, rights-based family planning services.

WHAT INFLUENCES FAMILY PLANNING IN RURAL PAKISTAN: FRANCHISED SERVICE PROVIDER AND COMMUNITY HEALTH WORKER PERSPECTIVE

Background: Pakistan has a low modern contraceptive prevalence rate, 26%, leading family planning (FP) programmes to explore partnerships with local private providers to improve access to quality FP services. This study aims to understand the socio-cultural and organizational factors that influence delivery of quality family planning services. Methods: This qualitative study was conducted with private service providers and community health workers (CHW) in Marie Stopes Society's (MSS) social franchise network. A total of 31 providers and 28 CHWs from Sindh, Punjab, and Khyber Pakhtunkhwa provinces of Pakistan were purposively selected for in-depth interviews. The study used thematic content analysis to understand providers' and health workers' perspectives of family planning service provision. Results: This study found that normative environment, propagation of myths and misconceptions, and health concerns remain major barriers to service provision in rural communities. Findings showed that CHWs were instrumental in increasing awareness and positive attitudes towards family planning in the catchment areas. Moreover, social franchising was effective in increasing access to high-quality, subsidised family planning services amongst economically marginalised and low-awareness communities. Providers and health workers expressed satisfaction with the franchising approach, and revealed that being part of this network substantially increased their client volume and ability to serve poorer segments of the population. Conclusion: The study found that franchising private service providers in rural areas enhances their ability to serve clients, and when coupled with demand-generation elements, such as vouchers and community health workers, it substantially increases their client volume. Albeit effective, the franchising approach currently lacks the element of long-term service provision at the current scale, and may require further strategizing by the franchisor. Moreover, alternate strategies should be explored to ensure continued provision of FP services without vouchers and CHWs.

Weighted log-linear models for service delivery points in Ethiopia: a case of modern contraceptive users at health facilities

BackgroundEthiopia is among countries with low contraceptive usage prevalence rate and resulted in high total fertility rate and unwanted pregnancy which intern affects the maternal and child health status. This study aimed to investigate the major factors that affect the number of modern contraceptive users at service delivery point in Ethiopia.MethodsThe Performance Monitoring and Accountability2020/Ethiopia data collected between March and April 2016 at round-4 from 461 eligible service delivery points were in this study. The weighted log-linear negative binomial model applied to analyze the service delivery point’s data.ResultsFifty percent of service delivery points in Ethiopia given service for 61 modern contraceptive users with the interquartile range of 0.62. The expected log number of modern contraceptive users at rural was 1.05 (95% Wald CI: − 1.42 to − 0.68) lower than the expected log number of modern contraceptive users at urban. In addition, the expected log count of modern contraceptive users at others facility type was 0.58 lower than the expected log count of modern contraceptive users at the health center. The numbers of nurses/midwives were affecting the number of modern contraceptive users. Since, the incidence rate of modern contraceptive users increased by one due to an additional nurse in the delivery point.ConclusionAmong different factors considered in this study, residence, region, facility type, the number of days per week family planning offered, the number of nurses/midwives and number of medical assistants were to be associated with the number of modern contraceptive users. Thus, the Government of Ethiopia would take immediate steps to address causes of the number of modern contraceptive users in Ethiopia.

Client-Centeredness of Family Planning Services in a Resource Limited Setting.

Clients' needs and their satisfaction are priority issues in studying quality in reproductive health services. However, only 24-37% of Ethiopian women were informed about the available family planning methods and their utilization. High national total fertility rate (4.8) and low contraceptive prevalence rate (29%) might be attributed to these and other reasons. This study assessed the level of client-centeredness of family planning services and their determinants in public health facilities of Bahir Dar Town, Northwest Ethiopia. Exit interviews of 326 consecutively enrolled clients were conducted using structured questionnaire. Thirty consultation sessions were observed using a checklist to record client-provider interaction. The outcome variable was client centeredness as measured by perceived informed choice with perceived client-provider interaction as the intermediate variable. The average levels of perceived informed choice and client provider interaction were 70.0% and 67.6%, respectively. Perceived clinical competence of providers, perceived integration and coordination of care, perceived accessibility of services, perceived participation of families and friends in care delivery, perceived physical comfort of the facilities and type of the health facility were the independent predictors of perceived client provider interaction. Perceived degree of client provider interaction, perceived clinical competence of providers, type of health facility and perceived accessibility of services were independent predictors of perceived informed choice (p≤0.01). Client-centeredness of family planning services, as measured by clien-provider interaction and informed choice was not sufficiently assured in the study facilities.

A qualitative study of provider perspectives on the barriers to contraceptive use in Kaliro and Iganga Districts, Eastern Central Uganda

Background: Family planning confers unique benefits including preventing unintended pregnancies, improving maternal and child health outcomes, and increasing women’s access to education and economic opportunities. However, Uganda has a low contraceptive prevalence rate of only 30%, and progress in improving maternal and child health outcomes is slow. Objective: This assessment explores community health workers’ and facility-based health workers’ qualitative perspectives on the use of contraceptives in the Iganga and Kaliro districts in Eastern Central Uganda. Methods: The baseline assessment used a qualitative approach with a focused sample of community- and facility-based health workers aged 20-60 years. Two focus group discussions with Community Health Workers and four key informant interviews with facility-based health workers were conducted. Thematic content analysis was done manually. Results: The main factors influencing contraceptive use in these communities were preference for large families, perceived inadequate knowledge of family planning and fear of side effects, inadequate spousal and family support, male domination and risk of violence, divorce and polygamy, inadequate human resource capacity and low motivation, and user fees. Conclusion: The study findings suggest that there is low use of contraceptives for family planning in the Kaliro and Iganga districts in Uganda. Recommendations include developing a strong focus in exploring policy options to build the capacities of trained health workers to offer long-term methods in order to increase the availability of family planning options. Family planning interventions should increase the availability of contraceptive methods using gender-sensitive strategies, including community mobilization.

Demand for Long Acting Reversible Contraceptives and Associated Factors among Women Accessing Family Planning Service in ARFH Model Clinic Ibadan, South West Nigeria

Inability of clients to pay as low as $ 1.2 to initiate a Family Planning method has contributed to the country’s low Contraceptive Prevalence Rate (CPR) in Nigeria. Until the adoption of free family planning policy in Nigeria, women had to pay fees ranging from about $1 to $3. Considering the fact that abortion is illegal in Nigeria, coupled with the fact that illegal abortion can be expensive, many of these women ended up with unintended pregnancies. The adoption of the policy on free family planning services to women by the Federal Government of Nigeria in 2012 was therefore received positively by civil society organisations. This paper intends to highlight the position before and after the adoption of this policy, by using the ARFH Model Clinic statistics as a primary guideline. In addition, the paper will provide an analysis of how this policy can be better implemented. Findings from this study show that free family planning service influences choice of modern contraceptives as demand for implanon increased when provided free compared to other modern methods. It is therefore, recommended that family planning services for all methods in all public health facilities should be provided free.

Prevalence and factors associated with unmet need for family planning among the currently married reproductive age women in Shire-Enda- Slassie, Northern West of Tigray, Ethiopia 2015: a community based cross-sectional study.

IntroductionUnmet family planning is one of the common causes for low contraceptive prevalence rate in developing countries including Ethiopia. Thus, this study designed to assess the prevalence and associated factors of unmet need in Shire Endaslassie town, Northern west of Tigray, Ethiopia.MethodsA community based cross sectional study design was employed. Multistage sampling technique was employed and data were collected using a semi-structured questionnaire by interviewer administered technique. Questionnaires were reviewed and checked for completeness, accuracy and consistency. Reviewed data were entered to Epi info 7 and analyzed by SPSS version 20 statistical software. Variables with P-value of less than 0.2 in bivariate analyses were entered for multivariate analysis and AOR at 95% CI with p-value of less than 0.05 were considered as significant variables.ResultsThe overall unmet need for family planning in the study area was 109(21.4%). 74(14.5%) for spacing and 35(6.9%) for limiting. Age group of 35-39 and >=40 (AOR= 2.7,95%CI:1.1,6.5), (AOR = 2.65, 95%CI:1.10, 6.40) respectively, decided numbers of desired children more than five (AOR = O.48, 95%CI: 0.28, 0.80), discussions of client with heath care providers (AOR = 6.32, 95%CI: 2.56, 15.58), previous use of modern family planning (AOR = 2.29, 95%CI, 1.20, 4.34) were significantly associated with unmet need for family planning.ConclusionUnmet need for family planning in the study area was high, so continuous discussion on modern family planning with community health workers and encouraging of women to decide desired numbers of children of less than five in general are better to be strengthened.