Measures Of Contraceptive Use Research Articles

Does Spousal Intimacy Improve Contraceptive Use? A Cross-Sectional Household Survey in Nigeria

Spousal intimacy has been argued to have the tendency to improve contraceptive use. In Nigeria, there is no empirical evidence to corroborate or refute this argument. This study attempts to fill this gap by examining the effect of spousal intimacy on contraceptive uptake using data from the Nigerian national demographic and health survey 2018. The dataset covers nationally representative 8,061 women of child-bearing age drawn from the 36 states of the country and the capital territory. Data are analyzed using the logistic regression model. We use two measures of contraceptive use: ever-used contraceptive and currently using contraceptive. Evidence shows that physical intimacy is positively and significantly associated with contraceptive use (with OR = 1.66, 95% CI: 0.28 - 0.73, for ever-used) and (OR = 1.60, 95% CI: 0.20 - 0.74, for currently using). Other covariates – education, number of children, family income, and age – are found to be significantly associated with both measures of contraceptive use. The study concludes that identifying and incorporating spousal-based innovations into family planning interventions may provide a leverage for improving contraceptive uptake in developing countries.

Contraceptive Congruence: A Novel Measure of Contraceptive Use that Acknowledges Pregnancy Ambivalence [A06

INTRODUCTION: Aligned with the bias that highly effective long acting reversible contraception (LARC) should be first-line for all women not intending pregnancy, historic measures emphasized contraceptive effectiveness. We propose an alternative measure, contraceptive congruence, which acknowledges pregnancy ambivalence by describing whether a method is aligned with individual attitudes about getting pregnant, specifically how important it is to avoid pregnancy and how pleased/upset she would be if pregnant. METHODS: Among 984 women not intending pregnancy in the next year, contraceptive congruence was defined as a three-level variable describing whether a woman’s current contraceptive method was very congruent, somewhat congruent, or incongruent with her pregnancy attitudes. If a woman was ambivalent about pregnancy, she was very congruent at a lower tier of contraceptive efficacy than someone very upset and importantly avoiding pregnancy. Patient-level variables were examined using chi-square analysis for associations with contraceptive congruence. RESULTS: Contraceptive methods included LARCs (8%), hormonal methods (50%), barrier methods (30%), or no method (12%). Methods for 43% of women were very congruent, 39% somewhat congruent, and 18% incongruent with attitudes about becoming pregnant. Therefore, many women were using methods that were aligned with their pregnancy attitudes. Predictors of contraceptive congruence included age, marriage, non-Hispanic white ethnicity, full-time employment, and higher income. CONCLUSION: By including individual attitudes about getting pregnant, contraceptive congruence acknowledges pregnancy ambivalence, which is missing when categorizing contraceptive methods by strictly effectiveness alone. Future research and clinical care that acknowledge pregnancy ambivalence will more closely align with actual complex attitudes that affect individual contraceptive behavior.

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."

Refining assessment of contraceptive use in the past year in relation to risk of unintended pregnancy

ObjectivesHealthy People 2020 establishes objectives for reducing the proportion of pregnancies in the United States that are unintended and for improving contraceptive use. This analysis describes ways to more closely align measurement of contraceptive use with periods of risk for unintended pregnancy using the National Survey of Family Growth (NSFG). MethodsUsing the 2011–2015 NSFG we constructed two measures of contraceptive use for women we defined as at risk of an unintended pregnancy: (1) we augmented a measure of recent contraceptive use by recoding non-users according to their method use during their last month of sex in the past 12 months; (2) we augmented use at last sex in the past 12 months by excluding women who were pregnant at last sex. Estimates were compared overall and within 5-year age groups. ResultsThe augmented measure of recent contraceptive use found fewer women to be using no contraception than the standard measure (7.3% vs 15.4%; p < .001); greater differences were found between the two measures for younger women. When considering contraceptive use at last sex, the augmented measure identified fewer women as using no contraception (15.8% vs 21.0%; p < .001) than the standard measure and more women to be using a most effective method (33.3% vs 31.1%; p = .04) than the standard measure. ConclusionsAligning periods of unintended pregnancy risk with contraceptive use assessment reduced estimates of no contraceptive use; changes in estimates by method type varied by age. ImplicationsWhen assessing contraceptive use for the purpose of unintended pregnancy prevention, researchers may consider the methods described here to further align contraceptive use measurement with periods of unintended pregnancy risk.

Does age-adjusted measurement of contraceptive use better explain the relationship between fertility and contraception?

Background: The typical contraceptive–fertility relationship has not held in some countries witnessing rapid increases in contraceptive uptake. With increasingly more diverse population age structures among developing countries, one explanation may be the different measurement approaches of total fertility rate (TFR), an age-adjusted measure, and contraceptive prevalence rate (CPR), an unadjusted measure. Objective: To examine whether the association between contraception and fertility has changed over time in less developed settings and whether the relationship is better explained with an age-adjusted measure of contraceptive use. Methods: Using data from 259 Demographic and Health Surveys, we examine associations between CPR and TFR in two 15-year periods. We then develop age-adjusted CPR and explore the relationship between TFR and unadjusted versus age-adjusted CPR, using linear regression analyses with country-level fixed effects. Results: A TFR decrease of 1 was associated with a CPR increase of 15.4 percentage points during 1985–2000 and of 17.2 percentage points during 2001–2016. On average, across 259 surveys, age-adjusted CPR was higher than unadjusted CPR by about 3% with significant regional variation. Regression model fit reveals that age-adjusted CPR better explains the CPR–TFR relationship. Contribution: Age-adjusted CPR addresses varying age structures and age patterns of contraceptive use across populations, facilitating cross-country and cross-temporal comparisons of contraceptive use. Updated demographic shorthand for the CPR–TFR relationship is that a TFR decrease of 1 is associated with a CPR increase of 17 percentage points overall and a 20 percentage point increase in sub-Saharan Africa.

No one to turn to: low social support and the incidence of undesired pregnancy in the United States

ObjectiveYoung women may experience social barriers to achieving their reproductive goals. This analysis explored whether low social support may contribute to the high incidence of undesired pregnancy in young women in the United States. Study designUsing 6 months of data from a prospective cohort of 970 women ages 18–22 years in the United States, we described contraceptive use and applied multivariable logistic regression and standardization to estimate adjusted odds and absolute risk of undesired pregnancy among women reporting low social support versus higher social support. We investigated several measures of contraceptive use as possible explanations for this pathway. ResultsSixty-five pregnancies were reported in the 6 months of the study, of which 30 (46%) were classified as undesired prior to conception. Among young women who reported low social support, 8% reported an undesired pregnancy during the study period as compared to 3% of the young women who reported higher levels of social support. Among non-black women, those who reported low social support had nearly seven times the odds of an undesired pregnancy as compared to women who reported higher social support (aOR: 6.8, 95%CI: 1.7, 27.1). We found no association between social support and undesired pregnancy among young black women. Contraceptive method use differed by social support at baseline, and throughout follow-up. ConclusionsLow social support — defined as the feeling of not having anyone to turn to – may be a risk factor for persistently high levels of undesired pregnancy among young women in the U.S. This association may be driven by differences in contraceptive use by level of social support. ImplicationsInterventions to increase young women's perceptions of social support may reduce the risk of undesired pregnancy for some individuals.

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.

Objective and Perceived Weight: Associations with Risky Adolescent Sexual Behavior.

Studies have shown that obesity is associated with increased sexual risk-taking, particularly among adolescent females, but the relationships between obesity, perceived weight and sexual risk behaviors are poorly understood. Integrative data analysis was performed that combined baseline data from the 1994-1995 National Longitudinal Study of Adolescent Health (from 17,606 respondents in grades 7-12) and the 1997 National Longitudinal Survey of Youth (from 7,752 respondents aged 12-16). Using six sexual behaviors measured in both data sets (age at first intercourse, various measures of contraceptive use and number of partners), cluster analysis was conducted that identified five distinct behavior clusters. Multivariate ordinal logistic regression analysis examined associations between adolescents' weight status (categorized as underweight, normal-weight, overweight or obese) and weight perception and their cluster membership. Among males, being underweight, rather than normal-weight, was negatively associated with membership in increasingly risky clusters (odds ratio, 0.5), as was the perception of being overweight, as opposed to about the right weight (0.8). However, being overweight was positively associated with males' membership in increasingly risky clusters (1.3). Among females, being obese, rather than normal-weight, was negatively correlated with membership in increasingly risky clusters (0.8), while the perception of being overweight was positively correlated with such membership (1.1). Both objective and subjective assessments of weight are associated with the clustering of risky sexual behaviors among adolescents, and these behavioral patterns differ by gender.

Measuring infertility in populations: constructing a standard definition for use with demographic and reproductive health surveys.

BackgroundInfertility is a significant disability, yet there are no reliable estimates of its global prevalence. Studies on infertility prevalence define the condition inconsistently, rendering the comparison of studies or quantitative summaries of the literature difficult. This study analyzed key components of infertility to develop a definition that can be consistently applied to globally available household survey data.MethodsWe proposed a standard definition of infertility and used it to generate prevalence estimates using 53 Demographic and Health Surveys (DHS). The analysis was restricted to the subset of DHS that contained detailed fertility information collected through the reproductive health calendar. We performed sensitivity analyses for key components of the definition and used these to inform our recommendations for each element of the definition.ResultsExposure type (couple status, contraceptive use, and intent), exposure time, and outcomes were key elements of the definition that we proposed. Our definition produced estimates that ranged from 0.6% to 3.4% for primary infertility and 8.7% to 32.6% for secondary infertility. Our sensitivity analyses showed that using an exposure measure of five years is less likely to misclassify fertile unions as infertile. Additionally, using a current, rather than continuous, measure of contraceptive use over five years resulted in a median relative error in secondary infertility of 20.7% (interquartile range of relative error [IQR]: 12.6%-26.9%), while not incorporating intent produced a corresponding error in secondary infertility of 58.2% (IQR: 44.3%-67.9%).ConclusionsIn order to estimate the global burden of infertility, prevalence estimates using a consistent definition need to be generated. Our analysis provided a recommended definition that could be applied to widely available global household data. We also summarized potential biases that should be considered when making estimates of infertility prevalence using household survey data.

Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator.

Although several key elements of sexual and reproductive health are included in the United Nations Millennium Development Goals, a measure of women's capacity to regulate their fertility safely and effectively is missing. We considered the usefulness of 3 pairs of indicators in monitoring this component of reproductive health: contraceptive prevalence and total fertility; unmet need for contraception and unplanned births; and unsafe abortion and abortion mortality. A single measure of contraceptive use is insufficient. The risks women face from unplanned births and unsafe abortion should also be incorporated into the monitoring process, either directly within the Millennium Development Goals framework or as a parallel effort by reporting governments and other agencies.

Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai

Purpose To evaluate the effectiveness of a youth-friendly intervention in promoting one safe sex behavior—contraception and condom use among unmarried young people aged 15–24 years in Shanghai, China. Methods The study was conducted in two towns of a suburban area of Shanghai (one as the intervention and the other as the control), with comparable socio-cultural-economic and demographic characteristics. The intervention intended to build awareness and offer counseling and services related to sexuality and reproduction among unmarried youths, in addition to the routine program activities, which were exclusively provided in the control site. Baseline surveys were conducted in both sites before the implementation of the intervention, and similar surveys were conducted in both sites 20 months after the intervention had been initiated to test the feasibility and effectiveness of the intervention. In total, 1220 unmarried young people from the intervention site and 1007 from the control site, including 1304 out-of-school youths and 923 high school students, were recruited, and about 92% of them were successfully followed up. Four main measures were examined (i.e., ever contraceptive use, current regular contraceptive use, ever condom use, and contraceptive use at onset of sexual intercourse—if it occurred during the course of the intervention). The reasons for nonuse of contraceptives, the status of joint decision on contraception and the first method used were also assessed. Data were analyzed using Logistic regression models with dichotomous measures of contraceptive use and Generalized Estimating Equations (GEEs) with repeated measures. Results At baseline, there was no statistical difference in contraceptive use between the intervention and control groups. After intervention, the proportions reporting regular contraceptive use and condom use in the intervention group were much higher than that in the control group ( p < .001). A group × time interaction effect ( p < .0001) was found for regular contraceptive use and ever condom use. Logistic regression analysis with dichotomous measures of contraceptive use and GEEs with repeated measures showed similar results. The regular contraceptive use and ever condom use were correlated with subject's occupation and family economic status, respectively. After adjusting for demographic factors, the subjects from the intervention group were 14.58 (OR) times as likely to use contraceptives at onset of intercourse as those from the control group (95%CI: 8.55–24.87, p < .0001). Similar results were found for both females and males. Conclusions A multifaceted intervention program that provided information and skills, as well as counseling and services, appears to have positive influences on contraceptive practice and condom use among unmarried young females and males in suburban Shanghai.

Contraception.

Health IssueContraception choices affect the long-term sexual health and fertility of women and men. Data from the 1998 Canadian Contraception Study and the 2000/2001 Canadian Community Health Survey were assessed for measures of contraceptive use and familiarity with various methods among Canadian women.Key FindingsThe oral contraceptive (OC) pill is the dominant method of contraception for Canadian women. Canadian women demonstrate high awareness of the benefits of condom use, but 75% are unaware of the female condom. Among youth, condom use drops as OC use increases. Contraception use in sexually active females aged 15–17 is fairly high, but use is inconsistent. Sexually active adolescent females report high awareness of emergency contraception but poor knowledge of the time frame within which it is most effective. Women aged 35–44 are more familiar with and likely to choose sterilization than younger women. There has also been a shift away from tubal ligation in favour of vasectomies.Data Gaps and RecommendationsNational data to guide policy and program development are limited. More data are needed on contraception use among males, and factors affecting accessibility, adherence and negotiation of choice. The importance of dual protection, and correct and consistent use of the chosen contraceptive method must be communicated to younger Canadians, as well as health care providers and educators. All women of reproductive age should be made aware of emergency contraception methods and increased efforts on sexual health promotion and education are required. Further research is essential to develop expanded contraceptive choices.

Measuring Contraceptive Use Patterns Among Teenage and Adult Women

Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.

Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unitended pregnancy.

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.The authors assessed the applicability of the transtheoretical model of behavior change to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Data were collected in 1992 from the US Centers for Disease Control's multisite Prevention of HIV in Women and Infants Demonstration Project. In the transtheoretical model, which originated from smoking cessation and psychotherapy research, behavior change is a gradual, continuous, dynamic process in which people move through a sequence of five stages. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess the use of oral contraceptives and hormonal implants, but that measurement of condom use requires separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. SE scores rose significantly across stages, from recontemplation to maintenance, and a shift in decisional balance was observed for two of three behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unintended pregnancy.

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

Contraceptive self-efficacy: a primary prevention strategy.

This paper discusses the development, implementation, and qualitative evaluation of an intervention designed to improve contraceptive self-efficacy (CSE) in a population at high risk for pregnancy. In a previous study, a relationship was found between CSE and a measure of contraceptive use for sexually active young women attending a family planning clinic. Here, the concept of CSE is further developed to identify contraceptive and sexual issues for adolescent males, for adolescents who show little or no motivation to obtain or use contraceptives, and for those adolescents who would plan to carry a pregnancy to term if they were to become pregnant. Implications are drawn for developing primary prevention programs.

Contraceptive Continuation Among Adolescents Attending Family Planning Clinics

An attempt to find a reliable way to measure contraceptive continuation among teenagers was made in a study of 445 adolescents under age 18 who made an initial visit to one of nine federally funded family planning clinics in the Philadelphia area in 1980 and 1981. The participants were interviewed at their initial visit and at six and 15 months to collect information on background characteristics, pregnancy history and contraceptive use. A cross-check of the information on contraceptive use reported during the study showed that 38 percent of the respondents who reported that they had been continuous users during the 15 months supplied information at other points indicating that they had not always used contraceptives during that period. In an attempt to examine the effects of adolescent reporting errors on measures of contraceptive use, the investigators constructed three alternative measures of contraceptive continuation. The simplest measure assessed current use at 15 months. A second measure accepted only reports of continuous use at 15 months and ignored inconsistent data. The third measure corrected for inconsistent data. Applying these measures to the study population produced proportions of contraceptive continuation ranging from a low of 43 percent when the most stringent measure was used to a high of 82 percent for the current-use category. Whatever the measure used, much of the discontinuation appears to have occurred in the first three months after the initial visit to a family planning clinic.(ABSTRACT TRUNCATED AT 250 WORDS)