Modern Contraceptive Use Research Articles

The Use of Modern Contraceptives among Women and its Implications to Menstrual Cycle According to Shariah

The Use of Modern Contraceptives among Women and its Implications to Menstrual Cycle According to Shariah

Prevalence and predictors of use of long-term and short-acting reversible contraceptives among women of reproductive age in Wakiso and Hoima districts, Uganda: A cross-sectional study

Modern contraceptive use has increased globally, but unmet needs persist in low- and middle-income countries. This study in Uganda aimed to examine the prevalence and factors influencing the use of short-acting reversible contraceptives (SARC) like pills and long-term methods such as intrauterine devices. Limited evidence exists on the use of SARC and long-term methods in Uganda. Data from the Africa Medical and Behavioural Sciences Organization (AMBSO) Population Health Surveillance (APHS) in Hoima and Wakiso districts were analysed. Among the 1642 women aged 15–49 years, the prevalence of modern contraceptive use was 30% for SARC, and 18% for long-term method. Women with formal education were three times more likely to use long-term methods than those without formal education, relative risk ratios (RRR), 3.1–3.4, (95%CI 1.2–8.2). Joint decision-making for contraceptive use increased SARC usage, RRR 1.4 (95%CI 1.1–1.8). Urbanization played a role, with women in more urbanized Wakiso district less likely to use any modern contraception, RRR 0.6–0.7 (95%CI 0.5–0.9) compared to those living in the less urbanized Hoima. About half of the women in the study used modern contraceptives and the use of SARC was almost twice that of long-term methods. Increased access to contraception education for all women of reproductive age could significantly improve the use of long-term methods which offer more reliable protection against unintended pregnancies. The findings shed light on the need to strengthen both general and sexuality education to girls and women and to tailor contraception access for all in need, for mobile semi-urban as well as rural women. Well-informed strategies that engage young men and male partners in informed decision-making for contraceptive use could enhance progress.

Time to initiation of modern contraceptive method use after childbirth and its predictors in Southern Ethiopia: a retrospective follow-up study

BackgroundTimely initiation of modern contraceptive use is vital to prevent unintended pregnancy and its related morbidities and mortalities. However, there is a scarcity of evidence about the duration of time elapsing from childbirth to initiating modern contraceptive use following childbirth and its associated factors in the study area for evidence-based interventions. Therefore, we aimed to assess the time to initiation of modern contraceptive method use and its predictors in Hossana town, southern Ethiopia.MethodsA retrospective follow-up study was conducted at public health facilities in Hosanna town. A total of 503 study participants were included in the study using a systematic random sampling technique. The Box and Whisker plot was used to estimate the time to initiation of modern contraceptive use. A Weibull regression model was applied to identify predictors of time to initiation of modern contraceptive use. Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was used to interpret the strength of the association.ResultsThe median time to initiation of modern contraceptive use was 6 months, with an interquartile range of 3 months. Husband/partner attending higher education [AHR = 1.64, 95% CI: 1.04, 2.57], women who had parity of more than two [AHR = 1.93, 95% CI: 1.01, 3.67], and women who had communicated with their husband/partner about modern contraceptive methods [AHR = 3.03, 95% CI: 1.41, 6.67] were more likely to initiate modern contraceptive method use within six months after childbirth. In contrast, women with an older age of greater than or equal to 30 years [AHR = 0.32, 95% CI: 0.13, 0.82] and who did not resume sexual intercourse after childbirth [AHR = 0.02, 95% CI: 0.01, 0.03] were less likely to initiate modern contraceptive method use within six months after childbirth.ConclusionsThe median time to initiation of modern contraceptive method use after childbirth in the postpartum period was delayed from the World Health Organization recommendation of at most 6 weeks. Emphasis should be given to older women, women with lower parity, and men’s participation in contraceptive communication to improve timing for initiation of modern contraceptive use after childbirth and to curb the five-month lag periods.

The Effect of a Decade Implemented Project in Improving the Uptake of Comprehensive Contraception: Difference-In-Difference Analysis.

Promotion and use of family planning in countries with high birth rates have the potential to avert a third of all maternal deaths and nearly a tenth of childhood deaths. To support government efforts in creating wider access to comprehensive contraceptive methods, EngenderHealth has contributed to the government of Ethiopia's long-term goal of improving maternal health outcomes through its Access to Better Reproductive Health Initiative project. Difference-in-Difference approach is the main methodology in this analysis to estimate the "contribution" or "effect" of the ABRI intervention by comparing the changes in family planning outcomes from 2005 to 2016 between the ABRI and non-ABRI areas. This analysis was based on pooled data from the 2005 and 2016 Ethiopian Demographic and Health Surveys. To track temporal changes in the family planning indicators in the ABRI and non-ABRI areas, we employed simple trend analysis. The results show that overall contraceptive prevalence rate, use of injectables, women's knowledge of Long-Acting Reversible Contraception (LARC) methods, and their exposure to family planning information/messages from health workers all significantly improved in the ABRI intervention areas beyond what occurred in the non-ABRI areas. The greatest increase in the use of modern contraception was among adolescents aged 15-19 years, with a DID estimate of 22.4% (p=0.007), ABRI areas compared to no-ABRI areas. In the ABRI areas, family planning indicators recorded positive and significant changes. EngenderHealth has contributed its part in improving access to the uptake of comprehensive contraception and supporting government programs.

The impacts of family planning and HIV service integration on contraceptive prevalence among HIV positive women in Tanzania: a comparative analysis from the 2016/17 Tanzania HIV impact survey

BackgroundPrevention of unplanned pregnancies through modern contraceptives among HIV-positive women is one of the essential strategies for reducing mother-to-child transmission of HIV. Family planning and HIV services integration is a national strategy designed to scale-up modern contraceptives among HIV-positive women. This study aims to evaluate the success of a service integration strategy by comparing the prevalence of modern contraceptive use among HIV-positive women receiving ART within integrated services and those not on integrated services (HIV-negative women and HIV-positive women unaware of their status).MethodsWe used data from the Tanzania HIV impact survey (THIS) of 2016/17. THIS provided HIV counselling and testing with a return of results in over 30,000 adults over 15 years of age. Women tested positive self reported their enrollment into ARV with further confirmation through laboratory analysis for any detectible ARV in their blood. All non-pregnant women reported their contraceptive use. Univariate and multivariate logistic regression was used to assess the effect of accessing integrated services controlling for potential confounders.ResultsA total of 14,986 women were included in the analysis; HIV-positive women were 1,066 and HIV-negative women were 13,830. Modern contraceptive use prevalence was 35% among HIV-positive women and 30% among HIV-negative women. Among HIV-positive women, those enrolled in integrated services (ART) had a higher prevalence of modern contraceptive (40%) compared to HIV-positive women unaware of their status (27%, p-value = 0.0014). The most common contraceptive methods in HIV-positive women were injectables (32%) and male condoms (31%), while in HIV-negative women, injectables (39%) and implants (30%, n = 1032) were the most preferred methods. Among HIV-positive women, enrolment into integrated services (currently on ART) demonstrated an increase in the odds of modern contraceptives by 85% (AOD = 1.85, 95%CI: 1.27–2.71).ConclusionThis study found relatively low modern contraceptive use among HIV-positive women in the general population despite the existance of service integration program and guidelines to guide its implementation.Our study therefore calls for the evaluation on the implementation of the integration programme to identify factors that constrain or facilitate programme effectiveness.

Family planning uptake and its associated factors among women of reproductive age in Uganda: An insight from the Uganda Demographic and Health Survey 2016.

Despite the government efforts to reduce the high fertility levels and increase the uptake of family planning services in Uganda, family planning use was still low at 30% in 2020 which was the lowest in the East African region. This study was undertaken to determine the prevalence and factors associated with the uptake of family planning methods among women of reproductive age in Uganda. This community-based cross-sectional study utilized secondary data from the Uganda Demographic and Health Survey (UDHS) of 2016. The survey data was downloaded from the Measure Demographic Health Survey website after data use permission was granted. Data was collected from a representative sample of women of the reproductive age group (15-49 years) from all 15 regions in Uganda. A total of 19,088 eligible women were interviewed but interviews were completed with 18,506 women. Data analysis was performed using SPSS statistical software version 32.0 where univariable, bivariable, and multivariable analyses were conducted. The prevalence of family planning use was found to be 29.3% and that of modern contraceptive use was found to be 26.6%. Multivariable analysis showed higher odds of current family planning use among older women (40-44 years) (aOR = 2.09, 95% CI: 1.40-3.12); women who had attained the secondary level of education (aOR = 1.91, 95% CI: 1.32-2.76); those living in households with the highest wealth index (aOR = 1.87, 95% CI: 1.29-2.72); and awareness of the availability of family planning methods (aOR = 1.41, 95% CI: 1.17-1.72). In conclusion, the study suggests improving women's education attainment, socio-economic position, and awareness may help increase use in the population.

Geographic weighted regression analysis of hot spots of modern contraceptive utilization and its associated factors in Ethiopia.

Utilization of modern contraceptives is a common healthcare challenge in Ethiopia. Prevalence of modern contraception utilization is varying across different regions. Therefore, this study aimed to investigate Geographic weighted regression analysis of hotspots of modern contraceptive utilization and its associated factors in Ethiopia, using Ethiopian Demographic and Health Survey 2016 data. Based on the 2016 Ethiopian Demographic Health Survey data, a total weighted sample of 8,673 women was included in this study. For the Geographic Weighted Regression analysis, Arc-GIS version 10.7 and SaTScan version 9.6, statistical software was used. Spatial regression was done to identify factors associated with the hotspots of modern contraceptive utilization and model comparison was carried out using adjusted R2 and AICc. Variables with a p-value < 0.25 in the bi-variable analysis were considered for the multivariable analysis. Multilevel robust Poisson regression analysis was fitted for associated factors since the prevalence of modern contraceptive was >10%. In the multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association. The prevalence of modern contraceptive utilization in Ethiopia was 37.25% (95% CI: 36.23%, 38.27%). Most of the hotspot areas were located in Oromia and Amhara regions, followed by the SNNPR region and Addis Ababa City administration. Single Women, poor Women, and more fertility preference were significant predictors of hotspots areas of modern contraceptive utilization. In the multivariable multilevel robust Poisson regression analysis, Women aged 25-34 years (APR = 0.88, 95% CI: 0.79, 0.98), 35-49 years (APR = 0.71, 95% CI: 0.61, 0.83), married marital status (APR = 2.59, 95% CI: 2.18, 3.08), Others religions (APR = 0.76, 95% CI: 0.65, 0.89), number of children 1-4 (APR = 1.18, 95% CI: 1.02, 1.37), no more fertility preference (APR = 1.21, 95% CI: 1.11, 1.32), Afar, Somali, Harari, and Dire Dawa: (APR = 0.42, 95% CI: 0.27, 0.67), (APR = 0.06, 95% CI: 0.03, 0.12), (APR = 0.78, 95% CI: 0.62, 0.98), and (APR = 0.75, 95% CI: 0.58, 0.98), respectively. Amhara region (APR = 1.34, 95% CI: 1.13, 1.57), rural residence (APR = 0.80, 95% CI: 0.67, 0.95) High community wealth index (APR = 0.78, 95% CI: 0.67, 0.91) were significantly associated with modern contraceptive utilization. There were significant spatial variations of factors affecting modern contraceptive use across regions in Ethiopia. Therefore, public health interventions targeting areas with low modern contraceptive utilization will help to increase modern contraception use considering significant factors at individual and community levels.The detailed map of modern contraceptive use cold spots among reproductive age group and its predictors could assist program planners and decision-makers to design targeted public health interventions.Government of Ethiopia must develop more geographic targeted strategies for improving socioeconomic status of women and availability & accessibility of health facilities in rural areas of the countries.

Role of Partner and Health Workers on Modern Contraceptive Use Among Married/In-union Women in Uzbekistan

Many factors contribute to the declining total fertility rate, including family planning programs. The successful implementation of the family planning method might be influenced by how the decision to choose a contraceptive method was made. This study aimed to examine the correlation between family planning decision makers and modern contraceptive use among married/in-union women of reproductive age in Uzbekistan. The 2021-2022 Multiple Indicator Cluster Survey was used by selecting only married/in-union women of reproductive age of 15 to 49 years, totaling 2,794 eligible samples. The modern family planning use variables were divided into not using, using Long-Acting Contraceptives (LAC), and Short-Acting Contraceptives (SAC). The univariate, bivariate(Chi-square and ANOVA), and multinomial logistic regression were performed. Family planning decision-makers from both women and husbands/partners, health workers, or others were significantly associated with modern contraceptive use for SAC and LAC, respectively. The type of family planning methods was significantly influenced by decision-makers. Spouses, family members, and health workers need to implicate women to decide the most applicable contraceptive method.

Trend, geographical distribution, and determinants of modern contraceptive use among married reproductive-age women, based on the 2000, 2005, 2011, and 2016 Ethiopian demographic and health survey

BackgroundThe most common family planning method is modern contraception. It is a cost-effective way to reduce maternal and neonatal morbidity and mortality and enable women to make informed choices about their reproductive and sexual health. The trend of modern contraceptive utilization has shown drastic change in Ethiopia, and identifying the major factors contributing to such a drastic change is vital to improving plans and strategies for family planning programs. Therefore, this study analyzed the trend, geographical distribution, and determinants of modern contraceptive use among married reproductive-age women in Ethiopia.MethodThis study used secondary data from the EDHS 2000–2016, collected from a population-based cross-sectional study by the Central Statistical Agency, focusing on married reproductive-age women aged 15–49. The study analyzed the modern contraceptive use trends through descriptive analyses conducted in three phases: 2000–2005, 2005–2011, and 2011–2016. The study utilized bivariable and multivariable logistic regression analyses to identify determinant factors, with significant variables declared using a P-value of 0.05 and an adjusted OR with 95% confidence interval. Analysis was conducted using STATA.14 and R. Spatial analysis was done using ArcGIS version 10.8 and SatScan™ version 9.6.ResultA weighted total of 33,478 women are included in the study, with a mean age of 31.4 years (8.6 SD). There was a significant increase in the trend of modern contraceptive use among married women over the study period, from 2000 to 2016, from 7.2% to 2000 to 15.7% in 2005, to 30% in 2011, and to 39.5% in 2016. The maximum increase was seen in the second phase (2005–2011), with a 14.3% increase. Factors like age of respondents, educational status, religion, residence, region, wealth index, number of living children, husbands’ desire to have more children, and media exposure were found to be predictors for modern contraceptive utilization.ConclusionThe prevalence of modern contraceptive use is below 50%, and there is also evidence of wide geographical variation in modern contraceptive use in Ethiopia. Thus, policymakers, high institutions, and other stakeholders must work collaboratively with the government in order to improve awareness about modern contraceptive use.

History of national sex surveys in Europe.

The historical background of European national sex surveys dates back to the late 1960s and early 1970s when the first such surveys were conducted in Europe. That was an era of Western sexual revolution, a time of increasing openness to discussion and debate of sexual issues, and legal reforms in many countries. During this period, there was a growing interest in understanding sexual behaviour, attitudes, and modern contraceptive use in the general population. Evidence was also needed for sexuality education that was emerging in some European countries. Despite this need for evidence, only a few countries (Sweden, Finland, France) conducted national surveys on the topic in the early 1970's, becoming pioneers in national sex surveys in Europe and in the world. It was the HIV and AIDS epidemic of the 1980s that gave more researchers and funders the impetus to conduct sex studies in many European countries. As a result, medical perspectives on sexuality became prioritised around Europe. Balancing the perspectives of the diverse disciplines (including public health, sociology, psychology) that use the data from national sex surveys remains a challenge for the modern surveys. The European Sexual Medicine Network (ESMN) is a part of European cooperation in science and technology (COST), which includes a strand of work on national sex surveys among the adult population. Since 2021, a subgroup of nationally representative sex surveys, co-chaired by Osmo Kontula and Hanneke de Graaf have worked together to further the field. This submission is based on a review of the literature, combined with Kontula's personal reflections following a history of participation in European collaboration in this field since the early 1990s.

Quantitative and qualitative assessment of maternal and child health services among hard-to-reach communities in Adamawa State, Nigeria

Background: Recent global reports highlighted the significance of improving the quality of healthcare delivery in all settings, including rural and hard-to-reach communities, as a central strategy for attaining sustainable development goals in universal health coverage. Objectives: This study aimed to assess and document relevant data associated with delivering qualitative Maternal and Child health services in the HTR communities using carefully selected indicators. Methods: The study used a mixed-design approach of quantitative and qualitative methods. Results: This study report high performance on the first antenatal visit (ANC 1), use of modern contraceptives (CPR), Penta 3, measles vaccination coverage, and, Low dropout rate also noticed in Penta 3, thus signifying a generally good performance in all the Local Government areas. Furthermore, Yola South, Fufore, Toungo, Ganye and Michika LGA were found to be the best performing LGAs on the selected maternal and Child indicators, namely: (ANC1), ANC4, ANC8, Institutional delivery rate, and Contraceptive Prevalence Rate (CPR), while Gombi, Guyuk and Madagali LGAs were the poorest performing LGAs. The poor performance of the fore mentioned LGAs was associated with human and environmental interferences: ongoing security challenges, high HTR communities due to mountains and riverine, low level of education, inadequate outreach services during the period under review, poverty, lack of adequate emergency transport system, inadequate HRH, inadequate and poor infrastructure, many communities lack a comprehensive PHC. Conclusion: The assessment highlights LGAs with low utilization of MCH services in HTR communities in Adamawa State, the reasons for the low coverage, and the possible strategies for increased utilization of these services.

Factors affecting utilization of modern contraceptive methods among women of reproductive age in Ethiopia.

Modern contraceptive use is important for improving health and socioeconomic outcomes, but Ethiopia is among the lowest-using countries. Therefore, this study aimed to determine factors affecting modern contraceptive use among women of reproductive age in Ethiopia. This population-based cross-sectional study used data obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). A total of 8,885 reproductive-age women were included in the analysis. A weighted generalized estimating equation approach was used to account for the clustering and weighting effects in the assessment of associations between modern contraceptive usage and socioeconomic and demographic variables. Modern contraceptive use among women of reproductive age in Ethiopia is low (28%). Prevalence is highest among women aged 25-34 (40.11%), with higher education (30.97%), who are Orthodox Christians (31.67%), married (40.40%), middle wealth index (31.70%), female-headed households (31.42%), with 1-3 living children (44.85%), who headed by under 31 years old (40.07%), and in the Amhara region (34.45%). In the generalized estimating equation analysis, women aged 35-44 and over 45, Muslims, households heads aged 41-50 and over 50, and in female-headed households were less likely to use modern contraceptives, while women with primary, secondary, and higher education, married, middle and rich wealth index, and with 1-3 and more living children were more likely to use modern contraceptive than their counterparts (reference group) and were statistically significant. Modern contraceptive use is notably low among women of reproductive age in Ethiopia. Factors such as age, women's educational level, religion, marital status, number of living children, wealth status, gender and age of household head, and region were identified as significant factors associated with modern contraceptive use. Therefore, to increase modern contraceptive use, governmental and non-governmental organizations should invest in women's education and financial empowerment and raise awareness about the benefits of modern contraceptives, especially among older, unmarried, financially poor, elderly-led households, with few living children, and uneducated women.

Married women’s decision-making autonomy on modern contraceptive use and its associated factors in high fertile sub-Saharan Africa countries: a multi-level analysis of Demographic and Health Surveys

BackgroundFor better maternal and child health, women’s independence on reproductive health issues is crucial; however, couples are restricted from discussing openly with their partner. Regarding this, information about women’s decision-making autonomy is low in the world, including Sub-Saharan Africa; therefore, this study was aimed to assess married women’s decision-making autonomy on modern contraceptive utilization in high fertility SSA countries.MethodsData for this study was obtained from the most recent (2010–2018) Demographic and Health Surveys. A total of weighted sample of 14,575 married reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of decision-making autonomy on modern contraceptive utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance.ResultsOverall prevalence of married women decision-making autonomy on modern contraceptive utilization in the high fertile SSA countries is 25.28% (95% CI:18.32%, 32.24%). The factors significantly associated with the decision-making autonomy on modern contraceptive utilization were women’s age 25–34 years (AOR = 1.88, 95% CI = 1.84–1.93) and 35–49 years (AOR = 1.90, 95% CI = 1.82–1.92), had media exposure (AOR = 1.13, 95% CI = 1.00- 1.28), Number of alive children, 1–2 (AOR = 2.35, 95% CI = 1.38–4.01), 3–4 (AOR = 2.98, 95% CI = 1.74–5.10), ge 5 (AOR = 2. 82, 95% CI = 1.63–4.86), educational status; primary education (AOR = 1.93, 95% CI = 1.77–2.83), Secondary and higher (AOR = 2.11, 95% CI = 1.78–2.89), Community media exposure (AOR = 1.80, 95% CI = 1.38–2.34), Community level poverty, (AOR = 1.43, 95% CI = 1.09–1.86) and resides in rural (AOR = 0.67, 95% CI = 0.64–0.71).ConclusionWomen’s decision-making autonomy on modern contraception utilization in this study was low. Therefore, the government should promote women’s autonomy on contraceptive use as an essential component of SRH rights through mass media, with particular attention for, women living in the poorest communities, and those residing in rural settings of the country. Moreover, health professionals should counsel the women about the benefits of using modern contraceptive to help them managing their number of children.

Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review

BackgroundDemand generation aims to increase clients’ desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning.MethodsWe searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings.ResultsForty-six studies (published 1990–2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services.ConclusionsDemand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization.Trial RegistrationSystematic review registration: Center for Open Science, osf.io/286j5

MODERN CONTRACEPTIVE USE AMONG URBAN AND RURAL YOUNG MARRIED WOMEN IN INDONESIA

Family planning is generally recognized as a crucial key in reducing maternal and neonatal mortality and morbidity. This study aimed to explore whether the predictors of modern contraceptive use among young married women differ by place of residence. The data were drawn from the 2019 Indonesia Population, Family Planning, and Family Development Program Performance and Accountability Survey. This study restricted the sample of non-pregnant married women aged 15-24, resulting in a sample of 3,927 young married women. Logistic regression with the place of residence variable used as an interaction term to model the association between selected social, economic, and demographic variables and the outcome variable, modern contraceptive use for each group of women. The number of living children and region exhibited significant variability in contraceptive use among urban and rural young married women. Urban young married women with 1-2 children had higher odds (OR = 27.10; p = 0.000) of using contraceptives compared to rural ones (OR = 15.60; p = 0.000) in regard to number of living children. Rural women residing other islands (non-Java Bali) were less affected (OR = 0.59; p = 0.000) than urban young married women in accessing modern contraceptives (OR = 0.64; p = 0.002). Disseminating information, education, and communication about the health risk of having more than two children would improve the use of modern contraceptives. Family planning policies should also be tailored to address the specific needs of different places of residence with geographical regions.

Association of migration and family planning use among women in Malawi: Evidence from 2019/2020 Malawi Multiple Indicators Survey

BackgroundFamily planning (FP) is known to bring multiple benefits to people both individually and collectively. Individually, FP has been associated with reduction in risk of unintended pregnancy which also correlates with low child mortality rates. Child mortality rates in women with child spacing of less than two years are 45% higher compared to their counterparts with child spacing of more than two years. Several factors that predict FP utilisation among women of childbearing age have been identified but there is limited literature on how migration impacts FP utilisation in Malawi. Our current study aimed at assessing the association between migration and modern contraceptive use among women of childbearing age in Malawi.MethodsData for this study came from a nationally representative 2019/20 Malawi multiple cluster indicator survey (MICS). At total of 24,543 women aged 15 to 49 participated in the survey. Contraceptive prevalence rate (CPR) analyses were conducted separately on all women of childbearing age and married women. The data was analysed using the complex survey data approach by applying sampling weights to correct unequal representation of participants at cluster, district, and regional level. We used binary logistic regression to assess association between migration status and modern contraceptive use among all women of childbearing age and married women separately. We included age, age at first sex, age at marriage, region of residence, education, residence wealth index and presence of disability as confounders in our final multivariable models.ResultsThe overall CPRs for married women and for all women of childbearing age were 64.7% and 40.5% respectively. The CPRs for all women of childbearing age were 40.5% for non-migrants and 33.0% for migrant women. For married women, CPRs were 51.5% for migrant women and 65.5% for non-migrant women. The fully adjusted odds ratios for the association between migration status and modern contraceptive use were 0.62 (0.49–0.78) for married women and 0.65 (0.52–0.80) for all women of childbearing age.ConclusionsWe conclude from our findings that migrant women were significantly less likely to utilize modern contraceptive methods for both married women and all women of childbearing age. Deliberate efforts are required to ensure that migrant women of childbearing age have equal access to sexual and reproductive health services which includes family planning.

Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis

BackgroundModern contraceptive refers to “a product or medical procedure that interferes with reproduction from acts of sexual intercourse”. The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana.MethodsWe examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15–49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05.ResultsIn the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097–1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065–1.289), middle (AOR = 1.24; 95% CI = 1.118–1.385), and fourth (AOR = 1.25; 95% CI = 1.113–1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042–1.830), rural-middle (AOR = 1.45; 95% CI = 1.084–1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128–2.059), and rural-high (AOR = 1.42; 95% CI = 1.019–1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20–24 (AOR = 2.33; 95% CI = 2.054–2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981–1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385–1.736), Central (AOR = 1.48; 95% CI = 1.296–1.682) and Eastern (AOR = 1.48; 95% CI = 1.289–1.695) regions significantly predicted modern contraceptive use.ConclusionModern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.

Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies.

Around half of adolescent pregnancies in low- and middle-income countries are unintended, contributing to millions of unsafe abortions per year. Adolescents 360 (A360), a girl-centred initiative, aimed to increase voluntary uptake of modern contraceptives among adolescents in Nigeria, Ethiopia and Tanzania. We evaluated the effectiveness and cost-effectiveness of A360 in increasing modern contraceptive use in selected geographies. We used before-and-after cross-sectional studies of adolescent girls in four settings. Two Nigerian settings had purposefully selected comparison areas. Baseline and endline household surveys were conducted. The primary study outcome was modern contraceptive prevalence rate (mCPR). Secondary outcomes mapped onto the A360 Theory of Change. Interpretation was aided by a process evaluation along with secular mCPR trends and self-reported A360 exposure data. Incremental design and implementation costs were calculated from implementer systems, site visits, surveys, and interviews. mCPR change was modelled into maternal disability-adjusted life years (DALY) averted to calculate incremental cost-effectiveness ratios. In Oromia, Ethiopia, mCPR increased by 5% points (95% CI 1-10; n = 1,697). In Nigeria, there was no evidence of an effect of A360 on mCPR in Nasarawa (risk ratio: 0·96, 95% CI: 0·76-1·21; n = 5,414) or in Ogun (risk ratio: 1·08, 95% CI: 0·92-1·26; n = 3,230). In Mwanza, Tanzania, mCPR decreased by 9% points (-17 to -0.3; n = 1,973). Incremental cost per DALY averted were $30,855 in Oromia, $111,416 in Nasarawa, $30,114 in Ogun, and $25,579 in Mwanza. Costs per DALY averted were 14-53 times gross domestic product per capita. A360 did not lead to increased adolescent use of modern contraceptives at a population level, except in Oromia, and was not cost-effective. This novel adolescent-centred design approach showed some promise in addressing the reproductive health needs of adolescents, but must be accompanied by efforts to address the contextual drivers of low modern contraceptive use.

Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria.

This study explored the influence of social norms on the access and utilization of sexual and reproductive health services by adolescents. Apart from individual and environmental barriers, social norms influence contraceptive decisions and ultimately sexual and reproductive health outcomes. Social norms that shape group behavior describe acceptable standards of behavior and evoke sanctions when such behavior standards are not adhered to. Sexually active adolescents in Nigeria have a relatively low level of modern contraceptive use being influenced by social norms. Scaling up adolescent reproductive health interventions that integrate normative change for a wider impact of programs remains challenging. Using data from 18 communities, 188 married and unmarried adolescents (F52% and M48%) and 69 (F37%; M63%) reference group participants were purposively sampled and participated in a social norms exploration intervention study conducted through focus group discussion and in-depth interviews between October and November 2019. The Advancing Learning and Innovation on Gender Norms (ALIGN) Social Norms Exploration Tool (SNET) was adapted for the data collection into discussion guides and vignettes. Pilot testing of the tools informed review and validation prior to actual data collection. Low contraceptive uptake by adolescents was characterized by early and forced marriage in childhood; a prominent practice enshrined in social norms around girl-childchastity, family honor, and disapproval of pre-marital sex and pregnancy out of wedlock. The understanding of harmful social norms, normative change actors, and potential norm-shifting factors for contraceptive decisions by adolescents is essential for effective adolescent sexual and reproductive health interventions for wider impact and adaptive programming in behavior change interventions for improving the access to and utilization of modern contraceptives by adolescents for improved sexual health outcomes, the attainment of the Family Planning (FP) 2030 commitment and universal health coverage policy.

A continuum of individual-level factors that influence modern contraceptive uptake and use: perspectives from community members and healthcare providers in Durban, South Africa

BackgroundSouth Africa faces numerous sexual and reproductive health challenges that can be mitigated with contraceptive use. Contraceptive use is defined and measured as use, non-use, or discontinued use. Research has shown that there are expanded definitions of use beyond these categories. Identifying such categories may assist in a better understanding of factors that influence contraceptive use.Setting and methodologyThis qualitative study was conducted in the eThekwini Municipality in KwaZulu-Natal, South Africa. The aim was to explore the factors influencing the uptake and use of modern contraception. One hundred and twenty-seven participants were enrolled in this study. One hundred and three of those were community members, and twenty-five were healthcare providers. Focus group discussions and in-depth interviews were conducted to gather the data. Data analysis was facilitated using NVivo 10 software. ResultsThe data show that numerous factors influence contraceptive uptake and use. From these factors, a continuum of use that captures a variety of states of use emerged. Five different states of use were uncovered: no-use, vulnerable use, compelled use, conditional use, and autonomous use. The development of the model illustrates the complexity of contraceptive needs and that it extends beyond definitions found in policies and large-scale surveys. Expanding conceptions of use can aid in developing counselling and information support tools that can improve the uptake and continued use of modern contraception.