Modern Contraceptive Prevalence Rate Research Articles

National Policy Influences of Contraceptive Prevalence and Method Mix Strategy: A Longitudinal Analysis of 59 Low- and Middle-Income Countries, 2010-2021.

Understanding the impact of family planning policy and actions is essential for building effective strategies to increase contraceptive use. This study identifies policies that correlate with modern contraceptive prevalence rate (mCPR) and private-sector contraceptive method mix strategies (the number of contraceptive methods offered in the private sector) in low-income and middle-income countries. While education, contraceptive choices, and economic growth are known determinants of contraceptive prevalence, many national policies intended to increase contraceptive prevalence in the short term to medium term have ambiguous evidence that they indeed do so. By developing beta and Poisson regression models using 12 years of reported Contraceptive Security Indicators Survey data (2010-2021) from 59 countries, this study investigated the effect of 20 independent variables on mCPR or method mix strategies. Furthermore, to help interpret the potential consequences of economic status, separate models segmented by gross national income (low, low-middle, and upper-middle) were assessed. Of 20 independent variables, 10 are implicated with mCPR and 6 with a method mix strategy. Of these, increasing the share of domestic financing (versus donor funding) for contraceptives had the broadest and strongest contribution. mCPR is also predicted by the existence of national insurance systems that cover contraceptive costs, contraceptive security committees, family planning logistics management information systems, and, inversely, by client fees. A comprehensive private-sector method mix strategy-which itself influences mCPR-is also driven by these, as well as the inclusion of more contraceptives on the national essential medicines list. These findings have implications for countries seeking to expand access to and use of contraceptives through policy initiatives.

Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study

IntroductionUganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda.MethodsA comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed.ResultsWe found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27–2.16], acquired skills [AOR = 2.28, 95% CI: 2.11–2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3–5 years [AOR = 2.24, 95% CI: 1.46–3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods.ConclusionOur findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.

CONFRONTING PAKISTAN'S OVERPOPULATION ISSUE FOR LONG-TERM SOLUTIONS

CONFRONTING PAKISTAN'S OVERPOPULATION ISSUE FOR LONG-TERM SOLUTIONS

Is Pakistan’s fertility transition stalling?

ABSTRACT This study examines the question as to whether Pakistan’s fertility transition is stalling. The paper reviews the trajectories of fertility and its various determinants and compares Pakistan’s trends with those of India and Bangladesh. Countries in the South Asia region share features such as cultural similarities (e.g. the low status of women and son preference) and high poverty levels. However, while Bangladesh and India are near replacement fertility today with modern contraceptive prevalence rates well above 50 per cent, Pakistan still has one of the highest fertility and lowest contraceptive prevalence levels in Asia. Our main conclusion is that Pakistan’s fertility transition is close to stalling in mid-transition. The key causes of this stall are a high and unchanging desired family size, stalling demand for contraception and relatively low satisfaction of this demand. These are important obstacles to future decline in fertility.

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.

Feasibility and Acceptability of LNG 1.5 mg as an On-Demand Pericoital Contraceptive in Ghana.

Globally, there is a need for more family planning method options as currently, available options do not adequately meet the needs of women, specifically those who have infrequent sex. Levonorgestrel (LNG) 1.5 mg is widely available as emergency contraception pills (ECP), and recent research has shown that certain women take it as their main form of contraception. Furthermore, limited studies have found repeat, on-demand use safe and efficacious. This 12-month prospective, single-arm, interventional study in Ghana tested whether a single LNG 1.5 mg on-demand or pericoital ("around the time of sex") dose contraceptive was acceptable to women who have infrequent sex and if pharmacy provision was feasible. The study sample (1,890) comprised women of reproductive age recruited from urban areas, having infrequent sex (i.e., coital frequency ≤ 6× per month), and not using any other modern methods except condoms or ECP at the time of study inclusion. Results indicated that there is demand and acceptability for a pericoital pill and that pharmacy provision is feasible. Furthermore, precoital use of the pill had high levels of satisfaction and was popular with new users. Adding LNG 1.5 mg for pericoital use to the family planning method mix has the potential to address an important segment of the population currently underserved, decreases unwanted pregnancies, and increases modern contraceptive prevalence rates.

Trends and determinants of modern contraceptive utilisation among adolescent girls aged 15-19 years in Sierra Leone: an analysis of Demographic and Health Surveys, 2008-2019

Background Modern contraceptives are effective interventions for preventing unwanted pregnancies, but their use remain low among adolescent girls in sub-Saharan Africa. First, we aimed to assess the trends of modern contraceptive use among adolescent girls aged 15-19 years in Sierra Leone in the period 2008-2019. Second, we explored how individual and contextual determinants of their use changed during this period. Methods We used a combined sample of 8,774 adolescent girls aged 15-19 years from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys (SLDHS), respectively, to estimate the modern contraceptive prevalence rate (MCPR) and unmet need for family planning. We described the method mix and sources of contraceptives among modern method users. We then conducted a multivariable logistic regression to examine the determinants of modern contraceptive use among sexually active adolescent girls, separately for 2008 and 2019. Results MCPR increased from 5.9% (95% CI=4.5-7.8) in 2008 to 21.0% (95% CI=19.2-22.9) in 2019. Most of the increase had occurred by 2013. Norplant (48.8%) and injectables (39%) were the common methods in 2019. Unmet need for family planning declined from 15.4% (95% CI=13.2-17.9) in 2008 to 11.3% (95% CI=9.9-12.7) in 2019, while the prevalence of modern contraceptive use among sexually active adolescent girls increased from 13.1% (95% CI=10-17.0) in 2008 to 43.5% (95% CI=40.2-46.9) in 2019. In both the 2008 and 2019 surveys, the adjusted odds of using modern contraceptives among sexually active adolescent girls were higher among those with more than one sexual partner in the past 12 months, and with secondary or tertiary education. In 2019, the adjusted odds of using a modern contraceptive were also lower among adolescent girls who were married or living with a partner, had more than one child, and lived in the Western province. Conclusions The increase in contraceptive use among adolescent girls in Sierra Leone had stalled since 2013. Interventions, including increasing awareness and accessibility to modern contraceptives, are urgently needed, particularly for adolescents without formal education. Comprehensive and affordable community and school-based interventions, including adolescent-friendly services, would be helpful.

Factors Associated with Contraceptive Use in Malaysia and Pakistan

Most developing countries launched the national family planning program in the 1960s/70s. However, some countries’ contraceptive prevalence rate (CPR) remains low or stagnated. Despite having a similar religious belief, the level of contraceptive use differed between Malaysia and Pakistan. This study examines the factors associated with contraceptive use in Malaysia and Pakistan. This study used secondary data from the 2014 Malaysian Population and Family Survey and the 2017–2018 Pakistan Demographic and Health Survey. A total of 5,175 Malaysian and 14,502 Pakistani currently married women aged 15–49 were included in this study. The dependent variable is current contraceptive use. The independent variables include women’s age, age at first marriage, place of residence, women’s educational level, employment status, and the number of living children. Crosstabulations show that urban, better-educated, and working women in Pakistan reported higher modern CPR than their rural, lesser-educated, and non-working counterparts; however, the opposite was observed in Malaysia. Multinomial logistic regression analysis reveals that rural women were less likely to practice modern and traditional methods than non-use in Pakistan. In Pakistan, the odds of practising modern and traditional methods than non-use were higher among women who attained at least primary education, while working women were more likely to practice modern contraceptive methods than non-use and traditional methods. However, women’s education and employment factors were insignificant in the multivariate context of the case of Malaysia. Enhancing women’s socio-economic status and reaching out to rural, uneducated, and jobless women are essential to improving contraceptive use, especially in Pakistan.

Community and Health Care Provider Perspectives on Barriers to and Enablers of Family Planning Use in Rural Sindh, Pakistan: Qualitative Exploratory Study.

Unmet need for family planning in Pakistan is high, with 17% of all married women wanting to avoid or delay pregnancy. However, they cannot owing to a lack of access to modern contraception and sociocultural hindrances. With the modern contraceptive prevalence rate stagnant at approximately 25% over the last 5 years, it is important to explore barriers and enablers to modern contraception uptake to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women. A formative research approach was taken to explore community member and health care provider perspectives on access to and use of family planning methods in 2 rural districts of Sindh, Pakistan. The broader goal of this study was to provide evidence to design and implement a socioculturally appropriate family planning intervention within the existing service delivery platforms to increase modern contraceptive uptake in the context of rural Sindh. A qualitative exploratory design was used. Between October 2020 and December 2020, 11 focus group discussions and 11 in-depth interviews were conducted. Focus group discussions were held with men and women from the community, including adolescents, to build an understanding of community beliefs and concepts regarding modern contraceptive methods. In-depth interviews were conducted with health care workers and explored intersections between family planning and reproductive health service delivery at the facility and outreach levels. The findings revealed that limited financial autonomy, restricted women's mobility, discriminatory gender norms, and cultural practices left women with little opportunity for independent decision-making on the use of modern contraceptive methods. Furthermore, facility-level and supply-side barriers, including frequent stock-outs of modern contraceptives combined with a lack of capacity of health workers to provide quality family planning services and counseling, played an important role in demotivating women from seeking services. In addition, a lack of integration of family planning with maternal and child health service delivery at the health system level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to family planning uptake were also highlighted. These included husbands' or in-laws' disapproval, social stigma, and perceived fear of side effects regarding modern family planning method use. More importantly, a lack of adolescent-friendly reproductive health services and spaces for counseling was identified as a critical intervention area. This study provides qualitative evidence on issues related to the effectiveness of family planning interventions, specifically in the context of rural Sindh. The findings emphasize the need to design socioculturally appropriate and health system-relevant family planning interventions-the effectiveness of which can be improved through their integration with maternal and child health service delivery mechanisms, consistent service provision, and opportunities for the capacity building of the health care workforce. RR2-10.2196/35291.

Demand for modern contraceptives and use among women of reproductive age in north central Nigeria

Background: The maternal mortality rate in north central Nigeria remained unacceptably high and the use of modern contraceptives among women of reproductive age in north central Nigeria may be a way of reducing maternal death. The study aimed to determine the contraceptive uptake among women of reproductive age in north central Nigeria and the factors that influence the use of contraceptives. Methods: The study was a secondary analysis of 2018 national demographic and household survey data. Data were abstracted for women of reproductive age 15-49 years across seven states in Nigeria. Results: The level of awareness of modern contraceptives was 91.6% while the modern contraceptive prevalence rate was 38.8% and current contraceptive prevalence use was 53.4%. The main source of information was radio 298 (22.4%) and the most common contraceptive used was implants 81 (29.3%) followed by hormonal contraceptive injections 77 (27.4%). The factors associated with the use of contraceptives include the age of the women, religion, level of education, number of children ever born, and partners’ opinion (p=0.001). The proportion of women who oppose contraceptive use was significantly higher (χ2=4.732, p=0.030). Similarly, the proportion of women whose husbands/partners opposed contraceptive use was significantly higher (χ2=8.589, p=0.003, OR=3.2). Conclusions: The prevalence of contraceptive use is low in north-central Nigeria despite the high level of awareness. There is a need to involve the women’s partner to increase the uptake of contraceptive use.

Spatial variations and multilevel mixed effect analysis on determinants factors of modern contraceptive utilization among reproductive age women in Ethiopia; proven by Ethiopian mini demographic health survey 2019

IntroductionGlobally, in 2019, there are 1.9 billion women of reproductive age (15–49), of which 1.1 billion have a need for family planning. Of these, 842 million use contraceptives, and 270 million still have an unmet need for contraception. Ethiopia is a low-income country with inadequate access to family planning (FP), especially in the developing regions. The Ethiopian government was striving to increase the number of health facility in order to provide quality maternal care and services. Increasing the modern contraceptive prevalence rate is one of the goals of the government to reduce maternal and child mortality and morbidity.MethodsSecondary data analysis was conducted using data from mini-EDHS of 2019 demographic and health Survey datasets. The study comprised a total of 8885 reproductive-age women. Spatial variations and multilevel mixed effect analysis on determinants factors of modern contraceptive use among reproductive age women in Ethiopia; evidenced by mini-EDHS 2019. Finally, the percentage and odd ratio, its 95% confidence intervals, and the result of spatial analysis were reported.ResultThis study includes a total weighted sample of 8885 reproductive-age women from the 2019 mini-Ethiopian demographic and health survey. The prevalence of modern contraceptive use was 25.5% in Ethiopia. living in urban area [AOR = 2.13; 95% CI = (1.75, 2.61); P = 0.000], being married [AOR = 1.42; 95% CI = (1.19, 1.70); P = 0.000] were found positively associated with contraceptive use. In contrast to this, attending primary education [AOR = 0.91; 95% CI = (0.74, 1.12); P = 0.000]., being Muslim [AOR = 0.25; 95% CI = (0.22, 0.29); P = 0.000], being poorest [AOR = 0.54; 95% CI = (0.45, 0.66); P = 0.000] were found negatively associated with contraceptive use.ConclusionIn this study Individual and community level factors were associated with modern contraceptive use and also there were spatial variations in modern contraceptive use across the region among reproductive-age women. Empowering women to have better educational status, improving the wealth index, promoting marriage, creating awareness among rural residences women and promoting education about modern contraceptives through religiously acceptable persons, and promoting modern contraceptive use in developing regions were the key factors to improve modern contraceptive use among reproductive age women in Ethiopia.

Community-Driven Family Planning in Urban Slums: Results from Rawalpindi, Pakistan.

Pakistan's contraceptive prevalence rate (CPR) has remained static (less than 1% annual increase since 2006) due to several demand and supply issues. The Akhter Hameed Khan Foundation implemented a community-driven, demand-generation intervention with complementary supply side family planning (FP) services in a large urban informal settlement in Rawalpindi, Pakistan. The intervention recruited local women as outreach workers called Aapis (sisters), who conducted household outreach and provided counseling, contraceptives, and referrals. Program data were used to guide in-program corrections, identify the most willing to use married women of reproductive age (MWRA), and target specific geographic locations. The evaluation compared results from two surveys. The baseline survey included 1485 MWRA while the endline included 1560 MWRA that were sampled using the same methodology. A logit model was used with survey weights and clustered standard errors, to estimate the odds of using a contraceptive method. CPR in Dhok Hassu increased from 33% at the baseline to 44% at endline. Long-acting reversible contraceptives (LARCs) usage increased from 1% at baseline to 4% at endline. Increase in CPR is correlated with increasing number of children and education of MWRA and is the highest between the ages of 25 and 39 and for working women. Qualitative evaluation of the intervention provided lessons about in-program corrections using data and empowerment of the female outreach workers and MWRA. The Aapis Initiative is a unique community-based demand-supply side intervention that successfully increased modern contraceptive prevalence rate (mCPR) by economically engaging the women from within the community as outreach workers and enabling healthcare providers to establish a sustainable ecosystem for increasing knowledge and access to family planning services.

Trend and Future Perspective of Modern Contraceptive Prevalence, Unmet Need, and Demand Satisfied for Modern Methods for All 38 Districts of Bihar State in India: Application of Family Planning Estimation Tool at District Level

Background: Estimating couples in need and demand of contraceptives for a country helps policy makers for better planning, budget allocation and implement a focused program to achieve the desired goals, especially at district level. In Bihar, the state with India’s highest population density and lowest socioeconomic standing. The family planning indicators have been estimated and projected at the national and state levels in most attempts, while estimation at the district level has rarely been attempted. Methods: We have used a statistical model that can generate estimates and projections of rates and trends of indicators related to access to reproductive health at the national and sub-national levels. Avenir Health has packaged this model in the form of a user-friendly web application, the Family Planning Estimation Tool (FPET), which can be operated by local stakeholders with little external support. We present here annual estimates and projections of rates and trends of the modern contraceptive prevalence rate, unmet need, and demand satisfied for modern family planning methods at state level and its 38 districts from 1991 to 2030 with application of FPET. Findings: There is a large amount of heterogeneity between the districts; only three districts have high modern contraceptive prevalence rate (mCPR > 54%) and high met demand with a modern contraception of more than 74 percent in 2021; whereas five districts have low mCPR of less than 40 percent in 2021. It is estimated that 11 districts out of 38 districts are likely to reach met demand with a modern method greater than 74 percent by 2030. Overall Bihar requires additional 3.6 million users of modern contraceptives from 2021 to reach 74 percent of demand satisfied with modern contraceptive methods by 2030. But the findings estimate that approximately 3 million additional MWRA will be using modern contraceptive methods during 2021 and 2030 in Bihar. Indeed, the estimates suggest that the increase in the mCPR needed to achieve 74 percent or more demand satisfied with modern methods by 2030 in Bihar, four districts, namely, Kisanganj, Katihar, Gopalganj and Saran should be focused and prioritized followed by another five districts, namely, Siwan, Arwal, Purba Champaran, Sitamarhi, and Sheohar as these districts will be at the bottom of the table with less than 70 percent of demand satisfied with modern methods by 2030. Conclusion: The identification of districts that are performing better or worse helps decentralized planning effectively. The analysis can be generalized to other states and districts as well as other types of population subgroups.

Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana.

Contraceptive use among sexually active women in Ghana remains low despite the efforts by the Ghana Health Service. This development has negative consequences on reproductive health care, particularly among adolescents. This study assessed the prevalence and factors influencing contraceptive use among sexually active young women in the Berekum Municipality, Ghana. A community-based cross-sectional analytical study was carried out in Berekum East Municipality among young women between the ages of 15 to 24 years. Using a probabilistic sampling technique, we recruited 277 young women from the four selected communities in the Berekum Municipality based on data available from the Municipal Health Administration. We applied a univariate and multivariate logistic regression analysis to test the associations between the dependent and independent variables at a 95% Confidence interval (CI) and 5% significance (p value = 0.005). The modern contraceptive prevalence rate among the study participants was 211 (76%). Contraceptives ever used were emergency contraceptive pills 88 (41.7%) condoms 84 (39.8%), injectables 80 (37.9%) and the rest used the Calendar method 16 (7.58%), withdrawal 15 (7.11%), and implants 11 (5.21%). In the adjusted multivariate logistic regression, Age (AOR = 2.93; 95% CI; 1.29-7.50) p = 0.023, marital status (AOR = 0.08; 95%CI; 0.01-0.91) p = 0.041 and religion (AOR = 0.17; 95% CI; 0.05-0.64) p = 0.009 were significantly associated with contraceptive use. Other determinants such as hearing about contraceptives (AOR = 9.44; 95%CI; 1.95-45.77) p = 0.005, partner opposition (AOR = 33.61; 95%CI; 1.15-985.39) p = 0.041, side effects (AOR = 4.86; 95%CI; 1.83-12.91) p = 0.001, lack of knowledge (AOR = 5.41; 95%CI; 1.15-25.42) p = 0.032, and respondents receiving counselling on family planning were significantly associated with contraceptive use (AOR = 4.02; 95% CI;1.29-12.42), p = 0.016. Contraceptive use among sexually active women in the Berekum Municipality is higher than the national conceptive prevalence rate. However, factors such as knowledge about the side effects of contraceptive influences contraceptive use among women. Healthcare providers must explore avenues to enhance partner involvement, intensify health education and detailed counselling about contraceptive use to address misconceptions and myths surrounding the side effects of contraceptives.

Quality of family planning counseling and associated factors among women attending family planning clinics at selected health centers in Akaki Kality sub-city, Addis Ababa, Ethiopia.

Ethiopia has achieved a remarkable improvement in the provision of family planning. The modern contraceptive prevalence rate has shown a fivefold increment in the last two decades, yet the family planning service in the country is still deficient and characterized by poor counseling quality. The aim of the study is to assess the quality of family planning counseling provided and the associated factors at selected health centers in Akaki Kality sub-city, Addis Ababa, Ethiopia. A cross-sectional study was conducted among 678 randomly selected women attending family planning services at health centers in Addis Ababa, Ethiopia. Multivariable logistic regression analysis was performed to identify factors associated with the quality of family planning counseling. A total of 678 women participated in the study. About 29.1% [95% confidence interval (CI): 25.7%-32.6%] of the respondents were adequately counseled. Age groups 37-49 [adjusted odds ratio (AOR) = 2.7; 95% CI: 1.1-6.6], being in marital union (AOR = 2.8; 95% CI: 1.2-6.7), attaining secondary education (AOR = 1.9; 95% CI: 1.1-3.6) or higher education (AOR = 2.2; 95% CI: 1.2-4.3), and visit status (AOR = 1.6; 95% CI: 1.1-2.4) were significantly associated with good counseling. Less than one in three women was counseled adequately. Health professionals should give due attention to younger women, single clients, and clients with their first presentation to the health facility. It also indicates that promoting education among Ethiopian women is crucial for a positive outcome of family planning counseling.

Socioeconomic inequalities and family planning utilization among female adolescents in urban slums in Nigeria.

Background/statement of problemFamily planning (FP) utilization is important for preventing unwanted pregnancy and achieving optimal reproductive health. However, the modern contraceptive prevalence rate (mCPR) among women of childbearing age is still low in many low- and middle-income countries (LMIC), particularly in Nigeria, despite interventions to increase access and utilization. The low mCPR has been associated with a high prevalence of unwanted pregnancy, unsafe abortion, sexually transmitted infections such as HIV/AIDS, and high maternal and infant mortality in LMIC. Despite existing studies associating high family planning utilization to urban settings relative to the rural areas, the socioeconomic inequality in urban settings, especially among adolescents in urban slums has been given less research attention. This study examines the role of socioeconomic inequality on family planning utilization among female adolescents of various ethnic backgrounds in urban slums in Nigeria.MethodsThe study utilized data from the Adolescent Childbearing Survey (2019). A total sample of 2,035 female adolescents of ages 14–19 years who were not pregnant at the time of the study and were resident in selected slums. Associations between socioeconomic inequalities—measured by wealth index, social status, and education—and modern contraceptive use were examined using relative and slope inequality indices, and logistic regression models.ResultsThe results show that only 15% of the female adolescents in the North, and 19% in the South reported modern contraceptive use. While wealth index and education were important predictors of FP use among adolescents in southern urban slums, only education was important in the North. However, the relative and slope inequality indices further indicate that adolescents with no education and those in the lowest social status group use much fewer contraceptives compared to their counterparts with higher wealth and social statuses. Those with secondary/higher education and the highest social status group, respectively, were more disadvantaged in terms of FP utilization (Education: RII = 1.86, p < 0.05; 95% C.I. = 1.02–2.71; Social Status: RII = 1.97, p < 0.05; 95% C.I. = 1.26–2.68) with results showing a more marked level of disparity when disaggregated by North and South.ConclusionThe persistent socioeconomic inequalities among female adolescents in Nigeria, especially those in the urban slums, have continued to limit their utilization. Policy measure in education, communication and subsidized contraceptives should be intensified for vulnerable female adolescents in the slums.

Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019

SummaryBackgroundMeeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019.MethodsWe used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15–49 years) self-reported their, or their partner's, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study.FindingsIn 2019, 162·9 million (95% uncertainty interval [UI] 155·6–170·2) women had unmet need for contraception, of whom 29·3% (27·9–30·6) resided in sub-Saharan Africa and 27·2% (24·4–30·3) resided in south Asia. Women aged 15–19 years (64·8% [62·9–66·7]) and 20–24 years (71·9% [68·9–74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3–48·0) women aged 15–24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15–19 years were substantially lower than among women aged 20–49 years at SDI values below 60 (on a 0–100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7–21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019.InterpretationThe dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15–24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users.FundingBill & Melinda Gates Foundation.

Contextual factors associated with contraceptive utilization and unmet need among sexually active unmarried women in Kenya: A multilevel regression analysis.

Unmarried women who report less recent sexual intercourse (>30 days from survey enumeration) are largely excluded from global health monitoring and evaluation efforts. This study investigated level and contextual factors in modern contraceptive utilization and unmet need within this overlooked female subpopulation in Kenya from 2014 to 2019. This study analyzed data from the Performance Monitoring and Accountability (PMA) survey in Kenya, a nationally representative survey of female respondents, to understand the level and contextual factors for family planning utilization and unmet need within female subgroups including married, unmarried sexually active (defined as sexual intercourse within 30 days of survey enumeration), and unmarried with less recent sexual intercourse (defined as sexual intercourse 1-12 months prior to survey enumeration). The analysis included multilevel regression modeling to assess correlates on outcomes of modern contraceptive prevalence rate (mCPR), unmet need, and recent emergency contractive pill (ECP) use, which is a unique PMA question: "Have you used emergency contraception at any time in the last 12 months?". Cumulatively, the surveys enumerated 19,161 women and this weighted analysis included 12,574 women aged 15-49 from three female subgroups: 9,860 married women (78.4%), 1,020 unmarried sexually active women (8.1%), and 1,694 unmarried women with less recent sexual intercourse (13.5%). In 2019, while controlling for covariates, unmarried women with less recent sexual intercourse exhibited statistically significant differences (p-value<0.02) in current mCPR, mCPR at last sexual intercourse, unmet need for modern contraceptives, and recent ECP use. As compared to an unmarried woman with less recent sexual intercourse (i.e., reported sex 1-12 months prior to survey), the odds of an unmarried sexually active woman (i.e., reported sex within last 30 days of survey) currently using modern contraceptives was 2.28 (95% CI: 1.64, 3.18), using modern contraceptives at last sexual intercourse was 1.44 (95% CI: 1.06, 1.95), and having an unmet need for modern contraceptives was 2.01 (95% CI: 1.29, 3.13) while controlling for covariates. The odds of a married woman using ECP during the last 12 months was 0.60 (95% CI: 0.44, 0.82) as compared to an unmarried woman with less recent sexual intercourse. In 2019, unmarried women with less recent sexual intercourse reported the highest rate of ECP use during the last 12 months at 13.5%, which was similar for unmarried sexually active women at 13.3%. Since 2014, summary measures of unmet need and total demand for modern contraceptives increased for unmarried women with less recent sexual intercourse, but declined for the other female subgroups. In Kenya, unmarried women with less recent sexual intercourse exhibited significantly different contraceptive utilization, unmet need, and recent emergency contraceptive use. Moreover, changes over time in key family planning indicators were asymmetrical by female subgroup. This study identifies an important monitoring gap regarding unmarried women with less recent sexual intercourse. Evidence dissemination by the global measurement community for these unmarried women is exceedingly scarce; therefore, developing an inclusive research agenda and actionable information about these marginalized women is needed to enable targeted planning and equitable service delivery.

Knowledge, Attitude and Practice towards Family Planning among the Reproductive Age Group of Married Women in Semi Urban Area

Background: Knowledge of contraceptive methods is nearly universal in Nepal, with almost all women and men knowing at least one method of contraception. The contraceptive prevalence rate among currently married women age 15-49 is 53%, with 43% using modern methods. This implies that Nepal needs to strengthen its family planning program to achieve the country’s commitments to global family planning goals and to reach a modern contraceptive prevalence rate of 52% by 2020.&#x0D; Materials and Methods: The study was descriptive cross sectional community based conducted in kharji, biratnagar municipality ward number 4, semi urban area or Eastern zone of Nepal. Total female of reproductive age 15 -49 married women 473 taken as a sample size. The data were collected by interview by predesigned and pretested questionnaire. Analysis of the data was done by SPSS.&#x0D; Results: Among all the respondents, 453 (95.77%) had the knowledge about the family planning. The majority of the study population 430 (90.90%) had positive attitude towards contraceptives. Among the all respondents, 210 (44.39%) were practice the different types of contraceptives methods. Most of the respondents 75(35.71%) practiced condom.&#x0D; Conclusion: The study concludes that the married women of reproductive age group had good knowledge and positive attitude towards family planning even though the practiced of family planning were low (44.39%).

Trend and determinants of quality of family planning counseling in Ethiopia: Evidence from repeated PMA cross-sectional surveys, (2014-2019).

The modern contraceptive prevalence rate (mCPR) among married women has increased by nearly five-fold in Ethiopia from 8.1% in 2000 to 37% in 2019. Despite this increase, receipt of high quality contraceptive counselling, as measured by the percentage of contraceptive users who were told about other methods, counseled on side effects and counseled what to do in the event that they encountered side effects, has declined in recent years. The quality of family planning counseling service measured by using these three components, known as the Method Information Index(MII), is an index designed to measure quality and a key indicator of the FP2020 initiative. The effects of potential client and service provider-level factors on receipt of high quality counseling and its progress over time have not been well studied in Ethiopia. We pooled data from seven Performance Monitoring for Action (PMA), formerly PMA2020, survey-rounds to examine the trend and effect of potential factors on receiving high quality of family planning counseling service in Ethiopia. Data from a total of 15,597 women aged 15 to 49 from seven survey-rounds were used in the analysis. To account for the study design and unequal probabilities of selection from target-populations for sampled women, design-based analysis was used to compute proportions. Multilevel ordinal regression model with enumeration area as a second level were employed to examine potential factors associated with quality of family planning counseling service. We found that the percentage of women who received high quality family planning counseling service declined from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally. Amhara region had the lowest percentage of women receiving high quality counseling at both the earliest(2014) and latest(2019) survey rounds(17% and 6%, respectively). Results show that lack of media exposure about family planning, having no formal education, using short-acting methods, and getting the service from pharmacy were the main factors associated with receiving low quality family planning counseling service. Given the importance of continuous provision of information on the range of family planning methods, it is imperative to use media and particularly regional media which can effectively address the rural populations in local languages as an important vehicle of information on family planning. Interventions aimed at improving quality of family planning counseling need to be mindful of regional disparities in the severity of the problem to ensure equity in service access. To improve the coverage of high quality family planning counseling service, there is an urgent need to re-visit the format of family planning counselling services.