Contraceptive Prevalence Research Articles

Influence of male targeted short message service on knowledge, nature of attitude and male involvement on uptake of family planning among spouses in Marsabit County, Kenya

Background: Family planning services helps the individuals or couples to regulate the number and determine healthy spacing and timing of pregnancies. Globally, contraceptive prevalence stands at 49.0%, Sub-Saharan Africa at 29.0%, Kenya at 56.9% and Marsabit County at 5.6%. Some of the reasons given for low uptake include low knowledge level, negative attitude and lack of male involvement on family planning matters. This study aimed at establishing the influence of male targeted short message service on knowledge, nature of attitude and male involvement on uptake of family planning among spouses in Marsabit County. Methods: A pre-test and post-test quasi experimental study design was adopted involving randomly selected 220 couples from Laisamis (control group) and Moyale (intervention group) sub-counties. Intervention of male targeted short message service was offered weekly to male spouses from Moyale sub-county. A questionnaire was used to collect data. Data analysis was done using SPSS. All the required ethical and logistical considerations were adhered to accordingly. Results: Male targeted short message service increased level of knowledge significantly (OR 4.173, p=0.001), changed nature of attitude (OR 2.7335, p=0.004) and male involvement in family planning (OR 4.4306, p=0.001). Conclusions: The study concluded male targeted SMS intervention increased level of knowledge, attitude changed and males were involved. The County government of Marsabit should engage opinion leaders in family planning to help in educating and changing the attitude of the men towards family planning.

Influence of male targeted short message service on uptake of family planning among spouses in Marsabit County, Kenya

Background: Family planning helps in regulating the number of children and determine healthy spacing and timing of births between pregnancies. The global contraceptive prevalence stands at 49.0%, Sub-Saharan Africa at 29.0%, Kenya at 56.9% while in Marsabit County at 5.6%. Male spouse involvement on matters of family planning deserves attention. This study aimed at establishing the influence of male targeted short message service on uptake of family planning among female spouses in Marsabit County, Kenya. Methods: A pre-test and post-test quasi experimental study design was adopted involving randomly selected 220 couples from Laisamis and Moyale sub-counties. Intervention of male targeted short message service was offered to male spouses from Moyale sub-county for a period of 4 months. A questionnaire was used to collect data. Quantitative data analysis was done using SPSS. All the required ethical and logistical considerations followed. Results: At baseline level of uptake was overall 14.3%, control 13.2% and intervention 15.4% while at endline overall 30.2%, control 20.4% and intervention 39.5%. Further results revealed that uptake of family planning was increased by use of short message service. Conclusions: The study concluded that the level of uptake was low but with SMS intervention uptake significantly increased. The Ministry of Health should consider integrating male targeted short message service intervention in provision of family planning services to increase uptake.

Societal Upheaval and the Contraceptive Transition

AbstractHuman development and family planning programs since the 1970s have led to a fast‐rising prevalence of modern contraceptive means at the global level. However, countries with rising but still low levels of contraceptive use experienced an increasing number of societal upheavals, including armed conflicts, sudden and high‐intensity natural disasters, as well as dramatic effects of health epidemics. This may challenge the continued diffusion of modern means of birth regulation as well as their adherent use. To better understand the role of societal upheavals in the contraceptive transition, we provide a narrative literature review of their multidimensional pathways of influence in the contraceptive decision‐making process. The review suggests four main findings. First, well‐known contemporary barriers to contraceptive use become more salient during societal upheavals. Second, historical barriers reemerge predominantly. Third, societal upheavals exert specific effects on the contraceptive transition, such as through birth replacement, the repopulation of communities, and the sexual vulnerability of girls and young women. Fourth, there are more pathways leading to a reduced (rather than a heightened) contraceptive prevalence. The conclusion discusses the implications of those insights for the contraceptive transition, provides a critical perspective of the literature, and draws avenues for future research.

Fertility Transitions in Low‐ and Middle‐Income Countries: The Role of Preferences

AbstractSince the mid‐twentieth century, the Global South has experienced unprecedently rapid and pervasive changes in reproductive behavior with fertility declining from high pre‐transitional levels to below 3 births per woman in most low‐ and middle‐income countries (LMICs). Over time a rough consensus has been reached on major theories about the causes of these declines. However, a controversy remains about the widely held view that changing reproductive preferences (i.e., declining desired family size and rising demand for birth limitation) are the dominant drivers of fertility transitions. Several studies question this conclusion and suggest instead that the rising implementation of existing demand is the main cause of the reproductive revolution in LMICs. The objective of this study is to reconcile the competing “demand” and “implementation” perspectives. This paper assesses the strengths and weaknesses of published decompositions which take trends in the observed total fertility and contraceptive prevalence and break them down into their respective demand and implementation components. The main conclusion from this exercise is that fertility transitions are driven by changes in both preferences and their implementation. Claims of a completely dominant role for either demand or implementation are based on flawed methods and hence must be rejected.

Health Transitions and the Rise of Modern Contraceptive Prevalence: Demand, Access, and Choice

Health Transitions and the Rise of Modern Contraceptive Prevalence: Demand, Access, and Choice

Unplanned births and their effects on maternal Health: Findings from the Constances Cohort

Unplanned births remain relatively common, even in regions with high contraceptive prevalence and accessible abortion services, such as contemporary France. Previous studies have shown that unplanned births can have numerous negative consequences for the well-being of mothers and children, including poorer maternal health behaviors, delayed and insufficient prenatal care, and depression during or immediately after pregnancy. However, these studies do not provide conclusive evidence on whether the observed outcomes are a consequence of unplanned births or of the conditions in which they likely occur. Furthermore, scant attention has been given to other dimensions of maternal well-being, such as physical health.This study uses longitudinal data from the French Constances Cohort and applies fixed-effects event study models to examine how women's self-rated general health and risk of depressive symptoms are affected in the years following an unplanned birth. Results show that women who had an unplanned birth reported a sudden, significant drop in their general health in the year following the birth, particularly among the youngest, while health outcomes following planned births showed a gradual, slight decrease over the time-period considered. The risk of depressive symptoms increased similarly after birth for both unplanned and planned births. This study contributes to the literature by using a longitudinally constructed measure of unplanned births based on pre-birth fertility intentions, rather than commonly used retrospective measures prone to ex post rationalization. It also distinguishes between unwanted and mistimed births while further examining their consequences on medium-term maternal health.

Mortality risk predicts global, local, and individual patterns of human reproduction

BackgroundHuman reproductive dynamics in the post-industrial world are typically explained by economic, technological, and social factors including the prevalence of contraception and increasing numbers of women in higher education and the workforce. These factors have been targeted by multiple world governments as part of family policies, yet those policies have had limited success. The current work adopts a life history perspective from evolutionary biology: like most species, human populations may respond to safer environments marked by lower morbidity and mortality by slowing their reproduction and reducing their number of offspring. We test this association on three levels of analysis using global, local, and individual data from publicly available databases.ResultsData from over 200 world nations, 3,000 U.S. counties and 2,800 individuals confirm an association between human reproductive outcomes and local mortality risk. Lower local mortality risk predicts “slower” reproduction in humans (lower adolescent fertility, lower total fertility rates, later age of childbearing) on all levels of analyses, even while controlling for socioeconomic variables (female employment, education, contraception).ConclusionsThe association between extrinsic mortality risk and reproductive outcomes, suggested by life history theory and previously supported by both animal and human data, is now supported by novel evidence in humans. Social and health policies governing human reproduction, whether they seek to boost or constrain fertility, may benefit from incorporating a focus on mortality risk.

New evidence on adolescent sexual and reproductive health and rights from the West and Central African region.

The African Journal of Reproductive Health is pleased to publish these compendiums of original research in this special edition that document new findings in adolescent sexual and reproductive health and rights from the West and Central African region (WCA). While sub-Saharan Africa has some of the worst indicators of sexual and reproductive health and rights (SRHR) in the world, the indicators are more daunting in the WCA region. To date, the WCA is recognized to have the highest rates of unwanted pregnancy, unsafe abortion, and human immunodeficiency virus (HIV) and other sexually transmissible infections, as well as the lowest contraceptive prevalence rates among adolescents worldwide.1 Despite the high rate of adverse adolescent reproductive health outcomes in WCA, there has been limited documentations of the socio-cultural and economic circumstances that perpetuate these adverse consequences. There have also been no purposefully designed interventions that provide strong scientific evidence for developing strategies to reverse the trend.

Determinants of Contraceptive Use Among Teenage Girls Aged (15-19) in Eastern Province, Zambia

Access to sexual and reproductive health information and services among the young people remains a highly contested issue in many traditional societies Zambia included. Access to youth-friendly health services such as contraceptives is vital for ensuring the well-being of adolescents. This study endeavoured to establish determinants of contraceptive use among teenage girls aged 15 to 19 years in Eastern Province, Zambia. This was a mixed methods study that employed a sequential explanatory design. In the quantitative arm, the study utilized the 2018 Zambia Demographic and Health Survey (ZDHS) women's dataset for Eastern Province, focusing on 326 teenage girls aged 15-19 years. The ZDHS data collection was done using multiple cluster sampling method and through household survey. The qualitative arm involved 6 focus group discussions with parents, 4 interviews with teachers and 6 interviews with healthcare providers in Petauke district. Contraceptive prevalence rate, and socio-economic and demographic factors influencing contraceptive use were measured in the quantitative part. The perception on teenage contraceptive use among key influencers was assessed in the qualitative arm. The prevalence of contraceptive use among teenage girls in Eastern province was at16%. Age, marital status, parity, visiting a health facility, being visited by a health provider and hearing about family planning on radio were significantly associated with contraceptive use (p< 0.05). Moreover, teenage girls who had ever been married had higher odds of contraceptive use than unmarried ones (AOR 3.57, 95% CI, 1.59, 8.01, p = 0.002). Further, those who heard about family planning at the health facility (AOR 2.37, 95% CI, 1.08, 5.21, p = 0.031) and those who heard on radio (AOR 2.55, 95% CI, 1.05-6.19, p = 0.038) had higher odds of contraceptive use than those who did not. The qualitative results found that most parents and teachers opposed the use of contraceptive by teenagers, while health providers supported it. Barriers to contraceptive use included religious beliefs, personal beliefs of healthcare providers, myths and misconceptions, and the fear of social stigma by teenagers. Whether or not adolescents have access to contraceptives, the decision to use them is heavily influenced by parents, and to some extent, teachers and health providers. Therefore, it is important to implement comprehensive educational programs not only for teenagers, but also for parents, teachers and healthcare providers, dispelling myths about contraceptives.

Using the Family Planning Estimation Tool (FPET) to assess national-level family planning trends and future projections for contraceptive prevalence and associated demand for HIV-infected women in sub-Saharan Africa.

The combination of low uptake of modern contraceptives, high rates of unintended pregnancies, and the pervasive HIV epidemic in Sub-Saharan Africa (SSA) poses a threat to maternal, newborn, and child health in the region. This study examined the prevalence, need, and demand satisfied by modern contraceptive methods for women who tested positive for HIV (both unmarried and married) in 10 countries in SSA. We used the Family Planning Estimation Tool (FPET) to generate national-level trends and projections from 1983 through 2030. Individual-level data from 30 DHS surveys conducted between 2004 and 2018 in 10 sub-Saharan Africa (SSA) countries were used to produce projections for 1) all women and 2) unmarried and married women who tested positive for HIV. Throughout the period, Ethiopian and Guinean women who tested positive for HIV had a higher %mCPR (utilization of modern family planning methods) vis-à-vis all women. Among women who tested positive for HIV, the highest percentage of family planning demand satisfied by modern methods was observed in Zimbabwe (85.27, CI: 76.32-91.69), Lesotho (82.75, CI: 71.80-89.86), Rwanda (80.17, CI: 70.01-87.62), Malawi (73.11, CI: 61.50-82.63), and Zambia (72.63, CI: 64.49-80.09). The highest unmet need for modern contraceptives was found in Senegal (25.38, CI:18.36-33.72), followed by Cameroon (23.59, CI:19.30-28.59) and Sierra Leone (23.16, CI:16.64-32.05). Zimbabwe had the lowest unmet need (10.61, CI:6.36-16.13) and achieved the highest change in %mCPR (49.28, SE:6.80). Among married women who tested positive for HIV, their unmet need for modern contraception will remain higher in 2030. Continuing existing policies until 2030 would result in significant coverage gain among married vis-à-vis unmarried women who tested positive for HIV. Our projections emphasize the importance of country-specific strengthening initiatives, programs, and services targeting unmarried women.

The Reliability of Contraceptive Discontinuation Reporting in Burkina Faso, Kenya, and Uganda.

Family planning researchers have been studying the discontinuation of contraception-the prevalence and reasons for it-for decades, as it has implications for contraceptive prevalence, total fertility, and unintended fertility. However little is known about the reliability of contraceptive discontinuation reporting: only two studies have examined the reliability of reported discontinuation in low-resource contexts. We use longitudinal and overlapping data from reproductive calendars to test the reliability of women's reporting of contraceptive discontinuation in Burkina Faso, Kenya, and Uganda. We test whether recent discontinuations reported at baseline are reported one year later, and if the same reason for discontinuation is reported. Results reveal moderate reliability at the aggregate level of reporting of the index discontinuation; however, reliability is low when the timing of discontinuation is considered. There is variability across the reliability of reasons for discontinuation; discontinuation due to desired pregnancy is reported reliably while other reasons are less reliably reported. Our findings have important implications for the field, particularly in how the data are used and interpreted; we urge caution around event-level analyses of contraceptive discontinuation and reasons for discontinuation, given low reliability.

The Healthy Timing and Spacing of Pregnancies (HTSP) project: improving family planning in Siaya County, Kenya.

Religious leaders are influential and can impact the uptake of family planning (FP). In this study of the Healthy Timing and Spacing of Pregnancies (HTSP) project, led in Siaya County, Kenya, from September 2017 to June 2019, we present findings from the project's evaluation, to determine changes in knowledge of the key HTSP messages; changes in the proportion of community members who correctly identify at least three methods of contraception; changes in knowledge of healthy child spacing; and changes in modern contraceptive prevalence rate. This is a two-staged (baseline and endline) cross-sectional study, designed to assess the knowledge, practice, and coverage of HTSP/FP services. Primary data was collected using a questionnaire adapted from the United States Agency for International Development. Focus group discussion participants included men, women, representatives of community groups, faith leaders, and community heath volunteers. Frequencies were calculated from the ODK platform. Bivariate analytics (paired t test) were performed. At baseline, women respondents aged 20-29 years constituted 66.3% of the women participants, dropping to 60.9% at endline. Women aged 30-34 years constituted 11.9% and 22% of the entire women respondents, at baseline and endline, respectively. Men aged 20-29 constituted 45.2% of all men respondents at baseline, and 35.4% at endline. There were statistically significant increases in the knowledge of modern contraceptives among women (p = 0.0342), faith leaders (p = 0.0464), and the entire population (p = 0.0097), from baseline to endline. The HTSP model identifies success factors for FP interventions in Kenya and other low- and middle-income countries where faith leaders and community stakeholders are influential, and that women and faith leaders are much more easily impacted positively with these efforts, as measured by increased knowledge and awareness of modern contraceptive methods, compared with men.

Economic and social determinants of women’s demand for modern family planning methods in Cameroon

Background: In low-income countries, the demand of family planning methods can help to address the imbalance between the population growth rate and the volume of the production of wealth. However, the contraceptive prevalence remains low in resources limited countries. Different strategies have been used to encourage the demand of modern family planning methods. This article examined the economic and social determinants of women’s demand for modern family planning methods in Cameroon. Methods: A cross-sectional study design was used with a two-stage stratified sampling, including 9,633 women of childbearing age. A logistic regression model was used for bivariate and multivariate analysis with a statistically significant level of p<0.05. Results: Women’s demand for modern family planning methods was relatively low (28.8%). Demand for modern family planning methods was significantly associated (p<0.05) with women’s economic and social characteristics, such as age groups (15 to 24 and 35 to 49), level of education (possibly for the spouse too), experiencing domestic violence, professional status, religion, place of residence, income, access to the media and place for antenatal visits, and women living in west, south and south-west, Adamawa, extreme-north, and Littoral regions. However, the women’s demand for modern family planning methods was non-significantly associated (p>0.05) with age between 25 and 34, marital status and women living in east, north and north-west regions. Conclusions: With a view of reducing poverty by controlling the birth rate, decision-makers should strive to improve economic and social conditions and raise women's awareness of how to demand family planning methods.

Effects of extreme climate events and child mortality on total fertility rate in Bangladesh

Floods, storms, and temperature extremes are examples of extreme weather events that have a substantial influence on a country's demographic dynamics, including migration, fertility, and mortality. Changes in population size, composition, and distribution may result from these occurrences. This study, which spans the years 1966–2018, looks at how Bangladesh's total fertility rate (TFR) is affected by extreme weather events and child mortality, including neonatal, infant, male infant, and under-five mortality. We use data from secondary publicly accessible sources, such as the World Bank and The Emergency Events Database (EM-DAT), and we investigate the correlations using the autoregressive integrated moving average model (ARIMA), complemented by bivariate and multivariable analyses.Our findings from the univariate analysis are noteworthy. Total extreme climate events (β = −0.345, 95 % CI: 0.510, −0.180), as well as individual extreme climate events, such as extreme temperatures (β = −1.176, 95 % CI: 1.88, −0.47), floods (β = −0.644, 95 % CI: 1.0729, −0.216), and storms (β = −0.351, 95 % CI: 0.63159, −0.07154), exhibited negative associations with the TFR. Additionally, factors such as contraceptive prevalence rate (CPR) (β = −0.085, 95 % CI: 0.09072, −0.07954) and gross national income (GNI) per capita (β = −0.003, 95 % CI: 0.0041123, −0.0024234) were negatively correlated with the TFR. Conversely, various categories of child mortality, namely, infants (β = 0.041, 95 % CI: 0.040474, 0.042748), males (β = 0.038, 95 % CI:0.037719, 0.039891), and under-five (β = 0.026, 95 % CI:0.025684, 0.026979) – are positively associated with TFR. Controlling for two pivotal confounding factors, time and GNI per capita, yielded consistent results in the multivariate analysis. These findings provide insight on the dual impact of extreme weather events, which can reduce TFR while also raising it through infant mortality. This phenomena may be due to the increased vulnerability of younger children in climate-event-prone areas, prompting parents to seek additional children as both a replacement for lost offspring and an insurance mechanism against future child loss.

Assessing Trends in the Desire to Avoid Pregnancy: A Cautionary Note.

The desire to avoid pregnancy-to delay the next birth or have no further births-is a fundamental sexual and reproductive health indicator. We show that two readily available measures-prospective fertility preferences and the demand for contraception [Demand] construct-provide substantially different portraits of historical trends. They also yield correspondingly different assessments of the sources of contraceptive change. We argue, with supporting empirical evidence, that Demand enormously overstates the historical trend in the desire to avoid pregnancy because Demand as currently constructed is in part a function of contraceptive prevalence. This makes for "reverse causality" in decompositions of contraceptive change, producing an upward distortion on the order of 25 percentage points in the amount of contraceptive change attributed to a change in fertility desires. Decomposition of contraception change free of the distortion reveals that contraceptive change has been due almost entirely to more complete implementation of fertility preferences. This is explained in part by the surprisingly slight historical change in preferences, a fact we document and then show is a consequence of a historical shift in parity composition toward lower parities.

Strategies for Sustainable Development: Leveraging Demographic Factors in Indonesia's Regions

This study investigates the impact of demographic factors on the demographic bonus and regional development in Indonesia, using a sample of 30 provinces from 2011 to 2019. Population growth positively influences both the demographic bonus and regional development. In contrast, life expectancy and contraceptive prevalence rate have negative effects on the demographic bonus. The school-age population positively impacts both the demographic bonus and regional development. The demographic bonus negatively affects regional development and fails to mediate the relationship between population growth and regional development. However, it mediates the effects of life expectancy and the school-age population on regional development. The analysis employs descriptive analysis and structural equation modelling (SEM) using Smart-PLS. The findings recommend effective management of population growth, enhanced healthcare to improve life expectancy, and balanced birth control programs. Increased investment in education and inclusive development strategies are vital. Policies should facilitate the active participation of the working-age population, supported by continuous research and development to ensure responsive policy formulation. These recommendations aim to maximize the potential of the demographic bonus and support sustainable regional development in Indonesia.

Assessing Africa's child survival gains and prospects for attaining SDG target on child mortality.

This study assessed Africa's child survival gains and prospects for attaining Sustainable Development Goals (SDG) target 3.2. We analysed multiple country-level secondary datasets of 54 African countries and presented spatial analysis. Results showed that only 8 out of the 54 African countries have achieved substantial reductions in under-5 mortality with an under-five mortality rate (U5MR) of 25 deaths per 1,000 live births or less. Many countries are far from achieving this target. Results of the predictions using supervised machine learning on the Bayesian network reveal that the probability of achieving the SDG target 3.2 (i.e., having U5MR of 25 deaths per 1000 live births or less) increases (from 21.6% to 100%) when the contraceptive prevalence increases from 49.8% to 78.5%; and the use of skilled birth attendants increases from 44.8% to 86.3%; and percentage of secondary school completion of female increases from 42.5 to 74.0%. Our results from Local indicator of spatial autocorrelation (LISA) cluster maps show that 7 countries (mainly in West/Central Africa) formed the high-high clusters (hotspots for U5M) and may not achieve the SDG target 3.2 unless urgent and appropriate investments are deployed. As 2030 approaches, there is a need to address the problem of limited access to quality health care, female illiteracy, limited access to safe water, and poor access to quality family planning services, particularly across many sub-Saharan African countries.

PREDICTION OF THE SUM OF NEW FAMILY PLANNING ACCEPTORS IN THE IMPACT OF THE COVID-19 PANDEMIC: A STUDY USING THE ARIMA MODEL

The sum of new Family Planning (KB) acceptors in Pamekasan Regency decreased from March to April 2020 due to the COVID-19 pandemic. This decline will hinder the increase in achieving the Modern Contraceptive Prevalence Rate (mCPR) as the target of the 2020-2024 National Medium Term Development Plan (RPJMN), so modelling is needed to predict the sum of new family planning acceptors in Pamekasan Regency. This research aims to predict the sum of new family planning acceptors in Pamekasan Regency using the ARIMA model. This research is a non-reactive quantitative research. The unit of analysis for this research is all-new monthly family planning acceptors in Pamekasan Regency. The data used is the number of new monthly family planning acceptors from January 2016 to December 2021, sourced from the Pamekasan Regency Women's Empowerment, Child Protection and Family Planning Service. The research results show that the best model for predicting the number of new family planning acceptors in Pamekasan Regency is ARIMA [1,1,1] with the equation 0.0011(B)11Zt=0.006+0.0001(B)at. Prediction results using the ARIMA model [1,1,1] show that the number of new family planning acceptors tends to increase in January-December 2022. The sum of new family planning acceptors shows an increasing pattern, but the increase does not reflect the impact of the end of the COVID-19 pandemic.

Contraceptive use, unmet need, and demand satisfied for family planning across Cameroon: a subnational study including indirect effects of COVID-19 and armed conflict on projections

BackgroundCameroon is among countries that have made notable investments nationwide in line with the Family Planning 2030 initiative. This study examines the progress made across the 10 regions and 58 divisions of the country, including potential impairments following COVID-19 and armed conflict.MethodsIn this time-series analysis, parameters were sourced from 5 Demographic and Health Surveys and 3 Multiple Indicator Cluster Surveys conducted between 1991 and 2018. The Family Planning Estimation Tool (FPET) was used to estimate key family planning indicators among married women of reproductive age. Data from official country reports and FPET results were incorporated into Bayesian models to assess how projections (from 2020 to 2030) would vary given varying contractions (i.e., 0%, 5%, 10%, and 25% annually) to services coverage.ResultsNationally, modern contraceptive prevalence rate (mCPR) and demand satisfied with modern (contraceptive) methods reached 16.8% (95% credible interval 12.0 to 23.0) and 37.6% (28.7 to 47.0), respectively; and unmet need for modern methods decreased to 27.9% (22.9 to 33.7) in 2022. Notable improvements were observed in the East region and Boumba et Ngoko division, with annual mCPR trends of 2.1 percentage points (%p) (− 0.2 to 4.2) and 7.0%p (4.5 to 9.3) from 2015–2020; and 2030 projections of 58.7% (41.3 to 74.0) and 79.1% (65.0 to 89.0), respectively. The least performing in terms of demand satisfied with modern methods include Adamawa at the regional and Boyo at the divisional level, with 2030 projections of 45.5% (26.5 to 65.1) and 0.4% (0.2 to 0.8), respectively. The northern regions (Adamawa, Far North, and North) recorded the lowest levels of unmet need for modern methods. To achieve ≥ 75% demand satisfied with modern methods in 2030, an additional 1.4 (0.6 to 2.2) million modern contraceptive users are required. Given large reductions (− 25% annually) in services coverage post-COVID-19/armed conflict (2020 to 2030), the South region could experience the most significant contraction in projected mCPR, with a decrease of − 9.2%.ConclusionsFamily planning outcomes vary significantly across subnational territories of Cameroon. While the East region shows notable success, greater attention is needed in the northern regions. Strategies must be adaptive to address unprecedented emergencies that may disrupt access to services.

Fertility patterns in Pakistan: a comparative analysis of family planning trends across different geographic regions.

Family planning includes a wide range of services, such as counseling, contraception, and support to couples. Evidence shows that developing countries have a high degree of inequality in contraception use and prevalence. Reasons for these inequalities include cultural barriers such as traditional preferences and a desire for larger families and lineage, especially in rural areas. The primary objective of this research was to examine the updated contraceptive method preferences of couples in rural and urban regions of Pakistan and how these translate to family planning practices among the different provinces. A secondary survey analysis using the Pakistan Demographic and Health Survey 2019 survey data was conducted. The dataset included 15 143 women sampled proportionally from the provinces, including Gilgit Baltistan and Azad Jammu and Kashmir. The unit of analysis was 'women' from the individual survey dataset. Age, type of residence (rural, urban), division, education level, and language were used to evaluate access to family planning and contraception services. The c2 test assessed the relationship between dependent and independent variables. Multivariate logistic regression analysis was then performed to see the likelihood of contraceptive use among women. Of the women in the sample, 55% were from rural areas and 50% were without formal education; 51.7% of these women were using or practicing any form of contraception method. The most common method used was condoms (9.2%), followed by injectables (6.2%). Regression analysis showed that women aged 15-19 years were less likely (odds ratio (OR)=0.71, 95% confidence interval (CI)=0.51-1.01) to use contraception when compared to the reference group. The likelihood of contraceptive use was higher in urban areas (OR=1.53, 95%Cl=1.39-1.69). Noticeably, contraceptive use was less likely in uneducated women (OR=0.62, 95%Cl=0.56-070). Punjab province had the highest contraceptive prevalence (34.3%), whereas Baluchistan had the lowest (6.9%). The use of contraception in urban and rural populations was similar in all provinces except Sindh and Gilgit Baltistan. In urban and rural areas, women in the age group 30-35 years who use contraception show a prevalence of 21% and 22% respectively. The study highlights suboptimal use of contraceptives and the existence of high levels of inequalities among the regions. There is a need for the implementation of focused educational initiatives and counseling interventions along with prioritization of accessibility and affordability of contraceptive methods among women in lower socioeconomic regions.