Family Planning Providers Research Articles

Brief Report: Impact of PrEP Training for Family Planning Providers on HIV Prevention Counseling and Patient Interest in PrEP in Atlanta, Georgia.

Safety net family planning (FP) clinics provide vital care for women in high HIV-burden areas and may be ideal pre-exposure prophylaxis (PrEP) delivery sites. Yet, many FP providers lack knowledge about PrEP. Four safety net FP clinics in Atlanta, Georgia. We provided a 1.5-hour PrEP informational training for 28 providers working in these sites. To assess the training's impact on PrEP counseling, we enrolled 500 female patients after training (47% ≤ 28 years; 69% black; 12% Hispanic) and determined their PrEP indication based on CDC guidelines. We conducted a postvisit survey to assess provider counseling and patients' interest in PrEP and acceptance of off-site PrEP referral. From pre-training to post-training, provider PrEP knowledge and confidence to identify women who may benefit from PrEP significantly increased. Only 19% of women knew about PrEP before the visit. Among 376 sexually active women, 29% had risk consistent with PrEP indication. Among PrEP-indicated women, 66% reported the provider discussed PrEP, 29% were interested in taking PrEP, but only 18% accepted off-site PrEP referral. Most (76%) were more willing to take PrEP if provided by the FP clinic. After a brief PrEP training, most women with HIV-risk indicators received PrEP counseling during their visits. Once counseled, women expressed interest if it were offered at the FP clinic rather than through off-site referral. Findings highlight the potential impact that PrEP capacity building within safety net FP clinics in high HIV-burden areas may have on PrEP scale-up for women.

Acceptability, feasibility and utility of a Mobile health family planning decision aid for postpartum women in Kenya

BackgroundUnmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. We developed a client facing mobile phone-based family planning (FP) decision aid and assessed acceptability, feasibility, and utility of the tool among health care providers and postpartum women.MethodsSemi-structured in-depth interviews (IDIs) were conducted among postpartum women (n = 25) and FP providers (n = 17) at 4 Kenyan maternal and child health clinics, 2 in the Nyanza region (Kisumu and Siaya Counties) and 2 in Nairobi. Stratified purposive sampling was used to enroll postpartum women and FP providers. Data were analyzed using an inductive content analysis approach by 3 independent coders, with consensual validation.ResultsFP providers stated that the Interactive Mobile Application for Contraceptive Choice (iMACC) tool contained the necessary information about contraceptive methods for postpartum women and believed that it would be a useful tool to help women make informed, voluntary decisions. Most women valued the decision aid content, and described it as being useful in helping to dispel myths and misconceptions, setting realistic expectations about potential side effects and maintaining confidentiality. Both women and providers expressed concerns about literacy and lack of familiarity with smart phones or tablets and suggested inclusion of interactive multimedia such as audio or videos to optimize the effectiveness of the tool.ConclusionsThe iMACC decision aid was perceived to be an acceptable tool to deliver client-centered FP counseling by both women and providers. Counseling tools that can support FP providers to help postpartum women make informed and individualized FP decisions in resource-limited settings may help improve FP counseling and contraceptive use in the postpartum period.

Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso

Background: The Family Health Directorate of the Ministry of Health (MoH/FHD) and Marie Stopes Burkina Faso (MS BF), with implementing partners, Association Burkinabé pour le Bien-être Familial (ABBEF) and Equilibres & Populations (Equipop) collaborated to conduct a pilot project in Burkina Faso focused on “increasing access to family planning (FP) services through task-sharing short- and long-acting family planning methods to primary care cadres.” Four cadres of providers were trained to provide intrauterine devices (IUDs) and implants, while community health workers (CHWs) were trained to provide pills and subcutaneous injectables. FHI 360 and the Institut Supérieur des Sciences de la Population (ISSP) evaluated the project’s impact on method uptake, client satisfaction, safety, acceptability and the feasibility of task sharing. Methods: The evaluation employed service statistics, client exit interviews (quantitative) and in-depth interviews (qualitative). New FP clients, community representatives, MoH officials, and pilot project-trained FP providers from Dandé and Tougan districts participated in these interviews. Results: Providers, community representatives and government officials all spoke favorably of the pilot project and considered it a boon to women and the communities in which they lived. FP clients were satisfied with their methods and the services they received from their respective providers, and they reported no safety concerns. However, service statistics did not show a clear and steady increase in method uptake for the four methods beyond spikes coinciding with pre-existing free contraceptive weeks. Conclusions: Results of the evaluation were largely positive. These evaluation findings are being used to guide decisions about scale-up.

Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial

Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p < 0.0001) when compared with historical clinical data for both TIPS-Basic and TIPS-Plus. Conclusions: We did not find an added benefit of patient activation messages in increasing frequency of sensitive discussions. Several patient characteristics appear to influence providers' likelihood of conversations about harmful partner behaviors. Compared with prior data, this pilot study suggests potential benefits of using provider scripts to guide discussions.

Over the counter: The potential for easing pharmacy provision of family planning in urban Senegal.

Background: This research assessed the potential for expanding access to family planning through private sector pharmacies in Senegal, by examining the quality of the services provided through private sector pharmacies, and pharmacy staff and client interest in private sector pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar and two urban districts outside of Dakar employing an audit of 225 pharmacies, a survey with 486 private sector pharmacy staff and a survey with 3,567 women exiting private sector pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users and 11% procured their method through a private sector pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a private sector pharmacy. Conclusions: There is both actual and latent demand for accessing family planning through Senegal's urban, private sector pharmacies. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Pre-Exposure Prophylaxis Integration into Family Planning Services at Title X Clinics in the Southeastern United States: A Geographically-Targeted Mixed Methods Study (Phase 1 ATN 155).

BackgroundBlack adolescent and young adult women (AYAW) in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to health services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. These services include those of family planning (FP) providers in high HIV incidence settings. However, PrEP has not been widely integrated into FP services, including Title X-funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies.ObjectiveThe aim of this study is to assess inner and outer context factors (barriers and facilitators) that may influence the adoption of PrEP prescription and treatment services in Title X clinics serving AYAW in the Southern United States.MethodsPhase 1 of Planning4PrEP is an explanatory sequential, mixed methods study consisting of a geographically-targeted Web-based survey of Title X clinic administrators and providers in the Southern United States, followed by key informant interviews among a purposively selected subset of responders to more comprehensively assess inner and outer context factors that may influence adoption and implementation of PrEP in Title X FP clinics in the South.ResultsPhase 1 of Planning4PrEP research activities began in October 2017 and are ongoing. To date, survey and key informant interview administration is near completion, with quantitative and qualitative data analysis scheduled to begin soon after data collection completion.ConclusionsThis study seeks to assess inner and outer contextual factors (barriers and facilitators) that may influence the adoption and integration of PrEP prescription and treatment services in Title X clinics serving AYAW in the Southern United States. Data gained from this study will inform a type 1 hybrid effectiveness implementation study, which will evaluate the multilevel factors associated with successful PrEP implementation while evaluating the degree of PrEP uptake, continuation, and adherence among women seen in Title X clinics.International Registered Report Identifier (IRRID)DERR1-10.2196/12774

Over the counter: The potential for easing pharmacy provision of family planning in urban Senegal

Background: This research assessed the potential for expanding access to family planning through private sector pharmacies in Senegal, by examining the quality of the services provided through private sector pharmacies, and pharmacy staff and client interest in private sector pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar and two urban districts outside of Dakar employing an audit of 225 pharmacies, a survey with 486 private sector pharmacy staff and a survey with 3,567 women exiting private sector pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users and 11% procured their method through a private sector pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a private sector pharmacy. Conclusions: There is both actual and latent demand for accessing family planning through Senegal’s urban, private sector pharmacies. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Over the counter: The potential for easing pharmacy provision of family planning in Senegal.

Background: This research assessed the potential for expanding access to family planning through private sector pharmacies in Senegal, by examining the quality of the services provided through private sector pharmacies, and pharmacy staff and client interest in private sector pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar and two urban districts outside of Dakar employing an audit of 225 pharmacies, a survey with 486 private sector pharmacy staff and a survey with 3,567 women exiting private sector pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users and 11% procured their method through a private sector pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a private sector pharmacy. Conclusions: Senegal's urban, private sector pharmacies are well-positioned to meet the increasing desire for modern contraception. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Understanding 'missed appointments' for pills and injectables: a mixed methods study in Senegal.

IntroductionHigh discontinuation rates of contraceptive methods have been documented in sub-Saharan Africa. However, little is known about gaps within individual episodes of method use, despite their implications for unintended pregnancies. The objective of this mixed methods study was to examine the prevalence of, and explore the factors contributing to, delays in repeat appointments for pills and injectables in Senegal.MethodsFirst, we constructed a longitudinal data set of women’s contraceptive consultations using routine records from 67 facilities in Senegal. Consultations for pills and injectables were classified as on time, delayed or with unknown delay status based on time since previous appointment. We described the prevalence of delayed appointments and used backward stepwise regression to build a mixed-effects model to investigate risk factors for delay. Second, we conducted workshops with family planning (FP) providers, and indepth interviews and focus group discussions with women of reproductive age, to explore factors contributing to delays.ResultsAlmost one-third (30%) of appointments for pills and injectables were delayed, resulting in risk of pregnancy. Previous delay, pill use, lower educational level, higher parity, third and subsequent visits, and Islamic faith were independently predictive of delays (p<0.04 for all). Although women’s ‘forgetfulness’ was initially mentioned as the main reason for delays by women and providers, examining the routines around appointment attendance revealed broader contextual barriers to timely refills—particularly widespread covert use, illiteracy, financial cost of FP services and limited availability of FP services.ConclusionDelays in obtaining repeat pills and injections are common among contraceptive users in Senegal, exposing women to unintended pregnancies. Strategies to reduce such delays should move beyond a narrow focus on individual women to consider contraceptive behaviour within the broader socioeconomic and health systems context. In particular, effective interventions addressing low acceptability of contraception and appointment reminder strategies in high illiteracy contexts are needed.

Factors related to married or cohabiting women's decision to use modern contraceptive methods in Mahikeng, South Africa.

BackgroundSexual and reproductive decision-making has emerged as an important health indicator in family reproductive health issues. While there is evidence of male dominance in sexual and reproductive health decisions, the role of socio-demographic factors on women’s decision to use contraception is not well understood.AimThis study aimed at exploring the socio-demographic factors associated with married women’s decision-making to use contraception.SettingThe study was conducted in Mahikeng local municipality in the Modiri Molema District Municipality.MethodsData were generated in Mahikeng from married and cohabiting women, aged 18–49 years, from a survey comprising 568 participants. Data were collected on women’s demographic characteristics and contraceptive behaviour. Descriptive, bivariate and multivariate analyses were used to examine factors related to decision-making on contraceptive use.ResultsThe result revealed that 57% of the participants were currently using contraception and 45% stated jointly-made decision regarding the use of contraception. Decisions on use of contraceptives were associated with education, occupation, religion, duration of union and home language. Other factors associated with decision-making on contraceptive use were perception on husband’s right to sex, use of force for sex and spousal communication about sex.ConclusionEmpowering women to use contraception to meet their fertility desire should aim at improving their socio-economic status and spousal communication. Family planning providers should recognise socio-cultural barriers under which the relationships exist and how women can navigate these contextual factors.

Editorial

Historical events and cultural practices, along with policymakers’ embrace of economic principles, all play formative roles in policy development, implementation, and success in addressing health outcomes in populations globally. In this issue of World Medical & Health Policy, our authors consider this complex interplay of factors from various angles. Petros, Abay, Desta, and O'Brien note the role of cultural factors in women's disempowerment, even in the face of intentional governmental and financial institution policy interventions. Women, particularly those living in poverty, are more likely than men to be exposed to adverse agricultural working conditions and consume compromised grains, burdening them with increased health risks on both counts. In order to reduce post-harvest loss in Ethiopia and improve population health broadly, the authors argue that impediments to women's empowerment must be meaningfully addressed. Despite the popularity of the adage “women and children first” it is more often the case that these groups suffer disproportionately in many categories of health and well-being. This is demonstrated in Petros et al.'s study of women and men farmers in Ethiopia, and in Mazecaite-Vaitilaviciene and Owens's service evaluation of the oral health of children with disabilities in post-Soviet Lithuania. Large-scale economic and political trends, even those that might be seen as politically positive, such as the restoration of the independent state of Lithuania, or the move toward a more market-based economy, can lead to disruptions that can compromise populations, particularly those with overlapping identities of marginalized groups. This study of oral health inequalities among children with disabilities in Lithuania points to what the authors convincingly characterize as an urgent need for policy reform. Even when it can be demonstrated that economic efficiencies are likely to accrue from certain categories of policy interventions, such as the provision of family planning in developing countries, historical and cultural factors hold sway in shaping such policies to a great extent. Harris examines how consideration of economic concepts such as efficiency, externalities, access to information and equity are also evident in policies providing for family planning in Uganda, Haiti, and the Philippines. She concludes that explicit consideration of economic policy concepts can complement rights-based policy rationales, to the benefit of nations applying such analysis. With regard to access to information, Patanavanich, Suriyawongpaisal, and Aekplakorn, note that the lack of a national database for malpractice claims in Thailand has hampered the ability of policymakers there to develop policy related to malpractice. Their findings with regard to the timing and location of wrongful death claims suggest the importance of such information in crafting meaningful policy. In addition to the policy importance of collecting pertinent information, Wiist points out that tax collection is critical to the provision of public health services and the funding of research to protect the public health. He identifies corporate income tax avoidance as one important cause of unrealized federal tax revenue that contributes to chronic fiscal and public health deficits. By defining the issue as a social determinant of health, he seeks to impel research and political interest in the issue to address its role in perpetuating inequality. Finally the review of Nora Kenworthy's Mistreated: The Political Consequences of the Fight Against AIDS in Lesotho by a physician with personal experience in the field, makes note of how closely intertwined political, social, and medical structures influence the design and implementation of HIV programs. Kaddis relates the book's coverage of factors ranging from disease stigma to misappropriation of funds from international aid organizations as being implicated in the country's flawed policy response to the public health crisis in its midst. These themes comport with World Medical & Health Policy's ongoing interest in advancing understanding of social determinants of health, most recently highlighted in an open access virtual issue available through June 2019 at https://onlinelibrary.wiley.com/doi/toc/10.1111/(ISSN)1948-4682.social-determinants-of-health

\u2018I wanted to enjoy our marriage first\u2026 but I got pregnant right away\u2019: a qualitative study of family planning understandings and decisions of women in urban Yogyakarta, Indonesia

BackgroundDespite several decades of investment into family planning and maternal health systems strengthening, Indonesia’s maternal mortality ratio remains among the highest in Southeast Asia. Among postpartum women unmet need for family planning is greater than at any other time, thus there is great potential to improve the reproductive health outcomes of Indonesian women through enhanced postpartum family planning access. This article explores the socially embedded nature of family planning choices in the Indonesian context, drawing on the experiences of a sample of urban dwelling and predominantly middle class women.MethodsThis was an ethnographic study which explored the reproductive experiences of women residing in Yogyakarta City, and Sleman and Bantul regencies. Fieldwork was undertaken over 18 months from September 2014 to March 2016. This article draws on 31 in-depth interviews (IDIs) conducted with 20 women aged 21 to 38 years who had given birth less than two years prior.ResultsThough there was great variance across women’s reproductive trajectories, the majority had limited understandings of family planning, especially in relation to contraception. Societal norms pertaining to women’s fertility and reproduction underpinned women’s desires to become pregnant soon after marriage. Normative ideals concerning family size and the composition of families underpinned women’s desires for a maximum of two to three children, with at least one child of each sex. Negotiations concerning timing of pregnancies and family size occurred within spousal relationships. The majority of women were using some form of fertility control to prevent or space pregnancies, with method choice decisions often informed by family members, friends and family planning providers. Quality of care among family planning providers was often lacking, perpetuating misinformation, and women’s choices were not always respected.ConclusionsOur analysis reveals the socially embedded nature of women’s postpartum family planning understandings and choices, and the ways in which social and relational factors sometimes constrain and at other times support women’s reproductive agency. We identify key areas for health sector reform to enhance women’s understandings of postpartum family planning and improve family planning quality of care.

Family planning provision in pharmacies and drug shops: an urgent prescription

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning (FP) services. Drug shop operators and pharmacists should not be viewed as mere merchants of short-acting contraceptive methods, as this ignores their capacity for increasing uptake of FP services and methods in a systematic and collaborative way with the public sector, social marketing groups and product distributors. We draw on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops. To integrate this setting that provides convenience, confidentiality, access to user-controlled contraceptive methods (i.e., pills, condoms and potentially Sayana Press®) and a gateway to clinic-based FP services, we propose three promising practices that should be encouraged in future interventions to increase access to quality FP services.

Economic Policy and the Provision of Family Planning in Developing Countries

Despite some progress, wide gaps remain in the provision of family planning and reproductive health services in developing countries. As governments debate how to provide such services, this commentary considers general economic motivation, what principles are being implemented in practice, and why government policy may not align with what economic analysis suggests. Case studies from three developing countries—Uganda, Haiti, and the Philippines—are presented in an attempt to bridge gaps between economic analysis, current policy, and implementation, and examine whether economic concepts are being considered in current policy responses. Following this preliminary review, all three countries appear to value economic concepts that reinforce the government's role in provision of family planning, but that does not necessarily correlate to effective policy implementation or access to services. More broadly, this consideration of economic policy and the provision of family planning in three developing countries suggests that economic policy can complement rights‐based policy arguments.

Client satisfaction with family planning services in the area of high unmet need: evidence from Tanzania Service Provision Assessment Survey, 2014-2015

BackgroundClient satisfaction has been found to be an important factor for the uptake and continuation of family planning services. This study aimed to examine the current status of and factors associated with client’s satisfaction with family planning services in Tanzania, which has a high unmet need for family planning.MethodsThe study used data from the Tanzania Service Provision Assessment survey of 2014–2015. A facility was classified as having high service readiness for FP if it scored at least 67.7% on a composite score based on three domains (staff training and guidelines, basic diagnostic equipment, and basic medicines), following criteria developed by the World Health Organization. The exit interview questionnaire was used to collect information from women about their level of satisfaction, whether “very satisfied,” “more or less satisfied,” or not satisfied with the services received. The response was dichotomized into “Yes” if the woman reported being very satisfied with services received otherwise coded as “No”. Unadjusted and adjusted logistic regression models were used to assess the association between the client satisfaction and covariate variables; service readiness, facility type, managing authority, location, management meetings, supervision, provider’s sex, and working experience, clients’ age and education. All analyses were weighted to correct for non-response, disproportionate and complex sampling by using the “SVY” command in Stata 14.ResultsOut of the 1188 facilities included in the survey, 427 (35.9%) provided family planning services. A total of 1746 women participated in observations and exit interviews. Few (22%) facilities had a high readiness to provide family planning services. While most facilities had the recommended equipment available, only 42% stocked contraceptives (e.g. oral pills, injectable contraceptives and/or condoms). Further, trained staff and clinical guidelines were present in only 30% of services. Nevertheless, the majority (91%) of clients reported that they were satisfied with services. In the multivariate analysis, a high service readiness score [AOR = 2.5, 95% CI; 1.1–6.0], receiving services from private facilities [AOR = 2.3, 95% CI; 1.1–5.0], and being in the age group 20 to 29 years [AOR = 0.3, 95% CI; 0.1–0.7] were all significantly associated with clients’ satisfaction with family planning services.ConclusionThere is a high level of client satisfaction with family planning services in Tanzania. Maintaining and exceeding this level will require improvements in the provision of staff training and the availability of contraceptives in existing services.

Over the counter: The potential for easing pharmacy provision of family planning in Senegal

Background: This research assessed the potential for expanding access to family planning through pharmacies in Senegal, by examining the quality of the services provided through pharmacies, and pharmacy staff and client interest in pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar employing an audit of 250 pharmacies, a survey with 486 pharmacy staff and a survey with 3,569 women exiting pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users; of these, 11% procured their method through the pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a pharmacy. Conclusions: Senegal’s urban pharmacies are well-positioned to meet the country’s increasing desire for modern contraception. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Motherhood increases support for family planning among Kenyan adolescents

ObjectiveAdolescent fertility rates are high in Kenya, and increase the risks of unintended repeat pregnancies and maternal and infant morbidity and mortality. Our objective was to examine knowledge, practices, and influences surrounding contraceptive access and use among Kenyan postpartum adolescents. Study designWe conducted a mixed methods study (surveys and focus group discussions) with postpartum adolescents and family planning (FP) providers at two maternal and child health clinics in Kenya. Main outcome measuresFour focus group discussions (FGDs) were conducted with postpartum adolescents (stratified by age and site), and two FGDs were conducted with FP providers (stratified by site). Transcripts were analyzed for prevalent themes. The participants also completed individual surveys that were analyzed for contraceptive knowledge. ResultsAdolescent contraceptive decision-making and use were shaped by social norms of adolescent sexual behaviour. Lack of FP knowledge, community misinformation, and insufficient counselling and time with providers all contributed to adolescent concerns about FP. However, as adolescents transitioned to motherhood, they felt more encouraged to use FP and had increased awareness of FP benefits. ConclusionBoth postpartum adolescents and providers felt delivery of FP services could be improved if providers had better training and counselling tools.

Determinants of family planning use among married women in bale eco-region, Southeast Ethiopia: a community based study

BackgroundFamily planning is the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. Providing family planning could prevent maternal deaths by allowing women to delay motherhood, space births, avoid unintended pregnancies and abortions, and stop childbearing when they reach their desired family size. Despite the fact that family planning is advantageous for maternal and newborn health and the services and commodities are free of charge, the reason of not using modern family planning methods is unclear in Bale Eco-Region. Therefore, this study assessed the contraceptive prevalence rate and its determinants among women in Bale Eco-Region, Ethiopia.MethodsA community-based cross-sectional study design (both quantitative and qualitative methods) was conducted from December 2016 to February 2017. Five hundred sixty-seven women were successfully interviewed using structured and pre-tested questionnaire. A multistage sampling technique was employed. Data were entered into Epi-data version 3.1 and exported to SPSS version 21. Logistic regression analyses were done and a significant association was declared at p-value less than 0.05. All focus group discussions and key informant interviews were recorded and analyzed thematically.ResultsThe overall contraceptive prevalence rate was 41.5%. Injectable (48.1%), implants (22.6%) and pills (20.0%) were the most contraceptive methods utilized by study participants. Spousal (husband’s) opposition (38.8%), religious beliefs (17.7%), concern and fear of side effects (14.8%), and distance of family planning service (5.9%) were the reasons for not using contraceptive methods. Having more than seven deliveries (AOR = 2.98, CI = 1.91–6.10, P = 0.000) and having birth interval less than 24 months between the last two children (AOR = 3.8, CI = 13.41–21.61, P = 0.003) were significantly associated with utilization of contraceptive methods.ConclusionLow contraceptive prevalence rate might be attributed by husband opposition, religious beliefs, concern and fear of side effects. Having more than seven deliveries and birth interval less than 24 months between the last two children were determinants of contraceptive use. Family planning consultation opportunities should be created to make male’s involved and to increase their responsibility for family planning use.

Contraceptive use by Palestine refugee mothers of young children attending UNRWA clinics: a cross-sectional follow-up study

BackgroundUNRWA introduced family planning services in 1994 as an integral part of its expanded maternal and child health-care programme. The main objective of UNRWA's family planning programme is to promote the health of mothers, children, and their families. The aim of this follow-up study was to assess contraceptive practices in the target population 5 years after the 2010 follow-up study and to identify future programme needs. MethodsThis cross-sectional survey was a done by trained nurses from June 1 to Dec 31, 2015. Participants were Palestinian refugee mothers who attended Well Baby Clinics at all UNRWA health centres with their youngest child (aged 2 months to 5 years). A sample size of 10 478 participants was calculated on the basis of contraceptive use in 2010, using Epi Info sample size calculation. Women were interviewed, and retrospective data from health records were used as supplementary data. We did a multiple logistic regression to test if maternal age and parity predicted contraceptive use. We used the χ2 test to analyse the relation between previous contraceptive use and birth interval, birth weight, and gestational age. All participants provided verbal informed consent. The study was approved by the ethical committee in the UNRWA Health Department. FindingsData were obtained from 9860 mothers (mean age 29·8 years [range 29·4–30·1]). 5849 (59%) women were using modern contraceptives at the time of the survey, 1745 (18%) were using traditional methods, and 2265 (23%) were not using any contraceptive method. The most common modern contraceptive was an intrauterine device (2186 [37%] women), and UNRWA was the main provider for 4827 (83%) women using modern contraceptives. The most common reasons for not using contraceptives were a wish to have a child (873 [22%] women), pregnancy (747 [19%]), and a husband's opposition (775 [20%]). Using women with less than three pregnancies as the reference category, use of contraceptives was most likely in women with three to six pregnancies (adjusted odds ratio 1·58, 95% 1·43–1·73; p<0·0001) and in women with more than six pregnancies (1·6, 1·28–1·99; p<0·0001). Women with at least one male child were more likely to use contraceptives than women with no male child (1·39, 1·24–1·56; p<0·0001). Maternal age over 35 years was not a significant predictor for modern contraceptive use. We found a statistically significant correlation between previous contraceptive use and birthweight [c2=23·88; p<0·0001)] but not with gestational age. InterpretationIt is encouraging that mothers seeking modern contraceptives rely on UNRWA to provide family planning services. We found that mothers with higher parity are more likely to use modern contraceptives that comply with UNRWA recommendations. As expected, modern contraceptives lead to better birth spacing. However, mothers above 35 years of age are not more likely to use modern contraceptives, and these mothers might be at higher risk for negative maternal and infant health outcomes. UNRWA family planning services could focus more on counselling this group of mothers. FundingNone.

Bias Provider Dan Peluang Terjadinya Unmet Need KB Pada Pasangan Usia Subur di Kecamatan Kraton Kota Yogyakarta

Purpose: This study aims to determine the relationship of provider bias with unmet need of KB in couples of childbearing age in Kecamatan Kraton Kota Yogyakarta.Method: This cross-sectional study involved 121 respondents of childbearing age couples in Kraton Sub-district Yogyakarta city. Data retrieval technique with multistage random sampling. Data analysis with univariable. Bivariable analysis using chi-square test with significance level (p &lt;0,05) and 95% confidence level CI. Multivariable analysis using logistic regression statistic test. This research was conducted in May-June 2017.Results: This study showed that there was a significant relationship both statistically and practically between provider bias and unmet need of KB in couples of childbearing age. The results of the provider's bias analysis after considering the support of husbands, occupations and the number of children affected by 15% in the opportunities for unmet need KB.Conclusion: Quality of service to provide understanding of contraception needs to be improved. Family planning providers need to acquire communication skills to provide family planning services through capacity building activities for providers in a sustainable manner.