Public Family Planning Research Articles

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

IntroductionAcross sub-Saharan Africa, ministries of health have proposed integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning (FP) services to reach adolescent girls and young women (AGYW); however, evidence on effective implementation strategies is still limited. We conducted a qualitative study of integrated PrEP-FP service implementation at two FP clinics in Kisumu, Kenya.MethodsFrom June 2017 to May 2020, the Prevention Options for Women Evaluation Research (POWER) study enrolled 1000 sexually active, HIV-negative AGYW age 16 to 25. Actions taken to implement PrEP were captured prospectively in 214 monitoring and evaluation documents and 15 interviews with PrEP implementers. We analysed data using conventional and directed content analysis, with the latter informed by the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation.ResultsPOWER deployed a variety of implementation strategies to train and educate stakeholders (e.g., having new providers shadow PrEP providers); develop stakeholder interrelationships (e.g., organizing support teams with protected time to reflect on implementation progress and make refinements); provide technical assistance; and change physical infrastructure and workflow. Although these strategies reportedly influenced contextual factors across four of the five CFIR domains, they primarily interacted with contextual factors relevant to inner setting, especially implementation climate and readiness for implementation. Overall, implementing PrEP proved easier and less labor-intensive at a private, youth-friendly clinic than a public FP clinic, largely because the baseline structural characteristics (e.g., space, workflow) and organizational mission of the former were more conducive to offering AGYW-centered care. Nevertheless, adoption of PrEP delivery among non-study staff at both sites was low, likely due to the widespread perception that PrEP was not within their scope of work.ConclusionsSome FP clinics may be “lower-hanging fruit” than others for PrEP implementation. Approaching PrEP implementation as a behavioral intervention for FP providers may help ensure that providers have the requisite capability, opportunity, and motivation to adopt the clinical innovation. In particular, PrEP implementers should assess the need for implementation strategies that support providers’ clinical decision-making, establish worker expectations and accountability, and address workload constraints.Trial registrationClinical Trial Number: NCT03490058.

Contraceptive priorities among women seeking family planning services in Finland in 2017–2019

ObjectiveTo assess how women's reproductive history, contraceptive experience and need of abortion care are associated with priorities for contraception. Study DesignIn this cross-sectional survey study, we gathered information on women's history of births and abortions, previous use and satisfaction with contraceptive methods, and features of contraceptive methods they value most. Women were recruited at public family planning and outpatient abortion clinics in the capital region of Helsinki, Finland. ResultsOf the 1006 women responding, 502 were recruited during visits for abortion care and 504 for contraceptive counseling. Women seeking abortion care more often had a history of abortion than women seeking contraceptive counseling (44% vs 11%), presented with a higher mean number of different contraceptive methods used (69% vs 55% with more than 2 previous methods), and were less often satisfied with the methods used (36% vs 60% satisfied with 2 out of 3 methods), p < 0.001 for all. In addition, women seeking abortion care had lower odds of prioritizing effectiveness (aOR 0.3, 95% CI 0.2–0.5), and higher odds of prioritizing lower hormonal levels or non-hormonal alternatives (aOR 2.0, 95% CI 1.3–3.2). There was no difference between the groups regarding priorities of lesser pelvic pain (aOR 0.7, 95% CI 0.5–1.1), regular period (aOR 01.2, 95% CI 0.8–1.9), or the method being easy to use (aOR 1.2, 95% CI 0.8–1.8). ConclusionsThere is a contrast between guidelines emphasizing effectiveness in postabortion contraception, and many women's contraceptive priorities. Implication statementClinicians providing contraceptive counseling must be mindful of each individual's personal contraceptive priorities.

Impact of a brief PrEP training for family planning providers on HIV prevention counseling and patient interest in PrEP

Objectives: Public family planning clinics provide vital care for women in high HIV burden areas and could be ideal preexposure prophylaxis (PrEP) delivery sites. Yet, many family planning providers lack knowledge about PrEP.

Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education

Background: Since 1960, contraceptive use has risen rapidly in Asia and Latin America reaching prevalence levels among married women of 61 and 69 percent, respectively, by 2015. In contrast prevalence in sub-Saharan Africa reached only 25 percent in 2015. Some countries in Africa have experienced very rapid increases (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study examines the causes of these different trends which remain controversial. Methods: The analysis focuses on trends from 1990 to 2015 in 24 sub-Saharan Africa. Countries. Country-level regression analysis (OLS and fixed effects models) are used to estimate the separate impact on prevalence of family planning programs and socioeconomic variables (women's educational attainment, GNI/cap (PPP), percent urban and child mortality). The quality and scope of the government's public family planning program is measured with a new index developed by Bongaarts and Hardee. Findings: First, women's educational attainment and program score are the main determinants of levels of contraceptive prevalence in sub-Saharan countries. Second, the very rapid increases in prevalence in several countries since the 1990s are mainly due to the rapid strengthening of family planning programs and not to an acceleration of education levels. Third, the improvements in family planning programs are directly traceable to increases in government actions including stronger commitment from political leaders and increased funding. Interpretation: Voluntary family programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impacts above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even when education levels have risen substantially. Funding: William and Flora Hewlett Foundation Declaration of Interest: We declare no competing interests.

Family Planning as an Investment in Human Capital: Cost-Benefit Analysis of the Programme in Malaybalay, Bukidnon, the Philippines

The objective of the study is to determine the effects of family planning and maternal and reproductive health (FP-MRH) programmes in cities and to analyze the institutional factors that can make them effective. The proposed methodology is experimental in design with data from both beneficiary and non-beneficiary households, the comparison of which will serve as the basis for measuring the benefits and costs of such programmes. The article analyzes three censuses of Malaybalay, Bukidnon, from 1998 to 1996, in which more than 65 per cent of the households were identified as family planning (FP) users. In this case, the relevant comparison is not only between those using or not using family planning, but also, most especially, between those receiving them from the public programmes or from private sources. Household data in Malaybalay confirm a decline in fertility of about 2 per cent on average in the public FP users compared with the privately sourced household FP users and non-users from 2008 to 2010. The consequences of the programme on a series of family welfare outcomes are then estimated, in addition to fertility: women’s and children’s health (measured using the incidence of death), ownership of house and lot, engagement of mothers in the labour market and finally the schooling of children. Within the three years being analyzed, many of these indicators of the welfare of women and their children improve slightly but significantly, in conjunction with the other health and social programmes of the city. The cost-benefit analysis show that, overall, the return of investment is 56 per cent, implying that for every peso spent on FP-MRH programmes, 56 centavos worth of savings can be used in other programmes. This suggests that the social returns to reproductive health programmes in the cities have many facets beyond fertility reduction but are also seen to be dependent on the existence of these other development programmes. Furthermore, the nascent success of these programmes provides the rationale for greater national support.

Evidence of Human Papillomavirus Vaccine Effectiveness in Reducing Genital Warts: An Analysis of California Public Family Planning Administrative Claims Data, 2007–2010

Because of the rapid development of genital warts (GW) after infection, monitoring GW trends may provide early evidence of population-level human papillomavirus (HPV) vaccine effectiveness. Trends in GW diagnoses were assessed using public family planning administrative data. Between 2007 and 2010, among females younger than 21 years, these diagnoses decreased 35% from 0.94% to 0.61% (P(trend) < .001). Decreases were also observed among males younger than 21 years (19%); and among females and males ages 21-25 (10% and 11%, respectively). The diagnoses stabilized or increased among older age groups. HPV vaccine may be preventing GW among young people.

Evidence of Human Papillomavirus Vaccine Effectiveness in Reducing Genital Warts: An Analysis of California Public Family Planning Administrative Claims Data, 2007–2010

Evidence of Human Papillomavirus Vaccine Effectiveness in Reducing Genital Warts: An Analysis of California Public Family Planning Administrative Claims Data, 2007–2010

O1-S02.04 Evidence of HPV vaccine effectiveness in reducing genital warts: an analysis of California Public Family Planning Administrative Claims Data, 2007–2009

BackgroundThe quadrivalent HPV vaccine, available in the US since 2006, is recommended for females age 9–26. This vaccine prevents HPV types 6 and 11, which cause 90% of genital warts...

Associations Between Low‐Income Women’s Relationship Characteristics and Their Contraceptive Use

Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between women's relationship characteristics and use of different methods. Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods. Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse. When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.

The Pace of Fertility Decline in Iran: Finding from the Demographic and Health Survey

The fertility transition experiences of many countries in Asia have been very slow and stalling. Yet, Iranian fertility rates have shown signs of sharp decline. The recent censuses and surveys, both regional and national, all are consistent with a strong declining trend which started in the later part of 1980s and seem to be continuing into the new century. The Demographic and Health Survey of Iran shows below replacement level fertility for urban areas and a very low fertility level for rural areas. A trend analysis of fertility levels suggests an unprecedented pace of fertility transition for Iran. Following Casterline (2001) we attempt to theorize about the cause of fast paced fertility transition. We conclude that the strong emerging economic aspirations among all families in all classes and communities, the high actual and perceptual level of child survival, and very low social and economic cost of birth control have been behind the speed of fertility transition in the Islamic Republic of Iran. We submit that the high economic aspirations of families will not only continue but will shift to higher levels among all classes and especially among the generations entering marriage in the coming years. The strong economic aspiration will curtail their desire for more than one child once they are married. Hence a strong public family planning program must continue to provide birth control supplies and services with low social and economic cost. Any effort to reduce the public support of family planning program will result in socially undesirable consequences such as an increase in abortion.

A Positive Orientation Toward Early Motherhood Is Associated with Unintended Pregnancy Among New Orleans Youth

Characterizing young women's willingness to enter motherhood is critical to understanding the high rates of unintended pregnancy among women under 20 years. Our objectives were to discuss a measure called Positive Orientation towards Early Motherhood (POEM), and investigate its association with self-reported unintended pregnancy experience. We used data from 332 African-American women 13-19 years old recruited at public family planning and prenatal clinics in New Orleans. Using a series of ANOVAs and multinomial logistic regression, we assessed differences in POEM between four different outcome groups: women who were never pregnant and those who had only intended pregnancies, only unintended pregnancies and both unintended and intended pregnancies. The data suggested that young women perceive pregnancy as an opportunity to assert responsibility, become closer with their families and achieve greater intimacy with their boyfriends. Multiple regression analysis indicated that this positive orientation toward early motherhood independently raised the likelihood that young women experienced unintended pregnancies. In particular, the perception that a pregnancy makes a young woman feel more responsible was associated with an increased likelihood that a young woman had only unintended pregnancies compared to no pregnancies at all. Interestingly, this perception did not differentiate young women who had only intended pregnancies from those who were never pregnant. When interpreting reports of unintended pregnancy, more attention should be given to young women's orientation toward early motherhood. Doing so will inform policies that address both personal and structural factors that contribute to persistently high rates of unintended pregnancy among adolescents.

Selective screening for chlamydial infection: which criteria to use?

Background: Screening sexually active women for Chlamydia trachomatis is necessary to detect asymptomatic infections. Selective screening is a common strategy because universal screening is too costly in many settings. In order to guide local programs in the choice of selective screening criteria, we examined the performance of previously proposed screening criteria for C trachomatis. Methods: A clinic-based, cross-sectional study was conducted in public family planning and sexually transmitted disease (STD) clinics in ten counties in North Carolina. Women ( n = 4471 in family planning and n = 2201 in STD clinics) undergoing pelvic examination were enrolled consecutively. Nine sets of screening criteria, including age alone, were compared using sensitivity, specificity, number of tests required and receiver-operator characteristic (ROC) analysis. All women underwent testing with ligase chain reaction assay of cervical specimens to identify C trachomatis infection. Results: The prevalence of C trachomatis was 7.8% and 11.0% in family planning and STD clinics, respectively. The sensitivities of published criteria ranged from 0.50 to 0.97. Specificities ranged from 0.05 to 0.66. In family planning clinics, the best performing criteria would detect 84% of infections while screening 51% of women. In STD clinics, the same criteria would detect 83% of infections but require testing 67% of women. Testing women aged ≤22 would detect 77% of infections in family planning and 74% of infections in STD clinics, while testing 51% and 48% of the women, respectively. Conclusions: When site-specific criteria cannot be developed, age alone is an acceptable strategy for selective screening for chlamydial infection.

A Situation Analysis of Public Family Planning Service Delivery in Pakistan

A nationally representative sample of 8 percent of the Government of Pakistan's primary family planning service facilities, the Family Welfare Centres (FWC), was carried out at the request of the Ministry of Population Welfare in mid-1992. The "situation analysis" approach used involved: 1) observation and inventory of services, facilities, supplies and record keeping reviews; 2) observation of interaction between service providers and FP clients at FWC's; 3) interviews with service providers; and 4) exit interviews with FP clients after service provision. This one-day on-site observation by teams of three interviewers provided a unique overview and baseline assessment of the availability of services, the staff functioning and the quality of service. Significant findings include a low caseload, inadequacies of facilities, some stockouts, lack of educational materials, insufficient outreach, unnecessary medical and social barriers to providing contraception as well as in some cases insufficient information to clients about contraindications to contraceptive usage and possible side-effects. The need to bolster in-service training and supervision is emphasized.

Fertility Decline and Participation in Georgia's Family Planning Program: Temporal and Areal Association

3 different analytic techniques are used to demonstrate a causal relationship between a Georgia statewide public family planning program and a subsequent decline in fertility. The Georgia family planning program developed rapid growth since 1967. By January 1973 42% of the states black women in the 15-44 age group had accepted contraception from a public family planning center; only 7.7% of white women in the same age groups had accepted. The proportions of young and of childless women increased over time. By 1969 oral contraceptives were the most popular method. The first analytic method a temporal one indicated an association between enrollment of black women 25 years or older in the family planning program and a subsequent decline in fertility. The second analysis showed that black fertility declined more than twice as much in counties with high rates of contraceptive acceptance than in counties with low rates of contraceptive acceptance. The third analysis a multivariate regression technique to control for other factors that might influence fertility controlled for the following factors: 1)female employment; 2)farm residence; 3)poverty; and 4)female education. The limitations of the model and the data are mentioned. This method indicated that socioeconomic factors became less important and contraceptive acceptance more important in declining fertility over time.

New Strategy in Public Family Planning Administration

New Strategy in Public Family Planning Administration

Prediction in family planning. Factors associated with involvement of low-income women in a public family planning program.

Prediction in family planning. Factors associated with involvement of low-income women in a public family planning program. E Siegel, D Thomas, R Tuthill, E Coulter, and S ChipmanCopyRight https://doi.org/10.2105/AJPH.60.8.1382 Published Online: August 29, 2011

Measurement of need and utilization rates for a public family planning program.

To determine the number of women in need of family planning services in the Charlotte North Carolina area and the proportion of these women currently served by the present family planning clinic 1693 randomly selected households in low-income districts were surveyed. Interviews were obtained from women between 15 and 44 years of age in 94.3% of the eligible households resulting in 800 usable interviews on a broad variety of items including socioeconomic background sexual history and family planning practices. 63% of the sample were determined to be financially eligible for the countys family planning program because of their poor or near-poor status. The proportion of these poor was twice as great among nonwhites as whites. 18.7% of these eligible women were infertile or had been sterilized. Significantly more white women fell into this category than nonwhites (p less than .05). 32.5% of the eligible women were determined to be temporarily not in need of family planning services because they were sexually inactive using nonclinic contraception or were in some stages of pregnancy. Thus 48.8% of the eligible women were found to be currently in need and 34.2% were going unserved by the clinic. Significantly more nonwhite women were in need than whites (p less than .01). Of the 292 women not financially eligible for the countys program 12.7% were found to be infertile or sterilized and 42.5% temporarily not in need. Significantly more whites fell into this latter category than nonwhites (p less than .001) due to their more frequent use of nonclinic contraception. Significantly more nonwhites were sexually active and not using contraception in this group than whites (p less than .001). The poor and financially eligible respondents were significantly more sterile (p less than .05) less using nonclinic contraception (p less than .05) and more sexually active without contraception (p less than .05) than the financially ineligibley It is concluded that the greatest need for family planning in this area is among the nonwhite poor.

Evaluating the Success of Enrollment Efforts in a Public Family-Planning Clinic

The Family Planning Clinic of the Mecklenburg County Health Department has been in operation since 1937 added orals in 1960 and intra-uterine devices in 1964. Six methods of evaluating the degree to which the clinic has reached the eligible population are presented and five of them are applied to the clinic figures. The methods presented are concerned with first admissions to the clinic. The problem of case-holding has many facets and is still under study. (authors)

Public family planning services in the south--a progress report.

Public family planning services in the south--a progress report.