Contraceptive Uptake Research Articles

COVID-19 and Contraceptive Use in Two African Countries: Examining Conflicting Pressures on Women.

Women in Africa may have experienced conflicting pressures during the COVID-19 pandemic. While the unpredictable nature of the pandemic was prompting some women to delay pregnancies, the pandemic was potentially limiting access to reproductive health services due to supply shortages, fears of virus exposure, and mobility restrictions. In this study, we used longitudinal data from Kenya and Burkina Faso and applied a multilevel perspective to better understand the factors contributing to change or persistence in contraceptive use during the early months of the pandemic. We found a marginal increase in contraceptive uptake in the early days of the pandemic. Multilevel logistic regression results revealed that interpersonal trust and accurate knowledge of COVID-19 precautions were associated with a greater likelihood of initiating contraception. These factors appeared to have provided women with confidence to navigate the complicated COVID-19 landscape. At the same time, we observed a decrease in contraceptive use in regions with high COVID-19 cases, suggesting the virus was limiting access to contraception in some contexts. These findings highlighted the need for public health officials to ensure that women have the necessary knowledge and ability to safely access contraception during public health crises, when overall demand for contraception may be increasing.

Adoption of contraception following a pregnancy loss in India.

The present study was carried out to describe contraceptive adoption following pregnancy terminations that resulted in outcomes other than live birth. Retrospective calendar data on 31486 women who had experienced a pregnancy loss within the last 60 months prior to the survey date were drawn from a nationally representative dataset. Logistic regression was employed to model the associated factors with contraceptive uptake. Overall, 57.8% reported not adopting any method following the end of the recent pregnancy. There was a significant association between the choice of contraceptive method and timing of adoption. Women with living children were significantly more likely to adopt contraception as compared to women without any child. Contraceptive uptake following a non-live birth is considerably low in India. Interventions in reproductive health should focus on provision of different contraceptive methods and counseling emphasizing on effectiveness and correct use of the methods at the end of any pregnancy.

Toward person-centred measures of contraceptive demand: a systematic review of the intentions to use contraception and actual use

Background Understanding people’s motivation and need for modern contraception is critical to ensuring access to quality rights-based contraceptive care and supporting reproductive justice. Current population level measures of contraception demand are proving limited; but there is a promising, more person-centred alternative - intention to use (ITU) contraception. ITU captures a person’s self-reported preferences and could better predict contraceptive use. This systematic review examines whether ITU predicts future contraceptive use and may be a better way to estimate desire to use contraception. Methods We searched PubMed, PsycInfo, Web of Science, and the Cochrane Collaboration to identify studies published from 1975-2020 that: (1) examined contraceptive behaviour, (2) included measures of ITU and future contraceptive use, and (3) included at least one quantitative measure of association between ITU and actual use. The inclusion criteria were: 1) examined contraceptive behaviour (excluding condom use only), (2) included disaggregated integral measures of ITU contraceptives and later contraceptive use, (3) included at least one quantitative measure of the association between ITU contraceptives and actual contraceptive use, (4) study population was women of reproductive age, (5) were peer-reviewed, and (6) written in English. Results 10 prospective cohort studies were included. Six indicated significant, increased, unadjusted odds of subsequent contraceptive use after reporting ITU. Of those, three reported adjusted values for contraceptive use across several covariates that were also significant and positive. The range of potential confounding factors indicate that contraceptive behaviour is a complex psychosocial process shaped by individual and contextual factors. Conclusions People’s self-reported ITU contraception have the potential to be a strong predictor of subsequent contraceptive use. Few studies directly examined the relationship between ITU and contraceptive uptake and recruitment was primarily pregnant or postpartum samples. Further high-quality research measuring the relationship between ITU and contraceptive use using standardized measures and variables are needed.

Trends and determinants of unmet need for modern contraception among adolescent girls and young women in Tanzania, 2004-2016.

Unintended pregnancy at a young age can lead to poor reproductive health, social and economic outcomes. The high rate of unintended teenage pregnancies in Tanzania is indicative of inadequate availability and uptake of modern contraception. Determining trends and determinants of unmet need for modern contraception among adolescent girls and young women (AGYW) in Tanzania will help address the burden of unintended pregnancies. An analytical cross-sectional study design was conducted using secondary data from three consecutive Tanzania Demographic and Health Surveys (TDHS) 2004/05, 2010 and 2015/6 among AGYW in need of modern contraception. Data analysis considered the complex survey design. Poisson regression model was used to determine factors associated with unmet need for modern contraception. We observed a steady decline in unmet need for modern contraception among sexually active AGYW in need of modern contraception from 31.8% in 2004/05 to 27.5% in 2015/16 survey. In the multivariable analysis, higher prevalence of unmet need for modern contraception was observed among adolescents, participants with at least one live birth, from poor wealth tertile, and those sexually active during the past four weeks compared to their counterparts. Despite declining levels, the unmet need for modern contraception among AGYW in Tanzania remains high. AGYW under 19 years, those from poor households, and those who are postpartum are most at risk. Greater efforts in empowering and educating AGYW at risk on their reproductive health rights and needs will further the uptake of modern contraceptive use, reduce the rates of unintended pregnancies, lower the adolescent fertility rate as a result lower unmet need for modern contraception.

Effective strategies for increasing the uptake of modern methods of family planning in South Asia: a systematic review and meta-analysis

BackgroundFamily planning (FP) interventions have improved the use of modern contraceptives, yet a high unmet need for contraception still exists in South Asia. This systematic review of existing research was conducted to identify effective FP interventions that led to an increase in the uptake of modern methods of contraception in South Asia.MethodsFive electronic databases were searched for relevant studies published between January 1st, 2000 and May 4, 2023. Experimental studies that reported data on the impact of FP interventions on modern contraceptive use among women of reproductive age (15–49 years) in the South Asian region were included. A random-effects Inverse Variance weighted model was employed to pool the adjusted odds ratio (OR) on modern contraceptive use and unmet need for contraception. In addition, we computed subgroup meta-estimates based on intervention type and the urban-rural divide.ResultsAmong 643 studies identified, 21 met the inclusion criteria. The overall pooled odds ratio for modern contraceptive use was significantly higher (OR 1.51; 95% CI 1.35–1.70; heterogeneity; I2 = 81%) for FP interventions with a significant reduction in unmet need for contraception (OR 0.86; 95% CI 0.78–0.94, I2 = 50%). The subgroup analysis revealed demand-generation (OR 1.61; 95% CI 1.32–1.96), health system integrated (OR 1.53; 95% CI 1.07–2.20), and franchised FP clinic interventions (OR 1.32; 95% CI 1.21–1.44) had promoted the modern contraceptive uptake. Further, FP interventions implemented in urban settings showed a higher increase in modern contraceptive use (OR 1.73; 95% CI 1.44–2.07) compared to rural settings (OR 1.46; 95% CI 1.28–1.66). Given the considerable heterogeneity observed across studies and the low degree of certainty indicated by the GRADE summary for the primary outcome, caution is advised when interpreting the results.ConclusionThe review collated experimentally evaluated FP interventions that increased modern contraception use and reduced the unmet need in South Asia. The demand generation interventions were the most effective in increasing the uptake of modern contraceptive methods. Furthermore, the urban environment provides a conducive environment for interventions to improve contraceptive usage. However, further studies should assess which aspects were most effective on attitudes towards contraception, selection of more effective methods, and contraceptive behaviors.

A randomized controlled study of the effects of targeted health education on uptake of contraceptives among women of reproductive age in Nnewi City, South-East Nigeria.

There is a need for contraception uptake among people to enable them to fulfil their right to determine the timing, number and spacing of their children. In regions with poor contraceptive prevalence rates, lack of effective education has been largely implicated, and Nigeria falls among such regions. Thus, the present study is designed to examine the impact of an educational intervention on uptake of contraceptives among women aged 18-49 years seeking care at the Nnamdi Azikiwe University Teaching Hospital Nnewi. Being an interventional study to underscore the effect of targeted health education on uptake of contraceptives, a randomized controlled trials design was adopted. A total of 275 women were randomly recruited and allocated into two groups-140 in intervention group and 135 in the control group. Data was collected by trained research assistants using a pretested structured interviewer-administered questionnaire and analyzed using Statistical Package for Social Sciences version 25. The level of significance was set at p < 0.05. At baseline, the level of uptake of contraceptives was similar in both the control and the intervention group (control = 2.48 points; intervention = 2.55 points). Overall, there were no statistically discernible differences between the two groups at baseline. The level of awareness and knowledge on contraceptives as well as the uptake of contraceptives significantly increased in both groups at the end of the study period. A statistically significantly higher increase was noted in the intervention group when compared to the control in level of awareness (t = 3.235; p < 0.05) and uptake of contraceptives (t = 2.628; p < 0.05). Significant positive changes in perceptions of contraceptives were observed more among the intervention group when compared to the control. Logistic regression analysis showed uptake of contraceptives was significantly influenced by occupation, monthly income, source of information, time of first use of contraceptives, level of knowledge on contraceptives as well as the targeted educational intervention. The targeted health educational intervention had a significant and positive effect on the level of awareness and uptake of contraceptives, as displayed in the intervention group. A significant and positive change in perception of contraceptives was also noted among the intervention group in almost all the questions. Certain factors were found to significantly impact the uptake of contraceptives. There is a need for studies with longer follow-up to ascertain sustained impact of health education on uptake of contraceptives. Further studies should be carried out in the other facilities in Nnewi to ensure a better coverage and representation of the target population. Finally, related studies should be carried out among men.

Effectiveness of an Interactive Mobile Health Intervention (IMHI) to enhance the adoption of modern contraceptive methods during the early postpartum period among women in Northeast Ethiopia: A cluster Randomized Controlled Trial (RCT).

Women in the early postpartum period face substantial unmet needs in contraception to encourage birth intervals and reduce unintended pregnancies. The widespread ownership of mobile devices offers an opportunity to employ mobile health strategies for enhancing communication between healthcare providers and clients. However, little is known about the effectiveness of mobile health interventions to improve early adoption of contraceptive methods after childbirth in Ehiopia. This study aimed to evaluate the effectiveness of a mobile health intervention in enhancing the uptake of modern contraceptive methods in the early postpartum period in Dessie and Kombolcha cities, northeast Ethiopia. The research was conducted in Dessie and Kombolcha cities zones located in the Amhara region of Northeast Ethiopia from 15th January to 15th June, 2023. Pregnant women with a confirmed gestation of 30 weeks were enrolled and followed up to the 45-day postpartum period. The study employed a cluster randomized control trial involving 764 participants (381 controls and 383 in the intervention group). The intervention group received a new mobile health intervention in addition to the existing healthcare practices, while the control group solely adhered to the current healthcare practices. Data were collected using the Open Data Kit (ODK) and exported to STATA 17 for analysis. The marginal model Generalized Estimating Equations (GEE) through the application of an exchangeable working correlation was applied. The effect of the intervention on the outcome was measured using the odds ratio with a 95% confidence interval at a p-value less than 0.05 significant level. The study found that 78.7% of participants in the control group and 77.3% in the intervention group had sexual practice after childbirth. The proportion of early postpartum contraceptive uptake in the intervention group (51.6%) was significantly higher than in the control group (38%). The odds of adopting modern contraceptive methods during the early postpartum period were 1.6 times higher among mothers who received the mHealth intervention compared to those in the control group (AOR: 1.6, 95% CI: 1.249-2.123). The study identified significant predictors for the uptake of contraceptive methods during the early postpartum period, including having a live newborn (AOR: 3.7, 95% CI: 1.034-13.353), parity (AOR: 1.7, 95% CI: 1.069-2.695), and previous experience with contraceptive initiation (AOR: 0.5, 95% CI: 0.358-0.912). This study findings demonstrated that the potential effectiveness of mobile health interventions in promoting timely contraceptive adoption during early postpartum period. The mobile health intervention, combined with factors such as timing of previous contraceptive initiation, newborn status, and maternal parity, significantly enhances the likelihood of early contraceptive adoption. These nuanced insights provide a strong foundation for developing targeted health interventions and policies aimed at improving early postpartum contraception. The trial was registered on December 23, 2022, in the Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ID: ClinicalTrials.gov ID: NCT05666037.

Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020.

Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019-February 2020. Women aged over 45years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician-patient discourse regarding these important issues should be explored.

Efficacy of Ngima Dhano Community Radio Programme in the Uptake of Contraceptives among Women in Cham GiWadu Division, Kenya

Efficacy of Ngima Dhano Community Radio Programme in the Uptake of Contraceptives among Women in Cham GiWadu Division, Kenya

Does Spousal Intimacy Improve Contraceptive Use? A Cross-Sectional Household Survey in Nigeria

Spousal intimacy has been argued to have the tendency to improve contraceptive use. In Nigeria, there is no empirical evidence to corroborate or refute this argument. This study attempts to fill this gap by examining the effect of spousal intimacy on contraceptive uptake using data from the Nigerian national demographic and health survey 2018. The dataset covers nationally representative 8,061 women of child-bearing age drawn from the 36 states of the country and the capital territory. Data are analyzed using the logistic regression model. We use two measures of contraceptive use: ever-used contraceptive and currently using contraceptive. Evidence shows that physical intimacy is positively and significantly associated with contraceptive use (with OR = 1.66, 95% CI: 0.28 - 0.73, for ever-used) and (OR = 1.60, 95% CI: 0.20 - 0.74, for currently using). Other covariates – education, number of children, family income, and age – are found to be significantly associated with both measures of contraceptive use. The study concludes that identifying and incorporating spousal-based innovations into family planning interventions may provide a leverage for improving contraceptive uptake in developing countries.

Improving the uptake of contraception, Somalia.

Improving the uptake of contraception, Somalia.

Contraception Crisis in Somalia: Unveiling the Shocking Reality of a Nation Left Behind

Background. Despite global efforts to promote contraceptive use and ensure reproductive health, Somalia continues to face significant challenges in this regard. This study aims to explore the prevalence of contraceptive use in Somalia and identify the determinants influencing its use. Methods. A total of 8,162 reproductive‐aged women’s data were analyzed extracted from 2020 Somali Health and Demographic Survey. The outcome variable was contraception use, classified as any contraception use (yes vs. no), any modern contraception use (yes vs. no), and any traditional contraception use (yes vs. no). The explanatory variables were factors at the individual, household, and community level. The multivariate binary logistic regression model was used to explore associations of outcome variables with explanatory variables. Results. The findings revealed low prevalence of contraceptive use among Somalia women, with only 7% reporting its use. Among them, less than 1% utilized modern contraceptive methods. Several determinants of contraception use were identified, including younger age, higher educational attainment (primary and secondary education), higher parity, exposure to family planning messages through mass media, urban place of residence, and residing in the northwest and northeast regions of Somalia. Conclusion. The results underscore the urgent need for substantial efforts to improve contraceptive use in Somalia. Strengthening healthcare facilities to provide comprehensive sexual and reproductive health services, with a particular focus on promoting contraception uptake, is crucial. Public awareness campaigns and educational programs should also be prioritized to enhance knowledge and understanding of contraception among Somali women.

Determinants of Contraceptive Options among Postpartum Women Attending Selected Health Care Facilities in Nigeria: A Cross-Sectional Study.

Differences in availability and choices of contraceptive methods among postpartum women have been found to influence their quality of life as the fertility rate is very high, and the contraceptive usage rate persistently remains low in Nigeria. This study assessed the determinants of contraceptive options among postpartum women in Nigeria. Two Local Governments were randomly selected from the four Local Governments. Within these two local governments, five health facilities were selected. A multistage sampling technique was used to select the 240 respondents, while a structured questionnaire was used to collect data. Findings from the study indicated that 81.7% of the respondents have planned to have their current baby, and about 65.4% of the women have resumed sexual activities since delivery. Of those who have resumed sexual activities, the majority, 91.1% did so 6 weeks after delivery. Some form of contraceptive usage was prominent among 59.2% of the respondents, as the most common contraceptive method used was withdrawal (24.8%). Contraceptive prevalence was slightly lower for urban respondents than rural respondents, although the relationship was not significant. Also, there was a statistically significant relationship between the current use of contraceptives and resumption of sexual activities since delivery (p = .001), resumption of menstruation (p = .001), and information received about postpartum family planning (p = 0.013). Findings from this study emphasize the urgent need for enhanced accessibility and availability of contraceptive methods, with a parallel emphasis on targeted interventions and effective communication strategies to promote contraceptive uptake and family planning. Addressing these determinants is vital in improving postpartum women's overall quality of life in the study area.

Patient Perceived Quality of Virtual Group Contraception Counseling.

The study examines the feasibility, quality of counseling, and knowledge after a virtual Group Contraception Counseling (GCC) session. At an urban academic hospital, we recruited English-speaking pregnant women aged 15-49 who had access to a video-enabled electronic device. Participants engaged in a standardized 45-minute educational session about contraceptive methods in groups of two to five persons conducted over a video conferencing platform. The primary outcome was participant perceived quality of contraception counseling measured by the Person-Centered Contraception Counseling (PCCC) scale. The secondary outcomes were knowledge change before and after counseling, and postpartum contraception uptake. We used an adjusted multivariable linear regression model to analyze knowledge scores. Twenty-two participants completed the study. Participants identified primarily as Black or Hispanic/Latinx (78%), in a partnership (50%), having completed college (59%), and having an annual income of less than $50,000 (78%). A total of 77% of participants recorded a perfect score for quality of counseling using the Person-Centered Contraceptive Counseling (PCCC) scale. There was an increase in knowledge after counseling (Mean difference (M)=0.07, p<0.01). Notably, certain subsets of participants had decrease in knowledge scores after counseling. Participants who used postpartum contraception were more likely to have increase in knowledge after counseling compared to those who did not (Mean difference (M)=0.09, p<0.01). Our findings suggest virtual group contraception counseling is feasible for providing high-quality counseling and can possibly increase contraceptive knowledge.

Determinants of Modern Contraceptive Uptake among the Youth in Akuse Township in the Lower Manya Krobo Municipality, Ghana

Determinants of Modern Contraceptive Uptake among the Youth in Akuse Township in the Lower Manya Krobo Municipality, Ghana

Post abortion contraceptive uptake and continuation rates at Korle-Bu Teaching Hospital, Accra, Ghana

Introduction: The tragedy of unsafe abortion is that it is one of the easily preventable causes of maternal death. In Ghana, the maternal mortality ratio was 319/100,000 live births. (WHO, 2015) of which 11% of these were abortion related. 13% of abortions had complications including chronic pelvic pain, offensive discharge and uterine perforation In spite of the above, this study sought to find out factors that affect uptake and continuation rates of post abortion contraception at the Korle Bu Teaching Hospital. Methods: This was a longitudinal study using interviewer administered questionnaire of women reporting for elective termination of pregnancy or for uterine evacuation for incomplete abortion either induced or spontaneous. Participants were followed up by telephone calls at end of 1, 3 and 6 months. Simple proportions was calculated for post-abortion contraception uptake and continuation rates. Multiple logistic regression was used to determine factors associated with uptake and continuation rates. A p-value of less than or equal to 0.05 was considered as statistically significant. Results: The study included 338 participants. The overall uptake was 132 (39.1%). Eighty-seven (25.7%) on discharge and 45 (13.4%) additional uptake within one month of the follow-up. Continuation rate at 6 months was 68.9%. Significantly associated factors were educational level, employment and marital status, gravidity/parity and previous contraceptive use. Conclusion: Post-abortion contraception uptake of 39.1% with 68.9% continuation rate at 6 months found in this study is low. This implies high unmet need for post-abortion contraception that needs to be addressed urgently.

Social-cultural factors influencing modern contraceptive uptake among women of the reproductive age in Turkana County, Kenya

Background: Modern contraceptive is pivotal for reproductive health, averting unplanned pregnancies, lowering maternal mortality, and enhancing women's well-being. Despite global strides, challenges still persist in adoption of modern family planning methods in regions, like Turkana County, Kenya with a 30.7% adoption rate marking high unmet contraception needs. This study delved into determining social-cultural factors impacting uptake of modern contraceptive in the remote area of Turkana, Kenya. Methods: A descriptive cross-sectional study was employed. The 360 participants were sampled from households using systematic random sampling. Data was analyzed using SPSS 21.0. Data analysis included frequencies, proportions and Chi-square tests to unveil vital variable correlations. Data was presented in tables, graphs and pie charts. Results: The study revealed higher utilization of modern contraceptives at 53%. Cultural factors associated with Modern contraceptive uptake included religion acceptance of family planning (χ2=6.997, p=0.008), myths and misconceptions (χ2=31.096, p=0.000), gender preference (χ2=28.876, p=0.000), cultural perception of child quantity (χ2=26.373, p=0.000), decision maker for family planning (χ2=19.745, p=0.000) and discussion with partner (χ2=55.063, p=0.000). Conclusions: In Turkana County, Kenya, socio-cultural factors seem to significantly shape modern contraceptive choices among women of reproductive age. Religious beliefs, misconceptions, and gender preferences influence decisions. Cultural norms impact family size views, and autonomy prevails. Tailored interventions addressing these issues are crucial for better reproductive health outcomes.

Fertility Has Been Framed: Why Family Planning Is Not a Silver Bullet for Sustainable Development

AbstractHigh fertility and population growth have been framed as villains in global health and development. Inspired by neo-Malthusian concerns around resource depletion, scholars have argued that fertility reduction through increased contraceptive use is necessary to protect maternal health, prevent environmental disaster, and promote economic prosperity throughout the Global South. Despite substantial critique from feminist and anticolonial scholars, the scientific evidence behind these arguments has often been treated as established fact. This ostensible scientific consensus on the instrumental benefits of contraceptive use has been marshalled by the global family planning establishment in the wake of the 1994 International Conference on Population and Development to justify continued efforts to maximize contraceptive uptake in the Global South. Here, we critically examine the evidence linking high fertility to adverse maternal health, environmental, and economic outcomes and evaluate whether reducing fertility through increased contraceptive use offers an effective strategy to address these challenges. We find the state of the evidence weaker and more conflicted than commonly acknowledged, with many claims relying on small effect sizes and/or unjustified assumptions. While increasing contraceptive uptake and reducing fertility may offer limited, marginal advantages, we argue that family planning cannot effectively address the multidimensional challenges of global poverty, ill health, and environmental degradation. Instead, global health and development should address root causes of these phenomena, while family planning programs must radically refocus on reproductive autonomy.

Applying Human-Centered Design to Replicate an Adolescent Sexual and Reproductive Health Intervention: A Case Study of Binti Shupavu in Kenya.

We present a case study describing the use of human-centered design (HCD) to determine how to adapt intervention components from an existing contraceptive uptake program for adolescent girls in 4 geographical contexts (Ethiopia, northern Nigeria, southern Nigeria, and Tanzania) for use in Kenya. First, we prioritized existing intervention components to be tested in Kenya using sacrificial concepts. Through these concepts, we identified key insights and behavioral archetypes from which to build higher-fidelity prototypes, leveraging existing program knowledge and resources while responding to unique opportunities for Kenyan adolescent girls. After 2 rounds of prototyping, we launched a high-fidelity intervention designed to improve contraceptive uptake among girls. We used program experience to identify strategies for improvement during early implementation. The resulting model, Binti Shupavu, is designed to tap into girls' aspirations and connect them with contraceptive use, build their trust in the health system, and work with influencers to build support for adolescent contraceptive use, following the global user journey. In the first year of implementation (January-December 2022), the intervention was scaled from 90 facilities to 360 facilities and reached 60,111 adolescent girls aged 10-19 years. Of these, 21,698 were new voluntary contraceptive users (36%) and an additional 3,873 (19%) were continuing users.Our design process suggests that HCD is a promising tool for navigating replication. The emphasis on users' perspectives, testing to learn, and collaboration facilitated a deep understanding of the new user population, thus guiding program designers to balance using existing components with developing new ones based on the population's unique needs. Finally, HCD has potential to support the localization agenda if design teams are supported by national, regional, and global experts to be aware of and use the evidence and implementation experience from earlier work.

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

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