Uptake Of Modern Contraceptives Research Articles

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study.

Family planning counselling can help improve the postpartum modern contraceptive uptake. However, studies in Ethiopia indicate inconsistent effects of integrated family planning counselling on postpartum modern contraceptive uptake. This study aimed to determine the extent of family planning counselling and its role in improving postpartum contraceptive uptake among women in Ethiopia. We used the Performance Monitoring for Action (PMA) Ethiopia panel survey data, a community-based prospective cohort study. Randomly selected pregnant women were recruited at the baseline interview and followed by six weeks and six months postpartum. A weighted generalised linear model fitted with a Poisson distribution and a log link function was used to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of modern contraceptive uptake. The coverages of family planning counselling provision during ANC, prior to discharge and child immunisation were 20%, 27% and 23%, respectively. The modern contraceptive uptakes by six weeks and six months postpartum were 18% and 36%, respectively. Family planning counselling prior to discharge from the facility was associated with increased modern contraceptive uptake by six weeks (aRR 1.25; 95% CI 0.94, 1.65) and six months postpartum periods (aRR 1.07; 95% CI 0.90, 1.27). Moreover, women who received family planning counselling during child immunisation were 35% more likely to use modern contraceptives by six months postpartum (aRR 1.35;95% CI 1.12, 1.62). However, counselling during ANC visits was not associated with modern contraceptive uptake by either six weeks or six months postpartum. A significant proportion of women had missed the opportunity, and the postpartum modern contraceptive uptake was low. Despite these, family planning counselling prior to discharge from the facility and during child immunisation improved the postpartum modern contraceptive uptake. However, our finding revealed insufficient evidence that family planning counselling during ANC is associated with postpartum modern contraceptive uptake.

Gaps and evidences on programming postpartum family planning services in Nepal

Background: Postpartum family planning (PPFP) is one of the strategic efforts mentioned in the National Family Planning Strategy 2011/12 and National FP Costed implementation plan 2015-2020 of Nepal. Postpartum women are recognized as one of the groups that need attention to strengthen FP services in the country. Methods: We conducted a situational analysis in Nepal from December 2019 to May 2020, to identify the needs, gaps and provide evidence for strengthening future programming in this area using a combination of three methods: (i) non-systematic literature review using Google Scholar, Pubmed, and grey literature, (ii) secondary analysis using the dataset from Nepal Demographic and Health Survey (NDHS) 2016 that was based on a two-stage, stratified, nationally representative sample of households, and (iii) virtual assessment in purposively selected eight health facilities using a standard checklist related to PPFP. Results: Results show a lower modern contraceptive uptake (22.6%) and higher unmet need (31.5%) among postpartum women compared to all currently married women (43% and 24% respectively). Three most commonly used modern contraceptive methods among postpartum women in Nepal are injectables (8%), male condoms (7%), and oral contraceptive pills (3%). The PPFP services are available only in limited health facilities and were not integrated in Antenatal care (ANC), Postnatal care (PNC), childbirth and immunization services. Provision of family planning counseling during the ANC period is not recorded in the ANC card. Male partners do not participate in family planning counseling. Similarly, the uptake of family planning services at immunization, child health, and postnatal clinics is not recorded. Conclusion: This analysis provided evidence of the current status of PPFP in the country. There are gaps and challenges especially in strategy and guidelines, training, regular supply of commodities, awareness of PPFP, recording and reporting of PPFP. These gaps should be addressed with appropriate strategies.

Contraceptive uptake and associated factors among women in the immediate postpartum period at Kawempe Hospital

IntroductionWithin Africa, contraceptive use is low although about 214 million women who are not using contraception want to avoid pregnancy. In Uganda, modern contraceptive uptake is at 35% resulting in unwanted or unplanned pregnancies which may increase morbidity and mortality among children and mothers. Contraceptive uptake at 6 weeks postpartum is encouraged but it is not very effective since there is low attendance during this visit. Additionally, some women may have become sexually active by the visit at 6 weeks postpartum leading to early conception.ObjectivesThis study sought to determine contraceptive uptake in the immediate postpartum period and the associated factors among women delivering at Kawempe Hospital.MethodsThis study employed a cross-sectional study design where 397 women aged 18–49 years were recruited using systematic random sampling. The women who were discharged within 72 h after delivery were considered. Data collection was done using an interviewer-administered data collection tool. Data was double entered into EpiData version 4.2 and analyzed using STATA version 13 at univariate using descriptive statistics then at bivariate and multivariate levels using logistic regression with contraceptive uptake as the outcome.ResultsWe enrolled 397 participants. Their mean age range was 18–45 years and a median of 25 years (IQR 22, 30). The majority of the participants, 333 (83.88%), were married and 177 (44.58%) were housewives or unemployed. Contraceptive uptake in the immediate postpartum period among these participants was 15.4% (61/397). The factors independently associated with immediate postpartum contraceptive uptake were grand multiparity (aOR = 2.57; 95% CI 1.11–5.95; p = 0.028), cesarean delivery (aOR = 2.63; 95% CI 1.24–5.57; p = 0.011), and prior contraceptive counseling during Antenatal (aOR = 9.05; 95% CI 2.65–30.93; p = < 0.001).ConclusionThere was a 15.4% contraceptive uptake among immediate postpartum women which is very low. The factors independently associated with immediate postpartum contraceptive uptake were grand multiparity, cesarean section, and prior contraceptive counseling during antenatal care. Efforts need to be made to improve contraceptive uptake among immediate postpartum mothers such that the high unmet need for contraception is reduced and short inter-pregnancy intervals are controlled.

Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey

BackgroundFamily planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of sub-Saharan Africa.MethodsThirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the best-fitted model.ResultsThe pooled estimate of modern contraception use in sub–Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [AOR = 1.38 (1.33, 1.42)], middle [AOR = 1.17, (1.14, 1.21)], rich wealth status [AOR = 1.29 (1.25, 1.34)], media exposure [AOR = 1.25 (1.22, 1.29)], and postnatal care (PNC) utilization [AOR = 1.25 (1.22, 1.29)] had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility [AOR = 1.74 (1.69, 1.79)] and birth order 2–4 [AOR = 1.36 (1.31, 1.41)] had higher odds of modern contraceptive utilization. On the other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] decreased the odds of modern contraceptive utilization.ConclusionThe uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention needs to be given to rural residents, illiterate women, and communities with low wealth status.

Does family planning counselling during health service contact improve postpartum modern contraceptive uptake in Ethiopia? A nationwide cross-sectional study

ObjectiveThis study examined the association between family planning counselling receipt during the 12 months preceding the survey and postpartum modern contraceptive uptake in Ethiopia. We hypothesised that receiving family planning...

‘Of course, women will adopt it!’: A qualitative study on the acceptability of medical menstrual regulation in Senegal

ObjectiveMedical menstrual regulation (MMR) may offer a promising way to reach Senegalese women and girls in need of fertility management, especially in rural contexts. To assess the feasibility of introducing a MMR service in Senegal, the study aimed to (1) understand how women and girls manage their menses and fertility, and (2) document acceptability of MMR among women, youth, and health providers. MethodsSix focus group discussions and 34 in-depth interviews were conducted with women, youth, and health providers in Kaolack, Mbour, and Thiès, Senegal. ResultsAll participants characterized the pubescent period by a lack of sexual education, familial support, and access to reproductive health services. Reproductive health service utilization in Senegal was portrayed as highly stigmatized, creating barriers to contraception and reliable information on family planning. Unwanted pregnancy and clandestine abortion were depicted as common occurrences among many participants. Senegalese women and youth perceived MMR services as an acceptable method to manage a missed period with discretion, rid of moral and legal ramifications – and framed MMR as a needed mechanism to prevent abortion and avoid undesired pregnancies. The majority of health providers, with the exception of female health volunteers, were reluctant to endorse the service, comparing MMR to abortion. ConclusionsIn a context fraught with restrictive abortion laws and limited uptake of modern contraception, MMR is an acceptable among potential service users. Nonetheless, introduction and implementation of MMR will be feasible in Senegal only if policymakers approve and support the service and health provider buy-in is achieved.

Factors influencing the use of modern contraceptives amongst postpartum women in a rural tertiary hospital in South-South Nigeria.

The postpartum period is a critical time to address the high unmet needs of family planning and reduce the risks associated with closely spaced pregnancies. Unintended pregnancies immediately following childbirth are associated with increased maternal mortality, morbidity, and poor pregnancy outcomes. Adoption of postpartum family planning is a cost-effective way that would reduce maternal and child morbidity and mortality. This study aimed to establish the prevalence, the clients' sociodemographic factors, and health care workers' influences on modern contraceptive uptake amongst postpartum women at Irrua Specialist Teaching Hospital (ISTH), Irrua. This descriptive cross-sectional study was carried out amongst postpartum mothers attending maternal and child health clinics in ISTH, Irrua, Edo State, Nigeria. The selection of participants was by simple random sampling technique. All consented participants selected through simple random sampling were administered questionnaires, and completed ones were coded and analysed while the level of significance was set at 5%. In this study, over 90% of the women were aware of a method of modern contraception. However, this did not translate to increased contraceptive uptake as only 17.8% of the respondents were currently on a method of postpartum contraception. The statistically significant sociodemographic factors influencing the utilization of modern contraceptives by postpartum women, as seen in this study, were: Age (p <0.001), level of education (p <0.001), religion (p=0.048), and parity (p=0.010). The women who have higher educational status, higher parity, and adequate information provided by healthcare providers were more likely to use at least a method of modern contraceptive postpartum. The uptake of modern contraceptives amongst postpartum women was low in this study. Strengthening family planning counseling services during prenatal care and emphasizing the girl child education, provision of adequate information by healthcare providers on the need for postpartum contraception could enhance modern contraceptive use for postpartum women.

The unmet need for abortion law reforms and modern contraceptive uptake in Nigeria, Kenya, Ghana and Ethiopia: A systematic review

Background: It is estimated that about 68,000-70,000 deaths occur from unsafe abortions annually, with 97% of this occurring in developing countries. The reality that almost 35% of these worldwide deaths occur in sub-Saharan Africa Countries alone is a lot to think about.Aim of Article: This article seeks to bring to better lamplight the direct and indirect proportional relationship between contraceptive uptake, unwanted pregnancies, abortion laws and unsafe abortions. To suggest for better abortion law reforms to reduce maternal mortalities from unsafe abortions.Discussion/Conclusion: Comprehensive male sex education, modern methods of pregnancy prevention and Reformed laws on Therapeutic Safe Abortion Care are key paths that should be taken more seriously in the quest to end the menace of unwanted pregnancies and unsafe abortions in Sub-Saharan Africa.Restrictive abortion laws only further fuel the pathology of unsafe abortion in sub-Saharan Africa. We need to legalize safe abortion care and in fact, illegalize unsafe abortion services and/or procurement.

Postpartum contraceptive initiation and use: Evidence from Accra, Ghana.

Postpartum contraceptive use reduces unintended pregnancies and results in better health outcomes for children and women. However, there is a dearth of knowledge on postpartum contraceptive use in Ghana, particularly among women in low-income urban settings. To shed light on strategies that might enhance access to postpartum family planning services in low-income urban settings, we examined contraceptive use among postpartum women in Accra, Ghana, at 1, 3, 6, and 12 months following the birth and the methods used. The predictors of modern contraceptive use in the 12-month postpartum period were also examined. Data come from a cross-sectional survey conducted in 2018 among 624 women aged 16-44 years who reported giving birth in the past 13-31 months prior to the interview. We generated descriptive statistics to examine the prevalence of contraceptive use among postpartum women at 1, 3, 6, and 12 months after birth. We further estimated a binary logistic regression to examine the predictors of modern contraceptive use at 12 months postpartum. Forty percent of postpartum women never used any contraceptive method during 1 year after birth and of those who used a method, 40% relied on traditional methods. Moreover, 29% of women started using a method the immediate 1 month post-birth. Results further show that postpartum modern contraceptive uptake was positively associated with higher education, having more live births, and being currently in a union. Findings highlight that there may be opportunities to improve the quality of counseling during antenatal and postnatal care visits by clients to ensure fully informed choices regarding postpartum contraception. Community outreach by health providers/promoters or similar models should be promoted in low-income population settings to educate postpartum women on modern contraceptive use. Women who plan to use traditional methods should be provided with information on the consistent and correct use of these methods.

Contraception for married adolescents (15\u201319\xa0years) in India: insights from the National Family Health Survey-4 (NFHS-4)

PurposeDespite the fact that marriage below the age of 18 years is illegal in India, a considerable number of females get married and start childbearing during their adolescent years. There is low prevalence of contraceptive methods and high unmet need for family planning (FP). Realizing this, new government programs have been launched to increase the uptake of sexual and reproductive health services among adolescents. However, evidence specific to this age group remains scarce.Aim and objectivesThe present study was conducted to assess the prevalence of modern contraceptives among married adolescents, and to determine its association with sociodemographic variables, health worker outreach, and media exposure to FP messages in India.MethodsData for this analysis was drawn from the fourth round of the National Family Health Survey (NFHS-4) conducted in India during 2015–16. The sample size is restricted to 13,232 currently married adolescent girls aged 15–19 years, who were not pregnant at the time of the survey. Bivariate and multivariate analysis were conducted to assess the levels of contraceptive use and its predictors among married adolescents.ResultsThe use of modern contraceptives among married adolescents increased from 4 to 10% between 1992–93 and 2015–16. The uptake of modern contraceptives was found to be low among the uneducated, those residing in rural areas, among backward classes, those practising Hindu religion, women in the poorest wealth quintile, women without children, and those with no exposure to FP messages via media or health care workers. Among those who met health care workers and discussed FP issues with them, 34.11% were using modern contraceptives as compared to 11.53% of those who did not have discussions with health care workers.ConclusionsThe evidence suggests that contact with health care workers significantly influences the use of modern contraceptives. Further focus on increasing contact between married adolescents’ and health care workers, and improving the quality of counselling will protect adolescents from early marriage and pregnancy.

Contraception before and after induced abortion: Trajectories of women in selected urban-poor settlements of Accra, Ghana.

This paper examined women's pre- and post-induced abortion contraceptive use and predictors of post-abortion modern contraceptive uptake in selected poor settlements of Accra, Ghana. Data from a cross-sectional study of 251 women aged 16-44 years were used. Patterns of contraceptive use were analysed descriptively while the predictors of modern contraceptive use in the month following induced abortion were examined using a binary logistic regression model. Majority of women (60%) were not using any method of contraception when they became pregnant before their abortion. Just over 30% of these women switched to using any method in the month immediately after abortion (22% modern and 9% traditional). Women who had became pregnant while using a modern method before their abortion had higher odds of using a modern method post-abortion than women who had not been using any method of contraception when they became pregnant. Following induced abortion, many women remained at potential risk of future unintended pregnancy. Our findings suggest the need for improved contraceptive counselling for women who seek abortion services, both during post-abortion care for facility-based abortions or at the time of obtaining medication abortion pills for those who are self-managing their abortion.

Reproductive Governance in a Fragile and Population-Dense Context: Family Planning Policies, Discourses, and Practices in Burundi

This article describes the reproductive governance deployed in Burundi, which promotes fertility control through uptake of modern contraceptives as a solution to the economic hardship and land pressure of individuals and communities. Using a qualitative approach, we explore how women and couples in rural Burundi set their preferences, choices and practices of family planning, and how they relate with the government discourse. We describe how reproductive practices are complex and modulated by social and material factors and power dynamics. We argue that the current hegemonic discourse—largely supported by external donors—adopts a depoliticised and technocratic approach to family planning that aligns with neoliberal development frameworks, leaving existing power dynamics and resources distribution issues unexamined and unaddressed. By situating reproductive navigation in context, we show how medicalisation of reproduction is not fully enacted, and partly resisted by women and other actors.

Quality of Care in Family Planning Services: Differences Between Formal and Informal Settlements of Kira Municipality, Uganda.

Background: Quality of care (QoC) of family planning (FP) affects contraceptive use, and it varies across types of urban settlement. This study assesses the difference in service delivery point (SDP) structural and process factors between formal and informal urban settlements, and the opinion of the client on the QoC in informal settlements. This is useful in creating an evidence base to advocate for better quality services for the most vulnerable in society.Methods: This was a cross-sectional survey that included SDPs of Kira municipality in Wakiso district, Uganda. Data were collected from all the service points in Kira municipality with the caretakers consented. In addition, using multi-stage sampling, 626 women of reproductive age (15–49 years) who lived in the informal settlements of Kira municipality were interviewed. Data were collected using structured questionnaires, descriptive analysis was carried out in Stata version 14.0, and Chi-square and t-tests were used to compare the informal with the formal settlements.Results: Formal settlements generally had more higher-level SDPs compared to informal settlements (value of p < 0.001). SDPs in the formal settlements provided more FP methods and had more community health workers (CHW) to support their work. Also, SDPs in the formal settlements were more likely to have long-term FP methods available and more likely to have trained personnel to insert and remove implants and IUDs compared to those in informal settlements. Additionally, more SDPs in the formal settlements provided counseling for permanent, long-term, and short-term FP methods. Of the 626 interviewed women, most of the women (68.6%) reported that they would not return to the previous FP provider or refer a friend to the same provider (72.7%).Conclusions: There is a lower quality FP services in the informal settlements with a commensurable effect on the client satisfaction with the services. Therefore, improving the quality of FP services in informal settlements should be a top priority. Improved quality of services could act as a motivation to increase the uptake of modern contraceptives in such settings.

Explicative factors of the low uptake of modern contraceptives practice among women of childbearing age in Kumbo West Health District, North West Region, Cameroon

Introduction: Contraception is a main pillar for reducing maternal mortality. Modern contraceptive (MC) prevalence is low in Cameroon. Objective: To analyze the explicative factors of low uptake of modern contraceptives. Material and methods: This was a cross-sectional analytic study in Kumbo West health district, in the North West Region, after the Catholic University Ethical Committee approval. A total of 250 women were interviewed on their use of MC, their socio-demographic and reproductive health characteristics. Ever users and never users of MCs were compared. Data analysis was performed using EPI-info.7.2 Odds ratio, with its 95% confidence interval (CI) was used to appreciate associations between different variables and no use of MC. The level of significance was set up at p&lt;0.05. Results: Among the overall 250 participants, 99 had ever use MC (39.6%) and 44 women were currently under MC (17.6%). Never use of MC was associated with low level of education (68.5% vs. 31.5 %; AOR=3.64; 95% CI: 2.74-4.82; p=0.0001); living far from the health facility (84.0% vs. 16.0%; AOR: 3.32; 95%CI: 2.23-4.95; p=0.0001); lack of counseling on MC (93.6% vs. 5%; AOR: 2.71; 95%CI: 1.97-3.75); p=0.0001); lack of couple discussion on MC (83.7% vs.16.3%; AOR: 3.07 (2.22-4.25); p=0.0001); decision for MC use belonging to the partner (71.2% vs. 28.8%; AOR: 1.31 (1.9-1.45); p=0.0001); and low monthly income less than 36 000 CFA was associated to non-use of MCs (64.9% vs. 35.1%; AOR: 2.56; 95%CI: 1.81-3.62, p=0.0001). Conclusion: MC Uptake is low in Kumbo and most explicative factors are modifiable. Program managers must use them for developing strategies if they are expecting to increase the MC use.

Rural-Urban Disparities in the Acceptance and Adoption of Family Planning among Couples in Oyo State, Nigeria

Modern contraceptive use can enhance the living standard and reduce mortality among people living in rural and urban areas. However, contraceptive use tends to be low in the rural than the urban populace. A descriptive, cross-sectional study of systematic sampling technique was used to select 570 persons of reproductive age in the rural and urban communities of Oyo State. A semi-structured questionnaire on socio-demographic characteristics, knowledge, attitude and factors influencing uptake of modern contraceptives was administered to respondents. of the 570 respondents, the mean age was 34.3 ±8.4 years. The majority (63.3%) were female compared to 36.7% male respondents. Most (97.0%) of respondents had heard of family planning in the past. The result shows significant differences in location, gender, marital status, occupation, ethnicity, and a number of children (P&lt;0.001). The majority (33.3%) of the respondents sourced family planning information from health care providers, while 31.3% sourced theirs from mass media – Radio, TV, or newspapers. Respondents in urban areas were currently using family planning methods than respondents in rural areas (61.8% vs. 38.2%). People in the urban area are 2.344 times the odds of utilizing any family planning compared to people in rural area (95% CI 1.495, 3.676). Urban and rural disposition to modern contraception services is influenced by economic, socio-cultural, environmental factors, location, age, educational, traditional beliefs, religion, family type, and level of knowledge. Although some signs of progress have been made in family planning at the communities, more work needs to be done. Men need to be actively involved, and other fears about family planning addressed. Keywords: Acceptance, Disparity, Family Planning, Rural, Urban.

Self-injected Depot–Medroxyprogesterone Acetate Subcutaneous (DMPA-SC) Uptake in Nigeria: A Paradigm Shift

Self-injection of DMPA-SC method is one of the Government of Nigeria’s (GON) national family planning goals to address the unmet need for contraception. Some studies on DMPA-SC/SI have demonstrated its feasibility to improve modern contraceptive uptake. However, there is a gap in the predictors of method uptake and continuation across self-injecting and provider-administered in Nigeria. This study explored the uptake of self-injection DMPA-SC contraceptives among women in two geopolitical zones of Nigeria. The study employed 20 focused group discussions (FGDs) and 40 In-depth interviews (IDIs). Self-structured pretested questionnaire to elicit information from 844 women registered for Family Planning in selected health facilities. Descriptive statistics were calculated and multivariate logistic regression was used to model determinants of DMPA-SC/SI family planning uptake. Six months of Secondary Data from the Health Management Information system (HMIS) was used to triangulate the trends in uptake. About 97.6% reported ever heard DMPA-SC/SI family planning method; 78.4% reported its uptake; while 88.5% reported ever heard of self-injection as an option of family planning method. Data for each State showed a remarkable increase in uptake of DMPA-SC/SI. The motivations to use DMPA-SC/Self Injection were ease of accessibility, convenience, and self-administer/care. Factors that encourage the uptake of DMPA-SC/SI were; health benefits, the prevailing economic situation and its effectiveness. Findings from the study showed that interventions that deploy health education, awareness, social mobilization, advocacy, policy implementation, and public sensitization, making contraceptive services available for free, will increase the uptake of Keywords: Determinants, DMPA-SC/SI, Practice, Self-injection, Uptake. DMPA-SC/SI in the study areas.

Multilevel mixed effects analysis of individual and community level factors associated with modern contraceptive use among married women in Uganda

BackgroundIn spite of the universal right for women to decide freely for themselves when, and how many children they want to have in life, married women in Uganda are less likely to use modern contraceptives as compared to other marital categories. This study examines the individual and community factors associated with modern contraceptive use among married women in Uganda.MethodsThe study used data from the 2016 Uganda Demographic and Health Survey which comprised of 8671 married women aged 15–49 years who were fecund and non-pregnant at the time of the survey. Analysis was done using a multilevel mixed-effects logistic regression model.ResultsFindings showed that married women who were; Muslims (AOR = 0.78, CI = 0.66–0.91), had more than five children (AOR = 0.76, CI = 0.61–0.98), staying in communities with high poverty (AOR = 0.78, CI = 0.65–0.93), with older age at first birth (AOR = 0.94, CI = 0.92–0.96) as well as having spousal age difference of more than 9 years (AOR = 0.86, CI = 0.76–0.98) were associated with low modern contraceptive use. Women living in communities with higher age at first marriage (AOR = 0.93, CI = 0.88–0.98) or higher sexual debut (AOR = 0.91, CI = 0.85–0.98) were also associated with reduced odds of modern contraception. In addition, older women (AOR = 1.03, CI = 1.01–1.04), having secondary/higher education (AOR = 1.93, CI = 1.58–2.37), living in a rich household (AOR = 1.32, CI = 1.14–1.53), short distance to health facility (AOR = 1.18, CI = 1.06–1.31), high community education (AOR = 1.38, CI = 1.17–1.62), high community exposure to family planning messages (AOR = 1.24, CI = 1.08–1.42), and communities with high proportion of women working (AOR = 1.22, CI = 1.06–1.39) were more likely to use modern contraceptives.ConclusionThe study revealed that both individual and community factors were important in explaining the factors associated with modern contraceptive use among married women in Uganda. Therefore, there is need to invest in community based programs like: family planning outreach services, mass media campaigns and community mobilization activities to help in dissemination of family planning information, increase awareness and promotion in use of modern contraceptives. Also, expansion of higher education and the need to make family planning services available and accessible to areas with limited physical access to health facilities will lead to sustained increase in uptake of modern contraceptives.

Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India

IntroductionKilkari is one of the world’s largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families,...

When Do Nigerian Women of Reproductive Age Initiate and What Factors Influence Their Contraceptive Use? A Contextual Analysis.

BackgroundContraceptive use initiation and continuation is one of the major interventions for reducing maternal deaths worldwide. Nigeria aimed to achieve a 27% prevalence rate of modern contraceptive uptake by 2020, however, this seems to have remained unachieved. The objective of this study was to investigate when Nigerian women initiate contraceptive use and its associated factors, using nationally representative data.MethodsData on 11,382 Nigerian women (aged 15–49 years) from the 2017 Performance Monitoring and Accountability 2020 (PMA2020) survey were used to determine the prevalence of lifetime contraceptive use. The Kaplan–Meier test was used to determine median time (years) to contraceptive uptake. In addition, the factors associated with contraceptive use were determined using multivariable logistic regression model. Statistical significance was determined at 5%.ResultsThe prevalence of modern contraceptive use was 14.2%. There were disparities in the timing (years) of contraceptive use initiation across several women’s characteristics. Women from urban residence, highest household wealth index, nulliparous, unmarried, and highly educated women had the minimum median time (years) to contraceptive use initiation. The multivariable logistic model showed that rural women were 26% less likely to initiate contraceptive use, when compared with the urban dwellers (OR= 0.74; 95% CI: 0.65, 0.84). Furthermore, married women were 24% less likely to initiate contraceptive use, when compared with the unmarried (OR= 0.76; 95% CI: 0.63, 0.93). In addition, geographical region, wealth, television source, ever given birth, education, age, and religion were significantly associated with contraceptive use.ConclusionThe prevalence of contraceptive use is low in Nigeria. There were differences in contraceptive use initiation among women of reproductive age in Nigeria. There is a need to adopt sustainable strategies to improve contraceptive uptake and to re-iterate the benefits of contraception, including providing enlightenment programs among key populations such as the rural dwellers and low income earners.

Pooled prevalence and determinants of modern contraceptive utilization in East Africa: A Multi-country Analysis of recent Demographic and Health Surveys.

According to the 2017 estimate, around 214 million reproductive-age women in developing regions who want to avoid pregnancy do not use a modern contraceptive method. Although there are studies done on factors associated with modern contraceptive utilization in individual East African countries, as to our search of the literature, there is limited evidence on the pooled prevalence and determinants of modern contraceptive utilization in the East African region. Therefore, this study aimed to estimate the pooled prevalence and determinants of modern contraceptive utilization in the East African region. The pooled prevalence of modern contraceptive utilization and the strength of determinants were estimated using STATA version 14. Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance were used for model fitness and comparison. The multilevel logistic regression model was fitted to identify determinants of modern contraceptive use in the region. Adjusted Odds Ratio with its 95% Confidence Interval was presented, and variables with a p-value ≤of 0.05 were declared significant determinants of modern contraceptive utilization. Overall, about 20.68% (95%CI:-20.46.,20.91)of women used modern contraceptive, ranging from 9.08% in Mozambique to 61.49% in Comoros. In the multilevel logistic regression model; maternal age group 25-34 (AOR: 0.79, 95%CI:0.76,0.82) and 35-49 (AOR:0.49, 95%CI:0.46,0.51). Being married (AOR:0.85, 95%CI:0.82,0.88), mothers with primary education (AOR:1.48, 95%CI:1.43,1.54) and secondary and above education level (AOR:1.60, 95%CI:1.52,1.69), husbands with primary education (AOR:2.43, 95%CI:2.35,2.51) and secondary and above education level (AOR:2.92, 95%CI:2.76,3.05). The mothers who had occupation (AOR:2.11, 95%CI:1.23,1.33), mothers from households with middle wealth index (AOR:1.23, 95%CI:1.19,1.28) and rich wealth index (AOR:1.28, 95%CI:1.23,1.33) were found to be significant determinants of modern contraceptive use. We found that modern contraceptive utilization in the 12 East Africa countries was low compared to SDG target 2030(75%). The governmental and non-governmental organizations should scale up their public health programs to the poor and marginalized communities to scale up modern contraceptive utilization uptake in the region. In addition, reforming the health system and reproductive health education through mass media to create awareness of modern contraceptive use benefits are effective strategies to improve modern contraceptive use among East Africa women.