Modern Contraceptive Use Research Articles

Missed opportunity for family planning counselling along the continuum of care in Arusha region, Tanzania.

Adequate sexual and reproductive health information is vital to women of reproductive age (WRA) 15 to 49 years, for making informed choices on their reproductive health including family planning (FP). However, many women who interact with the health system continue to miss out this vital service. The study aimed to identify the extent of provision of FP counselling at service delivery points and associated behavioral factors among women of reproductive age in two districts of Arusha region. It also determined the association between receipt of FP counselling and contraceptive usage. Data were drawn from a cross-sectional survey of 5,208 WRA residing in two districts of Arusha region in Tanzania; conducted between January and May 2018. Multistage sampling technique was employed to select the WRA for the face-to-face interviews. FP counseling was defined as receipt of FP information by a woman during any visit at the health facility for antenatal care (ANC), or for post-natal care (PNC). Analyses on receipt of FP counseling were done on 3,116 WRA, aged 16-44 years who were in contact with health facilities in the past two years. A modified Poisson regression model was used to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. Among the women that visited the health facility for any health-related visit in the past two years, 1,256 (40%) reported that they received FP counselling. Among the women who had had births in the last 30 months; 1,389 and 1,409 women had contact with the service delivery points for ANC and PNC visits respectively. Of these 31% and 26% had a missed FP counseling at ANC and PNC visit respectively. Women who were not formally employed were more likely to receive FP counselling during facility visit than others. WRA who received any FP counseling at PNC were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.28; 95% Confidence Interval [CI]: 1.09, 1.49). Overall, only 40% women reported that they received any form of FP counseling when they interfaced with the healthcare system in the past two years. Informally employed women were more likely to receive FP counselling, and women who received FP counselling during PNC visits were significantly more likely to use contraceptive in comparison to the women who did not receive FP counselling. This presents a missed opportunity for prevention of unintended pregnancies and suggests a need for further integration of FP counseling into the ANC and PNC visits.

Mass media exposure and use of reversible modern contraceptives among married women in India: An analysis of the NFHS 2015-16 data.

Since the inception of the National Programme for Family Planning, messages on family planning (FP) have been promoted across India using different mass media platforms. Mass media plays an important role in disseminating important information among the masses, such as how reversible modern methods give women more reproductive choices than opting for permanent methods that limit their child-bearing capacity. Mass media can provide a continuous flow of information and motivation to deter women from discontinuing the methods they have opted for. However, very few studies have been conducted on this issue, especially using recently available data. This study particularly focuses on exposure to mass media and the use of reversible modern methods of family planning among married women in India. The data for this study was obtained from the National Family Health Survey (2015–16) on currently married women aged 15–49 years. The association of reversible modern method use with media exposure variables was examined, controlling for a set of independent variables from multiple levels—individual, district, state, and region. The findings from this study showed that television was the most important medium for disseminating information on FP among married women in India. Spatial analysis revealed that some districts in the north, parts of the northeast, and Kerala in South India lacked any television exposure. The results from the decomposition analysis showed that mass media exposure was associated with a 14% increase in the use of reversible modern methods. Results from the multilevel analyses showed that exposure to TV along with other media (AOR 1.57 95% CI 1.49–1.65) and exposure to FP messages through different media (AOR 1.22 95% CI 1.12–1.32) had a significant positive effect on the use of reversible modern methods even when various individual, district, state, and regional-level factors were controlled. The findings of this paper provide evidence supporting the use of mass media to promote and increase awareness of voluntary contraceptive use in India. An increase in mass media exposure coupled with improvement in coverage and services of the FP program can significantly increase the use of reversible modern methods in a cost-effective yet efficient manner among women in need of FP services.

Family planning use and correlates among female sex workers in a community empowerment HIV prevention intervention in Iringa, Tanzania: a case for tailored programming

BackgroundFemale sex workers in sub-Saharan Africa face high unmet need for family planning and higher risk for unintended pregnancy. Community empowerment HIV prevention approaches have the potential to increase family planning uptake and present an opportunity to integrate HIV, reproductive health, and contraception. This article describes family planning use and pregnancy among female sex workers in Iringa, Tanzania and evaluates whether engagement in a community empowerment HIV prevention program is associated with contraceptive use.MethodsThis study consists of secondary analysis from a two-community randomized controlled trial following a longitudinal cohort over 18 months. We implemented a year-long community empowerment intervention consisting of 1) a community-led drop-in-center; 2) venue-based peer education, condom distribution, and HIV testing; 3) peer service navigation; 4) sensitivity trainings for providers and police; and 5) text messages to promote engagement. Additionally, monthly seminars were held at the drop-in-center, one of which focused on family planning. Modified Poisson regression models were used to estimate the association between program exposure and family planning use in the intervention arm. (Trials Registration NCT02281578, Nov 2, 2014.)ResultsAmong the 339 participants with follow-up data on family planning, 60% reported current family planning use; 6% reported dual use of modern contraception and condoms; over 90% had living children; and 85% sought antenatal care at their most recent pregnancy. Among the 185 participants in the intervention arm, the adjusted relative risk (aRR) of family planning use among female sex workers who reported ever attending the Shikamana drop-in-center and among female sex workers who reported attending a family planning-related workshop was respectively 26% (aRR 1.26 [95% Confidence Interval (CI): 1.02–1.56]) and 36% (aRR 1.36 [95%CI: 1.13–1.64) higher than among those who had not attended.ConclusionThere is a clear need for family planning among this population. General program exposure and exposure to a family planning workshop were associated with higher family planning use, which suggests that community empowerment models have potential to increase family planning uptake for this vulnerable group.

"Antibiotics Can Work as a Contraceptive:" Contraceptive Knowledge and Use Among University Students in Calabar, Nigeria.

Introduction: Many sexually active youths who wish to delay pregnancy are not using any form of modern contraceptives. In sub-Saharan Africa, less than 1 in 5 sexually active youth do not use contraceptives. In Nigeria, 48.4% of all sexually active unmarried women have an unmet need for contraception. Although the literature is replete with information on structural barriers to modern contraceptives, there is limited scholarship on contextual factors that may inhibit modern contraceptive use among Nigerian youth. This study uses a qualitative research approach to assess knowledge and use of natural, modern, and folkloric contraceptive methods among a sample of university students in Calabar, Nigeria.Methods: This study used data from focus group discussions among women and men in university halls of residence, all of whom were unmarried. Also, three male pharmacists and three female community health workers were interviewed. All focus group discussions and interviews took place in August 2017 and were conducted in Calabar Metropolis, Cross River State, Nigeria. The audio recordings were transcribed into detailed summaries of the interviews and focus group discussions. All data analysis was completed using Atlas.Ti (version 8).Results: University men and women have limited knowledge of and application of natural and modern contraception. Participants listed folkloric methods of contraceptives, including repurposing pharmaceuticals (e.g., antibiotics, quinine, and Andrews Livers Salt-a laxative) as contraceptive agents. Respondents also discussed the use of non-pharmaceuticals such as water, salt solution, and squatting after intercourse as contraceptives. Generally, university students defaulted to withdrawal, calendar method, and emergency contraceptives as preferred methods of contraception. Lastly, condoms were used among participants in causal sexual encounters. In dating relationships, however, both male and female students cited their partners' hesitancy to condom use as such act could indicate distrust.Conclusion: Awareness and use of modern contraceptives are limited among university students in Calabar, Nigeria. The use of folkloric contraceptives could lead to bodily harm and unintended pregnancy. Further research is needed to elucidate factors that promote use of folkloric methods of contraceptives. Integration of contraceptive awareness into health promotion services for young people may help to dispel myths about folkloric methods of contraceptives while promoting awareness and use of safe and effective contraception.

Alcohol consumption and use of contraceptives: Evidence from 2018 Nigerian Demographic and Health Survey in Nigeria

Per capita alcohol consumption in Nigeria is high when compared with other countries in Africa. Alcohol induces social behaviors which include home violence, sexual harassment, unwanted pregnancy, and infidelity among couples. On the good side of it, couples who find themselves in alcohol consumption chose modern contraceptives use to prevent unwanted pregnancy. The objective of the paper is to examine the effect of alcohol consumption on modern contraceptive use in Nigeria. A probit regression model using data from the 2018 Nigerian Demographic and Health Survey was employed. The paper found that alcohol intake among couples has a significant effect on their decision to use modern contraceptives. The result also signified that educational level significantly affects the use of modern contraceptives. Other significant factors affecting modern contraceptive use were the partner's occupation, the number of living children per couple, and the wealth index. The paper recommended that counseling should be made at social gatherings for those who take alcohol to use contraceptives.

Patterns and determinants of modern contraceptive use and intention to usecontraceptives among Malawian women of reproductive ages (15\u201349 years)

BackgroundMalawi is one of the countries in SSA with the highest TFR. This study aimed to explore factors associated with modern contraceptive use and intention to use contraceptives among women of reproductive ages (15–49 years) in Malawi.MethodsThe study used secondary data from 2015 to 16 Malawi Demographic and Health Survey (MDHS) dataset. Logistic regression models were used to derive adjusted odd ratios as the measures of association between need, predisposing and enabling factors, and contraceptive use and the intention to use contraceptives among women. The sample constituted 24,562 women who were successfully interviewed during the MDHS. All comparisons are considered statistically significant at 5% level.ResultsOverall 54.8% of women were currently using contraceptives, while 69.1% had the intention to use contraceptives. The odds of contraceptive use were significantly low among, women aged 15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years and 40–44 years compared to women aged 45–49 years; women of Tonga ethnic group (OR = O.60, CI = 0.43 0.84) compared to women of Nyanga ethnic group; women from poor households (OR = 0.78, CI = 0.68–0.90) and middle income households (OR = 0.84, CI = 0.74–0.95) compared to women from rich household. Nonetheless, women with no past experience of terminated pregnancy (OR = 1.50, CI = 1.34–1.68) were more likely to use contraceptives compared to women with past experience of terminated pregnancy. Similarly, Women with primary education (OR = 1.56, CI = 1.16–2.09) and secondary education (OR = 1.39, CI = 1.04–1.85) were more likely to use contraceptives compared to women with higher education. While the odds of intending to use contraceptives were significantly high with age only thus among women aged 15–19 years, (OR = 15.18, CI = 5.94–38.77); 20–24 years (OR = 16.77, CI = 7.46–37.71); 25–29 years (OR = 6.75, CI = 3.16–14.45); 30–34 years (OR = 7.75, CI = 3.61–16.65) and 35–39 years (OR = 5.05, CI = 2.29–11.12) compared to women aged 45–49 years.ConclusionAs direct policy measure; information, education and communication programmes on family planning among poor and middle income women, and all women in reproductive ages should be strengthened.

A STUDY OF FACTOR AFFECTING THE USE OF TEMPORARY AND PERMANENT METHODS OF CONTRACEPTION AMONG MARRIED WOMEN

Introduction: According to World Health Organization (WHO), 'Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility'. This study provides the relationship between sociodemographic factors and use of temporary contraceptive methods and permanent contraceptive methods. 1.To de Objectives: termines the factor affecting utilization of temporary and permanent contraceptives among married women. 2. To determine the relationship between socio demographic factors and use of modern contraceptive method among married women.Material & methods: This study was community based descriptive cross sectional study, conducted in urban area of Bilaspur (C.G.). Total 600 married women were interviewed by predesigned and pretested questionnaire. Data were analyzed using SPSS software. Chi-square test and logistic regression was applied to know the association among the various socioeconomic factors and contraceptive practices. In this study 600 married wome Result: n were studied. Out of all 600 respondent (172)28.7% were using sterilization and rest were using temporary method of contraception. Only 8.6% and 32.8% illiterate women were using temporary method and permanent method of contraception and only 42.9% and 21.4% women of lower socio economic class were using permanent method and spacing method of contraception respectively. Signicant association was found between various factors like age, education, parity, socio economic class, and number of living children. In this study choice of method of contrace Conclusion: ption (temporary and permanent methods) was associated with education, occupation, socioeconomic class, number of living children and parity. It was found that the female sterilization (permanent method) was more popular than temporary method. Education and mass media show signicant association in use of temporary methods.

Modern Contraceptive Use and Associated Factors During Extended Postpartum Period Among Women Who Gave Birth in the Last 12 Months at Northwest Ethiopia.

BackgroundThe extended postpartum period is a one-year follow-up period after giving birth, and it is critical for women to prevent unintended pregnancy and reduce the risk of maternal and child mortality by ensuring safe birth intervals. Many women, however, are unaware that they are at risk for pregnancy throughout this period. Hence, the aim of this study was to assess the utilization and associated factors of modern contraceptives during extended postpartum family planning (EPPP) in northwest Ethiopia.MethodsA community-based cross-sectional study design was conducted using 630 samples from October 01 to October 30, 2020, in northwest Ethiopia. The study participants were drawn through a multistage sampling technique and data were collected using structured questionnaires via interview. The collected data were entered into EpiData version 4.2 and exported into SPSS version 25.0 for management and further analysis. A bivariable logistic regression model was used to identify variables having an association with the outcome variable. In bivariable analysis, variables having P ≤ 0.25 were selected and entered into multivariable logistic regression analysis. Finally, in multivariable analysis, variables having P ≤ 0.05 with a 95% CI were declared as significantly associated with the outcome variable.ResultsAbout 60.6% of women were using modern contraceptive during extended postpartum period. Mothers to partner discussion (AOR= 7.6, 95% CI: 4.20–14.05), secondary educational status (AOR= 3.8, 95% CI: 1.36–10.93), college and above educational status (AOR= 7, 95% CI: 1.92–25.57), menstrual resumption (AOR= 9.2, 95% CI: 5.66–15.12), sex resumed (AOR=8.5, 95% CI: 2.19–33.58), fertility desire (AOR= 3.9, 95% CI: 1.99–6.15), linkage to FP during child immunization (AOR= 2.7, 95% CI: 1.67–4.50), and FP counseling during pregnancy (AOR=2, 95% CI: 1.25–3.34) were significantly associated with outcome variable.ConclusionAssociating factors were identified as partner discussion, education, menstrual resumption, fertility desire, sexual resumption, FP counseling, and FP during child immunization. Improving mothers’ education and informing couples about the dangers of becoming pregnant before menstruation are critical.

Determinants of intrauterine contraceptive device utilization at primary health care facilities in Mekelle City, northern Ethiopia

BackgroundEach year, the current level of modern contraceptive use averts 188 million unintended pregnancies, which in turn results in 112 million fewer abortions. Of the 867 million women in the developing world who are sexually active and want to avoid becoming pregnant, approximately 222 million of them have an unmet need for modern contraception. In spite of several advantages and potential effectiveness of Intra Uterine Contraceptive Device, its utilization still too low in Sub Saharan African countries including Ethiopia.ObjectivesTo identify the determinant factors for utilization of intra uterine contraceptive device among women visiting primary health care facilities in Mekelle city.MethodFacility based unmatched case-control study design was conducted among 234 women (78 cases and 156 controls). Data was collected by structured questionnaire. Data entry and cleaning was done using EPI- Info version 5.3.1 and analysis done using SPSS version 20.0 statistical software. During analysis the variables were defined, categorized and the difference in variables was determined. Odds ratio used to show degree of association between independent variables with Intra Uterine Contraceptive Device.ResultMarital status ([AOR (95%CI) =8.59(2.60–28.43)], number of pregnancies (AOR (95%) CI = 5.69(1.020–31.802), number of alive children [AOR (95%CI) =3.5 (1.03–11.9) are variables continued to have statistically significant association with use of Intra Uterine Contraceptive Device. Other determinants found to have significant association includes awareness about Intra Uterine Contraceptive Device, visual exposure to Intra Uterine Contraceptive Device, and participants told about availability of health care provider able to insert Intra Uterine Contraceptive Device.ConclusionThis study has identified marital status, Gravidity, number of alive children and awareness to Intra Uterine Contraceptive Device as major determinants for use of Intra Uterine Contraceptive Device. Thus, it is vital at addressing the aforementioned determinants will be vital to improve utilization of Intra Uterine Contraceptive Device.Plain English summaryAmong long acting reversible modern contraceptive methods, Intra Uterine Contraceptive Devices (IUCDs) are the most reliable and effective as well as with fewer side effects. Despite these advantages and cost effective potential of Intra Uterine Contraceptive Device its utilization is still too low in Sub Saharan countries like Ethiopia. Thus, this study intended to identify the factors that limit the utilization of Intra Uterine Contraceptive Device among women of Ethiopia in Mekele City. The study identify that the utilization of Intra Uterine Contraceptive Device was determined by the marital status of the women, the number of previous pregnancy and recent alive children and the level of awareness about Intra Uterine Contraceptive Device of the women. Therefore, providers training that focus on promoting Intra Uterine Contraceptive Device, centering on increasing awareness and practice about Intra Uterine Contraceptive Device is very important.

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.

Male\u2013female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India

ObjectiveWomen’s involvement in contraceptive decision-making increases contraceptive use and reduces unmet need, but study of this has been limited to women’s self-reports. Less research is available examining couple concordance and women’s involvement in contraceptive decision-making as reported by both men and women.Study designWe carried out a cross-sectional study using data from rural India (N = 961 young married couples). Using multivariable regression we examined the association between concordance or discordance in spousal reports of wife’s involvement in contraceptive decision-making and modern contraceptive use, adjusting for demographics, intimate partner violence, and contraceptive use discussion.ResultsMore than one third (38.3%) of women reported current modern contraceptive use. Report of women’s involvement in contraceptive decision-making showed 70.3% of couples agreed that women were involved, jointly or alone (categorized as Concordant 1), 4.2% agreed women were not involved (categorized at Concordant 2), 13.2% had women report involvement but men report women were uninvolved (categorized as Discordant 1), and 12.2% had women report uninvolvement but men report that women were involved (categorized as Discordant 2). Discordant 2 couples had lower odds of modern contraceptive use relative to Concordant 1 couples (adjusted RR = 0.61, 95% CI 0.45–0.83). No other significant differences between Concordant 1 couples and other categories were observed.ConclusionOne in four couples indicated discordance on women’s involvement in contraceptive decision making, with Discordant 2 category having lower odds of contraceptive use. Couples’ concordance in women’s involvement in contraceptive decision-making offers a target for family planning research and interventions to better meet their needs.Trial registration ClinicalTrial.gov, NCT03514914. https://clinicaltrials.gov/ct2/show/NCT03514914

A 4 Year Experience with Copper T Intrauterine Contraceptive Device at Federal Medical Centre (Fmc), Katsina

Background: The prevalence of contraceptive use is still very low in Nigeria. Use of modern contraceptive methods has been shown to reduce unwanted pregnancy, high parity and maternal mortality. Objectives: The aim of this study is to determine the acceptance rate of intrauterine contraceptive method, the socio-demographic characteristics of its users, side-effects, discontinuation and the reason thereof, at Federal Medical Centre, Katsina. Method: A retrospective study that reviewed records of all clients who used intrauterine contraceptive method at the family planning clinic over a 4-year period (1st January 2011 to 31st December 2014). Results: Out of the 1892 family planning clients, 111 used IUCD, with IUCD acceptance rate of 5.87%. The modal age group was 20-24 years (30.0%). Most of them (n=54) were grandmultiparous (48.6%), and of Islamic faith (98%). Almost all the clients were married (97.8%), and majority had secondary education (71%). Thirty- ive (31.5%) of the users discontinued the method, with the commonest indication being desire for pregnancy (45.7%). No contraceptive failure was recorded during the study period. Conclusion: IUCD is the fourth commonly used method. Its use is influenced by maternal age, parity and literacy level. In spite of its long duration of action, most of the reversal was due to the desire for pregnancy. Acceptability of IUCD can be improved by health education, adequate counseling and careful client selection.

Spatial heterogeneity in discontinuation of modern spacing method in districts of India

BackgroundDespite six decades of official family planning programme, the use of modern contraceptive method remained low in India. The discontinuation of modern spacing method (DMSM) has also increased from 42.3% in 2005−06 to 43.6% during 2015–16. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%).MethodsData from NFHS-4 (2015–16) comprising of 601,509 households, 699,686 women and a sample of 119,548 episode of modern spacing method was used for the analysis. Multiple decrement life table has used to estimate 12-month discontinuation rate of modern spacing methods (DMSM). Moran’s I statistics, Bivariate LISA cluster map has used to understand the spatial correlates and clustering the DMSM. OLS model and impact analysis has used to assess the significant associated covariates with discontinuation.ResultThe 12-month DMSM in India is 43.5%; largely due to desire for becoming pregnant and method failure. The high discontinuation rate was observed in most of the southern (62%) and central (46%) regions of India. DMSM has significantly and spatially associated with neighbouring districts of India (Moran’s I = 0.47, p-value = 0.00). The prevalence of modern spacing method is negatively associated with discontinuation in the neighbouring districts of India. The unmet need (β = 0.84, 95% CI 0.55–1.14), desire of children (β = 0.26, 95% CI − 0.05–0.57) and female sterilization (β = 0.54, 95% CI 0.14–0.95) were three main contributing factor to DMSM.ConclusionDistricts of high DMSM need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.

Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters' Community in Tanzania; A Community Based Cross-Sectional Study.

Background:Globally in 2017, Burundi was the 9th country with the highest population growth rate of 3.2% and a fertility rate of 5.5 children per woman. This probably suggested low uptake of Modern Contraceptive methods (MCM) in the country. Our analysis investigated factors associated with low uptake of MCM among women of reproductive age in Burundi.Methods:Cross sectional data of non-pregnant women aged 15-49 years was extracted from the Burundi Demographic and Health Survey (2016-2017). We analysed the data at univariate, bivariate and multivariate levels to assess factors influencing MCM uptake among these women using Epi-Info 7.2.2.6.Results:Of the 9,945 women, 2,372 (23.8%) were using MCM. Ngozi province had the highest prevalence of MCM users [284/691(37.7%)]. The most used MCM among respondents was injectable contraceptive (48.3%). As respondent's age increases, the odds of using MCM decreases; 20-24 years (aOR=0.9, 95% CI [0.6–1.2]), 30–34 years (aOR=0.8, 95% CI [0.5–1.0]), 35-39 years (aOR=0.7, 95% CI [0.5–0.9]), 40-44 years (aOR=0.5, 95% CI [0.5–0.9]) and 45-49 years (aOR=0.4, 95% CI [0.2–0.5]) compared with those in the age group 15–19 years. Muslims (aOR=1.5, 95% CI [1.2–1.9]) and Jehovah witnesses (aOR=3.1, 95% CI [1.7–6.5]) were more likely to use MCM than Catholics.Conclusion:The prevalence of MCM remains low among women of reproductive age in Burundi, with injectables being the most used method. Factors such as respondent's age and religion were significantly associated with MCM use. Enhanced access to family planning information and services targeting women who are 30 years or more and engaging religious leaders for their active participation is recommended.

Shifting dynamics: Changes in the relationship between total fertility rate and contraceptive prevalence rate in Jordan between 2012 and 2017.

Background: Between the two most recent Population and Family Health Surveys, Jordan saw a dramatic decline in the Total Fertility Rate (TFR) from 3.5 to 2.7 in 5.5 years. Over the same period, modern contraceptive use also declined, from 61.2% to 51.8% among married women. This decrease in both TFR and the contraceptive prevalence rate (CPR) diverges from the typical relationship seen between these two factors whereby historically as CPR increases, TFR decreases. This paper explores this unique pattern using multiple methodologies. Methods: First, we validate the survey data using nationally collected data on fertility and contraceptive distribution. Second, we look to changes that have historically influenced changes in CPR and TFR, including changes in ideal family size and wanted fertility rates. Third, we explore proximate determinants and other influences on fertility and changes in contraception, examining the changes in the method mix and unmet need; marriage patterns, including the demographics of the married population, spousal separation, and time since last sex; postpartum insusceptibility; infecundity, both primary and secondary; and abortion, to see if any have shifted significantly enough to allow for fertility to decline with less contraceptive use. Results: We find that the decline in fertility in Jordan was driven by a reduction in mistimed or unwanted pregnancies and there was a significant increase in the share of reproductive aged women who are infecund. We also concluded that the changes in fertility and contraceptive use are driven by changes in Jordanian nationals, not by the growing Syrian refugee population. Conclusions: Jordan is not the only country to be experiencing a shift in the typical relationship between CPR and TFR. Results can inform both future approaches for family planning programs and our expectations regarding what kind of change our family planning investments might buy.

Predictors of underachieved and overachieved fertility among women with completed fertility in Ghana.

BackgroundA woman’s ability to achieve her preferred family size is critical in addressing issues of high fertility in sub-Saharan Africa. The socio-cultural context in sub-Saharan Africa presents some difficulty for the attainment of preferred fertility for many women. Few studies in sub-Saharan Africa have examined the extent to which women are unable to achieve their preferred family sizes. This study, therefore, examines the factors that are associated with the non-attainment of women’s preferred fertility by the end of their reproductive years.Data and methodsThe study analyzed pooled cross-sectional data with a sub-sample of 1,888 currently married women aged 45–49 years from five rounds of the Ghana Demographic and Health Survey, 1993 to 2014. Test of associations and multinomial logistic regression analysis were used to examine the predictors of underachieved and overachieved fertility relative to achieved fertility.ResultsThe results indicate that 44 per cent of the women recorded overachieved fertility while about 36 per cent underachieved their fertility. Partner wants more, experiencing child loss and married more than once were significantly associated with overachieved fertility. Nonetheless, increased years of a woman’s education and delaying her at first birth were negatively associated with overachieved fertility. On the other hand, underachieved fertility was significantly associated with having a partner with fewer fertility preference, being of the Islamic faith and ever use of modern contraception.ConclusionPartner’s fertility preference, child loss experience, marrying more than once and ever use of modern contraception were important predictors of a woman’s inability to achieve her fertility preference. Policies to regulate men’s fertility behaviour, delaying age at first birth, use of modern contraception, encouraging longer years of education, and reducing infant and child mortality are important strategies to achieve fertility preference in Ghana.

Shifting dynamics: Changes in the relationship between total fertility rate and contraceptive prevalence rate in Jordan between 2012 and 2017

Background: Between the two most recent Population and Family Health Surveys, Jordan saw a dramatic decline in the Total Fertility Rate (TFR) from 3.5 to 2.7 in 5.5 years. Over the same period, modern contraceptive use also declined, from 61.2% to 51.8% among married women. This decrease in both TFR and the contraceptive prevalence rate (CPR) diverges from the typical relationship seen between these two factors whereby historically as CPR increases, TFR decreases. This paper explores this unique pattern using multiple methodologies. Methods: First, we validate the survey data using nationally collected data on fertility and contraceptive distribution. Second, we look to changes that have historically influenced changes in CPR and TFR, including changes in ideal family size and wanted fertility rates. Third, we explore proximate determinants and other influences on fertility and changes in contraception, examining the changes in the method mix and unmet need; marriage patterns, including the demographics of the married population, spousal separation, and time since last sex; postpartum insusceptibility; infecundity, both primary and secondary; and abortion, to see if any have shifted significantly enough to allow for fertility to decline with less contraceptive use. Results: We find that the decline in fertility in Jordan was driven by a reduction in mistimed or unwanted pregnancies and there was a significant increase in the share of reproductive aged women who are infecund. We also concluded that the changes in fertility and contraceptive use are driven by changes in Jordanian nationals, not by the growing Syrian refugee population. Conclusions: Jordan is not the only country to be experiencing a shift in the typical relationship between CPR and TFR. Results can inform both future approaches for family planning programs and our expectations regarding what kind of change our family planning investments might buy.

How does the sex composition of children affect men's higher ideal family size preference relative to women and contraceptive use patterns among couples? A cross-sectional analysis of dyadic couple's data in India

IntroductionSon preference, an ongoing concern in India, is a known driver of ideal family size preferences and contraceptive use among couples. These associations can vary substantially with parity and can influence men and women differently. This study assesses the association of sex composition of children by parity and a) men's higher ideal family size preference relative to women and b) use of modern contraceptives by couples. MethodsWe used the Couples Recode dataset from National Family Health Survey (NFHS) 2015-16 and identified couples who had at least one child and had complete responses for variables used in the study (N = 56,731 couples). We developed multivariable linear and logistic regression models to study the association between sex composition of children by parity and our dependent variables. ResultsOur findings indicate that the sex composition of children is associated with men's higher ideal family size preference, relative to women, among couples with four or more children. We also find that couples with less than four children are less likely to use modern contraceptives when they have an equal or a greater number of daughters than sons compared to those who have no daughters. Findings suggest that couples with four or more children are more likely to use modern contraceptives when they have at least one son and one daughter and are less likely to use contraceptives when they have all daughters and no sons, than couples who have no daughters. ConclusionThis study contributes to existing research on the relationship between sex composition of children with ideal family size preferences and contraceptive use by highlighting meaningful differences between higher and lower parity couples. Findings from the study can be used by family planning programs in India to customize family planning counselling messages by both sex composition and parity.

Predictors of modern contraceptive usage among sexually active rural women in Ethiopia: A\xa0multi-level analysis

BackgroundEthiopia is one of the Sub-Saharan Africa countries with the lowest modern contraceptive prevalence rate and the highest fertility rate. This study aimed to assess individual and community-level predictors of modern contraceptive use among sexually active rural women in Ethiopia.Data and methodsA sample of 9450 sexual active rural women aged 15-49 was extracted from the 15, 683 nationally representative samples of 2016 Ethiopian Demographic and Health Survey (EDHS). Multi-level logistic regression model was considered to identify determinant factors of modern contraceptive use among sexually active rural women in Ethiopia.ResultThe prevalence of modern contraceptive use among respondents was 20% in rural Ethiopia. Injection (66.35%) was the most common type of modern contraceptive use. In the last full model of the multilevel analysis, individual and community-level factors accounted for 86.69% of the variation in the use of modern contraceptive methods. Secondary and above-educated women (AOR = 1.39, 95%CI: 1.06, 2.81), having 1-4 living children (AOR = 2.70, 95%CI: 2.07, 3.53), rich wealth status (AOR = 2.26, 95%CI: 1.96, 2.60), married women (AOR = 17.31, 95%CI: 10.72, 27.94), having primary educated husband (AOR = 1.45, 95%CI: 1.27, 1.67) and being working husband (AOR = 2.26, 95%CI: 1.96, 2.60) were significantly positively associated with individual-level factors of the use of modern contraceptive methods. Besides, modern contraceptive use was negatively associated with Muslim women (AOR = 0.29, 95%CI: 0.25, 0.33). Compared to the Tigray region, women living in the Afar, Somali, Harari, and Dire Dawa regions had lower use of modern contraceptive methods. Women who had access to mass media (AOR = 1.35, 95%CI: 1.16, 1.57) were more likely to use contraceptives than their counterparts.ConclusionThe prevalence of modern contraceptive use among rural women has very low. Both individual and community-level factors were significant predictors of modern contraceptive use. Consequently, the government and other stakeholders need to address educational opportunities; creating awareness about modern contraception and valuable counseling would increase modern contraceptive methods utilization.

Understanding how social norms affect modern contraceptive use

BackgroundAn aim of this study is to introduce a practitioner-friendly behavior model. Few theories of health behavior explicitly take the effect of social norms on behavior into account. Generally, theories that do take social norms into account assume that the effect of social norms on behavior operates through motivation. We use the Fogg Behavior Model (FBM), a behavior model that is new to public health, to explore whether social norms are associated with modern contraceptive use among Nigerian women, and whether they affect behavior through motivation or through ability. In other words, do social norms that discourage contraception lower women’s motivation to use contraception or do they lower women’s ability to use contraception.MethodsThis study uses data from a cross-sectional household survey of Nigerian women, ages 14–24. The survey collected data on socio-economic and demographic characteristics of women, whether they were sexually experienced, and whether they used contraception. Modern contraceptive use was the outcome of interest for the study. The survey also collected data on social norms around premarital sex and contraceptive use. Multivariate logistic regression was used for the analysis.ResultsAfter adjusting for a range of socio-economic and demographic variables, we found that social norms that discourage contraception had a statistically significant negative association with contraceptive use (aOR = 0.90, p < 0.001). The analysis found that the negative association between social norms and contraceptive use remained statistically significant after controlling for motivation but did not remain statistically significant after controlling for ability.ConclusionThese findings suggest that social norms may affect contraceptive use in Nigeria through ability rather than motivation. In terms of programmatic implications, these finding suggest that public health interventions may be able to counter the negative effects of social norms that discourage contraceptive use by increasing women’s ability to practice contraception.