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Reporting sterilization as a current contraceptive method among sterilized women: lessons learned from a population with high sterilization rates, Rajasthan, India.
Contraception. 2018 Oct 31;OBJECTIVE: Measuring current use of contraception relies on self-reported responses from survey respondents. Reporting validity may be affected by women's interpretation of the question and may vary by background characteristics of women. The study aims to understand levels and patterns of under-reporting of female sterilization in a population with high sterilization rates. STUDY DESIGN: Data came from the Performance Monitoring and Accountability 2020 survey conducted in Rajasthan, India, in early 2017. In addition to a conventional question to ascertain current contraceptive use, the survey included a probing question; women who did not report sterilization as a current method were asked if they were ever sterilized. Women were defined as sterilization users based on either question. Among sterilized women, we estimated the percent who reported sterilization as a current method. Multivariable logistic regression analysis was conducted to assess differential reporting across background characteristics. RESULTS: Among women who were ever sterilized, 78% reported currently using any contraceptive method(s), and 77% reported sterilization as the current method. Women in the lowest household wealth quintile or in general caste were less likely to report sterilization as a current method. Time since sterilization was not associated with correct reporting of sterilization. CONCLUSION: This study demonstrates in a population with high sterilization, sterilization as a current contraceptive method would be substantially underestimated using conventional survey questions. It highlights the importance of context-specific questionnaire adaptation to measure and monitor contraceptive use and provides implications in measuring current use of contraception in populations with high rates of sterilization. IMPLICATIONS: The paper examined reporting of sterilization as a current method among sterilized women. Only 77% of sterilized women reported sterilization as a current contraceptive method. In a population with high sterilization, inclusion of a probe question in surveys is recommended to understand reporting quality and accurately measure contraceptive prevalence rates. Copyright (c) 2018. Published by Elsevier Inc.
Contraceptive use as limiters and spacers among women of reproductive age in southwestern, Saudi Arabia.
Saudi Medical Journal. 2018 Nov; 39(11):1109-1115.OBJECTIVES: To examine the prevalence, socioeconomic, and demographic determinants of contraceptive use among women of reproductive age residing in Abha, Kingdom of Saudi Arabia. METHODS: The data of this study was collected through a cross sectional survey conducted on unmet need for family planning in Abha, Kingdom of Saudi Arabia, between March and May 2016. Three hundred and seventy-four married women were recruited from 6 primary health care centers by a consecutive sampling technique. Data was collected via an interviewer-administered questionnaire. Chi-square test was carried out to identify the factors associated with contraceptive use. RESULTS: The prevalence of contraceptive use rate was 58.8%. Among users, 60% were spacers and 40% were limiters. Among more than two-thirds of the women, the decision to use a family planning method was a joint decision of the couple; and 25% reported it as their own decision. Oral pills and intrauterine contraceptive device (IUCD)were the most popular methods. The most significant associated factors were age, education of women, gravida, number of living children, gender, and age of the last child. Younger age was related with the spacers and older age with birth limiting. Woman's education level showed a significant positive association with birth spacing. CONCLUSION: This study demonstrated that a sizable percentage of women in Abha, Kingdom of Saudi Arabia, are using contraceptions. This finding indicates the need of comprehensive family planning program in the region.
Trends in contraceptive demands and unmet need for family planning in migrant population of Uttarakhand.
International Journal of Community Medicine and Public Health. 2018 Feb; 5(2):590-595.Background: The knowledge of contraceptive use and Unmet need is important to know the constraints for unmet need based on user perspective. The aim of the study was to find the prevalence of Contraceptive use, Contraceptive preferred and the Un-met demand for contraceptives. Methods: Married, non-pregnant women of reproductive age group (15-49 years) from the migrant population were interviewed by Census method using pre-designed and pre-tested instrument by cross-sectional survey. Operational definitions for unmet need for spacing, limiting and unfelt need used in the study were as per NFHS -4 findings and traditional methods of contraception like abstinence, withdrawal were included in Un-met need for contraceptive due to its very high failure rate. Results: 58.44% study subjects had ‘Ever Used FP’ and 56.78% are currently using FP methods. The CPR is 56.7% by ‘Any Method’ and 43.0% by ‘Modern method’. The method which is most popular is ‘Sterlisation 29% and 20.96% and ‘Others’ i.e. highly unreliable methods like coitus interruptus, calendar method etc found high number of users. The reasons for non use were apprehension of complication/side effects in 39%) and inconvience/ the difficulties with modern contraceptive methods or lack of knowledge by 7.67% and 6.95% respectively, 16% were relied on traditional methods, such as periodic abstinence, withdrawal and herbal mixtures from traditional healers as well as LAM 8% for a FP method, all of which have high failure rate. Only 24.8% Women were decision maker regarding the time and type of contraceptive to be used. The Unmet need was 29.7% out of which the unmet needs for spacing and limiting were 9.6 per cent and 20.1 per cent, respectively. Conclusions: The Un- met Need is high and can be addressed by removing the constraints such as poor accessibility to the knowledge thus removing apprehension for side effects, improve accessibility to resources and low decision-making autonomy.
Mapping evidence on decision-making on contraceptive use among adolescents: a scoping review protocol.
Systematic Reviews. 2018 Nov 20; 7(1):201.BACKGROUND: Contraceptive use among adolescents remains consistently low globally. Numerous studies have been done investigating factors that contribute to low contraceptive prevalence rates in this special population. It is particularly vital to understand decision-making processes that adolescents undergo when deciding whether or not to use contraceptives. Therefore, this scoping review seeks to map available evidence on decision-making processes in contraceptive use among adolescents. METHODS: We will conduct a scoping review to explore, describe and map literature on the adolescent decision-making regarding contraceptive use. The primary search will include peer-reviewed and review articles. Databases, including PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct and Scopus, will be searched for articles that meet the eligibility criteria. Keyword searches will be used, and for articles included after title screening, abstract and full articles will be screened by two independent reviewers with a third as a decider on any disputes. Content analysis will be used to present the narrative account of the reviews. DISCUSSION: Understanding how adolescents make decisions about whether or not to use contraception is essential for improving contraceptive prevalence rates in this special population. It is envisioned that the results from this review will highlight key evidence on how adolescent make decisions regarding contraceptive use as well as gaps and opportunities for future research. It will also be important in enhancing and re-focusing adolescent sexual and reproductive health policies and programmes.
Association between factors related to family planning/sexual and reproductive health and contraceptive use as well as consistent condom use among internal migrant population of reproductive ages in three cities in China, based on Heckprobit selection models.
BMJ Open. 2018 Nov 13; 8(11):e020351.OBJECTIVE: With the increased population mobility and the transition in population policy, scholars are quite concerned about family planning/sexual and reproductive health (SRH) and related factors among internal migrant population of reproductive age. Therefore, the proposed study was designed to explore the association between factors related to family planning/SRH and contraceptive use as well as consistent condom use among the above-described population in China. DESIGN: Cross-sectional study. SETTING: Three municipalities in China, namely Beijing, Shanghai and Chongqing. PARTICIPANTS: Among the 6545 participants, 2099, 2414 and 2031 subjects came from Beijing, Shanghai and Chongqing, respectively. RESULTS: A total of 6545 eligible participants were included as the full sample, 6188 of whom who had intercourse in the last 3 months were selected as the subsample. Among the subsample, 80.88% (5005/6188) adopted any form of contraceptive methods and 49.14% (3041/6188) consistently used condom in the last three sexual intercourses. Meanwhile, the involved participants had a better mastery of knowledge on SRH than on contraception (p<0.0001). The results of the Heckprobit models revealed that the factors associated with both contraceptive use and consistent condom use were relationship with the first intercourse partner, communication frequency with spouse/sexual partners on sex, actual number of children and knowledge on SRH, while knowledge on contraception and age at first intercourse were associated with contraceptive use and consistent condom use, respectively (p<0.05). CONCLUSIONS: In the current study, we revealed a high-level contraceptive prevalence, a relatively low-level consistent condom use and a poor mastery of knowledge on contraception and SRH. The Heckprobit selection model specified the existence of selection bias, providing evidence on the association between the factors on family planning/SRH and contraceptive use as well as consistent condom use, respectively. Our findings indicated that health institutions should offer appropriate technology and high-quality family planning/SRH services for the internal migrant population in China. (c) Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Spatial Analysis of Socio-Economic and Demographic Factors Associated with Contraceptive Use among Women of Childbearing Age in Rwanda.
International Journal of Environmental Research and Public Health. 2018 Oct 27; 15(11)Contraceptive use is considered as essential for protecting women's health and rights, influencing fertility and population growth, and helping to promote economic development. The main objective of this study was to analysis the factors and spatial correlates of contraceptive use among women of childbearing age. The 2015 Rwanda Demographic and Health Survey (RDHS) data were used to identify the factors associated with contraceptive use in Rwanda. A Bayesian geo-additive model was used in order to account for fixed effects, nonlinear effects, spatial and random effects inherent in the data. The overall prevalence of use of any contraceptive method among married women of childbearing age in Rwanda was 52.7%. A woman's age, wealth quintile, level of education, working status, number of living children, and exposure to the media was found to increase contraceptive use. The findings from the study also found disparities in contraceptive use at provincial and district level, where prevalence was higher in districts of Northern provinces and lower in districts of western provinces. The findings of this study suggest that exposure to information on contraceptive use in health centres, empowerment of women to access quality contraceptive-use services and religions to play an important role in explaining and informing their adherents on the importance of using a contraceptive method.
PloS One. 2018; 13(10):e0205927.BACKGROUND: Globally the trajectories of approaches in adoption and implementation of family planning programmes have varied subjecting to variation in cultural and political philosophies across the countries. Accordingly, the progress in family planning has varied over the time across the countries. OBJECTIVE: This study investigates long-term trajectories of demand for family planning and contraceptive prevalence rates and tests the hypothesis of convergence across the world countries. METHODS: This study used data from United Nations Population Prospects for 185 countries and regions during 1970-2015. Standard graphical, parametric and nonparametric convergence metrics have been used for testing of the convergence hypothesis. RESULTS: The results suggest a substantial increase in the global average of both demand and actual prevalence of contraceptive practice across the countries, but the actual contraceptive use is yet to catch up with the demand. Our findings suggest that there is a convergence in contraceptive use across the countries, particularly since the mid-1990s. CONCLUSION: A major part of the convergence in demand for family planning and contraceptive prevalence rate is due to its stalling in both developed and many developing countries and its increase in several developing and least developed countries. Family planning has a greater role in human wellbeing particularly enhancing reproductive, maternal and child health outcomes than being a mere tool for fertility reduction. Therefore, the emphasis is needed on family planning efforts in the lagged behind countries for global convergence of family planning.
Durham, North Carolina, FHI 360, 2018 Apr. 6 p.Since the London Summit on Family Planning (FP) in 2012, more than 40 countries have committed to making high-quality, voluntary FP services, information, and supplies more available, acceptable, and affordable for an additional 120 million women and girls in the world’s 69 poorest countries by 2020. Meeting the commitments of this initiative, known as FP2020, will ensure that every woman and every girl has the right, and the means, to shape her own life-to grow, to thrive, and to plan the family she wants. Costed implementation plans (CIPs) are multi-year action plans that contain detailed resource projections for achieving the goals of a FP program, thus enabling countries to operationalize and monitor progress toward their FP2020 commitments. Thus far, close to 30 countries in Africa and Asia have developed CIPs at either a national or subnational level, with new CIPs being developed on an ongoing basis. Translating CIPs into action, and ultimately into results, requires a sustained deliberate approach to the execution process throughout the plan. This notion may sound simple and straightforward, but it can be complex. Strategic planners agree that planning seldom fails; it is the execution that fails. Extensive literature describes the factors that can stall a plan, including lack of buy-in and ownership, unclear lines of responsibility and accountability, lack of dedicated efforts to mobilize resources, inability to recognize and facilitate change processes, poor communication and coordination among stakeholders, and inadequate leadership and management skills to effect execution. This case study describes the process of translating the plan into sustained action and measurable results-execution, challenges, and lessons learned. It is based on consultations with stakeholders, conducted in August 2016 to understand the execution process, and is enriched by reports from performance-monitoring efforts and follow-up with in-country stakeholders. (excerpt)
A cross sectional study of contraceptive prevalence and factors responsible for usage of different contraceptive methods in an urban slum area.
International Journal of Community Medicine and Public Health. 2018 Oct; 5(10):4363-4367.Background: According to WHO; contraceptive prevalence is the percentage of women who are currently using, or whose sexual partner is currently using, at least one method of contraception, regardless of method used. It is usually reported for married women aged 15-49. According NFHS-4 (2015-16) current use of any family planning method is 53.5%. The objectives of the study were to find out contraceptive prevalence and usage of different contraceptive methods among married women of reproductive age group and to study factors affecting contraception use among married women of reproductive age group. Methods: A community based cross sectional study was carried out in urban slum area catered under Urban Health Training Center of medical college. Sample size of 390 married women of reproductive age residing in urban slum area taken. By using systematic random sampling method data collected by house to house visits. Data was analyzed by using SPSS software version 24. Chi-square test used for showing association. Results: Contraceptive prevalence was found to be 53.84%.Use of tubal ligation was found maximum (12.05%) followed by condom, O.C.P. Contraceptive use was found to be significantly associated with age, number of living son, and number of living children of women. Conclusions: Counselling of women should be done for appropriate use of contraceptive method. Awareness regarding female education, birth spacing, advantage of small family, etc. should be done by I.E.C. activity.
A study on prevalence of contraceptive use and its determinants among eligible couples in urban slums of Gorakhpur district.
International Journal of Community Medicine and Public Health. 2018 Oct; 5(10):4288-4291.Background: As the urban slum population is increasing rapidly and have higher rate of illness than non-slum areas of the same city. Root of most of the health related problems are due to population which can be best controlled by family planning. The aims and objectives of the study were to know the prevalence of use of contraceptive methods and determinant of contraceptive use among couples in urban slums of Gorakhpur. Methods: A cross sectional study was conducted from September 2013-August 2014 in urban slums of District Gorakhpur. WHO 30 cluster sampling method was applied. Results: 145 (67.4%) of all eligible couple had ever used a contraceptive method. About one third of females (28.9%) had undergone Permanent sterilization followed by Condom (21.3%) use. About (15.0%) DMPA and IUCD were used in about equal in proportion. OCPs were used only by (12.4%) females. On the basis of caste, SC/ST showed highest ever use of contraception. Conclusions: Among the males 92.1% males and 89.8% females had the knowledge about contraceptives to be used. Prevalence of currently using contraceptives is 44.6%. About one third of females (28.9%) had undergone permanent sterilization followed by condom (21.3%) use. About (15.0%) DMPA and IUCD were used in about equal in proportion. OCPs were used only by (12.4%) females. Emergency contraceptives least used. No vasectomy done. About 10% lack of knowledge of contraception and a huge gap between knowledge and practice. So some educational programmes and motivational programmes must run in our community.
Family planning practices amongst women of reproductive age groups in field practice area of rural health training centre of Government Medical College, Miraj, Maharashtra.
International Journal of Community Medicine and Public Health. 2018 Nov; 5(11):4735-4738.Background: Family planning services have the potential to improve the quality of the lives of people. Family planning deals with reproductive health of mother, having adequate birth spacing, avoiding undesired pregnancies and abortions, preventing sexually transmitted diseases and improving the quality of life of mother, fetus and family as a whole. This study was conducted in the field practice area to learn about various family planning practices and reasons for non-use. Methods: A cross-sectional study was carried out amongst women of reproductive age group in the field practice area of Rural Health Training Centre of Dept. of Community Medicine of a Government Medical College, Miraj Dist- Sangli, Maharashtra during the period of January to March 2018. Total of 2964 eligible couples were interviewed by the trained staff using the pre-tested questionnaire. Data was analyzed by using appropriate test whenever necessary. Results: The contraceptive prevalence was found to be 80.8%. Majority 92.8% couples who had two children were using one of the contraceptive methods. Among 2396 contraceptive users, 76% of couples had followed permanent method of sterilization. The permanent method opted by majority of couples was female sterilization i.e. 75.8%, whereas male sterilization was carried out by only 0.2% partners. Among the couples who were using temporary methods, majority partners were using Nirodh. Conclusions: Promotion of contraceptive usage should be done through intense awareness campaigns and continuous motivation should be carried in the current contraceptive users.
Factors associated with contraceptive use among young women in Malawi: analysis of the 2015-16 Malawi demographic and health survey data.
Contraception and Reproductive Medicine. 2018; 3:12.Background: Although Malawi is one of the countries with highest Contraceptive Prevalence Rate (CPR) in Sub-Saharan Africa, pregnancies and fertility among young women remain high. This suggests low up take of contraceptives by young women. The aim of this study was to investigate the factors associated with contraceptive use among young women in Malawi. Methods: This is a secondary analysis of household data for 10,422 young women aged 15-24 years collected during the 2015-16 Malawi Demographic and Health Survey (MDHS). The sample was weighted to ensure representativeness. Descriptive statistics, bivariate and multivariate logistic regressions were performed to assess the demographic, social - economic and other factors that influence contraceptive use among young women. Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with their corresponding 95% confidence intervals (95% CI) were computed using the Statistical Package for the Social Sciences version 22.0. Results: Of the 10,422 young women, 3219 used contraception representing a prevalence of 30.9%. The findings indicate that age, region of residence, marital status, education, religion, work status, a visit to health facility, and knowledge of the ovulatory cycle are significant predictors of contraceptive use among young women in Malawi. Women who were in the age group 20-24 years (AOR = 1.93; 95% CI = 1.73-2.16), working (AOR = 1.26; 95% CI = 1.14-1.39), currently married (AOR = 6.26; 95% CI = 5.46-7.18), knowledgeable about their ovulatory cycle (AOR = 1.75; 95% CI = 1.50-2.05), and those with primary education (AOR = 1.47; 95% CI = 1.18-1.83) were more likely to use contraceptives than their counterparts. Conclusion: This study has demonstrated that several social demographic and economic factors are associated with contraceptive use among young women in Malawi. These findings should be considered and reflected in public health policies to address issues that could be barriers to the use of contraception by young women. Strengthening access to family planning information and services for young women is highly recommended to reduce pregnancies among young women in Malawi.
Modern contraceptive use among reproductive-aged women in Ghana: prevalence, predictors, and policy implications.
BMC Women's Health. 2018 Sep 25; 18(1):157.BACKGROUND: Modern contraceptive use remains an important public health intervention and a cost-effective strategy to reduce maternal mortality, avert unintended pregnancies and to control population explosion, especially in developing countries. Despite these benefits, there are reports of low usage among reproductive-aged women in most developing countries. This study examined the prevalence and predictors of use of modern contraceptive among reproductive-aged women in an urban center with a high density population in Ghana. METHODS: A cross-sectional, interviewer-administered survey was conducted with 217 randomly selected reproductive-aged women. Data was analyzed with STATA. Logistic regression was performed to identify factors influencing modern contraceptive use. RESULTS: Although we found high levels of knowledge and awareness (98%; n = 213) of modern contraception use, only 21% of participants were using modern contraceptives. Marital status, partner consent and support, and religious beliefs strongly predicted usage. CONCLUSION: Usage of modern contraceptives among reproductive-aged women in the Ledzokuku Krowor Municipality is lower than the national target. A multilevel family planning intervention program that primarily focuses on promoting inclusive participation of husbands, targets the unmarried and non-literates reproductive-aged women, and dispels misconceptions, misinformation and religious myths about modern contraceptives has been discussed.
Ethiopian Journal of Health Sciences. 2017 Mar; 27(2):106.Add to my documents.
Life time risk of maternal death in districts of Maharashtra State, India: mathematical estimation using proxy indicators.
Indian Journal of Community Health. 2017 Jul-Sep; 29(3):215-221.Background: Maternal Mortality Ratio, Maternal Mortality Rate, Life Time Risk of Maternal Death are used to describe maternal mortality. First is most commonly quoted indicator. The Life Time Risk is most comprehensive. Three simple methods of calculations of Life Time Risk are documented. The calculations require Maternal Mortality Ratio and Total Fertility Rate; Maternal Mortality Rate and Reproductive Age Group Span. Reliable district wise data of these indicators is unavailable. Aim & Objectives: To calculate district wise life time risk of maternal deaths. Material & Methods: The proportion of non-institutional deliveries was used as proxy for Maternal Mortality Ratio and the proportion of couples not using any family planning method was used as proxy for the Total Fertility Rate. The correlation and regression equation between estimated Life Time Risk using standard method and using proxies was calculated. District wise Life Time Risk for Maharashtra state was calculated using the regression equation. Results: Good correlation was observed using proxies (r=0.97) and regression equation was: y=0.09+1.71x. For Maharashtra state the estimated of Life Time Risk was found to be 0.14% which exactly matched the estimate using conventional method. Conclusion: Using proxies reliable estimates of Life Time Risk for districts can be calculated.
BMC Pregnancy and Childbirth. 2018 May 16; 18(1):172.BACKGROUND: The postpartum period provides an important opportunity to address unmet need for contraception and reduce short birth intervals. This study aims to assess the association between skilled maternal healthcare and postpartum contraceptive use in Ethiopia. METHODS: Data for this analysis come from the 2011 to 2016 Ethiopian Demographic and Health Surveys (EDHS) and include nearly 5000 married women of reproductive age with a recent birth. Multivariate logistic regression was conducted to investigate the relationship between skilled maternal healthcare and postpartum contraceptive use. RESULTS: Between rounds of the 2011 and 2016 EDHS, the postpartum contraceptive prevalence increased from 15 to 23% and delivery in public facilities, use of skilled birth assistance, and skilled antenatal care also grew. In both survey rounds, educated women had approximately twice the odds of postpartum contraceptive use, compared with non-educated women, while an initially significant relationship between wealth and postpartum contraceptive use diminished in significance by 2016. Women with a desire to limit future pregnancy had five to six times the odds of postpartum contraceptive use in both survey rounds, and women in 2016 - unlike those in 2011 - with a desire to delay pregnancy were significantly more likely to use contraception (adjusted odds ratio (AOR) = 4.38, 95% CI: 1.46-13.18) compared to women who wanted another child soon. In 2011, no statistically significant associations were found between any maternal healthcare and postpartum contraceptive use. In contrast, in 2016, postpartum contraceptive use was significantly associated with an institutional delivery (AOR = 1.71, 95% confidence interval (CI): 1.12-2.62) and skilled antenatal care (AOR = 2.41, 95% CI: 1.41-4.10). No significant relationship was observed in either survey round between postpartum contraceptive use and skilled delivery or postnatal care. CONCLUSIONS: A comparison of postpartum women in the 2011 and 2016 EDHS reveals increased use of both contraception and skilled maternal healthcare services and improved likelihood of contraceptive use among women with an institutional delivery or antenatal care, perhaps as a result of increased attention to postpartum family planning integration. Additionally, results suggest postpartum women are now using contraception to space future pregnancies, with the potential to help women achieve more optimal birth intervals.
Trends in family planning practices of women in child bearing age: a community based survey in northern peri-urban areas of Lahore.
Pakistan Journal of Medical Research. 2018 Apr-Jun; 57(2):66-70.Background: Pakistan being the sixth most populous country in the world needs to control its population explosion as well as understand the importance of family planning practices and its inherent relationship with improved maternal health. Objectives: This study was conducted with the aim to assess the family planning practices in the Northern Peri-Urban areas of Lahore, Pakistan. Subjects and Methods: Community based survey was conducted on 852 households by interviewing married females aged 15 – 49 years with the help of a pretested structured questionnaire. Every third household was selected by employing systematic random sampling. Results: Mean age of the women was 19 ± 3.54 years with mean number of pregnancies 4.05 ± 2.50. Contraceptive prevalence rate was 36%. Most preferred method of contraception was tubal ligation 37% and condoms 29% vasectomy being the least preferred. Tubal ligation 10%, condoms 6.5% and intrauterine contraceptive device 2.6% was the choice for females aged 15 – 20 years. Women having four to six pregnancies were opting for tubal ligation 10.3% (p-value <0.0001). Conclusion: In the Northern Peri-urban areas of Lahore, contraception is being practiced at the same rate as in the rest of the province. It is pertinent for improved maternal health to ensure maximum utilization of family planning services within this community.
BMC Women's Health. 2018 Jun 18; 18(1):97.BACKGROUND: Providing preferred methods of contraceptive for HIV-positive women and avoiding unintended pregnancy is one of the primary means of preventing mother to child transmission of HIV. This study assessed the prevalence of contraceptive use and method preference among HIV-positive women in Amhara region, Ethiopia. METHODS: A cross-sectional survey was conducted among HIV-positive women in three referral hospitals of Amhara region. Data were collected by interviewing HIV-positive women using a pre-tested and structured questionnaire. A binary logistic regression model was used to identify factors associated with contraceptive use, and odd ratio with 95% confidence interval (CI) was calculated to measure the strength of association. RESULTS: A total of 803 women living with HIV (with a response rate of 95.4%) were interviewed. The mean age of the study participants was 32.2 years (SD +/- 6.2 years). The prevalence of current contraceptive use was 30.3% (95% CI: 27.0-33.7%). The preferred and most commonly used contraceptive methods were injectable (42.8%) and male condom (32.9%). Younger age group (15-24 years) (AOR = 9.67; 95%CI: 3.45, 27.10), one or more number of living children (AOR = 4.01; 95%CI: 2.07, 7.79), HIV diagnosis > 2-4 years (AOR = 2.37; 95%CI: 1.10, 5.08), and having high CD4 count > 500 cell/ul (AOR = 3.25; 95% CI: 1.42, 7.44) were significantly associated with contraceptive use. CONCLUSION: The prevalence of contraceptive use among HIV-positive women in Amhara region referral hospitals is low, which suggests a high risk of unintended pregnancy. Injectable and male condoms are the most preferred type of contraceptive methods. Thus, it is better to integrate these contraceptive methods with ART clinic.
Contraceptive needs and practice of women in the extended post-partum period in Addis Ababa, Ethiopia.
Ethiopian Journal of Reproductive Health. 2017 Feb; 9(1):17-24.BACKGROUND: Family planning is the most cost-effective intervention to improve health outcomes in reproductive, maternal and child health. Extended post-partum defined as one-year post-birth period, 95% of low and middle-income countries women want to avoid a pregnancy within the next two years, but 70% are not using contraception. OBJECTIVE: To determine the magnitude and factors associated with contraceptive needs and practices of women during extended postpartum period in Addis Ababa, Ethiopia. METHODS: Institution based cross sectional study used. Women in the reproductive age group within their first year after delivery who came to selected health facilities with their infants for immunization or child health clinics were interviewed. Epi-Info version 7 and SPSS version 21 were used for data entry & analysis. Descriptive statistics were used to summarize the data. Bivariate and multi variable logistic regression model were used to see an association between variables. RESULT: Eight hundred thirty three post-partum mothers were interviewed. Mean age (+or- 1SD) of mothers at their last delivery was 27.3 (+ 4.5) years. The median number of pregnancy was 2. Regarding reproductive intention, 45.0% of mothers want to space the next pregnancy for more than two years. Among the 92.6% of mothers who wanted to use contraceptive method, 70.9% of them use modern contraceptives which give contraceptive prevalence rate of 65.7%. CONCLUSION: Reproductive intention, resumption of menses and sexual intercourse, knowledge, discussion with partner, post-partum visit and family planning counseling were found to be factors associated with postpartum family planning practice. Improving the knowledge on long term family planning methods and lactational amenorrhea method should be strengthen.
Washington, D.C., The Evidence Project, Population Council, 2018 May. 8 p. (Synthesis Brief)In Senegal, the National Action Plan for Family Planning (NAPFP) 2012–2015 and the National Strategic Framework for Family Planning 2016–2020 adopted a multi-sectoral approach to broaden access to family planning (FP) services and to reach 45% modern contraceptive prevalence (mCPR) by 2020 (NAPFP, 2012). The private sector and community actors are key partners with the public sector in implementing this approach. However, private pharmacies have not been actively involved in the provision of FP services due to legal and nonlegal barriers that limit their role to selling contraceptives and providing method-specific advice. As Senegal seeks to involve the private sector in improving access to FP, this study found that the country is in an optimal position to increase the role of private pharmacies in FP, which could contribute to the country reaching its mCPR goals. The brief includes policy recommendations for the Government of Senegal, for pharmacists and their professional organizations, and for technical and financial partners.
Evaluating the impact of an intervention to increase uptake of modern contraceptives among adolescent girls (15-19 years) in Nigeria, Ethiopia and Tanzania: the Adolescents 360 quasi-experimental study protocol.
BMJ Open. 2018 May 31; 8(5):e021834.INTRODUCTION: Nigeria, Ethiopia and Tanzania have some of the highest teenage pregnancy rates and lowest rates of modern contraceptive use among adolescents. The transdisciplinary Adolescents 360 (A360) initiative being rolled out across these three countries uses human-centred design to create context-specific multicomponent interventions with the aim of increasing voluntary modern contraceptive use among girls aged 15-19 years. METHODS: The primary objective of the outcome evaluation is to assess the impact of A360 on the modern contraceptive prevalence rate (mCPR) among sexually active girls aged 15-19 years. A360 targets different subpopulations of adolescent girls in the three countries. In Northern Nigeria and Ethiopia, the study population is married girls aged 15-19 years. In Southern Nigeria, the study population is unmarried girls aged 15-19 years. In Tanzania, both married and unmarried girls aged 15-19 years will be included in the study. In all settings, we will use a prepopulation and postpopulation-based cross-sectional survey design. In Nigeria, the study design will also include a comparison group. A one-stage sampling design will be used in Nigeria and Ethiopia. A two-stage sampling design will be used in Tanzania. Questionnaires will be administered face-to-face by female interviewers aged between 18 and 26 years. Study outcomes will be assessed before the start of A360 implementation in late 2017 and approximately 24 months after implementation in late 2019. ETHICS AND DISSEMINATION: Findings of this study will be widely disseminated through workshops, conference presentations, reports, briefings, factsheets and academic publications.
Washington, D.C., Population Reference Bureau [PRB], 2018 Apr. 8 p. (Policy Brief; USAID Project No. AID-I-0304)This policy brief explores wealth-based disparities in the modern contraceptive prevalence rate, total fertility rate, and demand satisfied for modern methods of family planning in Ethiopia, Ghana, Malawi, and Tanzania.
Multiple contraceptive method use and prevalence of fertility awareness based method use in the United States, 2013-2015.
Contraception. 2018 Sep; 98(3):188-192.OBJECTIVES: Contraceptive prevalence in the United States is typically calculated according to the most effective method of contraception reported. This could theoretically underestimate the number of women using fertility-awareness based methods (FABMs), including those who use other methods (e.g., condoms) during the fertile window, but the extent of any such underestimation has not been assessed. STUDY DESIGN: We used data from the 2013-2015 National Survey of Family Growth to examine the extent to which women report use of an FABM alone or with other methods. We investigated FABM use patterns and compared demographic profiles of FABM users versus other contraceptive users. We considered how to most appropriately define FABM prevalence. RESULTS: One in six (16.5%) female contraceptors 15-44 reported use of multiple contraceptive methods in their month of interview. Among women reporting current FABM use, 67% used it alone or with withdrawal, 24% also used condoms or emergency contraception, and 9% also used hormonal contraception or sterilization. An FABM was the most effective method reported for 2.2% of current contraceptive users; while 3.2% of contraceptors reported any current FABM use. We posit an FABM prevalence of 3% (1,113,000 users) among US female contraceptors (2013-2015). FABM users had similar sociodemographic characteristics as other method users, but were more likely married. CONCLUSIONS: Currently, consideration of multiple method use has modest implications for estimation of FABM prevalence among contraceptors (i.e., an increase from 2.2% to 3%). However, multiple method use patterns with FABMs may merit special consideration if FABM use continues to increase. IMPLICATIONS: Researchers and providers need to be familiar with the unique patterns of use among FABM users in order to more effectively measure and counsel about these methods. Copyright (c) 2018. Published by Elsevier Inc.
Assessment of utilization of long acting reversible contraceptive and associated factors among women of reproductive age in Harar City, Ethiopia.
Pan African Medical Journal. 2017; 28:222.Introduction: World health organization report indicated that, in 2013 alone, over 289,000 maternal death that resulted from pregnancy and delivery related complication were reported worldwide indicating a decline of 45% from 1990. The sub-Saharan Africa region alone accounted for 62% of maternal death followed by southern Asian country (24%). Provision of family planning is one of the effective intervention that prevent unwanted and ill spaced pregnancy there by reducing maternal mortality and morbidity. Given that its effectiveness and, associated fewer visits to health facilities, LARC are very important in tackling maternal mortality and morbidity. However, little is known regarding its prevalence in eastern Ethiopia. Thus, this study aimed to assess utilization of long acting reversible contraceptives and associated factors among women of reproductive age groups. Methods: A facility based cross-sectional study conducted in Harar city among 402 study participants. The study participants selected by using systematic random sampling method. The quantitative data collected using structured interviewer administered questionnaires. All variables with p-value of = 0.25 in bivariate logistic regression were taken into multivariable model. Variables having p value = 0.05 in the multivariate analysis were taken as significant predictors. Crude and adjusted odds ratios with their 95% confidence intervals were calculated. Results: The study identified that the utilization of long acting reversible contraceptive among mother of reproductive age was 38%. Study participants whose occupation was daily laborer were less likely to utilize long acting reversible contraceptive compared to those whose occupation was house wife (adjusted OR = 0.3; 95% CI 0.01 to 0.8). Moreover, those mothers who were unable to read and write utilize long acting reversible contraceptive 5 times more likely compared to those who were above grade 12 (adjusted OR = 4.9; 95% CI 1.2 to 19.6). Conclusion: The prevalence of long acting reversible contraceptive was found to be low. Maternal education and occupation were factors found to have a significant association with utilization of long acting reversible contraceptive. Community and facility level awareness creation should be reinforced to improve utilization of long acting reversible contraceptives.
Emergency contraception in Albania: a multimethods qualitative study of awareness, knowledge, attitudes and practices.
Contraception. 2018 Apr 11;OBJECTIVES: Contraceptive prevalence is relatively low in Albania, and abortion is the mainstay of family planning. Although levonorgestrel-only emergency contraceptive pills are available, uptake of this method is minimal. Emergency contraception (EC) could play a significant role in addressing women's need for an effective and discreet pregnancy prevention method. However, information about the dynamics surrounding EC is limited. STUDY DESIGN: In 2016-2017, we conducted a multimethods qualitative study that aimed to explore awareness, knowledge, attitudes and practices toward EC in Albania. This project comprised four components: a community-based survey with 115 respondents, six focus group discussions with women of reproductive age, 19 semistructured key informant interviews, and 16 structured interviews with retail pharmacists. We analyzed our data using descriptive statistics and for content and themes. RESULTS: Our findings suggest that EC is widely available in pharmacies in Albania. However, a quarter of our survey participants did not know whether EC was available, and more than a third did not think EC was safe to use. Women face numerous barriers to accessing this form of contraception. Misconceptions about hormonal contraceptives, in general, and about progestin-only EC in particular, lack of training among providers, and stigma and fear of judgment were common obstacles identified by participants. CONCLUSIONS: Misinformation and lack of knowledge about EC among women and providers in Albania appears common. Training health service providers, raising awareness among women, and developing linguistically and culturally resonant materials for distribution could be keys to improving access to and use of EC. IMPLICATIONS: Although the availability of progestin-only EC is widespread in Albania, our findings suggest that more work needs to be done to align national regulatory policies with international standards, facilitate evidence-based service delivery, and increase access to medically accurate information in Albanian. Copyright (c) 2018 Elsevier Inc. All rights reserved.