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Risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia.
Journal of Public Health and Epidemiology. 2018 Dec; 10(12):429-442.There is growing evidence suggesting that young people in school are practicing risky sexual behaviors. Ethiopian people aged 10 to 24 years have emerged as the segments of the population most vulnerable to a broad spectrum of serious sexual health problems. Therefore, the main aim of this study was to assess risky sexual behaviors and associated factors among preparatory school students in Arba Minch, Southern Ethiopia. An institution based cross sectional study was conducted among 465 study participants from April 20 to June 2, 2018. A self-administered pre-tested questionnaire was used to collect the data. Bivariate and multivariate analysis was done using binary logistic regression. In this study, 22.4% (95%CI: 18.6%, 26.2%) of study participants had risky sexual behaviors. Marital status, education and occupational status of the father, occupation of the mother, watching pornographic movies, drinking alcohol, using hashish/shisha and knowledge about HIV/AIDS were significantly associated with odds (AOR=3.28, 95%CI: 1.24, 8.70), (AOR=5.96, 95%CI: 1.35, 26.25), (AOR=0.33, 95%CI: 0.12, 0.93), (AOR=0.22, 95%CI: 0.09, 0.51), (AOR=8.80, 95%CI: 4.04, 19.17), (AOR=2.71, 95%CI: 1.35, 5.46), (AOR=14.88, 95%CI: 4.52, 48.96) and (AOR=2.89, 95%CI: 1.42, 5.88), respectively. This finding noted that significant numbers of students were engaged in risky sexual behaviours. Those students had multiple sexual partners, used condoms inconsistently, had sex with risky individuals, and an early sexual start. Watching pornographic movies, substance abuse and a knowledge gap on HIV/AIDS were some of the significant factors. Awareness creation for youths to reduce substance abuses, HIV/AIDS and sexual and reproductive health in the school community is recommended.
Assessment of the unmet needs of contraception among female undergraduate students in southern Nigeria.
Journal of Public Health and Epidemiology. 2018 Nov; 10(11):406-412.The proportion of women who have an unmet need for modern contraception is highest (24%) in Sub- Saharan Africa, which is double the world average of 12% in 2015. This unmet need leads to unintended pregnancies, unsafe abortions and limitation of women’s ability to achieve educational, employment and economic goals. This study aims to assess the unmet needs of contraception and the reasons for contraceptive non-use among female undergraduate students in Benin City. A descriptive crosssectional study was conducted on female undergraduate students in Benin City, Edo State from January to June, 2017. The respondents were selected using multistage sampling technique. Data was collected using pre-tested structured self- administered questionnaires and data analysis was by IBM SPSS version 21.0. The level of significance was set at p < 0.05. Results revealed that a total of 400 respondents with mean age (SD) of 21.3 (2.5) years participated in this study. One hundred and sixtyone (40.2%) respondents were sexually active and of these, 128 (79.5%) had ever used contraceptives. However, only 97 (76.4%) of those who had sexual exposure within the past 1 month were currently using contraceptives. The unmet need of contraception was 18.6%. Reasons for unmet need included partner’s disapproval 24 (80.0%), fear of side effects 12 (40.0%) and religious beliefs 8 (20.0%). Thus, unmet need of contraception was high among the study group.
Unmet need for modern contraception and associated factors among reproductive age group women in Eritrean refugee camps, Tigray, north Ethiopia: a cross-sectional study.
BMC Research Notes. 2018 Dec 4; 11(1):851.OBJECTIVE: Millions of women want to delay or avoid pregnancy, but they are not using contraception, especially in refugee settings. Due to lack of contraception, one fifth of reproductive age group women suffered from unwanted pregnancy and unsafe abortion, which accounted for 78% of maternal mortality in refugee camps. Therefore, the aim of this study was to assess the prevalence of unmet need for modern contraception and its associated factors among reproductive age group women in Eritrean refugee camps, Tigray, Northern Ethiopia, 2016. RESULTS: 400 women of reproductive age group interviewed. Prevalence of unmet need for modern contraception in this study was found to be 41.8% (95% CI 36.99%, 46.63%).Respondents' unfavorable attitude towards modern contraceptive methods [AOR = 0.372, 95% CI 0.170, 0.818] and the availability of modern contraceptive methods [AOR = 3.501, 95% CI 1.328, 9.231] were factors significantly associated with unmet need for modern contraception. Respondents' attitude towards modern contraceptive methods and availability of modern contraceptives were independent predictors of unmet need. Governmental and non-governmental organizations should design programs to create behavioral change in women's attitude towards contraceptive use and to secure the availability of contraceptive methods in refugee camp settings.
Programmatic implications of unmet need for contraception among men and young married women in northern Nigeria.
Open Access Journal of Contraception. 2018; 9:81-90.Purpose: The study was designed to provide programmatic recommendations for interventions to increase contraceptive prevalence in northern Nigeria. Family-planning use in North-East and North-West regions of Nigeria has remained very low, despite years of domestic and donor investments. We examine respondents' perceptions of their own need for contraception and specifically focus on young women because of their higher risk for maternal mortality. Methods: In this cross-sectional study, we interviewed 1,624 married women younger than 25 years and 1,627 men married to women younger than 25 years, in Kaduna and Katsina states in northern Nigeria. We classified respondents into five categories: 1) having no real need for contraception, 2) perceiving no need for contraception, despite physical or behavioral need, 3) having met need by using a modern contraceptive method, 4) perceiving met need by employing traditional practices, and 5) having unmet need for contraception. Results: Half of female respondents had no need for contraception because they were either pregnant or desiring a pregnancy at the time of the survey. A quarter of female and male respondents were not using contraception because of their religious beliefs. Less than 2% of respondents had unmet need because of lack of availability or access, or due to poor quality of care. Men had more positive views of family planning than women. Conclusion: Our findings suggest that young women in northern Nigeria would benefit from a programmatic approach that targets men, utilizes religious leaders, and addresses the prevalent religious and sociocultural norms that present barriers to contraceptive use. Such interventions have the potential to increase contraceptive prevalence more substantially, but the literature on these types of interventions in northern Nigeria is scarce. Therefore, more research is needed to identify and document what approaches work or do not work to increase contraceptive use in northern Nigeria.
Studies In Family Planning. 2018 Dec; 49(4):345-365.Global initiatives aim to add 120 million new family planning (FP) users by 2020; however supply-side interventions may be reaching the limits of their effectiveness in some settings. Our case study in Niger used demand analysis techniques from marketing science. We performed a representative survey (N = 2,004) on women's FP knowledge, attitudes, needs, and behaviors, then used latent class analysis to produce a segmentation of women based on their responses. We found that Nigerien women's demand for modern FP methods was low, with majorities aware of modern methods but much smaller proportions considering use, trying modern methods, or using one consistently. We identified five subgroups of women with distinct, internally coherent profiles regarding FP needs, attitudes, and usage patterns, who faced different barriers to adopting or using modern FP. Serving subgroups of women based on needs, values, and underlying beliefs may help more effectively drive a shift in FP behavior. (c) 2018 The Population Council, Inc.
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.
Knowledge, attitude, practice and learning needs of nursing personnel related to domestic violence against women: a facility based cross sectional survey.
International Journal of Community Medicine and Public Health. 2018 Mar; 5(3):996-1003.Background: Domestic violence against women (DVAW) is widely recognized as a public health problem. In India, health sector response to DVAW is suboptimal. Present study aimed to assess the knowledge, attitude, practice and learning needs of nursing personnel regarding women’s health issues related to domestic violence. Methods: This facility based cross sectional study was carried out among 100 nursing personnel from Public sector in Delhi, selected using stratified random sampling. Data were collected using a validated, pretested, structured self reported questionnaire with a few open ended questions. It included knowledge, attitude, practice and learning needs of nursing personnel relevant to DV. Descriptive statistics were used for data analysis using Stata 11.0 (College Station, Texas, USA). Results: Two third of nursing personnel (67%) had moderate knowledge scores and 27% had poor knowledge scores; 19% had favourable attitude scores towards DV; 57% had good practice scores; 44% reported moderate to high need for learning and majority lacked preparedness to manage DV victims. The knowledge was significantly associated with younger age, single, graduate/ Post graduates, B.Sc. Nursing degree holders, working in tertiary hospital, as staff nurse/public health nurse/sister in charge and those with lesser experience, (p<0.05). The attitude was significantly associated with younger age, single, graduate/post graduates, and those with lesser experience, (p<0.05). Conclusions: Nursing personnel had substantial gap in their knowledge, attitude and practice related to DV and a large unmet learning need highlighting the need for relevant pre service and continuing education.
Dynamics of postpartum IUD use in India. Quality of care received and interim results three months after insertion.
Washington, D.C., Population Council, The Evidence Project, 2018 Feb. 8 p. (Research Brief)This research brief explores the contraceptive use dynamics among 412 married women in India who received a postpartum intrauterine contraceptive device (PPIUD). The women were interviewed within one month of starting the method and again at a three-month follow-up. These preliminary findings should be of interest to program designers, policy makers and health service delivery professionals, especially family planning and antenatal care providers. Findings include reported quality of care received by PPIUD users at the time of insertion and dynamics of PPIUD use after three months, including method continuation, switching, and discontinuation. The brief also examines the role of husbands and frontline health workers in PPIUD use dynamics. This is the first in a series of briefs in a longitudinal study of the dynamics of contraceptive use among 2,699 married women aged 15-49 in Odisha and Haryana states in India. Future briefs will explore dynamics among IUD users, injectable users, and oral contraceptive pill users from enrollment through three-, six-, and twelve-month follow-up interviews.
International Journal of Community Medicine and Public Health. 2018 Apr; 5(4):1252-1261.Background: Although Egypt has a strong family planning program; the downward trend in the unmet need has been reversed recently. Thus the present study aimed to assess the magnitude of unmet need for family planning, its common reasons and the associated factors among women of reproductive age group. Methods: this is a community-based cross sectional household survey study conducted in Awish El-Hagar village, Mansoura, Egypt during the year 2015-2016. Using an interviewer questionnaire; 394 rural women in childbearing period were surveyed via a systematic random sampling technique with the help of the outreach community health workers affiliated to Awish El-Hagar family medicine center. Results: The overall prevalence rates of unmet need for family planning and contraceptive use were 11.2% and 69.5% respectively, while the total demand for family planning was 80.7%. Infrequent sex (27.3%), fear from the side effects (25%) and husband opposition (15.9%) were the most frequent reasons for non-use of family planning methods among unmet need women. Logistic regressions explored that risk factors for unmet need women were having husband disapproved family planning, having only girls, perception that having >3 children to be ideal, working, having husband with the main family planning decision maker, with no past history of unintended pregnancy and having only boys. Conclusions: A considerable proportion of Egyptian women still have an unmet need for family planning that need to be addressed by more effective family planning and health education programs together with improving counseling strategies and enforcing the role of outreach workers.
The unmet needs for family planning and its associated factors among ever married women in selected villages of Anekal taluk, Karnataka: a community based cross sectional study.
International Journal of Community Medicine and Public Health. 2018 May; 5(5):2048-2052.Background: According to the United Nations, India will become the most populated country by 2050.This will lead to further strain in social and economic life. Family planning plays a major role in bridging this rapid population growth. But unmet needs for family planning prevent women from availing this benefit. Aims of the study were to determine the prevalence of unmet needs for family planning and its associated factors among ever married women in selected villages of Anekal taluk, Karnataka. Methods: This was a cross sectional study conducted during a period of two months among ever married women in selected villages of Anekal. A structured interview schedule consisting of questions about unmet needs for family planning and its determinants was administered to 133 ever married women. Results: Of the 133 study participants 127 (95.5%) were aware of at least one contraceptive method. The prevalence of unmet needs for family planning was 11.3%. Younger age (18-24 years), <5 years active years of married life, women having a single live child and who were a sole decision maker had higher unmet needs for family planning. Among the women who had unmet needs for family planning, the major reason reported was family and cultural problems. Conclusions: The unmet need for family planning was found to be 11.3% which is more than the state value of 8.8% (rural Karnataka NFHS 4). So there is a need to create increased awareness among the women in the study area regarding the importance of contraceptive measures in the family and the society.
International Journal of Community Medicine and Public Health. 2018 May; 5(5):1968-1973.Background: Unmet need represents the gap between women’s reproductive intentions and their contraceptive behavior. Meeting the unmet need for family planning would help to reduce the mortality and morbidity from unwanted pregnancies. Objectives of the study were to assess the unmet need for family planning and its determinants among married rural women. Methods: The present study was community based cross-sectional study conducted in rural area of Haryana from September 2015 to August 2016 among 500 currently married women (18-49 years). Results: The unmet need for family planning was 19.2% (4.8% spacing and 14.4% limiting). Education, occupation and desirable number of children were significantly associated with unmet need for family planning. The commonest reason for not using contraception among those with unmet need was fear of side-effects (37.5%) followed by in-laws disapproval (21.9%) and others. Conclusions: The unmet need for family planning was high. Women’s education and empowerment by protecting their health, wellbeing and rights, including their reproductive rights would prove to be beneficial.
Journal of Nepal Health Research Council. 2018 Oct 30; 16(3):251-256.In Nepal, contraceptive use among married adolescents is low and has remained nearly stagnant since 2006, while little information is available about contraceptive use among unmarried adolescents. Nepal is committed to improve sexual and reproductive health rights among all the adolescents. Promoting modern contraceptive use especially among married adolescents is one of the key approaches in practice, to prevent HIV or sexual transmitted infections, avoid unintended pregnancy and sub-sequent unsafe abortion. In spite of these efforts, modern contraceptive use among married adolescents is not increasing. In this study, we aimed to review the prevalence and trends as well as factors influencing modern contraceptive use among both married and unmarried adolescents in Nepal. A review of existing published and unpublished articles, documents, and reports were conducted. An adapted and modified socio-ecological model was used to explore the factors influencing contraceptive use. Contraceptive use is persistently low among adolescents. Various interrelated factors like socio-cultural norms and traditions, lack of comprehensive knowledge on contraceptive methods among adolescents, inadequate adolescent friendly Services and health workers not having the competencies to work with adolescents, are the major influential factors that limit adolescents to seek and use contraceptive services and information. A multilevel approach is required to address the interrelated factors and to create an enabling environment in which adolescent are fully informed and equipped to make use of contraceptives and related services. For this to happen, Government and NGOs working on sexual and reproductive health rights have to work towards translating the existing policies into practice. Involving adolescents, their families and communities; equipping teachers to provide comprehensive sex education within school and sex education programme for out of school and enhancing the competencies of health workers to provide adolescent friendly services - all in line with the written policy - is urgently needed. Keywords: Adolescent; barriers; contraceptive; Nepal; SRHR.
SAGE Open Medicine. 2018; 6:2050312118809462.Objectives: Decision aids in the field of healthcare contribute to informed decision making. To increase the usefulness and effectiveness of decision aids, it is important to involve end-users in the development of these tools. This article reports on the development of an online contraceptive decision aid. Methods: An exploratory, qualitative study was conducted in the Netherlands between 2014 and 2016. The development process of the decision aid consisted of six steps and included a needs assessment and field test. Interviews were conducted with 17 female students. Results: The needs assessment provided information on the preferred content and structure of a contraceptive decision aid and guided the development of the online contraceptive decision aid prototype. Participants had an overall positive impression of the decision aid prototype during the field test. Minor revisions were made based on participants' feedback. Participants expected that the decision aid would positively contribute to decision making by increasing knowledge and awareness regarding the available contraceptive methods and their features and attributes, and by opening up to other options than the known methods. Conclusion: The developed contraceptive decision aid can contribute to better informed decision making and consultation preparation. Involving end-users in development seems valuable to adapt decision aids to specific needs and to identify in what way a decision aid influences decision making.
International Journal of Prisoner Health. 2018 Dec 17; 14(4):244-253.PURPOSE: The purpose of this paper is to examine the risk of unintended pregnancy among women during Cook County Jail intake by assessing basic contraceptive history, the need for emergency contraception (EC) at intake, and contraception at release. DESIGN/METHODOLOGY/APPROACH: This is a cross-sectional study of women 18-50 years old at Cook County Jail in Chicago, Illinois from June 2011 through August 2012. The authors administered the survey at the time of intake on 33 convenient evenings. Surveys consisted of multiple-choice close-ended questions administered via interview. Topics included contraceptive use, pregnancy risk and pregnancy desire. The authors computed frequencies to describe the distribution of question responses and used logistic regression modeling to identify factors significantly related to the use of contraception at intake and to the acceptance of contraception at release. FINDINGS: Overall, 194 women participated. Excluding women not at risk for pregnancy (4.6 percent currently pregnant, 17.5 percent surgically sterilized/postmenopausal and 4.6 percent using long-acting reversible contraceptives), 73.2 percent of women were at risk for pregnancy ( n = 142) and, therefore, had a potential need for contraception. Among these women at risk for unintended pregnancy, 68 (47.9 percent) had unprotected intercourse within five days prior to survey administration. When asked about EC, most women (81.4 percent) would be interested if available. Additionally, 141 (72.7 percent) of women would be interested in contraceptive supplies if provided free at release. ORIGINALITY/VALUE: Newly incarcerated women are at high risk for unintended pregnancy. Knowledge about EC and ability to access birth control services are both significantly limited. These conclusions support providing an intake screening in jails to identify women at risk for unintended pregnancy.
Tropical Doctor. 2018 Nov 12; 49475518809605.As mother-to-child transmission of HIV is difficult to predict and also hard to prevent in practice, pregnancy among women living with HIV/AIDS (WHA) needs to be taken with considerable aforethought. The prevention of unwanted pregnancy among WHA is therefore a public health issue. The aim of our study was to determine the unmet need for contraception among HIV-positive women and the associated factors. Ours was a cross-sectional study involving 425 non-pregnant WHA attending an adult HIV clinic in Nigeria. Interviewer-administered, structured questionnaires designed for the study were used to obtain data. The contraceptive uptake was 47% while the unmet need for contraception was 20%. There were significant associations between unmet need for contraception and age group ( P < 0.001), religion ( P < 0.001), ethnic group ( P < 0.001), knowledge about contraceptives ( P = 0.02), educational status ( P = 0.01) and partners' retroviral status ( P = 0.008) The unmet need for contraception was high. Advocacy programs should perhaps be focused on older women, Christians and those with little or no education.
They Destroy the Reproductive System: Exploring the Belief that Modern Contraceptive Use Causes Infertility.
Studies In Family Planning. 2018 Dec; 49(4):345-365.A common reason for nonuse of modern contraceptives is concern about side effects and health complications. This article provides a detailed characterization of the belief that modern contraceptives cause infertility, and an examination of how this belief arises and spreads, and why it is so salient. We conducted focus group discussions and key informant interviews in three rural communities along Kenya's eastern coast, and identified the following themes: (1) the belief that using modern contraception at a young age or before childbirth can make women infertile is widespread; (2) according to this belief, the most commonly used methods in the community were linked to infertility; (3) when women observe other women who cannot get pregnant after using modern contraceptives, they attribute the infertility to the use of contraception; (4) within the communities, the primary goal of marriage is childbirth and thus community approval is rigidly tied to childbearing; and, therefore (5) the social consequences of infertility are devastating. These findings may help inform the design of programs to address this belief and reduce unmet need. (c) 2018 The Authors. Studies in Family Planning published by John Wiley & Sons Ltd. on behalf of The Population Council, Inc.
Systematic review of barriers and facilitators to voluntary medical male circumcision in priority countries and programmatic implications for service uptake.
Global Public Health. 2019; 14(1):91-111.Voluntary medical male circumcision (VMMC) is an effective biomedical HIV prevention strategy. There is a need to identify key barriers and facilitators to VMMC uptake in priority countries to improve uptake. In this paper, we report findings from a systematic review of the barriers and facilitators of VMMC uptake, comparing them across countries in order to provide programmers critical information to design effective VMMC uptake interventions. Our review followed PRISMA protocol. Twenty three articles from 10 of the 14 priority countries were included. The top three barriers cited were: MC negatively perceived as being practiced by other or foreign cultures and religions, fear of pain caused by the procedure, and perceptions of VMMC as not helpful/needed. The top four facilitators cited in most countries were: Belief that VMMC reduces health risks and improves hygiene, family and peer support of MC, and enhanced sexual performance and satisfaction. The barriers and facilitators highlighted in this paper can help inform programmatic strategies in these countries. More research is needed to ensure that all sub-populations are being adequately reached. By applying this information to new research and programming, these countries can achieve greater VMMC uptake – and thus reductions in HIV transmission and prevalence.
Intentions on contraception use and its associated factors among postpartum women in Aksum town, Tigray region, northern Ethiopia: a community-based cross- sectional study.
Reproductive Health. 2018 Nov 9; 15(1):188.BACKGROUND: Increased access to contraceptive methods has been established as a cost-effective strategy for developing countries to reduce maternal and child mortality. Intentions to contraceptive uptake appear to be best predictors of actual contraceptive practice than the unmet need. However, intention to contraceptive use in Ethiopia particularly among postpartum women is not well assessed. Therefore, the objective of this study was to assess intention to use modern contraceptive and to identify factors associated among postpartum women in Aksum town. METHODS: A community -based analytical cross-sectional study design was done to collect the data from 604 postpartum mothers using a structured questionnaire. The data was collected from March 25 to April 24, 2015. A multivariable logistic regression was conducted to assess factors associated with intentions to use contraceptive methods. Factors influencing intentions on contraceptive methods use were assessed by computing adjusted odds ratios (AOR) at 95% confidence interval (CI) with statistical significant p- value < 0.05. RESULTS: Intention to use modern contraceptive was 84.3%. Resumed sexual intercourse (AOR = 1.78; 95% CI: 1.34, 3.92) and women whose their husband approved family planning to use (AOR = 1.57; 95% CI: 2.02, 5.57) were more likely to have intention on contraceptive use. In addition, those women who knew at least one method of modern contraceptive (AOR = 5.17; 95% CI: 1.69, 15.82) were more likely to had intention to use modern contraceptive during extended postpartum period compared to their counterparts. CONCLUSION AND RECOMMENDATION: More than eight in ten study participants have intention to use contraceptive in the Aksum town. Resumed sexual intercourse, husband's approval of family planning and knew at least one method of contraceptive are the three major predictors to be an areas when considering interventions to increase of intention on contraceptive. Therefore, this study highlighted that; in order to increase intention and adoption of contraceptive, the family planning services providers and programmers should continue the promotion of partner involvement and increasing family planning knowledge through printed media and mass media.
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.
Use of contraceptives, high risk births and under-five mortality in Sub Saharan Africa: evidence from Kenyan (2014) and Zimbabwean (2011) demographic health surveys.
BMC Women's Health. 2018 Oct 24; 18(1):173.BACKGROUND: Increasing uptake of modern contraception is done to alleviate maternal and infant mortality in poor countries. We describe prevalence of contraceptive use, high risk births, under-five mortality and their risk factors in Kenya and Zimbabwe. METHODS: This was a cross-sectional analysis on DHS data from Kenya (2014) and Zimbabwe (2011) for women aged 15-49. Geospatial mapping was used to compare the proportions of the following outcomes: current use of contraceptives, high-risk births, and under-5 mortality at regional levels after applying sample weights to account for disproportionate sampling and non-responses. Multivariate risk factors for the outcomes were evaluated by multilevel logistic regression and reported as adjusted odds ratios (aOR). RESULTS: A total of 40,250 (31,079 Kenya vs. 9171 Zimbabwe) women were included in this analysis. Majority were aged 18-30 years (47%), married/cohabiting (61%) and unemployed (60%). Less than half were using contraceptives (36% Kenya vs. 41% Zimbabwe). Spatial maps, especially in the Kenyan North-eastern region, showed an inverse correlation in the current use of contraceptives with high risk births and under-5 mortality. At individual level, women that had experienced high risk births were likely to have attained secondary education in both Kenya (aOR = 5.20, 95% CI: 3.86-7.01) and Zimbabwe (aOR = 1.63, 95% CI: 1.08-2.25). In Kenya, high household wealth was associated with higher contraceptive use among both women who had high risk births (aOR: 1.72, 95% CI: 1.41-2.11) and under-5 mortality (aOR: 1.66, 95% CI: 1.27-2.16). Contraceptive use was protective against high risk births in Zimbabwe only (aOR: 0.79, 95% CI: 0.68-0.92) and under-five mortality in both Kenya (aOR: 0.79, 95% CI: 0.70-0.89) and Zimbabwe (aOR: 0.71, 95% CI: 0.61-0.83). Overall, community levels factors were not strong predictors of the three main outcomes. CONCLUSIONS: There is a high unmet need of contraception services. Geospatial mapping might be useful to policy makers in identifying areas of greatest need. Increasing educational opportunities and economic empowerment for women could yield better health outcomes.
Impact of conditional cash transfer scheme (MAMATA) on the prevalent MCH care practices in rural areas of Ganjam district, Orissa: a descriptive study.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3537-3543.Background: RMNCH services are provided in an integrated manner to it’s beneficiaries under the premise of Primary Health Care. The utilization rates for such services have remained abysmally low and stagnated over the years. The problem lies in failure to generate a demand for such services among it’s beneficiaries. MAMATA a conditional cash transfer scheme implemented in Odisha, aims to bring around radical changes by addressing the issue of demand generation. The objectives of the study were to assess the implementation of MAMATA scheme services in the study area and to assess the impact made by the scheme in their life. Methods: The study was conducted on 200 women, who were randomly selected from the 903 pregnant women registered under Mamata Scheme from a randomly selected block of Odisha. They were then followed up for a period of 15 months. Results: Implementation of the scheme in the district was smooth, the instalments were paid regularly in most of the cases without any delay. Impact of the scheme- 98% got adequate rest during pregnancy, because of the scheme. 95% utilized the money for purchasing nutritious food and procuring medicines. The scheme has also helped develop a health seeking attitude in most of the beneficiaries (85%). 97% felt a sense of empowerment and independence compared to the past. Conclusions: The benefits of MAMATA scheme percolated beyond the boundaries of demand generation. It also brought about a sense of empowerment and independence among it’s beneficiaries.
Factors affecting contraceptive use and unmet need among currently married women in Afghanistan: further analysis of the 2015 Afghanistan Demographic and Health Survey.
Rockville, Maryland, ICF, DHS Program, 2018 Jun. 34 p. (DHS Working Papers No. 138)The objective of this study is to analyze sociodemographic factors affecting both contraceptive use and unmet need for family planning. Secondary analysis was conducted based on data from the 2015 Afghanistan Demographic and Health Survey. The sample included 29,461 women age 15-49 interviewed in the survey. A frequency distribution of independent variables for the study sample was carried out and then a Pearson’s chi-square test was conducted for association and strength of association measured by multinomial and binary logistic regression. The study found that 29% of women were using a contraceptive method (25.5% a modern method and 3.5% a traditional method). Among the modern methods, pills were the most common, followed by injection and male condom. The study found that a woman’s number of living children was positively associated with contraceptive use; women with more than six children were the most likely to be using contraception. Uzbek and other minority ethnic groups seemed less likely to use contraceptive methods. Each level of women’s educational attainment increased the use of contraceptive methods. Moreover, women who were exposed to media were more likely to use modern contraceptive methods compared with women not exposed to media. Finally, women in the two top wealth quintiles (richer and richest) were more likely to use modern contraceptive methods compared with poorer women. The study findings show that every factor except rural residence that is positively associated with contraceptive use is also negatively associated with unmet need for family planning, and vice versa. The key determinants for contraceptive use and for unmet need for family planning are parity, level of education, ethnicity, media exposure, and wealth index. The findings of this research show that there is still space in Afghanistan to increase contraceptive use among women of reproductive age, which consequently could decrease the proportion of unmet need for family planning.
A study to assess unmet need for family planning and contraceptive choices among married women of reproductive age in rural Madhya Pradesh.
International Journal of Community Medicine and Public Health. 2018 Nov; 5(11):4725-4730.Background: The unmet need of family planning refers to the gap between reproduction intention of a couple and their contraceptive behavior. According to NFHS-4 the unmet need for family planning is 12.9 in India. The objectives of the study were to assess the unmet need for family planning and to find out the contraceptive choices among married women. Methods: This cross sectional study was undertaken in the rural field practice area of Department of Community Medicine, Index Medical College, Indore, from October 2016 to March 2017. Total sample size calculated was 640. Systematic random sampling was used to select eligible couple a pretested, semi-structured questionnaire was administered to women of reproductive age (15-49 year) in local Hindi language after taking consent. Results: Out of 640 participants 39 (6.1%) were desiring pregnancy, 454 (70.9%) using contraceptives while 147 (23%) had unmet need and among them 74 (11.6%) for limiting while 73 (11.4%) for spacing. Unmet need was found more in age group of 15-24 (35%), Muslims (48.6%), illiterates (45.9%), housewives (24.4%) and in poor socioeconomic status (53.4%). Overall contraceptive use was 70.9% and tubectomy (60.8%) was the most preferred method followed by male condom and OCP. Unmet need was higher among those who were not having male child (p=0.00, X2=42.2).The main reasons for not using contraception was identified as family interference and cultural as well as religious restrictions. Conclusions: The study conclude that still there is need to create awareness regarding importance of spacing method as well as limiting methods and to clear the myths regarding contraceptives not only in young couples but also in other family members.
A time of uncertainty and opportunity: Findings from a formative assessment of first-time parents in Cross River State, Nigeria.
Washington, D.C., Evidence to Action Project [E2A], 2018 Oct. 10 p. (Research Brief)Over the past five years, the Evidence to Action (E2A) project has been working to understand and respond to the needs of First-Time Parents (FTP), defined as young women, under the age of 25 years who are pregnant with or have one child, and their male partners. Through an on-going safe motherhood initiative – Saving Mothers Giving Life (SMGL) – in Cross River State (CRS), Nigeria, E2A has had an opportunity to implement an intervention package that addresses the continuum of health needs and outcomes that arise during the FTP lifestage and generates much-needed evidence on effective programming for FTPs. As a first step, E2A conducted a qualitative formative assessment to understand more about these young FTPs, their specific reproductive health (RH) and maternal and newborn child health (MNCH) needs, and the underlying gender and social norms that influence their ability to take timely AYRH action. The assessment, conducted in 2017, yielded important insights drawn from the experiences shared by young First-Time Mothers (FTMs) and the critical influencers in their lives - their partners and their own mothers. This brief presents key findings on the situation of FTPs in CRS, Nigeria, as well as the emerging considerations for programs that are interested in reaching this critical population. (excerpt)
Contraceptive use and determinants of unmet need for family planning; a cross sectional survey in the North West Region, Cameroon.
BMC Women's Health. 2018 Oct 20; 18(1):171.BACKGROUND: Reducing unmet need for family planning by increasing the rate of modern contraceptive use is indispensable if Cameroon must meet maternal mortality targets of the Sustainable Development Goals. The objective of this survey was to estimate the rate of contraceptive use and identify factors associated with unmet need for family planning in rural Cameroon. METHODS: It was conducted a community-based cross sectional survey from February to March 2016 targeting women in a union of the Wum Health District. Participants were included by cluster multistep sampling and data collected by trained surveyors using a pretested questionnaire. Data were analysed using Epi-Info version 3.5.4. The odds ratio was used as a measure of association between unmet need for family planning and selected covariates with the statistical significant threshold set at p = 0.05. RESULTS: Among the 466 women included in the survey, 78.5% were legally married. The mean age of the participants was 28.7 +/- 7.2 years with a mean number of years of cohabitation of 9.1 +/- 7.4 years. A total of 438 women from the sample were evaluated for contraceptive use and unmet need for family planning. The rate of modern contraceptive use at the time of the survey was 13[10.1-16.6]% and about 5 in every 10 women had an unmet need for family planning (46.6[41.8-51.4]%) with 31.1% having an unmet need for spacing and 15.5% an unmet need for limiting births. The potential demand for contraception was estimated at 45.9% with only 39.8% of this demand met. When controlled for age, monthly revenue, occupation and partner's level of education, discussion of family planning within the couple (OR = 0.66[0.44-0.97], p-value = 0.032), and partner's approval of contraception (OR = 0.66[0.45-0.97], p-value = 0.035), were found to be significantly associated with decreasing unmet need for family planning. CONCLUSION: With the very low rates of modern contraceptive use and potential demand for contraception in the Wum Health District, the rate of unmet need for family planning is still very high. Non discussion of family planning within the couple, and disapproval of contraception by the partner are significantly associated with high unmet need for family planning. More of couple-based family planning interventions should be encouraged.