Contraceptive Implant Discontinuation in Huambo and Luanda, Angola: A Qualitative Exploration of Motives.

Introduction The Government of Angola is engaged in ongoing efforts to increase access to contraceptives, in particular contraceptive implants (CIs). Discontinuation of CIs, however, has been identified as being a challenge to this work, hindering the improvement of contraceptive prevalence, and in turn, maternal and child health. The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. Methods We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics across the provinces of Huambo and Luanda. Data collectors transcribed and translated key information from Portuguese into English. We used a combined deductive/inductive approach to code and analyze data. Results Participants described adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion as motives for discontinuation. Adverse side effects, including prolonged bleeding, amenorrhea, and headaches were most commonly cited by both clients and providers. Discussion Motives for discontinuation reflect existing findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

Partner Support for Family Planning and Modern Contraceptive Use in Luanda, Angola.

Husband's/partner's support for family planning may influence a women's modern contraceptive use. Socio-demographic factors, couple communication about family planning, and fertility preferences are known to play a role in contraceptive use. We conducted logistic regression analysis to investigate the relationship between perceived husband's/partner's approval and husband's/partner's encouragement of modern contraceptive use, adjusting for socio-demographic factors and recent couple communication about family planning. We also examined mediating roles potentially played by perceived contraceptive accessibility and contraceptive self-efficacy (using index created by principal component analysis). Perceived husband's/partner's approval was associated with triple the odds of women's modern contraceptive use and remained significantly associated with 1.6 times the odds, after controlling for contraceptive accessibility and contraceptive self-efficacy. Husband's/partner's encouragement, while initially significantly associated with contraceptive use, became non-significant after adjustments for socio-demographic factors and couple communication. Perceived husband's/partner's approval, separate from a woman's sense of self-efficacy and perceived accessibility of contraceptives, appears strongly and positively associated with current modern contraceptive use. Increased couple communication may help women identify their husband's/partner's approval. Difference between the meaning of approval and encouragement should be explored. Interventions involving information education and communication campaigns geared to men and promoting male involvement in family planning could increase contraceptive prevalence.

Varying family planning strategies across age categories: differences in factors associated with current modern contraceptive use among youth and adult women in Luanda, Angola.

BACKGROUND: The objective of this study is to identify factors associated with current modern contraceptive use among Angolan women. By differentiating according to age groups (15-24 and 25-49 years), this study aimed to help family planning program planners better tailor interventions to improve utilization of modern contraception. METHODS: A household survey was used to collect data from 1,545 women of reproductive age living in Luanda Province, Angola. Data on sociodemographic characteristics, reproductive behavior and intentions, contraceptive knowledge and use, and attitudes and beliefs regarding contraception and abortion were collected. The analyses were stratified based on age: 15-24 years (youth) and 25-49 years (adult). Multivariate logistic regression models were built for each age group, adding different subsets of variables in groups to see how relationships changed across the models. RESULTS: Common factors associated with modern contraceptive use among all ages include education level, perceived contraceptive accessibility, contraceptive knowledge, communication with partner about family planning in last year, and self-efficacy. Exposure to family planning information in the media in the last few months, perceived partner approval of family planning, and marital status were all positively associated with current modern contraceptive use among women aged 15-24 years. Meanwhile, receiving information about family planning from a pharmacy in the last year was uniquely associated with current modern contraceptive use among women aged 25-49 years. CONCLUSION: Young women in Luanda, Angola seem to have a unique set of factors affecting their contraceptive use. These findings highlight the need for family planning programs to cater services and messages toward specific age groups.

Lixo e o impacto na saúde: uma abordagem pedagógica interdisciplinar / Solid wates and their effects on health: a teaching approach

Aborda trabalho desenvolvido na área de saúde ambiental e realizado no 2§ semestre de 1990 e ano letivo de 1991 na rede pública de ensino de Botucatu, SP, com a participaçäo de professores, estagiários, alunos e médicos sanitaristas. Objetiva estimular o aluno a organizar dados de sua realidade em relaçäo aos problemas dos resíduos sólidos e limpeza pública do município e analisá-los de forma crítica, desenvolver e aplicar método mais participativo tendo como objetivo principal o cotidiano do aluno. A populaçäo-alvo do projeto consistia de alunos de 6ª, 7ª e 8ª séries de duas escolas, sendo uma central e outra periférica. Foram utilizadas as aulas de Geografia e Ciências. O trabalho foi desenvolvido em 6 etapas. Todas as etapas se caracterizaram como trabalho de equipe. O método escolhido - Construtivismo - permitiu a consecuçäo de objetivos bem definidos dentro das novas propostas curriculares da educaçäo no Estado de Säo Paulo, levando em consideraçäo os resultados da avaliaçäo, tanto no primeiro polo (alunos) quanto no segundo polo (educadores - profissionais, estagiários)