Relationship between classic indicators of health behaviour and contraceptive choices in women in Flanders.

BACKGROUND: In this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours. METHODS: Using the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women). RESULTS: Higher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method. DISCUSSION: The fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies. CONCLUSION: The results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women's contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way.

Contraceptive behavior of women in India after induced abortion.

Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.

Examining the decline in modern contraception usage among married women in Bangladesh: Applying Blinder-Oaxaca decomposition analysis.

OBJECTIVES: Controlling population expansion and reducing unintended pregnancies through the use of modern contraceptives is a cost-effective strategy. In recent years, the rate of modern contraceptive use in Bangladesh has been declining. So, this study aimed to investigate the associated factors of the deterioration in modern contraceptive usage. METHODS: This study used data from two successive Bangladesh Demographic and Health Surveys (2014 and 2017-18) and applied the Blinder-Oaxaca decomposition analysis to understand the drivers. A popular binary logistic regression model is fitted to determine the factors that influence the use of modern contraceptive methods over the years. RESULTS: This study revealed that highly educated women were more likely to use modern contraception methods, and their use increased by 3 percent over the years. Factors such as women's working status, husband's education, number of living children, and fertility preference were found significantly associated with decreased usage of modern contraception methods over years. The result of the Blinder-Oaxaca (BO) decomposition analysis found a significant decrease between 2014 and 2018. Respondent's age, working status, husband's age, opinion on decision making, region, and media exposure were the most significant contributors to explaining the shift between 2014 and 2018. The two factors that contributed most to narrowing the difference between the two surveys were women's decision on own health (26%), and employment status (35%). CONCLUSIONS: The factors that influence modern contraceptive prevalence are important to know for policy implication purposes in Bangladesh. The findings indicate the need for further improvement of factors for balancing the usage of modern contraception methods.

Early discontinuation of long-acting reversible contraceptives methods and its associated factors in Hosanna town, central Ethiopia: a cross-sectional study.

Long-acting reversible contraceptive (LARC) method use is an ideal strategy for longer protection against unintended pregnancies, unsafe abortions, maternal morbidities, and mortalities related to pregnancies and childbirth. Despite low utilization of LARC methods in Ethiopia, early discontinuation remains a problem. This study aimed to assess prevalence of early discontinuation of LARC methods and associated factors in Hossana town. A community-based cross-sectional study was conducted among 433 adult women of reproductive age who had a history of LARC use. Logistic regression model was considered for the analysis. Proportion of LARC methods discontinuation within one year was 24.5%, 95% CI (20.6, 26.8%). Women whose age ≥ 30 years (AOR = 3.16, 95% CI: 1.27, 7.89), who had < 3 live children (AOR = 5.17, 95% CI 2.30, 11.61), who had a desire for pregnancy (AOR = 2.35, 95% CI 1.14, 4.85), who did not get pre-insertion counseling on the benefits of LARC methods (AOR = 1.79, 95% CI 1.01, 3.21) and who experienced side effects (AOR = 3.63, 95% CI 2.07, 6.38) were more likely to discontinue LARC methods early than their counterparts. Nearly one-fourth of clients discontinued using the LARC methods within the first year of insertion, highlighting the need to promote longer use for improved protection and success of family planning programs.

Multilevel analysis on prevalence and associated factors of modern contraceptive uptake in Somaliland: based on The Somaliland Health and Demographic Survey 2020.

INTRODUCTION: Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data. METHODS AND MATERIALS: The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed. RESULTS: The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively. CONCLUSION: The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women.

Determinants of unmet need for modern contraceptives in Ethiopia.

OBJECTIVE: To identify the determinants of the unmet need for modern contraceptives in Ethiopia. DESIGN: Community-based cross-sectional study. SETTING: Ethiopia. PARTICIPANTS: A group of 6636 women of reproductive age (15-49 years) who were sexually active were included in the study. OUTCOME: Unmet need for modern contraceptives METHOD: The study used data from the 2019 Performance Monitoring for Action-Ethiopia survey, which was community-based and cross-sectional. The sample consisted of women aged 15-49 from households randomly selected to be nationally representative. Multinomial logistic regression and spatial analysis were performed to determine the factors influencing unmet needs for modern contraceptives. The descriptive analysis incorporated svy commands to account for clustering. RESULTS: The proportion of unmet need for modern contraceptives was 19.7% (95% CI: 18% to 21.5%). Women with supportive norms towards family planning had a lower risk of unmet need for spacing (relative risk ratio (RRR)=0.92, 95% CI: 0.86 to 0.99). Older age lowered the risk of unmet need for spacing 40-44 (RRR=0.28, 95% CI: 0.13 to 0.59) and 45-49 (RRR=0.11, 95% CI: 0.04 to 0.31). Being married increased the unmet need for spacing (RRR=1.9, 95% CI: 1.36 to 2.7) and limiting (RRR=3.7, 95% CI: 1.86 to 7.4). Increasing parity increases the risk of unmet need for spacing (RRR=1.27, 95% CI: 1.16 to 1.38) and limiting (RRR=1.26, 95% CI: 1.15 to 1.4). Contrarily, older age increased the risk of unmet need for limiting 40-44 (RRR=10.2, 95% CI: 1.29 to 79.5), 45-49 (RRR=8.4, 95% CI: 1.03 to 67.4). A clustered spatial unmet need for modern contraceptives was observed (Global Moran's I=0.715: Z-Score=3.8496, p<0.000118). The SaTScan identified 102 significant hotspot clusters located in Harari (relative risk (RR)=2.82, log-likelihood ratio (LLR)=28.2, p value<0.001), South Nations Nationalities and People, Oromia, Gambella and Addis Ababa (RR=1.33, LLR=15.6, p value<0.001). CONCLUSIONS: High levels of unmet need for modern contraceptives were observed in Ethiopia, showing geographical variations. It is essential to address the key factors affecting women and work towards reducing disparities in modern contraceptive unmet needs among different regions.

Time to first birth and its predictors among reproductive-age women in Ethiopia: multilevel analysis using shared frailty model.

OBJECTIVE: To determine the time to first birth and its predictors among reproductive-age women in Ethiopia. DESIGN, SETTING AND PARTICIPANTS: Nationwide secondary data analysis using mini Ethiopian Demographic and Health Survey, 2019. A stratified, two-stage cluster sampling technique was used to select the sample. Among 9012 women of age 15-49 years, 8885 completed the interview yielding a response rate of 99%. MAIN OUTCOMES MEASURED: Time to first birth was determined. Kaplan-Meier method was used to estimate the time to first birth. The lognormal inverse Gaussian shared frailty model was used to model the data at a 95% CI. CI and adjusted time ratio (ATR) were reported as effect size. Statistical significance was declared at p-value<0.05. RESULTS: The overall median time to give first birth was 18 years (IQR: 15, 21). Age 20-29 (ATR=1.08; 95% CI, 1.05 to 1.12), Age>29 years (ATR=1.08; 95% CI, 1.05 to 1.11), northern regions (ATR=1.06; 95% CI, 1.03 to 1.08), rural residence (ATR=0.95; 95% CI, 0.93 to 0.98), never using contraceptive methods (ATR=0.98; 95% CI, 0.96 to 0.99), sex of household head (ATR=1.01; 95% CI, 1 to 1.03), poorest wealth index (ATR=1.04; 95% CI, 1.02 to 1.06) and richest wealth index (ATR=1.07; 95% CI, 1.04 to 1.1) were the significant predictors of time to first birth among reproductive-age women. CONCLUSION: In Ethiopia, women often gave birth to their first child at a younger age than what is recommended. Explicitly, women aged 20-29 and over 29, living in the northern region, leading a household as females, and belonging to the poorest or wealthiest wealth index tended to have a slightly delayed first childbirth. On the other hand, women in rural areas and those who had never used contraception were more likely to have an early first birth. The findings indicated the necessity of implementing targeted measures for rural Ethiopian women, especially those lacking knowledge about contraception.

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

BACKGROUND: Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. METHODS: We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. RESULTS: Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. CONCLUSIONS: While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.

Assessment of knowledge on emergency contraceptives and factors associated with utilization among female students in Bonga College of Education, Southwest Region, Ethiopia: cross-sectional study.

BACKGROUND: Unintended pregnancy is a major public health problem in sexually active female students in Ethiopia. In higher education, female students are exposed to unprotected sex and are at risk of pregnancy, abortion, and its associated problems. OBJECTIVE: The objective of this study was to assess knowledge of female students about emergency contraceptives and determine factors associated with utilization among college female students at Bonga College of Education, Southwest Ethiopia. METHODS: The study was conducted from November 10, 2022 to May 30, 2023. All female students of Bonga College of education in all departments were included in this study purposively. Data were collected using Amharic version pretested questionnaire. Data obtained from the survey was entered into Microsoft Excel 2010 and analysed with SPSS version 20.0. Data summary was done with descriptive statistics. Logistic regression was used to measure associations between dependent and independent variables. Odds ratio was used to measure strengths of association between variables. Statistical significance was considered at 95% confidence level (CL). P-value less than 0.05 was considered significant during the analysis. RESULTS: In this study a total of 103 College female students were involved. The mean age of the respondents was 20.6 (SD ± 2.06) years. The finding showed that 31 (31.1%) female students had started sexual intercourse and among them 58.1% faced pregnancy. Among the total sexually experienced respondents, 93.5% use contraceptive methods while others 6.5% do not use. Among the total 31 study participants, 27(87.1%) started using EC. The majority of pregnancy (83.3%) was intended type whereas 16.7% was unwanted pregnancy. Regarding the general knowledge about contraceptive methods, 19(18.4%) had poor knowledge. Among the total 103 female college students, 66(64.1%) heard about emergency contraceptives. Forced sex and unprotected free sex are predicting factors that induces female students to use emergency contraceptives. Fear of discontinuing school was the main inducing factor to commit abortion. Logistic regression analysis showed that college female students whose age category above 25 years were more likely to use emergency contraceptives. Students who came from urban area are more likely to use EC than rural areas. Married female students (AOR = 2.5, 95% CI: 0.76, 8.7) were two times likely to use EC as contraceptive method. CONCLUSIONS: Female students who came from urban area use EC better than who came from rural areas. Majority of sexually active female students had good practice and knowledge of using EC but some had poor knowledge. Forced sex and free sexual practice are key determinant factors that induces to use EC. Abortion was mainly done in private clinic. Fear of discontinuing school was determinant factors identified to commit abortion. Therefore, responsible bodies should develop strategies to improve female students' reproductive health related to emergency contraceptives.

Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger.

BACKGROUND: Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS: Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS: Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION: Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).

Individual and community level factors associated with modern contraceptive utilization among women in Ethiopia: Multilevel modeling analysis.

BACKGROUND: Modern contraceptive utilization is the most effective intervention to tackle unintended pregnancy and thereby reduce abortion and improve maternal, child, and newborn health. However, multilevel factors related to low modern contraceptive utilization and the robust analysis required for decision-making were scarce in Ethiopia. OBJECTIVE: To investigate the individual and community-level predictors of modern contraceptive utilization among reproductive-age women in Ethiopia. METHODS: We utilized data from a cross-sectional 2019 Performance Monitoring for Action Ethiopia survey. The survey employed a stratified two-stage cluster sampling method to select households for inclusion. In Stata version 16.0, the data underwent cleaning, aggregation, and survey weighting, following which a descriptive analysis was performed utilizing the "svy" command. Subsequently, the primary analysis was executed using R software version 4.1.3. We fitted a two-level mixed effects logistic regression model on 6,117 reproductive-age women nested within 265 enumeration areas (clusters). The fixed effect models were fitted. The measures of variation were explained by intra-cluster correlation, median odds ratio, and proportional change in variance. The shrinkage factor was calculated to estimate the effects of cluster variables using the Interval odds ratio and proportion opposed odds ratio. Finally, the independent variables with a significance level of (P<0.05) and their corresponding Adjusted Odds ratios and 95% confidence intervals were described for the explanatory factors in the final model. RESULTS: In Ethiopia, the prevalence of modern contraceptive utilization was only 37.% (34.3 to 39.8). Women who attained primary, secondary, and above secondary levels of education were more likely to report modern contraceptive utilization with AOR of 1.47, 1.73, and 1.58, respectively. Divorced/widowed women were less likely to report modern contraceptive utilization (AOR:0.18, 95% CI 0.13,0.23) compared to never-married women. Discussions between women and healthcare providers at the health facility about family planning were positively associated with modern contraceptive utilization (AOR:1.84, 95% CI: 1.52, 2.23). Community-level factors have a significant influence on modern contraceptive utilization, which is attributed to 21.9% of the total variance in the odds of using modern contraceptives (ICC = 0.219). Clusters with a higher proportion of agrarian (AOR: 2.27, 95% CI 1.5, 3.44), clusters with higher literacy (AOR: 1.46, 95% CI 1.09, 1.94), clusters with empowered women and girls about FP (AOR: 1.47, 95% CI 1.11, 1.93) and clusters with high supportive attitudes and norms toward FP (AOR: 1.37, 95% CI 1.04, 1.81) had better modern contraceptive utilization than their counterparts. CONCLUSION: In Ethiopia, understanding the factors related to modern contraceptive use among women of reproductive age requires consideration of both individual and community characteristics. Hence, to enhance family planning intervention programs, it is essential to focus on the empowerment of women and girls, foster supportive attitudes towards family planning within communities, collaborate with education authorities to enhance overall community literacy, pay special attention to pastoralist communities, and ensure that reproductive-age women as a whole are targeted rather than solely focusing on married women.

The intersection between migration, HIV, and contraceptive use in Uganda: a cross-sectional population-based study.

BACKGROUND: Low use of modern methods of contraception has been linked to HIV seropositivity and to migration, but few studies have evaluated the intersection of both risk factors with contraceptive use. METHODS: We analyzed cross-sectional data from sexually active female participants aged 15 to 49 years in the Rakai Community Cohort Study (RCCS) between 2011 and 2013. The RCCS is an open population-based census and individual survey in south-central Uganda. Recent in-migrants (arrival within approximately 1.5 years) into RCCS communities were identified at time of household census. The primary outcome was unsatisfied demand for a modern contraceptive method (injectable, oral pill, implant, or condom), which was defined as non-use of a modern contraceptive method among female participants who did not want to become pregnant in the next 12 months. Poisson regression models with robust variance estimators were used to identify associations and interactions between recent migration and HIV serostatus on unsatisfied contraceptive demand. RESULTS: There were 3,417 sexually active participants with no intention of becoming pregnant in the next year. The mean age was 30 (± 8) years, and 17.3% (n = 591) were living with HIV. Overall, 43.9% (n = 1,500) were not using any modern contraceptive method. Recent in-migrants were somewhat more likely to have unsatisfied contraceptive demand as compared to long-term residents (adjusted prevalence risk ratio [adjPRR] = 1.14; 95% confidence interval [95%CI]: 1.02-1.27), whereas participants living with HIV were less likely to have unsatisfied contraceptive demand relative to HIV-seronegative participants (adjPRR = 0.80; 95%CI = 0.70-0.90). When stratifying on migration and HIV serostatus, we observed the highest levels of unsatisfied contraceptive demand among in-migrants living with HIV (48.7%); however, in regression analyses, interaction terms between migration and HIV serostatus were not statistically significant. CONCLUSIONS: Unsatisfied contraceptive demand was high in this rural Ugandan setting. Being an in-migrant, particularly among those living with HIV, was associated with higher unsatisfied contraceptive demand.

Through a cross-sectional study, we explored the relationship between HIV status, migration, and contraceptive use among sexually active women of reproductive age in rural south-central Uganda. People who had moved into the study area within the last 1.5 years were considered in-migrants, compared to long-term residents i.e. people who had not moved. We examined unsatisfied demand for a modern contraceptive method, which is to say female participants who did not want to become pregnant in the next 12 months and were not using at least one of the following contraceptive methods: injectable, oral pill, implant, or condom. We included 3,417 sexually active female participants with no intention of becoming pregnant in the next year. The average age of these women was 30 years, less than 20% were living with HIV, and almost half were not using any modern contraceptive methods. Recent in-migrants were somewhat more likely to have unsatisfied contraceptive demand as compared to long-term residents, whereas participants living with HIV were less likely to have unsatisfied contraceptive demand relative to HIV-negative participants. Being an in-migrant, particularly among those living with HIV, was associated with higher unsatisfied contraceptive demand. This study shows the need for integrating contraceptive and HIV services for mobile populations in East Africa.

Effect of postpartum family planning intervention and associated factors during child immunization in Addis Ababa, Ethiopia.

Introduction: World Health Organization (WHO) recommends postpartum family planning (PPFP) as a critical component of health care that has the potential to save millions of maternal and infant lives in low- and middle-income countries. Methods: participants in our randomized, controlled trial were mothers coming for vaccination of their child in three selected health centers in Addis Ababa during the first 10 weeks postpartum. Eligible mothers were randomly assigned to intervention (pamphlet-supported counseling about the benefits of family planning) and non-intervention (routine care) arms. Data were collected when mothers came with their infants for a routine measles vaccination at nine months of life. Family planning (FP) use was compared between the groups using logistic regression, and bivariate and multivariate analyses. The study also used Kaplan Meier and Cox regressions to compare the median time of PPFP use and its correlation using SPSS version 26. The research was undertaken from December 2019 to June 2021. Results: a total of 347 women (177 control, 170 intervention) enrolled in the study. Fifty-eight percent were 24-30 years old. Young age, knowledge about FP, previous use of an FP method, and being married were found to be independent predictors for PPFP use. When comparing intervention and non-intervention groups, there was no significant effect on contraceptive use (adjusted OR 0.633 [95% CI 0.385-1.040]). Conclusion: pamphlet-supported counseling of mothers in the first 10 weeks postpartum did not increase PPFP at nine months postpartum. Successful interventions will likely require holistic strategies, especially in resource-limited settings. The trial had been registered with clinicaltrials.gov (NCT04521517) on September 24, 2019.

Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: protocol for the TARANG cluster randomised controlled trial.

INTRODUCTION: In South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of these interventions in reproductive and sexual autonomy and contraception has not been examined. METHODS AND ANALYSIS: A two-arm, parallel, cluster randomised controlled trial will evaluate the impact of TARANG (Transforming Actions for Reaching and Nurturing Gender Equity and Empowerment), a life skills and reproductive health empowerment group-based intervention for newly married women, compared with usual services in the community in rural and tribal Rajasthan, India. TARANG will also provide light-touch sessions to husbands and mothers-in-law of newly married women. We will test the impact of TARANG in 80 village clusters among 800 eligible households comprising newly married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy within 1 year at the time of enrolment, their husbands and mothers-in-law who consent to participate. Women in the intervention villages will receive 14 sessions over a 6-month period, while husbands and mothers-in-law will receive 1 and 4 sessions (respectively) each. Three rounds of surveys will be collected over 18 months. Control villages will receive the intervention after the endline surveys. Primary outcomes include rate of unintended pregnancy and modern contraceptive use. We plan to start recruitment of participants and data collection in April 2024. We will estimate unadjusted and adjusted intention-to-treat effects using survival analysis and mixed models. ETHICS AND DISSEMINATION: Study protocols have been reviewed and approved by the human subjects review boards at the University of California, San Francisco, and the Centre for Media Studies, India (IRB00006230) and ACE Independent Ethics Committee, Bangalore (NET0062022). Results will be disseminated in international peer-reviewed journals and conferences, to stakeholders including local government and non-governmental organisations, and directly to the communities and individuals that participated in the intervention. TRIAL REGISTRATION NUMBER: NCT06024616.

Engaging Community Health Workers to Enhance Modern Contraceptive Uptake Among Young First-Time Parents in Five Cities of Uttar Pradesh.

INTRODUCTION: Young newly married women and first-time parents (FTPs), particularly those living in slum settlements, have a high unmet need for modern contraceptive methods to limit and space births. We describe an intervention in which adolescents and youth sexual and reproductive health (AYSRH) services tailored to FTPs were incorporated into the government's existing family planning (FP) program in 5 cities of Uttar Pradesh. We examined the effect of this intervention on modern contraceptive use among FTPs aged 15-24 years. METHODS: To assess the effect of this pilot, in 2019, 1 year after the implementation of the program, we analyzed community-based output tracking survey data on 549 married women who are FTPs in the pilot cities. These FTPs were compared with 253 women who were FTPs from other cities where the program was implemented without a specific focus on FTPs. Descriptive statistics and multivariate logistic regression analysis were applied to understand the association between exposure to FP information, either through accredited social health activists or through service delivery points, and use of modern contraceptives. RESULTS: Use of modern contraceptives was higher among FTPs in the 5 pilot cities than non-pilot cities (39% vs. 32%; P<.05). The interaction effect of city type and exposure to the information showed a positive association between modern contraceptive use and program exposure, greater in pilot cities than non-pilot cities. CONCLUSIONS: Higher uptake of modern contraceptives among young women may be achieved when an FTP-focused intervention is layered on the government's existing FP programs. Future studies with a longer duration of implementation, in a wider geography, and with longitudinal design are recommended to provide more robust measures of high impact intervention/practices in urban areas.

Prevalence of modern contraceptive discontinuation and associated factors among married reproductive age group women in Debre Berhan town, Ethiopia: a community-based cross-sectional study.

OBJECTIVE: To assess the prevalence of modern contraceptive discontinuation and associated factors among married reproductive age (15-49 years) group women. STUDY DESIGN, SETTING AND PARTICIPANTS: A community-based cross-sectional study was conducted in Debre Berhan town among 500 reproductive age group women. Study participants were selected using two-stage sampling procedures. Data were collected using a semistructured face-to-face interview questionnaire. The data were entered in EpiData V.4.2.0 and then exported to SPSS V.25 software for data analysis. Descriptive statistics such as mean, per cent and frequency were used to summarise women's characteristics. Binary logistic regression analysis was used to identify predictors' variables with modern contraceptive discontinuation and p<0.05 was used to declare association. RESULTS: The prevalence of modern contraceptive discontinuation among married reproductive age group women was 35.2% with a mean duration of use of 2.6±2.1 months. This study also revealed that the discontinuation rate was 12.6% within the first year of use. In the current study, those living with their husband (adjusted OR (AOR)=3.81, p<0.001), experiencing side effects while using modern contraceptives (AOR=2.45, p=0.02), getting counselling service (AOR=5.51, p<0.001) and respondent husband acceptance of her modern contraceptive use (AOR=3.85, p=0.01) were significantly associated with modern contraceptive discontinuation. CONCLUSION: The findings of this study showed that the prevalence of modern contraceptive discontinuation rate of all methods among married reproductive age group women was 35.2%. To reduce modern contraceptive discontinuation, mutually, it is important to create community awareness about the importance of the continued use of modern contraceptives, improve the quality of family planning service in the health institution, strengthen family planning counselling service and give adequate counselling on details of effectiveness and side effects.

National Postpartum Permanent Contraception Practices and Perceived Barriers.

Single institution-level studies have demonstrated low postpartum permanent contraception fulfillment rates after vaginal birth. To explore the national scope of the problem, we collected cross-sectional survey data from faculty at 109 U.S. academic medical centers to elicit perceptions about postpartum permanent contraception practices after vaginal birth, including barriers to and changes in practice after the Dobbs v Jackson Women's Health Organization decision, a decision that eliminated the U.S. federal protection of the right to abortion. Of 68 respondent institutions, 65 (95.6%) offered postpartum permanent contraception. A large majority (87.3%) perceived there to be a problem with postpartum permanent contraception fulfillment at their institution. Respondents at institutions with postpartum permanent contraception fulfillment rates in the bottom quartile used main operating rooms (66.7% vs 25.0% respectively, P =.032) and reported institutional culture barriers (86.7% vs 50.0%, respectively, P =.054) more frequently than respondents in the top quartile. Our national data indicate that health care culture changes and the use of labor and delivery operating rooms could increase postpartum permanent contraception fulfillment.

National Policy Influences of Contraceptive Prevalence and Method Mix Strategy: A Longitudinal Analysis of 59 Low- and Middle-Income Countries, 2010-2021.

Understanding the impact of family planning policy and actions is essential for building effective strategies to increase contraceptive use. This study identifies policies that correlate with modern contraceptive prevalence rate (mCPR) and private-sector contraceptive method mix strategies (the number of contraceptive methods offered in the private sector) in low-income and middle-income countries. While education, contraceptive choices, and economic growth are known determinants of contraceptive prevalence, many national policies intended to increase contraceptive prevalence in the short term to medium term have ambiguous evidence that they indeed do so. By developing beta and Poisson regression models using 12 years of reported Contraceptive Security Indicators Survey data (2010-2021) from 59 countries, this study investigated the effect of 20 independent variables on mCPR or method mix strategies. Furthermore, to help interpret the potential consequences of economic status, separate models segmented by gross national income (low, low-middle, and upper-middle) were assessed. Of 20 independent variables, 10 are implicated with mCPR and 6 with a method mix strategy. Of these, increasing the share of domestic financing (versus donor funding) for contraceptives had the broadest and strongest contribution. mCPR is also predicted by the existence of national insurance systems that cover contraceptive costs, contraceptive security committees, family planning logistics management information systems, and, inversely, by client fees. A comprehensive private-sector method mix strategy-which itself influences mCPR-is also driven by these, as well as the inclusion of more contraceptives on the national essential medicines list. These findings have implications for countries seeking to expand access to and use of contraceptives through policy initiatives.

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative.

Importance: Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. Objective: To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. Design, Setting, and Participants: In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. Exposure: The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Main Outcomes and Measures: Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). Results: A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. Conclusions and Relevance: In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness.

BACKGROUND: Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being. OBJECTIVES: This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness. STUDY DESIGN: A cross-sectional online survey. METHOD: A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates. RESULTS: Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image. CONCLUSION: Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.