Using Human-Centered Design to Explore Potential Users' and Men's Views of New Injectable Contraceptives in Kampala and Lagos.

BACKGROUND: Injectable contraceptives are the most used method in sub-Saharan Africa. We conducted market research to assess potential user attitudes toward 4- and 6-month injectables. We also present user suggestions for marketing these new injectables once they are available. METHODS: We implemented a 2-phase market research study from October through December 2021 in Kampala, Uganda, and Lagos, Nigeria. We conducted 11 focus group discussions (FGDs) with 51 participants in Kampala and 12 FGDs with 67 participants in Lagos. FGDs included current and potential injectable users and men stratified by marital status and age. Next, 23 women in Kampala and 24 in Lagos participated in cocreation workshops using human-centered design methods to explore marketing and communications strategies for each injectable. Data collection teams completed semistructured data extraction tables that were then analyzed thematically. RESULTS: Participants liked both injectable options due to the reduced number of facility visits that would save time and money and increase privacy. Primary concerns included side effects, delayed return to fertility, cost, self-efficacy to self-inject, and stock-outs. Participants in Kampala preferred a shorter reinjection window (or "grace period") because it is easier to remember and they assumed it meant a quicker return to fertility, but participants in Lagos preferred a longer window because it provides extra time for reinjection. Citing norms around women needing to get pregnant quickly after marriage, participants in both sites felt that the 4-month injectable would benefit young people with busy lifestyles or limited access to facilities, whereas the 6-month injectable would benefit women who already had children. CONCLUSIONS: We found that participants in Kampala and Lagos would prefer additional injectable options to meet the wide-ranging needs of users in different stages of their reproductive lives. Family planning program planners can apply the marketing insights we identified when these new injectables become available.

Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria.

Background: This study explored the influence of social norms on the access and utilization of sexual and reproductive health services by adolescents. Apart from individual and environmental barriers, social norms influence contraceptive decisions and ultimately sexual and reproductive health outcomes. Social norms that shape group behavior describe acceptable standards of behavior and evoke sanctions when such behavior standards are not adhered to. Sexually active adolescents in Nigeria have a relatively low level of modern contraceptive use being influenced by social norms. Scaling up adolescent reproductive health interventions that integrate normative change for a wider impact of programs remains challenging. Methods: Using data from 18 communities, 188 married and unmarried adolescents (F52% and M48%) and 69 (F37%; M63%) reference group participants were purposively sampled and participated in a social norms exploration intervention study conducted through focus group discussion and in-depth interviews between October and November 2019. The Advancing Learning and Innovation on Gender Norms (ALIGN) Social Norms Exploration Tool (SNET) was adapted for the data collection into discussion guides and vignettes. Pilot testing of the tools informed review and validation prior to actual data collection. Findings: Low contraceptive uptake by adolescents was characterized by early and forced marriage in childhood; a prominent practice enshrined in social norms around girl-childchastity, family honor, and disapproval of pre-marital sex and pregnancy out of wedlock. Conclusion: The understanding of harmful social norms, normative change actors, and potential norm-shifting factors for contraceptive decisions by adolescents is essential for effective adolescent sexual and reproductive health interventions for wider impact and adaptive programming in behavior change interventions for improving the access to and utilization of modern contraceptives by adolescents for improved sexual health outcomes, the attainment of the Family Planning (FP) 2030 commitment and universal health coverage policy.

Gender differences in work attendance among health care workers in Northern Nigeria during the COVID-19 pandemic.

Background: The COVID-19 pandemic has resulted in the overwork of health care workers (HCWs) and greater household burdens for women. This study examines gender differences in HCWs' work attendance under COVID-19 and household burdens as a potential mediator of the gender difference in Northern Nigeria. Methods: From April to May 2021, we conducted a cross-sectional survey on work and household burdens with a convenience sample of male and female HCWs (N=334) across 16 facilities in the Gombe, Katsina, and Zamfara states in Northern Nigeria. We used a series of multilevel modified Poisson regression models to examine the associations between gender and HCW work attendance. We also tested the mediation effect of household burdens on this observed association. Findings: Only 2·10% of HCWs reported <5 days of work in a typical week; 35·33% worked 6-7 days a week (i.e., HCW overwork). Males were more likely than females to report HCW overwork (46·33% vs. 22·93%), and females were more likely than males to report an increase in household burden (59·24% vs. 40·68%). Adjusted regression models found that men were more likely than women to report HCW overwork (ARR: 1·76, 95% CI: 1·17-2·66). Increased household burdens mediated 9 percent of the total effect between gender and HCW work attendance. Interpretation: The COVID-19 pandemic in Northern Nigeria made female HCWs contend with the dual burdens of formal and informal care work. This contributes to lower attendance among female HCWs and overwork for their male counterparts. Funding: Bill and Melinda Gates Foundation Grant Numbers: OPP1163682 & INV018007.