Contraceptive use Among Hispanic Women Living in Puerto Rico.

OBJECTIVE: To assess the contraceptive methods used by sexually active Hispanic women living in Puerto Rico. METHODS: From October 2016 through February 2018, 518 patients completed a self-administered questionnaire. The inclusion criteria were being over the age of 21 and having visited San Juan City Hospital or University District Hospital. The results were analyzed using descriptive statistics and a 2-sample t test, where P < .05 was considered significant. RESULTS: A total of 518 participants completed the questionnaire. Of the 518, 413 (81.0%) reported having used at least 1 form of contraception; 252 (49.4%) used OCPs, 305 (60.8%) used male condoms, 92 (33.8%) used the rhythm method, 83 (30.6%) undergone female sterilization, 98 (19.9%) used the withdrawal method, 92 (18.9%%) used an implant, 67 (13.5%) received progesterone injections, 41 (8.3%) used female condoms, 13 (4.9%) had partners who undergone male sterilization, 20 (4.1%) used the transdermal patch, 16 (3.2%) used a vaginal ring, and 26 (5.3%) used an intrauterine device. CONCLUSION: Of the 518 women, 24.2% used LARC, representing an increase in the usage by this population; this increase is likely linked to LARC's being easily accessible and free of charge. Public health interventions should be developed to increase knowledge about sexual health, educate about the effectiveness of different contraceptive methods and the prevention of sexually transmitted diseases, and reduce both the barriers to acquiring contraception and, thereby, the number of unintended pregnancies in this population.

Contributing factors for urban-rural inequalities in unmet need for family planning among reproductive-aged women in Ethiopia: a Blinder-Oaxaca decomposition analysis.

BACKGROUND: Unmet need for family planning (FP) is a global public health concern, particularly in low- and middle-income countries. In Ethiopia, although several studies have assessed unmet needs for FP, there have only been few empirical investigations into regional inequalities and their contributory factors. This study assessed urban-rural inequalities in unmet FP needs among reproductive-aged women in Ethiopia and particularly examined the contribution of material, cultural-behavioral, and psychosocial factors therein. METHODS: A cross sectional study was conducted among 8811 reproductive-aged women derived from the nationally representative 2019 Ethiopian Performance Monitoring for Action (PMA) data. The outcome variable was unmet need for FP. The exposure variable was place of residence (urban or rural). Contributing factors were categorized into material, psychosocial and cultural-behavioral factors. Blinder-Oaxaca decomposition analysis was used to assess urban-rural inequalities in unmet need for FP as well as to disentangle the contributory factors in percentage points. RESULT: In our study, 13.8% of reproductive-aged women in Ethiopia reported unmet FP needs. Urban-rural inequalities therein accounted for 6.8% points. Disparities in FP needs between urban and rural areas were mostly explained by psychosocial factors (81.0%) followed by material (21.0%), and cultural-behavioral (3.2%) factors. While women who were living with a partner (39.1%, p < 0.01) and multiparas (51%, p < 0.01) contributed to increasing inequalities, attending family planning counseling services with a healthcare provider (-1.7%, p = 0.03) reduced the gap in unmet need for FP between urban and rural areas. Women from the poorest and poor category contributed 14.1% (p = 0.02) and 11.1% (p = 0.04), respectively. Being from a Muslim religion also contributed to the disparity by 7.3% (p < 0.01). CONCLUSION: This study showed that among reproductive-aged women in Ethiopia, inequalities in unmet FP needs show distinct urban-rural patterning. Most inequalities could be attributed to psychosocial factors, mainly parity and marital status, followed by material and cultural-behavioral factors. Policymakers should target these modifiable psychosocial factors to reduce urban-rural inequalities in unmet need for FP in Ethiopia.

Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol.

BACKGROUND: Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth. METHODS: This is a mixed method cohort study on PPFP and is nested within an ongoing "Women and Infants Integrated Interventions for Growth Study" (WINGS). Married women aged 18-30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices. DISCUSSION: The findings from the study will provide useful insights into couples' contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women. TRIAL REGISTRATION: Trial registration number: CTRI/2020/03/023954 .

Male-female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India.

OBJECTIVE: Women's involvement in contraceptive decision-making increases contraceptive use and reduces unmet need, but study of this has been limited to women's self-reports. Less research is available examining couple concordance and women's involvement in contraceptive decision-making as reported by both men and women. STUDY DESIGN: We carried out a cross-sectional study using data from rural India (N = 961 young married couples). Using multivariable regression we examined the association between concordance or discordance in spousal reports of wife's involvement in contraceptive decision-making and modern contraceptive use, adjusting for demographics, intimate partner violence, and contraceptive use discussion. RESULTS: More than one third (38.3%) of women reported current modern contraceptive use. Report of women's involvement in contraceptive decision-making showed 70.3% of couples agreed that women were involved, jointly or alone (categorized as Concordant 1), 4.2% agreed women were not involved (categorized at Concordant 2), 13.2% had women report involvement but men report women were uninvolved (categorized as Discordant 1), and 12.2% had women report uninvolvement but men report that women were involved (categorized as Discordant 2). Discordant 2 couples had lower odds of modern contraceptive use relative to Concordant 1 couples (adjusted RR = 0.61, 95% CI 0.45-0.83). No other significant differences between Concordant 1 couples and other categories were observed. CONCLUSION: One in four couples indicated discordance on women's involvement in contraceptive decision making, with Discordant 2 category having lower odds of contraceptive use. Couples' concordance in women's involvement in contraceptive decision-making offers a target for family planning research and interventions to better meet their needs. Trial registration ClinicalTrial.gov, NCT03514914. https://clinicaltrials.gov/ct2/show/NCT03514914.

Evidence on women's involvement in decision-making are limited to women's self reports and often not specific to contraceptive decision-making. This study uses couples dyadic data to assess male­female concordance on women's involvement in contraceptive decision-making and contraceptive use outcomes. Couple's concordance on women's involvement in contraceptive decision-making is associated with contraceptive use. There is potential in couple-focused family planning counseling that enhances women's contraceptive decision-making agency to improve women's contraceptive use.

Determinants of modern contraceptive prevalence and unplanned pregnancies in Migori County, Kenya: results of a cross-sectional household survey.

Family planning and contraceptive utilization can have significant effects in reducing unplanned pregnancies and improving maternal and child health indicators. We conducted a retrospective cross-sectional study analyzing survey response data within six sub-locations of Migori County, Kenya in 2018 and 2019. We utilize this survey data to estimate both the prevalence of contraceptive uptake and unwanted pregnancies in the study populations, and to examine the potential role that different factors play in meeting related family planning targets. Descriptive statistics were calculated, and multivariable logistic regression was used to model determinants of contraceptive use and reported unplanned pregnancy. A total of 3,642 female heads of household were included. 63% of respondents reported that they currently use some form of contraception, and the prevalence of unplanned pregnancy was 36.7%. Our findings reflect the need for family planning programs to focus interventions on those at highest risk. There is a need for additional research and investigation into community and individual beliefs surrounding family planning in order to ensure that interventions are culturally sensitive and locally responsive.

Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.

BACKGROUND: With a fertility rate of 5.4 children per woman, Burundi ranked as seventh country with the highest fertility rate in the world. Family planning is an effective way of achieving desirable family size, appropriate birth spacing and significant reduction in unintended pregnancies. Furthermore, family planning has been linked to improvements in maternal health outcomes. Yet, in spite of the overwhelming evidence on the benefits of family planning and despite high knowledge and free services, utilisation is low especially in rural communities with conservative people. Employing a mixed methods approach, this study first quantifies contraceptive prevalence and second, explores the contextual multilevel factors associated with low family planning utilisation among community members. METHODS: An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n = 132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes. RESULTS: The overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29 (aOR 5.04 (95% CI 2.09-10.27 p = 0.038), those that have completed secondary school and having four or less children were significantly associated with use of family planning (aOR 1.72 (95%1.35-2.01) p = 0.002). Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. CONCLUSION: Given that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.

In the Burundian context, community members agree that large family sizes are difficult to maintain, yet use of family planning remains consistently low. This study explored the factors behind this low utilisation of family planning in two health districts located in the South of Burundi. The findings suggest that fear of side effects is the main reason for family planning non-utilization or discontinuation. The culture and religious beliefs in Rural Burundi also espouse large family sizes and among men, this is conceived as a sign of wealth, power, and respect. Lack of spousal communication and unequal gender relations in household also impedes women from contributing decisions on family planning. The onus on making decisions on contraceptive use lies on men, whom usually, have limited understanding of family planning methods. In improving coverage of family planning in these communities, capacity of the health system to provide quality, timely and people-driven family planning services should be strengthened. At the community level, the use of community health workers to deliver family planning services to the doorstep of community members could significantly increase uptake. Finally, men and religious leaders' involvement in promoting family planning use can contribute to reducing the impact of cultural and religious barriers to uptake.

Factors influencing maternal health choices among women of reproductive age in Hausa communities in Ibadan, Nigeria: an exploratory study.

INTRODUCTION: decision making is a vital aspect of women's reproductive life. In an attempt to fulfil the desire to procreate, women's lives are lost especially in developing countries where medical care is still inadequate. The researchers sought to explore the Hausa people's culture as regards maternal health choices concerning modern family planning methods, delivery places and parity. METHODS: a cross-sectional study using mixed methods was conducted among women of reproductive age (N=253) in three Hausa communities in Ibadan. Based on the objectives, semi-structured questionnaire and in-depth interview guide were used for data collection. Quantitative data were analysed using Chi-square and the level significance set at 0.05 while qualitative data were analysed thematically. RESULTS: over fifty percent respondents had more than 3 children and about one third (33.9%) preferred having more than 4 children. Nearly all participants (94%) were aware of modern family planning methods but only 49.0% used them. The most widely used methods are injectables (22.0%) and condoms (20.6%). Almost half of the study population (46.5%) delivered their babies at home with assistance from other residents with most preferring home delivery for various reasons. CONCLUSION: although the level of awareness about family planning methods is quite satisfactory, however, the level of contraceptive uptake is still sub-optimal. Most Hausa women prefer home delivery which predisposes them to associated complications. Findings further identified various reasons for maternal health choices and provided insights on viable nursing interventions that can be adopted to promote skilled birth delivery to reduce maternal morbidity and mortality.

Effect of distance to health facilities and access to contraceptive services among urban Turkish women.

OBJECTIVE: Worldwide unmet need for contraception remains high at 21.6%. As access to health facilities is one of the potential barriers to contraceptive uptake, the aim of our study was to evaluate the effect of distance to a health facility, according to its service availability, on contraceptive uptake among married Turkish women. METHODS: To calculate respondents' distance to a health facility, we used data from a household survey conducted among married women, as well as data from a health facility survey conducted among the facilities that were visited for contraceptive services by the respondents. The data were collected from the Istanbul area of Turkey under the Willows Impact Evaluation project in 2018. Health facilities were categorised according to contraceptive availability and the accurate distance from respondents' homes to each type of health facility was calculated. Logistic regression was used to estimate the effect of distance to each type of health facility on uptake of each type of contraception. RESULTS: The prevalence of overall contraceptive use among urban Turkish women was 71.9%. The most common method was withdrawal (32.5%), followed by the intrauterine device (IUD) (14.9%) and male condoms (12.4%). Distance to a health facility that did not provide long-acting contraception was not associated with any type of contraceptive use. On the other hand, distance to a health facility that provided long-acting contraception was negatively associated with the use of long-acting methods such as the IUD but was positively associated with the use of short-acting contraception such as condoms. CONCLUSION: The effect of distance to a health facility on contraceptive use significantly differed according to contraceptive availability at the facility. Further distance to a health facility that provided long-acting contraception decreased the use of long-acting contraception but had a substitute effect on the use of short-acting contraception. We conclude that when women face an accessibility barrier to the provision of long-acting contraception, they modify their behaviour by shifting from long- to short-acting contraception, which is less effective.

Women's autonomy and modern contraceptive use in Ghana: a secondary analysis of data from the 2014 Ghana Demographic and Health Survey.

OBJECTIVE: Women's empowerment and autonomy have been proven to promote women's use of modern contraceptives. This study examined women's autonomy as a potential factor for modern contraceptive use among Ghanaian women in a union. METHOD: We conducted a secondary analysis of data from the 2014 Ghana Demographic and Health Survey. The main outcome measure was current modern contraceptive use from women's self-report. Three composite indices were used to assess women's autonomy: household decision-making, attitudes towards wife-beating, and property ownership. RESULTS: A total of 4772 non-pregnant women aged 15-49 years in a union were included in the analysis. The mean age was 34.2(±7.97) years, 53.6% received at least secondary education, 87.7% were employed, and 76.5% received family planning information within the last 12 months. The prevalence of modern contraceptive use was 24.8% (95% CI: 22.9-26.7). Women's autonomy was independently associated with modern contraceptive use. Compared with women with low autonomy, women with moderate (AOR= 1.26, 95% CI: 1.02-1.55, p = 0.034) and high autonomy (AOR = 1.34, 95% CI: 1.01-1.79, p = 0.044) had increased odds of modern contraceptive use. Maternal age, education, number of living children, employment, region, and exposure to family planning information were also strongly associated with modern contraceptive use. CONCLUSIONS: The findings from this study support the assertion that women's autonomy may be vital in promoting the use of modern contraceptives among women in a union in Ghana and other low-income and middle-income countries and should be considered in family planning programs.

Women's empowerment, intrahousehold influences, and health system design on modern contraceptive use in rural Mali: a multilevel analysis of cross-sectional survey data.

BACKGROUND: Persistent challenges in meeting reproductive health and family planning goals underscore the value in determining what factors can be leveraged to facilitate modern contraceptive use, especially in poor access settings. In Mali, where only 15% of reproductive-aged women use modern contraception, understanding how women's realities and health system design influence contraceptive use helps to inform strategies to achieve the nation's target of 30% by 2023. METHODS: Using household survey data from the baseline round of a cluster-randomized trial, including precise geolocation data from all households and public sector primary health facilities, we used a multilevel model to assess influences at the individual, household, community, and health system levels on women's modern contraceptive use. In a three-level, mixed-effects logistic regression, we included measures of women's decision-making and mobility, as well as socio-economic sources of empowerment (education, paid labor), intrahousehold influences in the form of a co-residing user, and structural factors related to the health system, including distance to facility. RESULTS: Less than 5% of the 14,032 women of reproductive age in our study used a modern method of contraception at the time of the survey. Women who played any role in decision-making, who had any formal education and participated in any paid labor, were more likely to use modern contraception. Women had three times the odds of using modern contraception if they lived in a household with another woman, typically a co-wife, who also used a modern method. Compared to women closest to a primary health center, those who lived between 2 and 5 km were half as likely to use modern contraception, and those between 5 and 10 were a third as likely. CONCLUSIONS: Despite chronically poor service availability across our entire study area, some women-even pairings of women in single households-transcended barriers to use modern contraception. When planning and implementing strategies to expand access to contraception, policymakers and practitioners should consider women's empowerment, social networks, and health system design. Accessible and effective health systems should reconsider the conventional approach to community-based service delivery, including distance as a barrier only beyond 5 km.

RéSUMé: CONTEXTE: Au Mali, où seulement 15% des femmes en âge de procréer utilisent les contraceptifs modernes, la compréhension des réalités des femmes et de la conception du système de santé aident à éclairer les stratégies pour atteindre l'objectif national de 30% d'ici 2023. MéTHODES: En utilisant les données d'enquête de base d'un essai randomisé en grappes, avec la géolocalisation précise de tous les ménages et centres de santé publiques, nous avons utilisé un modèle à plusieurs niveaux pour évaluer l'influence de l'individu, du ménage, de la communauté et du système de santé sur l'utilisation de la contraception moderne. Nous avons utilisé la régression logistique à effets mixtes pour mesurer l'autonomisation et ses sources socio-économiques (éducation, travail rémunéré), les influences intra-ménages sous forme d'une utilisatrice co-résidante et les facteurs structurels liés au système de santé. RéSULTATS: Moins de 5% des 14 032 femmes en âge de procréer utilisaient la contraception moderne au moment de l'enquête. Les femmes jouant un rôle dans la prise de décision, celles ayant une éducation formelle, un travail rémunéré, étaient plus susceptibles d'utiliser les contraceptifs modernes. Les femmes avaient trois fois plus de chances de faire la contraception moderne si elles vivaient dans un ménage avec une autre femme, généralement une coépouse, qui utilisait une méthode moderne. Comparées aux femmes les plus proches d'un centre de santé, celles qui vivaient entre 2 and 5 kilomètres étaient deux fois moins susceptibles d'utiliser un contraceptif moderne et celles entre 5 and 10 étaient plus susceptibles dans un tiers des cas. CONCLUSIONS: Malgré une faible disponibilité des services dans toute la zone d'étude, certaines femmes­même celles en cohabitation­ont pu surmonter les barrières à l'utilisation des contraceptifs modernes. Lors de la planification et de la mise en œuvre de stratégies pour élargir l'accès à la contraception, les décideurs et les praticiens devraient tenir compte de l'autonomisation des femmes, des réseaux sociaux, et de la conception du système de santé. Les systèmes de santé accessibles et efficaces devraient reconsidérer l'approche conventionnelle de la prestation de services communautaires, en prenant en compte la distance même à moins de 5 kilomètres.

The association between early in marriage fertility pressure from in-laws' and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India.

BACKGROUND: Married adolescent girls are vulnerable to risky sexual and reproductive health outcomes. We examined the association of fertility pressure from in-laws' early in marriage with contraceptive use ever, parity, time until first birth, and couple communication about family size, among married adolescent girls. METHODS: Data were taken from a cross-sectional survey with married girls aged 15-19 years (N = 4893) collected from September 2015 to July 2016 in Bihar and Uttar Pradesh, India. Multivariable regression assessed associations between in-laws' fertility pressure and each outcome, adjusting for sociodemographic covariates. RESULTS: We found that 1 in 5 girls experienced pressure from in-laws' to have a child immediately after marriage. In-laws' fertility pressure was associated with lower parity (Adj. ß Coef. - 0.10, 95% CI - 0.17, - 0.37) and couple communication about family size (AOR = 1.77, 95% CI 1.39, 2.26), but not contraceptive use or time until birth. CONCLUSIONS: Our study adds to the literature identifying that in-laws' pressure on fertility is common, affects couple communication about family size, and may be more likely for those yet to have a child, but may have little effect impeding contraceptive use in a context where such use is not normative.

A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya.

BACKGROUND: Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. METHODS: Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. RESULTS: Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods. CONCLUSION: This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.

Zika virus public health crisis and the perpetuation of gender inequality in Brazil.

BACKGROUND: In 2015-2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. METHODS: We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18-40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. RESULTS: Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. CONCLUSION: Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.

Determinants of induced abortion in Tehran, Iran: the role of contraceptive failure.

OBJECTIVES: Induced abortion is highly restricted in Iran and many married women with unintended pregnancies resort to clandestine procedures, resulting in adverse health outcomes. As there is a lack of reliable data on abortion in Iran, this study aimed to examine factors predisposing women to practise abortion, factors facilitating the use of abortion and factors determining women's 'need' to use abortion to control their number of children. METHODS: The study used data from the 2014 Tehran Survey of Fertility, conducted among 3012 married women aged 15-49 years. Bivariate and multivariate binary logistic regression analyses were used. RESULTS: About 6% of women reported that they had had an abortion. The proportion was higher among women who were in their later reproductive years, women who were employed, women who intended to continue their education, women who reported a low level of religiosity, women who had two children and women who wanted no/no more children. Multivariate analysis showed that abortion was twice as high among women who had conceived their most recent birth because of the failure of a modern contraceptive method, compared with women who had discontinued or did not use a contraceptive method. CONCLUSION: The high risk of abortion among women experiencing failure of a modern contraceptive method indicates an unmet need for family planning counselling and education rather than a shortage of contraceptive methods.

Barriers and enablers of contraceptive use among adolescent girls and women under 30 years of age in Cambodia: a qualitative study.

OBJECTIVE: Unintended pregnancy and an unmet need for modern contraception remain high among adolescent girls and women in Cambodia. Qualitative descriptive research was conducted to explore the barriers to contraceptive use among young women in urban Cambodia. METHODS: Semi-structured interviews were conducted among 30 adolescent girls and women aged 16-27 years, using purposive and snowball sampling strategies until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and quality-checked. Inductive thematic data analysis was conducted. The results are presented using Bronfenbrenner's theoretical social ecological model. RESULTS: The emerging major and minor themes indicate misconceptions about hormonal contraception as well as women's preference for using oral contraceptive pills for family planning after an unintended pregnancy. Women had low autonomy in choosing a contraceptive method, as their partners or husbands tended to prefer the withdrawal method. Young women faced cultural and supply chain barriers in accessing short- and long-acting reversible modern contraceptive methods at health centres. CONCLUSION: Cambodian women aged 16-27 years are a vulnerable group who have low autonomy and sexual and reproductive health literacy and also face gender inequality.

Family planning perspectives and practices of married adolescent girls in rural Upper Egypt.

OBJECTIVES: The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception. METHODS: The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire. RESULTS: Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman's fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p < .001), older age (B = 0.42, p < .01), better reproductive health knowledge (B = 0.23, p < .05) and sharing in contraceptive decision making (B = 0.55, p < .05). CONCLUSION: Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.

Modern contraceptive use among unmarried girls aged 15-19 years in South Western Nigeria: results from a cross-sectional baseline survey for the Adolescent 360 (A360) impact evaluation.

PURPOSE: Adolescents 360 (A360) is an initiative being rolled out across Nigeria with the aim of increasing voluntary modern contraception use among women aged 15 to 19 years. Using evaluation study baseline data, we identified sexuality, fertility and contraceptive use characteristics of young unmarried girls in South Western Nigeria. METHODS: A cross-sectional baseline survey of unmarried girls aged 15 to 19 years was conducted in Ogun state, Nigeria in August 2017. A clustered sampling design was used. We identified determinants of modern contraceptive use in this subpopulation using logistic regression. RESULTS: Of 12,024 women interviewed, 15.3% reported sexual intercourse in the past year. The majority of respondents (79.6%, 9525/11,967) had heard of contraception. 45.3% of sexually active respondents were using a modern contraceptive method. Of those using any method of contraception, male condoms (50.3%) were the most widely used modern method followed by the emergency contraceptive pill (16.7%). Following adjustment for socio-demographic characteristics, there was evidence that the use of modern contraception was positively associated with having never given birth, living in an urban area, current enrolment in education, high level of education, high socioeconomic status, exposure to information about contraception, perceived social support for contraception, and self-efficacy for contraception. CONCLUSIONS: In South Western Nigeria, unmarried sexually active adolescent girls have relatively low levels of modern contraceptive use. Programmes should aim to increase access to modern contraception and to increase social support and acceptability of contraceptive use.

Socio-economic and demographic factors associated with fertility preferences among women of reproductive age in Ghana: evidence from the 2014 Demographic and Health Survey.

BACKGROUND: Understanding women's desire to have more children is critical for planning towards future reproductive health behaviour. We examined the association between socio-economic and demographic factors and fertility preferences among women of reproductive age in Ghana. METHODS: This  study used data from the 2014 Ghana Demographic and Health Survey. The sample consisted of 5389 women of reproductive age. We fitted Binary logistic regression models to assess the association between socio-economic status and fertility preferences, whiles controlling for demographic factors. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs) together with their corresponding 95% confidence intervals. RESULTS: Approximately 60% of women of reproductive age in Ghana desired for more children. Women with no formal education were more likely to desire for more children compared to those with higher level of education (aOR = 2.16, 95% CI 1.29-3.48). The odds of desire for more children was higher among women who lived in rural areas compared to those who lived in urban areas (aOR = 1.24, 95% CI 1.01-1.53). With region, women who lived in the Northern region were more likely to desire for more children compared to those who lived in the Ashanti region (aOR = 4.03, 95% CI 2.69-6.04). Similarly, women who belonged to other ethnic groups were more likely to desire for more children compared to Akans (aOR = 1.78, 95% CI 1.35-2.35). The desire for more children was higher among women with 0-3 births compared to those with four or more births (aOR = 7.15, 95% CI 5.97-8.58). In terms of religion, Muslim women were more likely to desire for more children compared to Christians (aOR = 1.87, 95% CI 1.49-2.34). CONCLUSION: This study concludes that women in high-socio economic status are less likely to desire more children. On the other hand, women in the Northern, Upper East and those belonging to the Islamic religious sect tend to desire more children. To aid in fertility control programmes designing and strengthening of existing ones, these factors ought to be critically considered.

Contraceptive use and fertility behaviour among Syrian migrant women.

OBJECTIVES: This study aimed to investigate fertility behaviours and contraceptive use among Syrian migrant women in western Turkey. METHODS: An epidemiological, single-centre, cross-sectional, descriptive study was conducted. The survey collected data on sociodemographic characteristics and types of marriage, use of contraceptive methods and fertility behaviours among 223 Syrian migrant women. RESULTS: The women's mean (± standard deviation) age range was 29.6 ± 9.1 (range 18-49) years; 29.6% had no formal marriage status; 61.0% had had an arranged marriage. The mean age at first pregnancy was 19.5 ± 3.4 (13-39) years; 26.4% had become pregnant before the age of 18. In total, 94.2% of participants had knowledge of contraceptive methods. However, 47.5% did not use contraception and the main reason for this was to become pregnant again. Intrauterine devices and oral contraceptive pills were known as contraceptive methods by 67.7% and 72.2% of women, but used by only 16.1% and 8.5%, respectively. Withdrawal (22.0%) was the most used contraceptive method. There was a risk of unwanted pregnancy in 13.0% of participants. Arranged marriage and low educational level were determined to be risk factors for adolescent pregnancy. CONCLUSION: Although Syrian migrant women were aware of contraceptive methods, the rate of method use was low.

Contraception and abortion among migrant women in Changzhou, China.

OBJECTIVES: Migrant women in China's industrial cities face particular contraceptive challenges, which have changed in recent years as family planning policy has shifted. Little is known about recent trends in contraception and abortion among China's large internal migrant population. We conducted a survey to examine these issues among factory workers in a large Chinese city. METHODS: Married migrant women (N = 801) aged 20-39 years and working in Changzhou, China, completed an anonymous self-administered questionnaire giving details about their sociodemographic background, work and migration situations, and reproductive health. RESULTS: Current contraceptive use was reported by 86.6% of women. Condoms, which have largely replaced longer acting contraceptive methods in this population in recent years, were being used by 54.9% of contraceptive users. Only 41.2% used a longer acting method, mostly an intrauterine device (IUD). A lifetime history of abortion was reported by 40.4%. In the past year, 5.5% had had an unintended pregnancy and 5.2% had had an induced abortion. Older age, lower level of education, lower income, area of origin and husband's residency were associated with IUD use. Lower income, husband's residency and stronger fertility desire were associated with recent unintended pregnancy. CONCLUSION: The results of the study provide evidence that migrant women in China are relying more than ever on less effective methods of contraception. Unintended pregnancy and abortion are common. China's current informed choice model needs to be improved with the provision of better health education before and after migration and easy access to health and reproductive health care services.