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2.
BMC Public Health ; 20(1): 1041, 2020 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-32605622

RESUMEN

BACKGROUND: The influence of health workers on uptake of maternal healthcare services is well documented; however, their outreach for family planning (FP) services and influence on the intention to use contraceptives is less explored in the Indian context. This study examined the extent of health worker outreach for FP service and its effects on intention to use contraceptives among currently married women aged 15-49 years. METHODS: This study used data from two rounds of the National Family Health Survey (NFHS) of India, conducted during 2005-06 and 2015-16 respectively. Bivariate analysis and multivariate logistic regression were used to understand the level of and change in health worker outreach for FP services over time, and its association with intention to use contraceptives among currently married women. RESULTS: In the past 10 years, health workers' outreach for FP service has significantly increased by about 10 percentage points, although the level is not optimal and only 28% of non-users were reached by health workers in 2015-16. Increase in the outreach to younger and low parity women was higher than their respective counterparts. Intention to use contraceptive among women who were not using any method was 41% when health workers contacted and discussed FP, compared to only 20% when there was no such contact with health workers. Multivariable analysis suggests that contact with health workers has significant positive effects on intention to use contraceptive (AOR = 3.05; p < 0.001; 95% CI 2.85-3.27). CONCLUSION: Increased scope of outreach of frontline health workers to provide FP communication and services will not only help in building knowledge of contraceptive methods but will also increase women's intention to use a method. For India, this may be the most promising way to achieve the Sustainable Development Goals 3.7, which calls for universal access to reproductive health services.


Asunto(s)
Relaciones Comunidad-Institución , Conducta Anticonceptiva/psicología , Servicios de Planificación Familiar/organización & administración , Personal de Salud/psicología , Intención , Matrimonio/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , India , Persona de Mediana Edad , Embarazo , Adulto Joven
4.
AIDS Patient Care STDS ; 34(6): 259-266, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32484743

RESUMEN

We aimed to systematically evaluate the feasibility of integrating HIV prevention services, including pre-exposure prophylaxis (PrEP), into a family planning setting in a high-prevalence community. We used the RE-AIM Framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to evaluate the integration of HIV prevention services into a family planning clinic over 6 months. Before the integration, PrEP was not offered. We implemented a staff training program on HIV PrEP. We determined the proportion of women presenting to the clinic who were screened, eligible for, and initiated PrEP through chart review. We assessed staff comfort with PrEP pre- and post-integration. We compared planned and actual implementation, interviewed staff to determine barriers and facilitators, and tracked systems adaptations. We assessed maintenance of PrEP after the study concluded. There were 640 clinical encounters for 515 patients; the rate of HIV counseling and PrEP screening was 50%. The rate was 10% in month 1 and peaked to 65% in month 3. Nearly all screened patients were eligible for PrEP (98.4%) and 15 patients (6%) initiated PrEP. Staff knowledge and comfort discussing PrEP improved after education. Facilitators included partnering with local experts, continuing education, clinical tools for providers, and patient education materials. Barriers included competing priorities during clinical encounters, limited woman-centered patient education materials, and insurance-related barriers. Embedding HIV prevention services in the family planning setting was feasible in this pilot. The proportion of women screened for PrEP rapidly increased. In this high HIV prevalence community, nearly all screened women were eligible and 6% initiated PrEP.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Prestación Integrada de Atención de Salud/organización & administración , Servicios de Planificación Familiar/estadística & datos numéricos , Infecciones por VIH/prevención & control , Tamizaje Masivo/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Adulto , Instituciones de Atención Ambulatoria , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , Consejo , Servicios de Planificación Familiar/organización & administración , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Estudios Prospectivos , Educación Sexual , Parejas Sexuales
5.
Best Pract Res Clin Obstet Gynaecol ; 66: 107-118, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32527659

RESUMEN

This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.


Asunto(s)
Conducta Anticonceptiva , Anticoncepción/estadística & datos numéricos , Servicios de Planificación Familiar/organización & administración , Accesibilidad a los Servicios de Salud , Embarazo en Adolescencia/prevención & control , Adolescente , Servicios de Salud del Adolescente , Anticonceptivos/administración & dosificación , Anticonceptivos/provisión & distribución , Dispositivos Anticonceptivos , Femenino , Derechos Humanos , Humanos , Embarazo
6.
Womens Health Issues ; 30(4): 277-282, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32507617

RESUMEN

BACKGROUND: Research on the impact of providers disclosing personal contraceptive experiences with patients is limited. In this study, we examine patient and provider perspectives about provider self-disclosure (PSD) of personal contraceptive experiences and its effects on contraceptive decision making and the provider-patient relationship. METHODS: We conducted 18 one-on-one telephone interviews with clinicians who provide contraceptive services to young women and 17 patients seeking emergency contraception from three Bay Area community-based, youth-friendly clinics regarding their contraceptive counseling practices and experiences, respectively. After transcribing and coding all interviews, we summarized structural codes related to contraceptive counseling and PSD. RESULTS: Although providers noted that PSD could help to build rapport and increase patient comfort, most did not report self-disclosing their contraceptive experiences, primarily owing to concerns that it might cross professional boundaries or compromise patient autonomy. All patients held positive attitudes toward and welcomed PSD practices, with many noting that it increased their comfort and trust in their provider. CONCLUSIONS: There were notable differences between patient and provider attitudes toward PSD of contraceptive method use, with patients expressing more positive feelings about the practice than providers. Community-based providers should consider that many young women welcome self-disclosure of provider contraceptive experiences and that more research is needed to understand the effects of PSD practices around contraception on the patient-provider relationship and autonomous contraceptive decision making.


Asunto(s)
Actitud del Personal de Salud/etnología , Conducta Anticonceptiva/psicología , Anticoncepción Postcoital/estadística & datos numéricos , Anticoncepción/psicología , Anticonceptivos Poscoito/provisión & distribución , Servicios de Planificación Familiar/organización & administración , Relaciones Profesional-Paciente , Adolescente , Adulto , Servicios de Salud Comunitaria , Anticoncepción/métodos , Conducta Anticonceptiva/estadística & datos numéricos , Anticonceptivos/administración & dosificación , Revelación , Servicios de Planificación Familiar/métodos , Femenino , Humanos , Entrevistas como Asunto
7.
Eur J Contracept Reprod Health Care ; 25(4): 323-325, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32567961

RESUMEN

The Novel Coronavirus disease that was first identified in Wuhan city of China in December 2019 has emerged as one of the fastest spreading pandemics all over the world affecting millions of people and causing millions of deaths worldwide. In an attempt to control its spread, countries have imposed local and national lockdowns, affecting many healthcare services, especially sexual and reproductive health services which are actually essential and lifesaving. In near future this will result in a large number of grave consequences including increased unmet need for modern contraceptives, unintended pregnancies, increased unsafe abortions, maternal and neonatal deaths and other harmful practices like female genital mutilation and child marriages in developing countries. The present short review focusses on such issues which will be dramatically increased depending on the duration of lockdowns and the time for which the sexual and reproductive health services will remain halted. It also reflects the need for considering reproductive health services as essential, allowing the people to avail these services without any fear and hence, saving many more lives which will be lost not due to coronavirus infection. Methodology: The data was searched from various governmental and non-governmental organisation sites including the World Health Organisation, United Nations, United Nations Population Fund, Guttmacher Institute and many PubMed indexed journals.


Asunto(s)
Anticoncepción , Infecciones por Coronavirus/epidemiología , Servicios de Planificación Familiar/organización & administración , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Neumonía Viral/epidemiología , Embarazo no Deseado , Betacoronavirus , Femenino , Humanos , Pandemias , Embarazo
8.
PLoS One ; 15(6): e0234474, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32525935

RESUMEN

INTRODUCTION: Ethiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children. METHODS: We used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance. RESULTS: Contraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0-55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use. CONCLUSION: Contraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Servicios de Planificación Familiar/organización & administración , Necesidades y Demandas de Servicios de Salud , Embarazo no Planeado , Adolescente , Adulto , Conducta Anticonceptiva/psicología , Estudios Transversales , Etiopía , Composición Familiar , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Islamismo/psicología , Persona de Mediana Edad , Embarazo , Factores Socioeconómicos , Adulto Joven
9.
PLoS One ; 15(6): e0234980, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32598371

RESUMEN

INTRODUCTION: Modern contraceptive use provides opportunities for women and couples to achieve optimal child spacing, achieve desired family size and reduce unsafe abortions. Despite these facts, modern contraceptive prevalence rate (mCPR) in Tanzania remains as low as 32%. This study aimed to determine trends and factors associated with changes in modern contraceptive use among women of reproductive age in Tanzania from 2004-2016. METHODOLOGY: This was a cross-sectional study utilizing data from Tanzania Demographic and Health Surveys of 2004-2005, 2010 and 2015-2016. Data analysis was performed using Stata version 14. Analysis considered the complex survey design through application of weights, clustering and strata. Multivariable Poisson decomposition analysis was used to assess factors associated with changes in modern contraceptive use. Results were presented in the form of decomposition coefficients and percentages. RESULTS: Modern contraceptive use increased from 23.0% in 2004 to 34.3% in 2016. Differences in women's characteristics contributed 12.5% of the increase in mCPR. These characteristics include partner's education levels, recent sexual activity and being visited by a family planning worker. The difference in coefficients contributed 87.5% increase in mCPR. The most increase in modern contraceptive use was attributed to rural population (44.1%) and women who experienced a termination of pregnancy (7.1%). CONCLUSION: Modern contraceptive use has steadily increased in Tanzania. Health policies and interventions need to target sexually active women, rural residents as well as less educated women and men to maintain and further accelerate the trends in mCPR. Interventions focusing on women who experienced a termination of pregnancy may also serve as an entry point to promote use of modern contraceptive methods.


Asunto(s)
Conducta Anticonceptiva/tendencias , Servicios de Planificación Familiar/tendencias , Población Rural/tendencias , Factores Socioeconómicos , Aborto Inducido/estadística & datos numéricos , Aborto Inducido/tendencias , Adolescente , Adulto , Conducta Anticonceptiva/psicología , Conducta Anticonceptiva/estadística & datos numéricos , Estudios Transversales , Países en Desarrollo/estadística & datos numéricos , Servicios de Planificación Familiar/organización & administración , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Política de Salud , Necesidades y Demandas de Servicios de Salud , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Embarazo , Población Rural/estadística & datos numéricos , Tanzanía , Adulto Joven
11.
Womens Health Issues ; 30(4): 268-276, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32376188

RESUMEN

BACKGROUND: The Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016-2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective. METHODS: An online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception. RESULTS: Of 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received. CONCLUSIONS: A contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.


Asunto(s)
Anticonceptivos/provisión & distribución , Consejo/métodos , Accesibilidad a los Servicios de Salud/organización & administración , Satisfacción del Paciente , Atención Dirigida al Paciente , Infección por el Virus Zika/prevención & control , Virus Zika , Adulto , Anticoncepción/métodos , Conducta Anticonceptiva , Brotes de Enfermedades/prevención & control , Servicios de Planificación Familiar/organización & administración , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Embarazo , Puerto Rico/epidemiología , Infección por el Virus Zika/epidemiología
13.
Reprod Health ; 17(1): 44, 2020 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-32245521

RESUMEN

BACKGROUND: Family planning (FP) is one of the high impact public health interventions with huge potential to enhance the health and wellbeing of women and children. Yet, despite the steady progress made towards expanding access to family planning, major disparities across different regions exist in Kenya. This study explored the socio cultural factors influencing FP use among two Muslim communities in Kenya. METHODS: A qualitative study involving Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) was conducted (from July to October 2018) in two predominant Muslim communities of Lamu and Wajir counties. Open ended questions explore key thematic areas around knowledge, attitudes and understanding of contraception, perceived FP barriers, and decision making for contraceptives, views on Islam and contraception, and fertility preference. All interviews were conducted in the local language, recorded, transcribed verbatim and translated into English. Data was analyzed using thematic content analyses. RESULTS: Although Islam is the predominant religion the two communities, perceptions and belief around FP use were varied. There were differing interpretations of Islamic teaching and counter arguments on whether or not Islam allows FP use. This, in addition to desire for a large family, polygamy, high child mortality and a cultural preference for boys had a negative impact on FP use. Similarly, inability of women to make decisions on their reproductive health was a factor influencing uptake of FP. CONCLUSION: Misinterpretation of Islamic teaching on contraception likely influences uptake of family planning. Cultural beliefs and lack of women's decision power on fertility preferences were a key inhibitor to FP use. Countering the negative notions of FP use requires active engagement of religious leaders and Muslim scholars who are in position of power and influence at community level.


Asunto(s)
Conducta Anticonceptiva , Anticoncepción/métodos , Servicios de Planificación Familiar/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Islamismo , Adolescente , Adulto , Conducta Anticonceptiva/etnología , Conducta Anticonceptiva/psicología , Cultura , Femenino , Grupos Focales , Humanos , Kenia , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Factores Socioeconómicos , Adulto Joven
14.
J Glob Health ; 10(1): 010705, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257163

RESUMEN

Background: There is ample evidence that gender norms affect contraceptive practice; however, data are mostly qualitative with limited geographical scope. We investigated that association quantitatively using collective community-level attitudes towards premarital sex and wife-beating as proxies for gender norms. Methods: Data came from nationally representative Demographic and Health Surveys (2005-2009) for women of reproductive age (15-49 years) in nine sub-Saharan African countries. Using multilevel logistic models, controlling for individual covariates and community-level indicators of women's empowerment, we assessed the community-level association of gender norms regarding premarital sex and wife-beating with individual contraception uptake and demand satisfied among fecund sexually active women. Norms were approximated as 'collective attitudinal norms' from female/male residents (aged 15-49 years) from the same community. We assessed the magnitude and significance of the community-level effects and attributed variance across communities. The same analysis was replicated for each country. Results: In a fully-adjusted model with a pooled sample of 24 404 adolescent women, the odds of contraception use increased with a 1 standard deviation (SD) increase in the variation of collective permissive attitudes towards premarital sex of female (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.02-1.15) and male (OR = 1.11, 95% CI = 1.05-1.17) peers (15-24 years), while odds of contraceptive use declined by 10% (OR = 0.90, 95% CI = 0.85-0.96) with collective accepting attitudes towards wife-beating of women aged 15-49 years. Similar results were found in separate models that controlled for adults' permissive attitudes towards premarital sex. The community-level attributed variance (V2 = 1.62, 95% CI = 1.45-1.80) represented 33% (intra-class correlation (ICC) = 33.0, 95% CI = 30.0-35.4) of the total variation of contraception use, and attitudes towards premarital sex and violence jointly explained nearly 26% of that V2 variance. The community-level shared of attributed variation of contraceptive use varied significantly across countries, from 3.5% in Swaziland (ICC = 3.5, 95% CI = 0.8-13.7) to 60.2% in Nigeria (OR = 60.2, 95% CI = 56.0-64.2). Conclusions: Overall, significant positive associations of collective permissive attitudes of both adolescent and adult women towards premarital sex were found for use of, and demand for, contraception, whereas collective accepting attitudes towards wife-beating were negatively associated with the use and demand for contraception. Ours is the first study to define quantitatively the influence of proxies for gender norms at the community level on women's family planning decisions. These findings offer new insights for understanding the role of sex-related attitudes and norms as important factors in shaping contraceptive practices and improving the effectiveness of family planning policies by targeting individuals as well as their groups of influence.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticonceptivos , Servicios de Planificación Familiar/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Maltrato Conyugal/psicología , Adolescente , Adulto , África del Sur del Sahara , Actitud , Conducta Anticonceptiva/etnología , Conducta Anticonceptiva/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducta Sexual , Adulto Joven
15.
PLoS One ; 15(3): e0227795, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32142517

RESUMEN

INTRODUCTION: All individuals and couples have a basic human right to decide freely and responsibly the number, spacing, and timing of their child. However, In Ethiopia, the prevalence of contraceptive utilization remains low and it varies in different regions. Therefore, this study was aimed to determine prevalence and determinant factors affecting the utilization of modern contraception in the reproductive age group (15-49 years) in Edaga-Hamus Town. METHODOLOGY: A community based Cross-Sectional study was carried out on April 23 to May 10, 2017. A systemic random sampling method was used to select study participants. Information was collected using a structured, pre-tested questionnaire. The data were entered into EPI-info version 7.1 and imported to SPSS version 20. Summary statistics and logistic regression analysis were performed using SPSS version 20. Those variables having a P-value of less than 0.2 in the bivariable analysis were fitted in multivariable analysis. AOR with 95% CI and P-value<0.05 were used during multivariable analysis to identify the factors associated with the utilization of modern in reproductive. RESULT: In this study the overall prevalence of modern contraceptive utilization was 58.5%. Age (AOR = 0.406,95%,Cl: (0.000,0.398)), Educational status (AOR = 0.901,95% Cl (0.340,4.107)), Feeling of husband towards Modern contraceptive (AOR = 0.186, 95% CI (0.056,0.617) had protective effect of utilization of modern contraceptive. But Number of children 1-3 and 4-5 wanted(AOR = 10.802,95%(4.027,28.975)), AOR = 2.624,95% CI (1.437,4.791), was a risk for utilization of modern contraceptive. CONCLUSION AND RECOMMENDATION: The prevalence of Modern contraceptive utilization was still to be low (far below the national target). Therefore, providing educational opportunities, creating awareness about contraception and effective counseling would increase modern contraceptive methods utilization.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/psicología , Servicios de Planificación Familiar/organización & administración , Esposos/psicología , Adolescente , Adulto , Anticoncepción/instrumentación , Anticoncepción/métodos , Anticoncepción/estadística & datos numéricos , Anticonceptivos , Dispositivos Anticonceptivos , Consejo/organización & administración , Estudios Transversales , Escolaridad , Etiopía , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Educación del Paciente como Asunto/organización & administración , Esposos/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto Joven
16.
Sex Reprod Health Matters ; 28(1): 1723321, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32178594

RESUMEN

In Africa, high discontinuation of contraceptive use is thwarting goals for healthy birth spacing or limiting childbearing. This paper investigates how well the contraception program is addressing the needs of women and couples in the Arusha region, Tanzania by studying contraceptive use continuation. We measured the overall and method-specific discontinuation rate, reasons for discontinuation, post-discontinuation reproductive behaviours/outcomes, and examined the determinants of contraceptive discontinuation. We used data from a household survey conducted in Arusha from January to May 2018. Information on contraceptive use during the 31 months preceding the survey was recorded in a monthly calendar. Using the single- and multiple-decrement life-table approach, we calculated the overall and cause-specific discontinuation of contraceptive methods. Logistic regression was used to evaluate the determinants of discontinuation. The 12-month overall discontinuation of contraceptive use was 44.6%. Discontinuation was lowest for implants (12.3%) and highest for male condoms (60.1%), the most common reason being side effects (11.7%). 59.8% of women who discontinued did not switch to another method within 3 months following discontinuation and 20.9% experienced pregnancy. Longer distance to a health facility is associated with higher discontinuation of hormonal methods such as injectables, but lower discontinuation of non-hormonal methods such as condoms. Discontinuation due to side effects is not explained by most of the women's background characteristics other than the method they used. Discontinuation of contraception is high among Arusha women. Effective contraception programs, especially improved counselling, need to address the reasons for the discontinuation of contraceptive use.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/métodos , Anticoncepción/estadística & datos numéricos , Anticonceptivos Femeninos/administración & dosificación , Servicios de Planificación Familiar/organización & administración , Accesibilidad a los Servicios de Salud , Cooperación del Paciente/estadística & datos numéricos , Adolescente , Adulto , Condones , Anticoncepción/psicología , Conducta Anticonceptiva/etnología , Conducta Anticonceptiva/psicología , Femenino , Humanos , Cooperación del Paciente/etnología , Cooperación del Paciente/psicología , Embarazo , Embarazo no Planeado , Embarazo no Deseado , Encuestas y Cuestionarios , Adulto Joven
18.
BMC Health Serv Res ; 20(1): 123, 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32066440

RESUMEN

BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV's knowledge through orientation on PPFP. METHODS: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. RESULTS: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. CONCLUSION: The orientation improved the FCHV's knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV's role in improving community-based PPFP services.


Asunto(s)
Agentes Comunitarios de Salud/educación , Servicios de Planificación Familiar/organización & administración , Servicios de Planificación Familiar/normas , Capacitación en Servicio , Periodo Posparto , Mejoramiento de la Calidad/organización & administración , Voluntarios/educación , Anticoncepción , Consejo/estadística & datos numéricos , Femenino , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Investigación sobre Servicios de Salud , Humanos , Dispositivos Intrauterinos/estadística & datos numéricos , Nepal , Investigación Cualitativa , Encuestas y Cuestionarios
19.
BMC Public Health ; 20(1): 265, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087705

RESUMEN

BACKGROUND: The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study. METHODS: We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically. RESULTS: In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita. CONCLUSIONS: These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.


Asunto(s)
Tasa de Natalidad/tendencias , África del Sur del Sahara , Mundo Árabe , Asia , Región del Caribe , Anticoncepción/estadística & datos numéricos , Escolaridad , Europa (Continente) , Servicios de Planificación Familiar/organización & administración , Femenino , Producto Interno Bruto/estadística & datos numéricos , Humanos , América Latina , Religión
20.
Am J Obstet Gynecol ; 222(4S): S915.e1-S915.e10, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31945337

RESUMEN

BACKGROUND: Zambia's total fertility rate (5 births per woman) and adult HIV prevalence (11.5%) are among the highest in the world, with heterosexual couples being the most affected group. Jointly counseling and testing couples for HIV has reduced up to 58% of new HIV infections in Zambian clinics. Married women using contraceptives in Zambia have a high (20%) unmet need for family planning and low (8.6%) uptake of cost-effective long-acting reversible contraceptives. We present an integrated counseling, testing, and family-planning program to prevent HIV and unplanned pregnancy in Zambia. OBJECTIVE: The objective of this study was to integrate effective HIV prevention and family-planning services for Zambian couples. STUDY DESIGN: A 3 year program (2013-2016) progressively integrated the promotion and provision of couples' voluntary HIV counseling and testing and long-acting reversible contraceptives. The program was based in 55 urban and 215 rural government clinics across 33 districts. In the first year, a couples' family-planning counseling training program was developed and combined with existing couples HIV counseling training materials. To avoid congestion during routine clinic hours, joint counseling services were initially provided on weekends, while nurses were trained in intrauterine device and hormonal implant insertion and removal during weekday family-planning services. Demand was created through mutual referral between weekend and weekday programs and by clinic staff, community health workers, and satisfied family-planning clients. When the bulk of integrated service training was completed, the program transitioned services to routine weekday clinic hours, ensuring access to same-day services. Performance indicators included number of staff trained, clients served, integrated service referrals, HIV infections averted, and unplanned pregnancies averted. RESULTS: A stepwise approach trained high-performing service providers to be trainers and used high-volume clinics for practicum training of the next generation. In total, 1201 (391 urban, 810 rural) counselors were trained and served 120,535 urban and 87,676 rural couples. In urban clinics, 236 nurses inserted 65,619 long-acting reversible contraceptives, while in rural clinics, 243 nurses inserted 35,703 implants and intrauterine devices. The program prevented an estimated 12,869 urban and 8279 rural adult HIV infections, and 98,626 unintended urban pregnancies. In the final year, the proportion of clients receiving joint counseling services on weekdays rose from 11% to 89%, with many referred from within clinics including HIV testing and treatment services (32%), outpatient department (31%), family planning (16%), and infant vaccination (15%). The largest group of clients requesting long-acting reversible contraceptives (45%) did so after joint fertility goal-based counseling, confirming the high impact of this couple-focused demand creation approach. Remaining family-planning clients responded to referrals from clinic nurses (34%), satisfied implant/intrauterine device users (13%), or community health workers (8%). CONCLUSION: Integrated HIV and unplanned pregnancy prevention can be implemented in low-resource public sector facilities. Combination services offered to couples mutually leverage HIV prevention and unplanned pregnancy prevention. The addition of long-acting reversible contraceptives is an important complement to the method mix available in government clinics. Demand creation in the clinic and in the community must be coordinated with a growing supply of well-trained providers.


Asunto(s)
Anticoncepción/métodos , Servicios de Planificación Familiar/organización & administración , Infecciones por VIH/prevención & control , Embarazo no Planeado , Esposos , Consejo/métodos , Prestación de Atención de Salud/organización & administración , Educación en Enfermería , Composición Familiar , Femenino , Infecciones por VIH/diagnóstico , Humanos , Capacitación en Servicio , Masculino , Enfermeras y Enfermeros , Embarazo , Derivación y Consulta , Población Rural , Formación del Profesorado , Población Urbana , Zambia
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