RESUMO
BACKGROUND: Despite their importance in reducing maternal mortality, information on access to Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited. METHODS: A standardized assessment tool measuring access to Mifepristone, Misoprostol, and contraceptive medicines included in the WHO essential medicines list (EML) was implemented in eight countries in the Eastern Mediterranean Region (Afghanistan, Iraq, Lebanon, Libya, Morocco, Palestine, Pakistan, and Somalia) between 2020-2021. The assessment focused on five access measures: 1) the inclusion of medicines in national family planning guidelines; 2) inclusion of medicines in comprehensive abortion care guidelines; 3) inclusion of medicines on national essential medicines lists; 4) medicines registration; and 5) procurement and forecasting of Mifepristone, Misoprostol, and contraceptive medicines. A descriptive analysis of findings from these eight national assessments was conducted. RESULTS: Only Lebanon and Pakistan included all 12 contraceptives that are enlisted in the WHO-EML within their national family planning guidelines. Only Afghanistan and Lebanon included mifepristone and mifepristone-misoprostol combination in post-abortion care guidelines, but these medicines were not included in their national EMLs. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLs-and registered-in six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan). However, only three countries procured misoprostol (Iraq, Morocco, and Somalia). CONCLUSION: These findings can guide efforts aimed at improving the availability of Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region. Opportunities include expanding national EMLs to include more options for Mifepristone, Misoprostol, and contraceptive medicines and strengthening the registration and procurement systems to ensure these medicines' availability were permitted under national law and where culturally acceptable.
Ensuring access to Mifepristone, Misoprostol, and contraceptive medicines is critical to improving women's health, and more specifically reducing maternal mortality and improving women's sexual and reproductive health in the Eastern Mediterranean Region.The aim of this study was to analyse findings from national assessments to capture information on the implementation of relevant policies and procedures. Those were the policies that ensure access to Mifepristone, Misoprostol, and contraceptive medicines in the public sector for the eight Eastern Mediterranean Region countries included in the study (Afghanistan, Iraq, Libya, Lebanon, Morocco, Palestine, Pakistan, and Somalia). The assessments were completed between 2020 and 2021.We found that most countries did not include all twelve contraceptives enlisted in the WHO essential medicines list (EML) in their national family planning guidelines. No country had developed a national abortion care guidelines nor included mifepristone (alone or in combination with misoprostol) on national EML. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLsand registeredin six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan) yet, only three countries procured misoprostol (Iraq, Morocco, and Somalia).Our findings provide evidence on system-level barriers to availability of Mifepristone, Misoprostol, and contraceptive medicines (e.g., lack of guidelines or inclusion on EML, lack of registration and procurement) that can support policy and advocacy efforts to strengthen the pharmaceutical sector to better ensure availability of Mifepristone, Misoprostol, and contraceptive medicines to women in reproductive age at the country-level in accordance with the national law and prevailing culture.
Assuntos
Acessibilidade aos Serviços de Saúde , Mifepristona , Misoprostol , Misoprostol/provisão & distribuição , Misoprostol/uso terapêutico , Humanos , Feminino , Mifepristona/provisão & distribuição , Mifepristona/administração & dosagem , Região do Mediterrâneo , Anticoncepcionais/provisão & distribuição , Oriente Médio , Aborto Induzido/estatística & dados numéricos , Aborto Induzido/métodos , Gravidez , Serviços de Planejamento Familiar/normasRESUMO
Introduction: The emigration of Venezuelans has seen a significant increase in recent years. The aim of this study was to identify factors associated with access to contraceptives in migrant women from Venezuela residing in Peru. Methods: An exploratory cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru. Access to contraceptives (yes/no) was established as the dependent variable. A Poisson regression model was performed for complex samples, and crude (PRc) and adjusted (PRa) prevalence ratios were reported. Results: A total of 3617 migrant women were analyzed, with 50.12% reporting access to contraceptives. Factors associated with greater access to contraceptives included being between 20 to 29 years old, having a university education, the entry period after the declaration of COVID-19 quarantine was associated with lower access to contraceptives. Conclusions: Access to contraceptives for Venezuelan migrants should be provided to all, as it is a free service in Peru. Additionally, education and family planning should be provided from the basic or middle school level to prevent unintended pregnancies in the future. Complete coverage should be provided regardless of the time of entry into Peru.
Assuntos
Acessibilidade aos Serviços de Saúde , Migrantes , Humanos , Feminino , Peru , Venezuela , Adulto , Estudos Transversais , Migrantes/estatística & dados numéricos , Adulto Jovem , Adolescente , COVID-19/epidemiologia , COVID-19/etnologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Anticoncepcionais/provisão & distribuição , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento FamiliarRESUMO
Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, P<.001) and 8% in Nigeria (aOR=0.92, P<.001) but increased by 15% in DRC (aOR=1.15; P=036) and 5% in Kenya (aOR=1.05, P=003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.
Assuntos
Anticoncepcionais , Humanos , Nigéria , Quênia , República Democrática do Congo , Índia , Burkina Faso , Anticoncepcionais/provisão & distribuição , Feminino , Serviços de Planejamento Familiar , AnticoncepçãoRESUMO
This Viewpoint argues that making a progestin-only contraceptive pill available for sale as an over-the-counter product will help reduce logistic barriers to safe and effective birth control.
Assuntos
Anticoncepcionais Orais , Equidade em Saúde , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Medicamentos sem Prescrição , Feminino , Humanos , Anticoncepção/métodos , Anticoncepcionais/provisão & distribuição , Anticoncepcionais Femininos/provisão & distribuição , Anticoncepcionais Orais/provisão & distribuição , Medicamentos sem Prescrição/provisão & distribuiçãoRESUMO
BACKGROUND: Youth ages 15 to 24, who comprise a large portion of sub-Saharan Africa, face a higher burden of unmet contraceptive need than adults. Despite increased international and national commitments to improving young people's access to contraception, significant barriers impede their access to a full range of methods. To further explore these barriers among youth in Kenya, Nigeria, and Uganda, we conducted a qualitative study to capture the challenges that affect contraceptive method decisionmaking and complicate youth access to the full method mix. METHODS: To understand factors that impact young people's contraceptive decisionmaking process across all three countries, we conducted a total of 35 focus group discussions with 171 youth ages 15 to 24 and 130 in-depth interviews with key stakeholders working in youth family planning. Questionnaires aligned with the High Impact Practices in Family Planning's elements of adolescent-friendly contraceptive services. Data were coded with MAXQDA and analyzed using a framework for contraceptive decisionmaking to identify relevant patterns and themes. RESULTS: In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms, complicating their ability to take full advantage of other available methods. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, and only a few youth reported that they are completely unable to access contraceptives, other barriers still present a major deterrent for youth, including cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers. CONCLUSIONS: Young people's ability to fully exercise their method choice remains limited despite availability of services, leading them to take the path of least resistance. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.
Despite increased international and national commitments to improving young people's access to contraception, youth ages 15 to 24 face significant barriers to accessing a full range of contraceptive methods. This study conducted in-depth interviews with key stakeholders and focus group discussions with youth in Kenya, Nigeria, and Uganda to understand what factors impact youth's decision to use or not use certain contraceptive methods. In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, other barriers like cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers still present a major deterrent for youth who want information on contraceptive methods. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.
Assuntos
Comportamento Contraceptivo , Anticoncepção , Anticoncepcionais/provisão & distribuição , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Adolescente , Adulto , Atenção à Saúde , Serviços de Planejamento Familiar , Feminino , Humanos , Quênia , Masculino , Nigéria , Pesquisa Qualitativa , Uganda , Incerteza , Adulto JovemRESUMO
BACKGROUND: Demand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs. MATERIALS AND METHODS: Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014-2018 was used. PMA2020 surveys are cross-sectional including women 15-49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15. RESULTS: Of the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15-19 and 45-49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0-13.8% over the 5-years, p<0.001. Married adolescent 15-19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7-79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9-37.2% and decrease in short acting methods from 49.9-42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence. CONCLUSIONS: Results show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.
Assuntos
Anticoncepcionais/provisão & distribuição , Serviços de Planejamento Familiar/tendências , Acessibilidade aos Serviços de Saúde/tendências , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Dispositivos Anticoncepcionais/provisão & distribuição , Estudos Transversais , Escolaridade , Características da Família , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Quênia , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Casamento , Pessoa de Meia-Idade , Satisfação Pessoal , População Rural , Educação Sexual , Fatores Socioeconômicos , Cônjuges/psicologiaRESUMO
OBJECTIVE: To understand how the COVID-19 pandemic affected women of reproductive age, specifically their economic conditions, desire for pregnancy, and access to contraceptive services during the pandemic. STUDY DESIGNS: A total of 554 women respondents age 18 to 49 and reside in the United States were recruited using social media between May 16, 2020 and June 16, 2020. Logistic regression models assessed predictors of reporting pandemic-related changes in economic conditions, desire for pregnancy, and contraceptive access. RESULTS: Compared to White/Caucasian respondents, Hispanics/Latinx and Black/African Americans have 4 times the odds of experiencing inability to afford food, transportation, and/or housing (p < 0.01) during the pandemic; Hispanics/Latinx have twice the odds of experiencing food insecurity (p < 0.05). Inability to afford food, transportation, and/or housing was associated with drop in desire to be pregnant (p < 0.01). Despite the 25% of participants who reported a drop in desire for pregnancy, 1 in 6 reported difficulty accessing contraceptives, particularly those who experienced reduced income (p < 0.01). CONCLUSIONS: In our sample, the pandemic unevenly affected people from different socioeconomic groups. Many simultaneously experienced reduced income, difficulties in accessing contraception, and a greater desire to avoid a pregnancy. This combination of factors increases the chance that people will experience unintended pregnancies. IMPLICATIONS: The pandemic caused economic hardship and an increased desire to postpone or prevent pregnancy at the same time that it created new barriers to contraceptive services. This pattern may lead to a potential net effect of an increase in unintended pregnancy, particularly among people who had difficulty affording food, transportation, and/or housing during the pandemic.
Assuntos
COVID-19/economia , Serviços de Planejamento Familiar/provisão & distribuição , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Intenção , Pobreza , Gravidez não Planejada , Gravidez/psicologia , Adolescente , Adulto , COVID-19/epidemiologia , Anticoncepcionais/provisão & distribuição , Economia , Etnicidade , Serviços de Planejamento Familiar/economia , Feminino , Acessibilidade aos Serviços de Saúde/economia , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Pandemias , Pobreza/economia , Pobreza/etnologia , Pobreza/psicologia , Gravidez/etnologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
La presente Guía para la provisión de métodos anticonceptivos en el subsistema público de salud de la ciudad de Buenos Aires propone pautas para los equipos y profesionales vinculados a la salud sexual y reproductiva de los hospitales y centros de salud y acción comunitaria que integran la red de cuidados progresivos. Aborda tres aspectos centrales: la población destinataria de los métodos, las prácticas previas que son indispensables para el uso de cada uno de ellos y la modalidad de provisión recomendada. Las definiciones sobre población destinataria, así como las prácticas previas indispensables, están basadas en los criterios de la Guía Práctica para el uso de métodos anticonceptivos del Ministerio de Salud de la Nación (Dirección de Salud Sexual y Reproductiva, 2019). La modalidad de provisión recomendada surge de decisiones técnico-políticas orientadas a mejorar el acceso y la adherencia a los métodos anticonceptivos, en particular a la anticoncepción hormonal de emergencia y los métodos de corta duración (pastillas e inyectables). Debido a la especificidad territorial que tiene la Guía, se han incluido aquellos métodos que forman parte de la canasta de disponible en el ámbito público porteño al momento de preparar este material. (AU)
Assuntos
Humanos , Masculino , Feminino , Educação Sexual/métodos , Educação Sexual/tendências , Anticoncepção/instrumentação , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Anticoncepcionais/provisão & distribuiçãoRESUMO
BACKGROUND: The private sector is playing an increasingly important role in family planning services globally. The active participation of private providers is associated with a higher contraceptive prevalence rate. OBJECTIVES: To examine the differentials and determinants of the utilization of private providers for family planning services. METHOD: This study used the 2014 Malaysian Population and Family Survey data. Cross-tabulations and logistic regression were performed on 1,817 current users of modern methods. RESULTS: Overall, 26% of modern method users obtained their supplies from private clinics/pharmacies and 15.2% from other sources, such as drug stores and sundry shops. The odds of utilizing the private sector for family planning services differ significantly across regions and socio-economic groups. The odds of obtaining supply from the private clinics/pharmacies were higher among the Chinese and urban women (AOR > 1), and it was lower among those from the eastern region (AOR = 0.47, 95% CI = 0.30-0.73). Non-Bumiputera, urban, higher educated, and working women, and those whose husbands decided on family planning had higher odds of obtaining the supply from the other sources (AOR > 1). CONCLUSION: The private sector complements and supplements the public sector in providing family planning services to the public.
Assuntos
Anticoncepção/métodos , Anticoncepcionais/provisão & distribuição , Serviços de Planejamento Familiar/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Setor Privado , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto , Comportamento Contraceptivo , Feminino , Humanos , Malásia , Pessoa de Meia-Idade , Características de Residência , População Rural , Educação Sexual , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
BACKGROUND: A remarkable decline in fertility rates has been observed in many countries, with a primary determinant being an increase in the use of contraceptives. However, the birth rate in Pakistan is still higher compared to the other countries of the region. Therefore, this study aims to assess the effect of demand- and supply-side factors associated with the use of contraceptive measures in Pakistan. METHODS: Secondary data analysis of four data series of the Pakistan Demographic and Health Surveys (PDHS 1990-1991, 2006-2007, 2012-2013 and 2017-2018) were used. The data includes ever-married women aged 15-49 years who had given birth in the previous five years and participated in the family planning module of the PDHS. A total of 25,318 women were included in the analysis. Data were analysed by investigating the associations between independent variables (demand- and supply-side factors) and the use of contraceptive measures through unadjusted odds ratios (OR) and adjusted OR (AOR). RESULTS: The results among demand-side factors indicated that in 2012-2013, women without media exposure were less likely to use contraceptives and the trend remains almost constant for 2017-2018 (AOR = 0.664, 95% CI 0.562-0.784) in 2012-2013 and (AOR = 0.654, 95% CI 0.483-0.885) in 2017-2018. However, they still show a lower likelihood of using contraceptives without media exposure. The results among supply-side factors indicated that absence of transport (2012-2013) and limited visits by family planning workers over the previous 12 months (2006-2007, 2012-2013 and 2017-2018) remained significant factors for not using contraceptive methods. CONCLUSIONS: The results of the study indicate that certain demand- and supply-side factors are associated with the use of contraceptive measures in Pakistan. It highlights the need for the provision of family planning resources and further structural factors, particularly in remote areas.
Assuntos
Anticoncepção , Anticoncepcionais , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/provisão & distribuição , Demografia , Serviços de Planejamento Familiar , Feminino , Humanos , Pessoa de Meia-Idade , Paquistão , Adulto JovemRESUMO
La enfermedad producida por el nuevo coronavirus SARS-CoV-2 se identificó por primera vez en diciembre de 2019 en la ciudad de Wuhan, en la República Popular China, y en pocos meses se convirtió en una pandemia. Desde el comienzo ha sido un desafío mundial, que amenazó la salud pública y obligó a tomar medidas estrictas de aislamiento social. Como consecuencia de la emergencia sanitaria se ha producido una reducción importante de la actividad asistencial, que puso en riesgo el acceso y la continuidad de los métodos anticonceptivos, exponiendo a mujeres a embarazos no intencionales. Los derechos sexuales y reproductivos resultan esenciales y deben garantizarse siempre. (AU)
The disease caused by the new coronavirus SARS-CoV-2 was identified for the first time in December 2019 in the city of Wuhan, in the People's Republic of China, and within a few months it became a pandemic. From the beginning, it has been a global challenge, threatening public health, having to take strict measures of social isolation. As a consequence of the health emergency, there has been a significant reduction in healthcare activity, putting access and continuity of contraceptive methods at risk, exposing women to unintended pregnancies. Sexual and reproductive rights are essential and must always be guaranteed. (AU)
Assuntos
Humanos , Feminino , Pneumonia Viral/complicações , Infecções por Coronavirus/complicações , Contracepção Hormonal/métodos , Pneumonia Viral/patologia , Gravidez não Desejada , Infecções por Coronavirus/patologia , Anticoncepcionais/administração & dosagem , Anticoncepcionais/classificação , Anticoncepcionais/provisão & distribuição , Direitos Sexuais e Reprodutivos , Coagulação Intravascular Disseminada/etiologia , Tromboembolia Venosa/etiologia , Pandemias , Betacoronavirus , Acessibilidade aos Serviços de SaúdeRESUMO
OBJECTIVE: In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. METHODS: Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. RESULTS: Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users. CONCLUSION: By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Adolescente , Adulto , Comportamento Contraceptivo/tendências , Anticoncepcionais/provisão & distribuição , Escolaridade , Empoderamento , Características da Família , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Parceiros Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: low levels of contraceptive use in Western Africa are responsible for high fertility rates, which limits economic development. The cost of modern contraceptives is a significant constraint, then the government of Burkina Faso has implemented free family planning. Given this new policy, we provided rural women with a healthcare voucher giving free access to modern contraceptives. We conducted an analysis of the determinants of good free voucher use in order to implement adequate government policy. METHODS: six months after the distribution of vouchers to women living in 30 villages in the Houet Province, we conducted a focus-group study based on individual in-depth health care provider interviews in partner healthcare centers. RESULTS: the benefits of family planning, free contraceptive use, husband's approval and moral obligation were factors facilitating voucher use. The desire to become pregnant, husband's opposition, women's reluctance, women's lack of knowledge of contraceptives and factors associated with the intervention were the leading reasons for not using the vouchers. CONCLUSION: the promotion of modern contraceptive use among married women or concubines requires a holistic approach combining free access to modern contraceptives, effective policies involving men in family planning and the reduction of fertility preferences among the couples.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/provisão & distribuição , Acessibilidade aos Serviços de Saúde , População Rural/estatística & dados numéricos , Adolescente , Adulto , Burkina Faso , Anticoncepcionais/economia , Serviços de Planejamento Familiar/economia , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Casamento , Cônjuges/psicologia , Adulto JovemRESUMO
The Zika Contraception Access Network (Z-CAN) program was a short-term emergency response intervention that used contraception to prevent unintended pregnancies to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak in Puerto Rico. The Centers for Disease Control and Prevention (CDC) reported that a collaborative and coordinated response was needed from governments and private-sector partners to improve access to contraception during the Zika outbreak in Puerto Rico. In response, the National Foundation for the CDC, with technical assistance from CDC, established the Z-CAN program, a network of 153-trained physicians, that provided client-centered contraceptive counseling and same-day access to the full range of the Food and Drug Administration-approved reversible contraceptive methods at no cost for women who chose to prevent pregnancy. From May 2016 to September 2017, 29,221 women received Z-CAN services. Through Z-CAN, public-private partnerships provided a broad range of opportunities for partners to come together to leverage technical expertise, experience, and resources to remove barriers to access contraception that neither the public nor the private sector could address alone. Public-private partnerships focused on three areas: (1) the coordination of efforts among federal and territorial agencies to align strategies, leverage resources, and address sustainability; (2) the mobilization of private partnerships to secure resources from private corporations, domestic philanthropic organizations, and nonprofit organizations for contraceptive methods, physician reimbursement, training and proctoring resources, infrastructure costs, and a health communications campaign; and (3) the engagement of key stakeholders to understand context and need, and to identify strategies to reach the target population. Public-private partnerships provided expertise, support, and awareness, and could be used to help guide programs to other settings for which access to contraception could improve health outcomes.
Assuntos
Anticoncepcionais/provisão & distribuição , Surtos de Doenças/prevenção & controle , Serviços de Planejamento Familiar/organização & administração , Programas Governamentais/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Parcerias Público-Privadas , Infecção por Zika virus/prevenção & controle , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Porto Rico/epidemiologia , Estados Unidos , Adulto Jovem , Zika virus , Infecção por Zika virus/epidemiologiaRESUMO
INTRODUCTION: Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. METHODS: Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15-24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. RESULTS: The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82-29.921], ranging from 11.30% [95% CI: 5.1-17.49] in Zimbabwe to 46.7% [95% CI: 36.92-56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12-1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20-1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81-0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20-24 [aOR = 0.74; CI = 0.70-0.77, p < 0.001], compared with 15-19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28-1.43, p < 0.001]. CONCLUSION: Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/provisão & distribuição , Serviços de Planejamento Familiar/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , África Subsaariana , Idoso , Comportamento Contraceptivo/etnologia , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Estado Civil , Avaliação das Necessidades , Gravidez , Prevalência , Saúde Pública , Saúde Reprodutiva , Adulto Jovem , ZimbábueRESUMO
DESIGN: This a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with implant utilization rates at 3 months post-enrollment. METHODS: In a region of rural Guatemala referred to as the Southwest Trifinio, twelve communities are served by a community-based antenatal and postnatal care program. The communities were combined into eight clusters based on 2017 birth rates and randomized to receive the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit. All participants receive comprehensive contraceptive counseling beginning at the first antenatal visit, so control clusters received this as part of routine care; this education preceded the study intervention. RESULTS: Once the 12 communities were combined into 8 clusters by expected birth volume and nurse team, which we expected to translate to eventual postpartum visits, the allocation sequence was generated in SAS. Of 208 women enrolled in the study, 108 were in four intervention and 100 in four control clusters. We used descriptive statistics to produce counts and percentages of characteristics of the study population overall and by intervention arm followed by univariate modeling using a mixed effects regression adjusted for cluster. Three-month contraceptive initiation rates were 56.0% in the control clusters compared to 76.8% in the intervention clusters, p < 0.001. Women in control clusters overwhelmingly opted for the injectable contraceptive (94.6%) while women in intervention clusters chose both the injection (61.5%) and the implant (33.7%), p < 0.001. Implant use by 3 months, the primary outcome of the study, was significantly higher in the intervention arm (25.9%) compared to the control arm (3.6%), p < 0.001, RR 1.3 CI [1.2, 1.4]. CONCLUSION: Our study was designed to respond to previously identified barriers to contraceptive uptake, and it was successful. Not only did it increase overall use of contraception by 3 months, but it shifted that contraceptive use away from short-acting methods in favor of longer-acting methods, with high continuation and satisfaction rates and no adverse outcomes reported. TRIAL REGISTRATION: clinicaltrials.gov , NCT04005391 ; Retrospectively Registered 7/2/2019.
Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Serviços de Planejamento Familiar/organização & administração , Acessibilidade aos Serviços de Saúde , Período Pós-Parto , Adulto , Anticoncepção/métodos , Anticoncepcionais/provisão & distribuição , Aconselhamento , Feminino , Guatemala , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Adulto JovemRESUMO
INTRODUCTION: Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. MATERIALS AND METHODS: Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. RESULTS: The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. CONCLUSION: This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/provisão & distribuição , Dispositivos Anticoncepcionais/provisão & distribuição , Serviços de Planejamento Familiar/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adolescente , África Subsaariana , Feminino , Inquéritos Epidemiológicos , Humanos , Estado Civil/estatística & dados numéricos , Análise Multinível/métodos , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Although community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention. METHODS: This was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n = 114), two with healthcare providers (n = 19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using a thematic analysis approach. RESULTS: Four thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C. programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting strategies that address structural failures, such as the feminisation of FP/C services and the lack FP/C services that are responsive to adolescent needs. CONCLUSIONS: Understanding and considering community members' and healthcare providers' views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.