Exploration of modern contraceptive methods using patterns among later reproductive-aged women in Bangladesh.

BACKGROUND: With the rapid increase in the number of women in their later reproductive years (aged 35 and above) in the present decade, the concern surrounding their contraceptive considerations has reached a critical point of importance. This study aims to examine the trends and determinants of modern contraceptive uptake among later reproductive-aged women in Bangladesh. METHODS: A total of 17,736 women aged 35 and above were included in the analysis, utilizing data from three consecutives Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017-18. The outcome variable was the uptake of modern contraceptive methods (yes or no). The explanatory variables encompassed survey years, individual characteristics of the women, as well as characteristics of their partners and the community. Multilevel logistic regression model was used to explore the association of the outcome variable with explanatory variables. RESULTS: We found that approximately 54% of women aged 35 and more do not use modern contraceptive methods, and there have been no significant shifts in their usage observed over the survey years. Compared to women aged 35-39, women aged 40-45 (aOR = 0.53, 95% CI: 0.49-0.57) and 45-49 (aOR = 0.24, 0.22-0.26) reported lower likelihoods of modern contraceptive method uptake. Higher education correlated with increased uptake of modern contraceptive methods (112%-142%), while partner's education showed a negative association. Later reproductive-aged women in richer (aOR = 0.83, 95% CI: 0.74-0.94) and richest (aOR = 0.76, 95% CI: 0.66-0.88) quintiles reported lower uptake of modern contraceptive methods compared to their counterparts in the poorest quintile. Later reproductive-aged women in Dhaka (aOR = 1.22, 95% CI: 1.07-1.38) and Rajshahi (aOR = 1.37, 95% CI: 1.19-1.59) regions had higher uptake of modern contraception than those residing in the Barishal division. Modern contraceptive methods uptake was 1.22 times higher among women who reported exposure to mass media and 1.19 times higher among women who reported engagement in paid work compared to among women who reported no exposure to mass media and participation in no formal work, respectively. Modern contraceptive methods uptake was 43% higher (aOR = 1.43, 95% CI: 1.32-1.55) in women with more than 2 children compared to those with ≤2 children. CONCLUSION: The study highlights no significant change in modern contraception uptake among later reproductive-aged women in Bangladesh. This raises concerns about the elevated risk of unintended pregnancies and shorter birth intervals, emphasizing the need for targeted interventions to address the specific needs and preferences of this demographic.

Evaluation of adherence to a daily progestin-only pill in a simulated over-the-counter setting.

OBJECTIVE: The Adherence with Continuous Dose Oral Contraceptive: Evaluation of Self-Selection and Use (ACCESS) study assessed whether consumers can adhere to the regimen for a progestin-only pill (norgestrel 0.075 mg) in an over-the-counter (OTC) setting. STUDY DESIGN: An actual use study in a simulated OTC environment assessed adherence to directions to take norgestrel 0.075 mg every day at the same time in 883 participants for up to 24 weeks. RESULTS: Eighty-five percent (747/883) of participants reported ≥85% adherence to taking norgestrel 0.075 mg every day and reported taking their dose within three hours of their scheduled dosing time on 96% of days. When accounting for use of a condom for 48 hours if a pill was missed, participants reported correctly following the label's directed use for 97% of doses overall, with 95% of participants following label directions for ≥85% of doses. The main limitations were related to finding a balance between intensely collecting data to ensure accurate assessment of adherence and leaving users to behave as they would in a real OTC situation without healthcare practitioner intervention. We observed that some participants reported taking more doses than they could have based on the supply of medication given to them. To fully examine the situation, and the impact on the conclusions, additional post hoc sensitivity analyses were performed, and showed remarkably consistent results. CONCLUSIONS: Consumers were highly adherent to taking norgestrel 0.075 mg when using only the information provided by the proposed OTC label. IMPLICATIONS: Adherence to a daily oral contraceptive pill was high when obtained OTC. This suggests that effectiveness of an OTC pill is likely to be like that of a prescribed pill and easier access to this effective contraceptive should allow more opportunity to prevent pregnancy.

Chronic and immediate refined carbohydrate consumption and facial attractiveness.

The Western diet has undergone a massive switch since the second half of the 20th century, with the massive increase of the consumption of refined carbohydrate associated with many adverse health effects. The physiological mechanisms linked to this consumption, such as hyperglycaemia and hyperinsulinemia, may impact non medical traits such as facial attractiveness. To explore this issue, the relationship between facial attractiveness and immediate and chronic refined carbohydrate consumption estimated by glycemic load was studied for 104 French subjects. Facial attractiveness was assessed by opposite sex raters using pictures taken two hours after a controlled breakfast. Chronic consumption was assessed considering three high glycemic risk meals: breakfast, afternoon snacking and between-meal snacking. Immediate consumption of a high glycemic breakfast decreased facial attractiveness for men and women while controlling for several control variables, including energy intake. Chronic refined carbohydrate consumption had different effects on attractiveness depending on the meal and/or the sex. Chronic refined carbohydrate consumption, estimated by the glycemic load, during the three studied meals reduced attractiveness, while a high energy intake increased it. Nevertheless, the effect was reversed for men concerning the afternoon snack, for which a high energy intake reduced attractiveness and a high glycemic load increased it. These effects were maintained when potential confounders for facial attractiveness were controlled such as age, age departure from actual age, masculinity/femininity (perceived and measured), BMI, physical activity, parental home ownership, smoking, couple status, hormonal contraceptive use (for women), and facial hairiness (for men). Results were possibly mediated by an increase in age appearance for women and a decrease in perceived masculinity for men. The physiological differences between the three meals studied and the interpretation of the results from an adaptive/maladaptive point of view in relation to our new dietary environment are discussed.

Chatbots That Deliver Contraceptive Support: Systematic Review.

BACKGROUND: A chatbot is a computer program that is designed to simulate conversation with humans. Chatbots may offer rapid, responsive, and private contraceptive information; counseling; and linkages to products and services, which could improve contraceptive knowledge, attitudes, and behaviors. OBJECTIVE: This review aimed to systematically collate and interpret evidence to determine whether and how chatbots improve contraceptive knowledge, attitudes, and behaviors. Contraceptive knowledge, attitudes, and behaviors include access to contraceptive information, understanding of contraceptive information, access to contraceptive services, contraceptive uptake, contraceptive continuation, and contraceptive communication or negotiation skills. A secondary aim of the review is to identify and summarize best practice recommendations for chatbot development to improve contraceptive outcomes, including the cost-effectiveness of chatbots where evidence is available. METHODS: We systematically searched peer-reviewed and gray literature (2010-2022) for papers that evaluated chatbots offering contraceptive information and services. Sources were included if they featured a chatbot and addressed an element of contraception, for example, uptake of hormonal contraceptives. Literature was assessed for methodological quality using appropriate quality assessment tools. Data were extracted from the included sources using a data extraction framework. A narrative synthesis approach was used to collate qualitative evidence as quantitative evidence was too sparse for a quantitative synthesis to be carried out. RESULTS: We identified 15 sources, including 8 original research papers and 7 gray literature papers. These sources included 16 unique chatbots. This review found the following evidence on the impact and efficacy of chatbots: a large, robust randomized controlled trial suggests that chatbots have no effect on intention to use contraception; a small, uncontrolled cohort study suggests increased uptake of contraception among adolescent girls; and a development report, using poor-quality methods, suggests no impact on improved access to services. There is also poor-quality evidence to suggest increased contraceptive knowledge from interacting with chatbot content. User engagement was mixed, with some chatbots reaching wide audiences and others reaching very small audiences. User feedback suggests that chatbots may be experienced as acceptable, convenient, anonymous, and private, but also as incompetent, inconvenient, and unsympathetic. The best practice guidance on the development of chatbots to improve contraceptive knowledge, attitudes, and behaviors is consistent with that in the literature on chatbots in other health care fields. CONCLUSIONS: We found limited and conflicting evidence on chatbots to improve contraceptive knowledge, attitudes, and behaviors. Further research that examines the impact of chatbot interventions in comparison with alternative technologies, acknowledges the varied and changing nature of chatbot interventions, and seeks to identify key features associated with improved contraceptive outcomes is needed. The limitations of this review include the limited evidence available on this topic, the lack of formal evaluation of chatbots in this field, and the lack of standardized definition of what a chatbot is.

Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries.

INTRODUCTION: Various countries in sub-Saharan Africa have taken divergent steps toward achieving the Sustainable Development Goal's target of universal access to sexual and reproductive health-care services by 2030, particularly among sexually active adolescent girls who are at risk of unplanned pregnancies and sexually transmitted infections. However, because contraceptive use among sexually active adolescents remains unexplored in sub-Saharan Africa, the researchers intended to examine the prevalence and factors associated with contraceptive use among adolescent girls who had been sexually active in the previous four weeks. MATERIALS AND METHODS: Cross-sectional data from the most recent demographic and health surveys of 25 sub-Saharan African countries on 16,442 sexually active adolescent girls were analyzed. In the analyses, descriptive statistics and multivariate binary logistic regression were used. Analyses were statistically significant at p<0.05. RESULTS: The overall prevalence of contraceptive use was 25.4%. Chad had the lowest prevalence (4%), while Namibia had the highest (60.5%). Over 90% of the countries studied had less than 50% contraceptive use among sexually active adolescent girls. Adolescent girls withhigher education were eight times more likely than those with no formal education to use contraception (aOR = 7.97, 95% Cl = 6.26-9.45). When compared to single adolescent girls, married adolescent girls were 66% less likely to use contraceptives (aOR = 0.34, 95% Cl = 0.31-0.36). Adolescent girls with two or more children were seven times more likely than those without a child to use contraceptives (aOR = 6.91, 95% Cl = 5.58-8.56). CONCLUSION: It is established that there exists a low prevalence of contraceptive use among adolescent girls in sub-Saharan Africa. As countries in the sub-region strive for universal access to reproductive health services, it is critical for the governments and civil societies in countries with low contraceptive use to strengthen mass education on the use of contraception among sexually active adolescents, with special emphasis on the less educated, married, and adolescent girls from poor households.

Contraceptive counseling, method satisfaction, and planned method continuation among women in the U.S. southeast.

OBJECTIVES: We used the validated Person-Centered Contraceptive Counseling (PCCC) scale to examine experiences with counseling and associations between counseling quality, method satisfaction, and planned method continuation at the population level in two southeastern states. STUDY DESIGN: We used data from the Statewide Survey of Women, a probability-based sample of reproductive-aged women in Alabama and South Carolina in 2017/18. We included women using a contraceptive method and reporting a contraceptive visit in the past year (n = 1265). Respondents rated their most recent provider experience across four PCCC items. Regression analyses examined relationships between counseling quality and outcomes of interest, and path analysis examined the extent to which method satisfaction mediated the effects of counseling quality on planned continuation. RESULTS: Over half of participants (54%) reported optimal contraceptive counseling. Optimal counseling was associated with method satisfaction (aPR = 1.16; 95% confidence interval (CI) = 1.04-1.29) in adjusted models. Optimal counseling was marginally associated with planned discontinuation in the bivariate analysis but was attenuated in the adjusted model (aPR = 1.07; 95% CI = 0.98-1.18). In the path analysis, counseling quality influenced method satisfaction (0.143 (0.045), p = 0.001) which influenced planned continuation, controlling for PCCC (0.74 (0.07), p < 0.001). The total indirect effect of counseling quality on planned continuation was significant (0.106 (0.03), p = 0.001), and a residual direct effect from counseling quality to planned continuation was noted (0.106 (0.03), p = 0.001). CONCLUSIONS: Counseling quality is independently associated with method satisfaction at the population level. The effect of counseling on planned continuation is partially mediated by method satisfaction. IMPLICATIONS: Interventions to support person-centered contraceptive counseling promise to improve quality of care, patient experience with care, and reproductive outcomes.

Development and evaluation of measures to assess self-determination in peripartum contraceptive decision-making.

OBJECTIVES: We aimed to adapt and validate person-centered measures to evaluate various contributors to self-determination in perinatal contraceptive decision-making. STUDY DESIGN: We developed and administered four scales adapted from existing measures in the context of Self-Determination Theory: the Treatment Self-Regulation Questionnaire (TSRQ), Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire. The TSRQ consists of three subscales: autonomous motivation, controlled motivation, and amotivation. We recruited a nonprobability convenience sample of 300 hospitalized postpartum patients in Baltimore, MD, between 2015 and 2016 and administered surveys in English and Spanish. We validated the scales with Cronbach's alpha coefficients, confirmatory factor analysis, and invariance analysis. We examined construct validity by testing correlations between the scales and other person-centered measures, such as satisfaction with counseling. RESULTS: Cronbach's alpha was >0.8 except for the amotivation subscale. Confirmatory factor analysis was adequate for all scales. Autonomous motivation correlated positively and significantly with perceived competence, health care provider autonomy support, important other autonomy support, and other measures of patient satisfaction. CONCLUSIONS: We found the four scales to be internally consistent and valid except for the amotivation subscale. We recommend using the autonomous motivation subscale in place of the full TSRQ. The autonomous motivation subscale, Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire showed adequate internal consistency, construct validity, and adherence to the expected conceptual structure of the scales. IMPLICATIONS: Autonomous decision-making is central to ethics and quality of care, especially for contraceptive methods that require a provider for initiation or discontinuation and at more vulnerable times, such as postpartum and postabortion. These scales may help tailor person-centered and autonomy-supportive interventions and programs to improve contraceptive counseling and care delivery.

Contraception use and satisfaction among mothers with low income: Evidence from the Baby's First Years study.

OBJECTIVES: Low income can lead to limited choice of and access to contraception. We examine whether an unconditional cash transfer (UCT) impacts contraceptive use, including increased satisfaction with and reduced barriers to preferred methods, for individuals with low income. STUDY DESIGN: Baby's First Years is a randomized control study of a monthly UCT to families with low incomes. The study enrolled 1000 mothers at the time of childbirth across four US sites in 2018-2019; 400 were randomized to receive a UCT of $333/mo and 600 were randomized to receive $20/mo for the first years of their child's life. We use intent-to-treat analyses to estimate the impact of the cash transfer on contraception use, satisfaction with contraception method, and barriers to using methods of choice. RESULTS: Over 65% of mothers reported using some type of contraception, and three-quarters reported using the method of their choice. We find no impact of the UCT on mothers' choice of, satisfaction with, or barriers to contraception. However, the cash transfer was associated with trends toward using multiple methods and greater use of short-term hormonal methods. CONCLUSIONS: We find high levels of satisfaction with current contraceptive use among mothers of young children with low income. Receipt of monthly UCTs did not impact contraception methods, perceived barriers to use, or satisfaction. Yet, 25% were not using the method of their choice, despite the provision of cash, indicating that this cash amount alone may not be sufficient to impact contraceptive use or increase satisfaction. IMPLICATIONS: Satisfaction with contraception use among low-income populations may be higher than previously documented. Nevertheless, provision of modest financial resources alone may not sufficiently address access, availability, and satisfaction for individuals with low-incomes of childbearing age. This suggests the importance of exploring how other nonfinancial factors influence reproductive autonomy, including contraceptive use.

Nonhormonal Male Contraceptive Development-Strategies for Progress.

Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.

Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study.

BACKGROUND: People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user's fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users' preferences and needs. OBJECTIVE: We examined the user experience offered by Natural Cycles-the first digital contraceptive-through an analysis of app reviews written by its users worldwide. METHODS: We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis. RESULTS: For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines. CONCLUSIONS: Digital contraception is experienced by users as a tamed natural approach-a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as "natural," which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception.

Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi.

Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.

The status of person-centered contraceptive care in the United States: Results from a nationally representative sample.

CONTEXT: The Person-Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person-centered contraceptive care. METHODS: Among 2228 women from the 2017-2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores. RESULTS: PCCC scores were high ( x ¯ : 17.84, CI: 17.59-18.08 on a 4-20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non-Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non-Hispanic white identity (B = -1.232 [-1.970, -0.493]; B = -0.792 [-1.411, -0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = -0.673 [-1.243, -0.103]). PCCC scores had a positive association with incomes of 150%-299% and ≥300% of the federal poverty level compared to those of income <150% (150%-299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = -0.542 [-0.971, -0.113]). CONCLUSIONS: The PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements.

Brief report: Influence of mandatory contraceptive education emphasizing long-acting reversible methods on continuation rates among military recruits.

OBJECTIVES: Determine if the replacement of patient-initiated, individual contraceptive education with mandatory group contraceptive education, during US Navy basic training, was associated with decreased LARC continuation. STUDY DESIGN: Secondary analysis of administrative billing data from female military recruits who began basic training between September 2012 and February 2020. RESULTS: Servicewomen who started LARC method during rather than after basic training had higher continuation rates. Servicewomen who started training before the implementation of mandatory group education had higher IUD continuation than those trained after. CONCLUSIONS: Implementation of mandatory group contraceptive education during basic training was not associated with a decline in LARC continuation.

Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study.

BACKGROUND: Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes. METHODS: We examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use. RESULTS: Median participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods. CONCLUSIONS: A high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.

Individual and community-level factors associated with discrimination among women aged 15-49 years in Bangladesh: Evidence based on multiple indicator cluster survey.

BACKGROUND: This research aimed to examine the factors at both the individual and community levels that are linked to discrimination experienced by women aged 15-49 in Bangladesh. METHODS: The relevant data was taken from the 2019 Multiple Indicator Cluster Survey in Bangladesh. The risk factors for discrimination against women in Bangladesh were determined using multilevel logistic regression models. RESULTS: The overall prevalence of discrimination against women was found to be 10.4% (95% CI: 10.1-10.6). Based on the final model (Model 1V), at the individual level higher odds of discrimination were observed among women from poor (AOR:1.21,95%CI: 1.12-1.32) and middle income households (AOR:1.12, 95%CI:1.02-1.22) compared to those from rich households etc. Women who have never used ICT were 1.27 times (AOR = 1.27, 95% CI = 1.07-1.51) higher odds of discrimination when compared with women who were ICT exposed. Respondents who married before 18 years 10% more likely to (AOR = 1.10, 95% CI:1.02-1.19) discriminated than women married aged 18 years old or above. Women from urban communities were 15% less likely to experience discrimination than their rural counterparts. In comparison to the Sylhet Division, women in the Barisal, Chattogram, Dhaka, Khulna Mymensingh, Rajshahi, and Rangpur Divisions were respectively 3.02, 1.84, 1.68, 2.06, 4.97, 4.06, and 1.74 times more likely to experience discrimination. CONCLUSION: Findings revealed that various individual-level factors such as wealth index, CEB, ICT exposure, marital status, functional difficulty, age, women's happiness, magazine and radio exposure, age at marriage, current contraceptive use, polygamy, husband beating, place of attack, and household head age were found to have a significant association with women discrimination. Community-level factors such as residence and division were also found to have a notable impact on discrimination. Policymakers should incorporate substantial components targeting both individual and community levels into intervention programs with the goal of raising awareness about women's discrimination.

Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria.

BACKGROUND: Patent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage. Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria. METHODS: This was a qualitative study guided by the UK Medical Research Council's Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015-2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software. RESULTS: The contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors' interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system. CONCLUSIONS: This study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions.

Relationship between history of hormonal contraceptive use and anaemia status among women in sub-Saharan Africa: A large population-based study.

BACKGROUND: Anaemia among women has been reported to be a significant contributor to hemorrhage, exacerbated risk of stillbirths, miscarriages, and maternal mortalities. Hence, understanding the factors associated with anaemia is imperative to develop preventive strategies. We examined the association between history of hormonal contraceptive use and risk of anaemia among women in sub-Saharan Africa. METHODS: We analyzed data from the recent Demographic and Health Surveys (DHS) of sixteen countries in sub-Saharan Africa. Countries with recent DHSs conducted from 2015 to 2020 were included in the study. A total of 88,474 women of reproductive age were included. We used percentages to summarize the prevalence of hormonal contraceptives and anaemia among women of reproductive age. We used multilevel binary logistic regression analysis to examine the association between hormonal contraceptives and anaemia. We presented the results using crude odds ratio (cOR) and adjusted odds ratios (aOR), with their respective 95 percent confidence intervals (95% CIs). RESULTS: On the average, 16.2% of women are using hormonal contraceptives and this ranged from 7.2% in Burundi to 37.7% in Zimbabwe. The pooled prevalence of anaemia was 41%, ranging from 13.5% in Rwanda to 58.0% in Benin. Women who used hormonal contraceptives were less likely to be anaemic compared to those who were not using hormonal contraceptives (aOR = 0.56; 95%CI = 0.53, 0.59). At the country-level, hormonal contraceptive use was associated with a reduced likelihood of anaemia in 14 countries, except for Cameroon and Guinea. CONCLUSION: The study underscores the importance of promoting the use of hormonal contraceptives in communities and regions that have a high burden of anaemia among women. Specifically, health promotion interventions aimed at promoting the use of hormonal contraceptives among women must be tailored to meet the needs of adolescents, multiparous women, those in the poorest wealth index, and women in union as these sub-populations were at significantly higher risk of anaemia in sub-Saharan Africa.

Factors facilitating the use of contraceptive methods among urban adolescents and youth in Guinea: a qualitative study.

BACKGROUND: The use of modern contraceptive methods among adolescents and youth is a public health priority to prevent unintended pregnancies. To our knowledge, no study has ever explored and documented factors promoting contraceptive use among urban adolescents and youth in Guinea. The objective of this study was to explore the factors that promote the use of contraceptive methods at the personal, interpersonal, community, and health system levels among urban adolescents and youth in Guinea. METHODS: We conducted a qualitative research study including twenty-six individual in-depth interviews among adolescents and youth, and 10 group interviews with an additional eighty individuals, for a total of 106 participants. The socio-ecological model was used to orient both data collection and analysis. Data were collected from June to October 2019. Both individual and group interviews were audio-recorded, and transcribed verbatims afterwards. Data was analyzed thematically, using deductive codes. RESULTS: The individual factors favoring contraceptive use among adolescents and youth pertained to perceived benefits of the methods (e.g., discretion, absence of side effects, duration of action, ease of use), knowledge of the family planning service channels, and means to afford the cost of the method. The interpersonal factors were spouse/sexual partner approval, and peer suggestions about contraceptive methods. The community factors included socio-cultural beliefs about the methods, and community expectation not to get pregnant before marriage. The health system factors included access to free contraceptive methods, availability of methods, clinical competence and attitude of the health care provider to advise or administer methods, and proximity of family planning services to users' place of residence. CONCLUSIONS: This qualitative research shows that many adolescents and youth living in Conakry use a variety of contraceptive methods, whether modern, traditional Access to free or affordable methods, discretion of method use, proximity and availability of methods, and suggestions of methods by peers are factors that motivate adolescents and youth to use contraception. In order to optimally facilitate the use of modern contraception among adolescent and young urban Guineans, we recommend that: (1) adolescents and youth have access to public health strategies enabling them to learn about, obtain, and use methods in a way that allows them to remain discreet; (2) the use of modern contraceptive methods be promoted by peers; and (3) health care providers and peers be adequately trained to have accurate and up-to-date knowledge about the different contraceptive methods available, demonstrate clinical skills for teaching and for method placement (if applicable), and show appropriate attitudes toward this population. This knowledge can inform policies and programs to improve the use of effective contraceptive methods by adolescents and youth living in urban Guinea.

BACKGROUND: The use of Family planning (FP) among adolescents and youth is essential to prevent unintended pregnancies. The objective of this study was to understand the personal, interpersonal, community, and health system factors that encourage the use of FP among urban adolescents and youth in Guinea. METHODS: We conducted a qualitative study with adolescents and youth living in Conakry, Guinea. The study took place between June and October 2019. Data were collected through 26 individual in-depth interviews (IDIs), and 10 group interviews (FGDs). Both IDIs and FGDs were recorded and transcribed. Data was analyzed using the "thematic analysis" method. RESULTS: The personal factors favoring the use of FP among adolescents and youth were related to perceived benefits of FP, knowledge of the FP service availability, means to afford the cost of FP. The interpersonal factors included spouse/sexual partner approval and friends' suggestions about FP. The community factors included socio-cultural beliefs about the methods, and community expectations not to get pregnant before marriage. The health system factors pertained to access to free FP, availability of methods, clinical competence and attitude of the health care provider, and proximity of FP services to users' place of residence. CONCLUSIONS: This research shows that many adolescents and youth living in Conakry use a variety of contraceptive methods, whether modern (implant; intrauterine device; injectable; pills; condom; lactational and amenorrhea method), traditional (fixed-day method; abstinence; withdrawal method). In order to optimally facilitate the use of modern contraception among adolescent and young urban Guineans, we recommend that: (1) adolescents and youth have access to public health strategies enabling them to learn about, obtain, and use methods in a way that allows them to remain discreet; (2) the use of modern contraceptive methods be promoted by peers; and (3) health care providers and peers be adequately trained to have accurate and up-to-date knowledge about the different contraceptive methods that exist, demonstrate clinical skills for teaching and for method placement (if applicable), and show appropriate attitudes towards this population. This knowledge can inform FP programs to improve the use of effective contraceptive methods by adolescents and youth in urban Guinea.