Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative.

Importance: Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. Objective: To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. Design, Setting, and Participants: In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. Exposure: The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Main Outcomes and Measures: Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). Results: A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. Conclusions and Relevance: In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

Access to family planning services and associated factors among young people in Lira city northern Uganda.

BACKGROUND: Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. METHODS AND MATERIALS: A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15-24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. RESULTS: Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09-0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01-0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01-0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24-0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60-7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05-0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02-5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. CONCLUSION: The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda.

Reproductive care in Thai women with diabetes mellitus: a descriptive cross-sectional study.

BACKGROUND: Pre-existing diabetes mellitus (DM) is a challenging pregnancy complication as poor glycemic control is associated with adverse maternal and fetal outcomes. In this study, we aimed to investigate DM-related knowledge, attitudes, preconception care practices, and contraceptive prevalence in women with DM. METHODS: This descriptive cross-sectional survey was conducted among reproductive-aged Thai women receiving DM treatment at King Chulalongkorn Memorial Hospital between August 1, 2021, and June 30, 2022. Patients with DM who were not pregnant or trying to conceive and could be contacted via the phone were included and a validated self-administered questionnaire was distributed electronically. RESULTS: A total of 238 participants were included in the final analysis, yielding 69.4% response rates. The mean (standard deviation) score for knowledge of pregnancy planning and pregnancy-related risks was 6.8 (3.5) out of 15. Only about half of the participants had discussed pregnancy planning with their physicians. Multivariable analysis showed that younger age at DM diagnosis, non-Buddhism, married, higher education, and medical personnel were significantly associated with higher knowledge scores. Women aged > 45 years and those with higher practice scores had significantly higher adjusted odds of using highly effective contraception; the most common methods included male condoms and combined oral contraceptive pills. There was an unmet need for contraception in 9.5% of women with DM. CONCLUSIONS: Although highly effective contraception is safe for patients with DM, only about half of our participants used tier one or two contraceptives or had received consultation regarding preconception planning. There was a notable gap in care coordination among specialists; integrating reproductive healthcare into DM therapy would improve access to preconception care.

We aimed to study the knowledge, attitudes, preconception care practices, and contraceptive usage among women with diabetes mellitus (DM) who were of reproductive age. A survey was conducted among Thai women receiving DM treatment at a university hospital. The results showed that participants had limited knowledge about pregnancy planning and diabetic-related risks. Only half of them had discussed pregnancy planning with their doctors. Factors such as younger age at DM diagnosis, being non-Buddhism, being married, having higher education, and being medical personnel were associated with higher knowledge scores. Older women and those with better practice scores were more likely to use highly effective contraception. However, there was still a need for contraception in some women with DM. We concluded that there was a lack of integration between specialists in reproductive healthcare and DM therapy, and improving this coordination would enhance access to preconception care for women with DM.

Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors.

BACKGROUND: The unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria. METHODS: This cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05). RESULTS: Mean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40-49 years compared to the younger women in age group 20-29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14-1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63-2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women. CONCLUSIONS: A high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.

Key drivers of fertility levels and differentials in India, at the national, state and population subgroup levels, 2015-2016: An application of Bongaarts' proximate determinants model.

OBJECTIVES: The transition to small family size is at an advanced phase in India, with a national TFR of 2.2 in 2015-16. This paper examines the roles of four key determinants of fertility-marriage, contraception, abortion and postpartum infecundability-for India, all 29 states and population subgroups. METHODS: Data from the most recent available national survey, the National Family Health Survey, conducted in 2015-16, were used. The Bongaarts proximate determinants model was used to quantify the roles of the four key factors that largely determine fertility. Methodological contributions of this analysis are: adaptations of the model to the Indian context; measurement of the role of abortion; and provision of estimates for sub-groups nationally and by state: age, education, residence, wealth status and caste. RESULTS: Nationally, marriage is the most important determinant of the reduction in fertility from the biological maximum, contributing 36%, followed by contraception and abortion, contributing 24% and 23% respectively, and post-partum infecundability contributed 16%. This national pattern of contributions characterizes most states and subgroups. Abortion makes a larger contribution than contraception among young women and better educated women. Findings suggest that sterility and infertility play a greater than average role in Southern states; marriage practices in some Northeastern states; and male migration for less-educated women. The absence of stronger relationships between the key proximate fertility determinants and geography or socio-economic status suggests that as family size declined, the role of these determinants is increasingly homogenous. CONCLUSIONS: Findings argue for improvements across all states and subgroups, in provision of contraceptive care and safe abortion services, given the importance of these mechanisms for implementing fertility preferences. In-depth studies are needed to identify policy and program needs that depend on the barriers and vulnerabilities that exist in specific areas and population groups.

Four out of ten married women utilized modern contraceptive method in Ethiopia: A Multilevel analysis of the 2019 Ethiopia mini demographic and health survey.

BACKGROUND: Modern contraceptive method is a product or medical procedure that interferes with reproduction from acts of sexual intercourse. Globally in 2019, 44% of women of reproductive age were using a modern method of contraception but it was 29% in sub-Saharan Africa. Therefore, the main aim of this analysis was to assess the prevalence of modern contraceptive utilization and associated factors among married women in Ethiopia. METHOD: The current study used the 2019 Ethiopia mini demographic and health survey dataset. Both descriptive and multilevel mixed-effect logistic regression analysis were done using STATA version 14. A p-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were used to report statistically significant factors with modern contraceptive utilization. RESULT: The overall modern contraceptive utilization among married women in Ethiopia was 38.7% (95% CI: 37.3% to 40.0%). Among the modern contraceptive methods, injectables were the most widely utilized modern contraceptive method (22.82%) followed by implants (9.65%) and pills (2.71%). Maternal age, educational level, wealth index, number of living children, number of births in the last three years, number of under 5 children in the household, religion, and geographic region were independent predictors of modern contraceptive utilization. CONCLUSION: In the current study only four out of ten married non-pregnant women of reproductive age utilized modern contraceptive methods. Furthermore, the study has identified both individual and community-level factors that can affect the utilization of modern contraceptive methods by married women in the country. Therefore, concerned bodies need to improve access to reproductive health services, empower women through community-based approaches, and minimize region wise discrepancy to optimize the utilization.

Exploring the effects of programmatic intervention on family planning health literacy and contraceptive utilization in eastern Uganda.

Uganda Village Project (UVP) implemented the Healthy Village Initiative (HVI) and conducted household surveys to assess the effects of the initiative. This data adds to the limited body of knowledge regarding the efficacy of community health interventions for reproductive health in rural east Africa. As part of the HVI, UVP surveys rural Ugandan households before and after a 3-year programmatic intervention to assess changes in family planning health literacy, and contraception utilization. Results showed that there was an increase in contraceptive utilization, an increase in family planning health literacy, and a decrease in unmet need for contraception. Community-based outreaches led by community members and health workers can contribute to improving access to contraception, utilization of contraception, and health literacy surrounding contraception.

Determinants of the use of family planning methods among rural women in Plateau state, Nigeria.

This study aimed at determining the factors that influence family planning practice among rural women of Pankshin district in Plateau state, Nigeria. A cross-sectional study using a simple random sampling method was conducted from October to December 2019. A self-administered questionnaire was used for data collection among 302 respondents. Among respondents, 48.3% had practised family planning and the most popular family planning method ever practised was injectables (57.5%). The determinants of family planning practice were age group 29-39 and 40-49 years old (AOR=4.373, p <0.001; AOR=5.862, p <0.001), discussion with partner (AOR=9.192, p <0.001) and partner's approval (AOR=2.791, p=0.007). Findings showed an encouraging family planning prevalence with the main determinants involving male partners. Further efforts need to be made to promote family planning practice among male partners and to empower women of all reproductive age groups by providing them with relevant information that is needed for them to make informed decisions.

The Role of Subcutaneous Depot Medroxyprogesterone Acetate in Equitable Contraceptive Care: A Lesson From the Coronavirus Disease 2019 (COVID-19) Pandemic.

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, health care professionals have made swift accommodations to provide consistent and safe care, including emphasizing remote access to allow physical distancing. Depot medroxyprogesterone acetate intramuscular injection (DMPA-IM) prescription is typically administered by a health care professional, whereas DMPA-subcutaneous has the potential to be safely self-injected by patients, avoiding contact with a health care professional. However, DMPA-subcutaneous is rarely prescribed despite its U.S. Food and Drug Administration approval in 2004 and widespread coverage by both state Medicaid providers and many private insurers. Depot medroxyprogesterone acetate users are disproportionately non-White, and thus the restriction in DMPA-subcutaneous prescribing may both stem from and contribute to systemic racial health disparities. We review evidence on acceptability, safety, and continuation rates of DMPA-subcutaneous, consider sources of implicit bias that may impede prescription of this contraceptive method, and provide recommendations for implementing DMPA-subcutaneous prescribing.

Using family planning service statistics to inform model-based estimates of modern contraceptive prevalence.

The annual assessment of Family Planning (FP) indicators, such as the modern contraceptive prevalence rate (mCPR), is a key component of monitoring and evaluating goals of global FP programs and initiatives. To that end, the Family Planning Estimation Model (FPEM) was developed with the aim of producing survey-informed estimates and projections of mCPR and other key FP indictors over time. With large-scale surveys being carried out on average every 3-5 years, data gaps since the most recent survey often exceed one year. As a result, survey-based estimates for the current year from FPEM are often based on projections that carry a larger uncertainty than data informed estimates. In order to bridge recent data gaps we consider the use of a measure, termed Estimated Modern Use (EMU), which has been derived from routinely collected family planning service statistics. However, EMU data come with known limitations, namely measurement errors which result in biases and additional variation with respect to survey-based estimates of mCPR. Here we present a data model for the incorporation of EMU data into FPEM, which accounts for these limitations. Based on known biases, we assume that only changes in EMU can inform FPEM estimates, while also taking inherent variation into account. The addition of this EMU data model to FPEM allows us to provide a secondary data source for informing and reducing uncertainty in current estimates of mCPR. We present model validations using a survey-only model as a baseline comparison and we illustrate the impact of including the EMU data model in FPEM. Results show that the inclusion of EMU data can change point-estimates of mCPR by up to 6.7 percentage points compared to using surveys only. Observed reductions in uncertainty were modest, with the width of uncertainty intervals being reduced by up to 2.7 percentage points.

Prevalence and factors associated with family planning during COVID-19 pandemic in Bangladesh: A cross-sectional study.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has negatively impacted health systems worldwide, including in Bangladesh, limiting access to family planning information (FP) and services. Unfortunately, the evidence on the factors linked to such disruption is limited, and no study has addressed the link among Bangladeshis. This study aimed to examine the socioeconomic, demographic, and other critical factors linked to the use of FP in the studied areas during the COVID-19 pandemic. METHODS: The characteristics of the respondents were assessed using a cross-sectional questionnaire survey and descriptive statistics. The variables that were substantially linked with FP usage were identified using a Chi-square test. In addition, a multivariate logistic regression model was used to identify the parameters linked to FP in the study areas during the COVID-19 pandemic. RESULTS: The prevalence of FP use among currently married 15-49 years aged women was 36.03% suggesting a 23% (approximately) decrease compared to before pandemic data. Results also showed that 24.42% of the respondents were using oral contraceptive pills (OCP) which is lower than before pandemic data (61.7%). Multivariate regression analysis provided broader insight into the factors affecting FP use. Results showed that woman's age, education level of the respondents, working status of the household head, locality, reading a newspaper, FP workers' advice, currently using OCP, ever used OCP, husbands' supportive attitude towards OCP use, duration of the marriage, ever pregnant, the number of children and dead child were significantly associated with FP use in the study areas during COVID-19 pandemic. CONCLUSIONS: This study discusses unobserved factors that contributed to a reduction in FP use and identifies impediments to FP use in Bangladesh during the COVID-19 epidemic. This research further adds to our understanding of FP usage by revealing the scope of the COVID-19 pandemic's impact on FP use in Bangladesh's rural and urban areas.

Factors influencing the use of modern contraception among reproductive aged women in Bangka Belitung Province, Indonesia.

INTRODUCTION: contraceptives in family planning are used to control the timings between pregnancies. Although the number of those using family planning has increased, determinants of contraceptive use among women in Indonesia remain insufficient. This research aimed to identify the factors associated with contraceptive use among reproductive aged women in Bangka Belitung Province. METHODS: this study employed data from the Indonesian demographic and health survey (IDHS) 2017. The selected respondents were 768 women aged 15-49 years. Then, the determinants of contraceptive use among women were examined by multinomial logistic regression. RESULTS: women's aged 15-49 years (adjusted Odds Ratio (aOR) =8.955; 95% CI=3.573-22.439), level of education (aOR=2.017; 95% CI=1.053-3.862), the number of children (aOR=1.207; 95% CI=0.498-2.926), residential location (aOR=0.877; 95% CI=0.601-1.282), wealth index (aOR=2.23; 95% CI=0.953-5.218), visited health facilities (aOR=1.683; 95% CI=1.174-2.412), knowledge of contraceptive method (aOR=2.043; 95% CI=2.043-2.043) were significantly associated with contraceptive use among reproductive age women. CONCLUSION: factors such as women's age, education, number of living children, area of residence, wealth index, knowledge, and visits to health facilities were still considered significant issues in determining contraceptive use among reproductive-age women in Bangka Belitung Province.

Association of Expanded Prenatal Care Coverage for Immigrant Women With Postpartum Contraception and Short Interpregnancy Interval Births.

Importance: Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective: To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. Design, Setting, and Participants: This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage for women whose births were covered by Emergency Medicaid and subsequent short IPI births. Additional maternal and infant health outcomes were also examined, including postpartum contraceptive use, preterm birth, and neonatal intensive care unit admission. The association between the policy change and measures of policy implementation (number of prenatal visits) and quality of care (receipt of 8 guideline-based screenings) was also analyzed. Statistical analysis was performed from August 2020 to March 2021. Exposures: Medicaid coverage of prenatal care. Main Outcomes and Measures: Postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery; short IPI births, defined as occurring within 18 months of a previous pregnancy. Results: The study population consisted of 26 586 births to women enrolled in Emergency Medicaid in Oregon and South Carolina. Among these women, 14 749 (55.5%) were aged 25 to 35 years, 25 894 (97.4%) were Black, Hispanic, Native American, Alaskan, Pacific Islander, or Asian women or women with unknown race/ethnicity, and 17 905 (67.3%) lived in areas with urban zip codes. Coverage of prenatal care for women in Emergency Medicaid was associated with significant increases in mean (SD) prenatal visits (increase of 10.3 [0.9] prenatal visits) and prenatal quality. Prenatal care screenings (eg, anemia screening: increase of 65.7 percentage points [95% CI, 54.2 to 77.1 percentage points]) and vaccinations (eg, influenza vaccination: increase of 31.9 percentage points [95% CI, 27.4 to 36.3 percentage points]) increased significantly following the policy change. Although postpartum contraceptive use increased following prenatal care expansion (increase of 1.5 percentage points [95% CI, 0.4 to 2.6 percentage points]), the policy change was not associated with a reduction in short IPI births (-4.5 percentage points [95% CI, -9.5 to 0.5 percentage points), preterm births (-0.6 percentage points [95% CI, -3.2 to 2.0 percentage points]), or neonatal intensive care unit admissions (increase of 0.8 percentage points [95% CI, -2.0 to 3.6 percentage points]). Conclusions and Relevance: This study found that expanding Emergency Medicaid benefits to include prenatal care significantly improved receipt of guideline-concordant prenatal care. Prenatal care coverage alone was not associated with a meaningful increase in postpartum contraception or a reduction in subsequent short IPI births.

Unmet need for family planning among reproductive-age women living with HIV in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Closing the gap of unmet for family planning is crucial to eliminate new pediatric HIV infections likewise to improve maternal and child health among reproductive-age women living with HIV. However, studies conducted on unmet need for family planning among reproductive-age women living with HIV showed inconsistent and non-conclusive findings on the magnitude of the problem. Moreover, there was no meta-analysis conducted in this area. So this systematic review and meta-analysis were conducted to estimate the pooled prevalence unmet need for family planning among reproductive-age women living with HIV in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review both published and unpublished studies in Ethiopia. All studies in PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health databases were searched. Meta-analysis was performed using STATA 14 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger regression asymmetry test, respectively. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI). RESULTS: This review included 7 studies, and 3333 study participants. The pooled prevalence of unmet need for family planning among reproductive-age women living with HIV in Ethiopia was 25.13% (95%CI: 19.97, 30.29). The pooled prevalence of unmet need for spacing and limiting was 13.91% (95%CI: 10.11, 17.72) and 9.11% (95%CI: 6.43, 11.78), respectively. CONCLUSIONS: One-fourths of reproductive-age women living with HIV had an unmet need for family planning. A variety of programmatic investments are needed to achieve more meaningful progress toward the reduction of unmet need for family planning among reproductive-age women living with HIV.

A comparative analysis of the availability of family planning services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya.

INTRODUCTION: this study assessed the availability of family planning (FP) services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya. Social franchises refer to a standardized delivery model of engaging private health facilities under a common brand name or contractual arrangement. METHODS: this was a facility-based mixed-method approach. Quantitative data was collected through 581 FP client exit interviews and a facility inventory in 32 health facilities. Association between the clients' characteristics and use of FP services was tested using univariable and multivariable logistic regression. Qualitative data were collected through five focus group discussions with FP clients and 16 key informant interviews with service providers and analysed through thematic analysis. RESULTS: the findings show that FP methods availability was the same across all facilities (p = 0.206). The findings were supported by views from the clients who indicated that contraceptives were available. Statistically significant predictors of FP use were found to be women's age group 20-24 years (Adjusted Odds Ratio (AOR) = 2.30, 95% Confidence Interval (CI): 1.12, 4.69) or 25 to 34 years (AOR = 2.10, 95% CI: 1.86, 2.36) versus the 15-19 years and the clients with tertiary level education and above compared primary level education and below (AOR = 0.020, 95% CI: 1.13, 4.41). CONCLUSION: this study demonstrates the need to support all private health facilities with policies and supplies to expand access to all FP services, especially for adolescents.

Integration of family planning services into HIV services in Nigeria: Evidence from the Performance Monitoring and Accountability 2020 survey in seven states.

Despite global calls for stronger linkages between family planning and HIV, a growing body of evidence in sub-Saharan Africa suggests that the integration of family planning and HIV service delivery is suboptimal in some countries. In this study, we assess the integration and quality of family planning services in health facilities that provide HIV-related services in Nigeria. This study analysed secondary data from the Performance Monitoring and Accountability 2020 cross-sectional survey conducted between May and July 2016 in seven states in Nigeria. Our study sample was restricted to 290 health facilities providing HIV services. We performed descriptive statistics and binary logistic regression analyses. Ninety-five per cent of the health facilities reported offering family planning counselling, provision of family planning methods, and/or referral for family planning methods to clients accessing HIV services. About 84% of these health facilities with integrated family planning and HIV services reported that they discussed the preferred method, dual methods, instructions and side effects of the chosen method, and the reproductive intentions with clients during an HIV consultation. None of the health facilities' characteristics was significantly associated with the integration of family planning services into HIV services. Private health facilities (aOR 0.3, 95% CI 0.07-0.92), urban health facilities (aOR 3.8, 95% CI 1.64-8.76), and provision of postnatal care (aOR 3.9, 95% CI 1.10-13.74) were statistically associated with the quality of family planning services provided to clients accessing HIV services. Family planning services were integrated into HIV services in a majority of the health facilities in our study. However, our findings indicate the need for improvement in the quality of family planning services provided to clients accessing HIV services.

Individual/Household and Community-Level Factors Associated with Child Marriage in Mali: Evidence from Demographic and Health Survey.

BACKGROUND: Child marriage is a major public health problem globally, and the prevalence remains high in sub-Saharan African countries, including Mali. There is a dearth of evidence about factors associated with child marriage in Mali. Hence, this studyaimed at investigating the individual/household and community-level factors associated with child marriage among women in Mali. METHODS: Using data from the 2018 Mali Demographic and Health Survey, analysis was done on 8,350 women aged 18-49 years. A Chi-square test was used to select candidate variables for the multilevel multivariable logistic regression models. Fixed effects results weree xpressed as adjusted odds ratios (aOR) at 95% confidence intervals (CI). Stata version 14 software was used for the analysis. RESULTS: The results showed that 58.2% (95% CI; 56.3%-60.0%) and 20.3% (95%; 19.0%-21.6%) of women aged 18-49 years were married before their 18th and 15th birthday, respectively. Educational status of women (higher education: aOR = 0.25, 95% CI; 0.14-0.44), their partner's/husband's educational status (higher education: aOR = 0.64, 95% CI; 0.47-0.87), women's occupation (professional, technical, or managerial: aOR = 0.50, 95% CI; 0.33-0.77), family size (five and above: aOR = 1.16, 95% CI; 1.03-1.30), and ethnicity (Senoufo/Minianka: aOR = 0.73, 95% CI; 0.58-0.92) were the identified individual/household level factors associated with child marriage, whereas region (Mopti: aOR = 0.27, 95% CI; 0.19-0.39) was the community level factor associated with child marriage. CONCLUSIONS: This study has revealed a high prevalence of child marriage in Mali. To reduce the magnitude of child marriage in Mali, enhancing policies and programs that promote education for both girls and boys, creating employment opportunities, improving the utilization of family planning services, and sensitizing girls and parents who live in regions such as Kayes on the negative effects of child marriage is essential. Moreover, working with community leaders so as to reduce child marriage in the Bambara ethnic communities would also be beneficial.

Mass media exposure and use of reversible modern contraceptives among married women in India: An analysis of the NFHS 2015-16 data.

Since the inception of the National Programme for Family Planning, messages on family planning (FP) have been promoted across India using different mass media platforms. Mass media plays an important role in disseminating important information among the masses, such as how reversible modern methods give women more reproductive choices than opting for permanent methods that limit their child-bearing capacity. Mass media can provide a continuous flow of information and motivation to deter women from discontinuing the methods they have opted for. However, very few studies have been conducted on this issue, especially using recently available data. This study particularly focuses on exposure to mass media and the use of reversible modern methods of family planning among married women in India. The data for this study was obtained from the National Family Health Survey (2015-16) on currently married women aged 15-49 years. The association of reversible modern method use with media exposure variables was examined, controlling for a set of independent variables from multiple levels-individual, district, state, and region. The findings from this study showed that television was the most important medium for disseminating information on FP among married women in India. Spatial analysis revealed that some districts in the north, parts of the northeast, and Kerala in South India lacked any television exposure. The results from the decomposition analysis showed that mass media exposure was associated with a 14% increase in the use of reversible modern methods. Results from the multilevel analyses showed that exposure to TV along with other media (AOR 1.57 95% CI 1.49-1.65) and exposure to FP messages through different media (AOR 1.22 95% CI 1.12-1.32) had a significant positive effect on the use of reversible modern methods even when various individual, district, state, and regional-level factors were controlled. The findings of this paper provide evidence supporting the use of mass media to promote and increase awareness of voluntary contraceptive use in India. An increase in mass media exposure coupled with improvement in coverage and services of the FP program can significantly increase the use of reversible modern methods in a cost-effective yet efficient manner among women in need of FP services.

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

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

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

Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa.

BACKGROUND: The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. METHODS: We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. RESULTS: Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = - 1.7%, p < 0.001) and unmarried (AARC = - 4.7%, p < 0.001) AGYW from poorest households in Mozambique. CONCLUSION: Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.