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1.
Reprod Health ; 18(1): 48, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622358

RESUMO

BACKGROUND: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults'/parents' and adolescent girls' narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. METHODS: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15-19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents. RESULTS: Findings highlighted adults' perceptions on adolescents' sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents' sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. CONCLUSIONS: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.


Assuntos
Comportamento Contraceptivo , Casamento , Relações Pais-Filho , Percepção , Psicologia do Adolescente , Adolescente , Comportamento do Adolescente/fisiologia , Adulto , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Quênia/epidemiologia , Casamento/psicologia , Casamento/estatística & dados numéricos , Relações Pais-Filho/etnologia , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Gravidez na Adolescência/estatística & dados numéricos , Pesquisa Qualitativa , Educação Sexual/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
2.
PLoS One ; 15(10): e0239903, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052975

RESUMO

INTRODUCTION: Modern contraceptive use during the first year postpartum potentially prevents unplanned pregnancies and help to improve maternal and child health. Therefore, identifying factors associated with contraceptive utilization among women of reproductive age during extended postpartum period is essential. OBJECTIVE: This study aimed to assess factors associated with modern contraceptives use among postpartum women in Bukombe District, Geita region. METHOD: A community-based cross-sectional study was conducted among women who were in their first year after child birth in Bukombe district. A total of 511 women were included using multistage sampling techniques. Data were collected using a structured questionnaire. Data analysis was performed using Stata 15 (College Station, Texas, USA). RESULTS: The prevalence of postpartum modern contraceptive was 11.9%. The most frequently used method was implant (6.5%). Most women started to use the contraceptive during the first three months after delivery. Living in urban (AOR = 1.85, 95% CI: 1.20-3.79), having business (AOR = 2.35, 95% CI: 1.31-2.28), last born aged 3-4 months (AOR = 3.31, 95% CI: 1.11-9.85) and menses resumption (AOR = 9.24, 95% CI: 3.60-23.72) were predictors for postpartum contraceptive use. However, fear of side effects, poor knowledge about contraceptives, husband restrictions, distance to health facility and contraceptive availability were reported as barriers for postpartum modern contraceptive use. CONCLUSION: Prevalence of postpartum modern contraceptive use in the study area is still low. Numerous factors were reported as barriers for postpartum contraceptive use. A strategy such as health education on befits of post-partum modern contraceptive use and counseling women about side effects may help to improve its uptake.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Uso de Medicamentos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Fatores Socioeconômicos , Tanzânia
3.
PLoS One ; 15(9): e0238293, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881873

RESUMO

BACKGROUND: Vasectomy is one of the most effective and permanent male contraceptive methods, and involves cutting and ligating the vas deferens to make the semen free of sperm during ejaculation. Although it is effective, simple, and safe, it is not well known and practiced in the majority of our community. This study assessed the intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019. METHODS: A community- based cross-sectional study was conducted among 402 married men from March 05 to April 15, 2019. A simple random sampling technique was employed to select the study participants. Data was collected by face to face interview using a structured and pre-tested questionnaire. Questions concerned socio-demographic and reproductive variables and views on vasectomy. The association between variables was analyzed using a bivariable and multivariable logistic regression model. RESULT: A total of 402 participants were included with a response rate of 98.75%. The mean participant age was 37.12(SD ± 6.553) years with the age range of 20-56 years. The prevalence of intention to use vasectomy was 19.6% with 95%CI (15.6%-23.4%). Multivariable logistic regression showed that age from 30-39 years (AOR = 3.2(95% CI: 1.19-8.86)), having more than three living children (AOR = 2.5(95% CI: 1.41-4.68)), good knowledge (AOR = 3.4(95%CI: 1.88-6.40)) and positive attitude (AOR = 4.8(95% CI: 2.61-8.80)) of married men were significantly associated with intention to use vasectomy. CONCLUSION AND RECOMMENDATION: Intention to use vasectomy was comparable with findings in four regions of Ethiopia (Amhara, Oromia, SNNP, and Tigray). Age, the number of living children, knowledge, and attitude were significantly associated with the intention to use vasectomy. Improving the level of knowledge and attitude towards vasectomy is an essential strategy to scale up the intention of men to use vasectomy.


Assuntos
Anticoncepção/psicologia , Vasectomia/psicologia , Adulto , Estudos Transversais , Escolaridade , Etiópia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários , Adulto Jovem
4.
BMC Public Health ; 20(1): 1025, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600290

RESUMO

BACKGROUND: Many unmarried young people in low- and middle-income countries (LMIC) want to avoid pregnancy but do not use modern methods of contraception-as a result, half of teen births in these countries are unintended. Researchers have identified numerous barriers that prevent youth from using contraception. However, much of the research in West Africa is narrowly focused on married women, and relatively little research has been done to understand the needs, preferences, barriers, and solution set for sexually active unmarried young people who would like to avoid pregnancy. The purpose of this study was to gain insight into the behavioral barriers that prevent unmarried young people in eastern Senegal from using modern methods of contraception. METHODS: This qualitative study conducted in 2017 in the Tambacounda and Kedougou regions in Senegal explores attitudes and beliefs relating to sex and contraception among unmarried young women and men through 48 in-depth individual interviews with young people aged 15-24 and parents of youth and 5 sex-segregated focus groups with 6-9 young people per group. The research team conducted a thematic content analysis and synthesized the findings by major theme following the behavioral diagnosis methodology. RESULTS: Drawing insights from behavioral science, the analysis yields five key findings: (1) unmarried young people avoid making a decision about contraception because thinking about contraceptive use provokes uncomfortable associations with a negative identity (i.e., being sexually active before marriage); (2) unmarried young people see modern methods as inappropriate for people like them; (3) unmarried young people are overconfident in their ability to prevent pregnancy through traditional and folk methods; (4) unmarried young people overestimate the social and health risks of modern contraceptive methods; and (5) unmarried young people fail to plan ahead and are not prepared to use modern contraceptive methods before every sexual encounter. CONCLUSIONS: Interventions aimed at increasing uptake of contraceptives among unmarried young people in eastern Senegal must address several significant behavioral barriers in addition to structural, informational, and socio-cultural barriers in order to be successful.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/psicologia , Gravidez na Adolescência/psicologia , Comportamento Sexual/psicologia , Pessoa Solteira/psicologia , Adolescente , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Masculino , Gravidez , Gravidez na Adolescência/prevenção & controle , Pesquisa Qualitativa , Senegal , Adulto Jovem
5.
Womens Health Issues ; 30(4): 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507617

RESUMO

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


Assuntos
Atitude do Pessoal de Saúde/etnologia , Comportamento Contraceptivo/psicologia , Anticoncepção Pós-Coito/estatística & dados numéricos , Anticoncepção/psicologia , Anticoncepcionais Pós-Coito/provisão & distribução , Serviços de Planejamento Familiar/organização & administração , Relações Profissional-Paciente , Adolescente , Adulto , Serviços de Saúde Comunitária , Anticoncepção/métodos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Revelação , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Entrevistas como Assunto
6.
BMC Public Health ; 20(1): 872, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503492

RESUMO

BACKGROUND: The effect of women's autonomy in decision-making for fertility control has been highlighted by research. The objective of this study was to analyze the effect of women's autonomy over decision-making regarding their health and access to family planning in Senegal in 2017. METHODS: The analyses in this study were carried out using data from the Senegal Demographic and Health Survey in 2017. The sample consisted of 8865 women aged 15-49. The propensity score-matching method was applied. Autonomy in health decision-making was considered the treatment variable. Matching was performed using confounding variables. The outcome variables were the current use of modern contraceptive methods and the existence of unmet needs. The common support condition had been met. The analysis was conducted using STATA.15 software. RESULTS: This study showed that 6.26% of women had decision-making autonomy in relation to their health. For 80.33% of the women, their husbands/partners made health-related decisions for them. Decision-making autonomy increased significantly with the age of the woman (p < 0.05). In addition, 15.24% of women were using a modern method of contraception. An estimated 26.2% of women had unmet needs. Propensity score matching split the women into two groups based on autonomy over decision-making for their health. After matching, there was no longer a significant difference between women who were autonomous with respect to their decision-making and those who were not autonomous with respect to their current use of a modern contraceptive method. On the other hand, there was a 14.42% reduction (p < 0.05) in unmet needs for family planning in the group of women who were autonomous with respect to their health decision-making. CONCLUSION: Autonomy in health decision-making would reduce unmet needs among Senegalese women. These results show the importance of accounting for gender in health interventions for the accessibility of family planning services.


Assuntos
Tomada de Decisões , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autonomia Pessoal , Adolescente , Adulto , Anticoncepção/psicologia , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Demografia , Feminino , Necessidades e Demandas de Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Senegal , Cônjuges/psicologia , Adulto Jovem
7.
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 245-254, jun. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1126159

RESUMO

INTRODUCCIÓN: El cuidado anticonceptivo es importante una vez que se inicia la vida sexual, pero esto no ha sido medido en distintas realidades de Latinoamérica. OBJETIVO: Determinar los factores socio-educativos asociados al no uso de métodos anticonceptivos en universitarias de cuatro países de Latinoamérica. METODOLOGÍA: Estudio transversal analítico, se encuestó a estudiantes mujeres que ya habían iniciado su vida sexual, se le preguntó por el uso de condón (preservativo), método del ritmo, anticoncepción oral y anticoncepción oral de emergencia. Estas fueron descritas y asociadas a variables socio-educativas. RESULTADOS: El 7% (47) no usaba ninguno de los 4 métodos anticonceptivos; al realizar el análisis multivariado, no hubo diferencias estadísticamente significativas según el país, el año de estudios o si eran católicas/cristianas (todos los valores p>0,05), en cambio, las de universidades particulares tuvieron un mayor porcentaje de ausencia de uso de los 4 métodos anticonceptivos (RPa: 2,52; IC95%: 1,24-5,14; valor p=0,010). Según el uso de alguno de los 4 métodos, el país donde se encuestó tuvo muchas diferencias entre el uso de uno u otro método; el año de la carrera no estuvo asociado al no uso de alguno de los cuatro métodos; las que fueron católicas o cristianas usaron menos la anticoncepción oral (p<0,001) y las que estudiaban en universidades particulares usaron más el método del ritmo (p<0,05). CONCLUSIONES: Un porcentaje importante no usó ninguno de los cuatro métodos anticonceptivos más comunes, estando esto asociado al tipo de universidad.


INTRODUCTION: The care of contraception is important once you start the sex lives, but this hasn't been measured in different realities of Latin-America. OBJECTIVE: To determine the socio-educational factors associated with non-use of contraceptive methods in universities in four Latin American countries. METHODOLOGY: Cross-sectional study. Surveyed women students, who have started their sexual lives. They were asked about the use of condoms, rhythm method, birth control pills and next day pill. These're described and associated to variables socio-educational. RESULTS: 7% (47) did not use any of the 4 contraceptive methods; when performing the multivariate analysis, there were no statistically significant differences by country, the year of study or if they were Catholic/Christian (all values p>0.05), on the other hand, those of particular universities had a higher percentage of non- take care of yourself with one of the 4 methods (RPa: 2,52; IC95%: 1,24-5,14; value p=0,010). According to the use of one of the 4 methods, the country where it was surveyed had many differences between the use of one or the other method; the year of the degree was not associated with the non-use of any of the four methods; those who were Catholic or Christian used less oral contraception (p <0.001) and those who studied at private universities used the rhythm method more (p <0.05). CONCLUSIONS: A significant percentage did not use any of the four most common contraceptive methods, this being associated with the type of university.


Assuntos
Humanos , Feminino , Adulto Jovem , Estudantes/psicologia , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Comportamento Sexual , Fatores Socioeconômicos , Universidades , Estudos Transversais , Análise Multivariada , Inquéritos e Questionários , Estudo Multicêntrico , Preservativos , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepcionais , Escolaridade , Informação , América Latina
8.
BMC Public Health ; 20(1): 771, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448153

RESUMO

BACKGROUND: Indian women are more prone to first birth at a relatively younger age after marriage. Also, we do not have sufficient literature available that focuses on contraceptive use before first birth. The analysis of the present study was done using data from the fourth round of National Family Health Survey (2015-16), India. The objectives of the present study were to measure the levels and trends of contraceptive use before first birth among Indian ever married women, aged 15-34 years. METHODS: The study includes 279,896 ever married women aged 15-34 years at the time of the NFHS-4 survey. To identify the socio-demographic determinants governing the pioneering study behavior, multivariable techniques have been used in the analysis. The statistical significance of the relationship between socio-demographic factors and contraceptive use prior to first birth was tested using a chi-squared test for association. Hosmer Lemeshow statistics and Nagelkerke R square have been used to check how well the logistic regression model fits the data. Map of India showing different zonal classification is made using the ArcGIS software version 10.3. RESULT: The trends of contraceptive usage show a decline in use before first birth and the various socio-demographic factors affecting the use of contraceptive before first birth are religion, caste, education, wealth index, media exposure, age at marriage and the zonal classifications. CONCLUSION: The noticeable result in this study is the comparative decline in contraceptive use by women in India before first birth in NFHS-4 with respect to previous NFHS done in India. The likelihood of using contraception before first birth is significantly affected by factors like place of residence, religion, caste, current age of women, age at marriage, education level of women, wealth index, media exposure and zonal classification.


Assuntos
Fatores Etários , Ordem de Nascimento/psicologia , Comportamento Contraceptivo/tendências , Anticoncepção/tendências , Casamento/psicologia , Adolescente , Adulto , Anticoncepção/psicologia , Comportamento Contraceptivo/psicologia , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Índia , Modelos Logísticos , Casamento/estatística & dados numéricos , Gravidez , Religião , Classe Social , Fatores Socioeconômicos , Adulto Jovem
9.
J Prev Med Public Health ; 53(2): 117-125, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32268466

RESUMO

OBJECTIVES: This study investigated the role of information and communication technology and women's empowerment in contraceptive discontinuation in Indonesia. METHODS: The study used data from the 2017 Indonesia Demographic and Health Survey and monthly contraceptive calendar data. A Gompertz proportional hazards model was used for analysis. RESULTS: The 12-month contraceptive discontinuation rate was higher among women who had used the Internet in the past year, women who were mobile phone owners, and women who reported having fully participated in household decision-making than among their counterparts. These factors significantly impacted the risk of contraceptive discontinuation in Indonesia, even after controlling for contraceptive method, age, parity, contraceptive intent, education, work status, place of residence, and wealth status. CONCLUSIONS: After adjustment for the control variables, a higher risk of contraceptive discontinuation was associated with having used the Internet in the past year, owning a mobile phone, and not participating in household decision-making. Higher contraceptive discontinuation risk was also associated with using contraceptive pills, older age, lower parity, intent of spacing births, more education, current unemployment, and rural residence, and the risk was also significantly higher for those in the lowest household wealth quintile than for those in the fourth household wealth quintile. The association of contraceptive discontinuation with the use of modern information and communication technology and relatively disempowerment in household decision-making may imply that information regarding family planning and contraception should be conveyed via social media as part of setting up an eHealth system. This must include a strong communication strategy to empower and educate women in contraceptive decision-making.


Assuntos
Comunicação , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Tomada de Decisões , Empoderamento , Tecnologia da Informação , Adolescente , Adulto , Anticoncepção/psicologia , Comportamento Contraceptivo/psicologia , Anticoncepcionais/uso terapêutico , Serviços de Planejamento Familiar , Feminino , Acesso aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Indonésia , Pacientes Desistentes do Tratamento/psicologia , Gravidez , Fatores Socioeconômicos
10.
PLoS One ; 15(3): e0227795, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142517

RESUMO

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


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/psicologia , Serviços de Planejamento Familiar/organização & administração , Cônjuges/psicologia , Adolescente , Adulto , Anticoncepção/instrumentação , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais , Dispositivos Anticoncepcionais , Aconselhamento/organização & administração , Estudos Transversais , Escolaridade , Etiópia , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/organização & administração , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
11.
Sex Reprod Health Matters ; 28(1): 1723321, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32178594

RESUMO

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


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Cooperação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Preservativos , Anticoncepção/psicologia , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/psicologia , Feminino , Humanos , Cooperação do Paciente/etnologia , Cooperação do Paciente/psicologia , Gravidez , Gravidez não Planejada , Gravidez não Desejada , Inquéritos e Questionários , Adulto Jovem
12.
Medicine (Baltimore) ; 99(12): e19490, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195948

RESUMO

INTRODUCTION: Contraceptive use and sexual health behavior remain a prominent public health concern in South Africa (SA). Despite many government interventions, unintended pregnancies and termination of pregnancies remain relatively high. This review aimed to map evidence on factors influencing contraceptive use and sexual behavior in SA. METHODS: We conducted a scoping review guided by Arksey and O'Malley's framework. We searched for articles from the following databases: PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host, Union Catalogue of Theses and Dissertations (UCTD) and SA ePublications via SABINET Online and World Cat Dissertations, Theses via OCLC and Google Scholar. Studies published from January 1990 to March 2018 were included. We used the Population, Concept, and Context (PCC) framework and the PRISMA chart to report the screening of results. The Mixed Method Appraisal Tool (MMAT) version 11 and ACCODS tools were used to determine the quality of the included studies. RESULTS: A total of 2030 articles were identified by our search criteria for title screening. Only 21 studies met our inclusion criteria and were included in quality assessment stage. We found that knowledge of a contraceptive method, length of a relationship, sexual debut, age difference between partners availability of a contraceptive method, long waiting hours, and nurse's attitudes toward human immunodeficiency virus (HIV) positive or younger clients predict whether or not women use a contraceptive method or improve sexual behavior. CONCLUSION: There remains a necessity for improving educational programs aimed at transferring knowledge on contraceptives and sexual behavior to both women and their male counterparts, alongside the public health systems' improvements.


Assuntos
Comportamento Contraceptivo/tendências , Anticoncepção/psicologia , Conhecimento do Paciente sobre a Medicação/estatística & dados numéricos , Comportamento Sexual/psicologia , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada/psicologia , Parceiros Sexuais/psicologia , África do Sul/epidemiologia , Adulto Jovem
13.
BMC Womens Health ; 20(1): 57, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32192473

RESUMO

BACKGROUND: Despite availability of modern contraceptive methods and documented unmet need for family planning in Ghana, many women still report forgoing modern contraceptive use due to anticipated side effects. The goal of this study was to examine the use of modern family planning, in particular hormonal methods, in one district in rural Ghana, and to understand the role that side effects play in women's decisions to start or continue use. METHODS: This exploratory mixed-methods study included 281 surveys and 33 in-depth interviews of women 18-49 years old in the Amansie West District of Ghana between May and July 2018. The survey assessed contraceptive use and potential predictors of use. In-depth interviews examined the context around uptake and continuation of contraceptive use, with a particular focus on the role of perceived and experienced side effects. RESULTS: The prevalence of unmet need for modern family planning among sexually active women who wanted to avoid pregnancy (n = 135) was 68.9%. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. Qualitative interviews revealed significant concerns about side effects stemming from previous method experiences and/or rumors regarding short-term impacts and perceived long-term consequences of family planning use. Side effects mentioned include menstrual changes (heavier bleeding, amenorrhea or oligomenorrhea), infertility and childbirth complications. CONCLUSION: As programs have improved women's ability to access modern family planning, it is paramount to address patient-level barriers to uptake, in particular information about side effects and misconceptions about long-term use. Unintended pregnancies can be reduced through comprehensive counseling about contraceptive options including accurate information about side effects, and the development of new contraceptive technologies that meet women's needs in low-income countries.


Assuntos
Comportamento Contraceptivo/etnologia , Anticoncepção/psicologia , Anticoncepcionais/efeitos adversos , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/estatística & dados numéricos , Adolescente , Adulto , Criança , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Medo , Feminino , Gana , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Gravidez , População Rural , Adulto Jovem
14.
BMC Womens Health ; 20(1): 61, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216823

RESUMO

BACKGROUND: Modern contraceptive methods enable couples to enjoy sexual intercourse without fear of the risk of pregnancy at any desired time. The evidence from different studies done in Ethiopia on modern contraceptive method utilization was highly varied and not conclusive. Therefore, the current study aims to study the magnitude of modern contraceptive utilization and associated factors among reproductive-age women in Ethiopia based on 2016 EDHS data. METHOD: A nationally representative 2016 EDHS data collected between January 18/ 2016 to June 27/2016 were used. Descriptive studies and logistic regression models were used to summarize descriptive data and measure statistical association respectively. Adjusted odds ratio and confidence interval were respectively used to measure association and its statistical significance. Finally, statistical significance was declared using a confidence interval. RESULT: In the current study, the overall modern contraceptive utilization among reproductive-age women in Ethiopia was 3203 (20.42%). The injectable contraceptive method was the most commonly used modern contraceptive method, 1886(58.88%) followed by implant/Norplant, 779 (24.32%). The results of multivariable logistic regression showed that age, residence, region, woman's occupation, number of living children, husband's education, age at first sexual intercourse, husband's desire for more children, wealth index and watching TV were independently associated to modern contraceptive utilization among reproductive-age women in Ethiopia. CONCLUSIONS: The magnitude of modern contraceptive utilization among reproductive-age women in Ethiopia in the current study is unexpectedly low. Age, residence, region, woman's occupation, number of living children, husband's education, age at first sexual intercourse, husband's desire for more children, wealth index and watching TV were independent predictors of modern contraceptive use among reproductive-age women in Ethiopia. Any intervention strategy that promotes modern contraceptive method utilization should consider these factors for its better success.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Cônjuges/psicologia , Adolescente , Adulto , Criança , Anticoncepção/métodos , Anticoncepção/psicologia , Comportamento Contraceptivo/etnologia , Estudos Transversais , Demografia , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Cônjuges/etnologia , Adulto Jovem
15.
BMC Womens Health ; 20(1): 29, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070339

RESUMO

BACKGROUND: Though modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women's perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision. METHODS: In-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically. RESULTS: Overall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling. CONCLUSIONS: There is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women's needs.


Assuntos
Comportamento Contraceptivo/psicologia , Aconselhamento/normas , Serviços de Planejamento Familiar/normas , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Anticoncepção/métodos , Anticoncepção/psicologia , Aconselhamento/métodos , Feminino , Hospitais Públicos , Humanos , Intenção , Nepal , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde , Adulto Jovem
16.
J Pediatr Adolesc Gynecol ; 33(4): 372-376, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32087401

RESUMO

STUDY OBJECTIVE: The occurrence and characteristics of contraception discussions with adolescents are unexplored. Our study sought to address this gap using transcripts of audiotaped healthcare visits. DESIGN, SETTING, AND PARTICIPANTS: This study was a secondary analysis of 153 transcripts of medical visits with female adolescents with asthma. Medical visits took place among 4 outpatient clinics in North Carolina. MAIN OUTCOME MEASURES: Transcripts were reviewed for occurrence and characteristics of contraception discussions. Demographics were collected from adolescent interviews, caregiver questionnaires, and provider questionnaires. RESULTS: Contraception was mentioned in 3% (n = 5) of office visits. Conversations about contraception included the topics of contraception efficacy (20%), contraception side effects (60%), contraception adherence (20%), and adolescent sexual health (20%). No conversations included the topics of contraception indication or alternative methods. CONCLUSIONS: Conversations about contraception occurred infrequently in healthcare visits. When conversations did occur, the topics that they covered lacked alignment with guideline recommendations.


Assuntos
Asma/psicologia , Anticoncepção/métodos , Educação Sexual/organização & administração , Adolescente , Saúde do Adolescente , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Estudos de Casos e Controles , Criança , Anticoncepção/psicologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , North Carolina , Comportamento Sexual , Inquéritos e Questionários
17.
Matern Child Health J ; 24(3): 291-298, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31897928

RESUMO

OBJECTIVES: Unintended pregnancy is an individual and public health problem with significant social and economic consequences. The literature has established that parents, especially mothers, play an important role in shaping the contraceptive attitudes and behaviors of young women and could therefore affect the likelihood of their daughter experiencing an unintended pregnancy. However, research has yet to fully explore the nuances of how mothers influence their daughters with respect to contraception. METHODS: We conducted a mixed methods study to explore the impact of mothers on women's contraceptive attitudes and behaviors. In-depth interviews were conducted with 86 women of reproductive age to identify potential patterns and explore the nature of mothers' influences. We then analyzed medical and prescription claims for a cohort of 9813 pairs of women (mother-daughter proxies) enrolled in Medicaid, to determine if such patterns of contraceptive use held in a larger sample. RESULTS: In-depth interviews reveal how and why mothers shape women's contraceptive attitudes and behaviors, particularly highlighting the nuances of communication, knowledge, and relationships. The statistical claims data supported such findings on a broader scale. For instance, across several types of contraceptives, including oral, injectable, and long-acting reversible contraceptives (LARCs), young women were significantly more likely to use a particular method if an older woman in the household (mother proxy) also used that method (AOR (95% CI) 1.99 (1.67-2.37), 2.06 (1.58-2.68) and 2.83 (1.64-4.88) respectively). CONCLUSIONS FOR PRACTICE: This study fills a gap in the literature regarding the nuanced ways in which mothers influence women's contraceptive behavior. In turn, it supports the importance of familial context-especially the influence of mothers-in contraception decision-making and suggests that interventions aimed at improving access to and uptake of effective methods of contraception consider this context in their design and implementation.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Relações Mãe-Filho , Mães/psicologia , Adolescente , Adulto , Anticoncepcionais , Feminino , Humanos , Entrevistas como Assunto , Medicaid , Estados Unidos , Adulto Jovem
18.
BMC Public Health ; 20(1): 26, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914967

RESUMO

BACKGROUND: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. METHODS: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. RESULTS: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. CONCLUSION: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.


Assuntos
Coeficiente de Natalidade/tendências , Serviços de Saúde Comunitária , Anticoncepção/psicologia , Aconselhamento , Adolescente , Cidades , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Áreas de Pobreza , Gravidez , Avaliação de Programas e Projetos de Saúde , Características de Residência/estatística & dados numéricos , Espanha , Adulto Jovem
19.
Patient Educ Couns ; 103(2): 315-320, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31537316

RESUMO

OBJECTIVE: To compare differences in patient-provider communication among patients who, prior to contraceptive counseling, used or did not use a decision support tool ("My Birth Control") which has educational and interactive modules and produces a provider printout with the patient's preferences. METHODS: As part of a cluster-randomized trial of the tool in four San Francisco safety net clinics, we collected and thematically analyzed 70 audio recordings of counseling visits (31 pre- and 39 post-tool implementation) from 15 providers randomized to the intervention. RESULTS: Without the tool, most providers began by asking participants what method they were considering and focused counseling on that method or on directing patients towards long-acting reversible contraception; with the tool, most focused on reviewing and discussing multiple methods of interest to the participant as indicated on the printout. Discussion of patients' preferences for specific method features was not observed in pre-implementation recordings but was part of several post-implementation recordings. Several participants explicitly noted they had gained knowledge from the tool. CONCLUSION: Observed counseling differences suggest the tool may have a positive impact on patient-centeredness of contraceptive counseling, consistent with findings from the main study. PRACTICE IMPLICATIONS: My Birth Control shows potential for improving patient-centeredness in counseling without extensive provider training.


Assuntos
Comunicação , Anticoncepção/psicologia , Aconselhamento/métodos , Técnicas de Apoio para a Decisão , Serviços de Planejamento Familiar/estatística & dados numéricos , Relações Profissional-Paciente , Adolescente , Adulto , Anticoncepção/métodos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Preferência do Paciente , São Francisco
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