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1.
J Contemp Dent Pract ; 21(1): 2-10, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32381793

RESUMO

AIM: The photobiomodulation (PBM) effect of 660 nm diode laser in reducing pain, edema, trismus and promote healing subsequently to the transalveolar extraction of mandibular third molars in female patients taking contraceptive pills were evaluated. MATERIALS AND METHODS: Fifty female patients participated in our study. The 660 nm diode laser was applied immediately on randomly selected patients of the study group (n = 25) over the surgical site for 1 minute with continuous laser beam application. For the control group (n = 25), the same extraction procedure was performed without the application of 660 nm diode laser. Pain intensity, swelling, trismus, and healing was evaluated before extraction and during recall visits 24 hours, 48 hours, and 7 days postoperatively. RESULTS: The values of pain, swelling, and trismus were significantly inferior in the study group compared to the control group (p < 0.05) at T2 and T3; while the values of the healing index were significantly superior in the study group compared to the control group (p < 0.001) at T1, T2, and T3. CONCLUSION: Using 660 nm diode laser reduced the postsurgical discomforts (pain, edema, and trismus) and promote healing associated following transalveolar extraction of the lower third molar. CLINICAL SIGNIFICANCE: To develop a framework based on the results regarding the PBM effect of 660 nm diode laser following transalveolar extraction of lower third molar in a female patient taking oral contraceptive pills, which may help to improve the treatment services provided to the community.


Assuntos
Terapia com Luz de Baixa Intensidade , Dente Impactado , Anticoncepcionais , Feminino , Humanos , Lasers Semicondutores , Dor Pós-Operatória
2.
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
3.
J Glob Health ; 10(1): 010705, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32257163

RESUMO

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


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais , Serviços de Planejamento Familiar/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Maus-Tratos Conjugais/psicologia , Adolescente , Adulto , África ao Sul do Saara , Atitude , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Adulto Jovem
4.
Cent Eur J Public Health ; 28(1): 3-12, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32228810

RESUMO

OBJECTIVE: This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors. METHODS: Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals. RESULTS: A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors. CONCLUSION: Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.


Assuntos
Anticoncepcionais/administração & dosagem , Assunção de Riscos , Comportamento Sexual/psicologia , Adolescente , República Tcheca/epidemiologia , Feminino , Humanos , Gravidez , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
6.
J Environ Sci (China) ; 89: 1-8, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31892382

RESUMO

Increasing concerns have been raised on endocrine disrupting chemicals like the sex hormone 17α-ethinylestradiol (EE2), the more since traditional wastewater (WW) treatments appear to be ineffective for their removal. The efficacy of the relatively novel disinfectant peracetic acid (PAA) in EE2 removal was evaluated, as well as its potential effects on WW quality parameters. The treatments tested for EE2 removal were also evaluated in terms of toxicity, through the determination of biochemical responses (antioxidant enzymes, lipid peroxidation and vitellogenin induction) using zebrafish (Danio rerio) as a biological model. PAA contact times less than 20 min appeared insufficient regardless of the PAA dose tested, but a 100% EE2 removal was attained at a PAA concentration of 15 mg/L with a contact time of 20 min. Total suspended solids, chemical oxygen demand and pH in PAA treatments remained well within levels set in European legislation for WW discharge. EE2 induced significant increased vitellogenin (VTG) levels in both female and male fish, indicating increased estrogenic activity, especially in males suggesting an endocrine disruption effect. With the addition of PAA (15 mg/L), however, VTG levels in both sexes returned to control values. Although this PAA treatment showed increased levels of the antioxidant enzyme catalase, the lipid peroxidation levels were similar or even lower than in controls. Overall the results suggest that the use of PAA appears a promising way forward as a less toxic alternative to chlorine disinfection with high efficiency in the removal of EDC like EE2.


Assuntos
Etinilestradiol/química , Ácido Peracético/química , Eliminação de Resíduos Líquidos/métodos , Águas Residuárias , Poluentes Químicos da Água/química , Anticoncepcionais , Estradiol , Etinilestradiol/análise , Ácido Peracético/análise , Vitelogeninas , Poluentes Químicos da Água/análise
8.
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
10.
BMC Public Health ; 19(1): 1520, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727032

RESUMO

BACKGROUND: Studies have shown that social networks influence health behaviors, including the adoption of health innovations. This study explored the potential for early adopters of community health worker-delivered injectable contraceptives (CHWDIC) to influence the uptake of this innovation by women in their social networks. METHODS: This Social Network Analysis (SNA) study was conducted in Gombe, Nigeria. Twenty women who were early adopters of the CHWDIC were recruited. Each participant (ego) listed ten women of reproductive age (alters) with whom they related. An interviewer-administered questionnaire was used to collect from each ego, data about the nature of her relationship with each alter (ego-alter relationship), whether she talked about CHWDIC with each alter, and whether her listed alters talked to each other about CHWDIC (alter-alter relationship). Data were also collected on age, marital status and education level for each ego and alter. Data were analyzed with UCINET social network analysis software. Variables of interest include homophilia (similarity), density (number of ties as a proportion of possible ties), degree (popularity) and betweeness (frequency of connecting actor pairs who otherwise might not communicate). RESULTS: There were 20 egos and 200 alters. Between two thirds (alters) and three quarters (egos) of the women were 30 years or older. All of the egos and 196 (98%) of alters were married. Most of the networks had similar (homophilic) actors according to certain sociodemographic characteristics - ethnicity, age, education and type of marriage. More than 90% of the networks had density greater than 50%, suggesting high cohesion in most networks. The majority of actors in these networks used injectable contraceptives. In some of the networks, few actors with the highest prominence (betweeness centrality) were not users of injectable contraceptives. CONCLUSION: The study illustrates the application and feasibility of ego SNA in identifying champions and opinion leaders among women of reproductive age group. It also shows the influence of social networks on the diffusion of community-based injectable contraceptives, and how homophilic and dense networks may have positive health externality. The interrelatedness of network members' decision to adopt a health innovation was also demonstrated by the findings of this study.


Assuntos
Redes Comunitárias , Comportamento Contraceptivo , Anticoncepcionais , Difusão de Inovações , Comportamentos Relacionados com a Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Rede Social , Adulto , Agentes Comunitários de Saúde , Tomada de Decisões , Assistência à Saúde/métodos , Feminino , Serviços de Saúde , Humanos , Relações Interpessoais , Liderança , Nigéria , Apoio Social , Inquéritos e Questionários
14.
S Afr Med J ; 109(10): 756-760, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635573

RESUMO

BACKGROUND: Evidence-informed priority setting is vital to improved investment in public health interventions. This is particularly important as South Africa (SA) makes the shift to universal health coverage and institution of National Health Insurance. OBJECTIVES: To measure the financial impact of increasing the demand for modern contraceptive methods in the SA public health sector. We estimated the total cost of providing contraceptives, and specifically the budgetary impact of premature removals of long-acting reversible contraceptives. METHODS: We created a deterministic model in Microsoft Excel to estimate the costs of contraception provision over a 5-year time horizon (2018 - 2023) from a healthcare provider perspective. Only direct costs of service provision were considered, including drugs, supplies and personnel time. Costs were not discounted owing to the short time horizon. Scenario analyses were conducted to test uncertainty. RESULTS: The base-case cost of current contraceptive use in 2018 was estimated to be ZAR1.64 billion (ZAR29 per capita). Injectable contraceptives accounted for ~47% of total costs. To meet the total demand for family planning, SA would have to spend ~30% more than the estimate for current contraceptive use. In the year 2023, the 'current use' of modern contraceptives would increase to ZAR2.2 billion, and fulfilling the total demand for family planning would require ZAR2.9 billion. The base-case cost of implantable contraceptives was estimated at ZAR54 million. Assuming a normal removal rate, the use of implants is projected to increase by 20% during the 5-year period between 2019 and 2023, with an estimated 46% increase in costs. The cost of early removal of Implanon NXT is estimated at ZAR75 million, with total contraception costs estimated at ZAR102 million in 2019, compared with ZAR56 million when a normal removal rate is applied. CONCLUSIONS: The costs of scaling up modern contraceptives in SA are substantial. Early and premature removals of implantable contraceptives are costly to the nation and must be minimised. The government should consider conducting appropriate health technology assessments to inform the introduction of new public health interventions as SA makes the shift to universal health coverage by means of National Health Insurance.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Programas Nacionais de Saúde/economia , Cobertura Universal do Seguro de Saúde/economia , Anticoncepção/economia , Anticoncepção/tendências , Comportamento Contraceptivo/tendências , Anticoncepcionais/economia , Implantes de Medicamento/administração & dosagem , Implantes de Medicamento/economia , Serviços de Planejamento Familiar , Humanos , Contracepção Reversível de Longo Prazo/economia , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/tendências , Modelos Teóricos , Setor Público/economia , Setor Público/tendências , África do Sul
15.
Afr Health Sci ; 19(2): 1875-1880, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656470

RESUMO

Background: Contraceptive use helps in preventing unplanned pregnancy and reducing maternal death among married women. Objective: To investigate the attitude of married women towards contraceptive use in Ilorin metropolis, Kwara State. The study also examined whether the variables of age and educational attainment would influence attitude of married women towards contraceptive use in Ilorin metropolis. Methods: Descriptive survey design and analytical methods were adopted for the study. Simple random sampling technique was adopted to draw a total of 200 respondents. A questionnaire was used to collect data for the study. Mean and rank order was used to answer the research question while Analysis of Variance was used to test the hypotheses at 0.05 alpha level. Results: The attitude of married women towards contraceptive use in Ilorin metropolis was negative. There was no significant difference in the attitude of married women towards contraceptive use based on age and educational attainment. Conclusion: Most married women in Ilorin metropolis have negative attitude towards contraceptive use. We recommended that counselling services be provided to women on how to deal with side effects associated with various modern contraceptive methods.


Assuntos
Comportamento Contraceptivo/etnologia , Anticoncepção/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Casamento , Adolescente , Adulto , Anticoncepção/métodos , Comportamento Contraceptivo/psicologia , Anticoncepcionais , Características Culturais , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Nigéria , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
16.
Metas enferm ; 22(8): 21-27, oct. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-184995

RESUMO

La adopción de la Convención de los Derechos de las Personas con Discapacidad oficializó un cambio de paradigma de un modelo biomédico a uno social en la comprensión de la discapacidad, permitiendo establecer el foco en su entorno y la importancia de adaptarlo a sus necesidades específicas. Sin embargo, este colectivo sigue haciendo frente a barreras a la hora de ejercer sus derechos. Uno de los mayores obstáculos a los que se enfrentan se produce en el ámbito de la salud, especialmente en la salud sexual y reproductiva, donde las mujeres con discapacidad intelectual conforman el grupo más vulnerable. Este trabajo tiene como propósito presentar el estado de la cuestión en lo que respecta a las desigualdades sociales en salud en materia de salud sexual y reproductiva en mujeres con discapacidad intelectual. Para ello se parte de un planteamiento de la discapacidad intelectual desde el modelo social, posteriormente se hace un análisis de los determinantes sociales en salud en la discapacidad intelectual, para llegar a exponer cuestiones concretas de la salud sexual y reproductiva en mujeres con discapacidad intelectual y que ponen de manifiesto las desigualdades sociales en salud. Ello evidencia la necesidad de generar datos sólidos acerca de su salud y de adaptar la atención sanitaria en el ámbito sexual y reproductivo de esta población


Adopting the Convention on the Rights of Persons with Disabilities formalized a change in paradigm from a biomedical to a social model in terms of understanding disability, allowing to place the focus on their setting and the importance of adapting it to their specific needs. However, this group still faces barriers at the time of exercising their rights. One of the major obstacles faced occurs in the health setting, particularly regarding sexual and reproductive health, where women with intellectual disability are the most vulnerable group. The objective of this article is to present the state of the matter regarding social inequalities in health, in the area of sexual and reproductive health in women with intellectual disability. To this aim, we have approached intellectual disability from the social model, with a subsequent analysis of the social determinants in health regarding intellectual disability, in order to finally present specific issues regarding sexual and reproductive health in women with intellectual disability, which show the social inequalities in health. This shows the need to generate solid data about their health, and adapt healthcare in the sexual and reproductive setting for this population


Assuntos
Humanos , Feminino , Iniquidade Social , Saúde Sexual , Saúde Reprodutiva , Deficiência Intelectual , Disparidades nos Níveis de Saúde , Atenção à Saúde , Anticoncepcionais/uso terapêutico , Anticoncepcionais Femininos , Delitos Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia
17.
Ups J Med Sci ; 124(3): 203-212, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31495254

RESUMO

Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.


Assuntos
Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Aconselhamento/métodos , Serviços de Planejamento Familiar/educação , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva/educação , Adulto , Conscientização , Aconselhamento/estatística & dados numéricos , Feminino , Fertilidade/fisiologia , Humanos , Cuidado Pré-Concepcional/métodos , Gravidez , Gravidez não Desejada , Medição de Risco , Inquéritos e Questionários , Suécia , Adulto Jovem
18.
BMC Public Health ; 19(1): 1226, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488094

RESUMO

BACKGROUND: Family planning is considered as an effective tool to control population and to bring improvement in maternal and child health. The Government of Pakistan has been continuously struggling to improve the availability of family planning services. However, like many other developing countries of the world, unmet need for family planning still exists in the country. According to Pakistan Demographic and Health Survey 2012-13, the prevalence of unmet need for family planning is 21% in the country. The objective of this study is to investigate the determinants of unmet need for family planning among married women in Pakistan. METHODS: Secondary data of Pakistan Demographic and Health Survey 2012-13 has been used to analyze the determinants of unmet need for family planning through Binary and Multinomial Logistic regressions. RESULTS: Outcomes of the study show that the likelihood of unmet need for family planning among married women in Pakistan goes on to decrease with an increase in their age and education. The likelihood of unmet need for family planning decreases with the increase in wealth status of women's household, number of living children and husband's education. Similarly, the women residing in rural areas are more likely to have unmet need for family planning as compared with women living in urban areas. The women who lack mass media exposure, who are not employed and who have fear of side effects for using contraceptives are more likely to have unmet need for family planning. CONCLUSIONS: Fear of side effects for using contraceptives has been identified as the major cause of unmet need for family planning in Pakistan. The Government of Pakistan has been putting a lot of efforts to convince people about the usefulness of population control programs. A huge media campaign has been launched to persuade people about the benefits of birth control. But the efforts of the government do not seem to be very much effective to clear the perception of people about side effects of contraceptive use. Hence, fear of side effects still remains one of the most important reason behind unmet need for family planning.


Assuntos
Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Casamento , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Anticoncepcionais/efeitos adversos , Demografia , Medo , Feminino , Governo , Humanos , Meios de Comunicação de Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Paquistão , Fatores Socioeconômicos , Adulto Jovem
19.
Reprod Health ; 16(1): 134, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488170

RESUMO

BACKGROUND: More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. METHODS: This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. DISCUSSION: In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. TRIAL REGISTRATION: The study is registered with the Clinical Trials Registry, NCT03973593 .


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Substituição de Medicamentos/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Adolescente , Adulto , Aconselhamento , Estudos Transversais , Feminino , Humanos , Quênia , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
20.
Int J Equity Health ; 18(1): 127, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420037

RESUMO

BACKGROUND: Difficulty in accessing sexual and reproductive healthcare is one of the challenges young refugee women face worldwide, in addition to sexual exploitation, violence and abuse. Although Ghana hosts several refugees, little is known about their sexual behaviour and contraceptive use. This study assesses sexual behaviour and contraceptive use among female adolescent refugees in Ghana. METHODS: A cross-sectional survey was conducted between June and August 2016. Respondents comprised 242 female adolescent refugees aged 14-19 years. Structured validated questionnaires were used to collect data. Descriptive statistical methods and multivariate logistic regression statistical analyses methods were used to analyze data. FINDINGS: Over 78% of respondents have had penetrative sex; 43% have had coerced sex; 71% have had transactional sex; 36% have had sex while drunk, 57% have had 4-6 sexual partners in the last 12 months before the study, and 38% have had both coerced and transactional sex. Factors that predicted ever having transactional sex included being aged 14-16 compared to those aged 17-19 (AOR =4·80; 95% CI = 2·55-9·04); being from Liberia compared to being from Ghana (AOR = 3·05; 95% CI = 1.69-13·49); having a mother who had no formal education compared to having a mother with tertiary education (AOR = 5.75; 95CI = 1.94-14.99); and living alone (self) compared to living with parents (AOR = 3.77; 95CI = 1.38-10.33). However, having 1-3 sexual partners in the last 12 months as against having 4-6 partners significantly reduced the odds of ever having transactional sex (AOR = 0·02; 95% CI = 0·01-0·08). Awareness about contraceptives was 65%, while ever use of contraceptives was 12%. However, contraceptive use at last sexual intercourse was 8.2%, and current use was 7.3%. Contraceptive use was relatively higher among those who have never had sex while drunk, as well as among those who have never had transactional sex and coerced sex. Contraceptive use was similarly higher among those who had 1-3 sexual partners in the last 12 months compared to those who had 4-6 during the same time period. CONCLUSION: In this time of global migration crises, addressing disparities in knowledge and access to contraception as well as high risk sexual behaviours in refugee situations is important for reducing inequalities in reproductive health outcomes and ensuring both universal health coverage and global health justice. Sex and contraception education and counselling, self-efficacy training, and skills acquisition are needed to help young refugee women negotiate and practice safe sex and resist sexual pressures.


Assuntos
Comportamento do Adolescente , Comportamento Contraceptivo , Anticoncepção , Anticoncepcionais , Refugiados , Assunção de Riscos , Comportamento Sexual , Adolescente , Adulto , Conscientização , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , Feminino , Gana , Humanos , Pais , Parceiros Sexuais , Inquéritos e Questionários , Adulto Jovem
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