Geographic and socioeconomic inequalities in the coverage of contraception in Uttar Pradesh, India.

BACKGROUND: Uttar Pradesh (UP) is the most populous state in India, with a historically lower level of family planning coverage than the national average. In recent decades, family planning coverage in UP has significantly increased, yet there are considerable geographic and socio-economic inequalities. METHODS: The data used for the study is derived from a cross-sectional quantitative survey of 12,200 currently married women conducted during December 2020-February 2021 in UP by the Technical Support Unit. Univariate and bivariate analyses were performed and equiplots were used to make visualizing inequalities easy. RESULTS: The findings of the study reveal significant variation in family planning coverage indicators amongst currently married women in reproductive ages by administrative divisions in UP. For instance, in the Jhansi division, it was 72.4%, while in Faizabad, it was 39.3%. Jhansi division experienced the highest modern contraceptive coverage with the lowest inequity compared to other divisions. However, the range of coverage within the division by Accredited Social Health Activist (ASHA) areas is 25% to 75%. In fact, for some ASHA areas in the Jhansi division, the family planning demand satisfied for modern contraception ranged from more than 85% to less than 22%. On the other hand, the Gonda division with the lowest coverage and lowest inequity for demand satisfied for modern contraception has some ASHA areas with less than 5% and some with more than 36%. The study also revealed intersectionality of education, wealth, place of residence and geographic divisions in identifying inequity patterns. For instance, in case of Mirzapur and Varanasi, the demand satisfied among the illiterates was 69% and the corresponding percentage for literates was 49%. With respect to place of residence, Basti division, where the coverage for modern contraception is extremely low, demand satisfied for modern contraceptive methods is 16.3% among rural residents compared to 57.9% in the case of urban residents. CONCLUSIONS: The findings showed inequality in the modern family planning methods coverage in UP in both best and worst performing divisions. The inequalities exist even in extremely small geographies such as ASHA areas. Within the geographies as well, the socio-economic inequalities persisted. These inequalities at multiple levels are important to consider for effective resource allocation and utilization.

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

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

Spatial analysis of modern contraceptive use among women who need it in Ethiopia: Using geo-referenced data from performance monitoring for action.

INTRODUCTION: The challenge of achieving maternal and neonatal health-related goals in developing countries is significantly impacted by high fertility rates, which are partly attributed to limited access to family planning and access to the healthcare systems. The most widely used indicator to monitor family planning coverage is the proportion of women in reproductive age using contraception (CPR). However, this metric does not accurately reflect the true family planning coverage, as it fails to account for the diverse needs of women in reproductive age. Not all women in this category require contraception, including those who are pregnant, wish to become pregnant, sexually inactive, or infertile. To effectively address the contraceptive needs of those who require it, this study aims to estimate family planning coverage among this specific group. Further, we aimed to explore the geographical variation and factors influencing contraceptive uptake of contraceptive use among those who need. METHOD: We used data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) survey of women of reproductive age and the service delivery point (SDP) survey conducted in 2019. A total of 4,390 women who need contraception were considered as the analytical sample. To account for the study design, sampling weights were considered to compute the coverage of modern contraceptive use disaggregated by socio-demographic factors. Bayesian geostatistical modeling was employed to identify potential factors associated with the uptake of modern contraception and produce spatial prediction to unsampled locations. RESULT: The overall weighted prevalence of modern contraception use among women who need it was 44.2% (with 95% CI: 42.4%-45.9%). Across regions of Ethiopia, contraceptive use coverage varies from nearly 0% in Somali region to 52.3% in Addis Ababa. The average nearest distance from a woman's home to the nearest SDP was high in the Afar and Somali regions. The spatial mapping shows that contraceptive coverage was lower in the eastern part of the country. At zonal administrative level, relatively high (above 55%) proportion of modern contraception use coverage were observed in Adama Liyu Zone, Ilu Ababor, Misrak Shewa, and Kefa zone and the coverage were null in majority of Afar and Somali region zones. Among modern contraceptive users, use of the injectable dominated the method-mix. The modeling result reveals that, living closer to a SDP, having discussions about family planning with the partner, following a Christian religion, no pregnancy intention, being ever pregnant and being young increases the likelihood of using modern contraceptive methods. CONCLUSION: Areas with low contraceptive coverage and lower access to contraception because of distance should be prioritized by the government and other supporting agencies. Women who discussed family planning with their partner were more likely to use modern contraceptives unlike those without such discussion. Thus, to improve the coverage of contraceptive use, it is very important to encourage/advocate women to have discussions with their partner and establish movable health systems for the nomadic community.

Knowledge, attitude, practices and associated factors of family planning among women living with hiv at the university of Gondar specialized hospital: a cross sectional study.

INTRODUCTION: HIV/AIDS poses a significant health challenge in sub-Saharan African countries, with a disproportionate impact on women of reproductive age. The disparities in knowledge, attitudes, and practices related to family planning among women living with HIV can be intricate and multi-faceted. This study aimed to assess the knowledge, attitude, practice, and associated factors regarding family planning among the women living with HIV at the University of Gondar specialized hospital, Gondar, Ethiopia. METHOD: A cross-sectional study was carried out at the University of Gondar Teaching Referral Hospital, focusing on HIV-positive women of reproductive age who visited the ART unit from July 8-28, 2022. Data collection involved the use of pre-tested, structured questionnaires administered through interviews. The gathered data were entered into the electronic Kobo Collect platform and subsequently exported for analysis using SPSS version 26. Descriptive summaries, including frequencies, means, and percentages, were presented through tables and figures. Logistic regression was employed to identify potential predictors, presenting adjusted odds ratios with a 95% confidence interval and a significance level set at a P-value of 0.05. RESULTS: A total of 328 study participants were included. About 93% of the study population had good knowledge about modern contraceptives, and about 94% of the study population had good knowledge about safer conception. Only 30.2% of the study population had knowledge of the dual contraceptive method. The attitude and practice of women towards family planning (FP) were 71.0% and 55.8%, respectively. The study revealed that the most commonly employed contraceptive method was injectable contraceptives, constituting 34.2% of usage. Having one and a greater number of children (AOR = 2.25, 95% CI: 1.10, 4.49), having discussions on fertility plans with healthcare providers (AOR = 2.20, 95% CI: 1.02, 4.761), and having good family planning practices (AOR = 2.15, 95% CI: 1.19, 3.87) were significantly associated with the attitude toward family planning. Married women (AOR = 1.88, 95% CI = 1.11, 3.1), able to read and write (AOR = 2.12, 95% CI:1.04,4.32), college and above educational level (AOR = 4.51, 95% CI:1.93,10.87), had discussion on fertility plan with healthcare providers (AOR = 5.09, 95% CI: 1.96, 13.24), knowledge about dual method (AOR = 1.95, CI: 1.08, 3.50), and knowledge about modern contraceptive methods (AOR = 7.24, 95% CI: 1.56, 33.58) were significantly associated with good practice of family planning. CONCLUSION: Women living with HIV exhibited notably high levels of knowledge regarding modern contraceptive methods and safer conception. The knowledge of the dual method was low. More than half of the study population had good practice in family planning. More than two-thirds of HIV-positive reproductive-age women had a good attitude about family planning. Having one or a greater number of children, having a discussion on a fertility plan with a healthcare provider, and having a good practice of family planning were significantly associated with a good attitude toward family planning. Married women, education status, discussions on fertility plans with healthcare providers, knowledge about dual methods, and knowledge about modern contraceptive methods were significantly associated with good family planning practices. The stakeholders should design interventions based on the aforementioned factors to improve the attitude and practice of family planning.

Social context of contraceptive use transition among sexually active women in Zambia (1992-2018): A decomposition analysis.

BACKGROUND: Contraception is an important public health initiative for addressing maternal health outcomes associated with unplanned pregnancies, unsafe abortions and maternal deaths. Although contraceptive use has been on the rise globally, the observed increases in sub-Saharan Africa (SSA) are sub-optimal and vary among countries. In Zambia, drivers of contraceptive use transition are not well documented. Thus, this study examined the drivers of contraceptive use change among sexually active women in Zambia between 1992 and 2018. METHODS: Data came from the six Zambia Demographic and Health Surveys conducted between 1992 and 2018. A sample of 44,762 fecund sexually active women aged 15-49 years was analysed using multivariable Blinder Oaxaca decomposition regression analysis. Analysis took into account the complex survey design. Results were presented using adjusted coefficients, their 95% confidence intervals, and percentages. RESULTS: The prevalence of contraceptive use among sexually active women increased significantly by 30.8 percentage points from 14.2% (95% CI: 12.8, 15.6) to 45.0% (95% CI: 43.6, 46.4) during the period 1992 to 2018. The major share of the increase happened during the period 1992-1996 (10.2%) while the least increase occurred between 2013 and 2018 (0.2%). Overall, about 15% of the increase in the prevalence of contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 85% of the increase was due to change in contraceptive behaviour of sexually active women. Changes in women's compositional characteristics such as secondary education (5.84%), fertility preference (5.63%), number of living children (3.30%) and experience of child mortality (7.68%) were associated with the increase in contraceptive use prevalence. CONCLUSION: Change in contraceptive behaviour of sexually active women contributed largely to the observed increase in contraceptive use prevalence in Zambia. Increase in the proportion of women attaining secondary education, decrease in the percentage of women who want large families and improvement in child survival were the major compositional factors driving the rise in contraceptive use. The findings imply that increasing investment in education sector and enhancing existing family planning programmes has the potential to further improve contraceptive use prevalence in Zambia.

Mobile solutions to Empower reproductive life planning for women living with HIV in Kenya (MWACh EMPOWER): Protocol for a cluster randomized controlled trial.

BACKGROUND: Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that support health care workers (HCWs) in providing high-quality RH counseling, tailored to the needs of WLWH, may improve reproductive health outcomes. METHODS AND DESIGN: We are conducting a non-blinded cluster randomized controlled trial (cRCT) of a digital health intervention for WLWH (clinicaltrials.gov #NCT05285670). We will enroll 3,300 WLWH seeking care in 10 HIV care and treatment centers in Nairobi and Western Kenya. WLWH at intervention sites receive the Mobile WACh Empower intervention, a tablet-based RH decision-support counseling tool administered at baseline and SMS support during two years of follow-up. WLWH at control sites receive the standard of care FP counseling. The decision-support tool is a logic-based tool for family planning (FP) counseling that uses branching logic to guide RH questions based on participants' reproductive life plans, tailoring counseling based on the responses. Follow-up SMSs are based in the Information-Motivation-Behavioral (IMB) Skills model of behavioral change and are tailored to participant characteristics and reproductive needs through separate SMS "tracks". Follow-up visits are scheduled quarterly for 2 years to assess plans for pregnancy, pregnancy prevention, and contraceptive use. The primary outcome, FP discontinuation, will be compared using an intent-to-treat analysis. We will also assess the unmet need for FP, dual method use, viral load suppression at conception and unintended pregnancy. DISCUSSION: The Mobile WACh Empower intervention is innovative as it combines a patient-centered counseling tool to support initial reproductive life decisions with longitudinal SMS for continued RH support and may help provide RH care within the context of provision of HIV care.

After the pill. Young women's contraceptive choices in the age of hormone rejection / Après la pilule. Le choix contraceptif des jeunes femmes à l'épreuve du rejet des hormones.

INTRODUCTION: Although the pill is still the contraceptive method most commonly used by young women in France, since the '00s there has been a decline in its use and a questioning of its centrality in the contraceptive norm. This questioning is part of a growing climate of mistrust toward hormonal methods. PURPOSE OF THE RESEARCH: Based on an analysis of a corpus of twenty-one interviews with women aged between twenty and twenty-eight on the subject of contraceptive choice, this article aims to provide information on the ways in which rejection of hormones is expressed and to determine its concrete effects on the interviewees' contraceptive choices. RESULTS: The survey shows the prevalence of mistrust of hormones among the young women interviewed. This mistrust is rarely rooted in their contraceptive experience; with a few exceptions, it seems to be more diffuse. This mistrust is most often expressed by women when it comes to justifying stopping the pill, the logistical burden of which becomes increasingly heavy as the years go by. However, the vast majority of women who reject the use of hormones continue to use medical contraception, including hormonal contraception, as long as it is perceived to be easier to use than the pill. CONCLUSIONS: By questioning hormonal contraception, and the pill in particular, young women are denouncing the lack of choice: they are not asking for less contraception, but for contraception that is better suited to their needs.

Introduction: Si la pilule demeure, en France, le moyen de contraception le plus utilisé par les jeunes femmes, on remarque depuis les années 2000 une diminution de cette utilisation et un questionnement quant à sa centralité dans la norme contraceptive. Ces remises en cause s'inscrivent dans une montée de ce que l'on peut qualifier de climat de défiance envers les méthodes hormonales. But de l'étude: À partir de l'analyse d'un corpus de 21 entretiens portant sur le choix en matière de contraception menés auprès de femmes ayant entre 20 et 28 ans, cet article vise à renseigner les modalités d'expression du rejet des hormones et à déterminer ses effets concrets sur leur choix contraceptif. Résultats: L'enquête montre la prévalence parmi les jeunes femmes interrogées d'une méfiance à l'égard des hormones, qui s'ancre rarement dans leur expérience contraceptive mais semble, à l'exception de certains cas, plus diffuse. Elle est surtout mobilisée par les femmes lorsqu'il s'agit de justifier l'arrêt de la pilule, dont la prise en charge matérielle devient de plus en plus pesante pour elles au fil des années. Finalement, les femmes qui rejettent l'utilisation des hormones continuent très majoritairement à utiliser une contraception médicalisée, y compris une contraception hormonale, à partir du moment où son usage est jugé plus facile que celui de la pilule. Conclusions: En remettant en cause la contraception hormonale, et plus précisément la pilule, c'est surtout le manque de choix que dénoncent les jeunes femmes : il ne s'agit pas de revendiquer moins de contraception, mais une contraception plus adaptée à leurs besoins.

Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study.

BACKGROUND: Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic. METHODS: This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15-49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. RESULTS: The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women's age, area of residence, mother tongue of household head, age of husband, and number of children ever born. CONCLUSION: The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.

Variables predictoras del uso de los métodos anticonceptivos en jóvenes: una revisión sistemática / Predictor variables of contraceptive method use in young people: A systematic review

Diseño: Revisión sistemática. Fuentes de datos: Se consultaron las bases de datos PubMed, CINAHL, Scopus, Cuiden Plus, LILACS e IME. Selección de estudios: Se realizó una evaluación de la calidad de los estudios que fue revisada por dos investigadores en paralelo. Como resultado, se seleccionaron un total de cinco investigaciones primarias. Extracción de datos: Se extrajo información sobre la población seleccionada en el estudio, método anticonceptivo estudiado y las variables predictoras identificadas. Resultados: Se identificaron siete variables predictoras que explican específicamente el uso del preservativo masculino, píldora anticonceptiva o píldora anticonceptiva de emergencia. Las variables más relevantes fueron el nivel de conocimiento y las actitudes hacia el empleo de los métodos anticonceptivos, de manera que un mayor conocimiento y unas actitudes positivas incrementan la probabilidad de uso de métodos anticonceptivos. Otro resultado destacado fue la presencia de un sesgo formativo con un mayor conocimiento de las mujeres sobre las opciones anticonceptivas hormonales y actitudes más positivas. Conclusión: Los futuros programas formativos deben orientarse hacia la evaluación de cambios en el comportamiento, mediante el desarrollo de actitudes positivas hacia el uso de los métodos anticonceptivos a través de la adquisición de un conocimiento de calidad sobre las opciones contraceptivas.(AU)

Objective: To analyse predictor variables of contraceptive method use in young people. Design: Systematic review. Data sources: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. Study selection: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. Data extraction: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. Results: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with womenhaving higher knowledge of hormonal contraceptive options and more positive attitudes. Conclusion: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.(AU)

Strategies to enhance indigenous men's support for utilisation of long-acting reversible contraceptives among women in Kiboga and Rubanda rural districts in Uganda.

Unintended pregnancies, a global public health concern with an annual incidence of about 74 million, significantly impact Africa, representing 25% of cases. These pregnancies, linked to health risks and mortalities, underscore the critical need for effective family planning especially the Long-acting reversible contraceptives (LARCs). Long-acting reversible contraceptives offer a significant solution, yet their uptake in Uganda faces challenges due to insufficient male support. This qualitative study in Rubanda and Kiboga revealed negative perceptions and belief systems among rural Indigenous Ugandan men regarding the use of LARCs by their wives, which acted as barriers to utilization. Recommendations include enhancing Social and Behavioural Change Communication (SBCC) and improving LARCs service delivery to counter limited knowledge and service concerns, aiming to foster better understanding and correcting the negative perceptions, belief sytems and acceptance of these contraceptive methods for improved maternal and child health outcomes.

Les grossesses non désirées, une préoccupation mondiale en matière de santé publique avec une incidence annuelle d'environ 74 millions, impactent significativement l'Afrique, représentant 25 % des cas. Ces grossesses, liées à des risques sanitaires et à des mortalités, soulignent le besoin critique d'une planification familiale efficace, en particulier des contraceptifs réversibles à longue durée d'action (LARCs). Les contraceptifs réversibles à longue durée d'action offrent une solution significative, mais leur adoption en Ouganda est confrontée à des défis en raison du manque de soutien des hommes. Cette étude qualitative menée à Rubanda et Kiboga a révélé des perceptions négatives et des systèmes de croyances parmi les hommes indigènes ougandais ruraux concernant l'utilisation des LARCs par leurs épouses, ce qui a agi comme des obstacles à leur utilisation. Les recommandations incluent le renforcement de la communication pour le changement social et comportemental (SBCC) et l'amélioration de la prestation de services de LARCs pour contrer le manque de connaissance et les préoccupations concernant les services, visant à favoriser une meilleure compréhension et à corriger les perceptions négatives, les systèmes de croyances et l'acceptation de ces méthodes contraceptives pour des résultats améliorés en matière de santé maternelle et infantile.

Perceptions of and barriers to uptake of contraceptives in plantation farming communities of Cross River State, Nigeria: A qualitative inquiry.

The contraceptive use in Nigeria is relatively low, indicative of the non-adoption of contraceptives by people of reproductive age to curtail the increasing fertility rate with its attendant consequences on the family. The non-use is attributed to numerous factors, including perceptions of and attendant barriers to the uptake of contraceptives. This study was aimed at assessing the perception of and barriers to the uptake of contraceptives among residents of plantation farming communities in Cross River State, Nigeria. It was a multi-sited qualitative descriptive study conducted in three Local Government Areas (Ikom, Yakurr, and Akamkpa) in Cross River State, Nigeria between March and April 2022. Nine Focus Group Discussions (FGDs) and twelve key informant interviews (KIIs) were conducted with respondents from three plantation farming communities. The FGDs were conducted on sexually active unmarried girls, married women within the reproductive age, and married men with spouses of reproductive age. The KIIs were conducted on health care providers, village heads, youth leaders, and women leaders. The generated data were thematically analyzed using both deductive and inductive analytical approaches. Married women were deemed eligible to use contraceptives, which are viewed as a method for preventing pregnancy. The information supplied by healthcare professionals was deemed insufficient for women to make informed decisions. Fear of side effects, dysfunctional health facilities, frequent stock outs, and spousal opposition were the most significant barriers to contraceptive use. Family planning programs should be targeted more at residents of rural areas to increase awareness, dispel misconceptions, and promote contraceptive use.

L'utilisation de contraceptifs au Nigéria est relativement faible, ce qui indique que les personnes en âge de procréer ne les adoptent pas pour freiner l'augmentation du taux de fécondité et ses conséquences sur la famille. La non-utilisation est attribuée à de nombreux facteurs, notamment les perceptions et les obstacles à l'adoption des contraceptifs. Cette étude visait à évaluer la perception et les obstacles à l'adoption des contraceptifs parmi les résidents des communautés agricoles des plantations de l'État de Cross River, au Nigeria. Il s'agissait d'une étude descriptive qualitative multisites menée dans trois zones de gouvernement local (Ikom, Yakurr et Akamkpa) dans l'État de Cross River, au Nigeria, entre mars et avril 2022. Neuf discussions de groupe (FGD) et douze entretiens avec des informateurs clés (KII). ont été menées auprès de répondants de trois communautés agricoles de plantations. Les groupes de discussion ont été menés auprès de filles célibataires sexuellement actives, de femmes mariées en âge de procréer et d'hommes mariés ayant des épouses en âge de procréer. Les KII ont été menées auprès des prestataires de soins de santé, des chefs de village, des jeunes leaders et des femmes leaders. Les données générées ont été analysées thématiquement en utilisant des approches analytiques déductives et inductives. Les femmes mariées étaient considérées comme éligibles à l'utilisation de contraceptifs, considérés comme une méthode permettant de prévenir une grossesse. Les informations fournies par les professionnels de santé ont été jugées insuffisantes pour permettre aux femmes de prendre des décisions éclairées. La peur des effets secondaires, le dysfonctionnement des établissements de santé, les ruptures de stock fréquentes et l'opposition des conjoints étaient les obstacles les plus importants à l'utilisation des contraceptifs. Les programmes de planification familiale devraient cibler davantage les résidents des zones rurales afin de les sensibiliser, de dissiper les idées fausses et de promouvoir l'utilisation des contraceptifs.

Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study.

INTRODUCTION: Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS: An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS: The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION: The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.

Prevalence of high-risk human papillomavirus infection and cervical lesions among female migrant head porters (kayayei) in Accra, Ghana: a pilot cross-sectional study.

BACKGROUND: Little attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters (kayayei) in Ghana, as a vulnerable group, and to promote cervical screening in these women. This pilot study aimed to determine the prevalence of hr-HPV infection and cervical lesions among kayayei in Accra, the capital of the Greater Accra Region of Ghana and to describe our approach to triaging and treating these women. METHODS: This descriptive cross-sectional cohort study involved the screening of 63 kayayei aged ≥ 18 years at the Tema Station and Agbogbloshie markets in March 2022 and May 2022. Concurrent hr-HPV DNA testing (with the MA-6000 platform) and visual inspection with acetic acid (VIA) was performed. We present prevalence estimates for hr-HPV DNA positivity and VIA 'positivity' as rates, together with their 95% confidence intervals (CIs). We performed univariate and multivariable nominal logistic regression to explore factors associated with hr-HPV infection. RESULTS: Gross vulvovaginal inspection revealed vulval warts in 3 (5.0%) and vaginal warts in 2 (3.3%) women. Overall, the rate of hr-HPV positivity was 33.3% (95% CI, 21.7-46.7), whereas the VIA 'positivity' rate was 8.3% (95% CI, 2.8-18.4). In the univariate logistic regression analysis, none of the sociodemographic and clinical variables assessed, including age, number of prior pregnancies, parity, past contraceptive use, or the presence of abnormal vaginal discharge showed statistically significant association with hr-HPV positivity. After controlling for age and past contraceptive use, only having fewer than two prior pregnancies (compared to having ≥ 2) was independently associated with reduced odds of hr-HPV infection (adjusted odds ratio, 0.11; 95% CI, 0.02-0.69). CONCLUSION: In this relatively young cohort with a high hr-HPV positivity rate of 33.3% and 8.3% of women showing cervical lesions on visual inspection, we posit that kayayei may have an increased risk of developing cervical cancer if their accessibility to cervical precancer screening services is not increased.

Residential and wealth-related disparities of high fertility preferences in Ethiopia: A decomposition analysis.

BACKGROUND: Fertility preference significantly influences contraceptive uptake and impacts population growth, especially in low and middle-income countries. In the previous pieces of literature, variations in fertility preference across residence and wealth categories and its contributors were not assessed in Ethiopia. Therefore, we decomposed high fertility preferences among reproductive-aged women by residence and wealth status in Ethiopia. METHODS: We extracted individual women's record (IR) data from the publicly available 2016 Ethiopian Demographic Health Survey (EDHS) dataset. A total of 13799 women were included in the study. Multivariate decomposition analysis was conducted to identify the factors that contributed to the differences in the percentage of fertility preferences between rural and urban dwellers. Furthermore, we used an Erreygers normalized concentration index and curve to identify the concentration of high fertility preferences across wealth categories. The concentration index was further decomposed to identify the contributing factors for the wealth-related disparities in high fertility preference. Finally, the elasticity of wealth-related disparity for a change in the socioeconomic variable was estimated. RESULTS: The weighted percentage of women with high fertility preference among rural and urban residents was 42.7% and 19%, respectively, reflecting a 23.7 percentage point difference. The variations in fertility preference due to the differences in respondents' characteristics accounted for 40.9%. Being unmarried (8.4%), secondary (14.1%) and higher education (21.9%), having more than four children (18.4%), having media exposure (6.9%), middle (0.4%), richer (0.2%) and richest (0.1%) wealth were the positive and city administration (-30.2%), primary education (-1.3%) were the negative contributing factors for the variations in high fertility preferences due to population composition. Likewise, about 59% of the variations in fertility preference were due to variations in coefficients. City administration (22.4%), primary (7.8%) and secondary (7.4%) education, poorer wealth (0.86%) were the positive and having media exposure (-6.32%) and being unmarried (-5.89%), having more than four children (-2.1%) were the negative factors contributing to the difference in high fertility preferences due to the change in coefficients across residents. On the other hand, there was a pro-poor distribution for high fertility preferences across wealth categories with Erreygers normalized concentration index of ECI = -0.14, SE = 0.012. Having media exposure (17.5%), primary (7.3%), secondary (5.4%), higher (2.4%) education, being unmarried (8%), having more than four children (7.4%), rural residence (3%) and emerging (2.2%) were the positive and city administration (-0.55) was the negative significant contributor to the pro-poor disparity in high fertility preference. CONCLUSION: The variations in high fertility preferences between rural and urban women were mainly attributed to changes in women's behavior. In addition, substantial variations in fertility preference across women's residences were explained by the change in women's population composition. In addition, a pro-poor distribution of high fertility preference was observed among respondents. As such, the pro-poor high fertility preference was elastic for a percent change in socioeconomic variables. The pro-poor high fertility preference was elastic (changeable) for a percent change in each socioeconomic variables. Therefore, women's empowerment through education and access to media will be important in limiting women's desire for more children in Ethiopia. Therefore, policymakers should focus on improving the contributing factors for the residential and wealth-related disparities in high fertility preferences.

"I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh.

BACKGROUND: The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. METHOD: A qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15-49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman's three-phase coding system. RESULTS: Five broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. CONCLUSION: Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.

The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Taking this into account, our objective is to investigate the socio-cultural factors that influence the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. A total of 14 IDIs and 16 KIIs were conducted in two unregistered Rohingya camps. We found that contraceptive use among Rohingya refugees was constrained by various socio-cultural and religious beliefs. The desire for a larger number of children to ensure the continuity of the lineage and to be able to contribute to the growth of the Islamic population serves as a major barrier. Lack of decision-making power regarding reproductive life not only stops participation but also makes women vulnerable to IPV and marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. Young women often acquire information about both true side effects and myths from their social networks. Therefore, developing culturally sensitive programs and educational interventions targeting the women, their peers, and other related communities is indispensable to assist Rohingya refugee women in overcoming the identified barriers to contraception.

Demographic and socio-economic correlates of knowledge of the ovulatory cycle among tribal women in India: Evidence from the nationally representative survey (NFHS-5).

BACKGROUND: The knowledge of ovulatory cycle (KOC) is the basis for natural family planning methods. The absence of knowledge is a notable issue since the ovulatory cycle plays a crucial role in reproductive health and empowers women to make informed decisions that influence their lives. This study examines the knowledge of the ovulatory cycle among reproductive tribal women in India and its demographic and socio-economic determinants. METHODS: The data were derived from the National Family Health Survey conducted in 2019-2021. The effective sample size for the present study was 1,01,914 tribal women aged 15-49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable binary logistic regressions were conducted to determine the likelihood of KOC among tribal women across different characteristics. We conducted statistical analysis in STATA 17.0 (StataCorp) and used ArcGIS 10.8.2 for spatial mapping. RESULTS: Out of 1,01,914 tribal women, 78.8 per cent lack correct knowledge of the ovulatory cycle. Notably, Education level significantly influences KOC, with secondary education showing higher odds of KOC (AOR: 1.24, 95% CI:1.006-1.528) compared to no education. Christian women exhibit lower odds of having KOC (AOR: 0.749, 95% CI:0.564-0.996) compared to Hindu women. Husband/partner's education level shows a strong association, with higher-educated partners correlating with higher odds of KOC (AOR: 2.501, 95% CI: 1.807-3.461) for higher education. Knowledge of any contraceptive method and current contraceptive use type are strongly associated with KOC. Additionally, rural residence negatively influences KOC (AOR: 1.545, 95% CI: 1.236-1.932), while exposure to mass media has a positive effect (AOR: 1.152, 95% CI: 0.975-1.362) albeit modest. CONCLUSION: The study highlights the need for targeted educational and awareness programs to improve KOC among tribal women in India. By addressing factors such as education, religious influences, and place of residence, we can empower these women to make informed decisions about their reproductive health, ultimately enhancing their overall well-being and quality of life. This knowledge is not only a foundation for natural family planning but also a key driver of women's agency and autonomy in shaping their lives.

Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes.

Importance: Pursuant to the Families First Coronavirus Response Act (FFCRA), continuous Medicaid eligibility during the COVID-19 public health emergency (PHE) created a de facto national extension of pregnancy Medicaid eligibility beyond 60 days postpartum. Objective: To evaluate the association of continuous Medicaid eligibility with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. Design, Setting, and Participants: This cohort study using a generalized difference-in-differences design included 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation in the Pregnancy Risk Assessment Monitoring System (PRAMS). Exposures: State-level change in Medicaid income eligibility after 60 days postpartum associated with the FFCRA measured as a percent of the federal poverty level (FPL; ie, the difference in 2020 income eligibility thresholds for pregnant people and low-income adults/parents). Main Outcomes and Measures: Health insurance, postpartum visit attendance, contraceptive use (any effective method; long-acting reversible contraceptives), any breastfeeding and depressive symptoms at the time of the PRAMS survey (mean [SD], 4 [1.3] months postpartum). Results: The sample included 47 716 PRAMS respondents (64.4% aged <30 years; 18.9% Hispanic, 26.2% non-Hispanic Black, 36.3% non-Hispanic White, and 18.6% other race or ethnicity) with a Medicaid-paid birth. Based on adjusted estimates, a 100% FPL increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance. This represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. In subgroup analyses by race and ethnicity, uninsurance reductions were observed only among White and Black non-Hispanic individuals; Hispanic individuals had no change. No policy-associated changes were observed in other outcomes. Conclusions and Relevance: In this cohort study, continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. These findings, though limited to the context of the COVID-19 PHE, may offer preliminary insight regarding the potential impact of post-pandemic postpartum Medicaid eligibility extensions. Collection of longer-term and more comprehensive follow-up data on postpartum health care and health will be critical to evaluating the effect of ongoing postpartum policy interventions.

Psychometric analysis and linguistic adaptation of the Persian version of Contraceptive Self-Efficacy Scale (CSES-P).

BACKGROUND: This study was aimed to test adaptability of the Contraceptive Self-Efficacy Scale (CSES) for use on Persian-speaking women of reproductive age. METHOD: A preliminary draft of the Contraceptive Self Efficacy Scale (CSES) was prepared according to the standard translation/back translation procedures and an expert panel appraised its content and face validities. The approved draft was tested on 400 randomly selected women of reproductive age (15-49 years) at the 29th Bahman Hospital of in Tabriz, the capital city of East Azerbaijan province, North West of Iran from May to August 2018. The exploratory and confirmatory factor analysis (EFA, CFA) was carried out to verify the implicit factor structure of the CSES for use on Persian-speaking women of fertile age. The Cronbach's α and Interclass Correlation coefficients were estimated for internal consistency and accuracy assessment of the instrument. RESULTS: This translated scale indicated good internal consistency (0.9) and reliability (0.9). A four-factor solution best fitted the study data and the estimated fit indices were in the acceptable range (chi square/ degree of freedom = 2.956, the Root Mean Square Error of Approximation = 0.070, Confirmatory Fit Index = 0.667, The Tucker-Lewis Index = 0.599). CONCLUSION: The CSES-P can be considered as a potentially valid and reliable tool to assess contraceptive self-efficacy among Persian-speaking women. The CSES-P is a general instrument to measure overall contraceptive self-efficacy of the Iranian reproductive age women and it would also be fascinating to work on method specific self-efficacy tools in future.

Women alone modern contraceptive use decision making and its correlates, evidence from PMA CS 2021 survey.

BACKGROUND: Women alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners' effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health. METHODS: Nationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance. RESULTS: This study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use. CONCLUSION: 59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.

Prevalence and dynamics of contraceptive use by type during the COVID-19 pandemic: Evidence from Western Iran.

Contraception represents a deliberate choice made by individuals, both men and women, to regulate their desired number of children. The primary objective of this study was to examine the prevalence and predictors of contraceptive use, while also exploring the shifts in contraception methods following the COVID-19 pandemic. This study employed a quantitative approach with a survey technique. The survey was conducted in Kermanshah, one of Iran's metropolises located in the western part of the country. The sampling methodology employed in this study involved a combination of multi-stage classification and systematic random methods. The survey took place between July and August 2022. The target population for the survey included women between the ages of 15 and 49. A total of 600 women from this population were selected and included in the survey sample. The sample was described using frequency tables, as well as central and dispersion indices (mean and standard deviation). Additionally, multivariate analysis was conducted through the application of logistic regression. Findings pointed out that approximately 65% of the women in the sample utilized contraception methods. Among these methods, the condom and oral pill were found to be the most prevalent choices. Moreover, the findings indicated that an increase in the number of both living and ideal children was associated with a decreased likelihood of contraceptive use. Following the occurrence of the COVID-19 pandemic, there was an observed increase in the utilization of traditional and natural methods of contraception. This shift highlights the importance of considering a broader range of contraceptive options and not solely focusing on restricting contraception services. In the midst of the coronavirus outbreak, women turned to traditional contraceptives, which may increase the risk of unintended pregnancies and subsequent miscarriages. Therefore, providing in-person services to women at their place of residence is necessary during epidemics.