Society of Family Planning Clinical Recommendation: Management of hemorrhage at the time of abortion.

Hemorrhage after abortion is rare, occurring in fewer than 1% of abortions, but associated morbidity may be significant. Although medication abortion is associated with more bleeding than procedural abortion, overall bleeding for the two methods is minimal and not clinically different. Hemorrhage can be caused by atony, coagulopathy, and abnormal placentation, as well as by such procedure complications as perforation, cervical laceration, and retained tissue. Evidence for practices around postabortion hemorrhage is extremely limited. The Society of Family Planning recommends preoperative identification of individuals at high risk of hemorrhage as well as development of an organized approach to treatment. Specifically, individuals with a uterine scar and complete placenta previa seeking abortion at gestations after the first trimester should be evaluated for placenta accreta spectrum. For those at high risk of hemorrhage, referral to a higher-acuity center should be considered. We propose an algorithm for treating postabortion hemorrhage as follows: (1) assessment and examination, (2) uterine massage and medical therapy, (3) resuscitative measures with laboratory evaluation and possible reaspiration or balloon tamponade, and (4) interventions such as embolization and surgery. Evidence supports the use of oxytocin as prophylaxis for bleeding with dilation and evacuation; methylergonovine prophylaxis, however, is associated with more bleeding at the time of dilation and evacuation. Future research is needed on tranexamic acid as prophylaxis and treatment and misoprostol as prophylaxis. Structural inequities contribute to bleeding risk. Acknowledging how our policies hinder or remedy health inequities is essential when developing new guidelines and approaches to clinical services.

Family planning integration in Ethiopia's primary health care system: a qualitative study on opportunities, challenges and best practices.

BACKGROUND: Family planning (FP) service integration into primary health care (PHC) is an effective approach to realize reproductive autonomy, increase the use of contraceptives, and improve maternal and child health outcomes. The Ethiopian government promotes integration of FP services into primary health care (PHC). However, there is paucity of evidence on the status of FP service integration. The aim of this study is to explore the state of FP integration into PHC services and identify facilitators and barriers to integration. METHODS: A qualitative study nested with a larger national study was conducted from July to October 2022. A total of 60 interviews were conducted with FP stakeholders including, government organizations, non-governmental organizations, donors, service providers, and clients. Interviews were audio recorded, transcribed, and coded using OpenCode 4.03. The coded data were analyzed using framework analysis approach, using the Primary Health Care Performance Initiative (PHCPI) framework. Direct quotes and results from the coding and categorization were used to develop the report. RESULTS: Family planning is largely provided in designated units by dedicated staff within PHC facilities. The provision of integrated FP service within each service unit is in its early stage. Successful examples of integration include integration of FP with postnatal care, abortion care, and youth-friendly service centers. Facilitators of integration include commitment of the government and partners, the presence of policies and guidelines, and positive attitude of service providers and clients. However, integration of FP also faces challenges that are largely related to challenges of the FP program even before integration. These include resource shortage, health workers shortage, health workers' capacity/skill gaps, misconceptions about FP, religious and socio-cultural norms, and lack of awareness. CONCLUSIONS: Integration of FP with PHC services in the Ethiopian public health facilities is viable. Pre-existing challenges of the FP program continued to be barriers to integration. Expanding the experiences of good practices in the integration of FP with post abortion care, post-natal care, and youth-friendly service centers to other components of PHC warrants attention. Addressing both supply- and demand-side challenges of the FP program is needed to facilitate the integration of FP with other PHC services.

This study aimed to explore the status of integrating family planning (FP) services into primary health care (PHC) in Ethiopia and identify the facilitators and barriers to integration. The study included 60 interviews with stakeholders, including government and non-government organizations, service providers, and clients. We found that while dedicated FP staff provide services in designated units within PHC facilities, the provision of integrated FP services within other PHC units is in its early stage. Integration with post-abortion care, post-natal care, and youth-friendly service centers showed exemplary results that need to be used as good practices. The study identified challenges including resource shortage, health worker shortage, misconceptions about FP, religious and socio-cultural norms, and lack of awareness. The positive attitude of service providers and the commitment of the government and partners were identified as facilitators of integration. The study recommends expanding the successful practices of FP integration to other components of PHC and addressing supply- and demand-side challenges to facilitate the integration of FP services with PHC.

Improving Effective Chlamydia Screening for Women at Risk at a Rural Family Planning Clinic.

Background: Chlamydia is the most common bacterial sexually transmitted infection (STI) in the United States, with an incidence of 1.7 million infections annually. It results in an estimated $691 million in lifetime medical costs. Objective: The objective of the project was to improve effective care for women at risk of chlamydia infection in a rural family planning clinic to 80% in 90 days. Methods: The Plan-Do-Study-Act process of quality improvement (QI) was implemented over four 2-week cycles. Qualitative and quantitative data were collected and analyzed iteratively and informed tests of change for each cycle. Results: Results indicated an improvement in effective care from a baseline of 42%-81%. Patient visit time decreased from 38 minutes at baseline to 23 minutes. Compared with pre-implementation, the number of positive chlamydia test results went from three to six, doubling the positivity rate, while the number of chlamydia tests billed increased by 32%. Conclusions: This project was successful in improving effective care. Implementing a standardized risk assessment decreased patient visit time. Implications for nursing: QI projects directed at meeting national standards for STI screening can be implemented in rural health clinics at low cost and with high impact.

Structural transition of parenthood among Chinese nulliparous couples with planned pregnancies, 2013-2019.

BACKGROUND: The postponement of parenthood is a global public health issue that has received attention of many public health experts. However, few studies have investigated the postponement in marriage age, marriage and conception interval, and pregnancy age in terms of demographic and regional heterogenicities. METHODS: This is a cross-sectional, registry-based study, and a total of 13 894 601 nulliparous couples who participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013-2019 were included. We calculated annual percentage change and forest plots for marriage age, marriage and conception interval, and pregnancy age. RESULTS: Late marriage (marriage age ≥ 35 years), long marriage and conception interval (marriage and conception interval ≥ 2 years), and advanced pregnancy (pregnancy age ≥ 35 years) increased from 1.20%, 22.01%, and 1.88% in 2013 to 1.69%, 32.75%, and 2.79% in 2019, respectively. The corresponding annual percentage changes were 6.55%, 8.44%, and 8.17%. Participants without higher education had a higher annual percentage change, but comparable prevalence for long marriage and conception interval with participants with higher education. Participants residing in second- or new first-tier cities, and the northeast of China who had a higher prevalence of parenthood postponement also had higher corresponding annual percentage changes. CONCLUSIONS: Structural postponement of parenthood with demographic and regional heterogenicities was observed among Chinese nulliparous couples with planned pregnancies during 2013-2019. Inclusive and comprehensive parenting support should be developed and implemented in mainland China to minimize the negative health effects arising from the postponement, especially for couples without higher education and living in new first/second-tier cities or the northeast China.

Family planning decision-making among young males in Southern Africa.

Male partners play a crucial role in reproductive health matters and seem to be identified as the main contributors responsible for the large proportion of poor reproductive health suffered by their female partners. Limited evidence exists, however, on effective strategies to increase male involvement in family planning. Therefore, this study aims to examine the prevalence and factors associated with male involvement in family planning decisions. Using recent data from Demographic and Health Surveys of seven countries in Southern Africa (Lesotho, Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe), age, education, wealth index, religion, occupation, exposure to media, contraceptive knowledge, and sex of household head showed significant associations of male involvement in family planning, and these associations differed by country. By country, the adjusted odds ratio (AOR) showed that education (Malawi (primary) AOR: 1.12; 95% CI: 0.91-1.38; South Africa (secondary/ higher) AOR: 1.44; 95% CI: 0.95-2.19), religion (Lesotho (Muslim) AOR: 2.10; 95% CI: 0.54-8.12; Zambia (Muslim) AOR: 1.01; 95% CI: 0.69-1.49; Zambia (Traditional) AOR: 1.06; 95% CI: 0.77-1.47), marital status (Malawi (widowed) AOR: 1.06; 95% CI: 0.55- 2.05; Lesotho (divorced/separated) AOR: 1.18; 95% CI: 0.84-1.66; Mozambique (divorced/separated) AOR: 1.03; 95% CI: 0.80- 1.33), and sex of household head (South Africa (female) AOR: 1.11; 95% CI: 0.96-1.27) were significant predictors of male involvement in family planning decision-making in Southern African countries. Certain socio-economic factors such as wealth status (Malawi (middle) AOR: 1.04; 95% CI: 0.91-1.19, ρ< 0.05; South Africa (Rich) AOR: 1.06; 95% CI: 0.91-1.23), and occupational status (Mozambique (working) AOR: 1.12; 95% CI: 0.97-1.29) were found to be positively associated with males' participation in family planning decision-making in Malawi, South Africa and Mozambique. Suggested strategies include programmes targeting couples jointly and family planning education for men provided by male outreach workers, especially in communities at the grassroots level. Therefore, to encourage men's involvement and approval of family planning, community - based intervention programmes that openly target men are required to reduce stigma and misconceptions and boost consciousness of the advantages of family planning utilization.

Les partenaires masculins jouent un rôle crucial en matière de santé reproductive et semblent être identifiés comme les principaux contributeurs responsables de la grande proportion de mauvaise santé reproductive subie par leurs partenaires féminines. Cependant, il existe peu de preuves sur les stratégies efficaces pour accroître la participation des hommes à la planification familiale. Par conséquent, cette étude vise à examiner la prévalence et les facteurs associés à l'implication des hommes dans les décisions de planification familiale. En utilisant des données récentes d'enquêtes démographiques et sanitaires de sept pays d'Afrique aus trale (Lesotho, Malawi, Mozambique, Afrique du Sud, Tanzanie, Zambie et Zimbabwe), l'âge, l'éducation, l'indice de richesse, la religion, la profession, l'exposition aux médias, les connaissances en matière de contraception et le sexe du chef de ménage a montré des associations significatives de l'implication des hommes dans la planification familiale, et ces associations différaient selon les pays. Par pays, l'odds ratio (AOR) ajusté a montré que l'éducation (AOR au Malawi (primaire) : 1,12 ; IC à 95 % : 0,91­1,38; AOR en Afrique du Sud (secondaire/ supérieur) : 1,44 ; IC à 95 % : 0,95 ­2,19), religion (RCA du Lesotho (musulman) : 2,10 ; IC à 95 % : 0,54­8,12; RCA de la Zambie (musulmane) : 1,01 ; IC à 95 % : 0,69­1,49; Zambie (traditionnel) AOR : 1,06 ; IC à 95 % : 0,77­1,47), état matrimonial (Malawi (veuve) AOR : 1,06 ; IC à 95 % : 0,55­2,05; Lesotho (divorcé/séparé) AOR : 1,18 ; IC à 95 % : 0,84­1,66; Mozambique (divorcé/séparé) AOR : 1,03 ; IC à 95 % : 0,80­1,33) et le sexe du chef de ménage (Afrique du Sud (fémme) AOR : 1,11 ; IC à 95 % : 0,96-1,27) étaient des prédicteurs significatifs de l'implication des hommes dans la prise de décision en matière de planification familiale dans les pays d'Afrique australe. Certains facteurs socio-économiques tels que le statut de richesse (Malawi (moyen) AOR : 1,04 ; IC à 95 % : 0,91-1,19; Afrique du Sud (riche) AOR : 1,06 ; IC à 95 % : 0,91- 1,23), et le statut professionnel (Mozambique (actif) AOR : 1,12 ; IC à 95 % : 0,97­1,29) se sont révélés positivement associés à la participation des hommes à la prise de décision en matière de planification familiale au Malawi, en Afrique du Sud et au Mozambique. Les stratégies suggérées comprennent des programmes ciblant conjointement les couples et une éducation à la planification familiale pour les hommes dispensée par des agents de proximité masculins, en particulier dans les communautés au niveau local. Par conséquent, pour encourager la participation et l'approbation des hommes à la planification familiale, des programmes d'intervention communautaires qui ciblent ouvertement les hommes sont nécessaires pour réduire la stigmatisation et les idées fausses et renforcer la prise de conscience des avantages de l'utilisation de la planification familiale.

Influence of sex composition of surviving children on childbearing intention among high fertility married women in stable union in Northwestern, Nigeria.

Achievement of Sustainable Development Goals (SDGs), especially goals one (end all forms of poverty), three (ensure healthy lives and promote well-being for all at all ages), four (ensure inclusive and equitable quality education and promote life-long learning opportunities for all) and five (achieve gender equality and empower all women and girls) might be a mirage without conscious efforts on the part of many developing countries to reduce population growth. Rapid population growth due to a high fertility rate and fertility desire may engender strife, poverty, unemployment, competition for scarce resources.The study explored the influence of sex composition of living children on childbearing intention among high fertility married women in stable union. This was a cross-sectional descriptive study and the study population were married women with high fertility in stable union. Results showed that sex composition of surviving children were significantly associated with respondents' fertility intentions. The following were the predictors of fertility intentions; sex composition of surviving children, type of family, contraceptive use, child parity, women empowerment status and others. Sex composition of surviving children was significantly associated with the fert ility intentions of the high fertility married women in stable union.

Réalisation des objectifs de développement durable (ODD), en particulier les objectifs un (mettre fin à toutes les formes de pauvreté), trois (garantir une vie saine et promouvoir le bien-être de tous à tous les âges), quatre (garantir une éducation inclusive et équitable de qualité et promouvoir tout au long de la vie opportunités d'apprentissage pour tous) et cinq (atteindre l'égalité des sexes et autonomiser toutes les femmes et les filles) pourraient être un mirage sans des efforts conscients de la part de nombreux pays en développement pour réduire la croissance démographique. Une croissance démographique rapide due à un taux de fécondité élevé et à un désir de fécondité peut engendrer des conflits, la pauvreté, le chômage et la compétition pour des ressources rares. L'étude a exploré l'influence de la composition par sexe des enfants vivants sur l'intention de procréer parmi les femmes mariées à forte fécondité en union stable. Il s'agissait d'une étude descriptive transversale et la population étudiée était composée de femmes mariées à fécondité élevée et en union stable. Les résultats ont montré que la composition par sexe des enfants survivants était significativement associée aux intentions de fécondité des répondants. Les éléments suivants étaient les prédicteurs des intentions de fécondité : composition par sexe des enfants survivants, type de famille, utilisation de contraceptifs, parité des enfants, statut d'autonomisation des femmes et autres. La composition par sexe des enfants survivants était significativement associée aux intentions de fécondité des femmes mariées à forte fécondité vivant en union stable.

Validation of a measure to assess decision-making autonomy in family planning services in three low- and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM).

BACKGROUND: Integrating measures of respectful care is an important priority in family planning programs, aligned with maternal health efforts. Ensuring women can make autonomous reproductive health decisions is an important indicator of respectful care. While scales have been developed and validated in family planning for dimensions of person-centered care, none focus specifically on decision-making autonomy. The Mothers Autonomy in Decision-Making (MADM) scale measures autonomy in decision-making during maternity care. We adapted the MADM scale to measure autonomy surrounding a woman's decision to use a contraceptive method within the context of contraceptive counselling. This study presents a psychometric validation of the Family Planning Autonomous Decision-Making (FP-ADM) scale using data from Argentina, Ghana, and India. METHODS AND FINDINGS: We used cross-sectional data from women in four subnational areas in Argentina (n = 890), Ghana (n = 1,114), and India (n = 1,130). In each area, 20 primary sampling units (PSUs) were randomly selected based on probability proportional to size. Households were randomly selected in Ghana and India. In Argentina, all facilities providing reproductive and maternal health services within selected PSUs were included and women were randomly selected upon exiting the facility. Interviews were conducted with a sample of 360 women per district. In total, 890 women completed the FP-ADM in Argentina, 1,114 in Ghana and 1,130 in India. To measure autonomous decision-making within FP service delivery, we adapted the items of the MADM scale to focus on family planning. To assess the scale's psychometric properties, we first examined the eigenvalues and conducted a parallel analysis to determine the number of factors. We then conducted exploratory factor analysis to determine which items to retain. The resulting factors were then identified based on the corresponding items. Internal consistency reliability was assessed with Cronbach's alpha. We assessed both convergent and divergent construct validity by examining associations with expected outcomes related to the underlying construct. The Eigenvalues and parallel analysis suggested a two-factor solution. The two underlying dimensions of the construct were identified as "Bidirectional Exchange of Information" (Factor 1) and "Empowered Choice" (Factor 2). Cronbach's alpha was calculated for the full scale and each subscale. Results suggested good internal consistency of the scale. There was a strong, significant positive association between whether a woman expressed satisfaction with quality of care received from the healthcare provider and her FP-ADM score in all three countries and a significant negative association between a woman's FP-ADM score and her stated desire to switch contraceptive methods in the future. CONCLUSIONS: Our results suggest the FP-ADM is a valid instrument to assess decision-making autonomy in contraceptive counseling and service delivery in diverse low- and middle-income countries. The scale evidenced strong construct, convergent, and divergent validity and high internal consistency reliability. Use of the FP-ADM scale could contribute to improved measurement of person-centered family planning services.

Health system cost for providing antiretroviral therapy, family planning, and pregnancy-related services to women living with HIV in public health settings, Mumbai, India.

Background: Integration of HIV care into family planning (FP) services would help in reducing unintended pregnancies among women living with HIV. Objectives: This study focuses on determining the health system cost for providing the linked HIV-FP services per beneficiary for the year 2019-2020. Materials and Methods: Using mixed micro-costing approach costs were collected from two tertiary hospitals in Maharashtra, India. The economic costs collected from gynaecology department and anti-retroviral treatment center were combined and added with package, program, and intervention costs to obtain health-system costs. We conducted probabilistic sensitivity analysis. Results: The unit cost and annual per-capita cost for providing HIV care (without considering cost of drugs and investigations) per beneficiary were INR 1033.8 (USD 13.6) and INR 9304.2 (USD 122.7), respectively. The unit cost was least for the outpatient services INR 197.5 (USD 2.6), followed by inpatient services INR 2735.92 (USD 36.21) and operation theater INR 4410 (USD 58.2). Cost was highest for dual-permanent (INR 13866.8 [USD 182.9]) followed by dual-reversible user (INR 2104.8 [USD 24.8]). It was the least for a person who only used condoms at INR 1674.1 (USD 22.1). In pregnancy-related services, cost for ante-natal services was least (INR 2043.6 [USD 27.96]), followed by vaginal delivery (INR 7120.5 [USD 93.93]), abortion (INR 11530.5 [USD 152.097]), and C-section (INR 18703.8 [USD 246.7]). Conclusion: We found no staggeringly additional costs for providing FP and pregnancy-related services to HIV-affected population, in comparison to general population. The findings could improve programs and insurance with a focus on this vulnerable population.

Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review.

BACKGROUND: Demand generation aims to increase clients' desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning. METHODS: We searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings. RESULTS: Forty-six studies (published 1990-2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services. CONCLUSIONS: Demand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization. TRIAL REGISTRATION: Systematic review registration: Center for Open Science, osf.io/286j5.

Family planning could prevent one third of maternal deaths by allowing women to delay motherhood, avoid unintended pregnancies and subsequent abortions. Demand generation is one of the critical factors for increasing coverage and sustainability of family planning programs. Demand generation activities aim to increase clients' desire to use family planning by changing their attitudes or perceptions about FP or increasing their awareness or knowledge about FP methods and also by improving access to contraceptive services. Many demand generation activities also aim to shift social and cultural norms to affect individual behavior change. Scaling up demand generation and ensuring that demand for family planning is satisfied is essential for achieving universal access to reproductive health-care services. We systematically searched for and summarized reports of strategies to scale up demand generation for family planning. Available evidence shows that interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. The effect of new media is uncertain. Demand-side financing approach probably increase awareness of contraceptives and the use of modern contraceptive methods among poor women. The most apparent factors influencing the success of implementing these strategies include knowledge about family planning methods, especially regarding side effects and health concerns, the availability of modern contraceptive methods, and the accessibility to family planning services.

Perspectives and practices of personnel involved in family planning with women at reproductive risk.

OBJECTIVE: To analyze the perspectives and practices of personnel involved in family planning with women at reproductive risk due to chronic diseases. METHOD: Qualitative study in which physicians and nurses from primary care centers in a state in central Mexico were interviewed. Interviews were transcribed and analyzed under the Grounded Theory proposal. RESULTS: The perspectives and practices in family planning interventions are unilaterally framed in the biomedical model. Three categories of analysis emerged: "The battle", "Convince by imposing", "Monitor them and catch them". CONCLUSION: It is necessary to promote competencies in interculturality, gender perspective and human rights to make the intervention more of a counseling and less of a prescription for life projects.

ACCEPTANCE AND UTILIZATION OF MODERN FAMILY PLANNING METHODS AMONG WOMEN OF CHILD BEARING AGE IN RURAL COMMUNITIES OF NORTH-EASTERN NIGERIA.

Introduction: Modern family planning is one of the most "health-promoting" and cost-effective activities in public health promotion and has the potential to avert approximately 30% of maternal and 10% of child deaths. Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. It confers important health and development benefits to individuals, families, communities, and the nation at large. Objectives: The study examined the acceptance and utilization of modern family planning methods among women of childbearing age in Potiskum town of Yobe State, North-eastern Nigeria. Methodology: A descriptive cross-sectional study design was adopted for the study. A semi-structured questionnaire was used to collect data from 271 respondents comprising women of childbearing age (15-49 years) residing in Bolewa 'B', Yerimaram, and DogoNini wards of Potiskum town, Yobe State. A multi-stage sampling technique was used to select the participants for the study. Results: The findings of the study revealed that the women of child-bearing age in Potiskum town, Yobe State have a high level of knowledge on modern family planning methods (88.6%) with friends and relatives as the predominant source of information (60.4%). More than half of the respondents (54.2%) have good utilization of modern family planning with cultural and religious misconceptions playing vital roles. The unmet needs were found to be (37.4%). Established determinants of utilization of modern family planning services among the respondents include male noninvolvement, side effects, religion, and distance beyond 5km to a health facility. Conclusion: In conclusion, despite a good level of knowledge of modern contraceptives among the respondents, only half utilize the services. It is recommended among others that, there is a need for the government, through the Ministry of Health, to revive and support family planning education at both household and community levels that targets the woman and her partner. This could be undertaken through community mobilization and engagement using print and mass media, traditional leaders, community resource groups, market places as well as newsletters, posters, and social media.

Factors affecting utilization of modern contraceptive methods among women of reproductive age in Ethiopia.

INTRODUCTION: Modern contraceptive use is important for improving health and socioeconomic outcomes, but Ethiopia is among the lowest-using countries. Therefore, this study aimed to determine factors affecting modern contraceptive use among women of reproductive age in Ethiopia. METHODS: This population-based cross-sectional study used data obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). A total of 8,885 reproductive-age women were included in the analysis. A weighted generalized estimating equation approach was used to account for the clustering and weighting effects in the assessment of associations between modern contraceptive usage and socioeconomic and demographic variables. RESULTS: Modern contraceptive use among women of reproductive age in Ethiopia is low (28%). Prevalence is highest among women aged 25-34 (40.11%), with higher education (30.97%), who are Orthodox Christians (31.67%), married (40.40%), middle wealth index (31.70%), female-headed households (31.42%), with 1-3 living children (44.85%), who headed by under 31 years old (40.07%), and in the Amhara region (34.45%). In the generalized estimating equation analysis, women aged 35-44 and over 45, Muslims, households heads aged 41-50 and over 50, and in female-headed households were less likely to use modern contraceptives, while women with primary, secondary, and higher education, married, middle and rich wealth index, and with 1-3 and more living children were more likely to use modern contraceptive than their counterparts (reference group) and were statistically significant. CONCLUSION: Modern contraceptive use is notably low among women of reproductive age in Ethiopia. Factors such as age, women's educational level, religion, marital status, number of living children, wealth status, gender and age of household head, and region were identified as significant factors associated with modern contraceptive use. Therefore, to increase modern contraceptive use, governmental and non-governmental organizations should invest in women's education and financial empowerment and raise awareness about the benefits of modern contraceptives, especially among older, unmarried, financially poor, elderly-led households, with few living children, and uneducated women.

Partnerships with religious leaders to promote family planning in rural Tanzania: an open-label, cluster randomised trial.

BACKGROUND: Family planning benefits maternal-child health, education, and economic wellbeing. Despite global efforts, an unsatisfied demand for family planning persists in sub-Saharan Africa. Based on previous successful partnerships, the aim of this study was to determine whether an educational intervention for religious leaders would increase community knowledge, demand for, and ultimately uptake of family planning. METHODS: In this open-label, cluster randomised trial in Tanzania, 24 communities were randomised (1:1) to intervention or control arm. Communities, defined as the catchment area of a single public health facility, were eligible if they were at least 15 km from Mwanza City and had not previously participated in a health intervention for religious leaders. Random allocations were determined by coin toss and were not revealed to clinicians at health facilities in intervention and control communities, nor to the data entry team; however, due to the nature of the intervention, masking of religious leaders in the intervention communities was not possible. All Christian religious institutions were invited to send four leaders to an educational intervention that incorporated cultural, theological, and medical teaching about family planning. The primary outcome was contraceptive uptake at the community health facility during the year post intervention versus the year before the intervention. This trial was registered at clinicaltrials.gov, NCT03594305. FINDINGS: 75 communities in three districts were assessed for eligibility. 19 communities were excluded and 56 were eligible for study inclusion and were placed in random order to be invited to participate. The first 24 communities that were invited agreed to participate and were randomly assigned to receive the educational intervention either during the trial or after trial completion. Between July 10, 2018 and Dec 11, 2021, we provided the intervention in 12 communities and compared contraceptive uptake with 12 control communities. All were followed up for 12 months. In intervention communities, contraceptive uptake increased by a factor of 1·47 (95% CI 1·41-1·53) in the post-intervention (prospective) versus pre-intervention (historical) year (geometric mean of contraceptive uptake, 466 in the prospective year vs 312 in the historical year), versus 1·24 (95% CI 1·20-1·29) in control communities (geometric mean, 521 in the prospective year vs 429 in the historical year). The rate of change in contraceptive uptake was greater in intervention communities (between-group ratio of geometric mean ratios over time, 1·19 [95% CI 1·12-1·25]; p<0·0001). The COVID-19 pandemic was associated with decreased contraceptive uptake (geometric mean, 365 during the pandemic in communities that had the majority of their prospective 12-month data collection periods occur after March 16, 2020, vs 494 before the pandemic; geometric mean ratio, 0·72 [95% CI 0·57-0·90]; p=0·0040). INTERPRETATION: This intervention offers a scalable model, leveraging influence of trusted religious leaders to increase knowledge and uptake of family planning. New strategies such as this could help to overcome setbacks that occurred during the COVID-19 pandemic. FUNDING: John Templeton Foundation and Weill Cornell Medicine Dean's Diversity and Healthcare Disparity Award. TRANSLATION: For the Kiswahili translation of the abstract see Supplementary Materials section.

Results of a cluster randomized trial testing the Systems Analysis and Improvement Approach to increase cervical cancer screening in family planning clinics in Mombasa County, Kenya.

BACKGROUND: Cervical cancer is the leading cause of cancer death in Kenyan women. Integrating cervical cancer screening into family planning (FP) clinics is a promising strategy to improve health for reproductive-aged women. The objective of this cluster randomized trial was to test the efficacy of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), as a tool to increase cervical cancer screening in FP clinics in Mombasa County, Kenya. METHODS: Twenty FP clinics in Mombasa County were randomized 1:1 to SAIA versus usual procedures. SAIA has five steps: (1) cascade analysis tool to understand the cascade and identify inefficiencies, (2) sequential process flow mapping to identify bottlenecks, (3) develop and implement workflow modifications (micro-interventions) to address identified bottlenecks, (4) assess the micro-intervention in the cascade analysis tool, and (5) repeat the cycle. Prevalence ratios were calculated using Poisson regression with robust standard errors to compare the proportion of visits where women were screened for cervical cancer in SAIA clinics compared to control clinics. RESULTS: In the primary intent-to-treat analysis in the last quarter of the trial, 2.5% (37/1507) of visits with eligible FP clients at intervention facilities included cervical cancer screening compared to 3.7% (66/1793) in control clinics (prevalence ratio [PR] 0.67, 95% CI 0.45-1.00). When adjusted for having at least one provider trained to perform cervical cancer screening at baseline, there was no significant difference between screening in intervention clinics compared to control clinics (adjusted PR 1.14, 95% CI 0.74-1.75). CONCLUSIONS: The primary analysis did not show an effect on cervical cancer screening. However, the COVID-19 pandemic and a healthcare worker strike likely impacted SAIA's implementation with significant disruptions in FP care delivery during the trial. While SAIA's data-informed decision-making and clinic-derived solutions are likely important, future work should directly study the mechanisms through which SAIA operates and the influence of contextual factors on implementation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03514459. Registered on April 19, 2018.

Trend, geographical distribution, and determinants of modern contraceptive use among married reproductive-age women, based on the 2000, 2005, 2011, and 2016 Ethiopian demographic and health survey.

BACKGROUND: The most common family planning method is modern contraception. It is a cost-effective way to reduce maternal and neonatal morbidity and mortality and enable women to make informed choices about their reproductive and sexual health. The trend of modern contraceptive utilization has shown drastic change in Ethiopia, and identifying the major factors contributing to such a drastic change is vital to improving plans and strategies for family planning programs. Therefore, this study analyzed the trend, geographical distribution, and determinants of modern contraceptive use among married reproductive-age women in Ethiopia. METHOD: This study used secondary data from the EDHS 2000-2016, collected from a population-based cross-sectional study by the Central Statistical Agency, focusing on married reproductive-age women aged 15-49. The study analyzed the modern contraceptive use trends through descriptive analyses conducted in three phases: 2000-2005, 2005-2011, and 2011-2016. The study utilized bivariable and multivariable logistic regression analyses to identify determinant factors, with significant variables declared using a P-value of 0.05 and an adjusted OR with 95% confidence interval. Analysis was conducted using STATA.14 and R. Spatial analysis was done using ArcGIS version 10.8 and SatScan™ version 9.6. RESULT: A weighted total of 33,478 women are included in the study, with a mean age of 31.4 years (8.6 SD). There was a significant increase in the trend of modern contraceptive use among married women over the study period, from 2000 to 2016, from 7.2% to 2000 to 15.7% in 2005, to 30% in 2011, and to 39.5% in 2016. The maximum increase was seen in the second phase (2005-2011), with a 14.3% increase. Factors like age of respondents, educational status, religion, residence, region, wealth index, number of living children, husbands' desire to have more children, and media exposure were found to be predictors for modern contraceptive utilization. CONCLUSION: The prevalence of modern contraceptive use is below 50%, and there is also evidence of wide geographical variation in modern contraceptive use in Ethiopia. Thus, policymakers, high institutions, and other stakeholders must work collaboratively with the government in order to improve awareness about modern contraceptive use.

Level of knowledge, attitude, and practice on modern contraceptive method and its associated factors among housemaids living in Debre Tabor town, northwest Ethiopia: a community-based cross-sectional study.

BACKGROUND: Contraception is widely recognized as an effective technique for avoiding unplanned pregnancies and sexually transmitted diseases. Promoting contemporary contraceptive methods would minimize the number of unplanned pregnancies and the high number of maternal fatalities connected with unsafe abortions. OBJECTIVE: This study aims to assess the level of knowledge, attitude, and practice of modern contraceptive methods and its associated factors among housemaid residents of Debre Tabor Town, northwest Ethiopia: METHODS: A structured questionnaire supplemented with face-to-face interviews was used to conduct a community-based cross-sectional study with 423 housemaids' women of reproductive age in Debre Tabor City. The data were analyzed using descriptive analysis, binary analysis, and multivariable logistic regression. RESULTS: A 12.8% of respondents in this study used modern contraceptive methods. A 44.68% of study participants had good knowledge of modern contraceptive methods, and 36.40% had a positive attitude towards them. Housemaids' older age, urban location, educational status, work experience, and family situation were found to be positive predictors of a good understanding of current contraceptive techniques. Housemaids' older age, urban residence, educational level, work experience, family situation, and first sex before now are all positive predictors of a positive attitude and good practices. CONCLUSIONS: Housemaids' knowledge, attitude, and practice of modern contraceptive methods were influenced by a variety of socio-demographic factors. As a result, housemaids should be educated about modern contraceptive methods by the health sector and other stakeholders to improve their knowledge, attitude, and practices.

[Acceptance of family planning methods in birth, cesarean and curettage]. / Aceptación de los métodos de planificación familiar en parto, cesárea y legrado.

Background: More than 120 million women worldwide want to avoid pregnancy, but most are not using contraception. This could be because they may not have received clear instructions on how to use the method properly, may not have obtained the most appropriate method for their needs, or may not have been aware of the side effects. Objective: To compare the acceptance of family planning methods (FPM) in women attended for childbirth, caesarean section, and curettage. Material and methods: Cross-sectional, analytical, prolective study. Women between 18 and 40 years of age in the immediate puerperium attended at a third level hospital were included. A survey which included 5 items with multiple choice answers and 7 with open answers was applied. General data were gathered, included the acceptance or not of some planning method, and the reason for its use or rejection. In addition, it was identified which methods they knew, if they received counseling and the perspective of effectiveness. Results: A total of 648 women were included; 216 women in each group. It was found that there is a higher percentage of acceptance of FPM in women attended by cesarean section, compared to those attended by delivery and curettage (p = 0.0158). Conclusions: Women attended by cesarean section are more willing to approve FPM, compared to those attended by delivery and curettage. Those patients who receive counseling are the most informed and the ones who approve FPM. Nurses and family physicians are the health workers who offer more counseling.

Introducción: más de 120 millones de mujeres en el mundo quieren evitar el embarazo, pero la mayoría no están empleado algún método anticonceptivo. Esto puede deberse a que no hayan recibido instrucciones claras acerca de cómo utilizar el método de manera adecuada, no hayan conseguido el anticonceptivo más apropiado a sus necesidades o no conocieran los efectos secundarios. Objetivo: comparar la aceptación de los métodos de planificación familiar (MPF) de mujeres atendidas de parto, cesárea y legrado. Material y métodos: estudio transversal, analítico, prolectivo. Se incluyeron mujeres entre 18 y 40 años que estaban en puerperio inmediato y que fueron atendidas en un hospital de tercer nivel. Se aplicó una encuesta que incluía 5 ítems con respuesta de opción múltiple y 7 con respuestas abiertas. Se tomaron datos generales, la aceptación o no de algún método de planificación, el motivo de su uso o rechazo. Además, se identificaron cuáles métodos conocían, si recibieron consejería y la perspectiva de la efectividad. Resultados: se incluyeron 648 mujeres, 216 por cada grupo. Se encontró que hay un mayor porcentaje de aceptación de los MPF en mujeres atendidas por cesárea, en comparación con aquellas atendidas por parto y legrado (p = 0.0158). Conclusiones: las mujeres atendidas por cesárea aceptan más los MPF, en comparación con aquellas atendidas por parto y legrado. Las pacientes que reciben consejería son las más informadas y las que aceptan más los MPF. Enfermería y médicos familiares son el personal de salud que más otorga consejería.