Impact of Integrated Family Planning and HIV Care Services on Contraceptive Use and Pregnancy Outcomes

Background: Unsafe abortion is one of the commonest causes of maternal mortality and post-abortion care services have been acclaimed as the best remedy for this situation. Yet, high maternal mortality still prevails pointing to issues with the quality of services. The paper was designed to investigate women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services and identify the challenges women faced in accessing PAC services in Buea. Methods: This study recruited 10 participants in Buea. Using a structured interview, data was collected on women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services, and identify the challenges women faced in accessing PAC services in Buea. Thematic and grounded theory analytical techniques were used to organize and interpret the data. Results: Majority of women in Buea did not use contraceptives for different reasons ranging from personal, spousal consent, ignorance, and the fear of side effects of contraceptive use. The low contraceptive use accounts highly for unwanted pregnancy cases which results in the decisions to induce. Most of these women involuntarily engage in induced abortion, highly driven by second party influence like the request from spouse/partner, disappointment from the spouse, and fear of parents’ reactions; while some occur as a result of missed abortion. The quality of PAC services received by most of these women were merely emergency treatments without proper PAC activities like family planning counseling, provision of modern contraceptive methods, linkages to other reproductive health care services. Women in Buea encounter some challenges in the use of PAC services, pains associated with the procedure, the cost, the absence of some family planning methods, the absence of counselling before PAC and above all, non constant availability of blood in the bood bank for transfusion. Conclusion: This study concluded that most women in Buea engage in induced abortion on account of the pressure to terminate an unwanted pregnancy; resulting from low contraceptives use; desire to avoid problems from their spouses/partners as well as to pursue career ambition. Moreover, the quality of PAC services offered to women in Buea was emergency treatment; void of important aspects like family planning services, linkage to other reproductive health care services, and facilitating their social reinsertion and preventing future induce abortion.

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INDUCED ABORTIONS IN PAKISTAN: EXPOSITIONS, DESTINATIONS AND REPERCUSSIONS. A QUALITATIVE DESCRIPTIVE STUDY IN RAWALPINDI DISTRICT

Journal of Biosocial Science ◽

10.1017/s0021932015000255 ◽

2015 ◽

Vol 48 (5) ◽

pp. 631-646 ◽

Cited By ~ 1

Author(s):

Zaeema Naveed ◽

Babar Tasneem Shaikh ◽

Muhammad Asif Nawaz

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Service Providers ◽

Unmet Need ◽

Care Seeking ◽

Formal Schooling ◽

Care Services ◽

Induced Abortions ◽

Unwanted Pregnancies ◽

Post Abortion

SummaryOver 2 million abortions occur annually in Pakistan, mostly in a clandestine and unsafe environment. This is an area of grave concern for the reproductive health of women. A dearth of credible data and incomplete information make the problem more difficult to address. This qualitative study was conducted in semi-urban settings in Pakistan to record perceptions and practices concerning care seeking, experiences and outcomes regarding induced abortions and post-abortion care services. Women who had had induced abortions and abortion service providers were interviewed. Unwanted pregnancies and poverty were found to be the main reasons for seeking an abortion. Moreover, the unwanted pregnancies occurred due to low use of contraceptives, mainly due to a fear or past experience of their side-effects, unfamiliarity with correct usage and perceived inefficacy of the methods, especially condoms. There is an obvious need for practical and innovative interventions to address unmet need for birth spacing through improved access to contraceptives. Contraceptive providers should be provided with up-to-date and detailed training in family planning counselling, and perhaps allowed unrestricted provision of contraceptives. As a long-term measure, improvement in access to education and formal schooling could increase young girls’ and women’s knowledge of the benefits of family planning and the risks of unsafe abortion practices. Males must be involved in all the initiatives so that both partners are in agreement on correct and consistent contraceptive use.

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Using Andersen’s Behavioral Model of Health Care Utilization to Assess Contraceptive Use among Sexually Active Perinatally HIV-Infected Adolescents in Uganda

International Journal of Reproductive Medicine ◽

10.1155/2020/8016483 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Scovia N. Mbalinda ◽

Dan K. Kaye ◽

Mathew Nyashanu ◽

Noah Kiwanuka ◽

Robert Gaspar

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Health Workers ◽

Behavioral Model ◽

Hiv Care ◽

Sexually Active ◽

Perceived Need ◽

Andersen’S Behavioral Model ◽

The Mean ◽

Depth Interviews

Background. Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. Methods. Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen’s Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. Results. Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. Conclusion. Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.

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Unmet Need for Modern Family Planning and associated factors among Women Attending HIV Care Services at Rural Area Public Health facilities in South Gondar, Ethiopia.

10.21203/rs.3.rs-130769/v1 ◽

2020 ◽

Author(s):

Mulgeta Adugna ◽

Moges Muluneh Boke ◽

Amare Tariku

Keyword(s):

Family Planning ◽

Unmet Need ◽

Reproductive Age ◽

Hiv Care ◽

P Value ◽

Care Services ◽

Hiv Positive Women ◽

Modern Family ◽

Modern Family Planning ◽

South Gondar

Abstract Introduction: To achieve the elimination of mother to child transmission of the human immunodeficiency virus (HIV), preventing unintended pregnancy and reducing the high unmet need for family planning among HIV positive women was crucial. Despite being crucial little has been known on the unmet need for family planning and its determinants among women living with HIV in the rural area. Therefore, this study aimed to assess the prevalence of unmet need for modern family planning and its determinants among women Attending HIV Care Services at rural Public Health Facilities.Methods: An institution-based cross-sectional study was conducted from March to April 2020 in rural South Gondar. A total of 931 respondents were included in the study. To recruit respondents a multi-stage sampling technique was used. The data were collected using a pretested and semi-structured questionnaire. Data were entered by Epi data version 4.6 and exported to Stata version 14 for analysis. Variables with a p-value<0.2 in the bivariable logistic regression model were fitted to the multivariable logistic regression model. Adjusted Odds ratio with 95% CI was computed and variables with P-value < 0.05 in the multivariable analysis were taken as significant determinants.Results: The prevalence of unmet need for family planning was 25.67% with 95% CI (22.9628.58). Age group (3549) (AOR=6.5,95% CI (2.86,14.66)), education status (912) (AOR=0.25,95%CI (0.10,0.61)), history of ever use Contraception (AOR=3.9, 95%CI (2.28, 6.67)), having five and above parity (AOR=5.1, 95%CI (2.08, 12.43)) and not Counselling for contraception (AOR =4.2, 95 CI, (1.91, 9.37)) were determinant for unmet need of contraception among HIV positive women in South Gondar.Conclusion: prevalence of unmet need for family planning was high. It was mainlyInfluenced by last reproductive age group (35-49)), education (9-12), having no experience of contraception use, having five and above parity, and no counseling for contraception. Therefore, family planning programs need to focus on old (35-49) reproductive age women, and multi-para women.

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The Effect of Women’s Empowerment in the Utilisation of Family Planning in Western Ethiopia: A Structural Equation Modelling Approach

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126550 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6550

Author(s):

Muluken Dessalegn Muluneh ◽

Lyn Francis ◽

Mhiret Ayele ◽

Sintayehu Abebe ◽

Misrak Makonnen ◽

...

Keyword(s):

Decision Making ◽

Family Planning ◽

Structural Equation ◽

Contraceptive Use ◽

Women's Empowerment ◽

Women’S Empowerment ◽

Household Decision ◽

Planning Methods ◽

Western Ethiopia ◽

Family Planning Methods

This study examines the associations between women’s empowerment and family planning use in Jimma Zone, Western Ethiopia. A total of 746 randomly selected married women of reproductive age were interviewed. The data were employed by structural equation modelling (SEM) to investigate the complex and multidimensional pathways to show women’s empowerment domains in family planning utilisation. Results of the study revealed that 72% of married women had used family planning. Younger women, having access to information, having access to health facilities and being aware about family planning methods, living in a rural area, having an older partner and increased household decision-making power were associated with using family planning methods. Women’s empowerment is an important determinant of contraceptive use. Women’s empowerment dimensions included increased household decision-making power, socio-demographic variables and having access to information about family planning and accessible health facilities. These were found to be important determinants of contraceptive use. Future interventions should focus on integrating women’s empowerment into family planning programming, particularly in enhancing women’s autonomy in decision making. Further research is warranted on the socio-cultural context of women that influences women’s empowerment and family planning use to establish an in-depth understanding and equity of women in society.

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189: Expanded access to family planning services and the risk of adverse pregnancy outcomes

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2008.09.216 ◽

2008 ◽

Vol 199 (6) ◽

pp. S64

Author(s):

Allison Bryant ◽

Joan Hilton

Keyword(s):

Family Planning ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Family Planning Services ◽

Expanded Access ◽

Adverse Pregnancy

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Health facility capacity to provide postabortion care in Afghanistan: a cross-sectional study

Reproductive Health ◽

10.1186/s12978-021-01204-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Farzana Maruf ◽

Hannah Tappis ◽

Enriquito Lu ◽

Ghutai Sadeq Yaqubi ◽

Jelle Stekelenburg ◽

...

Keyword(s):

Public Health ◽

Family Planning ◽

High Volume ◽

Health Facilities ◽

Public Health Facilities ◽

Care Services ◽

Vacuum Aspiration ◽

Postabortion Care ◽

Products Of Conception ◽

Family Planning Counseling

Abstract Background Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment.

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Family Planning Beliefs and Their Association with Contraceptive Use Dynamics: Results from a Longitudinal Study in Uganda

Studies in Family Planning ◽

10.1111/sifp.12153 ◽

2021 ◽

Author(s):

Linnea A. Zimmerman ◽

Dana O. Sarnak ◽

Celia Karp ◽

Shannon N. Wood ◽

Caroline Moreau ◽

...

Keyword(s):

Longitudinal Study ◽

Family Planning ◽

Contraceptive Use

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