The role of structural and process quality of family planning Care in Modern Contraceptive use in Indonesia: a multilevel analysis

Abstract Introduction Despite contraceptive behaviors are influenced by multiple and multilevel variables, studies on modern contraceptive use in Indonesia has concentrated on single-level and mostly individual and household variables, and less interest has been devoted to multilevel analysis that accounts for community and SDP characteristics that may affect woman’s decision to use modern FP method. This study aimed to assess the role of structural and process quality of family planning care in modern contraceptive use among women in reproductive ages in Indonesia. Methods This study analyzed data from the 2016 PMA2020 survey of 10,210 women in 372 enumeration areas in Indonesia. The data were analyzed using categorical principal component analysis and multilevel mixed-effects logistic regression. Results The key variables for structural quality were number of contraceptive provided, SDP supports CHWs, available water and electricity, and skilled FP personnel, while the main factors for process quality were privacy of clients and provision of post-abortion service. There were significant differences across communities in how study variables associated with modern FP adoption. The finding shows the evidence of significant roles of structural and process quality FP care in modern contraceptive use. Moreover, women with high autonomy in FP decision, those who had free national/district health insurance, and those living in a community with higher proportion of women visited by CHW, had higher odds of modern contraceptive usage. Yet, women who live in a community with higher mean ideal number of children or greater proportion of women citing personal/husband/religion opposition to FP, had lower odds of modern contraceptive use than their counterparts. Conclusion Study findings suggest improvement in structural and process quality of FP care will yield substantial growths in modern contraceptive use. Moreover, FP workers should also address adverse cultural/traditional customs in community and should target communities where the demand for modern FP was degraded by opposing social beliefs and norms. There was significant variation across communities in how individual, household, community, and SDP factors affect modern FP practice, hence, context should be taken into consideration in the development of FP intervention and promotion programs.

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The Role of Structural and Process Quality of Family Planning Care in Modern Contraceptive Use in Indonesia: A Multilevel Analysis

10.21203/rs.3.rs-379186/v1 ◽

2021 ◽

Author(s):

Nurjaeni Nurjaeni ◽

Yothin Sawangdee ◽

Umaporn Pattaravanich ◽

Charamporn Holumyong ◽

Aphichat Chamratrithirong

Keyword(s):

Family Planning ◽

Multilevel Analysis ◽

Contraceptive Use ◽

Process Quality ◽

Structural Quality ◽

Modern Contraceptive ◽

Contraceptive Usage ◽

Modern Contraceptive Use

Abstract Introduction Relatively low modern contraceptive prevalence and high unintended childbearing pose substantial encounters for Indonesia to achieve sustainable development goals. Despite contraceptive behaviors are influenced by multiple and multilevel variables, studies on modern contraceptive use in Indonesia has concentrated on single-level and mostly individual and household variables, and less interest has been devoted to multilevel analysis that accounts for community and SDP characteristics that may affect woman’s decision to use modern FP method.Methods This study analyzed data from the 2016 PMA2020 survey of 10,210 women in 372 communities in Indonesia. The data were analyzed using a multilevel mixed-effects logistic regression to assess the role of structural quality and process quality of family planning care and other factors in modern contraceptive utilization.Result The highest loading factors for structural quality were number of contraceptive provided, SDP supports CHWs, available water and electricity, and skilled FP personnel, while the highest loading factors for process quality were privacy of clients and provision of post-abortion service. There were significant differences across communities in how study variables associated with modern FP adoption. The finding shows the evidence of significant roles of structural and process quality FP care in modern contraceptive use. Moreover, women with high autonomy in FP decision, those who had free national/district health insurance, and those living in a community with higher proportion of women visited by CHW had higher odds of modern contraceptive usage, yet, women who live in a community with higher mean ideal number of children or greater proportion of women citing personal/husband/religion opposition to FP, had lower odds of modern contraceptive use than their counterparts.Conclusions Study findings suggest improvement in structural and process quality of FP care will yield substantial growths in modern contraceptive use. Moreover, FP workers should also address prevailing cultural/traditional customs in community and should target communities where the demand for modern FP was deprived by social beliefs and norms. There was significant variation across communities in how individual, household, community, and SDP factors affect modern FP practice, hence, context should be taken into consideration in the development of FP intervention and promotion programs.

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The role of empowerment in the use of modern contraceptives among women in need of family planning in Burkina Faso: A multilevel analysis

10.21203/rs.3.rs-17908/v1 ◽

2020 ◽

Author(s):

Sylvain Y. M. SOME ◽

Christy Pu ◽

Song-Lih Huang

Keyword(s):

Secondary Education ◽

Family Planning ◽

Burkina Faso ◽

Gender Equality ◽

Multilevel Analysis ◽

Contraceptive Use ◽

Community Level ◽

Modern Contraceptive ◽

Modern Contraceptives ◽

Modern Contraceptive Use

Abstract Background In Burkina Faso, women still have difficulty satisfying their family planning demand because of the patriarchal and gender-unequal society. Despite evidence that women’s empowerment can help, few studies have measured its impact at both community and household levels. Taking into account these two parameters, we looked into the association between women’s empowerment and modern contraception use among Married Women of Reproductive Age (MWRA) with no desire for having children in Burkina Faso. Methods Using the 2010 Demographic and Health Survey (DHS), we analyzed data from 4714 MWRA with family planning needs from 573 communities. Indicators of gender equality at the community level were composed of aggregated variables for each primary sampling unit, and domains of women’s agency in households matters were derived with principal component analysis. A multilevel logistic regression model was used to gauge the effects of empowerment on modern contraceptives use adjusted for household socioeconomic status and demographics of women. Results Among MWRA, 30.8% satisfied their demand for family planning using modern methods. At the community level, higher women’s assets ownership (aOR 1.26, CI 1.04 - 1.54), secondary education (aOR 1.45, OR 1.08 - 1.64), and exposure to family planning messages (aOR 1.33, CI 1.08 - 1.64) were associated with more modern contraceptive use; higher ideal number of children was negatively associated (aOR 0.76, CI 0.61 - 0.95). Unexpectedly, higher community prevalence of female genital mutilation was positively associated with contraceptive use (aOR 1.25, CI 1.03-1.52). Women’s agency in household matters, including opposing domestic violence, involved with decisions and enjoying freedom in seeking healthcare were positively associated with use, but only the last domain remained significant in multilevel analysis (aOR 1.29, CI 1.08 - 1.54). Living in richer household, being older, and having secondary education level were also positively associated with modern contraceptive use. Conclusion Gender equality at the community level and women’s situation in the household constitute the context in which women’s demand for family planning is determined. Therefore, promoting gender equality and ensuring women’s entitlement to make life choices have the potential to increase modern contraceptive coverage along with improved life conditions.

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Family planning counseling and its associations with modern contraceptive use, initiation, and continuation in rural Uttar Pradesh, India

Reproductive Health ◽

10.1186/s12978-019-0844-0 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 3

Author(s):

Nabamallika Dehingia ◽

Anvita Dixit ◽

Sarah Averbach ◽

Vikas Choudhry ◽

Arnab Dey ◽

...

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Uttar Pradesh ◽

Married Women ◽

Modern Contraceptive ◽

Advantages And Disadvantages ◽

Modern Contraceptives ◽

Modern Contraceptive Use ◽

Continued Use

Abstract Background We examine the association between the quality of family planning (FP) counseling received in past 24 months, and current modern contraceptive use, initiation, and continuation, among a sample of women in rural Uttar Pradesh, India. Methods This study included data from a longitudinal study with two rounds of representative household survey (2014 and 2016), with currently married women of age 15–49 years; the analysis excluded women who were already using a permanent method of contraceptive during the first round of survey and who reported discontinuation because they wanted to be pregnant (N = 1398). We measured quality of FP counseling using four items on whether women were informed of advantages and disadvantages of different methods, were told of method(s) that are appropriate for them, whether their questions were answered, and whether they perceived the counseling to be helpful. Positive responses to every item was categorized as higher quality counseling, vs lower quality counseling for positive response to less than four items. Outcome variables included modern contraceptive use during the second round of survey, and a variable categorizing women based on their contraceptive use behavior during the two rounds: continued-users, new-users, discontinued-users, and non-users. Results Around 22% had received any FP counseling; only 4% received higher-quality counseling. Those who received lower-quality FP counseling had 2.42x the odds of reporting current use of any modern contraceptive method (95% CI: 1.56–3.76), and those who received higher quality FP counseling at 4.14x the odds of reporting modern contraceptive use (95% CI: 1.72–9.99), as compared to women reporting no FP counseling. Women receiving higher-quality counseling also had higher likelihood of continued use (ARRR 5.93; 95% CI: 1.97–17.83), as well as new use or initiation (ARRR: 4.2; 95% CI: 1.44–12.35) of modern contraceptives. Receipt of lower-quality counseling also showed statistically significant associations with continued and new use of modern contraceptives, but the effect sizes were smaller than those for higher-quality counseling. Conclusions Findings suggest the value of FP counseling. With a patient-centered approach to counseling, continued use of modern contraceptives can be supported among married women of reproductive age. Unfortunately, FP counseling, particularly higher-quality FP counseling remains rare.

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Quality of Family Planning Care as Enabling Factor for Modern Contraceptive Use in Indonesia: Evidence from PMA2020 Survey

10.21203/rs.3.rs-516964/v1 ◽

2021 ◽

Author(s):

Nurjaeni Nurjaeni ◽

Yothin Sawangdee ◽

Umaporn Pattaravanich ◽

Charamporn Holumyong ◽

Aphichat Chamratrithirong

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Modern Method ◽

Modern Contraceptive ◽

Number Of Children ◽

Modern Family ◽

Modern Contraceptive Use ◽

Ideal Number ◽

Modern Family Planning

Abstract BackgroundThe utilization of modern family planning methods is a key pointer that mirrors universal access to reproductive health cares. Fulfilling unmet needs for modern contraceptives may decrease the level of maternal mortality by almost a third. This research employed the 2016 PMA2020 survey to assess multilevel variables related to modern family planning method use among women of reproductive age in Indonesia. MethodData from interviews of female and Service Delivery Point (SDP) of the 2016 Performance Monitoring and Accountability 2020 (PMA2020) survey were linked to generate a merged dataset comprising women’s individual, cluster and SDP factors (N=10,210). Multilevel analysis was done to assess the influence of contextual factors including a summary index of SDP quality FP care on woman’s modern family planning practice. Adjusted odds ratios and 95% CIs were analysed and interpreted.ResultsModern contraceptive prevalence among women of childbearing age was 42.3% in 2016. There was a considerable variation in the likelihood of modern method use across the 372 clusters/EAs. Age, education, marital status, parity, residency, region, woman’s FP decision autonomy, cluster’s average ideal number of children, percentage of females dissatisfied with FP, and percent of females visited by CHVs were significant factors for modern FP use after adjusting for multilevel characteristics. Quality of FP care was revealed to be a significant enabling factor for modern contraceptive use in Indonesia. ConclusionsModern contraceptive prevalence among females aged 15-49 years was relatively low in 2016. The findings indicate that an advancement in modern method use can be gained by improving quality of family planning care. Likewise, an enhancement in women’s FP decision autonomy and their level of education, decline in women’s ideal number of children and diminution of the dissatisfaction with family planning are all major concerns to be addressed. Family planning policies must tackle adverse cultural norms and inequities in quality of family planning care and women’s education that would produce welfares to women, children, and communities.

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Predictors of modern contraceptive usage among sexually active rural women in Ethiopia: A multi-level analysis

Archives of Public Health ◽

10.1186/s13690-021-00621-4 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Setegn Muche Fenta ◽

Shewayiref Geremew Gebremichael

Keyword(s):

Rural Women ◽

Contraceptive Use ◽

Community Level ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

Sexually Active ◽

Contraceptive Methods ◽

Contraceptive Usage ◽

Modern Contraceptive Use ◽

Multi Level

Abstract Background Ethiopia is one of the Sub-Saharan Africa countries with the lowest modern contraceptive prevalence rate and the highest fertility rate. This study aimed to assess individual and community-level predictors of modern contraceptive use among sexually active rural women in Ethiopia. Data and methods A sample of 9450 sexual active rural women aged 15-49 was extracted from the 15, 683 nationally representative samples of 2016 Ethiopian Demographic and Health Survey (EDHS). Multi-level logistic regression model was considered to identify determinant factors of modern contraceptive use among sexually active rural women in Ethiopia. Result The prevalence of modern contraceptive use among respondents was 20% in rural Ethiopia. Injection (66.35%) was the most common type of modern contraceptive use. In the last full model of the multilevel analysis, individual and community-level factors accounted for 86.69% of the variation in the use of modern contraceptive methods. Secondary and above-educated women (AOR = 1.39, 95%CI: 1.06, 2.81), having 1-4 living children (AOR = 2.70, 95%CI: 2.07, 3.53), rich wealth status (AOR = 2.26, 95%CI: 1.96, 2.60), married women (AOR = 17.31, 95%CI: 10.72, 27.94), having primary educated husband (AOR = 1.45, 95%CI: 1.27, 1.67) and being working husband (AOR = 2.26, 95%CI: 1.96, 2.60) were significantly positively associated with individual-level factors of the use of modern contraceptive methods. Besides, modern contraceptive use was negatively associated with Muslim women (AOR = 0.29, 95%CI: 0.25, 0.33). Compared to the Tigray region, women living in the Afar, Somali, Harari, and Dire Dawa regions had lower use of modern contraceptive methods. Women who had access to mass media (AOR = 1.35, 95%CI: 1.16, 1.57) were more likely to use contraceptives than their counterparts. Conclusion The prevalence of modern contraceptive use among rural women has very low. Both individual and community-level factors were significant predictors of modern contraceptive use. Consequently, the government and other stakeholders need to address educational opportunities; creating awareness about modern contraception and valuable counseling would increase modern contraceptive methods utilization.

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Predictors of modern contraceptive use among women and men in Uganda: a population-level analysis

BMJ Open ◽

10.1136/bmjopen-2019-034675 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034675 ◽

Cited By ~ 2

Author(s):

Amrita Namasivayam ◽

Sarah Lovell ◽

Sarah Namutamba ◽

Philip J Schluter

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Secondary Data ◽

Population Level ◽

Modern Contraceptive ◽

Cross Sectional ◽

Factors Affecting ◽

Logistic Regression Models ◽

Modern Contraceptive Use

Objective(s)Despite substantial and rapid improvements in contraceptive uptake in Uganda, many women continue to have unmet need for contraception. As factors affecting contraceptive use are dynamic and complex, this study seeks to identify current predictors and provide effect size estimates of contraceptive use among women and men in Uganda.Study designA nationally representative cross-sectional population survey, using secondary data from Uganda’s 2016 Demographic and Health Survey. Stratified by sex, weighted bivariable and multivariable logistic regression models were derived from a suite of potential predictor variables. Predictive abilities were assessed via 10-fold cross-validated area under the receiver operating characteristic curves (AUCs).SettingUganda.ParticipantsAll women aged 15–49 years who were permanent residents of the selected households or stayed in the household the night before the survey were eligible to participate. In one-third of the sampled households, all men aged 15–54 years who met the same residence criteria were also eligible.Primary outcome measuresModern contraceptive use.ResultsOverall, 4914 (26.6%) women and 1897 (35.6%) men reported using a modern contraceptive method. For women and men, both demographic and proximate variables were significantly associated with contraceptive use, although notable differences in effect sizes existed between sexes—especially for age, level of education and parity. Predictively, the multivariable model was acceptable for women with AUC=0.714 (95% CI 0.704 to 0.720) but less so for men with AUC=0.654 (95% CI 0.636 to 0.666).Conclusion(s)Contemporary significant predictors of contraceptive use among women and men were reported, thereby enabling key Ugandan subpopulations who would benefit from more targeted family planning initiatives to be identified. However, the acceptable AUC for women and modest AUC for men suggest that other important unmeasured predictors may exist. Nonetheless, these evidence-based findings remain important for informing future programmatic and policy directions for family planning in Uganda.

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The effect of Women’s decision-making autonomy on family Planning acces in Senegal in 2017

European Journal of Public Health ◽

10.1093/eurpub/ckz186.125 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

N M Sougou ◽

O Bassoum ◽

M M M M Leye ◽

A Tal-Dia

Keyword(s):

Decision Making ◽

Family Planning ◽

Contraceptive Method ◽

Contraceptive Use ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Modern Contraceptive Method ◽

Significant Difference ◽

Modern Contraceptive Use ◽

The Impact

Abstract Background The impact of access to decision-making on women’s health in the choice of fertility control has been highlighted by research. The aim of this study was to analyze the impact of access to decision-making for women’s health on access to family planning in Senegal in 2017. Methods The analyses of this study had been done on the Individual Records file of Senegal’s Demographic Health Survey 2017. This data covered 8865 women aged 15 to 49 years. The propensity scores matching method had been done. The variable access to the decision was considered as the variable of interest. Matching was done using variables that were not modified by the effect of the treatment. These were religion and socio-economic level. The outcome variables were modern contraceptive use, the existence of unmet needs and the type of modern contraceptive method used. Significance was at 5%. The condition of common support had been respected. The analysis was done with the STATA.15 software. Results Six percent (6.26%) of women could decide about their health on their own. Access to decision-making increased significantly with the woman’s age (p < 0.05). Fifteen percent (15.24%) women used a modern contraceptive method. Women using a contraceptive method were more numerous in the group with access to decision-making (29.43%) with a significant difference with the other group of 8% (p < 0.05). After matching, there was no significant difference between women in terms of modern contraceptive use and the existence of unmet needs. There was a significant difference in the type of contraceptive method used between the two groups of women. These differences were 23.17% for Intra Uterine Device, 52.98% for injections, 08.9% for implants and 10.79% for condoms. Conclusions Access to decision-making for health would facilitate women’s access to long-acting contraceptive methods. These findings show the importance of implementing gender transformative interventions in improving access to family planning. Key messages Access to decision-making for health would allow better access to modern contraceptive methods, especially those with a long duration of action. Better consideration of gender disparity reduction could improve access to family planning in Senegal.

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Predictors of Time-to-Contraceptive Use from Resumption of Sexual Intercourse after Birth among Women in Uganda

International Journal of Population Research ◽

10.1155/2017/3875452 ◽

2017 ◽

Vol 2017 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Robert Wamala ◽

Allen Kabagenyi ◽

Simon Kasasa

Keyword(s):

Family Planning ◽

Sexual Intercourse ◽

Formal Education ◽

Contraceptive Use ◽

Traditional Birth Attendant ◽

Wealth Quintile ◽

Northern Region ◽

Modern Contraceptive ◽

Sampling Weights ◽

Modern Contraceptive Use

Globally, there is extant literature on patterns and dynamics of postpartum contraceptive use with hardly any evidence examining time-to-contraceptive use from resumption of sexual intercourse after birth among women in Uganda. Methods. The analysis was based on data from 2011 Uganda Demographic and Health Survey on a sample of 2983 married women with a birth in the past three years preceding the survey and had resumed sexual intercourse. A time-to-contraceptive use was adopted in the analysis using life tables based on the Kaplan-Meier estimates, while the Log-Rank Chi-square tests assessed the variables to be included in regression analysis. Cox-Proportional Hazard regression was run to identify the predictors of time-to-contraceptive use among postpartum women in Uganda. Sampling weights were applied in the analysis to ensure representativeness. Results. The median time-to-contraceptive use was 19 months (range 0–24). Time to adoption of modern contraceptive use was significantly longer among women with no formal education, residing in northern region, who (HR=0.56, CI: 0.40–0.78) had delivered at home/traditional birth attendant (HR=0.75, CI: 0.60–0.93), had 1–3 antenatal care visits (HR=0.83, CI: 0.70–0.98), and were in poorest wealth quintile. Conclusions. Measures for enhancing modern contraceptive use during and after the postpartum period should focus on (i) addressing hindrances in accessing family planning, particularly among poor and noneducated women; (ii) integration of family planning service delivery into routine ANC through counseling; and (iii) promoting deliveries in health facilities.

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