scholarly journals Expanding contraceptive choice in Ethiopia: a comparative analysis of method mixes in post-abortion contraception versus routine family planning

2019 ◽  
Vol 3 ◽  
pp. 1518
Author(s):  
Melaku Samuel ◽  
Samuel Muluye ◽  
Tewodros Tolossa ◽  
Ashenafi Alemayehu
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Trend Analysis ◽  
Intrauterine Device ◽  
Descriptive Analysis ◽  
Unmet Need ◽  
Maternal Health Services ◽  
Delivery Strategies ◽  
Post Abortion ◽  
Method Mix

Background: In Ethiopia, a low contraceptive prevalence and high unmet need coupled with skewed method mix clearly signify the need for comprehensive family planning delivery strategies.  Ipas implemented problem-focused intervention to improve service delivery standards and provide accessible, high-quality family planning services. This analysis seeks to compare the contraceptive method mix in routine and post-abortion contraception services and to suggest how multifaceted service delivery approaches can help address the unmet family planning need. Methods: The intervention was implemented in 127 public health facilities providing both routine and post-abortion contraception services, from 2010 to 2017.  The intervention focused on service delivery and program management gaps identified during the baseline assessment.  Service data regularly collected from intervention facilities and entered into a Microsoft Excel database to conduct descriptive analysis, review trends, and monitor progress. Results: Trend analysis of method choice patterns revealed that the share of method mix for long-acting reversible contraceptives(LARCs) rose from 3% in 2010 to 40% in 2017 in routine family planning service, whereas in the post-abortion contraception service, the share for LARCs climbed from 2% in 2010 to 62% in 2017(P<0.001).  Trend analysis of LARC uptake in post-abortion contraception revealed that implant use rose from 2% in 2010 to 54% in 2017, while intrauterine device (IUD) use increased from 0.1% in 2010 to 9% in 2017.  In routine program, proportion of implant acceptors increased from 3% in 2010 to 35% in 2017, while IUD acceptance increased far more slowly, from only 0.07% to 5% over the same period. Conclusions: Comprehensive contraceptive service delivery strategies, such as integration of family planning with other maternal health services can help the service to reach clients with a variety of needs, a key factor for a higher uptake of LARCs by abortion clients as compared to routine family planning program.

Demography as Diplomacy

2021 ◽  
pp. 127-157
Author(s):  
Emily Klancher Merchant
Keyword(s):  
Developing Countries ◽  
Family Planning ◽  
Intrauterine Device ◽  
Unmet Need ◽  
Family Planning Programs ◽  
The Social ◽  
Philanthropic Organizations ◽  
Heads Of State ◽  
Development Agendas ◽  
And Training

Chapter 5 demonstrates how, in the 1950s and 1960s, U.S.-based philanthropic organizations invested in the growth of demography, the social science of human population dynamics, and used demography to convince heads of state of developing countries to integrate family planning programs into their nation-building and economic development agendas. The Population Council and the Ford Foundation established population research and training centers at major U.S. universities, to which they recruited graduate students from developing countries, with the understanding that they would return home after completing their education to advocate for the establishment of family planning programs. These organizations also funded fertility surveys by American demographers in Africa, Asia, and Latin America that promoted small-family norms and the distribution of new systemic contraceptive technologies, specifically the intrauterine device and birth control pill, and documented the existence of what demographers termed “unmet need” for family planning services.

Post-abortion fertility desires, contraceptive uptake and unmet need for family planning: voices of post-abortion care clients in Tanzania

2020 ◽  
pp. 1-16
Author(s):  
Colin Baynes ◽  
Erick Yegon ◽  
Grace Lusiola ◽  
Japhet Achola ◽  
Rehema Kahando
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Unmet Need ◽  
Pregnancy Intentions ◽  
Middle Income ◽  
Fertility Desires ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Post Abortion ◽  
Contraceptive Uptake

Abstract Post-abortion care (PAC) integrates elements of care that are vital for women’s survival after abortion complications with intervention components that aid women in controlling their fertility, and provides an optimal window of opportunity to help women meet their family planning goals. Yet, incorporating quality family planning services remains a shortcoming of PAC services, particularly in low- and middle-income countries. This paper presents evidence from a mixed method study conducted in Tanzania that aimed at explaining factors that contribute to this challenge. Analysis of data obtained through client exit interviews quantified the level of unmet need for contraception among PAC clients and isolated the factors associated with post-abortion contraceptive uptake. Qualitative data analysis of interviews with a subset of these women explored the multi-level context in which post-abortion pregnancy intentions and contraceptive behaviours are formed. Approximately 30% of women interviewed (N=412) could recall receiving counselling on post-abortion family planning. Nearly two-thirds reported a desire to either space or limit childbearing. Of those who desired to space or limited childbearing, approximately 20% received a contraceptive method before discharge from PAC. The factors significantly associated with post-abortion contraceptive acceptance were completion of primary school, prior use of contraception, receipt of PAC at lower level facilities and recall of post-abortion family planning counselling. Qualitative analysis revealed different layers of contextual influences that shaped women’s fertility desires and contraceptive decision-making during PAC: individual (PAC client), spousal/partner-related, health service-related and societal. While results lend support to the concept that there are opportunities for services to address unmet need for post-abortion family planning, they also attest to the synergistic influences of individual, spousal, organizational and societal factors that influence whether they can be realized during PAC. Several strategies to do so emerged saliently from this analysis. These emphasize customized counselling to enable client–provider communication about fertility preferences, structural intervention aimed at empowering women to assert those objectives in family and health care settings, availability of information and services on post-abortion fertility and contraceptive eligibility in PAC settings and interventions to facilitate constructive spousal communication on family planning and contraceptive use, after abortion and in general.

scholarly journals Immediate IUD insertion after second trimester abortion: process evaluation and implications for service delivery

2021 ◽  
Author(s):  
Oluwaseyi Dolapo Somefun ◽  
Deborah Constant ◽  
Margit Endler
Keyword(s):  
Service Delivery ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Medical Abortion ◽  
Barriers And Facilitators ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Post Abortion ◽  
Clinical Records

Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of post-abortion care. A randomized controlled trial (RCT) in South Africa compared immediate to interval insertion of the copper intrauterine device (IUD) after second trimester medical abortion (MA). Immediate insertion resulted in higher use at 6 weeks post-abortion, however expulsion rates were higher than interval insertion. This process evaluation sheds light on barriers and facilitators to the implementation of the study intervention.MethodsWe performed a process evaluation alongside the RCT in which we reviewed clinical records for fidelity to the RCT protocol and conducted in-depth interviews with 14 staff providing healthcare to RCT participants and 24 RCT participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the potential impact of context and supplementary trial activities on trial findings. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text.ResultsIn the RCT, there were 8 crossovers from the immediate to the delayed arm: 5 had a clinical contraindication to the IUD post-MA and 3 changed their mind about the IUD. In deviation of the RCT protocol 10 women in the delayed arm were given the injectable instead of oral contraceptives. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to the allocated intervention over the trial duration. For women, convenience, protection from pregnancy and privacy issues were paramount and they expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Clinical trials registration: clinicaltrials.gov/ (ID NCT03505047), Pan African Trials Registry (www.pactr.org), ID PACTR201804003324963ConclusionsWomen and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.

scholarly journals Introducing the hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: results from a pilot study

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Kendal Danna ◽  
Grace Jaworski ◽  
Bakoly Rahaivondrafahitra ◽  
Francia Rasoanirina ◽  
Anthony Nwala ◽  
...  
Keyword(s):  
Intrauterine Device ◽  
Descriptive Analysis ◽  
Unmet Need ◽  
Cumulative Probability ◽  
User Characteristics ◽  
Middle Income ◽  
Prospective Longitudinal Study ◽  
Highly Effective ◽  
Long Acting ◽  
Prospective Longitudinal

Abstract Background The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low- and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. Methods A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, 3-month, and 12-month follow-up questionnaires. Kaplan–Meier time-to-event models were used to estimate the cumulative probability of method continuation rates up to 12 months post-insertion. Results Each country had a unique demographic profile of hormonal IUD users with different method-use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67–100%) and high rates of continuation at the 12-month mark (82–90%). Conclusions Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

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

2015 ◽  
Vol 48 (5) ◽  
pp. 631-646 ◽  
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.

scholarly journals RGs and the development of service delivery strategies

2001 ◽  
Vol 24 (3) ◽  
pp. 33
Author(s):  
Onno Van Der Wel
Keyword(s):  
Service Delivery ◽  
Trend Analysis ◽  
Structural Changes ◽  
Research Trend ◽  
The Past ◽  
Delivery Strategies

Having used DRGs extensively over the past decade for research, trend analysis and funding purposes, it isapparent to me that we have come a long way since the early inception of the DRG work by Fetter and theCommonwealth need to be acknowledged for the leadership and support they have provided in this process.However it is also apparent that we can make more significant improvements given what we have learned to date.I am interested in structural changes of DRGs for at least three purposes: funding, clinical understanding, andstrategic development of service delivery.

scholarly journals Egypt Family Planning Method Mix Indicates Shifting toward Hormonal Contraceptives

2021 ◽  
Vol 9 (E) ◽  
pp. 1279-1287
Author(s):  
Ghada Wahby ◽  
Hend Sabry ◽  
Madiha Abdel-Razik ◽  
Marwa Rashad Salem ◽  
Fayrouz EL Aguizy
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Service Providers ◽  
Practical Importance ◽  
Healthcare Providers ◽  
Hormonal Contraceptives ◽  
Public And Private ◽  
Four Levels ◽  
The Times ◽  
Method Mix

BACKGROUND: The study is of practical importance for policy makers and family planning (FP) program managers as the profile of FP method-mix with a shift from a mechanical method as intrauterine devices (IUD) to hormonal methods such as oral contraceptives (OCs) and injectables predicts a critical situation for maternal and child health and reflects shortcomings in FP service delivery program. AIM: The purpose of the current study was to identify reasons for the progressive shift from IUD to OCs in Egypt. METHODS: The study is an-operations research conducted at four levels of the Ministry of Health and Population/FP (MOHP/FP) service delivery: Central (headquarter, HQ), governorate, district, and service delivery points. It included five of MOHP/United Nations Fund for Population Activities-Contraceptive Security Project governorates that represent, urban governorates, Lower Egypt, and Upper Egypt. Both qualitative data in-depth interviews with MOHP/HQ staff, Two Focus Group Discussions with FP Health Directorates staff and nurses in the five governorates, and quantitative data through a self-administered questionnaire for 607 service providers (SP). RESULTS: There was a consensus on the actual shift from IUD to OCs use. Reasons were the absence of incentives for healthcare providers for IUD insertion services (64%) and improper training of physicians (45%), and the availability of OCs all time. CONCLUSION: The three articulating issues that lead to shifting from IUD to OCs are: Unsatisfactory training and incentive systems for SPs and the clients’ choice of OCs for independent use/autonomy, and availability of OCs all the times at a reasonable cost in both the public and private sectors.

scholarly journals Development of an Android-Based Application for Family Planning Education and Consultation (SIDUTA KB)

2021 ◽  
Vol 1 (4) ◽  
pp. 1-5
Author(s):  
Vika Rifti Ananditya ◽  
Muhammad Azinar
Keyword(s):  
Family Planning ◽  
Health Center ◽  
Descriptive Analysis ◽  
Unmet Need ◽  
Planning Education ◽  
New Family ◽  
Consultation System ◽  
Analysis Technique ◽  
The Family ◽  
The Government

In suppressing the rate of population growth, the government seeks to optimize the Family Planning (KB) program. Miroto Public Health Center is a health center in the Central Semarang District which experienced a decrease of 13.4% of new family planning memberships. The decline was caused by the increase in the number of births, the delay in contraceptive services and the soaring unmet need during the pandemic. To support the role of cadres in providing socialization easily without having to meet during this pandemic, a Family Planning Education and Consultation System (SIDUTA KB) was created. Methods: This study uses Research and Development (RnD) which refers to the Sugiyono model with limited trials. The research data analysis technique is descriptive analysis and the data collected consists of qualitative and quantitative. Results: In this study, design validation was carried out through media expert tests with a percentage score of 83.55% (5 experts), material experts at 81.11% (3 experts), and users by 86.72% (73 users). Conclusion: SIDUTA KB makes it easy for users to find educational content about family planning programs, conduct consultations, and choose Miroto Health Center facilities or services related to the family planning program.

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