The National Composite Index for Family Planning (NCIFP): Results and Methodological Issues

Background: The “ FP2020 Global Partnership” signaled a shift to broader, rights-based approaches to family planning programs, and the National Composite Index for Family Planning was developed as part of related measurement efforts. Methods: In each country 10-15 experts on the family planning program completed a 35-item questionnaire, first in 2014 in 89 countries, and in 2017 in 84 countries. Data were entered in Excel, with checks for consistency and data quality. The total score, and scores for each of 5 dimensions of effort are averages across the 35 indicators. Analytic techniques included cross-tabulations, graphical and correlation approaches. Results: The average total score for all countries in 2017 was 64 of the maximum of 100 of effort. Sub-regions differed: Anglophone and Francophone sub-Saharan Africa (SSA) scored highest in the total score and across all 5 dimensions. Next in order came Latin America and the Caribbean, Asia, the Middle East and North Africa, and Eastern Europe and Central Asia. Despite large differences in scores, the sub-regions followed similar profiles across the 35 indicators. The long term rise in the basic family planning effort scores continued, extending the series from surveys approximately every five years beginning in the 1980s. The highest score reached was for the strategy dimension, but the others were close. Their relative levels remained essentially the same as in the 2014 survey. NCIFP scores correlated positively with modern contraceptive use in both the sub-Saharan Africa (SSA) and non-sub-Saharan Africa (non-SSA) countries, but the relationships were stronger for SSA. Access to long-acting and permanent methods (LAPMs) was accompanied by greater LAPM use and modern method use. Conclusion: Repeated surveys in most developing countries show improvements in family planning effort, though unevenly, by 35 indicators and across regions.

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USING COUPLES’ DISCORDANT REPORTS TO ESTIMATE FEMALE COVERT USE OF MODERN CONTRACEPTION IN SUB-SAHARAN AFRICA

Journal of Biosocial Science ◽

10.1017/s0021932017000256 ◽

2017 ◽

Vol 50 (3) ◽

pp. 326-346 ◽

Cited By ~ 6

Author(s):

Natalie C. Gasca ◽

Stan Becker

Keyword(s):

Contraceptive Use ◽

Modern Method ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

African Countries ◽

Couple Communication ◽

Significant Difference ◽

Contraceptive Prevalence ◽

Sub Saharan

SummarySubstantial numbers of married women use contraceptives without their partner’s knowledge in sub-Saharan Africa, but studies of female covert use across time are rare. This study investigates the levels, trends and correlates of covert use in nine countries and determines which contraceptive methods are more frequently used covertly by women. Data from monogamous couples in Demographic and Health Surveys were used from nine sub-Saharan African countries that had experienced an increase of 10 percentage points in current modern contraceptive use between an earlier (1991–2004) and later (2007–2011) survey. Covert use was indirectly estimated as the percentage of women who reported a female modern method whose husband did not report a modern method. The percentage of women using covertly increased in eight of the countries studied (significantly in three of them), yet when comparing across countries cross-sectionally, covert use was lower where contraceptive prevalence was higher. In general, women with more years of schooling and those with larger spousal schooling gaps had lower odds of covert use. There was no significant difference between covert and open injectable use, though more than half of both groups used this method in the later surveys. Encouraging couple communication about contraception, where the woman feels it is safe to do so, could be an important strategy to minimize covert use. Further research is needed to better identify the contraceptive prevalence and social context in which covert use declines within a country.

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As long as (I think) my husband agrees…: role of perceived partner approval in contraceptive use among couples living in military camps in Kinshasa, DRC

Reproductive Health ◽

10.1186/s12978-021-01256-y ◽

2022 ◽

Vol 19 (1) ◽

Author(s):

Julie H. Hernandez ◽

Saleh Babazadeh ◽

Philip A. Anglewicz ◽

Pierre Z. Akilimali

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Educational Achievement ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

Common Error ◽

Couple Communication ◽

Female Partners ◽

Modern Contraceptive Use ◽

Sub Saharan

Abstract Background Male partner’s approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men’s support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women’s perception of their partner’s opinion. Methods This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. Results Results confirm women are poorly aware of their partner’s opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner’s actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner’s approval. Conclusions Women’s perceptions of partner’s approval are much stronger determinant of contraceptive use than the latter’s actual opinion, and stereotyping men’s opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women’s capacity to negotiate contraceptive use.

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As Long as (I Think) My Husband Agrees…: Role of Perceived Partner Approval in Contraceptive Use Among Military Couples Living in Kinshasa, DRC

10.21203/rs.3.rs-647149/v1 ◽

2021 ◽

Author(s):

Julie H. Hernandez ◽

Saleh Babazadeh ◽

Philip Anglewicz ◽

Pierre Z Akilimali

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Educational Achievement ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

Common Error ◽

Couple Communication ◽

Female Partners ◽

Modern Contraceptive Use ◽

Sub Saharan

Abstract Background: Male partner’s approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men’s support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women’s perception of their partner’s opinion.Methods: This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. Results: Results confirm women are poorly aware of their partner’s opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner’s actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner’s approval. Conclusions: Women’s perceptions of partner’s approval are much stronger determinant of contraceptive use than the latter’s actual opinion, and stereotyping men’s opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women’s capacity to negotiate contraceptive use.

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Coverage and Determinants of Modern Contraceptive Use in Sub-saharan Africa: Further Analysis of Demographic and Health Surveys

10.21203/rs.3.rs-882664/v1 ◽

2021 ◽

Author(s):

Isaac Boadu

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

Women Of Reproductive Age ◽

Modern Contraceptives ◽

Modern Contraceptive Use ◽

Sub Saharan

Abstract Background: The use of modern contraceptives (MC) in most African countries has been low despite the high fertility rate and unmet need for family planning. This study sought to determine the coverage and determinants of modern contraceptive use among women of reproductive age in Sub-Saharan Africa (SSA). Methods: Data for the study was obtained from the latest Demographic and Health Surveys (DHS) conducted between 1995-2020 across 37 SSA countries. Women of reproductive age (15-19 years) was the unit of analysis. Analyses of data was done using STATA version 16 for windows. A bivariate Rao Scott’s chi-square test of independence was done to determine factors associated with the use of modern contraceptives. Factors that showed significance (p<0.05) were included in a multilevel logistic regression to determine significant predictors of modern contraceptives. Clustering, stratification and sample weighting were accounted for in the analyses. Results: The overall prevalence of the use of MC was found to be 22.0%. This ranged from 3.5% in the Central Africa Republic to 49.7% in Namibia. The most common type of contraceptives used were injections (39.4%), condoms (17.5%) and implants (26.5%). Women were less likely to use contraceptive if they: had no education (aOR = 0.4, 95% CI: 0.38-0.44), had no children (aOR=0.27-0.42), not told of family planning at a health facility (aOR = 0.69, 95% CI: 0.67-0.71), not heard of family planning in the media (aOR = 0.77, 95% CI: 0.74-0.79) and being poor (aOR=0.76, 95%CI: 0.73-0.79). On the other hand, women were more likely to use modern contraceptive if they were between the age of 35-39 years (aOR=1.69, 95%CI: 0.73-0.79), married (aOR=2.66, 95%CI: 2.50-2.83), had seven or more children (aOR=1.27, 95%CI:1.17-0.38), had knowledge of any method of contraceptives (aOR=303.8, 95%CI: 89.9-1027.5) and when field worker visited and talked about family planning (aOR=1.53, 95%CI: 1.39-0.68).Conclusion: The study showed a low prevalence of modern contraceptive use in Sub-Sahara Africa. Findings from the study highlight the need to provide education to women to increase uptake of contraceptive use and also re-enforce contraceptive interventions to improve women’s health and well-being.

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Postpartum Family Planning Use and Its Determinants among Women of the Reproductive Age Group in Low-Income Countries of Sub-Saharan Africa: A Systematic Review and Meta-Analysis

International Journal of Reproductive Medicine ◽

10.1155/2021/5580490 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Tesfalem Tilahun Yemane ◽

Getahun Gebre Bogale ◽

Gudina Egata ◽

Tilahun Kassa Tefera

Keyword(s):

Systematic Review ◽

Family Planning ◽

Low Income ◽

Contraceptive Use ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Modern Contraceptive ◽

Pooled Prevalence ◽

Sub Saharan

Background. Postpartum family planning is the initiation and use of family planning services within the first 12 months following childbirth. Postpartum contraceptives reduce maternal and infant mortality by preventing unplanned and unwanted pregnancies and by spacing pregnancies at least two years after the previous birth. Thus, it is usually designed as an integral part of reproductive and maternal and child health programs. Therefore, the aim of this systematic review and meta-analysis is to estimate the pooled prevalence of postpartum modern contraceptive use and identify its determinants in low-income countries of sub-Saharan Africa. Methods. A systematic review and meta-analysis of published and unpublished studies were used. PubMed, HINARI, ScienceDirect, Cochrane Library, Wiley Library, ETH Library, and Google Scholar were used to search all articles. STATA 14 software was used for data analysis. Funnel plots and Egger’s test were used to examine the risk of publication bias. Heterogeneity was checked by using Cochran’s Q test and I 2 test. A random effect model was computed to estimate the pooled prevalence. Results. A total of 33 articles were included. The pooled prevalence of postpartum contraceptive use in low-income countries of sub-Saharan Africa was 37.41%, 95% CI: (31.35, 43.48%). Secondary and above level of education (AOR 2.09, 95% CI: (1.52, 2.86)), discussion with husband (AOR 3.68, 95% CI: (1.96, 6.89)), resumption of menses (AOR: 3.98, 95% CI: (2.62, 6.03)), ANC follow-up (AOR; 5.10, 95% CI: (3.57, 7.29)), knowledge of modern family planning (AOR: 5.65, 95% CI: 3.58, 8.93)), and family planning counseling during ANC (AOR =5.92, 95% CI: (2.54, 13.79)) were found to be determinants of postpartum contraceptive utilization. Conclusion. In this systematic review and meta-analysis, the prevalence of postpartum modern contraceptive use was found to be low compared to the existing global recommendations. Therefore, empowering maternal education, delivering adequate counseling, and strengthening existing integrated maternal and child health services are highly recommended to increase postpartum contraceptive use. This trial is registered with CRD42020160612.

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Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review

International Quarterly of Community Health Education ◽

10.1177/0272684x16685254 ◽

2017 ◽

Vol 37 (2) ◽

pp. 79-91 ◽

Cited By ~ 46

Author(s):

Sarah R. Blackstone ◽

Ucheoma Nwaozuru ◽

Juliet Iwelunmor

Keyword(s):

Contraceptive Use ◽

Male Partner ◽

Sub Saharan Africa ◽

Modern Contraceptive ◽

African Countries ◽

Factors Influencing ◽

Contraceptive Side Effects ◽

Modern Contraceptive Use ◽

Negative Perceptions ◽

Sub Saharan

The purpose of this study was to systematically review the literature regarding factors influencing contraceptive use in sub-Saharan Africa between 2005 and 2015. A total of 58 studies from twelve Sub-Saharan African countries were reviewed. Keywords were grouped using the PEN-3 cultural model. Negative factors prohibiting or reducing contraceptive use were women’s misconceptions of contraceptive side–effects, male partner disapproval, and social/cultural norms surrounding fertility. Positive factors included education, employment, and communication with male partner. Increasing modern contraceptive use in Sub-Saharan Africa is a multi-faceted problem that will require community and systems wide interventions that aim to counteract negative perceptions and misinformation.

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EFFECTS OF COUPLES' CHARACTERISTICS ON CONTRACEPTIVE USE IN SUB-SAHARAN AFRICA: THE GHANAIAN EXAMPLE

Journal of Biosocial Science ◽

10.1017/s0021932097000333 ◽

1997 ◽

Vol 29 (1) ◽

pp. 33-49 ◽

Cited By ~ 19

Author(s):

YAW OHENEBA-SAKYI ◽

BAFFOUR K. TAKYI

Keyword(s):

Family Planning ◽

Health Survey ◽

Contraceptive Use ◽

Sub Saharan Africa ◽

Men And Women ◽

Socioeconomic Characteristics ◽

Sub Saharan ◽

Using Data ◽

The Impact

Using data from the 1988 Ghana Demographic and Health Survey, this study examines couples' demographic and socioeconomic characteristics in the context of their attitudes towards family planning, and the impact of these factors on the use of contraceptives. The characteristics of the husbands and their influence on wives' behaviour illustrate the role of intra-household relations between men and women and their effect on fertility-related behaviour in patriarchal African societies.

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Trends in Modern Contraceptive Use among Young Adult Women in sub‐Saharan Africa 1990 to 2014

Studies in Family Planning ◽

10.1111/sifp.12075 ◽

2018 ◽

Vol 49 (4) ◽

pp. 319-344 ◽

Cited By ~ 3

Author(s):

Julia Andrea Behrman ◽

Kelsey Quinn Wright ◽

Monica J. Grant ◽

Erica Soler‐Hampejsek

Keyword(s):

Young Adult ◽

Contraceptive Use ◽

Sub Saharan Africa ◽

Adult Women ◽

Modern Contraceptive ◽

Young Adult Women ◽

Modern Contraceptive Use ◽

Sub Saharan

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Currently married women with an unmet need for contraception in Eritrea: Profile and determinants

Canadian Studies in Population ◽

10.25336/p6gs4s ◽

2011 ◽

Vol 38 (1-2) ◽

pp. 61 ◽

Cited By ~ 11

Author(s):

Gebremariam Woldemicael ◽

Roderic Beaujot

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Economic Status ◽

Unmet Need ◽

Married Women ◽

Sub Saharan Africa ◽

The Status ◽

Sub Saharan ◽

Using Data ◽

Unmet Need For Contraception

Eritrea’s contraceptive prevalence rate is one of the lowest in sub-Saharan Africa and its fertility has only started to decline. Using data from the 2002 Eritrea Demographic and Health Survey (EDHS), this study examines the determinants of unmet need for family planning that is the discrepancy between fertility goals and actual contraceptive use. More than one-quarter of currently married women are estimated to have an unmet need, and this has remained unchanged since 1995. The most important reason for unmet need is lack of knowledge of methods or of a source of supply. Currently married women with higher parity, and low autonomy, low or medium household economic status, and who know no method of contraception or source of supply are identified as the most likely to have an unmet need. Addressing the unmet need for family planning entails not merely greater knowledge of or access to contraceptive services, but also the enhancement of the status of women.

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Modern Contraceptive and Dual Method Use among HIV-Infected Women in Lusaka, Zambia

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2011/261453 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 25

Author(s):

Carla J. Chibwesha ◽

Michelle S. Li ◽

Christine K. Matoba ◽

Reuben K. Mbewe ◽

Benjamin H. Chi ◽

...

Keyword(s):

Reproductive Health ◽

Contraceptive Use ◽

Sub Saharan Africa ◽

Dual Method ◽

Modern Contraceptive ◽

Reproductive Health Services ◽

Sexually Transmitted ◽

Counseling Intervention ◽

Substantial Risk ◽

Sub Saharan

HIV-infected women in sub-Saharan Africa are at substantial risk of unintended pregnancy and sexually transmitted infections (STIs). Linkages between HIV and reproductive health services are advocated. We describe implementation of a reproductive health counseling intervention in 16 HIV clinics in Lusaka, Zambia. Between November 2009 and November 2010, 18,407 women on antiretroviral treatment (ART) were counseled. The median age was 34.6 years (interquartile range (IQR): 29.9–39.7), and 60.1% of women were married. The median CD4+cell count was 394 cells/uL (IQR: 256–558). Of the women counseled, 10,904 (59.2%) reported current modern contraceptive use. Among contraceptive users, only 17.7% reported dual method use. After counseling, 737 of 7,503 women not previously using modern contraception desired family planning referrals, and 61.6% of these women successfully accessed services within 90 days. Unmet contraceptive need remains high among HIV-infected women. Additional efforts are needed to promote reproductive health, particularly dual method use.

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