The influence of health facility-level access measures on modern contraceptive use in Kinshasa, DRC

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

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The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

10.1101/2020.04.17.046524 ◽

2020 ◽

Author(s):

Anooj Pattnaik ◽

Diwakar Mohan ◽

Amy Tsui ◽

Sam Chipokosa ◽

Hans Katengeza ◽

...

Keyword(s):

Family Planning ◽

Health Facility ◽

Catchment Area ◽

Contraceptive Use ◽

Modern Contraceptive ◽

Summary Measure ◽

Modern Contraceptives ◽

Family Planning Programs ◽

Modern Contraceptive Use ◽

Combined Impact

AbstractBackgroundTo explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve.Methods and findingsWe used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength.ConclusionMetrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

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Spatial variations and associated factors of modern contraceptive use in Ethiopia: a spatial and multilevel analysis

BMJ Open ◽

10.1136/bmjopen-2020-037532 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037532

Author(s):

Teketo Kassaw Tegegne ◽

Catherine Chojenta ◽

Peta Michelle Forder ◽

Theodros Getachew ◽

Roger Smith ◽

...

Keyword(s):

Health Facility ◽

Contraceptive Use ◽

Addis Ababa ◽

Married Women ◽

Spatial Variations ◽

High Fertility ◽

Modern Contraceptive ◽

Cross Sectional ◽

Modern Contraceptives ◽

Modern Contraceptive Use

ObjectiveTo assess spatial variations in modern contraceptive use and to identify factors associated with it among married women in Ethiopia.DesignCross-sectional analysis of population-based and health facility data.SettingEthiopia Demographic and Health Survey data linked to Service Provision Assessment data.Population8473 married women and 1020 facilities that reported providing family planning services.MethodsA linked secondary data analysis of population and health facility data was carried out. Both multilevel and spatial analyses were conducted to identify key determinants of women’s use of modern contraceptive and spatial clustering of modern contraceptive use.Main outcome measureModern contraceptive use.ResultsAbout 24% of the variation in the use of modern contraception was accounted for by location. A one-unit increase in the mean score of health facilities’ readiness to provide short-term modern contraceptives in a typical region was associated with a 20-fold increase in the odds of modern contraceptive use (adjusted OR (AOR) 20.49, 95% CI 1.44 to 29.54). In the spatial analysis, it was found that Addis Ababa and the Amhara region had high clusters of modern contraceptive use rates. On the other hand, low rates of contraceptive use were clustered in the Afar and Somali regions.ConclusionThere were significant variations in the use of modern contraceptives across the different regions of Ethiopia. Therefore, regions with low contraceptive rates and high fertility rates should be targeted for scaling up and tailoring of services to the culture and lifestyles of the population of those regions.

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Belief System: A Barrier to the Use of Modern Contraceptives among the Idoma of Benue State, North Central Nigeria

Journal of Asian and African Studies ◽

10.1177/0021909619888774 ◽

2019 ◽

Vol 55 (4) ◽

pp. 600-616

Author(s):

Chiemezie Scholastica Atama ◽

Uzoma Odera Okoye ◽

Amelia Ngozi Odo ◽

Aloysius Odii ◽

Uche Teresa Okonkwo

Keyword(s):

Contraceptive Use ◽

Group Discussion ◽

Belief System ◽

Modern Contraceptive ◽

Chi Square ◽

North Central ◽

System A ◽

Modern Contraceptives ◽

Depth Interview ◽

Modern Contraceptive Use

Despite the benefit of modern contraception, its use remains low in Nigeria. This study examined belief system as a barrier to the use of modern contraceptives among the Idoma of Benue State, North Central Nigeria. Questionnaire ( n = 1107), in-depth interview ( n = 6) and focus group discussion ( n = 52) were used to collect data from three local government areas (LGAs). The results showed high levels of knowledge (88.0%), however, only 37.8% used modern contraceptives. The male condom had the highest percentage use (56.7%). Chi-square results showed that LGA, education and occupation were significantly related to the use of modern contraceptives. Being of greater age increased the likelihood of use, whereas higher levels of education and income decreased the likelihood of modern contraceptive use ( p < 0.05). Qualitative data indicated that married women were expected to eschew modern contraceptives due to their belief in Alekwu, the community deity. Designing interventions that are culturally specific could promote use of modern contraceptives among the group.

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Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

BMJ Global Health ◽

10.1136/bmjgh-2021-005833 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005833

Author(s):

Leena N Patel ◽

Samantha Kozikott ◽

Rodrigue Ilboudo ◽

Moreen Kamateeka ◽

Mohammed Lamorde ◽

...

Keyword(s):

Health Facility ◽

Healthcare Workers ◽

National Level ◽

Lessons Learned ◽

Health Facilities ◽

Infection Prevention And Control ◽

Health Facility Level ◽

Ensure Patient Safety ◽

Increased Risk ◽

Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

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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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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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Married women's decision making power on modern contraceptive use in urban and rural southern Ethiopia

BMC Public Health ◽

10.1186/1471-2458-11-342 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 51

Author(s):

Binyam Bogale ◽

Mekitie Wondafrash ◽

Tizta Tilahun ◽

Eshetu Girma

Keyword(s):

Decision Making ◽

Contraceptive Use ◽

Southern Ethiopia ◽

Modern Contraceptive ◽

Modern Contraceptive Use

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Gender norms and modern contraceptive use in urban Nigeria: a multilevel longitudinal study

BMC Women s Health ◽

10.1186/s12905-018-0664-3 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Chinelo C. Okigbo ◽

Ilene S. Speizer ◽

Marisa E. Domino ◽

Sian L. Curtis ◽

Carolyn T. Halpern ◽

...

Keyword(s):

Longitudinal Study ◽

Contraceptive Use ◽

Gender Norms ◽

Modern Contraceptive ◽

Modern Contraceptive Use

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International Migration and Modern Contraceptive Use: A Research Note on African Migrants to France

Demography ◽

10.1215/00703370-9611478 ◽

2021 ◽

Author(s):

Julia A. Behrman ◽

Michelle A. Eilers ◽

Isabel H. McLoughlin Brooks ◽

Abigail Weitzman

Keyword(s):

Contraceptive Use ◽

Family Background ◽

Research Note ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

African Countries ◽

Proximate Determinant ◽

African Migrants ◽

Modern Contraceptive Use ◽

Long Acting

Abstract This research note presents a multisited analysis of migration and contraceptive use by standardizing and integrating a sample of African migrants in France from six West and Central African countries in the Trajectoires et Origines survey with a sample of women living in the same six African countries in the Demographic and Health Surveys. Descriptive analyses indicate that the contraceptive use of migrants more closely aligns with that of native French women than with that of women from origin countries. In particular, migrants report dramatically higher use of long-acting reversible contraceptives and short-acting hormonal methods and lower use of traditional methods than do women in the countries of origin. Although migrants differ from women in the countries of origin on observed characteristics, including education and family background, reweighting women in the origin countries to resemble migrants on these characteristics does little to explain differences in contraceptive use between the groups. Given that contraceptive use is an important proximate determinant of fertility, our results suggest that contraceptive use should feature more prominently in the dominant demographic paradigms of migrant fertility.

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