Utilization and associated factors of modern contraceptives during postpartum period among women who gave birth in the last 12 months in injibara town Awi Zone, North-West Ethiopia 2019

Abstract Background: The postpartum period is an important entry point for family planning service providers to reduce unintended and too closely spaced pregnancy. A postpartum modern contraceptive service is one of the recommended public health interventions for reducing maternal and child morbidity and mortalities. However, In Ethiopia modern contraceptive use during the postpartum period is low; resulting in unintended pregnancies and unwanted childbearing . there for this study was done to assess utilization and associated factors of modern contraceptives during the postpartum period among women who gave birth in the last 12 months in Injibara Town Awi Zone, North-Western Ethiopia. Methods: A Community based cross-sectional study design was conducted from March 01 to 15/2019 on 400 women who gave birth in the last 12 months preceding the survey. A simple random sampling technique was used to recruit study subjects. Data was collected using interviewer-administered pretested and structured questionnaires. Data were entered using Epi data 3.5 and exported to SPSS version 23 for analysis. The association between variables was analyzed using Bivariate and multivariable logistic regression models and p-value < 0.05 at 95% Confidence interval was considered as statistically significant. Result: The prevalence of modern contraceptive utilization was 58.5% (95% CI: 53.5- 63%) among postpartum mothers. Secondary school and higher educational levels [AOR= 5.02; 95% CI (1.53-16.47)],[AOR= 4.25; 95% CI:(1.32-13.64) respectively)], previous history of abortion [AOR= 3.93; 95%, CI: (1.43-10.84)], having three and four antenatal care visit [AOR= 4.74; 95%, CI: (1.94-11.54)] [AOR= 5.9; 95%, CI: (2.42-14.39) respectively], family planning counselling during antenatal care [AOR=2.81; 95% ,CI: (1.63- 4.86)], having postnatal care [AOR =1.79, 95%, CI: (1.09-2.96)], menses returning after birth [AOR=2.84, 95% CI: (1.77- 4.57)] and resuming sexual activity [AOR= 2.86, 95% CI: (1.71-4.78)] were factors affecting contraceptive use in postpartum period. Conclusion : The prevalence of modern contraceptive use among postpartum women was found to be high in Injibara town. Therefore, strengthen family planning counseling during antenatal care and postnatal care to reduce the missed opportunity of postpartum women to get family planning methods, especially long-acting reversible contraceptives.

Download Full-text

Determinants of modern contraceptive use among postpartum women in two health facilities in urban Ghana: a cross-sectional study

Contraception and Reproductive Medicine ◽

10.1186/s40834-019-0098-9 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Jonathan Ian Coomson ◽

Abubakar Manu

Keyword(s):

Family Planning ◽

Antenatal Care ◽

Contraceptive Use ◽

Male Partner ◽

Postpartum Women ◽

Modern Contraceptive ◽

Cross Sectional ◽

Modern Methods ◽

Modern Contraceptive Use ◽

Contraceptive Uptake

Abstract Background Postpartum contraception is important for spacing and limiting childbirth. Although the use of modern contraception has been shown to reduce maternal and child morbidities and mortalities, postpartum women have one of the highest unmet needs for family planning. Inter-birth intervals less than 24 months have adverse effects on both the mother and the child, yet very limited empirical evidence exist on contraceptive use among postpartum women in Ghana. This study sought to determine the prevalence and determinants of modern contraceptive use among postpartum women in the Tema Metropolis, Ghana. Methods A facility-based cross-sectional survey was conducted among 320 postpartum women with babies aged between three and 15 months. Participants were recruited from child welfare clinics in two government health facilities in the Tema metropolitan area using a simple random sampling technique. Data were analyzed using STATA version 15. Chi-square and multiple logistic regressions techniques were used to examine associations between postpartum contraceptive use and key independent variables. Statistical significance was set at p = 0.05. Adjusted odds ratios and their 95% confidence intervals were used to assess the strength of association. Results The prevalence rate of modern contraceptive use among postpartum women was 26.3%. Postpartum contraceptive use was significantly associated with past contraceptive use [AOR = 7.7 (95%CI: 3.4–17.5)]; return of menses [AOR = 4.3 (95%CI: 1.7–11.3)]; resumption of sexual activity [AOR = 4.7 (95%CI: 1.4–15.4)]; discussion of family planning with male partner [AOR = 3.1 (95%CI: 1.03–9.2)]; male partners’ approval of modern contraception [AOR = 18.1 (95%CI: 6.3–51.6)]; family planning counselling received during antenatal care [AOR = 3.5 (95%CI: 1.3–9.9)] and knowledge of at least one modern methods of contraception available at the health facility [AOR = 4.7 (95%CI: 1.9–11.5)]. Conclusions Postpartum contraceptive uptake is low among women in the Tema area. Factors that influence modern contraceptive uptake among postpartum women include past modern contraceptive use, resumption of sexual activity and menstruation, male partner involvement in contraception, family planning counselling during antenatal care and knowledge of the modern methods of contraception available at the health facility. Strengthening family planning education and counselling during antenatal care and using a multi-prong strategy to engage men as partners in family planning will improve postpartum contraceptive uptake.

Download Full-text

The intention on Modern Contraceptive Use and Associated Factors among Postpartum Women in Public health institutions of Sodo Town, Southern Ethiopia 2019: Institutional Based Cross-Sectional Study.

10.21203/rs.2.22139/v1 ◽

2020 ◽

Author(s):

Natnael Atnafu Gebeyehu ◽

Kelemu Abebe

Keyword(s):

Family Planning ◽

Antenatal Care ◽

Contraceptive Use ◽

P Value ◽

Postpartum Women ◽

Modern Contraceptive ◽

Cross Sectional ◽

Antenatal Care Visit ◽

Care Visit ◽

Modern Contraceptive Use

Abstract Background: The postpartum period is an important transitional time for couples to put the decision on family planning utilization. However, women in Ethiopia are usually uncertain about the use of family planning during this period. This study was aimed to assess the intention of modern contraceptive use and associated factors among postpartum women attending the immunization clinic in Sodo Town.Method: Institutional based cross-sectional study design with a sample size of 416 was conducted from May 25 to June 20, 2019. The data were collected by using a systematic random sampling technique of interviewer-administered questionnaires. Those candidate variables at Bivariate analysis with a p-value<0.2 were moved to the Multivariate logistic regression model to control potential confounding variables and P-value<0.05 at multivariate analysis was considered as a cutoff pointResults: A total of 416 postpartum women participated in the study yielding a response rate of 98.1 % and 291 (70%) of them had an intention on modern contraceptive use. The odds of intention on modern contraceptive use was higher among respondents who had secondary school education (AOR=2.052, 95%CI: 1.064-3.958) than participants with no formal education. It was also higher among antenatal care visit attendees (AOR=1.736,95%CI:1.021-2.951) than those did not attend antenatal care visit. Knowledgeable participants on modern contraceptive use were more likely intend to use (AOR=2.535, 95%CI: 1.499-4.282) than their counterparts. Besides, the odds of the intention of modern contraceptive use among postpartum women who had menses resumption were higher (AOR=2.047,95%CI:1.141-3.675)than those whose menses not resumed.Participants who had husband approval were more likely to intend to use contraceptives (AOR=2.395,95%CI:1.501-5.458) than their counterparts.Conclusion: The intention of modern contraceptives among postpartum women was low. Family planning providers should emphasize reducing barriers of intention like lack of education, knowledge, male partner approval, antenatal care visit and advise the impact of menses on fertility.

Download Full-text

Prevalence of postpartum family planning utilization and associated factors among postpartum mothers in Arba Minch town, South Ethiopia

Contraception and Reproductive Medicine ◽

10.1186/s40834-021-00150-z ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Biresaw Wassihun ◽

Kidist Wosen ◽

Asmare Getie ◽

Kalkidan Belay ◽

Rehal Tesfaye ◽

...

Keyword(s):

Family Planning ◽

Antenatal Care ◽

Odds Ratio ◽

Postnatal Care ◽

Associated Factors ◽

Adjusted Odds Ratio ◽

Educational Status ◽

Postpartum Women ◽

Postpartum Family Planning ◽

Study Participants

Abstract Background Contraception allows women to realize their human right to decide if and when to have children and helps people to attain their desired family size. Yet 214 million women of a reproductive age in developing countries who want to avoid pregnancy are not using a modern contraceptive method. Women who have recently given birth are among the group with the highest unmet need for contraception. Therefore, this study was aimed to assess the prevalence of postpartum family planning use and associated factors among postpartum women in Southern Ethiopia. Methods Institution based cross-sectional study design was conducted. A structured and pretested interviewer-administered questionnaire was used to collect the data from study participants. Study participants were selected using a systematic random sampling technique by allocating proportionally to each health facility. The data was entered using EPI data version 3.1statistical software and exported to Statistical Package for Social Sciences version 22.0 for further analysis. Both bivariate and multivariate logistic regression analyses were performed to identify associated factors. P values < 0.05 with 95% confidence level was used to declare statistica significance. Result Overall, 44% of postpartum women utilize postpartum family planning. Having an antenatal care visit [adjusted odds ratio (AOR) =1.89(95%CI, 2.42–7.90), having planned pregnancy [adjusted odds ratio (AOR) = 1.17(95%CI, 1.60–2.28)], being married (adjusted odds ratio (AOR) =2.86(1.94–8.73), and having a college and above level educational status (AOR) =1.66(1.28–3.55) were significantly associated with utilization of postpartum family planning. Conclusion This study showed that the prevalence of postpartum family planning was 44%. Marital status, educational status of mothers, the status of pregnancy, and having an antenatal care follow-up during pregnancy were some factors associated with postpartum family planning utilization. Therefore, strengthening family planning counselling during antenatal and postnatal care visits, improving utilization of postnatal care services and improving women’s educational status are crucial steps to enhance contraceptive use among postpartum women.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Modern contraceptive use among female adolescents in rural Nigeria: Does exposure to family planning messages matter? A cross-sectional study

Gates Open Research ◽

10.12688/gatesopenres.12904.2 ◽

2019 ◽

Vol 3 ◽

pp. 627

Author(s):

Victor Chima ◽

Oluwatobi Abel Alawode

Keyword(s):

Family Planning ◽

Mass Media ◽

Rural Areas ◽

Contraceptive Use ◽

Female Adolescents ◽

Rural Adolescents ◽

Modern Contraceptive ◽

Modern Contraceptives ◽

Rural Nigeria ◽

Modern Contraceptive Use

Background: The world currently has the highest number of adolescents in all of history. Africa is home to quite a number of them, with most of these adolescents in Africa live in rural areas where they are more disadvantaged and their reproductive decisions could have telling impacts on their lives, family planning (contraception) has been identified as important to avoid such impacts. Factors associated with the use of modern contraceptives among female adolescents have been extensively researched but the importance of mass media family planning messages on modern contraceptives use among female adolescents in rural Nigeria is under-researched, hence this study. Method: This paper uses the 2013 Nigeria Demographic and Health Survey (NDHS) data with a weighted sample size (n=4473) to examine the association between exposure to family planning messages and use of modern contraceptives among female adolescents in rural Nigeria. Results: Findings indicated that exposure to family planning messages on radio and television were significantly associated with modern contraceptive use, however, educational attainment and region of residence were other factors that influenced modern contraceptive use.. Conclusion: The study concludes that family planning messages through mass media especially radio and television are associated with modern contraceptives use among rural adolescents. The continued use of mass media would enhance opportunities to achieve more results, however, other interventions addressing education with objectives of closing the rural-urban socio-economic gap should be encouraged also, as these factors play critical roles in improving uptake of family planning among rural adolescents. Further, messages on modern contraceptive use should be sensitive to regional divides in terms of content and delivery.

Download Full-text

Family planning utilization and associated factors among postpartum women in Addis Ababa, Ethiopia, 2018

PLoS ONE ◽

10.1371/journal.pone.0245123 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245123

Author(s):

Lema Tafa ◽

Yoseph Worku

Keyword(s):

Family Planning ◽

Antenatal Care ◽

Sexual Activity ◽

Health Facility ◽

Postnatal Care ◽

Associated Factors ◽

Addis Ababa ◽

Postpartum Women ◽

Factors Associated ◽

Care Services

Background Pregnancies that occur in the first year after birth can result in adverse outcomes for the mothers and their babies. Postpartum family planning (PPFP) can save lives of many mothers and children. Only few data are available about the magnitude of PPFP use and its determinants in Addis Ababa, Ethiopia. Objective To assess PPFP utilization and associated factors in Addis Ababa, Ethiopia. Method A facility-based cross-sectional study was conducted from April to June 2018. A total of 625 women were enrolled in the study. Statistical Package for the Social Sciences (SPSS) software was used to analyze the data. Binary logistic regression model with adjusted odd ratio (AOR) and 95% confidence interval (CI) was used to identify the factors associated with PPFP use. A p-value less than 0.05 was considered as significant. Result The magnitude of PPFP utilization in Addis Ababa was 71.8%. Previous family planning (FP) information (AOR = 13.2; 95% CI: (1.96, 88.07)), FP information from health facility visit (AOR = 2.23; 95% CI: (1.45, 3.43)), antenatal care (AOR = 4.96; 95% CI: (1.58, 15.64)), counseling on FP at postnatal care (AOR = 1.97; 95% CI: (1.27, 3.05)), menses resumption after birth (AOR = 1.75; 95% CI: (1.11, 2.76)), and commencing sexual activity after birth (AOR = 9.34; 95% CI: (5.39, 16.17)) were the factors associated with PPFP use. Conclusion and recommendation Though the magnitude of PPFP use is encouraging, still three out of the ten postpartum women did not use PPFP. The determinants of PPFP use were having FP information, having FP information from health facility visit, antenatal care, counseling about FP during postnatal care, menses resumption after birth, and commencing sexual activity after birth. The health system in the City and the healthcare providers should strive to reach every woman who is not accessing the PPFP services and antenatal care services, and improve counseling services on PPFP during delivery and postnatal care services.

Download Full-text

Timely initiation of postpartum contraceptive and associated factors among women of extended postpartum period in Pawe district, northwest Ethiopia, 2019

10.21203/rs.2.15665/v1 ◽

2019 ◽

Author(s):

Desalegn Nazi Jaleta ◽

Hedeja Yenus Yeshita ◽

Koku Sisay Tamirat

Keyword(s):

Family Planning ◽

Postpartum Period ◽

Associated Factors ◽

Northwest Ethiopia ◽

P Value ◽

Postpartum Women ◽

Modern Contraceptive ◽

Multivariable Logistic Regression Model ◽

Cross Sectional ◽

Timely Initiation

Abstract Background: Postpartum family planning is an important intervention for reducing high risk fertility behavior and spacing birth intervals; which ultimately helpful for the health of mothers and their babies. Hence, this study aimed to determine the magnitude of timely initiation of postpartum contraceptive and associated factors among extended postpartum women in Pawe district, Northwest Ethiopia.Methods: Community based cross-sectional study design was employed from February to March 2019 in Pawe district. A stratified multistage sampling technique was used to select a total of 820 women in the extended postpartum period. Data were collected using a pretested interviewer administered questionnaire. A bivariable and multivariable logistic regression model was fitted to identify determinants of timely initiation of postpartum contraceptive among extended postpartum women. Adjusted Odds ratio (AOR) with 95% CI was computed to assess the strength and presence of an association. Variable with less than 0.05 p-value considered as a significant determinant of contraceptive initiation.Results: Out of the total participants about 37.2% [95% CI (34.0, 40.5)] initiated postpartum contraceptive. Time return of menses [AOR=18.32, 95% CI(11.66,28.80)], postnatal care [AOR=7.8, 95%bCI(3.98,15.44)], knowledge level regarding modern contraceptive methods [AOR=3.0, 95% CI(1.40,6.59)], time of resumption of sexual intercourse [AOR=2.1, 95% CI(1.327,3.21), husband approval to use contraceptive [AOR=2.45,95%CI(1.42,4.22), antenatal care [AOR=2.1,95% CI(1.13,3.76), place of delivery at institution [AOR=2.0, 95% CI(1.22,3.39)], and got family planning counseling at delivery [AOR=2.34, 95% CI(1.22,4.49)] were factors associated with timely initiation of postpartum contraceptive. Conclusion and recommendation: The magnitude of timely initiation of postpartum contraceptive was low. This suggests strengthening the integration of postpartum contraceptive use with other basic maternal health services and improving knowledge of women in practicing timely initiation of postpartum contraceptive before engagement to risk activities of unintended pregnancy is important.

Download Full-text

The Intention on Modern Contraceptive Use and Associated Factors among Postpartum Women in Public Health Institutions of Sodo Town, Southern Ethiopia 2019: An Institutional-Based Cross-Sectional Study

BioMed Research International ◽

10.1155/2020/9815465 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Natnael Atnafu Gebeyehu ◽

Eyasu Alem Lake ◽

Kelemu Abebe Gelaw ◽

Gedion Asnake Azeze

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Cross Sectional Study ◽

Postpartum Women ◽

Modern Contraceptive ◽

Sectional Study ◽

Cross Sectional ◽

Care Visit ◽

Modern Contraceptive Use ◽

Study Participants

Background. The postpartum period is an important transitional time for couples to put the decision on family planning utilization. However, women in Ethiopia are usually uncertain about the use of family planning during this period. This cross-sectional study was, therefore, aimed at determining the intention of modern contraceptive use and associated factors among postpartum women attending the immunization clinic in Sodo town, Ethiopia. Method. This institution-based cross-sectional study was conducted among 416 study participants from May 25 to June 20, 2019. The data were collected by using a systematic random sampling technique of interviewer-administered questionnaires. Descriptive analysis was done, and results were presented in texts and tables. Variables at bivariate analysis with a p value < 0.2 were moved to the multivariate logistic regression model to control potential confounding variables. Statistical tests at p value < 0.05 during multivariate analysis were considered as a cutoff point to determine statistical significance. Results. A total of 416 postpartum women participated in the study yielding a response rate of 98.1%. The prevalence of intention on modern contraceptive use among study participants was 70%. The odds of intention on modern contraceptive use was higher among study participants who had secondary school education (AOR=2.052, 95% CI: 1.064-3.958), antenatal care visit (AOR=1.74; 95% CI: 1.02-2.95), knowledge on modern contraceptive use (AOR=2.54; 95% CI: 1.50-4.28), menses resumption (AOR=2.05; 95% CI: 1.14-3.68), and husband approval to use contraceptives (AOR=2.395, 95% CI: 1.501-5.458). Conclusion. The intention of modern contraceptive use among postpartum women was low. Family planning providers should emphasize reducing barriers of intention like lack of education, knowledge, male partner approval, antenatal care visit, and advise the impact of menses on fertility.

Download Full-text

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

PLoS ONE ◽

10.1371/journal.pone.0232504 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0232504

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

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.

Download Full-text