scholarly journals Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis

2020 ◽  
Author(s):  
Oluwasegun Jko Ogundele ◽  
Milena Pavlova ◽  
Wim Groot

Abstract Background Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored. Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis. Results The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR=2.54, 95% CI: 1.90−3.39) and in Ghana (OR=1.257, 95% CI: 0.77−2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR= 1.579, 95% CI: 1.081−2.307, p ≤0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services. Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.

2020 ◽  
Author(s):  
Oluwasegun Jko Ogundele ◽  
Milena Pavlova ◽  
Wim Groot

Abstract Background To understand differences in access to reproductive healthcare services, the use of family planning and maternal care by women in Ghana and Nigeria is examined.Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 in two-step cluster analysis followed by multinomial logistic regression analysis.Results The initial two-step cluster analyses on family planning identify three groups of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses identify five distinct groups: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. The multinomial logistic regression shows that education and occupation are associated with access to family planning and maternal health services. Women without education often have poor access to reproductive health services in both countries. In Nigeria, household wealth is strongly associated with access to maternal health services but household wealth does not explain access in Ghana. Not having insurance in Ghana is associated with low access to family planning service, while this is not the case in Nigeria.Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socioeconomic status.


2019 ◽  
Author(s):  
Oluwasegun Jko Ogundele ◽  
Milena Pavlova ◽  
Wim Groot

Abstract Background To understand differences in access to reproductive healthcare services, the use of family planning and maternal care by women in Ghana and Nigeria is examined.Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 in two-step cluster analysis followed by multinomial logistic regression analysis.Results The initial two-step cluster analyses on family planning identify three groups of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses identify five distinct groups: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. The multinomial logistic regression shows that education and occupation are associated with access to family planning and maternal health services. Women without education often have poor access to reproductive health services in both countries. In Nigeria, household wealth is strongly associated with access to maternal health services but household wealth does not explain access in Ghana. Not having insurance in Ghana is associated with low access to family planning service, while this is not the case in Nigeria.Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socioeconomic status.


2014 ◽  
Vol 12 (2) ◽  
pp. 42-46
Author(s):  
Khadga Bahadur Shrestha

Transforming family planning rights into practices is not an easy task especially in a developing nation like Nepal where society is patriarchal and literacy is low. Besides, coverage and quality of reproductive health services and active involvement of the community is crucial in the transformation. For properly addressing these challenges, all the sectors that provide family planning services need to act on advocacy, creating demand, reshaping service delivery, sustainability (financial and self-reliance) and high level political and financial commitments are necessary.DOI: http://dx.doi.org/10.3126/hprospect.v12i2.9874 Health Prospect Vol.12(2) 2013: 42-46


2018 ◽  
Vol 12 (4) ◽  
pp. 1074-1083 ◽  
Author(s):  
Megan Hamm ◽  
Elizabeth Miller ◽  
Lovie Jackson Foster ◽  
Mario Browne ◽  
Sonya Borrero

Despite demonstrable need, men’s utilization of sexual and reproductive health services remains low. This low utilization may particularly affect low-income men, given the disproportionate prevalence of unintended pregnancy in low-income populations. Bolstering men’s utilization of sexual and reproductive health services requires understanding the services that are most relevant to them. Semistructured interviews about fatherhood, fertility intention, and contraceptive use were conducted with 58 low-income Black and White men in Pittsburgh, Pennsylvania. The interviews were analyzed using content analysis to determine common themes that were most relevant to the men interviewed. The primacy of financial stability emerged as a dominant theme in men’s perceptions of fatherhood readiness, successful fathering, and fertility intentions. However, men had children despite feeling financially unprepared, and their contraceptive use was not always congruent with their stated fertility intentions. Some men described financial services as a feature of family planning services that they would find useful. Because of the salience of financial stability in preparation for fatherhood, integrating financial counseling and job skills training into the context of sexual and reproductive health services could be a useful structural intervention to increase men’s use of family planning services and to provide them with the support they say they need as fathers.


2021 ◽  
Vol 3 ◽  
Author(s):  
Gabrielle O'Malley ◽  
Kristin M. Beima-Sofie ◽  
Stephanie D. Roche ◽  
Elzette Rousseau ◽  
Danielle Travill ◽  
...  

Background: Successful integration of pre-exposure prophylaxis (PrEP) with existing reproductive health services will require iterative learning and adaptation. The interaction between the problem-solving required to implement new interventions and health worker motivation has been well-described in the public health literature. This study describes structural and motivational challenges faced by health care providers delivering PrEP to adolescent girls and young women (AGYW) alongside other SRH services, and the strategies used to overcome them.Methods: We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with HCWs from two demonstration projects delivering PrEP to AGYW alongside other SRH services. The Prevention Options for the Women Evaluation Research (POWER) is an open label PrEP study with a focus on learning about PrEP delivery in Kenyan and South African family planning, youth mobile services, and public clinics at six facilities. PrIYA focused on PrEP delivery to AGYW via maternal and child health (MCH) and family planning (FP) clinics in Kenya across 37 facilities. IDIs and FGDs were transcribed verbatim and analyzed using a combination of inductive and deductive methods.Results: We conducted IDIs with 36 participants and 8 FGDs with 50 participants. HCW described a dynamic process of operationalizing PrEP delivery to better respond to patient needs, including modifying patient flow, pill packaging, and counseling. HCWs believed the biggest challenge to sustained integration and scaling of PrEP for AGYW would be lack of health care worker motivation, primarily due to a misalignment of personal and professional values and expectations. HCWs frequently described concerns of PrEP provision being seen as condoning or promoting unprotected sex among young unmarried, sexually active women. Persuasive techniques used to overcome these reservations included emphasizing the social realities of HIV risk, health care worker professional identities, and vocational commitments to keeping young women healthy.Conclusion: Sustained scale-up of PrEP will require HCWs to value and prioritize its incorporation into daily practice. As with the provision of other SRH services, HCWs may have moral reservations about providing PrEP to AGYW. Strategies that strengthen alignment of HCW personal values with professional goals will be important for strengthening motivation to overcome delivery challenges.


2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Stewart Britten ◽  
Wahida Paikan

Reduction of child mortality while coverage of family planning services remains low may render Afghanistan a testing ground for the theory of demographic transition. Meanwhile there is a vicious circle: young men lacking employment join the Taliban and so increase national insecurity, discouraging industry and reducing employment opportunities. For progress towards peace to be made and sustained, family planning, education and employment need to be major parts of the peace effort, and UN reports need to emphasise more which way the scales tip.


Author(s):  
Shireen Parker ◽  
Vera Scott

Background: The United Nations Political Declaration on HIV and AIDS of 2006 stressed the need to strengthen policy and programme linkages between HIV and Sexual and Reproductive Health (SRH). However, the effectiveness and best practices for strengthening SRH and HIV linkages are poorly researched in the context of family-planning services. In Cape Town, HIV-prevention services have been integrated into family-planning services. There are two models of service configuration: dedicated stand-alone reproductive health clinics and family planning services located in comprehensive primary-care facilities.Objective: To describe how reproductive health services are integrating HIV prevention and care strategies and to measure the coverage and quality of these integrated services.Methods: A cross-sectional study was conducted using structured interviews with facility managers; a facility-based checklist; and a patient record review to assess the availability of resources, training, access, quality and integration.Results: Facilities in Cape Town are equipped adequately to offer integrated HIV-prevention and SRH services. Overall there was poor coverage of integrated services with 54% of family planning clients having a known HIV status; 47% being screened for a sexually transmitted infection and 55% being offered HIV counselling and testing and receiving condoms. Quality and continuity of care seemed better at the dedicated clinics than at the comprehensive facilities,supported by better training coverage.Conclusion: Engaging middle-level management is crucial with regard to improving integration within a well-resourced setting.


2017 ◽  
Vol 9 (4) ◽  
pp. 440-446 ◽  
Author(s):  
Maryam Guiahi ◽  
Jennifer Hoover ◽  
Maryke Swartz ◽  
Stephanie Teal

ABSTRACT Background  Catholic hospitals operate under the Ethical and Religious Directives for Catholic Health Care Services, which for obstetrics and gynecology residents may create barriers to receiving adequate training in family planning. Objective  We evaluated how training at a Catholic hospital affects trainees' subsequent provision of reproductive health services at secular institutions. Methods  This qualitative study used semistructured interviews with recent obstetrics and gynecology graduates in generalist practice at secular institutions. We queried about their training experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts, using grounded theory. Results  We reached thematic saturation after 15 of 31 graduates (48%) from 7 Catholic hospital residencies participated in interviews between June 2014 and February 2015. Many participants reported a lack of awareness regarding limitations on this aspect of their training. All participants reported reproductive health care training deficiencies, and many explained that “elective” training required resident initiative to obtain. After graduation, participants reported dissatisfaction with training in family planning, delayed competency in this area, and a lack of ability to provide certain family planning procedures. All felt that Catholic programs should improve family planning training by providing routine, opt-out family planning opportunities. Conclusions  Obstetricians and gynecologists who trained at Catholic institutions felt that religion-based policies negatively affected their training experiences and the range of reproductive health services they subsequently provide in practice. Forming collaborations with off-site facilities, particularly for postpartum tubal ligation and uterine evacuation, may improve the reproductive care these physicians ultimately provide to women.


2000 ◽  
Vol 39 (4II) ◽  
pp. 675-693 ◽  
Author(s):  
Naushin Mahmood ◽  
Durr-e- Nayab

Population programmes in many developing countries have emphasised on family planning services driven largely by numbers and demographic targets. With the advent of the International Conference on Population and Development (ICPD) in 1994, it has been recognised to move beyond a narrow focus on family planning to a more comprehensive concern of reproductive health oriented towards meeting the needs of individuals and families. This advocated shift in population and development strategy, especially in health emphasises that services be offered to women, men and adolescents with a special focus on fulfilling women’s health needs, safeguarding their reproductive rights and involving men as equal partners in meeting the goal of responsible parenthood [United Nations (1995)]. In response to ICPD’s mandate, Pakistan’s population programme has increasingly been focussed on various aspects of reproductive health and is in the process of broadening the scope of services for a transition to reproductive health without losing focus on achieving fertility reduction goal. In this regard, the government has adopted a comprehensive population and development policy incorporating an array of reproductive health services and has integrated population and health departments and their activities in dealing with RH problems. Under the consideration that the revised programme can not simultaneously address all of the RH problems, an integrated National Reproductive Health Services Package has been developed to provide services to eligible women, men and adolescents [Pakistan (1999)]. The major components of RH package include:


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