Assessing the Acceptability of Vasectomy as a Family Planning Option: A Qualitative Study with Men in the Kingdom of Eswatini

The uptake of vasectomy in many countries in sub-Saharan Africa is low. In Eswatini, a kingdom with strong patriarchal norms, the use of vasectomy is at 0.3%. This is despite great efforts to introduce vasectomy and involve men in reproductive health. This study explored the views of men about the acceptability of vasectomy and their willingness to adopt vasectomy as a family planning option. Focus group discussions were conducted with adult men recruited from health facilities located in rural, semi urban, and urban areas in two of the regions of Eswatini. A thematic approach was used to analyze the data. The acceptability of and intention to use vasectomy as a family planning option was very low. Cultural beliefs, societal norms, lack of knowledge about the procedure for vasectomy, and misconceptions influenced the acceptability of vasectomy greatly. The participants could not grasp the concept of a family planning method that is as permanent as vasectomy. However, the decisions to accept or reject vasectomy were influenced by their misconceptions and fears about vasectomy and were not based on facts. To address the need to involve men in reproductive health and improve the acceptability and adoption of vasectomy, planning should be conducted with them and informed by their understanding of their needs.

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Global Gag Rule

10.1093/oso/9780190876128.003.0002 ◽

2018 ◽

Cited By ~ 1

Author(s):

Yana van der Meulen Rodgers

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Foreign Aid ◽

Mexico City ◽

Abrupt Change ◽

Population Control ◽

Sub Saharan Africa ◽

George Bush ◽

Large Fluctuations ◽

Sub Saharan

This chapter discusses the evolution of the global gag rule and the existing evidence on its effects. When it was announced in Mexico City, the policy created global uproar with its abrupt change in position on population control and abortion. Pressure from domestic antiabortion groups weighed heavily in the administration’s new policy stance on family-planning assistance. Subsequent rescissions and reinstatements of the global gag rule have caused large fluctuations in US funding for family planning, as demonstrated in the chapter’s analysis of aggregate data. Evidence from qualitative studies indicates that the restrictions on US family-planning assistance under George Bush beginning in 2001 caused major disruptions in service delivery, especially in sub-Saharan Africa. This evidence is crucial for understanding the channels through which women’s reproductive health outcomes are related to restrictions on US foreign aid.

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Reproductive Health and Family Planning Needs Among HIV-Infected Women in Sub-Saharan Africa

Current HIV Research ◽

10.2174/1570162x11311020008 ◽

2013 ◽

Vol 11 (2) ◽

pp. 160-168 ◽

Cited By ~ 27

Author(s):

Clea C. Sarnquist ◽

Lisa Rahangdale ◽

Yvonne Maldonado

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Sub Saharan Africa ◽

Sub Saharan

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Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Qualitative Research in Medicine & Healthcare ◽

10.4081/qrmh.2018.7062 ◽

2018 ◽

Vol 2 (1) ◽

Cited By ~ 7

Author(s):

Kelli Stidham Hall ◽

Abubakar Manu ◽

Emmanuel Morhe ◽

Vanessa K. Dalton ◽

Sneha Challa ◽

...

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Sub Saharan Africa ◽

Structured Interviews ◽

Community Members ◽

Sexually Transmitted ◽

Enacted Stigma ◽

Sub Saharan ◽

Marital Sex

Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women’s family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents’ use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide.

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Influence of Religion and Religiosity on Fertility and Contraceptive Use in Continental Sub-Saharan Africa: A Comprehensive Review

10.31237/osf.io/sezdq ◽

2021 ◽

Author(s):

Nicola Turner

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Negative Relationship ◽

Qualitative Studies ◽

Sub Saharan Africa ◽

Religious Leaders ◽

Group Discussions ◽

Sub Saharan ◽

Indigenous Religions ◽

Depth Interviews

The global human population has been increasing at an alarming rate over the last 100 years and is projected by the United Nations (UN) to continue to increase and reach 10 billion by 2057, despite a declining growth rate. Although some countries and regions, primarily Japan and Europe, have stabilised or declining populations, Sub-Saharan Africa is dramatically growing at an annual rate of 2.7% as of 2019, and is projected to sustain a rapid population growth up to 2100. Addressing the subject of population growth and overpopulation is an important but unfortunately neglected task. The consequences of a large, growing human population are already having distressing impacts on the planet, both on the natural environment and on humans, especially women and children. Until recently, there have been few studies on the effects of religion and religiosity on fertility and contraceptive use, and these factors are often overlooked as possible determinants. The aim of this review is to explore and seek to clarify the role of religion and religiosity on fertility and contraceptive use in continental Sub-Saharan African countries. The review of quantitative publications supported by insights and opinions from actual quotes of respondents from qualitative studies shows that followers of African Indigenous Religions and Islam have higher fertility rates than followers of Christianity. Across Christian denominations, Catholics generally had higher fertility than Protestants although the difference is small. Followers of the Apostolic Church exhibited the highest fertility among Christian groups. Focus group discussions and in-depth interviews from the qualitative studies found that religious beliefs were frequently cited as a barrier to contraceptive uptake. The findings clearly suggest that religion influences fertility and contraceptive use, although countries differ in this respect. Few studies mentioned religiosity; existing results show a positive relationship across Sub-Saharan Africa between degree of religiosity and fertility, and a negative relationship with contraceptive use. These relationships are stronger in Islamic and Indigenous religions compared with Christianity. Religious leaders across all religions were found to be highly influential and many participants were inclined to follow the recommendations of religious leaders regarding fertility and contraceptive use. The implication of this finding is that educating religious leaders about rights-based family planning and its benefits should be part of a comprehensive strategy to increase contraceptive uptake and reduce fertility. With knowledge of its benefits, religious leaders could spread accurate messages about family planning to their followers and promote higher contraceptive use and low fertility. In addition, other important socioeconomic and cultural factors influence fertility and contraceptive use. Education, economy and access to family planning have a negative relationship with religiosity, but the strength of this relationship varies depending on religion, residence and region, with Muslims generally reported as the most disadvantaged in terms of education and wealth across Sub-Saharan Africa. Polygyny, gender attitudes, social status and misconceptions about family planning were additional influences on fertility and contraceptive use mentioned in focus group discussions and in-depth interviews from the qualitative studies. Religion and religiosity have an important role to play in relation to fertility and contraceptive use, but they also depend on other factors, their interactions and their relative influences. They have variable relationships to education, economy, gender equality, residence (rural/urban) and access to family planning, due to the different levels of these factors among and within countries in Sub-Saharan Africa. The review suggests that with a more religiously open stance towards family planning, population policies can be more easily implemented. Religion and religiosity need to be considered in surveys and studies on fertility and contraceptive use to inform and help policymakers, economic planners, program managers, researchers and survey specialists. In addition, this has the potential to improve environmental conditions in Sub-Saharan Africa.

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Managing African Urbanization in the Context of Environmental Change

INTERdisciplina ◽

10.22201/ceiich.24485705e.2014.2.46528 ◽

2014 ◽

Vol 2 (2) ◽

Cited By ~ 13

Author(s):

Shuaib Lwasa

Keyword(s):

Climate Change ◽

Economic Growth ◽

Social Services ◽

Urban Areas ◽

Urban Governance ◽

Sub Saharan Africa ◽

African Countries ◽

Sub Saharan ◽

Urbanization Rate ◽

Development And Management

Africa’s urbanization rate has increased steadily over the past three decades and is reported to be faster than in any other region in the world . It is estimated that by 2030, over half of the African population will be living in urban areas . But the nature of Africa’s urbanization and subsequent form of cities is yet to be critically analyzed in the context of city authorities’ readiness to address the challenges . Evidence is also suggesting that urbanization in African countries is increasingly associated with the high economic growth that has been observed in the last two decades . Both underlying and proximate drivers are responsible for the urbanization, and these include population dynamics, economic growth, legislative designation, increasing densities in rural centers, as well as the growth of mega cities such as Lagos, Cairo and Kinshasa, that are extending to form urban corridors . With the opportunities of urbanization in Sub–Saharan Africa, there are also challenges in the development and management of these cities . Those challenges include provision of social services, sustainable economic development, housing development, urban governance, spatial development guidance and environmental management, climate change adaptation, mitigation and disaster risk reduction . The challenge involves dealing with the development and infrastructure deficit, in addition to required adaption to and mitigation of climate change . This paper examines the current state of urban management in Africa .

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QOLP-03. NEURO-ONCOLOGY PALLIATIVE CARE SURVEY OF PHYSICIANS IN SUB-SAHARAN AFRICA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.728 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii175-ii175

Author(s):

Ramya Tadipatri ◽

Amir Azadi ◽

Madison Cowdrey ◽

Samuel Fongue ◽

Paul Smith ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Cultural Beliefs ◽

Oral Feeding ◽

Statistical Testing ◽

Sub Saharan Africa ◽

Neurological Deficits ◽

Survey Study ◽

Prior Training ◽

Sub Saharan

Abstract BACKGROUND Early access to palliative care is a critical component of treating patients with advanced cancer, particularly for glioblastoma patients who have low rates of survival despite optimal therapies. Additionally, there are unique considerations for primary brain tumor patients given the need for management of headaches, seizures, and focal neurological deficits. METHODS We conducted a survey of 109 physicians in Sub-Saharan Africa in order to determine level of understanding and skill in providing palliative care, types of palliative care therapies provided, role of cultural beliefs, availability of resources, and challenges faced. Demographic data including age, gender, and prior training was collected and analyzed using ANOVA statistical testing. RESULTS Among the participants, 48% felt comfortable in providing palliative care consultations, 62% have not had prior training, 52% believed that palliative care is only appropriate when there is irreversible deterioration, 62% expressed having access to palliative care, 49% do not have access to liquid opioid agents, 50% stated that cultural beliefs held by the patient or family prevented them from receiving, palliative care, and 23% stated that their own beliefs affected palliative care delivery. Older providers (age > 30) had a clearer understanding of palliative care (p = 0.004), were more comfortable providing consultation (p = 0.052), and were more likely to address mental health (p < 0.001). CONCLUSIONS Palliative care delivery to glioblastoma patients in Sub-Saharan Africa is often delayed until late in the disease course. Barriers to adequate palliative care treatment identified in this survey study include lack of training, limited access to liquid opioid agents, and cultural beliefs. Challenges most often identified by participants were pain management and end-of-life communication skills, but also included patient spirituality and psychological support, anxiety and depression, terminal dyspnea, ethics, and intravenous hydration and non-oral feeding.

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“This is not my decision; I have no alternative”. Perceptions and experiences of marriage age and family planning among Syrian women and men: a primary care study

Primary Health Care Research & Development ◽

10.1017/s1463423621000220 ◽

2021 ◽

Vol 22 ◽

Author(s):

Pinar Döner ◽

Kadriye Şahin

Keyword(s):

Health Care ◽

Primary Health Care ◽

Family Planning ◽

Reproductive Health ◽

Religious Beliefs ◽

Economic Status ◽

Cultural Beliefs ◽

Contraceptive Methods ◽

Factors Affecting ◽

Primary Health

Abstract Purpose: Reproductive health includes the capability to reproduce and the freedom to decide. In this context, both women and men have rights. In this study, it is aimed to reveal the obstacles in using these rights and to describe perceptions on marriage and family planning (FP) of Syrian women and men and to increase awareness for developing new policies on the Primary Health Care. Methods: The study was conducted using qualitative method, consisting of in-depth interviews with 54 participants; 43 women and 11 men who had to emigrate from varied regions of Syria at different times since 2011. Syrian women living in Hatay, in the south of Turkey were identified from Primary Health Care Center. Most of the Syrian women had given birth to the first two children before the age of 20 years. The interviewees were selected by purposive and snowball sampling. Results: The result was examined under seven headings: knowledge about FP and contraceptive methods, hesitation about contraceptive methods, emotional pressure of family and fear of maintaining marriage, embarrassing of talking about sexuality and contraception, the effects of belief and culture on contraception, psychological reflections of war, and changes in the perception of health during the process of immigration. The most significant factors affecting the approaches to FP and contraceptive methods of the women in this study were determined to be education, traditions, economic status, and religious beliefs. The most important factors affecting participants’ FP and contraceptive method approaches are education, cultural beliefs, economic status, and religious beliefs. Conclusions: The primary healthcare centers are at a very strategical point for offering FP services to help address patients’ unmet contraceptive needs and improve pregnancy outcomes. More attention should be paid to social determinants that influence the access to reproductive health. Moreover, efforts can be done to address gender inequality that intercept FP. The most important strategy for primary health systems to follow the gender barriers that hinder access to FP services and men are empowered to share responsibility for FP.

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Mapping 20 Years of Urban Expansion in 45 Urban Areas of Sub-Saharan Africa

Remote Sensing ◽

10.3390/rs13030525 ◽

2021 ◽

Vol 13 (3) ◽

pp. 525

Author(s):

Yann Forget ◽

Michal Shimoni ◽

Marius Gilbert ◽

Catherine Linard

Keyword(s):

Case Studies ◽

Urban Areas ◽

Urban Expansion ◽

Local Population ◽

Sub Saharan Africa ◽

Annual Growth Rate ◽

Urban Dynamics ◽

Mapping Approach ◽

Sub Saharan ◽

The Impact

By 2050, half of the net increase in the world’s population is expected to reside in sub-Saharan Africa (SSA), driving high urbanization rates and drastic land cover changes. However, the data-scarce environment of SSA limits our understanding of the urban dynamics in the region. In this context, Earth Observation (EO) is an opportunity to gather accurate and up-to-date spatial information on urban extents. During the last decade, the adoption of open-access policies by major EO programs (CBERS, Landsat, Sentinel) has allowed the production of several global high resolution (10–30 m) maps of human settlements. However, mapping accuracies in SSA are usually lower, limited by the lack of reference datasets to support the training and the validation of the classification models. Here we propose a mapping approach based on multi-sensor satellite imagery (Landsat, Sentinel-1, Envisat, ERS) and volunteered geographic information (OpenStreetMap) to solve the challenges of urban remote sensing in SSA. The proposed mapping approach is assessed in 17 case studies for an average F1-score of 0.93, and applied in 45 urban areas of SSA to produce a dataset of urban expansion from 1995 to 2015. Across the case studies, built-up areas averaged a compound annual growth rate of 5.5% between 1995 and 2015. The comparison with local population dynamics reveals the heterogeneity of urban dynamics in SSA. Overall, population densities in built-up areas are decreasing. However, the impact of population growth on urban expansion differs depending on the size of the urban area and its income class.

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Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

Global Implementation Research and Applications ◽

10.1007/s43477-021-00013-4 ◽

2021 ◽

Author(s):

Laura Ghiron ◽

Eric Ramirez-Ferrero ◽

Rita Badiani ◽

Regina Benevides ◽

Alexis Ntabona ◽

...

Keyword(s):

Family Planning ◽

Scale Up ◽

Scaling Up ◽

Sub Saharan Africa ◽

Health System Strengthening ◽

Country Level ◽

Look Ahead ◽

Republic Of The Congo ◽

Sub Saharan ◽

Multi Stakeholder

AbstractThe USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

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Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review

Reproductive Health ◽

10.1186/s12978-021-01183-y ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Lesley Rose Ninsiima ◽

Isabel Kazanga Chiumia ◽

Rawlance Ndejjo

Keyword(s):

Reproductive Health ◽

Health Services ◽

Sexual And Reproductive Health ◽

Health Workers ◽

Sub Saharan Africa ◽

Inclusion Criteria ◽

Reproductive Health Services ◽

Factors Influencing ◽

Sub Saharan ◽

Youth Friendly

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.

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