Harmonizing Methods for Estimating the Impact of Contraceptive Use on Unintended Pregnancy, Abortion, and Maternal Health

In 2010, the G8 placed renewed focus on maternal health via the Muskoka Initiative by committing to spend an additional $5 billion on maternal, newborn, and child health before 2015. Following the end of the Millennium Development Goals and the advent of the Sustainable Development Goals, maternal health issues have continued to feature prominently on the global health agenda. Despite these substantial investments of foreign aid over the past decade, there is limited evidence on the effectiveness of foreign aid in reducing maternal mortality in low- and middle-income countries (LMICs). Using data from the Organisation for Economic Cooperation and Development, the World Development Indicators and the Institute of Health Metrics and Evaluation, this study analyzes the effects of aid on maternal health in a sample of 130 LMICs from 1996 through 2015. Our results show that the effects of total foreign aid on maternal mortality are limited, but that aid allocated to the reproductive health sector and directly at maternal health is associated with significant reductions in maternal mortality. Given these targeted effects, it is important to channel more donor assistance to the promotion of reproductive health and contraceptive use among women as it serves as a tool towards the reduction of maternal mortality.

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Typical use effectiveness of Natural Cycles: postmarket surveillance study investigating the impact of previous contraceptive choice on the risk of unintended pregnancy

BMJ Open ◽

10.1136/bmjopen-2018-026474 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026474 ◽

Cited By ~ 2

Author(s):

Jonathan Bull ◽

Simon Rowland ◽

Olof Lundberg ◽

Elina Berglund-Scherwitzl ◽

Kristina Gemzell-Danielsson ◽

...

Keyword(s):

Unintended Pregnancy ◽

Contraceptive Use ◽

Unprotected Sex ◽

Contraceptive Effectiveness ◽

Real World Evidence ◽

Contraceptive Choice ◽

Pearl Index ◽

The Individual ◽

The Impact ◽

Natural Cycles

ObjectiveTo investigate the association between contraceptive effectiveness of Natural Cycles and users’ previous choice of contraceptive, and to evaluate the impact of shifting from other methods to Natural Cycles on the risk of unintended pregnancy.SettingNatural Cycles mobile application.Participants16 331 Natural Cycles users in Sweden for the prevention of pregnancy.Outcome measuresRisk of unintended pregnancy.Study designReal world evidence was collected from Natural Cycles users regarding contraceptive use prior to using Natural Cycles and sexual activity while using Natural Cycles. We calculated the typical use 1-year Pearl Index (PI) and 13-cycle failure rate of Natural Cycles for each cohort. The PI was compared with the population PI of their stated previous methods.ResultsFor women who had used condoms before, the PI of Natural Cycles was the lowest at 3.5±0.5. For women who had used the pill before, the PI of Natural Cycles was the highest at 8.1±0.6. The frequency of unprotected sex on fertile days partially explained some of the observed variation in PI between cohorts. 89% of users switched to Natural Cycles from methods with higher or similar reported PIs.ConclusionThe effectiveness of Natural Cycles is influenced by previous contraceptive choice and this should be considered when evaluating the suitability of the method for the individual. We estimate that Natural Cycles usage can reduce the overall likelihood of having an unintended pregnancy by shifting usage from less effective methods.

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analysing the relationship between family planning workers’ contact and contraceptive switching in rural bangladesh using multilevel modelling

Journal of Biosocial Science ◽

10.1017/s0021932004007096 ◽

2005 ◽

Vol 37 (5) ◽

pp. 529-554 ◽

Cited By ~ 10

Author(s):

mian b. hossain

Keyword(s):

Family Planning ◽

Unintended Pregnancy ◽

Contraceptive Use ◽

Modern Method ◽

Alternative Form ◽

Rural Bangladesh ◽

Outreach Workers ◽

Increased Risk ◽

Study Results ◽

The Impact

with a population of over 131 million and a fertility rate of 29·9 per 1000, population growth constitutes a primary threat to continued economic growth and development in bangladesh. one strategy that has been used to cease further increases in fertility in bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. this study uses a longitudinal database to assess the impact of family planning outreach workers’ contact upon contraceptive switching and upon the risk of an unintended pregnancy. using longitudinal data on contraceptive use from the operations research project (orp) of the international centre for diarrhoeal disease research (icddr,b) in bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. after controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers’ contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. this contact also reduces the risk of an unintended pregnancy. family planning workers’ contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. the study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural bangladesh.

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UNINTENDED PREGNANCY AND WOMEN’S PSYCHOLOGICAL WELL-BEING IN INDONESIA

Journal of Biosocial Science ◽

10.1017/s0021932003006321 ◽

2004 ◽

Vol 36 (5) ◽

pp. 617-626 ◽

Cited By ~ 25

Author(s):

KAREN HARDEE ◽

ELIZABETH EGGLESTON ◽

EMELITA L. WONG ◽

IRWANTO ◽

TERENCE H. HULL

Keyword(s):

Unintended Pregnancy ◽

Contraceptive Use ◽

Multinomial Logistic Regression ◽

Well Being ◽

Psychological Well Being ◽

Number Of Children ◽

Small Family Size ◽

High Level ◽

Negative Feelings ◽

The Impact

Few studies have examined the impact of unintended pregnancy on women in developing countries. This paper examines the impact of unintended pregnancy on Indonesian women’s psychological well-being. It is hypothesized that experiencing unintended pregnancy is associated with lower psychological well-being and that use of family planning and small family size are associated with higher levels of psychological well-being. Data are drawn from a 1996 survey of 796 women aged 15–49 from two Indonesian provinces, Lampung and South Sumatra. This article focuses on the 71% of women (n=562) who answered all 41 survey items related to psychological well-being. In cluster analysis, women grouped into three clusters, differentiated by their scores on four scales of well-being established through factor analysis (general negative feelings, satisfaction with relationships, satisfaction with economic/family/personal conditions, and negative feelings regarding domestic issues). Women in cluster 3 were characterized mainly by their high level of psychological well-being. Women in cluster 1 had the lowest level of well-being, and women in cluster 2 were in the middle. Multinomial logistic regression was used to assess jointly the effect of unintended pregnancy, contraceptive use, number of children and other factors on a woman’s level of psychological well-being. Unintended pregnancy was associated with lower levels of psychological well-being and contraceptive use was associated with higher levels of psychological well-being, while number of children was not associated with level of well-being. Women who had experienced an unintended pregnancy were less likely to be in the high psychosocial well-being cluster versus both the medium and low clusters. In addition, women using contraception were more likely to be classified in the high than in the low or medium well-being clusters.

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Measuring the impact of contraceptive use on unintended pregnancy and other health outcomes

10.31899/rh4.1023 ◽

2014 ◽

Author(s):

Keyword(s):

Health Outcomes ◽

Unintended Pregnancy ◽

Contraceptive Use ◽

The Impact

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More Than Shelter: Housing for Urban Maternal and Infant Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073331 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3331

Author(s):

Jason Reece

Keyword(s):

Public Health ◽

Maternal Health ◽

Health Outcomes ◽

City Planning ◽

Infant Health ◽

The United States ◽

Housing Quality ◽

Housing Discrimination ◽

Maternal Health Outcomes ◽

The Impact

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

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Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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