ZIKV-Related Ideations and Modern Contraceptive Use: Cross-Sectional Evidence from the Dominican Republic, El Salvador, Honduras, and Guatemala

Zika virus (ZIKV) can be sexually transmitted and can lead to severe neonatal and child health issues. The current study examines whether ZIKV-related ideational factors, including awareness of ZIKV and associated birth defects, are related to modern contraceptive use among women and men with sexual partners in four Latin American and Caribbean (LAC) countries. Data used are from cross-sectional household surveys conducted in 2018 in the Dominican Republic, El Salvador, Guatemala, and Honduras with representative samples of men and women aged 18–49 (N = 1,100). The association between self-reported use of modern contraception and measures of Zika knowledge, risk perceptions and social norms, and contraceptive self-efficacy was examined via sex disaggregated multivariate logistic regression models. Both men (OR 3.70, 95% CI 1.36–10.06, P < 0.05) and women (OR 3.71, 95% CI 2.30–5.99, P < 0.0001), who reported discussing family planning with their partner in the last year were more likely to use modern contraception compared with those who did not. Contrary to our hypothesis, knowledge that ZIKV can affect a fetus was negatively associated with modern contraceptive use for women (OR 0.49, 95% CI 0.29–0.85, P < 0.05). Given the cross-sectional nature of the survey, women not using contraception may be more likely to remember that ZIKV can affect a fetus. In the event of a related outbreak, future health promotion and communication efforts in LAC should focus on known determinants of modern contraceptive use, such as knowledge and partner communication, and knowledge of the health effects of ZIKV if pregnant, to influence family planning decision-making behavior.

CONTRACEPTIVE CHOICE AMONG COUPLES OF CHILDBEARING AGE (PUS) IN BENGKULU PROVINCE

Contraceptives are very useful in achieving the family planning (keluarga berencana) program; however, not all contraceptives are suitable for everyone. The choice of contraception depends on how each person must be able to choose a contraceptive that is suitable for him or her. In general, there are two methods of contraception, namely modern and traditional. The government recommends couples of childbearing age or pasangan usia subur (PUS) to use the modern method, as it is more effective in preventing pregnancy. This study was conducted to determine factors (predisposing, enabling, and reinforcing) that influenced the use of contraceptives in Bengkulu Province. The research design was cross-sectional and used secondary data from the Performance Survey and Accountability Program/Survei Kinerja dan Akuntabilitas Program (SKAP) in 2019. The sample of this study was couples of childbearing age ranged 15-49 years old in Bengkulu. The results showed that 232 couples (59.9%) used modern contraception, while 155 people did not use modern contraception (40.1%). The results of the bivariate analysis of predisposing factors show that there is a relationship between work, education, and attitudes towards using family planning in the future, while age and knowledge are not related. It was also found that there are relationships between enabling factors such as place of residence, level of welfare, number of children, desire to have children, and informed choice. Meanwhile, there is no relationship between insurance membership and mass and room information media. It is known that there is no relationship between reinforcing factors in information sources for health workers, non-health workers, information sources for formal institutions, and information sources for non-formal institutions with the selection of contraceptive methods. The factor that most influenced the choice of family planning methods among the respondents aged 15-49 years in Bengkulu was informed choice with OR of 20.11 (95% CI = (11.24-35.98).

Embracing the Autonomy of Catholic Women – Discussing the Healthcare and Environmental Consequences of the Church’s Ban on Contraception

"The modern Catholic Church represents a body of 1.3 billion people who follow the Church’s teachings, given to them in the form of documents on different topics, including family issues. The latest, 2016 Apostolic Exhortation Amoris Laetitia, confirmed the previous documents on the topic, stating that periodical abstinence is the only contraceptive method possible for Catholic Christians. This means that 1.3 billion people are forbidden to use modern contraception. This significantly contributes to the spread of sexually transmitted infections (including AIDS/HIV pandemics) and the global epidemic of unintended pregnancies and their consequences (induced abortions, maternal and infant morbidity and mortality, etc.). These consequences are the most severe in sub-Saharan Africa and Latin America, where the Catholic Church prevails. Unintended pregnancies also greatly contribute to the rapid population growth currently being witnessed by humanity. As such, unintended pregnancies lead to severe environmental consequences (environmental degradation, resource depletion, species extinction, climate change, etc.). Unintended pregnancies are highly preventable if women are well-informed about family planning methods and if they are free to choose a contraceptive method based on their personal opinion, expectations, contraindications, and more. This merely underlies the important fact that voluntary family planning is fundamental to human dignity and critical for women’s health as well as the health of the planet. For the aforementioned reasons, it is necessary to openly discuss the healthcare and environmental implications of the Church’s ban on modern contraception, and bring the Church’s representatives to acknowledgement of women’s autonomy to freely choose their preferable contraceptive method. "

Determinants of Long Acting Contraception Among Women Using Modern Contraception in Cameroon.

Background: In Cameroon, 23% of married women, 34% of sexually active single women have unmet needs for family planning and 58% of the reproductive age patients are not interested in family planning. While a long acting contraception such as intra uterine devise is known to be safe, highly effective, and cost effective; less than 1% of reproductive age women in Cameroon use a long acting reversible contraception. These contribute to Cameroon’s mother mortality rate of 600 per 100,000 live births. In this study, we tried to identify the determinants of use or none use of long acting contraception among Cameroonian women using a modern contraception so that they can be acted upon to improve long acting contraception use in cameroon.Methods: The study uses data from 2,231 women aged 15 to 49 years old, using a modern contraception and included in the demographic health survey of Cameroon 2018/19. Bivariate, then multivariate logistic regression analysis was conducted for the study outcome of short versus long term modern contraception. Statistical significance was taken at p < 0.05.Results: Among women using a modern contraception in Cameroon, 45.4% were using a long acting contraception. The mean determinants for this were: increase age, being more than 10 people in the household, belonging to the poorer and middle economic quintiles, being insulted or made to feel bad sometimes by the husband or the partner. Conclusion: To improve the use of long acting contraception among women using a modern contraception in Cameroon, a special consideration should be given to women experiencing domestic violence without forgetting the other determinants.

Determinants of Modern Contraception use Among Reproductive Age Women in Cameroon.

Background: In Cameroon, 23% of married women, 34% of sexually active single women have unmet needs for family planning and 58% of reproductive age women are not interested in family planning. This contributes to the high mother mortality rate, which is at 600 per 100.000 live births. In this study, we tried to identify the factors contributing to the current use of modern contraception by Cameroonian women so that they can be act on to meet the unmet need for modern contraception. Methods: The study uses data from 12,411 women aged from 15 to 49 years old included in the demographic health survey of Cameroon 2018/19. Bivariate, then multivariate logistic regression analysis were conducted on the study outcome of Modern versus non-modern contraception. Statistical significance was taken at p < 0.05.Results: We found out that 18% of the women in Cameroon use a modern contraception. The main determinants for this were; not working, increasing socioeconomic class, no more wanting children, wanting to delay the next childbirth by at least 2 years, and history of domestic violence. Conclusion: The above factors should be considered in the making of a national contraception improvement plan. Meanwhile, none working women being more likely to use a modern contraception should be considered with some reserve because this is a highly unexpected finding.

Discontinuation of modern contraception methods due to side effects and method failure in India: an analysis using reproductive calendar data

Background: Contraceptive discontinuation for reasons other than the desire to get pregnant is a significant public health concern. This study aimed to understand the elaborated role of side effects and method failure behind modern reversible contraception method discontinuation among married women aged 15-49 years in India.Methods: The analysis was based on 142992 episodes of contraceptive use contributed by 90414 married women aged 15-49 years covered in the National family health survey-4 (2015-2016). Multivariate analyses, discontinuation rates using the multiple/single decrement life table and multi-level multinomial competing risk analyses were performed.Results: Discontinuation rate due to side effects within 12 months of use was highest for injectables (14.7%) and lowest for male condoms (3%) and due to method failure, it was highest for male condoms (3%) and lowest among IUD users (1.2%). Compared to women using IUD, those using pills had 2.3 times and 1.6 times the higher hazard of discontinuation due to method failure and side effects, respectively.Conclusions: The discontinuation rate of all selected methods was higher due to side effects than method failure. The high discontinuation rate of many contraceptive methods and the frequency of contraceptive failure suggest the need for strategies to promote improved contraceptive use following method selection. Improved quality of services through proper counselling of the potential contraceptive users would enhance informed choice, thus increasing modern contraception continuation among women in India.

Service delivery point and individual characteristics associated with the adoption of modern contraceptive: A multi-country longitudinal analysis

Background Women who start using contraception (“adopters”) are a key population for family planning goals, but little is known about characteristics that predict the adoption of contraception as opposed to current use. We used prospective data from women and facilities for five countries, (Democratic Republic of Congo, India, Kenya, Nigeria, and Burkina Faso) and identified baseline characteristics that predicted adoption of modern contraception in the short term. Methods We used data from the Performance Monitoring for Action (PMA) Agile Project. PMA Agile administered service delivery point (SDP) client exit interview (CEI) surveys in urban sites of these five countries. Female clients responding to the CEI were asked for phone numbers that were used for a phone follow-up survey approximately four months later. For our analysis, we used data from the SDP and CEI baseline surveys, and the phone follow up to compare women who start using contraception during this period with those who remain non-users. We used characteristics of the facility and the woman at baseline to predict her contraception adoption in the future. Results Discussing FP with a partner at baseline was associated with greater odds of adoption in DRC (OR 2.34; 95% CI 0.97–5.66), India (OR 2.27; 95% CI 1.05–4.93), and Kenya (OR 1.65; 95% CI 1.16–2.35). Women who discussed family planning with any staff member at the health facility had 1.72 greater odds (95% CI 1.13–2.67) of becoming an adopter in Nigeria. The odds of adoption were lower in Nigerian facilities that had a stockout (OR 0.66 95% CI 0.44–1.00) at baseline. Other characteristics associated with contraception adoption across settings were education, age, wealth, parity, and marital status. Conclusions Characteristics of both the woman and the health facility were associated with adoption of modern contraception in the future. Some characteristics, like discussing family planning with a spouse, education, and parity, were associated with contraceptive adoption across settings. Other characteristics that predict contraceptive use, such as health facility measures, varied across countries.

Contraceptive prevalence and factors influencing utilization among women in Pakistan: a focus on gender-based violence

PurposeIn this study, the authors determined the prevalence of contraceptive use among Pakistani women and assessed factors influencing the utilization of contraception with a particular focus on the experience of gender-based violence.Design/methodology/approachThe dataset used in this study was the Pakistan Demographic Health Survey 2018, which includes married women only. Bivariate analysis and multivariate logistic regression were used to investigate the association between contraceptive use and a number of explanatory variables including experience of gender-based violence.FindingsFrom 2006 to 2018, the contraceptive prevalence rate (CPR) and the use of modern contraceptive methods increased slowly. The findings of this study demonstrated that higher educational level and wealth index increased the likelihood of contraceptive uptake and the use of modern contraception. Media exposure to family planning and spousal communication were protective factors that encouraged women to use contraception, including modern contraception, to avoid unwanted pregnancy. Women who experienced gender-based violence (GBV) were more likely to use contraception than women who did not experience GBV.Research limitations/implicationsThe use of secondary data limited the variety of important variable that should be investigated including knowledge of women on SRH, the attitude of women toward SRH and family planning, the skills of a healthcare provider on counseling family planning, and other barrier variables such as transportation and willingness to pay for contraceptive methods. 10;The sensitivity of the topic is considered as another challenge when collecting data. Women might be hesitant to share about their GBV experience. The experience to GBV is also hard to define and depends on the feeling of each person, especially emotional violence.Originality/valueThis paper is one of the very few studies to examine the association between GBV and contraceptive use, and thus is valuable in opening up debate about the links between these two factors.

Determinants of Modern Contraceptive Utilization Among Married Women in Sub-saharan Africa: Multilevel Analysis Using Recent Demographic and Health Survey

Background: Family planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study was aimed at determining the pooled prevalence and determinants of modern contraceptive utilization in Sub-Saharan Africa. Methods: Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women were included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Four models were fitted to select the best-fitted model using Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as a best fitted model. Results: The pooled estimate of modern contraception use in sub–Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization among women living in East Africa was (AOR=1.47 (1.40, 1.54)), urban (AOR=1.18 (1.14, 1.24)), women primary and secondary and above educational level (AOR=1.49 (1.44, 1.55)), and (AOR=1.66 (1.58, 1.74)), respectively. Moreover, husband primary (AOR=1.38 (1.33, 1.42)), middle (AOR=1.17, (1.14, 1.21)), rich wealth status (AOR=1.29 (1.25, 1.34)), media exposure (AOR=1.25 (1.22, 1.29)), and postnatal care (PNC) utilization (AOR=1.25 (1.22, 1.29)) had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility (AOR=1.74 (1.69, 1.79)) and birth order 2-4 (AOR=1.36 (1.31, 1.41)) had higher odds of modern contraceptive utilization. On the otherhand, women living in Central (AOR=0.23 (0.22, 0.24)), Western regions (AOR=0.46 (0.40, 0.54)), women decided with husband (AOR=0.90 (0.87, 0.93)), and husband alone (AOR=0.73 (0.71, 0.75)) were decreased the odds of modern contraceptive utilization. Conclusion: The uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention need to be given to rural residents, illiterate women, and communities with low wealth status.

Determinants of Modern Contraceptive Utilization Among Married Women in sub-Saharan Africa; Multilevel Analysis of Recent Demographic and Health Survey

Background Family planning is a low-cost, high-impact public health and development strategy. Planned pregnancies are essential for both the child and mother’s health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa, hence this study aimed to determine the pooled prevalence and determinants of modern contraceptive utilization across Sub-Saharan Africa. Methods Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included in the study. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported for sub- Saharan Africa countries. Four models were fitted to select the best-fitted model for the data using Likelihood Ratio (LLR) and Deviance. Model III was selected because of its highest LLR and Smallest deviance. Results The pooled estimate of modern contraception use in sub–Saharan African countries were 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were increased; women living in East Africa (AOR = 1.47 (1.40, 1.54)), urban (AOR = 1.18 (1.14, 1.24)), women primary and secondary and above educational level (AOR = 1.49 (1.44, 1.55)), and (AOR = 1.66 (1.58, 1.74)) respectively, husband primary and secondary and above educational level (AOR = 1.38 (1.33, 1.42)) and (AOR = 1.38 (1.36, 1.47)), wealth status middle and rich (AOR = 1.17, (1.14, 1.21)) and (AOR = 1.29 (1.25, 1.34)) respectively, media exposure (AOR = 1.25 (1.22, 1.29)), Postnatal care(PNC) utilization (AOR = 1.25 (1.22, 1.29)), deliver at health facility (AOR = 1.74 (1.69, 1.79)), and birth order 2–4 and 5+ (AOR = 1.36 (1.31, 1.41)) and (AOR = 1.35 (1.28, 1.43)) whereas the odds of contraception use were decreased among women living in Central, and Western regions (AOR = 0.23 (0.22, 0.24)), and (AOR = 0.46 (0.40, 0.54)) respectively, women decided with husband and husband alone (AOR = 0.90 (0.87, 0.93)) and (AOR = 0.73 (0.71, 0.75)). Conclusion The uptake of modern contraception in sub-Saharan Africa is low compared to other developing region. Therefore, family planning program activities need to give attention to the rural resident, illiterate women and low wealth status community.