Four out of ten married women utilized modern contraceptive method in Ethiopia: A Multilevel analysis of the 2019 Ethiopia mini demographic and health survey

Background Modern contraceptive method is a product or medical procedure that interferes with reproduction from acts of sexual intercourse. Globally in 2019, 44% of women of reproductive age were using a modern method of contraception but it was 29% in sub-Saharan Africa. Therefore, the main aim of this analysis was to assess the prevalence of modern contraceptive utilization and associated factors among married women in Ethiopia. Method The current study used the 2019 Ethiopia mini demographic and health survey dataset. Both descriptive and multilevel mixed-effect logistic regression analysis were done using STATA version 14. A p-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were used to report statistically significant factors with modern contraceptive utilization. Result The overall modern contraceptive utilization among married women in Ethiopia was 38.7% (95% CI: 37.3% to 40.0%). Among the modern contraceptive methods, injectables were the most widely utilized modern contraceptive method (22.82%) followed by implants (9.65%) and pills (2.71%). Maternal age, educational level, wealth index, number of living children, number of births in the last three years, number of under 5 children in the household, religion, and geographic region were independent predictors of modern contraceptive utilization. Conclusion In the current study only four out of ten married non-pregnant women of reproductive age utilized modern contraceptive methods. Furthermore, the study has identified both individual and community-level factors that can affect the utilization of modern contraceptive methods by married women in the country. Therefore, concerned bodies need to improve access to reproductive health services, empower women through community-based approaches, and minimize region wise discrepancy to optimize the utilization.

Community acceptability of contraception after induced versus spontaneous miscarriage.

Objective: To study the relationship between history of miscarriage (induced or spontaneous) and current use of modern contraceptive method among women in Pakistan. Study Design: Cross Sectional study. Setting: OPD of MCH, PIMS. Period: July 2019 to December 2019. Material & Methods: A total of 80 married women were enrolled, 40 women who had induced miscarriage (group A) and 40 from spontaneous miscarriage (group B). Data is obtained on predesigned questionnaire. Primary outcome was acceptance of contraception (LARC) after induced versus spontaneous miscarriage. Results: About 51% of women were in the age group of 30–35 years and out of total 80 women, 67 (83%) women had parity of three or above (27 % had parity of three). Out of 66 women who used contraception, 35 (53%) had induced miscarriage (group A) and 31 (46%) had spontaneous miscarriage (group B). Women who belonged to induced miscarriage (group A) faced menstrual irregularity, as the reason of leaving contraception, followed by chronic PID and husband opposition. While in the group B, fertility desire was main reason of discontinuation of contraception. In Group A, 20 (50%) women were willing to use LARC (long acting reversible contraception) after induced abortion to reduce the chances of unwanted pregnancy while in other group B, 15 (37.5%) women were wanted to use LARC and 18 (45%) women were not ready to use contraception due to fertility. Conclusion: High rate of induced abortion due to failed contraception and dis-continuation of contraceptives needs to be addressed by encouraging women to manage the side effects to ensure continuity of contraceptives.

Spatial heterogeneity in discontinuation of modern spacing method in districts of India

Background Despite six decades of official family planning programme, the use of modern contraceptive method remained low in India. The discontinuation of modern spacing method (DMSM) has also increased from 42.3% in 2005−06 to 43.6% during 2015–16. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%). Methods Data from NFHS-4 (2015–16) comprising of 601,509 households, 699,686 women and a sample of 119,548 episode of modern spacing method was used for the analysis. Multiple decrement life table has used to estimate 12-month discontinuation rate of modern spacing methods (DMSM). Moran’s I statistics, Bivariate LISA cluster map has used to understand the spatial correlates and clustering the DMSM. OLS model and impact analysis has used to assess the significant associated covariates with discontinuation. Result The 12-month DMSM in India is 43.5%; largely due to desire for becoming pregnant and method failure. The high discontinuation rate was observed in most of the southern (62%) and central (46%) regions of India. DMSM has significantly and spatially associated with neighbouring districts of India (Moran’s I = 0.47, p-value = 0.00). The prevalence of modern spacing method is negatively associated with discontinuation in the neighbouring districts of India. The unmet need (β = 0.84, 95% CI 0.55–1.14), desire of children (β = 0.26, 95% CI − 0.05–0.57) and female sterilization (β = 0.54, 95% CI 0.14–0.95) were three main contributing factor to DMSM. Conclusion Districts of high DMSM need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.

Bivariate Multilevel Modeling of Modern Contraceptive Use and Knowledge of HIV/AIDS Prevention of Women in Ethiopia

Background: Ethiopia is one of the most populous countries in Africa and has the highest number of new HIV infections. Therefore, the main objectives of this study were to demonstrate the joint predictors and association between modern contraceptive use and knowledge of HIV prevention in women aged 15-49 across clusters in Ethiopia.Methods: This study considered a weighted sample of 10,223 married women aged 15-49 years, extracted from the 2016 EDHS data. The bivariate multilevel logistics regression model was used in this study.Results: In Ethiopia, 64.75%, 54.58% of the women didn’t use the modern contraceptive method and didn’t know about HIV prevention, respectively. A positive relationship between the use of modern contraceptives and knowledge of HIV prevention of women across the clusters was found, which implies that modern contraceptive use has positive implications on women's knowledge of HIV prevention techniques across the clusters.Conclusions: Predictor visiting a health facility, wealth index, media exposure, religion, place of residence, and the contextual region are statistically related with the use of modern contraceptive use and knowledge of HIV prevention of women across the clusters. Those women who use the modern contraceptive method have more likelihood of knowing about HIV prevention. The study result confirmed that modern contraceptive use has a spillover effect on women's knowledge of HIV prevention across the clusters. Therefore, the integration of the two programs with taking into account their joint predictors was an advantage in terms of clinical benefit, cost, and for seeking care individuals in the communities. The integration of two programs with due consideration of community-specific was recommended.

The effect of women’s bargaining power within couples on contraceptive use in Cameroon

Background: The prevalence of contraception among married women, evaluated at 23%, is low in Cameroon. Maternal death rates, estimated at 782 deaths per 100,000 live births, are very worrying. The National Strategic Plan for Reproductive, Maternal, Newborn and Child Health (2015-2020) and the Health Sector Strategy (2016-2027) focuses on increasing modern contraceptive prevalence as a means to reduce maternal death. This paper identifies women’s bargaining power as a factor that may stimulate contraceptive use. The objective of this study is to analyze the association between women's bargaining power within couples and modern contraceptive use. Methods: The data used come from the fifth Demographic and Health Survey (DHS) conducted in 2018. Women’s bargaining power within couple is measured by a Woman Bargaining Power Composite Index (WBPCI) built through a multiple correspondence analysis. The logistic regression model was used to analyze the relationship between WBPCI and modern contraceptive use. Results: The results of the descriptive statistics show that women's bargaining power is higher among women who use contraception than for those who do not. The results of the logistic regression model show that an increase of WBPCI was significantly associated with higher chances of using a modern contraceptive method (OR = 1.352; 95% CI: 1.257, 1.454; p <0.01). The education of women is also a key determinant since educated women were at least two times more likely to use a modern contraceptive method than uneducated women. Conclusions: To reduce high maternal death rates in Cameroon, public health policies should not only focus on the health system itself, but should also focus on social policies to empower women in the household.

Role of social network in decision making for increasing uptake and continuing use of long acting reversible (LARC) methods in Pakistan

Introduction Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan. Methods In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts. Results Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women’s experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method’s use. Conclusion This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.

Role of Social Network in Decision Making for Increasing Uptake and Continuing Use of Long Acting Reversible (LARC) Methods in Pakistan

Background: Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only, from 2.1% to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan.Methods: In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a comparative content analysis approach to analyze the transcripts.Results: Four key themes, supported by sub-themes relating to a temporal model, was identified to explain women’s experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining their use.Conclusion: This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.

A Relationship Between Contraception Service Sources And Modern Contraception Methods Used By Couple Of Bearing Age In Indonesia

<p>Population growth is a big problem for a country. The number of couple of bearing age who using contraception should be increased in order to deal with this problem. Based on the results of the 2017 Indonesian Health Demographic Survey, the number of couple of bearing age using contraceptives was 57%, and the most widely used type of contraceptive method was the non-Long-Term Contraceptive Method. To increase the use of contraception, it is necessary for health facilities to play a role not only as providers of contraception, but also as providers of promotive and preventive services, so that couple of bearing age can rationally choose the contraception to be used as needed. This research aimed to discover the relationship between contraceptive service sources and the modern contraceptive method used by couple of bearing age.</p><p>This research used the secondary data from the 2018 Program Performance and Accountability Survey of Population, Family Planning, and Family Development (abbreviated<em> SKAP-KKBPK</em> in Indonesia), using the cross-sectional research design and the Chi-square bivariate analysis. The population used in this research was all couple of bearing age in Indonesia who becomes responden in SKAP-KKBPK, which were 60.599 couples, and the samples were all couple of bearing age who used modern contraception, which were 26,776 couples. The analysis results showed that there was a relationship between the contraceptive service sources and the contraceptive method used by the reproductive couples, shown by the <em>p</em>-value = 0.000. As many as 76.9% preferred to use the non-MKJP contraception. The respondents who used the non-MKJP contraception were more likely to visit the private contraception service sources (85.9%), while those who used the MKJP contraception were more likely to visit the state-owned (government) contraception service sources (52.6%).<strong></strong></p>

Child marriage and its impact on fertility and fertility-related outcomes in South Asian countries

Although South Asia (SA) is reported as a home of child marriage, the association of child marriage with fertility and fertility-related outcomes in this region is poorly explored. The most recent data of the Demographic and Health Survey of six SA countries – Afghanistan, Bangladesh, India, Maldives, Nepal and Pakistan – have been used in this article. The unit of analysis is 584,213 currently married women aged 20–49. The outcomes of interest are fertility and fertility-outcomes. Quantitatively important and reliable estimates were obtained from the statistical analyses. The results are presented by odds ratios with 95% CIs. Findings reveal that, overall, 42.1% of the respondents were married-off before age 18. The prevalence of child marriage was lowest in the Maldives and highest in Bangladesh at 20.5% and 74.4% respectively. The likelihood of early childbirth and repeated childbirth were significantly ( p < 0.001) lower and that for high fertility, unintended pregnancy, lifetime pregnancy termination and use of a modern contraceptive method was significantly higher in the child married women compared to their adult married counterparts. Reforms should aim to have more girls remain in schooling for both personal and overall societal development and also to reduce adverse reproductive outcomes caused by child marriage.