Frequency of basic public health services utilization by married female migrants in China: associations of social support, discrimination and sociodemographic factors

Background Utilization of basic public health services (BPHS) allows for disease prevention and management and is an essential component for protecting health. Disparities in utilization exist between rural-to-urban migrants and their local counterparts in China. This study sought to determine the frequency of BPHS utilization and whether social support, discrimination, and sociodemographic features were risk factors for low BPHS utilization by Chinese female migrants. Methods Data were derived from a survey of female rural-to-urban migrants at nine work sites in Changsha, China. The association between social support, discrimination, sociodemographic factors and BPHS utilization was obtained using Chi-square and logistic regression analysis. Results Between December 2017 and April 2018, 307 female participants completed the survey. A total of 24.7% reported having had health education, 26.1% had breast and cervical cancer screening, 27.2% had established a health care record, and 40.9% had received basic contraceptive services. Two factors were associated with the reduced likelihood of BPHS utilization: Length of migration and health record establishment (OR = 0.53; 95% CI = 0.31, 0.92) and years of education and basic contraceptive service use (OR = 0.36; 95% CI = 0.20, 0.67). The remaining six factors were associated with an increased likelihood of BPHS utilization: Living circumstances and health record establishment (OR = 2.11; 95% CI = 1.17, 3.80), health education (OR = 2.71; 95% CI = 1.51, 4.87) and cancer screening (OR = 2.38; 95% CI = 1.30, 4.36). Utilization of social support was associated with health record establishment (OR = 1.24; 95% CI = 1.06, 1.44), basic contraceptive service use (OR = 1.21; 95% CI = 1.04, 1.42) and cancer screening (OR = 1.29; 95% CI = 1.10, 1.51). Objective social support was associated with health education utilization (OR = 1.15; 95% CI = 1.04, 1.26), while subjective social support was associated with basic contraceptive service use (OR = 1.11; 95% CI = 1.05, 1.18) and cancer screening (OR = 1.10; 95% CI = 1.02, 1.17). Family location was associated with basic contraceptive service use (OR = 1.96; 95% CI = 1.12, 3.44) and migration time in Changsha was associated with basic contraceptive service use (OR = 2.24; 95% CI = 1.18, 4.27). Conclusions Overall, there was low utilization rate for four BPHS by Chinese female migrants, and social support appears to be an important factor in this setting. Government, community, and workplace education efforts for enhancing BPHS utilization among female rural-to-urban migrants are recommended.

Choice of temporary contraception based on client’s demographic status and parity

Aim: To analyse the demographic factors and parity in women influencing choice of contraceptive methods. Methods: This is a hospital record based retrospective study at Bhaktapur hospital, a tertiary hospital in a span of 6 months from October 2020 to March 2021. Data were collected from medical record and descriptive analysis was done. Results: There were 142 women taking contraceptive service in six months.Implant was the most commonly used method of contraception (48%), followed by the IUCD (26%), Injectable (16%) and OCP (10%). Age group of 20-39 had more acceptance of contraception as compared to adolescent and women above 40. More the parity more usage of long acting reversible contraception was found. Conclusion: The most common contraceptive method used among women was implant. Client having two or more children are more to receive long acting contraception.

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>

How do users of a ‘digital-only’ contraceptive service provide biometric measurements and what does this teach us about safe and effective online care? A qualitative interview study

ObjectivesTo describe user experience of obtaining and uploading biometric measurements to a ‘digital-only’ contraceptive service prior to a prescription for the combined oral contraceptive (COC). To analyse this experience to inform the design of safe and acceptable ‘digital-only’ online contraceptive services.SettingAn online contraceptive service available free of charge to women in South East London, UK.ParticipantsTwenty participants who had ordered the combined oral contraceptive (COC) online. Our purposive sampling strategy ensured that we included participants from a wide range of ages and those who were and were not prescribed the COC.InterventionA ‘digital-only’ contraceptive service that prescribes the COCafter an online medical history and self-reported height, weight and blood pressure (BP) with pills prescribed by a GMC registered doctor, dispensed by an online pharmacy and posted to the user.DesignSemistructured interviews with a purposive sample of 20 participants who were already enrolled in a larger study of this service.AnalysisInductive, thematic analysis of the interviews assisted by NVivo qualitative analysis software.ResultsUsers valued the convenience of ‘digital-only care’ but experienced measuring BP but not height or weight as a significant barrier to service use. They actively engaged in work to understand and measure BP through a combination of recent/past measurements, borrowed machines, health service visits and online research. They negotiated tensions around maintaining a trusting relationship with the service, meeting its demands for accurate information while also obtaining the contraception that they needed.ConclusionDigital strategies to build trusting clinical relationships despite a lack of face-to-face contact are needed in ‘digital-only’ health services. This includes acknowledgement of work required, evidence of credible human support and a digital interface that communicates the health benefits of collaborating with an engaged clinical team.

Perspectives of the Health Extension Program Enhancing Contraceptive Provision in Southern Ethiopia: A Qualitative Exploration

Aim: To uncover information gap on the health extension program contribution in improving access, the study explored the lived experiences towards creating enabling environments for contraceptive service provision and use in light of the health extension program. Methods: Interpretative phenomenological design was employed for the study. Data were collected using focus group discussions, individual in-depth interviews and key informant interviews. Analysis was done using an interpretive phenomenological analysis framework including phases of data immersion, transcribing, coding, theme development and phenomenological interpretation through the hermeneutic circle. Results: The finding captures the contribution of the health extension program in accelerating/decelerating contraceptive use in the study area. Contraceptive services organization, access and extension in the era of the health extension program were presented. Since the beginning of the program, contraceptive use has alarmingly improved as witnessed by both the service users and providers. The linkage of primary health care with the community organization, a women development army and the one-to-five network are among the major contributed factors for the outcomes. Conclusion and Recommendation: The study concludes that the health extension program has given a special momentum in shaping the principles of PHC. The study revealed that women witnessed encouraging involvements in contraceptive service access and use. Hence, the study recommends that the experiences of women development armies and other networks have to be strengthened. Moreover, the existing community networks should be strengthened through proper evaluation and feedback.

Evaluating a longitudinal cohort of clinics engaging in a contraceptive access initiative in Utah: the Family Planning Elevated Contraceptive Access Program (FPE CAP) study protocol (Preprint)

BACKGROUND Access to high quality, comprehensive contraceptive care is an inherent component of reproductive human rights. Yet hindrances to specific aspects of contraceptive provision, including availability, accessibility, acceptability and quality continue to perpetuate unmet need. The state of Utah has recently passed a series of contraceptive policies intended to improve contraceptive access. Despite these positive changes to theoretical access, fiscal appropriations to support implementation of these policies have been minimal and many individuals still struggle to access contraception. The Family Planning Elevated Contraceptive Access program (FPE CAP), part of a larger statewide contraceptive initiative, specifically aims to improve contraceptive access within health clinics. OBJECTIVE This paper describes the study protocol for evaluating the success of FPE CAP. METHODS Health clinics apply for membership in the FPE CAP. Upon acceptance in the program, they receive: 1) a cash grant for clinical supplies, equipment, and personnel expenses; 2) reimbursement for contraceptive services and methods for eligible clients; 3) technical support, training, and proctoring on counseling and providing all methods of contraception; 4) method stocking of intrauterine devices and implants; 5) demand generation activities, including local media campaigns, to inform community members about the FPE CAP program and possible eligibility. FPE collects monthly service delivery reports from participating clinics for evaluation purposes. The primary outcomes of FPE CAP are: 1) level and trend changes in contraceptive service delivery among individuals earning ≤138% FPL following membership in FPE CAP compared to historical data and control clinics; and 2) level and trend changes in contraceptive service delivery among FPE CAP clients earning between 139-250% FPL (including those ineligible for Medicaid) compared to historical data and control clinics. To assess this, we will conduct comparative interrupted time series analyses assessing level and trend changes in intervention and control clinics 12-months prior to the intervention, for the 2-year duration of the intervention, and for the subsequent 12-months following the intervention. RESULTS We found that the study is adequately powered (>80% power) with our planned number of clinics and the number of months of data available in the study. To date, we have successfully completed recruitment and enrollment of 8 of the expected 9 health organizations and four of the expected 9 control clinics. Completed health organization enrollment for both intervention and control organizations is expected finish in December of 2020. CONCLUSIONS The study aims to provide insight into a new approach to contraceptive initiatives, through addressing comprehensive aspects of contraceptive care at the health system level. Ongoing state policy changes and implementation components may affect evaluation outcomes. CLINICALTRIAL ClinicalTrials.gov Protocol Record 117213 Open Science Framework: DOI 10.17605/OSF.IO/QJC9K

Contraception

Effective contraception is central to reproductive health and unintended pregnancies have a major negative impact on both maternal and child health. It is recognized that there is a global unmet need for effective contraception and often the unplanned pregnancy is terminated, sometimes by unsafe practices. There is recognition of the importance of accessible, effective fertility regulation both in the Millennium Development Goal 5b and now in Sustainable Development Goal 3. It is hoped that contraceptive provision will be expanded and made accessible to many women who previously were not able to address their fertility needs. The World Health Organization offers input and excellent clinical advice through the Medical Eligibility Criteria for contraceptive use which are regularly updated. It is recommended that these should be adapted for local use where appropriate. An understanding of the success of contraceptive methods with typical rather than perfect use is central to advising women and their partners on their contraceptive options. Attention to women with special needs such as those with medical disorders, young women, and women living with HIV must be central to any contraceptive service. Counselling should include discussing the risks and benefits of appropriate methods, the availability of emergency contraception, and the ongoing access to contraceptive counselling and reproductive health services. The aim of contraceptive service provision is to avoid unintended pregnancies and ensure that women feel empowered in the choices they make. Services providers are encouraged to provide a spectrum of contraceptive options which are accessible and acceptable to all clients.