Non-use of modern contraceptives among women in humanitarian contexts: evidence from a qualitative study in Akwa Ibom State, Nigeria

The continuing conflict situation in Nigeria have created over 2 million displaced persons. In 2019, women and children accounted for about 80% of the internally displaced population in the country. Displacement increases the need for reproductive health services. This study explored the reasons for non-use of modern contraceptives among forcibly displaced Bakassi women in Akwa Ibom State, southern Nigeria. Focus group discussions were used to collect data from a convenience sample of 40 women of reproductive age (15–49 years) in two makeshift resettlement camps in the region in January and February 2020. Data were analysed using a qualitative inductive approach, with thematic organization and analysis of the transcribed responses from the focus group discussions. The findings revealed that many of the women were not using modern contraceptives at the time of the study, and the major reasons they gave for non-use were misconceptions, costs, religious beliefs, desire for more children and the inaccessibility and unavailability of contraceptive services. The use of family planning services can be a life-saving intervention in unstable, crisis environments. Programme implementation to address non-use of contraceptive services among women in crisis contexts should target social norm change, reproductive health education, empowerment programmes and health service provision.

GAMBARAN PERAN SUAMI DALAM PEMILIHAN ALAT KONTRASEPSI DI PMB BIDAN ELIS YANTI S KABUPATEN TASIKMALAYA

Praktek Mandiri Bidan sangat berperan dalam pelayanan kontrasepsi, PUS lebih banyak konsultasi KB di PMB dibandingkan ke fasilitas kesehatan lainnya. Keterlibatan suami sangat penting dalam mendukung program KB, namun kenyataannya banyak suami yang tidak mendampingi istri saat memilih kontrasepsi. Tujuan penelitian ini untuk mengetahui gambaran peran suami dalam pemilihan alat kontrasepsi. Jenis penelitian ini termasuk penelitian deskriptif dengan populasi pasangan usia subur yang sudah menjadi akseptor KB hormonal dan non hormonal di PMB bidan Elis Yanti S Kabupaten Tasikmalaya pada 3 bulan terakhir mencapai 107 orang, teknik sampling secara random yaitu 52 Responden. Hasil penelitian menunjukkan peran suami dalam pemilihan alat kontrasepsi di PMB bidan Elis Yanti S Kabupaten Tasikmalaya dapat disimpulkan bahwa dalam pemilihan alat kontrasepsi di PMB bidan Elis Yanti S Kabupaten Tasikmalaya lebih dari setengahnya suami memiliki peran yang cukup yaitu 29 orang (55,8%). Agar suami terlibat atau berperan dalam pengambilan keputusan maka salah satu caranya adalah dengan memberikan penyuluhan seperti konseling tentang pentingnya KB, macam macam KB, dampak serta efek kedepannya yang merupakan solusi yang tepat untuk meningkatkan peran serta dukungan suami terhadap pengambilan keputusan istri dalam ber-KB. Peneliti selanjutnya diharapkan menganalisis faktor yang berhubungan dengan peran suami dalam pendampingan istriThe practice of Mandiri Midwife plays a role in contraceptive services, PUS has more kb consultations in PMB than to other health facilities. Husband's involvement is very important in supporting kb program. The purpose of this study is to find out the picture of the role of husbands in the selection of contraceptives. This type of research includes descriptive research with a population of couples of childbearing age who have become hormonal and non-hormonal kb acceptors in PMB midwife Elis Yanti S Tasikmalaya district in the last 3 months reached 107 people, random sampling techniques that are 52 Respondents. The results showed the role of husbands in the selection of contraceptives in PMB midwives Elis Yanti S Tasikmalaya district can be concluded that in the selection of contraceptives in PMB midwives Elis Yanti S Tasikmalaya more than half of husbands have a sufficient role that is 29 people (55.8%). In order for the husband to be involved or play a role in decision making, one way is to provide counseling such as counseling about the importance of birth control, various kinds of birth control, the impact and effect of the future which is the right solution to increase the role and support of the husband to the wife's decision making in kb.

KONTRASEPSI VASEKTOMI PRIA: PERSPEKTIF TEOLOGI ETIKA TERAPAN

<em>The Covid-19 pandemic that began in early 2020 has had serious impacts on various aspects of life globally, nationally and locally, including family planning program services in Indonesia. BKKBN, for example, carries out various policies to increase participation in family planning programs to maintain community welfare by anticipating the baby boom during the Covid-19 pandemic. Based on the results of the survey conducted, the interest of men to participate in becoming MOP contraceptive acceptors began to increase. This is certainly a progress where the awareness of men to participate in family planning programs is increasing. The increase in participants occurred because of ‘correct’ knowledge about family planning programs. Before the Covid-19 pandemic, many men and their families did not have adequate knowledge about vasectomy as a method of contraception. Consequently, this caused limited accessibility to contraceptive services and acceptance among men. The main objective of this paper is therefore to provide complete and clear information to men regarding the benefits, impacts and perspectives of applied ethical theology on the use of the vasectomy method of contraception. Methodologically, this study uses a qualitative method by collecting several journals and books related to the formulation of the problem and looking for possible equations to answer this research problem. The expected results are therefore a wider recognition of the important role of health workers, culture, and experienced family planning cadres, as well as a provision of knowledge and direction in socializing the vasectomy method, including understanding the theologically ethical perspectives of vasectomy as a method of contraception.</em> <br /> <br /><strong>Key words:</strong> Covid-19, Ethical Theological Perspectives, Family Planning Program, Men, Vasectomy.

Would you offer contraception to a 14-year-old girl? Perspectives of health students and professionals in Dar es Salaam, Tanzania

Background Rates of unplanned adolescent pregnancy and unsafe induced abortions are very high in Sub-Saharan African countries including Tanzania. Despite their availability and accessibility, modern family planning methods are reported to be critically underutilized by adolescents. This study is part of a broader study that aims to develop a curriculum that will be used in training health professionals by investigating the sexual health training needs of health providers and students in Tanzania. Aim This study describes the perceptions of health professionals and students on the provision of contraceptives to adolescents. Methods Qualitative formative assessment type of research was conducted using 18 focus groups stratified among health professionals and students (midwives, nurses, and medical doctors). Study participants were presented with the theoretical scenario of a 14-year-old girl who sought contraceptive services at a family planning clinic. This theoretical scenario was used to determine how health professionals and students would handle the case. Thematic analysis guided the examination and determination of data results. Results Three main themes emerged from the data, including (1) knowledge about the provision of contraceptives to adolescents, (2) perception of the adolescents’ right to contraceptive use, and (3) barriers to the provision of contraceptives to adolescents. Participants stated that having a baseline knowledge of contraceptive services for adolescents and their rights to contraceptives would trigger their decision on offering the contraceptive. On the other hand, being unaware of the reproductive health rights for adolescents, judgmental behavior of providers, as well as religious and cultural dynamics were all found to be major barriers for providers to offer contraceptive services to the 14-year-old adolescent girl in the theoretical scenario. Conclusion These findings support the need for comprehensive sexual health education in Tanzanian health professional training programs.

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Background The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.

Contraceptive Access Through School-Based Health Centers: Perceptions of Rural and Suburban Young People

Purpose School-based health centers (SBHCs) have traditionally been concentrated in urban centers but have increasingly moved to rural and suburban settings. Adolescents living outside urban centers continue to experience barriers accessing contraceptives and reproductive health care. SBHCs are well positioned to reduce these barriers since they often offer convenient, in-school reproductive health care services. We describe the experiences of adolescents and emerging adults as they navigate access to contraceptives at SBHCs and nonschool locations in nonurban, low-income communities. Method We interviewed 30 sexually active individuals aged 15 to 21 living in rural and suburban communities in Colorado where high school SBHCs were recently introduced. Participants reflected on their experiences with or without in-school access to sexual and reproductive health services. Results Overall, young people supported within-school access to contraceptives, citing convenience, low cost, and greater confidentiality and privacy compared with out-of-school providers, particularly in rural areas. At the same time, findings point to the need for SBHCs to overcome adolescents’ and emerging adults’ misunderstanding of age requirements to access confidential contraceptive services and their remaining concerns around confidentiality in the school setting. Conclusions Our results indicate that SBHCs in low-income rural and suburban areas provide essential contraceptive services that young people access and value. Policy makers in nonurban communities should look to the SBHC model to reduce barriers for young people accessing reproductive health care, and health care providers should work to ensure confidentiality and to correct misinformation about their right to access contraceptive services.