Family Planning Practices in Kerala: A Critical Appraisal Using National Family Health Survey Data

Background Adequate attention to family planning can not only reduce poverty and hunger in countries with high birth rates but also avert maternal and childhood deaths. Kerala, the southernmost state of India, has achieved its replacement level fertility rate far ahead of India. The study aims to analyze the contraceptive prevalence of the state over the years and also at the district level and the choices of different family planning methods in the state. Methodology This study is a secondary data analysis using the available information from the National Family Health Survey (NFHS) available from “The demographic health survey program’s data distribution system.” Results The contraceptive prevalence rate (CPR) of Kerala showed an initial increase followed by a sudden fall by more than 10% in 10 years period during the 2015 survey, thereafter stabilized in 2019. Among the modern contraceptive methods, the most commonly used method consistently over the years was female sterilization (46.6%) and the least common method was male sterilization (0.1%). The unmet needs in family planning in the state varied across the districts from as high as 19.3% to 5.6% though it was reduced by 1.2 percentage units as compared to NFHS-4 data. Conclusion The findings contradict the assumption that the use of modern spacing techniques will increase with female literacy and a higher standard of living. Female-oriented nature of family planning practices in the state should be revisited and strategies should be brought to bring equal participation of males and females. Districts with reduced CPR should be prioritized and region-specific policy recommendations are necessary to address specific needs.

Women’s post-abortion contraceptive use: Are predictors the same for immediate and future uptake of contraception? Evidence from Ghana

This study seeks to identify the socio-demographic, reproductive, partner-related, and facility-level characteristics associated with women’s immediate and subsequent use of post-abortion contraception in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were utilized in this study. The weighted data comprised 1,880 women who had ever had an abortion within the five years preceding the survey. Binary logistic regression analyses were performed to examine the associations between the predictor and outcome variables. Health provider and women’s socio-demographic characteristics were significantly associated with women’s use of post-abortion contraception. Health provider’s counselling on family planning prior to or after abortion and place of residence were associated with both immediate and subsequent post-abortion uptake of contraception. Among subsequent post-abortion contraceptive users, older women (35–49), women in a union, and women who had used contraception prior to becoming pregnant were strong predictors. Partner-related and reproductive variables did not predict immediate and subsequent use of contraception following abortion. Individual and structural/institutional level characteristics are important in increasing women’s acceptance and use of contraception post abortion. Improving and intensifying family planning counselling services at the health facility is critical in increasing contraceptive prevalence among abortion seekers.

Contraceptive Use among Gender Based Violence Survivors: The Case of Matabeleland South, Zimbabwe

Zimbabwe’s contraceptive utilisation has improved significantly, but this progress is not uniform across all its provinces. Matabeleland South in particular, is one province with the lowest contraceptive prevalence, against a background of significantly high spousal violence. This study sought to investigate modern contraceptive prevalence among GBV survivors in rural Matabeleland South. The study used cross-sectional data collected from 130 female survivors of Intimate Partner Violence (IPV) from Bulilima and Umzingwane districts in Matabeleland South. The study found the modern contraceptive prevalence to be 56%, with the most commonly reported contraceptive method being the oral pill, followed by injectables and implants, condoms, and lastly, female sterilisation. The study also found that education, age, and level of health care access had a positive association with contraceptive use, whilst age difference with a partner and marital status had a negative association with contraceptive use. Overall, the study indicates that contraceptive utilisation is still low amongst GBV survivors in Matabeleland South. Programming aimed at improving contraceptive use should therefore emphasize increasing education among young women to raise awareness on the benefits of using contraceptives, as well as involving spouses of survivors in programming to facilitate rapid adoption of contraceptives.

Using family planning service statistics to inform model-based estimates of modern contraceptive prevalence

The annual assessment of Family Planning (FP) indicators, such as the modern contraceptive prevalence rate (mCPR), is a key component of monitoring and evaluating goals of global FP programs and initiatives. To that end, the Family Planning Estimation Model (FPEM) was developed with the aim of producing survey-informed estimates and projections of mCPR and other key FP indictors over time. With large-scale surveys being carried out on average every 3–5 years, data gaps since the most recent survey often exceed one year. As a result, survey-based estimates for the current year from FPEM are often based on projections that carry a larger uncertainty than data informed estimates. In order to bridge recent data gaps we consider the use of a measure, termed Estimated Modern Use (EMU), which has been derived from routinely collected family planning service statistics. However, EMU data come with known limitations, namely measurement errors which result in biases and additional variation with respect to survey-based estimates of mCPR. Here we present a data model for the incorporation of EMU data into FPEM, which accounts for these limitations. Based on known biases, we assume that only changes in EMU can inform FPEM estimates, while also taking inherent variation into account. The addition of this EMU data model to FPEM allows us to provide a secondary data source for informing and reducing uncertainty in current estimates of mCPR. We present model validations using a survey-only model as a baseline comparison and we illustrate the impact of including the EMU data model in FPEM. Results show that the inclusion of EMU data can change point-estimates of mCPR by up to 6.7 percentage points compared to using surveys only. Observed reductions in uncertainty were modest, with the width of uncertainty intervals being reduced by up to 2.7 percentage points.

Utilization of modern contraceptive methods and its determinants among youth in Myanmar: Analysis of Myanmar Demographic and Health Survey (2015-2016)

Reproductive health service is crucial for youth to reduce maternal and child mortality. However, many young women face unintended pregnancies and pregnancy-related complications due to insufficient knowledge of contraceptive methods and low contraceptive utilization. This study aims to assess the modern contraceptive prevalence rates among youth and identify factors influencing modern contraceptive utilization among youth. We used Myanmar Demographic and Health Survey (2015–2016) data. This study included 1,423 men and 3,677 women aged 15–24 years from all states and regions of Myanmar. We used multivariable binary logistic regression analysis and reported the results using adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). Data analysis was done by STATA software (version 15.1). Ever-married youth used mainly injectable contraception, followed by oral contraceptive pills. Never-married male youth mainly used oral contraceptive pills; however, almost all never-married female youth did not use contraception. The modern contraceptive prevalence rates were 14.9% among total youth, 10% among males, 16.8% among females, 1.5% among never-married males, 44.7% among ever-married males, and 54% among ever-married female youth. The knowledge on modern contraceptive methods favored the utilization. Sexually active youth utilized more contraception than sexually inactive youth. We also found geographical variation and low utilization among rural youth. The desire for more children was also a significant predictor of contraceptive utilization among married youth. The utilization of modern contraception was low among Myanmar youth. Reproductive health program needs to be emphasized on the youth population especially in the area with low utilization to have equitable access to quality reproductive health services. Moreover, the revitalization of Youth Information Corner and youth-friendly reproductive health education programs should be implemented to increase reproductive health knowledge and prevent unsafe sex, unintended pregnancies, and abortions which might help in reducing maternal and child mortality. We warranted conducting mixed method studies to explore the barriers and challenges of contraceptive utilization and male involvement in the choice of contraception among youth.

The family planning “know–do” gap among married women of reproductive age in urban Pakistan

OBJECTIVE: To examine the prevalence and predictors of family planning (FP) know-do gaps among married women of reproductive age (MWRA) in low socio-economic urban areas of Karachi, Pakistan.DESIGN: This was a cross-sectional survey of randomly selected 7288 MWRA (16–49 years) to identify predictors of the know-do gap in FP using a logistic regression model.RESULTS: More than one third (35.5%) of MWRA had FP know-do gap, i.e., despite having a knowledge of contraceptives and desire to limit or delay childbearing, they were not using contraceptives. Women were less likely to use FP if they were getting older (25–35 years: OR 1.45, 95% CI 1.09–1.94; >35 years: OR 3.02, 95% CI 1.90–4.80), from certain ethnicities (Sindhi: OR 1.64, 95% CI 1.11–2.42; Saraiki: OR 1.66, 95% CI 1.01–2.71; other minorities: OR 2.37, 95% CI 1.63–3.44); did not receive FP counselling: OR 1.43, 95% CI 1.13–1.80; and had not made a joint decision on FP: OR 1.44, 95% CI 1.06–1.98). Conversely, women were more likely to use contraceptives if they had >10 years of schooling (OR 0.66, 95% CI 0.46–0.94), with each increasing number of a living child (OR 0.68, 95% CI 0.62–0.75) and each increasing number of contraceptive method known (OR 0.93, 95% CI 0.88–0.98).CONCLUSION: The predictors associated with the FP know-do gap among MWRA should be considered when planning future strategies to improve the contraceptive prevalence rate in Pakistan.

Hubungan Tingkat Pengetahuan Tentang Alat/Cara KB dengan Pemakaian Kontrasepsi Modern pada Wanita Kawin Usia Remaja di Pulau Jawa, Indonesia (Analisis Data SDKI 2017)

Prevalensi pemakaian metode KB modern pada wanita kawin usia remaja di Pulau Jawa tahun 2017 tergolong masih rendah, yakni 27,8%. Terbatasnya tingkat pengetahuan remaja mengenai pilihan kontrasepsi adalah salah satu hambatan pemakaian kontrasepsi pada remaja. Penelitian ini memiliki tujuan untuk mengetahui hubungan antara tingkat pengetahuan tentang alat/cara KB dengan pemakaian kontrasepsi modern pada wanita kawin usia remaja di Pulau Jawa. Penelitian ini menggunakan data sekunder dengan menganalisis hasil dari Survei Demografi dan Kesehatan Indonesia (SDKI) Tahun 2017. Sampel adalah 309 orang wanita berusia 15-19 tahun yang berdomisili di Pulau Jawa dengan status kawin. Pada hasil ditemukan sebanyak 62,4% responden memakai alat kontrasepsi modern. Berdasarkan Renstra BKKBN 2020-2024 angka ini masih dibawah target capaian modern Contraceptive Prevalence Rate (mCPR) yakni 63,41%. Selain itu diketahui hanya 56,4% wanita kawin usia remaja yang memiliki tingkat pengetahuan alat/cara KB yang baik (mengetahui setidaknya 7 alat/cara KB). Hasil analisis multivariat menunjukkan bahwa tingkat pengetahuan tentang alat/cara KB tidak mempengaruhi pemakaian kontrasepsi pada wanita kawin usia remaja di Pulau Jawa setelah dikontrol variabel paritas, pendidikan suami, pengambil keputusan KB, dan kepemilikan jaminan kesehatan. (PR = 0,75; CI 95% 0,42-1,36). Kuesioner SDKI kurang dapat menggambarkan tingkat pengetahuan mengenai alat/cara KB karena kurang tereskplorenya pertanyaan yang digunakan sehingga hasil ini kemungkinan masih dipengaruhi adanya bias informasi. Studi ini merekomendasikan untuk dilakukan perbaikan pada pengukuran variabel pengetahuan pada survei selanjutnya dengan menggunakan definisi yang lebih spesifik sehingga dapat menggambarkan tingkat pendidikan responden dengan lebih akurat.

701To estimate contraceptive prevalence rate and unmet need for family planning in rural Shimla

Background The utilization of family planning services has improved over the decade, but still the SDG’s health target to ensure universal access to sexual and reproductive health care services is yet to be achieved. Methods A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent. Results The mean age of the participants was 28.9 ± 5.9 years. The modern contraceptive prevalence rate (mCPR) was found to be 67.7% among women of reproductive age group (15-49 years). Male condom (36%), followed by female sterilisation (30%) were the most common methods preferred. Conclusions Besides male condoms and female sterilisation, other methods of contraception were adopted by meagre number of women. Though, the unmet need for family planning was lesser in this study, still, efforts are needed to plunge it, for ameliorating the contraceptive prevalence rate. Also, the availability of basket of contraceptive choices in government sector need sheer assiduity. Key messages The continuing IEC activity related to family planning methods need to be upsurged, so that the available contraceptives reach the community by and large. The government system of provision of contraceptives may be made accessible and convenient, so that the beneficiaries are inclined to utilise these services.

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.

Spatial Variation in Contraceptive Practice Across the Districts of India, 1998–2016

India is currently one of the most demographically diverse regions of the world. Fertility and mortality rates are known to show considerable variation at the level of regions, states and districts. Little is known however, about the spatial variations of the contraceptive usage—a critical variable that is relevant to fertility as well as health policy. This paper uses data from four national population-based household surveys conducted between 1998 and 2016 to explore district-level variations in the contraceptive prevalence rate. We find no clear evidence of convergence. The gap between the best and worst performing districts is more than 70 percent across the four rounds and does not diminish over time. We also find considerable evidence of spatial clustering across districts. Districts with high prevalence concentrate in Southern states and more recently, in the Northeast of the country. Our analysis suggests that female literacy and health care infrastructure are important correlates of spatial clusters. This suggests that investments in women’s human capital and health-care infrastructure play a role in expanding women’s opportunities to time their births.