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Trend in the use of modern contraception in sub-Saharan Africa: Does women’s education matter?
... 3,4 With the high-level efforts of governmental and nongovernmental organizations' promotion of contraceptive use6, there was an improvement in modern contraceptive prevalence in the last three decades in many sub-Saharan African countries. 5 In Ethiopia, the prevalence of modern contraceptives increased from 14.7% in 2005 to 35% in 2016. However, with a total fertility rate of 4.6, the country has not achieved the TFR of 4 and contraceptive prevalence of 44% as targeted in population policy of the country formulated in 1993. ...
... 23 The fertility rate difference observed among women of different educational backgrounds also contributed to the fact that more educated women were also more likely to use contraceptives and delay marriage. 5,24 Of all the PD fertility, postpartum in-fecundity contributed the highest fertility inhibiting effect among the poorest women in 2016. By applying the fertility decomposing formula, it was observed that fertility decline between 2005 and 2016 was mainly contributed by the contraceptive use while the effect of the other indices relatively increased the fertility from what it was in 2005. ...
Introduction:
In Ethiopia, the fertility rate declined from 5.4 in 2005 to 4.6 by 2016. Many factors have been contributing to this decline. Understanding the factors contributing to the fertility decline and their level of fertility inhibiting effect has a paramount policy implication in any country. This study aimed to assess the contribution of the four proximate determinants of fertility, ie, contraception use, postpartum infecundity, marriage and abortion rate, to fertility decline in Ethiopia since 2005.
Methods:
This study used publicly available data from the Ethiopia Demographic and Health Surveys (EDHS) of 2005, 2011 and 2016. The EDHS data were the representative data collected from the reproductive-age women through a cross-sectional study. The revised and fine-tuned Bongaarts model of proximate fertility determinants was used for data analysis. The components needed for the analysis were extracted from the full EDHS data using the STAT compiler. Finally, the analysis was done using Microsoft Excel.
Results:
Of the four proximate determinants of fertility, postpartum insusceptibility contributed the highest fertility inhibiting effect in all three EDHS, and its level was also more prominent among the poorest women. While post partum infecundity, marriage and abortion had a relatively constant effect on fertility over the last 15 years, the fertility inhibiting effect of contraceptive use significantly increased from 15% to 37%.
Conclusion:
In conclusion, fertility variation in Ethiopia is largely due to the three intermediate determinants of fertility. Over the last one and half decades, contraceptive use was the single most important determinant responsible for fertility decline in Ethiopia. To achieve fertility at replacement level, the country needs a contraceptive prevalence rate of 69%, an increment of nearly 100% from its current contraceptive prevalence rate.
... Dovepress Dovepress 2 Prata et al beliefs, and spousal communication affect family planning use. [4][5][6][7][8][9] Though research typically generalizes contraceptive use among all women with age as a covariate, more recent studies have highlighted the need to differentiate by age when studying factors affecting contraception use, with many studies providing evidence that young women in particular need special attention in order to increase contraceptive prevalence, recognizing that improving availability, affordability, and youth-friendliness may not fully address the psychosocial barriers to contraceptive use among them. 7,[10][11][12] The objective of this paper is to explore differences in factors associated with modern contraceptive use between young and adult women of reproductive age in Luanda, Angola. ...
... The factors that were associated with current contraceptive use among all women were not unusual; education, perceived accessibility, and contraceptive knowledge were significant predictors in many studies of contraceptive use in other studies from the region. [6][7][8]23,24 Condom knowledge was the only method to have a positive impact on contraceptive use among young women. This may suggest the importance of condoms as the preferred method and/or mostly used form of contraception among young women. ...
Background
The objective of this study is to identify factors associated with current modern contraceptive use among Angolan women. By differentiating according to age groups (15–24 and 25–49 years), this study aimed to help family planning program planners better tailor interventions to improve utilization of modern contraception.
Methods
A household survey was used to collect data from 1,545 women of reproductive age living in Luanda Province, Angola. Data on sociodemographic characteristics, reproductive behavior and intentions, contraceptive knowledge and use, and attitudes and beliefs regarding contraception and abortion were collected. The analyses were stratified based on age: 15–24 years (youth) and 25–49 years (adult). Multivariate logistic regression models were built for each age group, adding different subsets of variables in groups to see how relationships changed across the models.
Results
Common factors associated with modern contraceptive use among all ages include education level, perceived contraceptive accessibility, contraceptive knowledge, communication with partner about family planning in last year, and self-efficacy. Exposure to family planning information in the media in the last few months, perceived partner approval of family planning, and marital status were all positively associated with current modern contraceptive use among women aged 15–24 years. Meanwhile, receiving information about family planning from a pharmacy in the last year was uniquely associated with current modern contraceptive use among women aged 25–49 years.
Conclusion
Young women in Luanda, Angola seem to have a unique set of factors affecting their contraceptive use. These findings highlight the need for family planning programs to cater services and messages toward specific age groups.
... An estimated 230 million births are prevented annually due to contraception [3]. The use of modern contraceptives is, therefore, a key intervention to reduce maternal deaths, ensuring women's and children's health as well as promoting economic development [5]. ...
... The speculated reasons for the high use of modern contraceptives among educated women are that education enhances women's knowledge on contraception, improves access to contraceptives, and strategically repositions them within the family. This is achieved through the building of their confidence and power to participate in decision making on reproductive health issues within the family [5]. A positive link between increased maternal knowledge and decision-making power, and increased use of modern contraceptives has been suggested by other studies from sub-Saharan Africa [26]. ...
Objective
Women’s empowerment and autonomy have been proven to promote women’s use of modern contraceptives. This study examined women’s autonomy as a potential factor for modern contraceptive use among Ghanaian women in a union.
Method
We conducted a secondary analysis of data from the 2014 Ghana Demographic and Health Survey. The main outcome measure was current modern contraceptive use from women’s self-report. Three composite indices were used to assess women’s autonomy: household decision-making, attitudes towards wife-beating, and property ownership.
Results
A total of 4772 non-pregnant women aged 15–49 years in a union were included in the analysis. The mean age was 34.2(±7.97) years, 53.6% received at least secondary education, 87.7% were employed, and 76.5% received family planning information within the last 12 months. The prevalence of modern contraceptive use was 24.8% (95% CI: 22.9–26.7). Women’s autonomy was independently associated with modern contraceptive use. Compared with women with low autonomy, women with moderate (AOR= 1.26, 95% CI: 1.02–1.55, p = 0.034) and high autonomy (AOR = 1.34, 95% CI: 1.01–1.79, p = 0.044) had increased odds of modern contraceptive use. Maternal age, education, number of living children, employment, region, and exposure to family planning information were also strongly associated with modern contraceptive use.
Conclusions
The findings from this study support the assertion that women’s autonomy may be vital in promoting the use of modern contraceptives among women in a union in Ghana and other low-income and middle-income countries and should be considered in family planning programs.
... The enumerators administered the SRH questionnaire to a total of 745 female respondents, allowing for more than one eligible respondent per household. The median (IQR) age of the respondents was 29 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). 568 (76%) were currently in a marital union i.e. either legally married or living with a man as if married while 646 (87%) reported they had ever attended school with the median (IQR) years of education being 8 (7)(8)(9)(10)(11). ...
... Further, we found that women who reported having ever attended school were more than twice as likely to be currently using a contraceptive method. Several studies have shown that educated individuals are able to make better-informed health-related decisions including the choice to lower their fertility [30]. In sub-Saharan Africa in particular, completion of primary education among girls has been strongly associated with reduced fertility as well as a host of other predictors of socioeconomic development of women [31,32]. ...
Background:
Contraceptive usage has been associated with improved maternal and child health (MCH) outcomes. Despite significant resources being allocated to programs, there has been sub-optimal uptake of contraception, especially in the developing world. It is important therefore, to granulate factors that determine uptake and utilization of contraceptive services so as to inform effective programming.
Methods:
Between March and December 2015, we conducted a cross-sectional survey among women of reproductive age (WRA) from the Digo community residing in Kwale County, Kenya. The study aimed to describe the pattern and determinants of contraceptive usage in this population. Respondents were selected using stratified, systematic sampling and completed a household sexual and reproductive health (SRH) questionnaire.
Results:
We interviewed 745 respondents from 15 villages in 2 out of 4 sub-counties of Kwale. Their median (interquartile range, IQR) age was 29 (23-37) years. 568 (76%) reported being currently in a marital union. Among these, 308 (54%) were using a contraceptive method. The total unmet need, unmet need for spacing and for limiting was 16%, 8% and 8%, respectively. Determinants of contraceptive usage were education [adjusted Odds Ratio, aOR = 2.1, 95% confidence interval, CI: 1.4-3.4, P = 0.001]; having children [aOR = 5.0, 95% CI: 1.7-15.0, P = 0.004]; having attended antenatal care (ANC) at last delivery [aOR = 4.0, 95% CI: 1.1-14.8, P = 0.04] as well as intention to stop or delay future birth [aOR = 6.7, 95% CI: 3.3-13.8, P < 0.0001].
Conclusions:
We found high levels of contraceptive usage among WRA from the Digo community residing in Kwale. To further improve uptake and utilization of contraception in this setting, programs should address demand-side factors including ensuring female educational attainment as well as promotion of ANC and skilled birth attendance.
... Modern contraception, including hormonal and nonhormonal contraceptives, can help prevent unintended pregnancies. Paralleling a global shift, a marked increase in modern contraceptive prevalence has occurred in sub-Saharan African in recent decades, with average prevalence ranging from 8% in the 1980s to 22% in 2010 [9,10]. Longacting reversible contraception (LARC), including progestin-containing subdermal implants and intrauterine devices (IUDs), are preferred by the World Health Organization (WHO) [11], and implants are the most effective LARC with increasing use in sub-Saharan Africa, including among HIV-positive women [9,10,[12][13][14]. ...
... Paralleling a global shift, a marked increase in modern contraceptive prevalence has occurred in sub-Saharan African in recent decades, with average prevalence ranging from 8% in the 1980s to 22% in 2010 [9,10]. Longacting reversible contraception (LARC), including progestin-containing subdermal implants and intrauterine devices (IUDs), are preferred by the World Health Organization (WHO) [11], and implants are the most effective LARC with increasing use in sub-Saharan Africa, including among HIV-positive women [9,10,[12][13][14]. ...
Introduction: Preventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV-positive women, choose progestin-containing subdermal implants, which are one of the most effective forms of contraception. However, drug–drug interactions between contraceptive hormones and efavirenz-based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter-related perspectives on this issue.
Discussion: First, as a case study, we discuss how limited data prompted country-level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz-based ART had three-fold higher rates of pregnancy than women using implants plus nevirapine-based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50–70% reductions in plasma progestin concentrations in women concurrently using efavirenz-based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally.
Conclusion: This controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how HIV-positive women and their partners choose contraceptives, as well as information from providers on how they present and counsel patients on contraceptive options are needed to help guide policy and service delivery. Lastly, greater collaboration between HIV and reproductive health experts at all levels are needed to develop successful strategies to ensure the best HIV and reproductive health outcomes for women living with HIV.
... Part of such research has focused mainly on reasons for non-use of contraception [11] and factors that positively influence the use of contraception, with others have focused specifically on the influence of social support and parity [12], internal migration, and knowledge of contraceptive use on the use of contraception [13]. In terms of geography, such research has focused on countries such as India [14], twenty-seven sub-Saharan African countries [15], Gambia [16], and Ethiopia [17]. Research by Adebowale et al. [11], for instance, revealed being married more than once and husband's non-approval as barriers to contraception use in Burkina Faso. ...
... Research by Adebowale et al. [11], for instance, revealed being married more than once and husband's non-approval as barriers to contraception use in Burkina Faso. Women's education [15], parity [17], age, religion, and type of marriage [18] have also been identified as predictors of modern contraceptive use among women. ...
Background
Universal access to family planning has been emphasized by the international development agenda, as evident in the Sustainable Development Goal 3.7. This notwithstanding, the use of modern contraceptives has been minimal in low- and middle-income countries, especially in Papua New Guinea. In view of this, we investigated the factors associated with the use of modern contraceptives and the associated factors among married and cohabiting women in Papua New Guinea.
Methods
The study utilised the Demographic and Health Survey data of 2345 women in sexual unions in Papua New Guinea. We employed a descriptive and binary logistic regression analyses. We presented the results as crude Odds Ratios (COR) and adjusted Odds Ratios (AOR), with 95% confidence intervals (CI) signifying level of precision. Level of statistical significance was set at p < 0.05.
Results
We found that 74.4% of the women were using modern contraceptives ranging from injectables (44.5%) to other modern methods (0.23%). Women aged 15–19 [AOR = 7.425, 95% CI = 2.853, 19.32], residents of the Highland region [AOR = 1.521, 95% CI =1.086, 2.131], self-employed women in the agricultural sector [AOR = 1.710, 95% CI = 1.218, 2.400], and women who listened to radio at least once a week [AOR = 1.409, 95% CI = 1.048, 1.895] had higher odds of modern contraceptive usage. However, women in the Islands region [AOR = 0.291, 95% CI = 0.224, 0.377], women whose husbands had higher education [AOR = 0.531,95%CI = 0.318,0.886], women in professional/technical/managerial work [AOR = 0.643, 95% CI = 0.420, 0.986], and those with no child [AOR = 0.213, CI = 0.0498,0.911] had lower odds of modern contraceptive use.
Conclusion
Out of the 2345 participants, we found that majority of them were using modern contraceptives and the commonly used modern contraceptive was injectables. Age, region of residence, partner's education, employment, partner's desire for children, and frequency of listening to radio are associated with modern contraceptive usage. Tailored reproductive healthcare should be developed for women who are disadvantaged when it comes to the usage of modern contraceptives in order to boost modern contraceptive use among them. Further investigation is needed to unravel the motivation for the high usage of injectables among married and cohabiting women in Papua New Guinea.
... Frequently the choice of contraceptive depends more on the woman and a number of factors could influence the choice of family planning method. [6] In this paper we report our findings, part of a larger study, on the patterns and determinants of choice of contraceptive by mothers at antenatal clinics in Enugu a major town in Nigeria. ...
... [12][13][14][15] More efforts need to be made to achieve a sustained optimal utilization of the services including continuing education of women at antenatal clinic visits and in other fora. [6,12] There should be emphasis on assisting women to be able to make informed choices concerning safety and real world effectiveness of the available methods of family planning. [1,10,16,17] ...
... Mass media exposure influences FP attitudes and behavior by either providing new information or alternative forms of behavior, or by altering ideation pathways that shape consumer's aspiration and self-identity [21][22][23][24]. It is beyond the scope of this paper to evaluate the mechanisms underlying the associations between mass media exposure and FP but these findings provide additional support for the impact of ongoing FP promotion efforts on men's uptake of FP [36]. ...
Men are underrepresented in family planning (FP) research, and despite the widespread promotion of FP through mass media, there is no systematic evaluation on how mass media exposure influences their FP knowledge, attitudes and behavior. Using Demographic and Health Survey (DHS) data from 31 countries in Sub-Saharan Africa (SSA), collected between 2010 and 2019, this paper examines the associations between three types of traditional mass media (radio, television and print) with FP knowledge, attitudes and method choices among reproductive age men in SSA, relative to other socio-cultural factors. Estimates to quantify the relative contribution of each type of mass media, relative to other evidence-based socio-cultural influences on FP outcomes, were derived using the Shorrocks-Shapley decomposition. Radio exposure had the largest impact on FP knowledge, attitudes and method choice, accounting for 26.1% of the variance in FP knowledge, followed by Television (21.4%) and education attainment (20.7%). Mass media exposure had relatively minimal impact on FP method choice, and between the three types of mass media, television (8%) had the largest influence on FP method choice. Print media had comparatively lesser impact on FP knowledge (8%), attitudes (6.2%) and method choice (3.2%). Findings suggest that mass media exposure has positive influences on FP knowledge, attitudes and method choice but its influence on FP knowledge, attitudes and method choice is smaller relative to other socio-cultural factors such as education, household wealth and marital status. As such, efforts to increase FP uptake in Sub-Saharan Africa should take into consideration the impact of these socio-cultural economic factors.
... A few studies among 1 3 this population demonstrated low levels of contraceptive use resulting in unintended pregnancy and abortion [11,12]. Studies have mostly focused on the influence of community factors and female education in contraceptive use [13,14], and most have been conducted among women who fully participated in prevention trials [8,[15][16][17]. Other studies related to contraception among women at high risk have investigated the association of family planning methods with HIV incidence [18][19][20], and have not necessarily focused on broader participant characteristics, other than sex-worker status, that influence contraceptive use and the incidence of pregnancy. ...
Contraceptive preferences of women at risk for HIV acquisition are not well documented. We report on contraceptive choices among women residing in small townships in southwestern Uganda. This was part of preparatory efforts for recruitment into the Ring Study, a phase 3 microbicide trial, between July 2013 and October 2014. Clinicians provided contraceptives per a woman’s choice. HIV testing and screening for other sexually transmitted infections were done at first contact and at screening for the trial. Contraceptive choice was summarized by demographics and regression analysis to show factors associated with use of the injectable method. Of 6725 women contacted, 489 were prescreened. Of these 489 women, most (306, 63%) were already using contraception. Injectables were most preferred (58.7%), followed by implants (23.9%). Women living with a regular sexual partner preferred the injectable method (61.0%, P = 0.06), compared with other methods. Women at risk for HIV infection are willing to initiate use of modern contraceptives, which may reduce study dropout during intervention trials due to unintended pregnancy. Registration no: NCT01539226.
... A number of the study results are similar to published results from other countries; however this study provides unique information for the Sierra Leone context. Determinants which remain in the final models both for boys and girls: literacy and distance to school and health facilities are well described in four recent systematic reviews of contraception use determinants in LMICs in general [13] or specifically in sub-Saharan Africa [14][15][16]. Distance presumably functions in two manners: directly as the time it takes in terms of reduced access, and probably also as an indicator of populations difficult to reach out to, with less opening to the modern world. Literacy remained in the present model; whereas age and education, which are ubiquitous in studies of determinants of contraception use, and which were present in the bivariate analysis, did not remain in the multivariate. ...
Background:
Sexual initiation occurs early in Sierra Leone. This study aims to analyze the determinants of condom and/or contraceptive use among a representative sample of young persons (10 to 24 years) in Sierra Leone.
Methods:
This is a secondary analysis of data from a study conducted to monitor the implementation of a UNFPA package of interventions directed to improve SRH in young people of Sierra Leone. This assessment was conducted in 2016 at the end of the Ebola outbreak. In consequence, determinants linked to healthy lifestyle behaviors and UNFPA interventions were explored in addition to the usual determinants: socio demographic and sexual lifestyle. This study is a household quantitative survey with open ended questions used to illustrate and complete the analysis.
Results:
A total of 1409 young people were interviewed: of these, 216 boys and 381 girls were sexually active. Those who were pregnant or wished for pregnancy were excluded, leaving 194 boys and 268 girls for the analysis of determinants. The proportion of young people using neither condom nor other contraception at their last sexual intercourse in the whole sample was 40.5% and there was no statistically significant difference between boys and girls (42.3 vs 39.2; P = 0.504). Determinants were assessed and, after multivariable analysis, results differed between boys and girls and showed the importance of behavioral aspects. Four determinants were common to boys and girls: literacy, distance, negotiation capacity and hand washing. However, the distance factor for girls was to the health facility and for boys it was to school. Three more determinants remained in the boy's model: sleeping under a bednet, number of sexual partners and knowledge of contraceptive methods. Opinions about condoms and contraception revealed important barriers; opposition to contraceptive use was the main reason for non-use for both boys and girls, while lack of access was an important reason for boys.
Conclusion:
There is a need to reach out to the 40% of young people who are sexually active and neither pregnant nor with pregnancy desire, and are not using condom or contraception.
... The well-described infanticide motive categories are (1) an unwanted child, (2) perceived altruistic or mercy killing, (3) stimulus rising outside of the victim, (4) stimulus rising from the victim, and (5) aggression attributable to mental illness (Pitt and Bale, 1995). Each of the five described categories of infanticide motives were present in the retrieved reports First, many women worldwide do not have access to family planning services and/or have limited sexual rights (Glasier et al., 2006;Emina et al., 2014). Thus, children are often born to women that are not ready or equipped to care for them (Wado et al., 2014). ...
Objective
We aimed to describe the scope of cleft-related infanticide and identify issues that might inform prevention strategies.
Design
Systematic reviews of both academic (eg, PubMed, EBSCOhost) and lay literature (eg, LexisNexis Academic, Google) databases were performed to identify all primary reports of cleft-related infanticide. All languages were included. Records before 1985 were excluded. Reference lists of all included reports were screened for potentially relevant records.
Main Outcome Measures
Country of origin and excerpts that pertained to the concepts surrounding cleft-related infanticide were extracted. Extracted excerpts were examined using a content analysis framework.
Results
Of the 1,151 records retrieved, 70 reports documented cleft-related infanticide from 27 countries. The largest number of reports was from China (14 reports; 48% of reports), followed by India (4; 14%) and Nigeria (4; 14%). However, 2 countries had 3 reports, 5 countries had 2 reports, and 17 countries had 1 report. Themes that emerged from excerpt analysis included stigma, lack of affordable cleft care, abandonment, orphanage overcrowding, and abuse and slavery.
Conclusions
Cleft-related infanticide is a global problem. Initiatives to sensitize communities to cleft lip and/or cleft palate, provide timely and affordable cleft care, and build support systems for affected families may prove beneficial. Cleft care organizations have the opportunity to advocate for these initiatives, reduce the incidence of infanticide by providing or supporting timely and affordable cleft care, and demonstrate that children with successful cleft repairs reassimilate well into their communities.
... Scholars who focus on the importance of education in enhancing women's autonomy in general have done so in other contexts and have underlined the positive impact on the woman and her children (Allotey et al., 2011;Emina, Chirwa, & Kandala, 2014;Harrison, 1997;Oye-Adeniran, Adewole, Iwere, & Mahmoud, 2004;Saleem & Bobak, 2005). Other researchers have focused on only a specific aspect of reproductive autonomy such as pregnancy, use of contraception, marriage, household decision-making, or sexual coercion. ...
In this article, we examine the influence of education on the exercise of married women's reproductive autonomy. We carried out 34 in-depth interviews (IDIs) with purposively sampled married Ikwerre women in Rivers State, Nigeria. The participants were between the ages of 22 and 60, had different educational backgrounds, and were in monogamous and polygynous marriages. Data were analyzed using MAXQDA 11 software. We found that although formal education enhanced women's ability to exercise reproductive autonomy, the culture of demanding absolute respect for men remains a major barrier. Formal education provides women with the knowledge that they need in order to access adequate health services for themselves and their children. Participants also believed that educating men was critical for the exercise of women's reproductive autonomy. The cultural aspects that promote female subordination and patriarchy should be addressed more openly in Nigeria.
... 36 The relationship between attending school and contraceptive use was mediated by other predictors such as approval of family planning, knowledge of contraceptive methods and visiting a health clinic. 37,43,44 So access to care and ability to access care appear important in addition to education. ...
Context:
The persistent low contraceptive use and high fertility in Nigeria despite improvements in educational achievements calls for an examination of the role of factors, which may moderate the use of modern contraception. This article explores the influence of sexual autonomy on the use of modern contraceptive methods among women and its relative importance compared with other, more traditional, indicators of women's autonomy such as education and occupation.
Data and methods:
Data from two Demographic and Health Surveys (DHS), 2008 and 2013, were used in this study. An index of sexual autonomy was constructed by combining related DHS variables, and its association with current use of modern contraception was examined at each time point as well as over time using multivariate regression analysis.
Results:
The observed prevalence for use of modern contraception was 2.8 and 2.6 times higher among women who had high sexual autonomy in 2008 and 2013, respectively. The corresponding figures for women with secondary or higher education were 8.2 and 11.8 times higher, respectively, compared with women with no education. But after controlling for wealth index, religion, place of residence, autonomy and experience of intimate partner violence (IPV), the likelihood of use of modern contraception was lowered to about 2.5 (from 8.2) and 2.8 (from 11.8) times during 2008 and 2013, respectively, among women with secondary or higher education. The likelihood of use of modern contraception lowered only to 1.6 (from 2.8) and 1.8 (from 2.6) times among women with high sexual autonomy after controlling for other covariates, respectively, during the same period.
Conclusion:
Sexual autonomy seems to play an important role in women's use of modern contraceptive methods independent of education and a number of other factors related to women's status. Sexual autonomy needs to be simultaneously promoted alongside increasing educational opportunities to enhance women's ability to use modern contraception.
... The ongoing increase in the contraceptive use is due to changes in behavior consistent with the ongoing family planning promotion over the past 30 years. By contrast, an increase in the proportion of women with secondary education does not explain the change in modern contraceptive prevalence in most SSA countries [11]. Ethiopia is one of the Sub-Saharan African countries with highest MMR which is 676 maternal deaths per 100,000 live births. ...
Abstract
Introduction: world health organization report indicated that, in 2013 alone, over 289,000 maternal death that resulted from pregnancy and delivery related complication were reported worldwide indicating a decline of 45% from 1990. The sub-Saharan Africa region alone accounted for 62% of maternal death followed by southern Asian country (24%). Provision of family planning is one of the effective intervention that prevent unwanted and ill spaced pregnancy there by reducing maternal mortality and morbidity. Given that its effectiveness and, associated fewer visits to health facilities, LARC are very important in tackling maternal mortality and morbidity. However, little is known regarding its prevalence in eastern Ethiopia. Thus, this study aimed to assess utilization of long acting reversible contraceptives and associated factors among women of reproductive age groups.
Methods: a facility based cross-sectional study conducted in Harar city among 402 study participants. The study participants selected by using systematic random sampling method. The quantitative data collected using structured interviewer administered questionnaires. All variables with p-value of ≤ 0.25 in bivariate logistic regression were taken into multivariable model. Variables having p value ≤ 0.05 in the multivariate analysis were taken as significant predictors. Crude and adjusted odds ratios with their 95% confidence intervals were calculated.
Results: the study identified that the utilization of long acting reversible contraceptive among mother of reproductive age was 38%. Study participants whose occupation was daily laborer were less likely to utilize long acting reversible contraceptive compared to those whose occupation was house wife (adjusted OR = 0.3; 95% CI 0.01 to 0.8). Moreover, those mothers who were unable to read and write utilize long acting reversible contraceptive 5 times more likely compared to those who were above grade 12 (adjusted OR = 4.9; 95% CI 1.2 to 19.6).
Conclusion: the prevalence of long acting reversible contraceptive was found to be low. Maternal education and occupation were factors found to have a significant association with utilization of long acting reversible contraceptive. Community and facility level awareness creation should be reinforced to improve utilization of long acting reversible contraceptives.
... They found an association between education and increased contraceptive use, yet the impact of woman's education varies according to context, region, culture, and level of development (Larsson & Stanfors, 2014). Emina, Chirwa, and Kandala (2014) reported results consistent with findings in Larsson and Stanfors (2014) Several studies confirm that educated women are more likely to use contraceptives than uneducated women in Bangladesh, India, Nigeria, Ethiopia (Haq et al., 2017;Islam, 2017;Johnson, 2017;Tekelab et al., 2015) respectively. This relationship is because educated women have a greater opportunity for better access to family planning services and information (Haq et al., 2017). ...
Social ecological model Predictors Family planning Ethiopia
A B S T R A C T
Unintended pregnancy is a global public health threat that affects the lives of women, families, communities, and society. In 2008, the rate of unintended pregnancy in Ethiopia was 101 per 1,000 women aged 14 to 44 years. Although Ethiopia has experienced a steady increase in modern contraceptive use since 2000, this increase did not result in a proportional decline in unintended pregnancy, total fertility rates, and rapid population growth. In this cross-sectional study, associations between individual, interpersonal, community, and societal factors and contraceptive use were tested using a sample of 3,863 women aged 15 to 49 years who participated in the 2016 Ethiopian Demographic and Health Surveys. Statistically significant predictors of contraceptive use were included in the logistic regression model. Findings showed that age, education, marital status, type of residence, and wealth index reliably predicted contraceptive use. Increase in age, highest level of education, and wealth index were associated with 13%, 15%, and 65% increase in the odds of contraceptive use, respectively. Being married was associated with 85% decrease in the odds of contraceptive use and being from an urban residence was associated with 56% increase in the odds of contraceptive use. Results of the study can be used to develop targeted family planning interventions to increase contraceptive use and reduce unintended pregnancy, child and maternal mortality, total fertility rates, and rapid population growth in Ethiopia.
... The increase in the proportion of women with at least secondary education from 34 percent to 46 percent explained much of the change in modern contraceptive use between 2000 and 2012. This finding corroborated previous studies that have found women's education to be a key determinant of modern contraceptive use 43 . This result suggested that, even in slum settlements, education may have a powerful effect in bringing about social change. ...
As urbanization continues unabated in Kenya, the wellbeing of the urban poor - whose majority live in slum settlements - will increasingly drive national development indicators including Vision 2030, SDGs and FP2020 goals. It is therefore central to understand and identify ways to address the poor reproductive health outcomes among poor urban slum populations in the country. Taking advantage of APHRC's NCSS surveys conducted in 2000 and 2012 among a representative sample of slum households across Nairobi, we show that there has been a considerable increase in use of modern contraception among women in Nairobi slums, from 34% in 2000 to 53% in 2012, and a reduction in inequity in access through much higher increases among previously disadvantaged groups. Using decomposition analysis techniques, we show that much of the observed increase is due to behavioral changes in the effect of fertility preferences on contraceptive use; and to compositional changes in woman's education, child survival and exposure to FP information. This may be the result of efforts by the government of Kenya and its development partners to reduce the disparities in uptake and use of FP services through various programs and policies targeting the poor segments of the Kenyan population.
... An estimated 13 million HIV-positive women of reproductive age live in sub-Saharan Africa 1 where a marked increase in modern contraceptive prevalence has occurred in recent decades, with average prevalence ranging from 8% in the 1980s to 22% in 2010. 2,3 Effective contraception, including hormonal contraception, prevents unintended pregnancies and reduces maternal morbidity and mortality. 4 Family planning is also one of the pillars of preventing perinatal HIV transmission. ...
Background:
To explore the association between concomitant hormonal contraceptive and antiretroviral therapy (ART) use and (1) plasma viral suppression and (2) genital HIV shedding among HIV-positive women initiating ART.
Methods:
We analyzed plasma viral load and genital viral RNA shedding from 1079 HIV-positive women initiating ART who were followed prospectively in 3 sub-Saharan African HIV prevention studies. Plasma and endocervical swab samples were collected every 6 months. Self-reported contraceptive use was categorized into injectable, implant, oral, or nonhormonal/no contraception. We used multivariate Cox regression to assess time to plasma viral suppression and logistic regression with generalized estimating equations to assess genital viral shedding for each contraceptive method.
Results:
At the time of ART initiation, there were 211 (20%) injectable, 69 (6%) implant, 50 (5%) oral, and 749 (69%) nonhormonal or no method users. Plasma viral suppression was high (90% by 6 months) and hormonal contraceptives did not diminish time to plasma viral suppression as compared to nonhormonal/no methods [adjusted hazard ratios: injectables 0.89 (95% confidence interval: 0.75 to 1.07), implants 0.91 (0.68 to 1.23), and oral methods 1.33 (1.06 to 1.66)]. Genital viral shedding was uncommon any time after ART initiation (only 9% of samples had detectable viral shedding) and hormonal contraceptives were not associated with an increased detection of genital viral shedding [adjusted odds ratios: injectables 1.07 (0.69 to 1.65), implants 0.67 (0.31 to 1.49), and oral methods 0.56 (0.19 to 1.69)].
Conclusions:
The hormonal contraceptives assessed were not associated with reduced ART effectiveness among HIV-positive women initiating ART. HIV-positive women should continue to be offered contraceptive options, including hormonal ones that best meet their needs.
... In Nigeria and Uganda women most frequently gained access to contraceptives via the pharmacy (33%) and a private hospital or clinic (35%), respectively (results not shown). Because contraception use is often closely tied to a woman's financial resources and education-with wealthier and more educated women displaying higher rates of contraception use-providing contraception free of charge or at a low-cost is more likely to promote use among those with the greatest unmet need [30,31]. ...
Despite improved availability of simple, relatively inexpensive, and highly effective antiretroviral treatment for HIV/AIDS, the disease remains a major public health challenge for women in sub-Saharan Africa (SSA). Given the numerous barriers in access to care for women in this region, every health issue that brings them into contact with the health system should be optimized as an opportunity to integrate HIV/AIDS prevention. Because most non-condom forms of modern contraception require a clinical appointment for use, contraception appointments could provide a confidential opportunity for access to HIV counseling, testing, and referral to care. This study sought to investigate the relationship between contraceptive methods and HIV testing among women in SSA. Data from the Demographic and Health Survey from four African countries-Congo, Mozambique, Nigeria, and Uganda-was used to examine whether modern (e.g., pills, condom) or traditional (e.g., periodic abstinence, withdrawal) forms of contraception were associated with uptake of HIV testing. Data for the current analyses were restricted to 35,748 women with complete information on the variables of interest. Chi-square tests and logistic regression models were used to assess the relationship between uptake of HIV testing and respondents' baseline characteristics and contraceptive methods. In the total sample and in Mozambique, women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception. This positive association was not demonstrated in Congo, Nigeria, or Uganda. That many women who access modern contraception are not tested for HIV in high HIV burden areas highlights a missed opportunity to deliver an important intervention to promote maternal and child health. Given the increasing popularity of hormonal contraception methods in low-income countries, there is an urgent need to integrate HIV counseling, testing, and treatment into family planning programs. Women on hormonal contraceptives should be encouraged to continue to use condoms for HIV-prevention. ©2016 Center et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
... According to the World Bank, the average CPR in sub-Saharan Africa is 21% (World Bank 2010). Countries in East Africa have observed a greater increase in modern contraceptive use than countries in West and Central Africa (Emina, Chirwa, and Kandala 2014). For example, modern contraceptive use increased in Malawi from 26% in 2004 to 42% in 2012 (Chintsanya 2013) and in Rwanda from 10% in 2005to 45% in 2010, but in Ghana only from 13% in 1998to 17% in 2008(ICF International 2012. ...
Accessing family planning can reduce a significant proportion of maternal, infant, and
childhood deaths. In Ethiopia, use of modern contraceptive methods is low but is increasing.
This study aimed to analyze the levels, trends, and determinants of modern contraceptive use and
changes over time among young married women in Ethiopia.
The study used data from the three Demographic Health Surveys (DHS) conducted in
Ethiopia, in 2000, 2005, and 2011. Non-pregnant, young married women age 15-24 were
included in the final samples, for sample sizes of 2,157 in 2000, 1,904 in 2005, and 2,146 in
2011. The major statistical techniques used were logistic regression for analysis of determinants
of current contraceptive use and logit-based decomposition analysis of factors contributing to the
recent changes. STATA 12 was employed for data management and analyses. All calculations
presented in this paper were weighted for the sampling probabilities and non-response. Complex
sampling procedures were also considered during testing of statistical significance.
Among young married women, modern contraceptive prevalence increased from 6% in
2000 to 16% in 2005 and to 36% in 2011. The study found that young women’s wealth status,
age, religion, education, family size concordance with husbands, and fertility preference for
spacing or limiting births were significantly associated with their use of modern contraception.
The decomposition analysis indicated that about a third of the overall change in modern
contraceptive use was due to difference in women’s characteristics. For this component, changes
in women’s age, educational status, religion, family size concordance, and fertility preference
were significantly associated with change in modern contraceptive use. Particularly, an increase
in women’s attainment of primary and above education accounted for about a tenth of the change
in modern contraceptive use over the study period.
About two-thirds of the increase in contraceptive use was due to difference in
coefficients. Change in contraceptive use behavior among the rural population and among
Orthodox Christians and Protestants showed a significant contribution to the increase. Other
things being constant, about a third of the increase in modern contraceptive use in the past
decade was due to change in contraceptive use behavior among the rural population.
Programmatic interventions targeting poor, younger (adolescent), illiterate, and Muslim
women would help to maintain the increasing trend in contraceptive use among young women in
Ethiopia.
... The World Health Organization (2013) has reported that the highest contraceptive prevalence is in Asia and Latin America, whereas sub-Saharan African countries have the lowest contraceptive prevalence. Countries in East Africa have observed a greater increase in modern contraceptive use than countries in West and Central Africa (Emina et al, 2014). The average contraceptive prevalence rate (CPR) in sub-Saharan Africa in 2009 was 21 percent, far lower than in South Asia (51 percent), Latin America and Caribbean (75 percent), and East Asia (77 percent) (World Bank 2011). ...
The 2014 Contraceptive Prevalence Survey (2014 CPS) is the fourth survey of its kind to be carried out in the Republic of Mauritius following 1985, 1991 and 2002 CPSs. This survey is an important evaluation tool for identifying the strengths and weaknesses of the family planning programme.
The primary purpose of the 2014 survey was to provide detailed information on fertility, family planning, contraceptive source, breastfeeding, HIV/AIDS-related knowledge and attitude, and infertility. The 2014 CPS also included modules on reproductive health perception and behaviour.
... 20 Most recently, the global gag rule has been not only reinstated but expanded in 2017 to now include all global health organizations receiving USAID funding, compared with only family planning organizations in the past. While the success of HIV care and access to contraception in Ghana has been steadily improving, [21][22][23] it is currently unclear how policy changes will impact this success. ...
Background or objectives:
HIV-positive women have higher rates of unmet need for contraception and unintended pregnancy and face unique obstacles in accessing family planning services, such as healthcare-related stigma and disclosing HIV status to partners. This study characterizes factors that influence the reproductive decision-making of women living with HIV and identifies areas for improvement in reproductive counseling in Kumasi.
Methods:
In this cross-sectional study, HIV-positive women, ages 18 to 45 years, presenting for care at Komfo Anokye Teaching Hospital between June and August 2017 were interviewed using structured surveys. Information gathered included demographics, method of contraceptive use, initiation of anti-retroviral therapy (ART), knowledge and use of contraception, and future reproductive plans. The primary outcome was current family planning use and future reproductive desire. Univariate analysis was used to characterize the demographics of the study group. Bivariate analysis including Chi-squared test was employed to assess the association between use of family planning between women with an HIV-positive and HIV-negative partner, with significance set at p < 0.05.
Results:
A total of 88 women were interviewed. The unmet need for contraception was 10%. Among all sexually active women, 26% did not use contraception. Fewer women with HIV-negative or untested partners were using contraception (65% and 67%, respectively), compared to women with HIV-positive partners (93%). Partner preference was the most common reason cited for not using a method of contraceptive (46%). Similar trends were found in future reproductive desires based on age cohorts, partner status, and use of family planning.
Conclusion and global health implications:
Significant barriers to family planning use among HIV-positive women remain, especially those with a serodiscordant partner. Most partners were aware of their partner's HIV status. This highlights an important opportunity to include partners in HIV and contraceptive counseling.
... The modern contraceptive prevalence and met need has increased in SAA due to changes in behaviour consistent with ongoing family planning promotions and programmes [9]. However, none use of modern contraception remains predominant in many SAA countries despite it being more effective than traditional methods in preventing unwanted pregnancies. ...
Background:
Zambia, with its women having five children on average, is one of the countries in sub-Saharan African with the highest fertility rates. As the country works on expanding its reproductive health programs, this analysis sought to understand factors behind the current utilisation of injectable, long acting and permanent methods (iLAPMs) of contraception.
Methods:
Cross-sectional secondary data drawn from the Zambia Demographic and Health Surveys (ZDHS) were used. This included married women aged 15-49 for the years 1992 (n = 620), 1996 (n = 1176), 2001/02 (n = 1483), 2007 (n = 1665) and 2013/14 (n = 4394). Frequencies, cross-tabulations and logistic regression were used to analyse levels and differentials in use of iLAPMs.
Results:
Except for the variables "religion" and "region", the rest of the independent variables show significance on the use of iLAPMs, at varying levels. "Desire for children" is the strongest predictor of use of iLAPMs as it was significant at all the five data points. This is followed by "age", although it was not significant in 2007. "Education of the woman and partner" and "number of living children" were also significant, but only for two out of the five data collection points. "Ethnicity", "type of residence", "heard about FP in last 12 months", and "main decision maker on woman's health" were only significant for one out of the five data points.
Conclusion:
This study has established that women's desire for children is the main factor influencing use of iLAPMs in Zambia. Women who still want to have children are less likely to use iLAPMs even though the odds of using these methods among these women increased between 1992 and 2014. This indicates that most of this increase is due to the desire by these women to space births rather than stop having children. The 2013/2014 data also suggest an increase in access to iLAPMs among the less privileged women i.e. those in rural areas and those with low levels of education. This trend appears to have stemmed from the scaling up of family planning programmes to cover rural communities. Greater effort should be invested into family planning programs that reach all categories of women.
... With the high efforts of governmental and non-governmental organizations', there was an improvement in modern contraceptive prevalence in the last three decades in many sub-Saharan African countries [3]. In Ethiopia, the prevalence of contraceptives was increased from 6.3% in 2005 to 35.9% in 2016. ...
Objectives: Understanding factors contributing to the recent fertility decline and their level of fertility inhibiting effect has a paramount policy implication in a given country . So, in this paper, the 2015 revised Bongaarts model of proximate determinants of fertility was applied, and the contribution and trends of each of the determinants over one and half of the decade (from 2005 to 2016) was evaluated. This study utilized the publicly available data from the Ethiopian demographic and health survey of 2005, 2011 and 2016. The revised and fine-tuned Bongaart's model of proximate fertility determinants was used throughout for data analysis. Results: Postpartum insusceptibility contributed the highest fertility inhibiting effect in all the three EDHS and its level is more prominent among the poorest women. Contraceptive use was the second leading fertility inhibiter and its effect was significantly increased from 15% (inhibition effect by 2005) to 37% (fertility inhibiting effect by 2016). This is an increment in fertility reduction effect nearly 26%. In conclusion, over the last one and half-decade, contraceptive use was the single most important determinant responsible for fertility decline in Ethiopia. To achieve the fertility of replacement level, the country needs a contraceptive prevalence rate of 69%.
... For the vast majority of women living with HIV (WLHIV), preventing unintended pregnancies is not only paramount for the woman's health but also important for the prevention of mother-to-child transmission of HIV. Great strides have been made in improving universal access to antiretroviral therapy (ART) and the provision of effective contraception in resource-limited settings [2,3]. For example, the use of subdermal contraceptive implants, which are the most effective contraceptive method with failure rates < 1%, has risen from a prevalence of 1.7% in 2003 to 18.1% in 2016 among married women in Kenya [4]. ...
Background
Preventing unintended pregnancies is paramount for women living with HIV (WLHIV). Previous studies have suggested that efavirenz-containing antiretroviral therapy (ART) reduces contraceptive effectiveness of implants, but there are uncertainties regarding the quality of the electronic medical record (EMR) data used in these prior studies.
Methods
We conducted a retrospective, cohort study of EMR data from 2011 to 2015 among WLHIV of reproductive age accessing HIV care in public facilities in western Kenya. We validated a large subsample of records with manual chart review and telephone interviews. We estimated adjusted incidence rate ratios (aIRRs) with Poisson regression accounting for the validation sampling using inverse probability weighting and generalized raking.
Results
A total of 85,324 women contributed a total of 170,845 women-years (w-y) of observation time; a subset of 5080 women had their charts reviewed, and 1285 underwent interviews. Among implant users, the aIRR of pregnancy for efavirenz- vs. nevirapine-containing ART was 1.9 (95% CI 1.6, 2.4) using EMR data only and 3.2 (95% CI 1.8, 5.7) when additionally using both chart review and interview validated data. Among efavirenz users, the aIRR of pregnancy for depomedroxyprogesterone acetate (DMPA) vs. implant use was 1.8 (95% CI 1.5, 2.1) in EMR only and 2.4 (95% CI 1.0, 6.1) using validated data.
Conclusion
Pregnancy rates are higher when contraceptive implants are concomitantly used with efavirenz-containing ART, though rates were similar to leading alternative contraceptive methods such as DMPA. Our data provides policymakers, program staff, and WLHIV greater confidence in guiding their decision-making around contraceptive and ART options. Our novel, 3-phase validation sampling provides an innovative tool for using routine EMR data to improve the robustness of data quality.
... Despite investment in family planning programs and an increase in education attainment, African women are disproportionally deprived of the means to meet their family planning needs [5]. Economic, cultural and geographical disparities that hinder the promotion of family planning also prevent modern contraceptive decisions [6,7]. ...
Background
In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso.
Methods
We analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach’s alpha test to explore and assess specific and consistently relevant components of women’s agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women’s agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors.
Results
Overall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women’s agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06–1.51) associated with mDFPS. For community-level variables, women’s greater access to assets (aOR 1.72, 95% CI 1.13–2.61) and family planning messages (aOR 2.68, 95% CI 1.64–4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64–0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52–3.99) to have mDFPS.
Conclusions
Empowering women has the potential to reduce gender inequality, raise women’s agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women’s rights.
Trial registration
No clinical trial has been performed in this study.
... 33,49 The current use model demonstrated a positive association of wife's education level within a couple and contraceptive use, which was anticipated and consistent with the existing body of literature. [50][51][52][53] In couples in which the wife had at least a primary level of education (except in couples where both spouses only had a primary level of education), couple-level variable combinations of education level were positively and significantly associated with reported contraceptive use. ...
Objectives
Couple communication about family planning has been shown to increase uptake of contraception. However, couple communication is often measured based solely on one partner’s report of communication. This research investigates the influence of couple-reported communication about family planning on current and future use of contraception using couple-level data.
Methods
We used baseline data from the Measurement, Learning, and Evaluation (MLE) project collected through household surveys in 2011 from a cross-sectional representative sample of women and men in urban Senegal to conduct secondary data analysis. We used multivariable logit models to estimate the average marginal effects of couple communication about family planning on current contraception use and future intention to use contraception.
Results
Couple communication about family planning reported by both partners was significantly associated with an increased likelihood of current use of contraception and with future intention to use contraception among non-contracepting couples. Couples where one partner reported discussing family planning had a 25% point greater likelihood of current contraception use than couples where neither partner reported discussing, while couples where both partners reported discussing family planning had a 56% point greater likelihood of current contraception use, representing more than twice the effect size. Among couples not using contraception, couples where one partner reported discussing family planning had a 15% point greater likelihood of future intention to use contraception than couples where neither partner reported discussing, while couples where both partners reported discussing family planning had a 38% point greater likelihood of future intention to use contraception.
Conclusion
These findings underscore the importance of the inclusion of both partners in family planning programs to increase communication about contraception and highlight the need for future research using couple-level data, measures, and analysis.
... However, the significance of children ever born to modern contraceptive uptake was inconsistent within the countries. These factors have been earlier identified with the use of modern contraceptive in literature [5,29,31,32,[41][42][43]. Besides, the place of residence was significant in Cote d'Ivoire and wealth quintile and religion in Nigeria. ...
While studies abound on the utilization of modern contraceptive (MC), the timing of its uptake after sexual debut has not been given fair attention in the literature. The study estimated the time to MC uptake after sexual debut and identified the factors associated with the timings among the ever-had sex never-in-union (EHS-NIU) women in Mozambique, Nigeria and Cote d'Ivoire adopting the health belief model. This was a cross-sectional study using the Mozambique, 2011, Nigeria, 2013 and Cote d'Ivoire, 2014 DHS data. The analysis was limited to 8,251 EHS-NIU women: Mozambique (1800), Nigeria (4082) and Cote d'Ivoire (2369). Descriptive statistics, survival analysis, log-rank tests, and multivariable Cox proportional hazard regression were used at p=0.05. Over a third (38%) of the EHS-NIU women had ever used MC: Mozambique (26%), Nigeria (47%) and Cote d'Ivoire (32%). While the median time to first MC use was 2 years across the countries, the overall median survival time was 11 years: Nigeria (7), Cote d'Ivoire (17) and Mozambique (18). The hazard of MC uptake was 50% (Hazard Ratio (HR)=1.50, 95% Confidence Interval (CI): 1.34-1.68) times higher among EHS-NIU women in Nigerian compared to those in Cote d'Ivoire. Compared with the EHS-NIU women aged 15-19 years, the hazard of MC uptake was 71% lower in Nigeria (adjusted Hazard Ratio (aHR)=0.29, 95% CI: 0.52-0.65), 43% lower in Mozambique (aHR=0.57, 95% CI: 050-0.67) and 49% lower in Cote d'Ivoire (aHR=0.51, 95% CI: 040-0.65) among those aged 20-24 years. EHS-NIU women with higher education, who lives in urban areas, who delayed sexual debut, who frequently listened to the radio, in richest wealth quintiles had earlier uptake of MC. There were low lifetime prevalence and late uptake of MC among ever-had sex never-in-union women in Mozambique, Nigeria, and Cote d'Ivoire. The timing of MC uptake was associated with respondents’ age, age at sexual debut, place of residence, educational attainment, wealth quintile, number of children ever born, radio listening frequency and regions of residence.
... In areas of reproductive health, which are critical for attaining the MDGs for child and maternal health, Sub-Saharan Africa is particularly poor. This brief looks at reproductive health accomplishments and failures in Sub-Saharan Africa, concentrating on differences in family planning use and family size, maternal mortality, and HIV/AIDS in major sub-Saharan areas (2,4,6,7). ...
Background: Appropriate contraceptive use prevents unintended pregnancy, protects the health of mother and child, and promotes women's well-being. Use of modern Family planning in Ethiopia was still very low. The purpose of this study was to assess the factors that are associated with non-use of modern family planning services among women of reproductive age.
Method: A nationally representative 2016 EDHS women data were used for analysis. Descriptive and multilevel multivariable binary logistic regression models were used to summarize descriptive data and measure statistical association between the dependent and the individual and community level variable, respectively. Adjusted odds ratio and confidence interval were respectively used to measure association and its statistical significance.
Result: Among women in the reproductive age group 79.49% did not use a modern contraceptive method. Of this, 65.9 %, were from rural areas. Women age between 25-34 years (AOR=0.54, 95% CI: 0.5-0.61) and age between 34-49 year (AOR=0.62, 95% CI: 0.55-0.71), Women with a primary level of education (AOR=0.8, 95% CI: 0.68-0.87), husband’s education level was secondary and above were 0.83(AOR = 0.83, 95% CI: 0.72-0.96), middle income women (AOR=0.66, 95% CI: 0.58-0.76) , rich women (AOR=0.74,95%CI:0.65-0.85), women delivered at the health facility were lower by 0.84 (AOR = 0.84, 95%CI: 0.73-0.0.98), watched family planning related information from TV (AOR=0.74, 95% CI: 0.65-0.85) had 1-2 and 3 or more children in the previous five years (AOR = 0.21, 95% CI: 0.19-0.23) and (AOR = 0.4, 95% CI: 0.28-0.56), respectively, are individual-level factors that are less likely to not use contraception were identified. Furthermore, Muslim women (AOR=1.4, 95% CI: 1.23-1.62), women living in rural area (AOR=3.43; 95% CI: 2.72-4.32), and ANC visit 1.3(1.07-1.5) were more likely to not use contraception. Further, Women in Afar, Somali, Gambela, Harari, and Dire Dawa were less likely to use modern contraception methods than women in Tigray, but Amhara region had a lower rate of non-use.
Conclusion: Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. Moreover, initiatives to empower women associated to family planning programs would be beneficial in increasing contraceptive uptake among sexually active women in Ethiopia.
... There has been an appreciable increase in modern CP use over the past 30 years consistent with behavioural change and ongoing family planning programmes. 26 However, our study found that the overall use of modern CP still remains low in Africa. This latest finding is consistent with similar studies that reported low level of CP use within the African region. ...
Objective To assess the prevalence and factors
associated with modern contraceptive (CP) use among
women of the reproductive age.
Design Cross-sectional study.
Setting We used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018.
Participants Data on 1 177 459 women aged 15–49 years old.
Methods Multivariable logistic regression was used to identify factors associated with modern CP use, while controlling simultaneously for independent variables, and accounting for clustering, stratification and sample weights from the complex sampling design. We used random
effects meta-analysis to pool adjusted estimates across the 20 countries.
Results The overall prevalence of modern CP use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe. Overall, injectable (32%) was the most preferred method of CP, followed by oral pill (27%) and implants (16%). Women were more likely to use a modern CP if they: had a primary (adjusted prevalence odds ratios (aPORs): 1.68, 95% CI:
1.47 to 1.91)) or secondary/higher education (aPOR: 2.16, 95% CI: 1.80 to 2.59) compared with women with no formal education; had no delivery in the last 2 years (aPOR: 3.89, 95% CI: 2.76 to 5.47) compared with women who delivered in the last 2 years; were aged 25–34 years (aPOR: 1.33, 95% CI: 1.20 to 1.47) compared with women
aged 15–24 years; were of middle-income status (aPOR: 1.25, 95% CI: 1.11 to 1.39) or rich (aPOR: 1.53, 95% CI:1.27 to 1.84) compared with poor women and had two or more antenatal care visits compared with women without a visit. Perceived domestic violence was not ssociated
with modern CP use (aPOR: 0.98, 95% CI: 0.92 to 1.05).
Conclusion Our findings are relevant in a global context, particularly in the African region, and improve our understanding on relevant factors essential to increasing modern CP use.
... Numerous non-profit, faith-based, governmental, and academic institutions from high-income countries provide health education programmes in middle-and low-income countries (Emina et al., 2014;Ford-Jones and Daly, 2017;Haggblade et al., 2016;Ndira et al., 2014). The goal of these programmes is to improve the health of individuals and communities. ...
Objective
Each year, humanitarian groups provide health education programmes and interventions to underserved communities in Nicaragua. The purpose of this study was to identify the health education needs of a small community in rural Nicaragua to inform health education programming.
Design
Mixed methods approach that used a quantitative survey and a qualitative questionnaire to determine health education priorities.
Setting
Rural community in the Jinotega region of northern Nicaragua.
Methods
The quantitative survey was completed by 125 participants to gauge the importance of specific health topics, while 49 of those participants also completed a qualitative questionnaire that solicited information about participants’ current health knowledge, beliefs and practices.
Results
Quantitative results showed that participants ranked the prevention of respiratory illness as their highest education need, while exercise was their lowest priority. Smoking cessation and reducing alcohol use were viewed as significantly higher priorities by men than by women. Qualitative findings revealed five major themes related to reproductive health, respiratory health, nutrition, stress and exercise. Within each theme, participants demonstrated knowledge of health promoting behaviours; however, barriers to adopting healthy behaviours were also evident. For example, some female participants expressed feelings of powerlessness in sexual relationships despite knowledge of how sexually transmitted infections could be prevented. Participants also identified the importance of nutrition but described poor access to healthy foods.
Conclusion
Findings from this study provided information to develop future health education programmes that build upon the community’s strengths while addressing the health topics most important to residents.
... Many developing countries have substantial geographic variations in contraceptive use, although the factors shaping these variations are to date little understood (Amin et al., 2002). Kenya, Bangladesh and Italy have all reported a geographic pattern of modern contraceptive use (Amin et al., 2002;Kravdal, 2002;Borgoni & Billari, 2003;Ettarh, 2011;Emina et al., 2014). A fundamental factor in the study of contraceptive decision-making is the environment in which people operate, which is a core requirement for the proper availability and accessibility of contraception (Borgoni & Billari, 2003). ...
Summary This study investigates inequalities at the province level of the use of modern contraception and the proportion of short birth intervals among women in the DRC using data from the 2007 Demographic and Health Survey. Logistic regression and Bayesian geo-additive models were used. The posterior odds ratio and the associated 95% credible interval (95% CI) were estimated using Markov Chain Monte Carlo (MCMC) techniques. Posterior spatial effects were mapped at the province level with the associated posterior probability maps showing statistical significance at 5%. The overall rates of modern contraception use among the entire sample of women (15-49 years old; N=7172) and youth (15-24 years old; N=1389) were 5.7% and 6.0% respectively. However, there was striking variation in contraceptive use between the two groups across provinces with a clear east-to-west gradient. The highest use in the total sample was in Nord-Kivu (OR 1.32; 95% CI 1.12, 1.55) and Bas Congo provinces (1.47; 1.22, 1.78). For the youth, the highest use was observed in Nord-Kivu (1.19; 0.92, 1.65). In multivariate Bayesian geo-additive regression analyses among the entire sample of women, factors consistently associated with lower use of modern contraception were living in rural areas (0.71; 0.62, 0.82), living in low-income households (0.67; 0.54, 0.80) and having no education (0.83; 0.67, 0.97). For the youth sample, living in low-income households (0.57; 0.41, 0.84) and no breast-feeding (0.64; 0.47, 0.86) were consistently associated with a lower use of modern contraception. The study shows a distinct geographic pattern in the use of modern contraception in youth and the entire sample of women in the DRC, suggesting a potential role for socioeconomic factors, such as accessibility, affordability and availability, as well as environmental factors at the province level beyond individual-level risk factors.
Objective:
To measure the prevalence of contraceptive use among women of reproductive age in 17 sub-Saharan Africa countries and identify factors associated with contraceptive use in these countries.
Study design:
We conducted a population-based cross-sectional study using data on contraceptive use from the Demographic and Health Surveys (DHS) for 17 sub-Saharan Africa countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, Congo, Gambia, Ghana, Guinea, Ivory Coast, Liberia, Mali, Niger, Nigeria, Senegal, Togo, and Uganda). We restricted our sample to women aged 15-49 years and used generalized estimating equations to identify factors associated with contraceptive use while controlling for other covariates.
Results:
The overall prevalence of current contraceptive use among women of reproductive age was only 17%, with rates ranging from 7% in Gambia to 29% in Uganda. After adjusting for potential confounders, we found that women were more likely to use a method of contraception if they were sexually active (adjusted prevalence ratio (aPR) 2.17 [95% confidence interval (CI) 2.11, 2.24]); had 5-7 living children (aPR 2.19 [95% CI 1.89, 2.55] compared to no children); had secondary or higher education (aPR 1.71 [95% CI 1.63, 1.78] compared to no education); and were wealthy (aPR 1.34 [95% CI 1.29, 1.40] compared to poor).
Conclusion:
The use of contraceptives is low in sub-Saharan Africa, but varies substantially across countries. Use of contraception is associated with both personal and socioeconomic factors.
Time trends in demand for family planning satisfied: analysis of 73 countries using national health surveys over a 24-year period Background Universal access to family planning is key to extend its health and economic benefits worldwide. Our aim was to track progress in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in low-and middle-income countries (LMICs).
Background Sub-Saharan African (SSA) countries have the highest worldwide levels of unmet need for modern contraception. This has led to persistently high fertility rates in the region, rates which have had major adverse repercussions on the development potential there. Family planning programmes play a key role in improving the uptake of modern contraception, both by fostering women’s health and by lowering their fertility. Increasing awareness of contraception benefits is a major component of such programmes. Here, we ask whether internet access can bridge the gap between women’s need for modern contraception and women’s uptake of the same.
Methods We use a compendium of data for 125 242 women, aged 15–49, from the Demographic Health Survey, Akamai and International Communication Union data, covering eight SSA countries, for the period 2014–2019. We apply a Two-Stage Least Square model, using as instruments for individual internet exposure the distance to the main server in the country and whether the backbone network in the country has been connected to at least one submarine cable.
Results Internet exposure, measured as women access the internet at least monthly (almost daily), is associated with a positive, 11.4% (95% CI 10.6% to 12.2%) (53.8% (95% CI 13.4% to 94.1%)), increase in modern contraception uptake. Education is an important moderator. Poorly educated women benefit the most from internet exposure.
Discussion Internet exposure appears to have significantly increased the uptake of modern contraception among sub-Saharan women. The poorly educated appear particularly to benefit. There are two mechanisms at play: the internet increases women’s knowledge of contraception; and, in parallel, fosters their empowerment.
Objective: The main objective of this study is to examine the trends, differentials and to identify the determining factors of unmet need for contraception (UNC) among currently married women of reproductive age in rural and urban Bangladesh.
Methods: The data analyzed for this study comes from Bangladesh Demographic and Health Surveys (BDHS). The BDHS is an ongoing cross-sectional study of a nationally representative sample of currently married women of 15–49 years of age living in households. In trends analysis, the overall change and the average annual rate (AAR) of change in UNC was observed from 2004 to 2014 by socio-demographic characteristics. Thereafter, Chi-square test and multivariate logistic regression analysis were used to measure the association and to identify the determinants of UNC among currently married women in rural and urban areas of Bangladesh.
Results: The data on Table 2.2 suggest that the unmet need for contraception remained steady from 2004 to 2014, increasing slightly between 2004 and 2007, and decreasing between 2007 and 2014. This study demonstrated a high prevalence of UNC in Sylhet regions of Bangladesh. Among urban women, sexual activity (OR = 0.082, 95% CI: 0.059–0.114) and watching television (OR = 2.147, 95% CI: 1.451–3.176) were the most important predictors of UNC along with age, education and husband’s education. For rural women, sexual activity women (OR = 0.138, 95% CI: 0.115–0.165), visit by FP workers (OR = 0.764, 95% CI: 0.595–0.981), watching television (OR = 2.147, 95% CI: 1.755–2.262) and age at marriage (OR = 0.701, 95% CI: 0.566–0.869) were the main determinants of UNC together with respondent’s age, couple’s education and children ever born in Bangladesh.
Conclusion: This study recommends that by increasing level of education, knowledge and awareness of contraceptive use, the unmet need for contraception can be met and contraceptive prevalence rate can be increased in Bangladesh.
Background:
Universal access to family planning is key to extend its health and economic benefits worldwide. Our aim was to track progress in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in low- and middle-income countries (LMICs).
Methods:
Analyses were based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys carried out between 1993 and 2017 in 73 LMICs, using data for married women aged 15-49 years. We estimated trends in mDFPS coverage by country and world region and evaluated trends in wealth-based inequalities. The analyses pooling all countries together were stratified by wealth quintiles, area of residence and woman's age. mDFPS coverage in 2030 for each country was predicted using a linear model.
Results:
Overall, mDFPS increased and poor-rich gaps narrowed. Eastern & Southern Africa showed an average increase of 1.5 percentage points (p.p.) a year, being the region with the fastest progress. West & Central Africa had an increase in mDFPS of 1 p.p. a year but current coverage is still below 40%. Generally, inequalities were reduced, except for West & Central Africa and Europe & Central Asia where almost no change was observed. The country with the fastest progress in mDFPS was Rwanda, with an increase of 5 p.p./y, while Timor Leste had the fastest reduction in absolute inequality, less 3.8 p.p./y. Inequalities by area of residence were reduced, but large gaps remain. A similar trend was observed for different age groups. If the current trend is not accelerated, 44 countries will not achieve universal coverage in mDFPS by 2030.
Conclusions:
Generally, mDFPS is increasing and inequalities are decreasing. However, progress is slow in some regions, especially West & Central Africa, where low coverage is combined with high levels of inequalities. Efforts to increase family planning coverage must be prioritized in countries where progress is slow or inexistent.
Background:
In Tunisia, the "Revolution" of January 2011 highlighted significant regional disparities and social inequalities in access to health care, including reproductive health services. The purpose of this study was to analyze the social determinants of the use of contraception in Tunisia.
Methods:
A cross-sectional national study conducted in 2012; on a sample of 15 to 49-year married women (n=4374) drawn by a two levels random sampling. Prevalence of contraception and its association factors were assessed. Logistic regression was used to evaluate the variation of contraception prevalence with area of residence, age, level of education, number of children and household income.
Results:
The prevalence of contraception was 66.4 %. Eighty-two percent of women used a modern contraceptive method. The use of contraceptive methods was significantly dependent on the age (P<0.001), area of residence (P=0.008), education (P<0.001). The prevalence of contraception was higher in North West (OR=1.1 [0.81-1.5]; P<0.001), among multiparous women (OR=4.49 [3.57-5.66]; P<0.001), among the youngest women (OR=1.4 [0.9-2,19]; P<0.001) and among those with higher levels of education (OR=1.62 [1.19-2.21]; P=0.008).
Conclusion:
Tunisia, precursor Arab country in family planning, is recording a slowdown in the use of contraception in comparison with other countries of North Africa. Social determinants, such as, age, living conditions, area of residence and level of education are indicators to consider when targeting interventions.
Background
From mid‐2015, reproductive and child health interventions were integrated into a routine 6‐month contact point: vitamin A supplementation, nutrition counseling with the mother's participation in the preparation of a complementary food, and confidential family planning counseling with provision of modern forms of contraceptives. By mid‐2017, these services had reached 28% of health facilities nationwide.
Objective
To evaluate awareness and uptake of modern contraception and complementary feeding practices.
Methods
All health facilities were visited, and the health worker “in‐charge” were interviewed to ascertain their training status and supply chains. Within each catchment, community mothers of children 6 to 23 months of age were interviewed.
Results
Interviews were conducted with 321 “in‐charges” and 670 mothers. Advantages and different types of contraception were understood by 99.0% of mothers, and 52.7% reported they were utilizing depot injections, hormonal implants, or oral contraceptive pills (45.1%, 34.6%, and 20.6% of users, respectively). Uptake was higher among Christians (62.1%) versus Muslims (48.6%) and among those with secondary/tertiary (61.5%) or primary education (60.5%) versus no education (43.3%) (P < 0.005 and P < 0.05, respectively).
Complementary feeding practices included minimal meal diversity, 49.2% (fed three or more of six food groups), and recommended minimal meal frequency appropriate for age, 52.6%.
Health workers reported frequent stockouts of vitamin A capsules (8%), male condoms (1%), oral contraceptives (10%), depot injections (20%), and hormonal implants (30%).
Conclusion
In communities served by these integrated services, awareness and uptake of modern contraception exceeded national targets despite weak supply chains, and complementary feeding practices were favorable compared with the national survey.
Demographic and Health Survey (DHS) data are used to examine what predicts current contraception and condom use among married women in Ghana. Women’s gender-based power is examined in the three dimensions of interpersonal decision-making power, household status, and socioeconomic status; these dimensions are considered as predictor or focal variables. Ghanaian women’s higher sexual decision-making power, greater education, work outside of the home, work for pay, more living children, and monogamous marriages are associated with a greater likelihood of contraceptive use. Higher contraceptive use is found among young urban women who do not want more children and who have been visited by a family planning worker. In contrast, condom use is shaped by different factors that highlight its distinctiveness as being male-controlled. Policy planning should consider the importance of women’s power and the uniqueness of condom use as a male-controlled contraceptive method as well as the positive effect of contact with a family planning worker in shaping both contraceptive and condom use.
After about a decade of civil war, Liberia still has a fertility similar to other countries who have not had such similar experiences. The civil war was expected to lead to a decrease in fertility given the expected increased usage of contraceptives and decrease in the desire for children. So, the question about the role of education, contraception and desired fertility was asked. To answer this question, four main questions were asked. First, whose education is more significant in reducing fertility, husband or wife? Second, does usage of contraceptive lead to low fertility? Also, does the desire for more children or another child lead to having higher fertility? Lastly, does the woman’s education (wife’s) have only a direct effect, only an indirect effect or both direct and indirect effects? Unfortunately, there was no available data that was collected during or a few years after the civil war. Trends for Liberia from the 1970s to the 2010s have shown that education and contraceptive usage shows an upward trajectory while the average ideal number of children (proxy for desired fertility) shows a downward trajectory. Using three waves of the Liberia Demographic and Health Survey data along with a Poisson regression analysis and the Structural Equation Model, this study found; First, for 1986 wave, husband’s education, rather than wife’s education, was more significant in explaining fertility.
OBJECTIVE: To review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. METHODS: Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys, which are nationally representative and yield internationally comparable data. Trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. FINDINGS: In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007). CONCLUSION: In western Africa, progress towards adoption of contraception has been dismally slow. Attitudinal resistance remains a barrier and access to contraceptives, though improving, is still shockingly limited. If this situation does not change radically in the short run, the United Nations population projections for this subregion are likely to be exceeded. In eastern Africa, the prospects for a future decline in fertility are much more positive.
Sub-Saharan Africa has the highest total fertility rate in the world, but some countries in the region are undergoing dynamic and unprecedented fertility transitions. Contraceptive prevalence rates, especially for modern contraceptive methods, have increased several-fold in Malawi, Namibia, Tanzania, Zambia, and Zimbabwe. The region is also witnessing changes in the proximate determinants of fertility, including increases in the age of marriage and the incidence of induced abortion. In countries in which the greatest progress has been made, some of the key ingredients of success have been a high level of political commitment, strong country-level institutions, and effective family planning service delivery strategies. Sub-Saharan Africa has the highest average fertility rate in the world. In 2009 the average number of births per woman was 5.1—more than twice as many as in South Asia (2.8) or Latin America and the Caribbean (2.2) (World Bank 2009). The average contraceptive prevalence (22 percent) is less than half that of South Asia (53 percent) and less than a third that of East Asia (77 percent) (World Bank 2009). As a result of these patterns, the region is growing at a faster rate (2.3 percent) than other regions of the developing world, including both Asia and Latin America (1.1 percent each) (UN DESA 2008). These dismal indicators at the aggregate level conceal ongoing and imminent fertility transitions taking place in the region. Contrary to the popular perception of no or very limited fertility decline, there is evidence of fertility decline in countries across Africa (Cohen 1998). The shift in fertility patterns have implications for policy level planning in all sectors.
Forthcoming summit will tackle questions of funding, service delivery, and monitoring
More than 120 million women worldwide aged 15-49 years have an unmet need for family planning,1 which is due a renaissance after years of neglect.2 On 11 July 2012, the Bill & Melinda Gates Foundation and the UK government will co-host an international summit in London to shine a spotlight on the world’s massive unmet need for family planning. The summit hopes to catalyse a global movement to provide 120 million women in low income countries access to family planning by 2020. Achieving this target, which would bring vast public health benefits, will require new funding—no small order in a time of global fiscal constraint—combined with transformational cost effective approaches to increasing coverage.
Women in sub-Saharan Africa, about 35 million of whom cannot access or use family planning, and those living with HIV, have the greatest unmet need.1 3 In one Ugandan survey, three quarters of people infected with HIV (men and women) reported an unmet need for contraception, compared with a third of uninfected individuals (odds ratio 3.97, 95% confidence interval 1.97 to 8.03).3 Assuming a similar prevalence across the continent, we calculate that about 10 million HIV infected women in sub-Saharan Africa have an …
To review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use.
Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys, which are nationally representative and yield internationally comparable data. Trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007.
In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007).
In western Africa, progress towards adoption of contraception has been dismally slow. Attitudinal resistance remains a barrier and access to contraceptives, though improving, is still shockingly limited. If this situation does not change radically in the short run, the United Nations population projections for this subregion are likely to be exceeded. In eastern Africa, the prospects for a future decline in fertility are much more positive.
We use data from the Demographic and Health Surveys to examine the patterns of stall in fertility decline in four Eastern African countries. Contrary to patterns of fertility transition in Africa that cut across various socio-economic and geographical groups within countries, we find strong selectivity of fertility stall across different groups and regions in all four countries. In both Kenya and Tanzania where fertility decline has stalled at the national level, it continued to decline among the most educated women and in some regions. While fertility has remained at pre-transition level in Uganda over the past 20 years, there are signs of decline with specific groups of women (especially the most educated, urban and those in the Eastern region) taking the lead. For Zimbabwe, although fertility has continued to decline at the national level, stall is observed among women with less than secondary education and those in some of the regions. We link these intra-country variations to differential changes in socio-economic variables, family planning programme environment and reproductive behaviour models. The results suggest that declines in contraceptive use, increases in unmet need for family planning, increasing preferences for larger families, and increases in adolescent fertility were consistently associated with stalls in subgroup fertility across all four countries. These results are consistent with models that emphasize the role of declines in national and international commitments to family planning programmes in the premature stall in sub-Saharan fertility transition.
Women's ability to practice contraception is essential to protecting their health and rights. Reproductive health care--including contraceptive services--enables women and their partners to make choices about pregnancy, have healthy babies and protect themselves from infections. Contraception also promotes economic development. An investment in contraceptive services can be recouped four times over--and sometimes dramatically more--by reducing the need for public spending on health, education and other social services.
The ICPD agenda of reproductive health was declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health and drove the states to embark upon initiatives to improve reproductive health status of their populations. However, like all other countries, Pakistan also seems to have shifted focus of its policies and programs towards achieving MDGs. As a result, concepts highlighted in the ICPD got dropped eventually. In spite of specific goals on maternal and child mortalities in MDGs and all the investment and policy shift, Pakistan has still one of the highest maternal mortality ratios among developing countries. Lack of synchronized efforts, sector wide approaches, inter-sectoral collaboration, and moreover, the unmet need for family planning, unsafe abortions, low literacy rate and dearth of women empowerment are the main reasons. Being a signatory of both of the international agendas (ICPD and MDGs), Pakistan needed to articulate its policies to keep the balance between the two agendas. There are, however, certainly some common grounds which have been experimented by various countries and we can learn lessons from those best practices. An inter-sectoral cooperation and sector wide approaches would be required to achieve such ambitious goals set out in ICPD-Program of Action while working towards MDGs. There is a need of increasing resource allocation, strengthening primary health care services and emergency obstetric care and motivating the human resource employed in health sector by good governance. These endeavors should lead to formulate evidence based national policies, reproductive health services which are affordable, accessible and culturally acceptable and finally a responsive health system.
This article examines the relationship between female schooling and two behaviors—cumulative fertility and contraceptive use—in
fourteen Sub-Saharan African countries where Demographic and Health Surveys (DHS) have been conducted since the mid-1980s.
Average levels of schooling among women of reproductive age are very low, from less than two years to six. Controlling for
background variables, the last years of female primary schooling have a negative relation with fertility in about half the
countries, while secondary schooling is associated with substantially lower fertility in all countries. Female schooling has
a positive relationship with contraceptive use at all levels. Among ever-married women, husband's schooling exerts a smaller
effect than does female schooling on contraceptive use and, in almost all cases, on fertility. Although the results suggest
commonalities among these Sub-Saharan countries, they also reveal intriguing international differences in the impact of female
schooling, which might reflect differences in the quality of schooling, labor markets, and family planning programs, among
others.
Women's access to education has been recognized as a fundamental right. At the national level, educating women results in improved productivity, income, and economic development, as well as a better quality of life, notably a healthier and better nourished population. It is important for all kinds of demographic behaviour, affecting mortality, health, fertility, and contraception, The personal benefits that women attach to education vary widely according to region, culture, and level of devlopment, but it is clear that educaiton empowers women, providing them with increased autonomy and resulting in almost every context in fewer children. Beyond these few general assertions, however, there is little consensus on such issues as how much education is required before changes in autonomy or reproductive behaviour occur; whether the education-autonomy relationship exists in all cultural contexts, at all times, and at all levels of development; and which aspects of autonomy are important in the relationship between education and fertility. It is in the need to address these fundamental issues that this book took shape. The author reviews the considerable evidence about education and fertility in the developing world that has emerged over the last twenty years, and then passes beyond the limits of previous studies to address three major questions: BL Does increased education always lead to a decrease in the number of children, or is there a threshold level of education that a woman must achieve before this inverse relationship becomes apparent? BL What are the critical pathways influencing the relationship of women's education to fertility? Is fertility affected because education leads to changes in the duration of breast-feeding? Because it raises the age at marriage? Because it increases the practice of contraception? Or because education reduces women's preferences for large numbers of children? BL Do improvements in education empower women in other areas of life, such as their improving exposure to information, decision-making, control of resources, or confidence in dealing with family and the outside world? Supported by full documentation of the available survey data, this study concludes that such contextual factors as the overall level of socio-economic development and the situation of women in traditional kinship structures complicate the general assumptions about the interrelationships between education, fertility, and female autonomy. It lays out the policy implications of these findings and fruitful directions for future research.
This study examines current disparities in access to family planning services in developing countries with data drawn from 64 Demographic and Health Surveys conducted between 1994 and 2008. The percent of demand satisfied is used as a proxy measure for access to family planning. In all regions, married women aged 15-19 have greater difficulty than older women in meeting their need for contraceptive services. Inequities in the percent of demand satisfied among individuals of varying economic status, area of residence, and education are observed in all regions except Central Asia. These gaps are larger and more common in sub-Saharan Africa. Strategies that seek to increase contraceptive use rapidly without consideration for disadvantaged groups are likely to increase observed inequities in percent of demand satisfied in the short-term. Efforts to monitor progress toward the goals enumerated in 1994 at the International Conference on Population and Development and toward other development goals must go beyond global, regional, and national averages to address the needs of population groups that are at greatest risk of adverse health outcomes.
Using data from Demographic and Health Surveys for 22 countries in Sub-Saharan Africa, I show that the average educational level in a village or a community of a similar size has a significant depressing effect on a woman's birth rates, net of urbanization and her own education. According to simulations, average fertility for these countries would be 1.00 lower if education were expanded from the current level in the region to the relatively high level in Kenya. The exclusion of aggregate education from the model leaves a response of only 0.52. A considerable aggregate contribution is estimated even when several potential determinants of education are included. This finding illustrates the need to consider aggregate education in future assessments of the total impact of education.
The interval between births is associated with child survival in the developing world. We aimed to investigate associations between use of depot-medroxyprogesterone acetate and other reversible contraception and short birth intervals in sub-Saharan Africa.
Data from successive Demographic and Health Surveys undertaken in nine African countries were analyzed. Logistic regression was used to explain changes in the proportion of short birth intervals in four countries with relatively high use of reversible contraception.
The overall odds ratio for the trend was 0.90 (95% CI 0.84 to 0.95) and this was unaffected by adjusting for the other variables. The odds of a short birth interval were reduced by exclusive breastfeeding (OR 0.67, 95% CI 0.58 to 0.78) and increased by use of injectable contraception (OR 1.23, 95% CI 1.11 to 1.38).
The proportion of short birth intervals has changed little over the last decade in a context of very low use of the intrauterine device. Widespread adoption of injectable contraception is associated with greater odds of a short birth interval, thus not contributing favorable conditions for improved child health.
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