Esber A, McRee AL, Norris Turner A
… +2 more, Phuka J, Norris A
J Fam Plann Reprod Health Care
· 2017 Apr · PMID 26944955
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BACKGROUND: Malawi has the highest incidence of cervical cancer in the world. Only 3% of Malawian women have ever been screened for cervical cancer. Self-collection of samples for human papillomavirus (HPV) testing could...BACKGROUND: Malawi has the highest incidence of cervical cancer in the world. Only 3% of Malawian women have ever been screened for cervical cancer. Self-collection of samples for human papillomavirus (HPV) testing could increase screening among under-screened and hard-to-reach populations. However, little is known about the acceptability of self-collection in rural African settings. AIM: We aimed to characterise Malawian women's willingness to self-collect vaginal samples for HPV testing and to identify potential barriers. DESIGN: We used data from the baseline wave of a community-based cohort study, collected from July 2014 to February 2015. SETTING: Participants were enrolled from the catchment area of a clinic in rural Lilongwe District, Malawi. METHODS: We enrolled women aged 15-39 years (=824). Participants answered questions assessing willingness to self-collect a sample for HPV testing, concerns about testing and other hypothesised correlates of willingness to self-collect. RESULTS: Two-thirds (67%) of the women reported willingness to self-collect a vaginal sample in their homes. Awareness of cervical cancer, supportive subjective norms, perceived behavioural control, and clinician recommendations were all positively associated with increased willingness to self-collect samples for HPV testing. Identified barriers to self-testing endorsed by women included: concerns that the test might hurt (22%), that they might not do the test correctly (21%), and that the test might not be accurate (17%). CONCLUSIONS: This study suggests that self-collection for HPV testing could be an acceptable cervical cancer screening method in this rural population. Findings identify modifiable beliefs and barriers that can inform the development of effective screening programmes.
Inoue K, Kelly M, Barratt A
… +5 more, Bateson D, Rutherford A, Black KI, Stewart M, Richters J
J Fam Plann Reprod Health Care
· 2017 Apr · PMID 26941357
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OBJECTIVE: Few studies have explored Australian women's understandings of contraception. This study examined the attitudes towards, and understandings of, the subdermal contraceptive implant expressed by women living in...OBJECTIVE: Few studies have explored Australian women's understandings of contraception. This study examined the attitudes towards, and understandings of, the subdermal contraceptive implant expressed by women living in New South Wales (NSW), Australia. STUDY DESIGN: As part of a larger qualitative study using in-depth, open-ended interviews in 2012-2013 with women aged 16-49 years who had ever used contraception (=94), 65 interviews from women who discussed or mentioned the subdermal implant, but had not previously used the device, were examined and analysed using thematic analysis. RESULTS: The emergent themes were: satisfaction with current method; weak personal opinions and ambivalence; uncertainty due to specific concerns; and strong negative reactions - fear and dislike. Although there were a few positive perceptions expressed by women who had never used the subdermal implant, for the majority of women the perception was predominantly negative. DISCUSSION AND CONCLUSION: Women tended to form negative impressions from the stories of other women about the subdermal implant. Interventions to enhance evidence-informed awareness of the relative advantages and disadvantages of the implant - for example, improved access to supportive contraceptive counselling - need investigation in the Australian context. Avenues to improve women's perceived control over the device could also be usefully investigated.
Bisits-Bullen P, Phiri P, Chirwa S
… +1 more, Chauwa L
J Fam Plann Reprod Health Care
· 2017 Jan · PMID 26880760
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BACKGROUND: Engaging community, government and non-governmental organisation (NGO) stakeholders in the design of family planning (FP) programmes is best practice. Stakeholders can provide local insights on barriers to FP...BACKGROUND: Engaging community, government and non-governmental organisation (NGO) stakeholders in the design of family planning (FP) programmes is best practice. Stakeholders can provide local insights on barriers to FP. However, it can be difficult to know whether there may be limited programme perceptions if only one method of enquiry is used. AIM: This study aimed to validate the perceptions of stakeholders on barriers to FP in Malawi. METHODS: The study was conducted in a rural area in Lilongwe District, Malawi and employed a mixed-methods exploratory design. Five focus groups were run with community, government and NGO stakeholders to identify barriers to using modern FP. The results of the qualitative phase were then compared using a quantitative survey of 960 women who had at least one child aged under 5 years. RESULTS: The qualitative phase identified a range of barriers to FP, including lack of awareness, lack of access, religious beliefs, myths, and opposition by husbands. However, the quantitative survey found that these issues are not a concern for the majority of women. The main reasons given by women for not using FP were that were not currently having sex or had a child recently, and so they felt they did not need to use it. CONCLUSIONS: Perceptions of stakeholders from a qualitative approach do not necessarily reflect the perspectives of the population as documented in a quantitative survey. When involving stakeholders it is important to recognise that different approaches may elicit different responses, particularly with regard to sensitive issues or issues that apply to particular subgroups. Consequently, a deeper understanding is likely to be obtained by using a multimethod approach.
Tsuyuki K, Gipson JD, Urada LA
… +2 more, Barbosa RM, Morisky DE
J Fam Plann Reprod Health Care
· 2016 Oct · PMID 26880759
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BACKGROUND: Syndemic HIV and unintended pregnancy is prevalent in Brazil, where 79% of female HIV cases occur in women of reproductive age and 55% of all pregnancies are unintended. Although increasing condom use to prev...BACKGROUND: Syndemic HIV and unintended pregnancy is prevalent in Brazil, where 79% of female HIV cases occur in women of reproductive age and 55% of all pregnancies are unintended. Although increasing condom use to prevent HIV may decrease non-barrier contraception and increase unintended pregnancy, few studies focus on dual protection or dual methods (condoms with another modern contraceptive). AIM: To describe the correlates of dual method use and consistent condom use in women of reproductive age in Brazil. METHOD: Data are from the 2006 Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança, a decennial nationally representative household survey of women of reproductive age in Brazil. Multivariate logistic regression models identify the socio-demographic, sexual debut, fertility and relationship factors associated with dual method use and consistent condom use. RESULTS: Two-thirds of contracepting women in Brazil used dual protection (40% exclusive condoms, 27% dual methods). Consistent condom use in the past year occurred among 61% of exclusive condom users and 27% of dual method users. Dual methods (vs exclusive condoms) was associated with some high school education [relative risk ratio (RRR)=1.69, <0.05], living in the Southern region (RRR=1.59, <0.01), and number of children (RRR=1.22, <0.01), net of other factors. Consistent condom use was associated with condom use at sexual debut [adjusted odds ratio (AOR)=1.84, <0.001], wants no (more) children (AOR=1.86, <0.001), single/separated relationship status (AOR=2.77/2.45, <0.001) and using exclusive condoms (vs dual methods: AOR=0.19, <0.001). CONCLUSIONS: Findings highlight that targeting and delivering integrated HIV and family planning services should focus on completed/large families. single/separated individuals, and promoting dual protection at sexual debut.
J Fam Plann Reprod Health Care
· 2016 Jul · PMID 26869694
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OBJECTIVE: To assess pharmacy workers' knowledge and provision of abortion information and methods in Kenya. METHODS: In 2013 we interviewed 235 pharmacy workers in Nairobi, Mombasa and Kisumu about the medical abortion...OBJECTIVE: To assess pharmacy workers' knowledge and provision of abortion information and methods in Kenya. METHODS: In 2013 we interviewed 235 pharmacy workers in Nairobi, Mombasa and Kisumu about the medical abortion services they provide. We also used mystery clients, who made 401 visits to pharmacies to collect first-hand information on abortion practices. RESULTS: The majority (87.5%) of pharmacy workers had heard of misoprostol but only 39.2% had heard of mifepristone. We found that pharmacy workers had limited knowledge of correct medical abortion regimens, side effects and complications and the legal status of abortion drugs. 49.8% of pharmacy workers reported providing abortion information to clients and 4.3% reported providing abortion methods. 75.2% of pharmacies referred mystery clients to another provider, though 64.2% of pharmacies advised mystery clients to continue with their pregnancy. Pharmacy workers reported that they were experiencing demand for abortion services from clients. CONCLUSIONS: Pharmacy workers are important providers of information and referrals for women seeking abortion, however their medical abortion knowledge is limited. Training pharmacy workers on medical abortion may improve the quality of information provided and access to safe abortion.
J Fam Plann Reprod Health Care
· 2016 Oct · PMID 26864741
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BACKGROUND: World Health Organization (WHO) guidelines recommend dual contraceptive method use with condoms and another contraceptive to reduce both incidence of HIV/sexually transmitted infection transmission and uninte...BACKGROUND: World Health Organization (WHO) guidelines recommend dual contraceptive method use with condoms and another contraceptive to reduce both incidence of HIV/sexually transmitted infection transmission and unintended pregnancies. This qualitative study assessed the barriers to and motivations for dual contraceptive use in Kenyan HIV-serodiscordant couples. METHODS: HIV-serodiscordant couples in Nairobi, Kenya, were recruited from two longitudinal cohorts. Qualitative semistructured interviews were conducted using a semistructured questionnaire. Twelve male and 12 female members of serodiscordant couples and 10 women with incident pregnancies during the cohort studies were included. RESULTS: Few couples reported using dual contraceptive methods, with men reporting more condom use than women. No HIV-seropositive men or HIV-seronegative women reported using non-condom contraception. Men and women agreed that men play a dominant role in decisions to use both condoms and contraception in HIV-serodiscordant couples. Participants reported that perceptions of side effects, male partner preference, and reproductive desire were critical factors in contraceptive decisions. Both men and women saw dual contraceptive method use as redundant and a sign of possible unfaithfulness. Many participants actively desired pregnancy, but few were able to accurately define monthly fertility windows. CONCLUSIONS: Dual contraceptive method use was low in these HIV-serodiscordant couples, with some couples finding it unnecessary while using condoms, and others being more focused on conceiving a child. Biomedical HIV prevention, including male circumcision, pre-exposure prophylaxis or antiretroviral therapy to reduce HIV transmission, may be more acceptable strategies to promote safer sexual relations among HIV-serodiscordant couples and safer conception when desired.
J Fam Plann Reprod Health Care
· 2016 Oct · PMID 26811435
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BACKGROUND: Women commonly report changing contraceptive methods because of side-effects. However, there is a lack of literature that has thoroughly examined women's perspectives, including why they changed contraception...BACKGROUND: Women commonly report changing contraceptive methods because of side-effects. However, there is a lack of literature that has thoroughly examined women's perspectives, including why they changed contraception. AIM: Using qualitative data from a contraceptive survey of young Australian women, we explored women's explanations for their recent changes in contraception. METHOD: A thematic analysis of 1051 responses to a question about why women recently changed contraception was conducted. RESULTS: Themes reflected reasons for changing contraception which included: both contraceptive and non-contraceptive (4%); relationship/sexual (9%); medical (11%); contraceptive (18%); non-contraceptive (41%). A minority of responses were uncoded (17%). Non-contraceptive effects (effects unrelated to pregnancy prevention) featured most frequently in women's reasons for changing contraception. CONCLUSIONS: While cessation of various contraceptives due to unwanted side-effects is a well-known phenomenon, this analysis provides evidence of the changing of contraception for its non-contraceptive effects and reframes the notion of 'side-effects'.