Studies In Family Planning[JOURNAL]
Sun
200 papers
"If the Woman Doesn't Prevent, You Will Become Pregnant": Exploring Male Involvement in Contraceptive Use Preceding Unplanned Pregnancy in Sierra Leone.
McLean KE, Thulin EJ
Stud Fam Plann · 2022 Mar · PMID 35238042 · Publisher ↗
Globally, millions of unintended pregnancies occur each year resulting in a host of social, economic, and health-related problems. Improving knowledge of and access to family planning services is an effective way to prev...
Globally, millions of unintended pregnancies occur each year resulting in a host of social, economic, and health-related problems. Improving knowledge of and access to family planning services is an effective way to prevent unintended pregnancy, and research suggests that men's involvement promotes greater contraceptive uptake. To explore this issue, we assess contraceptive knowledge, attitudes, and behaviors among Sierra Leonean men who experienced an unplanned pregnancy. Findings indicate that men's participation in family planning was limited due to barriers including inadequate knowledge about contraception, poor access to services, and gender norms that consider family planning a woman's responsibility. As a result, men often resorted to a pattern of control that put the onus of contraceptive use on women and blamed women when they became pregnant, without considering their own role in pregnancy prevention. We suggest that family planning policies and interventions both engage men and address the barriers to their participation in reproductive health.
Gifting Relationships and School Dropout in Rural Malawi: Examining Differences by Gender and Poverty Level.
Pike I, Grant M
Stud Fam Plann · 2022 Mar · PMID 35229304 · Full text
Research from sub-Saharan Africa has shown the heightened likelihood of dropping out of school for students in sexual relationships, particularly girls. However, our knowledge is limited as to whether the risk of school...
Research from sub-Saharan Africa has shown the heightened likelihood of dropping out of school for students in sexual relationships, particularly girls. However, our knowledge is limited as to whether the risk of school dropout is exacerbated by the exchange of gifts in the relationship as well as students' poverty level. Drawing on longitudinal survey data from rural Malawi, this study explores these questions, examining differences by gender and poverty level in the association between being in a sexual relationship in which gifts are exchanged and school dropout for adolescents in primary school. Our findings show that for both boys and girls, being in a gifting relationship heightens the risk of school dropout and eliminates the protective advantages of being nonpoor on dropout. However, non-gifting sexual relationships also erase the protective advantage of being nonpoor for girls, but not for boys. These results point to the value of examining poverty-gender interactions to gain a more nuanced understanding of the impact of sexual relationships on adolescent trajectories.
Getting Intentional about Intention to Use: A Scoping Review of Person-Centered Measures of Demand.
Boydell V, Galavotti C
Stud Fam Plann · 2022 Mar · PMID 35119110 · Full text
In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention-to-use (ITU) contraception, however, has had less at...
In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention-to-use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer-range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use.
Child Marriage in Mainland China.
Fan S, Qian Y, Koski A
Stud Fam Plann · 2022 Mar · PMID 35118678 · Publisher ↗
Child marriage, defined as marriage before 18 years of age, has harmful consequences for health and development and is an indicator of gender inequality. We used publicly available data from the 2000 and 2010 censuses to...
Child marriage, defined as marriage before 18 years of age, has harmful consequences for health and development and is an indicator of gender inequality. We used publicly available data from the 2000 and 2010 censuses to estimate the national and provincial-level prevalence of child marriage across mainland China. Between 2000 and 2010, the prevalence of child marriage rose from 2.41 percent to 2.85 percent among women and from 0.54 percent to 0.77 percent among men. The 2010 estimates are equivalent to roughly 1.8 million women and 0.5 million men. Child marriage was more common in western provinces among both girls and boys. Provincial prevalence estimates ranged from 0.44 percent in Beijing to 12.94 percent in Qinghai among girls. Among boys, estimates ranged from 0.13 percent in Beijing to 5.03 percent in Tibet. The gender gap widened across much of the country between censuses. Our results indicate that child marriage continues across mainland China despite laws that ostensibly prohibit the practice. They also draw attention to the global nature of child marriage as a threat to gender equality.
Does Provider Bias Affect Choice of a Facility for Family Planning Services by Women in Urban Senegal?
Speizer IS, Guilkey DK, Winston J … +1 more , Calhoun LM
Stud Fam Plann · 2022 Mar · PMID 35083745 · Full text
Few studies to date have determined the effect of provider bias based on age, parity, and marital status on women's method and facility choice. Using data from women using modern methods in six cities of Senegal and a fa...
Few studies to date have determined the effect of provider bias based on age, parity, and marital status on women's method and facility choice. Using data from women using modern methods in six cities of Senegal and a facility survey that included a facility audit and provider interviews, we undertake conditional logit analyses to determine whether women's choice of a family planning facility is associated with provider bias at the facility, controlling for other facility characteristics (e.g., size, sector, and number of methods available). We find that women bypass facilities where there is greater provider bias to attain their current family planning method. Women also bypass facilities of lower quality. This is the first study to demonstrate the effects of provider bias on women's contraceptive seeking behaviors and suggests the importance of training providers to reduce age and parity bias that affect access to a full range of methods and facilities for all women.
Anemic Women are More at Risk of Injectable Contraceptive Discontinuation due to Side Effects in Ethiopia.
Stevens R, Malbos B, Gurmu E … +2 more , Riou J, Alvergne A
Stud Fam Plann · 2022 Mar · PMID 35060627 · Publisher ↗
This paper investigates the importance of women's physiological condition, alongside sociocultural factors, for predicting the risk of discontinuation of the injectable contraceptive due to side effects in Ethiopia. Cont...
This paper investigates the importance of women's physiological condition, alongside sociocultural factors, for predicting the risk of discontinuation of the injectable contraceptive due to side effects in Ethiopia. Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analyzed. Women aged 15-49 who had initiated the injectable contraceptive in the last two years were included in the analysis (n = 1,513). Physiological factors investigated were body mass, iron status, reproductive depletion, and physical strain. After checking for reverse causality, associations between physiological and sociocultural risk factors and discontinuation due to side effects (DSE) or discontinuation due to other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Anemia status was associated with DSE, but not DOR. Anemic women were two times more at risk of DSE compared with nonanemic women (adjusted hazard ratios [aHR] = 2.38, confidence interval [CI] = 1.41-4.00). DOR was predicted by religion, wealth, and relationship status. Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side effects. To reduce side effects, family planning programs might benefit from providing hormonal contraception within an integrated package addressing anemia.
Association between Intimate Partner Violence and Contraceptive Use Discontinuation in India.
Upadhyay AK, Kumar K, James KS … +3 more , Mcdougal L, Raj A, Singh A
Stud Fam Plann · 2022 Mar · PMID 35032028 · Full text
Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap...
Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap using microdata collected from women aged 15-49 in the 2015-2016 National Family Health Survey (NFHS). Analyses used multivariable multinomial logistic regressions stratified by long-acting reversible contraceptive methods (LARC)/non-LARC and condom/pill to examine the association between experience of IPV and contraceptive use discontinuation while still in need (DWSIN). Experience of physical violence was associated with DWSIN among LARC/IUD users (RRR: 3.73, 95 percent CI [1.55-8.95]) Among condom users, DWSIN was higher among women who experienced emotional violence compared with women who did not experience any violence (RRR: 4.16, 95 percent CI [1.59-10.90]). Although we did not find an association between IPV and overall contraceptive use discontinuation, we did find compelling evidence of an association between IPV and IUD and condom use discontinuation in India. There is a need to understand women's experience of IPV as a part of a broader strategy to provide high-quality family planning services to all women while considering individual circumstances and reproductive aspirations to support the uninterrupted use of contraception in India.
How Do Women Learn They Are Pregnant? The Introduction of Clinics and Pregnancy Awareness in Nepal.
Musse I, Thornton R, Ghimire D
Stud Fam Plann · 2022 Mar · PMID 34878176 · Full text
The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and infant's health. This paper examines how women learn about their pregnancy status and measures how access to preg...
The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and infant's health. This paper examines how women learn about their pregnancy status and measures how access to pregnancy tests affects earlier pregnancy knowledge. Using 10 years of individual-level monthly panel data in Nepal, we find that, on average, women learn they are pregnant in their 4.6th month of pregnancy. Living approximately a mile further from a clinic offering pregnancy tests increases the time a woman knows she is pregnant by one week (5 percent increase) and decreases the likelihood of knowing in the first trimester by 4.5 percentage points (16 percent decrease). Women with prior pregnancies experience the most substantial effects of distance within the first two trimesters, while, for women experiencing their first pregnancy, distance does not affect knowledge. These results suggest that, while access to clinics can increase pregnancy awareness for women who recognize pregnancy symptoms, other complementary policies are needed to increase pregnancy awareness of women in their first pregnancy.
"We Don't Fear HIV. We Just Fear Walking around Pregnant.": A Qualitative Analysis of Adolescent Sexuality and Pregnancy Stigma in Informal Settlements in Kisumu, Kenya.
Miller LE, Zamudio-Haas S, Otieno B … +9 more , Amboka S, Odeny D, Agot I, Kadede K, Odhiambo H, Auerswald C, Cohen CR, Bukusi EA, Truong HM
Stud Fam Plann · 2021 Dec · PMID 34766351 · Full text
In Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision-making among adol...
In Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision-making among adolescents in the informal settlements of Kisumu. We used purposive sampling to recruit 120 adolescent boys and girls aged 15-19 for focus group discussions. A semistructured interview guide was used to elicit social norms and community attitudes about sexual and reproductive health. We analyzed the data using the Framework Approach. The social stigma of adolescent sexuality and the related fear of pregnancy as an unambiguous marker of sexual activity emerged as main themes. This stigma led adolescents to fear social retribution but did not lead to more frequent contraception use due to additional stigma. The intensity of this fear was most acutely expressed by girls, leading some to seek unsafe, sometimes fatal, abortions, and to contemplate suicide. Fear of pregnancy outweighed fear of contracting HIV that was viewed as both treatable and less stigmatized. Our findings illustrate how fear of pregnancy among these adolescents is driven primarily by fears that their community will discover that they are sexually active. Interventions are urgently needed to address adolescent sexual stigma and to prevent negative outcomes.
An Assessment of Third-Party Reporting of Close Ties to Measure Sensitive Behaviors: The Confidante Method to Measure Abortion Incidence in Ethiopia and Uganda.
Giorgio M, Sully E, Chiu DW
Stud Fam Plann · 2021 Dec · PMID 34762302 · Full text
Indirect estimation techniques are important tools for measuring sensitive and stigmatized behaviors. This includes third-party reporting methods, which have become increasingly common in the field of abortion measuremen...
Indirect estimation techniques are important tools for measuring sensitive and stigmatized behaviors. This includes third-party reporting methods, which have become increasingly common in the field of abortion measurement, where direct survey approaches notoriously lead to underreporting. This paper provides the first in-depth assessment of one of the most widely used of these techniques in the field of abortion measurement: the confidante method. We outline six key assumptions behind the confidante method and describe how violations of these assumptions can bias resulting estimates. Using data from modules added to the performance monitoring for action surveys in Uganda and Ethiopia in 2018, we compute one-year abortion incidence estimates using the confidante method. We also perform a validation check, using the method to estimate intrauterine device /implant use. Our results revealed implementation problems in both settings. Several of the method's foundational assumptions were violated, and efforts to adjust for these violations either failed or only partially addressed the resulting bias. Our validation check also failed, resulting in a gross overestimate of intrauterine device/implant use. These results have implications more broadly for the potential biases that can be introduced in using third-party reporting of close ties to measure other sensitive or stigmatized behaviors.
Childhood Origins, Migration, and First Modern Contraceptive Use in Turkey.
Erman J, Behrman JA
Stud Fam Plann · 2021 Dec · PMID 34708405 · Publisher ↗
This paper integrates contraception into the extant migrant-fertility framework using the case of internal migration within Turkey. Drawing from the 2013 Turkish Demographic and Health Survey data, we show that migration...
This paper integrates contraception into the extant migrant-fertility framework using the case of internal migration within Turkey. Drawing from the 2013 Turkish Demographic and Health Survey data, we show that migration is positively associated with age of first modern contraceptive use. As women's migration is quickly followed by family formation, women also take up modern contraception after first childbirth, likely due to new encounters with medical professionals, differing contraceptive access and other social exposures. We also find that women whose childhoods were spent in urban areas have a higher risk of first modern contraception relative to women from rural areas, thus suggesting the enduring importance of socialization. These results show how selection processes, life-cycle factors, and sociocultural norms jointly shape modern contraceptive behavior in Turkey. Our results also demonstrate a need for increased reproductive care in rural areas and suggest continued fertility decline with urban migration.
Contraceptive Method Skew in India 1992-2016: Analysis Using a New Method Skew Index.
Chaurasia AR
Stud Fam Plann · 2021 Dec · PMID 34671984 · Publisher ↗
This paper analyses method skew in India over more than two decades using a new method skew index. The analysis reveals clear regional pattern in method skew in the country. In north and east regions of the country, meth...
This paper analyses method skew in India over more than two decades using a new method skew index. The analysis reveals clear regional pattern in method skew in the country. In north and east regions of the country, method skew is average and below average, but it is high or very high in the south region. We investigate roles of such factors as poverty, education, social class, and religion in deciding the method skew at the district level using the classification modeling approach and find that the roles of these factors are different in different regions of the country. An important finding of the analysis is that there is a positive correlation between the degree of the method skew and contraceptive prevalence at the district level.
Demographic and Fertility Characteristics of Contraceptive Clusters in Burundi.
MacQuarrie KLD, Allen C, Gemmill A
Stud Fam Plann · 2021 Dec · PMID 34626481 · Full text
Examining women's reproductive experiences over time reveals a more dynamic view of women's behaviors and needs than current status measures alone. This study uses sequence and cluster analyses, which are designed for id...
Examining women's reproductive experiences over time reveals a more dynamic view of women's behaviors and needs than current status measures alone. This study uses sequence and cluster analyses, which are designed for identifying patterns and subgroups in longitudinal data. We apply these methods to contraceptive calendar data in Burundi to identify discrete clusters of women based on contraceptive and pregnancy behaviors over the past 5 years. We identify six unique clusters; three characterized by no use of contraception (85 percent of women) and three by use (16 percent). The Quiet Calendar cluster (42 percent) comprise women who neither experience pregnancy nor use contraception. Family Builder 1 (25 percent) and 2 (18 percent) both include women who experience two pregnancies, but differ in unmet need and lifetime experience with contraception. Modern Mother (8 percent), Consistently Covered Mother (6 percent), and Traditional Mother (2 percent) clusters differ by type of contraception used following pregnancy. Factors associated with cluster membership are need for family planning, lifetime experience with contraception, marital status, pregnancy intention, and age. This clustering approach provides a new, more holistic way to measure the diverse needs across unique subpopulations and can inform the development of multifaceted, adaptable strategies to meet women's dynamic fertility needs over the reproductive life course.
The Impact of Mass Media-Delivered Family Planning Campaigns in Low- and Middle-Income Countries: A Meta-Analysis of Advertising and Entertainment-Education Format Effects.
Rogers D, Snyder LB, Rego M
Stud Fam Plann · 2021 Dec · PMID 34585400 · Publisher ↗
Effective family planning methods are shown to save lives, contribute to gender equality, and boost economic development. Mass media communication campaigns in low- and middle-income countries have been effective in incr...
Effective family planning methods are shown to save lives, contribute to gender equality, and boost economic development. Mass media communication campaigns in low- and middle-income countries have been effective in increasing contraceptive use, although the strategies that increase the likelihood of success are unclear. The present study uses meta-analyses to uncover the average effect of media campaigns on family planning behaviors in low- and middle-income countries and to examine the effectiveness of two communication strategies: entertainment-education and advertising/public service announcements. Results indicated that mass media-delivered family planning campaigns have a positive impact on family planning behaviors: d = 0.19, 95% CI [0.15, 0.24] for women (k = 64), d = 0.16, 95% CI [0.11, 0.21] for men (k = 27), and d = 0.20, 95% CI [0.17, 0.23] for an undifferentiated target group of men and women (k = 37). The use of an entertainment-education format, often in addition to campaign advertising messages, was associated with greater campaign success rates for women. Men, however, responded negatively to education-entertainment and positively to campaigns using only advertising and public service announcement formats. Recommendations for future family planning mass media campaigns and academic research opportunities are discussed.
Contraceptive Conversations among Adolescent Girls and Young Women and Their Partners, Peers, and Older Female Family Members in Lilongwe, Malawi: A QualitativeAnalysis.
Bhushan NL, Phanga T, Maseko B … +6 more , Vansia D, Kamtsendero L, Gichane MW, Maman S, Pettifor AE, Rosenberg NE
Stud Fam Plann · 2021 Dec · PMID 34585384 · Full text
In sub-Saharan Africa, adolescent girls and young women (AGYW) have high levels of unmet need for contraception, particularly those who are unmarried or nulliparous. Conversations with partners, peers, and family members...
In sub-Saharan Africa, adolescent girls and young women (AGYW) have high levels of unmet need for contraception, particularly those who are unmarried or nulliparous. Conversations with partners, peers, and family members influence AGYW contraceptive decision-making yet little is known about conversation content and impact or how they vary by relationship status and parity. This paper draws on qualitative data from 60 AGYW (aged 15-24) participating in a sexual and reproductive health study in Malawi to examine contraceptive conversation patterns among participants and their social ties. AGYW's relationship status and parity influenced whether they talked about contraceptives, who they talked to about contraceptives, and the type of contraceptives that were endorsed during conversations. Unmarried and nulliparous AGYW were less likely to discuss contraceptives with all social ties and when conversations occurred, norms and misinformation regarding nonbarrier methods were reinforced, and condoms were largely prescribed. Conversations with intimate partners often provided permission for contraceptive use while conversations with peers and older women in the family provided information on contraceptive methods. Our results highlight the unique roles that social ties play in AGYW contraceptive decision-making and suggest that existing contraceptive conversation patterns might exclude unmarried, nulliparous AGYW from accurate and comprehensive contraceptive information and options.
Measuring Family Planning Provider Bias: A Discrete Choice Experiment among Burkinabé, Pakistani, and Tanzanian Providers.
Dieci M, Wagner Z, Friedman W … +5 more , Burgess S, Vandermark J, McCoy SI, Shah M, Dow WH
Stud Fam Plann · 2021 Sep · PMID 34472623 · Full text
The unmet need for modern contraception remains high around the world, particularly for youth. While some of this unmet need is driven by limited health infrastructure and method mix availability, many adolescents who vi...
The unmet need for modern contraception remains high around the world, particularly for youth. While some of this unmet need is driven by limited health infrastructure and method mix availability, many adolescents who visit family planning providers still do not receive methods that fit their needs. This suggests that providers may be biased against youth and that interventions to change provider behavior could help close this gap. However, it is unclear if this bias is a result of age or other characteristics common among young women such as not being married and not having children. We use a discrete choice experiment in Burkina Faso, Pakistan, and Tanzania to disentangle the effects of age on providers' decisions to provide contraception from the effects of other potential confounding factors. We find that, although young women may experience the most bias, age is not the main driver. Rather, marital status and parity seem to influence provider decisions to offer services or counsel on modern methods. These findings suggest that interventions to reduce provider bias should focus on changing behavior towards unmarried and nulliparous women, regardless of their age.
Assessing the Reliability of the Retrospective Reproductive Calendar: Evidence from Urban Kenya.
Tumlinson K, Curtis SL
Stud Fam Plann · 2021 Dec · PMID 34390002 · Full text
The reproductive calendar is a data collection tool that collects month-by-month retrospective histories of contraceptive use. This survey instrument is implemented in large-scale demographic surveys, but its reliability...
The reproductive calendar is a data collection tool that collects month-by-month retrospective histories of contraceptive use. This survey instrument is implemented in large-scale demographic surveys, but its reliability is not well-understood. Our analysis helps to address this research gap, using longitudinal panel data with overlapping calendars from urban Kenya. Our findings indicate calendar data collected in 2014 underestimated 2012 reports of current use by 5 percentage points. And while the overall percentage of women reporting at least one episode of contraceptive use was similar across the two calendars (67 percent vs. 70 percent), there was notable disagreement in contraceptive behavior when comparing the histories of individual women; less than 20 percent of women with any contraceptive use reported the exact same pattern of use in both calendars. Low calendar reliability was especially apparent for younger women and those with complicated contraceptive histories. Individual-level discordance resulted in a small difference in 12-month discontinuation rates for the period of calendar overlap; when surveyed in 2014, women reported a 12-month discontinuation rate of 39 percent, compared to a rate of 34 percent reported in 2012. When using retrospective calendar data, attention must be paid to the potential for individual reporting errors.
Is Client Reporting on Contraceptive Use Always Accurate? Measuring Consistency and Change with a Multicountry Study.
Tsui AO, Cardona C, Srivatsan V … +8 more , OlaOlorun F, Omoluabi E, Akilimali P, Gichangi P, Thiongo M, PMA Agile Team, Radloff S, Anglewicz P
Stud Fam Plann · 2021 Sep · PMID 34383305 · Publisher ↗
The consistency of self-reported contraceptive use over short periods of time is important for understanding measurement reliability. We assess the consistency of and change in contraceptive use using longitudinal data f...
The consistency of self-reported contraceptive use over short periods of time is important for understanding measurement reliability. We assess the consistency of and change in contraceptive use using longitudinal data from 9,390 urban female clients interviewed in DR Congo, India, Kenya, Niger, Nigeria, and Burkina Faso. Clients were interviewed in-person at a health facility and four to six months later by phone. We compared reports of contraceptive use at baseline with recall of baseline contraceptive use at follow-up. Agreement between these measures ranged from 59.1 percent in DR Congo to 84.4 percent in India. Change in both contraceptive method type (sterilization, long-acting, short-acting, nonuse) and use status (user, nonuser, discontinuer, adopter, switcher) was assessed comparing baseline to follow-up reports and retrospective versus current reports within the follow-up survey. More change in use was observed with panel reporting than within the cross section. The percent agreement between the two scenarios of change ranged from 64.8 percent in DR Congo to 84.5 percent in India, with cross-site variation. Consistently reported change in use status was highest for nonusers, followed by users, discontinuers, adopters, and switchers. Inconsistency in self-reported contraceptive use, even over four to six months, was nontrivial, indicating that studying measurement reliability of contraceptive use remains important.
Birth Collapse and a Large-Scale Access Intervention with Subdermal Contraceptive Implants.
Ceni R, Parada C, Perazzo I … +1 more , Sena E
Stud Fam Plann · 2021 Sep · PMID 34339522 · Publisher ↗
Between 2016 and 2018, we observe in Uruguay a steep decline of almost 20 percent in the number of total births, leading to the collapse of the adolescent fertility rate after decades of relative stagnation. We estimate...
Between 2016 and 2018, we observe in Uruguay a steep decline of almost 20 percent in the number of total births, leading to the collapse of the adolescent fertility rate after decades of relative stagnation. We estimate the quantitative contribution on birth rates, especially teen births, of a policy of expanded availability of subdermal contraceptive implants. We exploit the expansion schedule of a large-scale policy of free-of-charge access to subdermal implants in the country's public health system through an event study to capture causal effects. We use detailed birth administrative records for the past 20 years. We document an average reduction of 3 percent in the birth rate in public health facilities across the two years after the policy was implemented in each department. These reductions were notably higher among teens and first births. Although changes in women's fertility decisions are a multicausal phenomenon, we claim that the expanded availability of subdermal contraceptive implants accounted for one-third of the teen and young women's birth collapse.
Safety, Quality, and Acceptability of Contraceptive Implant Provision by Community Health Extension Workers versus Nurses and Midwives in Two States in Nigeria.
Douthwaite M, Alabi O, Odogwu K … +8 more , Reiss K, Taiwo A, Ubah E, Uko-Udoh A, Afolabi K, Church K, Fenty J, Munroe E
Stud Fam Plann · 2021 Sep · PMID 34297857 · Full text
Task sharing is a strategy with potential to increase access to effective modern contraceptive methods. This study examines whether community health extension workers (CHEWs) can insert contraceptive implants to the same...
Task sharing is a strategy with potential to increase access to effective modern contraceptive methods. This study examines whether community health extension workers (CHEWs) can insert contraceptive implants to the same safety and quality standards as nurse/midwives. We analyze data from 7,691 clients of CHEWs and nurse/midwives who participated in a noninferiority study conducted in Kaduna and Ondo States, Nigeria. Adverse events (AEs) following implant insertions were compared. On the day of insertion AEs were similar among CHEW and nurse/midwife clients-0.5 percent and 0.4 percent, adjusted odds ratio (aOR) 0.92 (95 percent CI 0.38-2.23)-but noninferiority could not be established. At follow-up 6.6 percent of CHEW clients and 2.1 percent of nurse/midwife clients experienced AEs. There was strong evidence of effect modification by State. In the final adjusted model, odds of AEs for CHEW clients in Kaduna was 3.34 (95 percent CI 1.53-7.33) compared to nurse/midwife clients, and 0.72 (95 percent CI 0.19-2.72]) in Ondo. Noninferiority could not be established in either State. Implant expulsions were higher among CHEW clients (142/2987) compared to nurse/midwives (40/3517). Results show the feasibility of training CHEWs to deliver implants in remote rural settings but attention must be given to provider selection, training, supervision, and follow-up to ensure safety and quality of provision.
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