International Perspectives On Sexual And Reproductive Health[JOURNAL]
Sun
200 papers
Reproductive Autonomy Is Nonnegotiable, Even in the Time of COVID-19.
Senderowicz L, Higgins J
Int Perspect Sex Reprod Health · 2020 Aug · PMID 32790638 · Publisher ↗
The COVID-19 pandemic has swept across the world, altering nearly every facet of contemporary life and causing behavioral and socioeconomic changes that seemed unthinkable a few months ago. The increased risks for human...
The COVID-19 pandemic has swept across the world, altering nearly every facet of contemporary life and causing behavioral and socioeconomic changes that seemed unthinkable a few months ago. The increased risks for human health include not just the dangers posed by the virus itself, but also the upheaval to the broader health care and societal landscapes, which has threatened access to critical sexual and reproductive health services. In this viewpoint, we describe how the pandemic has already posed challenges to reproductive autonomy in both the United States and globally, and then offer insights on how it may do so in the future. We conclude with a call not only to resist a rollback of access to reproductive health care during this pandemic, but to center a broad conception of reproductive autonomy in sexual and reproductive health research, policies and programs moving forward.
Perceived Conflicting Desires to Delay the First Birth: A Household-Level Exploration in Nepal.
Diamond-Smith N, Plaza N, Puri M … +3 more , Dahal M, Weiser SD, Harper CC
Int Perspect Sex Reprod Health · 2020 Jul · PMID 32723708 · Full text
CONTEXT: It is accepted as the norm that couples in South Asia begin childbearing immediately after marriage and that, even if they would like to delay, they are pressured to have children by household members. Little re...
CONTEXT: It is accepted as the norm that couples in South Asia begin childbearing immediately after marriage and that, even if they would like to delay, they are pressured to have children by household members. Little research, however, has explored the desire to delay childbearing among newly married couples and their household members in Nepal-a setting with changing marriage formation patterns, increasing women's education and falling fertility. METHODS: To explore the dynamics of current childbearing desires, in-depth interviews of 20 intact triads of newly married women, their husbands and their mothers-in-law were conducted in one district of Nepal in February-March 2017. Using thematic analysis, interviews were read and coded separately by type (wives, husbands, mothers-in-law), and then the triads were read together and coded to determine household-level patterns and themes. RESULTS: Most newly married women and men want to delay their first birth, but have not communicated with each other about this. Even though couples are often in agreement about delaying, they feel pressured by in-laws and society to bear children early. Contrary to expectations, some mothers-in-law support delaying childbearing to allow their daughter-in-law to mature, continue her education or earn wages; however, they too perceive societal pressure. Male migration for work also contributes to early childbearing pressure. CONCLUSIONS: Helping couples to sort through conflicting fertility norms and desires may be important to delay childbearing when desired. Programs should engage all household members, and work to increase couples' and household communication to address misperceptions about fertility desires.
Explaining the Education-Health Gradient in Preventing STIs in Andean Peru: Cognitive Executive Functioning, Awareness and Health Knowledge.
Muñoz IG, Baker DP, Peters E
Int Perspect Sex Reprod Health · 2020 Jul · PMID 32701061 · Full text
CONTEXT: Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of...
CONTEXT: Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of preventive behavior (e.g., condom use); however, evidence supporting this mechanism has been limited. METHODS: Survey data were collected in 2010 from a sample of 247 adults aged 30-62 living in an isolated Andean district of Peru; these individuals had widely varying exposure to schooling, and their community had recently experienced elevated risks of STIs. Structural equation modeling was used to estimate the degree to which schooling is associated with cognitive resources, STI awareness and sexual health knowledge, and how these jointly are associated with ever-use of condoms. RESULTS: Thirty-two percent of respondents reported ever-use of condoms. One additional year of schooling was associated with a 2.7-percentage-point increase in the probability of condom use, after adjustment for covariates. The pathway between education and condom use was mediated by cognitive executive functioning (CEF) skills (0.26 standard deviations), STI awareness (0.09) and sexual health knowledge (0.10); CEF skills were associated with condom use both directly and indirectly, through STI awareness and sexual health knowledge, and accounted for two-thirds of the education-condom use gradient. CONCLUSIONS: The relationship between education and STI prevention may be more complex than is often assumed and is mediated by CEF skills, STI awareness and sexual health knowledge. Studies should examine whether STI prevention interventions are more effective if they enhance cognitive skills used to translate information into protective behaviors.
The Health System Costs of Postabortion Care in Senegal.
Lince-Deroche N, Sene I, Pliskin E … +2 more , Owolabi OO, Bankole A
Int Perspect Sex Reprod Health · 2020 Jun · PMID 32584778 · Publisher ↗
CONTEXT: Unsafe abortion is common in Senegal, but postabortion care (PAC) is not accessible to some women who need it, and the cost to the health care system of providing PAC is unknown. METHODS: The cost to Senegal's h...
CONTEXT: Unsafe abortion is common in Senegal, but postabortion care (PAC) is not accessible to some women who need it, and the cost to the health care system of providing PAC is unknown. METHODS: The cost to Senegal's health system of providing PAC in 2016-at existing service levels and if access were hypothetically expanded-was estimated using the Post-Abortion Care Costing Methodology, a bottom-up, ingredients-based approach. From September 2016 to January 2017, face-to-face interviews were conducted with PAC providers and facility administrators at a national sample of 41 health facilities to collect data on the direct and indirect costs of care provision, as well as the fees charged to patients. A sensitivity analysis was conducted to examine the precision of the results. RESULTS: In total, 1,642 women received PAC at study facilities in 2016, which translates to 18,806 women receiving PAC nationally. Public facilities provided nearly all services. The average cost per patient at study facilities was US$26.68; nationally, the estimated cost was US$24.72. The estimated total national cost of providing PAC at existing levels was US$464,928; direct costs accounted for more than three-quarters of the cost. Charges to PAC patients amounted to 20% of all incurred costs. If service provision had been expanded to meet all PAC needs, estimated total costs to the health system would have been US$804,518. CONCLUSION: The annual costs of PAC are substantial in Senegal. Greater investment in ensuring access to contraceptives could lower these costs by reducing the number of unintended pregnancies that often lead to unsafe abortion.
Provision of Emergency Contraceptive Pills in Kinshasa's Informal Drug Shops: Results from a Mystery Client Study.
Hernandez JH, Akilimalib P, Mbadu MF
Int Perspect Sex Reprod Health · 2020 Jun · PMID 32538791 · Publisher ↗
CONTEXT: Despite the prominence of informal drug shops as sources of contraceptives in Kinshasa, Democratic Republic of the Congo, evidence on the quality of services they provide is scant. Given efforts to leverage the...
CONTEXT: Despite the prominence of informal drug shops as sources of contraceptives in Kinshasa, Democratic Republic of the Congo, evidence on the quality of services they provide is scant. Given efforts to leverage the private sector to increase contraceptive access, evaluating the contraceptive knowledge, attitudes and practices of these providers is warranted. METHODS: In April-May 2018, a mystery client study on the provision of emergency contraception (EC) was conducted in 854 informal drug shops in Kinshasa. Twelve mystery clients, presenting as younger or older than 18 and married or unmarried, visited the outlets to request something to "avoid getting pregnant" after unprotected sex, and to purchase the recommended medicine. Frequencies of key outcomes were calculated, and chi-square testing assessed associations between client age and marital status and the methods and counseling received. RESULTS: Overall, providers recommended EC in 77% of visits, and in 54% of visits, clients left with the method. In 62% of the visits in which providers recommended EC, they specified a time frame for taking the pill; the correct window of efficacy was indicated in 75% of these visits. In 18% of visits, other (noncontraceptive) drugs were provided, and in 7% of visits, providers did not help the client. Regardless of the visit outcome, providers were nearly always deemed respectful (96%). CONCLUSIONS: Leveraging informal outlets to increase contraceptive provision will require identifying quality outlets, strengthening supply chains and advocating for policy changes that recognize them as effective contraceptive providers without decreasing their perceived advantages for women.
Modern Contraceptive Use Following an Unplanned Birth in Bangladesh: An Analysis of National Survey Data.
Khan MN, Harris M, Loxton D
Int Perspect Sex Reprod Health · 2020 May · PMID 32401729 · Publisher ↗
CONTEXT: Ineffective use or nonuse of contraceptives following an unplanned birth can contribute to the risk of a subsequent unintended pregnancy; however, the literature on the relationship between unintended pregnancy...
CONTEXT: Ineffective use or nonuse of contraceptives following an unplanned birth can contribute to the risk of a subsequent unintended pregnancy; however, the literature on the relationship between unintended pregnancy and postpartum contraceptive use is sparse, especially in low- and middle-income countries. METHODS: Data on 4,493 women from the 2014 Bangladesh Demographic and Health Survey were analyzed; the subjects of the analysis had had a live birth in the three years prior to the survey and were currently at risk of pregnancy. Multilevel logistic regression analysis was used to examine associations between the intendedness of a woman's last pregnancy resulting in a live birth and her current modern contraceptive use adjusting for individual, household and community-level variables. RESULTS: Twenty-six percent of women reported that their last pregnancy resulting in a live birth had been unintended (15% mistimed and 11% unwanted); 61% reported current use of a modern contraceptive method. Compared with women who reported the pregnancy as having been wanted, those who reported the pregnancy as mistimed had greater odds of current modern contraceptive use (odds ratio, 1.6); no association was found between having had an unwanted pregnancy and subsequent modern contraceptive use. Other important correlates of modern contraceptive use included women's autonomy and desire for children, time since last birth and community-level poverty. CONCLUSIONS: Bangladeshi women who experience an unwanted pregnancy may have an elevated risk of subsequent unintended pregnancy. Broader coverage of family planning services, and integration of family planning with maternal health care, may increase modern contraceptive use following an unplanned birth.
Exploring Conscientious Objection to Abortion Among Health Providers in Ghana.
Awoonor-Williams JK, Baffoe P, Aboba M … +5 more , Ayivor P, Nartey H, Felker B, Van der Tak D, Biney AAE
Int Perspect Sex Reprod Health · 2020 May · PMID 32375118 · Publisher ↗
CONTEXT: Few studies have explored clinicians' roles in the abortion experience in Ghana. Examining how clinicians understand conscientious objection to abortion-the right to refuse to provide legal abortion on the basis...
CONTEXT: Few studies have explored clinicians' roles in the abortion experience in Ghana. Examining how clinicians understand conscientious objection to abortion-the right to refuse to provide legal abortion on the basis of moral or personal beliefs-may provide insight that could help manage the practice. METHODS: Eight in-depth interviews and four focus group discussions were conducted with 14 doctors and 20 midwives in health facilities in Ghana's Eastern and Volta Regions in May 2018. The semi-structured interview guides covered such topics as clinicians' understanding of conscientious objection, how it is practiced and the consequences of conscientious objection for providers and clients. The data were analyzed using thematic analysis. RESULTS: Most clinicians did not understand the term "conscientious objection," and midwives had more knowledge on the subject than doctors. The main reasons for conscientious objection were antiabortion religious and cultural beliefs. Clinicians who objected referred clients to willing providers, counseled them to continue the pregnancies or inadvertently encouraged unsafe abortions. The negative consequences of conscientious objection to abortion for clients were complications and death from unsafe abortions; the consequences for providers included high patient volume and stigma for nonobjectors, leading some to claim objection to avoid these. CONCLUSIONS: The findings highlight the need for further research on the consequences of conscientious objection, including stigma leading to refusals. Such research may ultimately help to restrict clinicians' misuse of the right to object and improve women's reproductive health care in Ghana.
Addressing Abortion Provider Stigma: A Pilot Implementation of the Providers Share Workshop in Sub-Saharan Africa and Latin America.
Mosley EA, Martin L, Seewald M … +8 more , Hassinger J, Blanchard K, Baum SE, Santana D, Echeverri L, Garrett J, Njunguru J, Harris LH
Int Perspect Sex Reprod Health · 2020 Apr · PMID 32375117 · Publisher ↗
CONTEXT: In much of Sub-Saharan Africa and Latin America, abortion is legally restricted, and abortion providers experience stigma and legal jeopardy. The Providers Share Workshop group intervention has been shown to red...
CONTEXT: In much of Sub-Saharan Africa and Latin America, abortion is legally restricted, and abortion providers experience stigma and legal jeopardy. The Providers Share Workshop group intervention has been shown to reduce provider stigma in the United States, but has not been evaluated in other settings. METHODS: In 2014-2015, the Providers Share Workshop was adapted and piloted among 59 abortion caregivers from three Sub-Saharan African countries and 93 caregivers from seven Latin American countries. Survey data collected before, directly following and six months after each workshop measured stigma, attitudes, and legal safety and advocacy engagement, using original items and adapted scales. Univariate analyses and baseline pairwise correlations were used to measure changes in outcomes over time, and between demographic characteristics and outcomes. Mixed-effects linear regressions and multivariable models controlling for demographics were used to assess changes in outcomes over time. RESULTS: Six months after workshop participation, total abortion stigma had decreased among caregivers in Sub-Saharan Africa and in Latin America (beta coefficients, -0.2 and -0.4, respectively). Unfavorable attitudes had decreased in Africa (-0.2) but not in Latin America, where attitudes were favorable to start; emotional exhaustion and depersonalization also had decreased in Africa (-2.9 and -1.2), and legal safety had increased (0.8). Increased total abortion stigma was negatively associated with legal safety, in both Africa and Latin America (-1.9 and -0.6), and with legal advocacy in Africa (-1.5). CONCLUSIONS: The Providers Share Workshop is a promising intervention to support the abortion care workforce in Sub-Saharan African and Latin American settings.
Perceived Infertility Among Young Adults in Balaka, Malawi.
Polis CB, Moore AM, Chilungo A … +1 more , Yeatman S
Int Perspect Sex Reprod Health · 2020 May · PMID 32375116 · Full text
CONTEXT: Perceived infertility-an individual's belief that she or he is unable to conceive or impregnate a partner-may lead to contraceptive nonuse and unintended pregnancy, among other concerns, but has not been widely...
CONTEXT: Perceived infertility-an individual's belief that she or he is unable to conceive or impregnate a partner-may lead to contraceptive nonuse and unintended pregnancy, among other concerns, but has not been widely studied in low-income settings. METHODS: A measure of perceived infertility previously used in the United States was included in a 2015 survey of young adults in Balaka, Malawi. The prevalence of potential perceived infertility (i.e., believing it is a little or substantially likely that one is infertile, or would have difficulty getting pregnant or impregnating a partner; PPI) was estimated among the analytic sample of 1,064 women and 527 men aged 21-29. Multivariable logistic regression was used to identify variables associated with PPI; respondents' reasons for PPI and their estimates of the probability of pregnancy after unprotected sex were also investigated. RESULTS: The prevalence of PPI was 8% overall, and 20% among nulliparous women. Factors associated with PPI and reasons for PPI varied by gender. For women, PPI was significantly associated with age, education, an interaction term between age and education, number of sexual partners, feelings if she were to become pregnant next month, parity and contraceptive use. For men, PPI was associated with an interaction term between age and education, number of sex partners and marital status. Respondents tended to overestimate the probability of pregnancy after unprotected sex. CONCLUSIONS: Perceived infertility was lower in Malawi than in the United States, although substantial among certain subgroups. Educational interventions aimed at increasing knowledge about pregnancy probabilities and the return of fertility after contraceptive discontinuation may reduce concerns around perceived infertility.
Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- and Middle-Income Countries.
Riley T, Sully E, Ahmed Z … +1 more , Biddlecom A
Int Perspect Sex Reprod Health · 2020 Apr · PMID 32343244 · Publisher ↗
The novel coronavirus (SARS-CoV-2) that causes COVID-19 has spread rapidly since emerging in late 2019, leading the World Health Organization (WHO) to declare the disease a global pandemic on March 11, 2020. Governments...
The novel coronavirus (SARS-CoV-2) that causes COVID-19 has spread rapidly since emerging in late 2019, leading the World Health Organization (WHO) to declare the disease a global pandemic on March 11, 2020. Governments around the world have had to quickly adapt and respond to curb transmission of the virus and to provide care for the many who have been infected. The strain that the outbreak imposes on health systems will undoubtedly impact the sexual and reproductive health of individuals living in low- and middle-income countries (LMICs); however, sexual and reproductive health will also be affected by societal responses to the pandemic, such as local or national lockdowns that force health services to shut down if they are not deemed essential, as well as the consequences of physical distancing, travel restrictions and economic slowdowns.
Applying Inverse Probability Weighting to Measure Contraceptive Prevalence Using Data from a Community-Based Reproductive Health Intervention in Pakistan.
Özçelik EA, Rohr J, Hackett K … +2 more , Shah I, Canning D
Int Perspect Sex Reprod Health · 2020 Apr · PMID 32301732 · Publisher ↗
CONTEXT: Many community-based reproductive health programs use their program data to monitor progress toward goals. However, using such data to assess programmatic impact on outcomes such as contraceptive use poses metho...
CONTEXT: Many community-based reproductive health programs use their program data to monitor progress toward goals. However, using such data to assess programmatic impact on outcomes such as contraceptive use poses methodological challenges. Inverse probability weighting (IPW) may help overcome these issues. METHODS: Data on 33,162 women collected in 2013-2015 as part of a large-scale community-based reproductive health initiative were used to produce population-level estimates of the contraceptive prevalence rate (CPR) and modern contraceptive prevalence rate (mCPR) among married women aged 15-49 in Pakistan's Korangi District. To account for the nonrandom inclusion of women in the sample, estimates of contraceptive prevalence during the study's four seven-month intervention periods were made using IPW; these estimates were compared with estimates made using complete case analysis (CCA) and the last observation carried forward (LOCF) method-two approaches for which modeling assumptions are less flexible. RESULTS: In accordance with intervention protocols, the likelihood that women were visited by intervention personnel and thus included in the sample differed according to their past and current contraceptive use. Estimates made using IPW suggest that the CPR increased from 51% to 64%, and the mCPR increased from 34% to 53%, during the study. For both outcomes, IPW estimates were higher than CCA estimates, were generally similar to LOCF estimates and yielded the widest confidence intervals. CONCLUSION: IPW offers a powerful methodology for overcoming estimation challenges when using program data that are not representative of the population in settings where cost impedes collection of outcome data for an appropriate control group.
Contraceptive Use Behavior Change After an Unintended Birth in Colombia and Peru.
Batyra E
Int Perspect Sex Reprod Health · 2020 Mar · PMID 32142469 · Publisher ↗
CONTEXT: No studies using longitudinal contraceptive histories have investigated whether having an unintended birth (i.e., one resulting from an unintended pregnancy) is associated with change in contraceptive behavior,...
CONTEXT: No studies using longitudinal contraceptive histories have investigated whether having an unintended birth (i.e., one resulting from an unintended pregnancy) is associated with change in contraceptive behavior, including in Colombia and Peru, where levels of unintended fertility remain high. METHODS: Monthly reproductive history calendar data from the 2010 Colombia and 2012 Peru Demographic and Health Surveys were used to study contraceptive behavior among 13,373 and 7,425 women, respectively. Transition matrices and hazard models were utilized to identify associations between prepregnancy and postpartum contraceptive methods used, and to assess how these relationships differed between women who reported an unintended birth and those with an intended birth. RESULTS: Women who had been using a traditional, barrier or (in Colombia) short-acting hormonal method before pregnancy were more likely to choose a more effective method postpartum, than to use no method, if their birth had been unintended rather than intended (relative risk ratios, 1.2-1.3 in Colombia; 1.6 in Peru). Compared with their counterparts whose birth had been intended, women with an unintended birth who had been utilizing the most effective methods used in the country (IUD or implant in Colombia, pill or injectable in Peru) were less likely to resume using them postpartum than to use no method (0.7 in Colombia; 0.8 in Peru). CONCLUSIONS: Unintended birth is associated with change in contraceptive behavior. Efforts to understand postpartum contraceptive choices of women who have had an unintended birth should take into account contraceptive behavior at more than one point in women's reproductive lives.
The Extended Role of Health Facility Cleaners in Maternity Care in Kenya.
Golub G, Sudhinaraset M, Giessler K … +2 more , Dunlop-Korsness K, Stone A
Int Perspect Sex Reprod Health · 2020 Jan · PMID 31990643 · Publisher ↗
CONTEXT: A growing body of evidence indicates that nonclinical health care facility staff provide support beyond their traditional roles, particularly in low- and middle-income countries. It is important to examine the r...
CONTEXT: A growing body of evidence indicates that nonclinical health care facility staff provide support beyond their traditional roles, particularly in low- and middle-income countries. It is important to examine the role of health facility cleaners in Kenya-from their perspective-to better understand their actual and perceived responsibilities in maternity care. METHODS: In-depth, face-to-face interviews using a semistructured guide were conducted with 14 cleaners working at three public health facilities in Nairobi and Kiambu Counties, Kenya, in August and September 2016. Results were coded and categorized using a thematic content analysis approach. RESULTS: Cleaners reported performing a range of services beyond typical maintenance responsibilities, including providing emotional, informational and instrumental support to maternity patients. They described feeling disrespected when patients were untidy or experienced bleeding; however, such examples revealed cleaners' need to better understand labor and childbirth processes. Cleaners also indicated a desire for training on interpersonal skills to improve their interactions with patients. CONCLUSION: Cleaners' direct involvement in maternity patients' care is an alarming symptom of overburdened health facilities, insufficient staffing and inadequate training. This key yet overlooked cadre of health care staff deserves appropriate support and further research to understand and alleviate health system shortcomings, and to improve the quality of maternity health care provision.
Partnering with Private Providers to Promote Long-Acting Contraceptives in Urban Bangladesh: A Mixed-Methods Feasibility Study.
Bates L, Huque R, Bhowmik P … +4 more , King R, Elsey H, Newell J, Walley J
Int Perspect Sex Reprod Health · 2019 Dec · PMID 31895041 · Publisher ↗
CONTEXT: Bangladesh's pluralistic health system has diversified opportunities for clients to obtain family planning, but public-private partnerships could improve access to services, particularly in urban areas. METHOD:...
CONTEXT: Bangladesh's pluralistic health system has diversified opportunities for clients to obtain family planning, but public-private partnerships could improve access to services, particularly in urban areas. METHOD: Sixteen providers, clients and program managers were interviewed to assess perspectives on a family planning orientation and demand-side financing referral program tested in Mirpur, Bangladesh. The 15-month program, conducted in 2015-2016, was designed to encourage private providers to identify non-family planning clients with unmet contraceptive needs, promote choice of a broader contraceptive mix and refer clients to one of three public or nonprofit clinics for provision of their preferred method. Use of the system was assessed by tracking referral slips. RESULTS: Most stakeholders reported that it was acceptable and feasible to discuss fertility intentions with clients presenting for non-family planning matters. Providers were able to alleviate clients' misconceptions and fears concerning long-acting contraceptive methods, but were unable to address patriarchal and religious barriers. The majority of referrals were done by private providers who had a pre-existing relationship with one of the family planning clinics and referred clients to that clinic; overall, documented referrals accounted for 13% of provision of reversible and permanent methods at that clinic during the study period. CONCLUSIONS: Providing private practitioners with appropriate training on contraceptives and referral could improve Bangladeshi women's access to long-acting and other contraceptive methods in urban areas, and may be useful for other types of health workers. Further study of suitable referral systems is warranted.
Male Participation in Reproductive Health Interventions in Sub-Saharan Africa: A Scoping Review.
Nkwonta CA, Messias DKH
Int Perspect Sex Reprod Health · 2019 Dec · PMID 31859670 · Publisher ↗
CONTEXT: Despite improvements in reproductive health indicators among women living in Sub-Saharan Africa, the persistence of poor outcomes underscores the need to examine recent interventions to inform future research, p...
CONTEXT: Despite improvements in reproductive health indicators among women living in Sub-Saharan Africa, the persistence of poor outcomes underscores the need to examine recent interventions to inform future research, programming and policy. Because men in this context have an outsize role in reproductive decision making, assessing their involvement in reproductive health programs is an important step in meeting men's needs, supporting women's health and improving family health. METHODS: A scoping review was conducted to identify relevant literature and assess evidence of the impact of male involvement in reproductive health interventions. Seven databases were searched using terms related to male involvement and reproductive health; searches were limited to research conducted in Sub-Saharan Africa and published in English between 2007 and 2018. Remaining studies were assessed by participant characteristics, settings, research design, theoretical frameworks, outcome measures and findings. RESULTS: Searches identified 18 studies conducted in eight countries. Interventions engaged participants by using such strategies as community health workers, written invitation, peers, community or religious leaders and media campaigns. Results show that men are willing to participate in reproductive health programs and that their involvement is associated with increased uptake of family planning services, and HIV counseling and testing; reduction in risk behaviors; and improved maternal health and spousal communication. CONCLUSIONS: Given the findings that male involvement is positively associated with improved reproductive health outcomes in Sub-Saharan Africa, health providers and program planners should consider including men in reproductive health interventions, when feasible.
Feasibility and Safety of IUD Insertion by Mid-Level Providers in Sub-Saharan Africa.
Mhlanga FG, Balkus JE, Singh D … +7 more , Chappell C, Kamira B, Harkoo I, Szydlo D, Mukaka S, Piper J, Hillier SL
Int Perspect Sex Reprod Health · 2019 Dec · PMID 31859669 · Full text
CONTEXT: The copper IUD is safe and effective, but underutilized in Sub-Saharan Africa, in part because of a lack of trained providers. The World Health Organization recommends training mid-level providers-including nurs...
CONTEXT: The copper IUD is safe and effective, but underutilized in Sub-Saharan Africa, in part because of a lack of trained providers. The World Health Organization recommends training mid-level providers-including nurses and midwives-to insert IUDs; however, the safety of such task shifting has not been evaluated in Sub-Saharan Africa. METHODS: Data were drawn from baseline surveys and study charts of 535 sexually active women aged 18-45 who used a copper IUD while participating in an HIV-prevention clinical trial conducted from August 2012 through June 2015 in Malawi, South Africa, Uganda and Zimbabwe. IUDs were inserted by study physicians, nurses and midwives trained as part of the trial, and by local nonstudy providers. Chi-square and Fisher's exact tests were used to compare women's experiences of adverse events-such as irregular bleeding, pelvic pain or device expulsion-by provider type. RESULTS: Half (54%) of women reported experiencing an adverse event; the most common were irregular bleeding and pelvic pain (45% and 25%, respectively). Compared with women who had received an IUD from a study physician or study nurse, greater proportions of women who had received one from a nonstudy provider reported any adverse event (76% vs. 49% and 51%, respectively), irregular bleeding (57% vs. 41% and 45%) and pelvic pain (35% vs. 15% and 32%); the difference between study physicians and nurses was significant only for pelvic pain. Expulsion rates were comparable for study nurses and nonstudy providers (12.3 and 11.9 per 100 woman-years, respectively), but lower for study physicians (7.3 per 100 woman-years). CONCLUSIONS: The findings support task shifting of IUD insertion to mid-level providers to improve IUD access in Sub-Saharan Africa.
Missed Opportunities: Menstruation Matters for Family Planning.
Hennegan J, Tsui AO, Sommer M
Int Perspect Sex Reprod Health · 2019 Nov · PMID 31751292 · Publisher ↗
Increased global attention is being paid to the importance of adolescent and adult women's experiences of menstruation in low- and middle-income countries, and the challenges these experiences present to health, educatio...
Increased global attention is being paid to the importance of adolescent and adult women's experiences of menstruation in low- and middle-income countries, and the challenges these experiences present to health, education and gender equality. Although much of the focus has been on menarche as a window of opportunity for early engagement in young women's sexual and reproductive health, minimal attention has been paid to the natural linkages between menstrual health and hygiene and females' management of reproduction over their life course.
Drug Seller Provision Practices and Knowledge of Misoprostol in Bangladesh.
Reiss K, Keenan K, Church K … +4 more , Dijkerman S, Mitu SA, Nuremowla S, Ngo TD
Int Perspect Sex Reprod Health · 2019 Oct · PMID 31639080 · Publisher ↗
CONTEXT: In Bangladesh, prior to the availability of the approved combination regimen of mifepristone and misoprostol for menstrual regulation (MR), drug seller provision of misoprostol-only regimens for MR without a pre...
CONTEXT: In Bangladesh, prior to the availability of the approved combination regimen of mifepristone and misoprostol for menstrual regulation (MR), drug seller provision of misoprostol-only regimens for MR without a prescription was widespread but service quality was poor. Examining provider practices relating to misoprostol-only provision in Bangladesh may increase understanding of misoprostol use and provision in other low-resource, legally restrictive settings. METHODS: In 2013-2014, a countrywide cross-sectional knowledge, attitudes and practice survey was conducted among 777 randomly selected drug sellers; data were analyzed descriptively. Logistic regression was used to test the associations between exposure to three interventions designed to improve drug seller practice (nongovernmental organization [NGO]-led training, a call center and in-shop training from pharmaceutical company representatives) and correct knowledge of the misoprostol-only MR regimen. RESULTS: Almost all (97%) of the drug sellers reported providing medications intended for MR; misoprostol-only was more commonly sold than the combination regimen (96% vs. 26%). Nine percent had received NGO-led training, 62% had received in-shop training from a pharmaceutical company representative and 27% had used the call center. Overall, 19% of drug sellers knew the correct misoprostol-only MR regimen, and 74% wanted more information about this regimen. Correct regimen knowledge was positively associated with receipt of NGO training and call center utilization (odds ratios, 2.0 and 1.9, respectively). CONCLUSIONS: NGO-led training and call centers should be considered in other settings in which misoprostol alone is provided off-label for pregnancy termination.
Religion and Use of Institutional Child Delivery Services: Individual and Contextual Pathways in Mozambique.
Cau BM, Agadjanian V
Int Perspect Sex Reprod Health · 2019 Oct · PMID 31639079 · Full text
CONTEXT: Research on institutional child delivery in Sub-Saharan Africa typically focuses on availability and accessibility of health facilities. Cultural factors, including religion, that may facilitate or hinder the us...
CONTEXT: Research on institutional child delivery in Sub-Saharan Africa typically focuses on availability and accessibility of health facilities. Cultural factors, including religion, that may facilitate or hinder the use of such services have not been well examined and remain poorly understood. METHODS: The relationship between religious affiliation and delivery in a health facility was explored using data from a household survey of 1,297 women aged 18-50 and a census of 825 religious congregations, both conducted in a predominantly Christian district in Mozambique in 2008. Multilevel logistic regression analyses were conducted to predict the likelihood of recent institutional delivery according to both individual religious affiliation and the concentration of religious congregations of certain denominations in the community of residence. RESULTS: Approximately 63% of deliveries occurred in a health facility. The odds of such deliveries were lower among women who belonged to Apostolic churches or had no religious affiliation than among members of Catholic or mainline Protestant churches, net of other factors (odds ratios, 0.5 and 0.6, respectively). In addition, regardless of a woman's religion, the odds that she had an institutional delivery increased by 9% for each additional Catholic or mainline Protestant congregation in her community of residence (1.1). CONCLUSIONS: Organized religion is associated with critical health outcomes in Mozambique and, potentially, in other Sub-Saharan African contexts. Policymakers should consider designing programs and interventions that promote the use of institutional delivery services among members of religious groups characterized by low use of these services and in areas where such religious groups have a strong presence.
Closing the Poor-Rich Gap in Contraceptive Use in Rwanda: Understanding the Underlying Mechanisms.
Muhoza DN, Ruhara CM
Int Perspect Sex Reprod Health · 2019 Oct · PMID 31592771 · Publisher ↗
CONTEXT: Evidence suggests that as Rwanda has strengthened its family planning program, disparities in contraceptive use by socioeconomic status have narrowed. However, the changes in these gaps, and the mechanisms that...
CONTEXT: Evidence suggests that as Rwanda has strengthened its family planning program, disparities in contraceptive use by socioeconomic status have narrowed. However, the changes in these gaps, and the mechanisms that underlie them, are not well understood. METHODS: Data from the 2005, 2010 and 2015 Rwanda Demographic and Health Surveys on 19,028 in-union women aged 15-49 were analyzed to examine trends in socioeconomic disparities in contraceptive use. Descriptive statistics and multivariate regression with interaction terms were used to identify changes in these disparities, as well as to describe trends in desired fertility, and in types and sources of contraceptives used. RESULTS: Between 2005 and 2015, the prevalence of modern contraceptive use rose from 11% to 48%. In the regression analysis, interaction terms indicated that prevalence increased to a lesser extent among women who were wealthy, had a least a secondary education or lived in urban areas than among those who were poor, were uneducated or lived in rural areas (odds ratios, 0.5-0.7). In parallel, declines in desired fertility were greater among women with no education than among those with at least a secondary education (by 0.7 vs. 0.5 children); among the poorest than the richest women (by 1.0 vs. 0.5 children); and among rural than urban residents (by 0.9 vs. 0.4 children). CONCLUSIONS: The shrinking of gaps in contraceptive use by socioeconomic status coincided with narrowing of disparities in demand for children and with improvements in family planning services, suggesting that disadvantaged populations may have especially benefited from public programs to increase contraceptive access.
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