International Perspectives On Sexual And Reproductive Health[JOURNAL]
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200 papers
Unmet Need for Family Planning in Sri Lanka: Low Enough or Still an Issue?
DeGraff DS, Siddhisena KA
Int Perspect Sex Reprod Health · 2015 Dec · PMID 26871728 · Publisher ↗
CONTEXT: Family planning efforts achieved considerable success in Sri Lanka during the late 20th century; however, overall levels and trends may mask relatively high levels of unmet need under certain conditions. METHODS...
CONTEXT: Family planning efforts achieved considerable success in Sri Lanka during the late 20th century; however, overall levels and trends may mask relatively high levels of unmet need under certain conditions. METHODS: Data from the 2007 Demographic and Health Survey of Sri Lanka (DHS-SL) were used to estimate unmet need for limiting and spacing births among ever-married women aged 15-49, overall and by key characteristics. Twelve definitions of unmet need of varying stringency were used to assess the sensitivity of results to a variety of measurement issues. Comparable estimates from the 1987 DHS-SL were used to provide context on changes in unmet need over time. RESULTS: Total unmet need in 2007 ranged from 1.6% under the narrowest definition to 19.3% under the broadest. Levels of unmet need for spacing births in 2007 were lower than 3% for all measures and for most subsamples. In contrast, levels of unmet need for limiting were generally higher and more varied, both in relation to the definition of unmet need used and across subsamples. Unmet need for limiting was particularly high in certain groups if women's use of traditional contraceptive methods and practice of prolonged abstinence were considered not to meet their contraceptive need. CONCLUSIONS: Continued progress regarding contraceptive prevalence and method mix could contribute to further reducing unmet need for family planning in Sri Lanka and to meeting women's reproductive and health goals. Renewed policy emphasis on the family planning needs and concerns of selected groups would promote such goals.
Belief in Family Planning Myths at the Individual and Community Levels and Modern Contraceptive Use in Urban Africa.
Gueye A, Speizer IS, Corroon M … +1 more , Okigbo CC
Int Perspect Sex Reprod Health · 2015 Dec · PMID 26871727 · Full text
CONTEXT: Negative myths and misconceptions about family planning are a barrier to modern contraceptive use. Most research on the subject has focused on individual beliefs about contraception; however, given that myths sp...
CONTEXT: Negative myths and misconceptions about family planning are a barrier to modern contraceptive use. Most research on the subject has focused on individual beliefs about contraception; however, given that myths spread easily within communities, it is also important to examine how the prevalence of negative myths in a community affects the aggregate level of method use. METHODS: Baseline data collected in 2010-2011 by the Measurement, Learning & Evaluation project on women aged 15-49 living in selected cities in Kenya, Nigeria and Senegal were used. Multivariate analyses examined associations between modern contraceptive use and belief in negative myths for individuals and communities. RESULTS: In each country, the family planning myths most prevalent at the individual and community levels were that "people who use contraceptives end up with health problems," "contraceptives are dangerous to women's health" and "contraceptives can harm your womb." On average, women in Nigeria and Kenya believed 2.7 and 4.6 out of eight selected myths, respectively, and women in Senegal believed 2.6 out of seven. Women's individual-level belief in myths was negatively associated with their modern contraceptive use in all three countries (odds ratios, 0.2-0.7). In Nigeria, the women's community-level myth variable was positively associated with modern contraceptive use (1.6), whereas the men's community-level myth variable was negatively associated with use (0.6); neither community-level variable was associated with modern contraceptive use in Kenya or Senegal. CONCLUSION: Education programs are needed to dispel common myths and misconceptions about modern contraceptives. In Nigeria, programs that encourage community-level discussions may be effective at reducing myths and increasing modern contraceptive use.
Understanding the Broader Sexual and Reproductive Health Needs of Female Sex Workers in Dhaka, Bangladesh.
Katz KR, McDowell M, Green M … +3 more , Jahan S, Johnson L, Chen M
Int Perspect Sex Reprod Health · 2015 Dec · PMID 26871726 · Publisher ↗
CONTEXT: Little is known about the sexual and reproductive health care needs of female sex workers in Dhaka, Bangladesh. METHODS: Survey data were collected from 354 hotel-based and 323 street-based female sex workers us...
CONTEXT: Little is known about the sexual and reproductive health care needs of female sex workers in Dhaka, Bangladesh. METHODS: Survey data were collected from 354 hotel-based and 323 street-based female sex workers using a venue-based stratified cluster sampling approach. In addition, in-depth interviews were conducted with 20 female sex workers recruited from drop-in centers. We calculated unmet need for family planning and examined fertility desires, use of condoms and other contraceptive methods, experiences with gender-based violence, sexual and reproductive health service needs, and preferences on where to receive services. RESULTS: The prevalence of unmet need was 25% among hotel-based female sex workers and 36% among street-based female sex workers. Almost all participants reported having used condoms in the past 30 days, and 44% of hotel-based sex workers and 30% of street-based sex workers reported dual method use during that period. Condom use was inconsistent, however, and condom breakage and nonuse for extra money were common. Many women reported experiencing gender-based violence. Sexual and reproductive health services had been obtained by 64% of hotel-based and 89% of street-based sex workers in the past six months; drop-in centers were their preferred site for receiving health services. CONCLUSIONS: Female sex workers in Dhaka need family planning and other sexual and reproductive health services and prefer receiving them from drop-in centers.
The Incidence of Abortion in Nigeria.
Bankole A, Adewole IF, Hussain R … +3 more , Awolude O, Singh S, Akinyemi JO
Int Perspect Sex Reprod Health · 2015 Dec · PMID 26871725 · Full text
CONTEXT: Because of Nigeria's low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country's restrictive abortion l...
CONTEXT: Because of Nigeria's low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country's restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS: A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS: An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15-49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION: Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality.
A Fresh Look at the Level of Unmet Need for Family Planning in the Postpartum Period, Its Causes and Program Implications.
Cleland J, Shah IH, Benova L
Int Perspect Sex Reprod Health · 2015 Sep · PMID 26600569 · Publisher ↗
Abstract loading — click title to view on PubMed.
Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study.
Dasgupta AN, Zaba B, Crampin AC
Int Perspect Sex Reprod Health · 2015 Sep · PMID 26600568 · Full text
CONTEXT: Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this...
CONTEXT: Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance. METHODS: A one-year prospective longitudinal data set was created from patient-held family planning cards of 4,678 reproductive-age women living in a demographic surveillance site in rural northern Malawi. Contraceptive service data recorded on the women's cards by providers were linked to their socioeconomic, demographic and health data. Contraceptive point prevalence estimates calculated from these data were compared with mCPR estimates from cross-sectional surveys. Survival analyses examined contraceptive adherence. RESULTS: The contraceptive point prevalence of 35% was slightly lower than comparable cross-sectional estimates of mCPR. Only 51% of users of the injectable-the most widely used modern method-received their first reinjection on time, and just 15% adhered to the method for 12 months. Although various study variables were associated with contraceptive use, none were associated with adherence. CONCLUSIONS: Gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. Interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened.
An Assessment of Family Planning Decision Makers' and Advocates' Needs and Strategies in Three East African Countries.
Smith E, Musila R, Murunga V … +1 more , Godbole R
Int Perspect Sex Reprod Health · 2015 Sep · PMID 26600567 · Publisher ↗
CONTEXT: Despite decades of evidence-based advocacy for family planning in developing countries, research on how decision makers perceive and respond to such efforts is lacking. METHODS: A literature review yielded 10 pe...
CONTEXT: Despite decades of evidence-based advocacy for family planning in developing countries, research on how decision makers perceive and respond to such efforts is lacking. METHODS: A literature review yielded 10 peer-reviewed journal articles published between 1999 and 2012 on decision makers' needs for and experiences with health advocacy and evidence. Two sets of questions about family planning research and advocacy-one for decision makers and another for advocates-were developed from emerging themes and used in structured interviews with 68 key informants in Ethiopia, Kenya and Malawi. RESULTS: Decision makers reported understanding family planning's value and confirmed that advocacy had helped to spur recent favorable shifts in government support of family planning. Key informants stressed that advocacy messages and formats must be tailored to the needs and interests of particular audiences to be effective. Messages must also consider barriers to decision makers' support for family planning: constituents' negative attitudes; fear that increased adherence to family planning will shrink the size and influence of specific voting blocs and ethnic groups; and competing economic, social, cultural, religious and political priorities. Decision makers reported valuing the contributions of international family planning organizations and donors, but were more comfortable receiving advocacy messages from local sources. CONCLUSIONS: According to decision makers, sustained and strategic family planning advocacy developed and delivered by culturally attuned national actors, with support from international actors, can diminish barriers to government support for family planning.
Empowering Women or Pleasing Men? Analyzing Male Views on Female Condom Use in Zimbabwe, Nigeria and Cameroon.
Koster W, Bruinderink MG, Janssens W
Int Perspect Sex Reprod Health · 2015 Sep · PMID 26600566 · Publisher ↗
CONTEXT: Usage rates of female condoms are low throughout Sub-Saharan Africa. Programs have traditionally presented female condoms as a means of women's empowerment. However, prevailing gender norms in Sub-Saharan Africa...
CONTEXT: Usage rates of female condoms are low throughout Sub-Saharan Africa. Programs have traditionally presented female condoms as a means of women's empowerment. However, prevailing gender norms in Sub-Saharan Africa assign sexual decision making to men, suggesting that male acceptance is imperative for increased use. METHODS: In 2011, data on perceptions of and experiences with female condom use were collected from 336 men in Zimbabwe, Nigeria and Cameroon through 37 focus group discussions and six in-depth interviews; participants also completed pre-focus group discussion questionnaires. The data were analyzed by country, using thematic content analysis. Results were stratified by marital status and regularity of female condom use. RESULTS: Perceived advantages of female condoms over other protection methods were enhanced pleasure, effectiveness and lack of side effects. Single and married men preferred using female condoms with stable rather than casual partners, and for purposes of contraception rather than protection from infections. In Cameroon and Nigeria, where contraceptive rates are lower than in Zimbabwe, men favored female condoms as a contraceptive device. Its acceptability as a method of protection from HIV infection is greater in highly AIDS-affected Zimbabwe than in the other two countries. In Cameroon, some men did report regular use of female condoms in casual encounters. Initiation of female condom use by men's stable partners was not acceptable in any of the countries. CONCLUSION: The findings suggest the importance of accounting for local contexts and targeting both men and women in campaigns to promote female condom use.
Meeting Contraceptive Needs: Long-Term Associations of the PRACHAR Project with Married Women's Awareness and Behavior in Bihar.
Jejeebhoy SJ, Prakash R, Acharya R … +2 more , Singh SK, Daniel E
Int Perspect Sex Reprod Health · 2015 Sep · PMID 26600565 · Publisher ↗
CONTEXT: Although interventions such as the PRACHAR project in Bihar, India, have been associated with increased contraceptive knowledge and use in the short term, less is known about whether such gains are sustained yea...
CONTEXT: Although interventions such as the PRACHAR project in Bihar, India, have been associated with increased contraceptive knowledge and use in the short term, less is known about whether such gains are sustained years later. METHODS: Survey data, collected in 2013 from 2,846 married women aged 15-34, were used to compare contraceptive awareness and use between those who lived in areas where the PRACHAR project had been implemented in 2002-2009 and those who lived in matched comparison areas. Multivariate analyses assessed whether, after adjustment for covariates, outcomes differed between women in comparison and intervention areas, as well as between women directly exposed to the program and those who lived in intervention areas but had been only indirectly exposed. RESULTS: Compared with women in comparison areas, those in intervention areas were more likely to have method-specific knowledge of oral contraceptives, IUDs, condoms and the Standard Days Method (odds ratios, 1.4-1.7); to know that oral contraceptives and condoms are appropriate for delaying first pregnancy (2.3 for each) and IUDs and injectables are appropriate for spacing births (1.4 for each); to have ever used contraceptives (2.1) or be using a modern method (1.5); and to have initiated contraception within three months of their first birth (1.8). Levels of awareness and use were elevated not only among women directly exposed to the intervention but also, for many measures, among indirectly exposed women. CONCLUSIONS: The association of multipronged reproductive health programs like PRACHAR with contraceptive awareness and practices may last for years beyond the project's conclusion.
Sexual Pleasure, Partner Dynamics and Contraceptive Use in Malawi.
John NA, Babalola S, Chipeta E
Int Perspect Sex Reprod Health · 2015 Jun · PMID 26308262 · Publisher ↗
CONTEXT: Despite increases in the use of modern contraceptives, Malawian women have a high unmet need for contraception. Because current understanding of contraceptive use ignores sexual pleasure and partner dynamics, th...
CONTEXT: Despite increases in the use of modern contraceptives, Malawian women have a high unmet need for contraception. Because current understanding of contraceptive use ignores sexual pleasure and partner dynamics, this study explores the links between sexual pleasure seeking, partner dynamics and contraceptive use. METHODS: As part of a larger qualitative study conducted in 2012, 23 focus group discussions among married women and men and 10 in-depth interviews with service providers were conducted with a total of 192 participants in two districts of Malawi. Thematic analysis was performed to identify recurrent categories and patterns. RESULTS: Method choice and consistent use were affected by the quantity and quality of sex desired and, most important, by any perceived change in sexual pleasure for respondents or their partner. For women, more so than for men, experiences of sexual pleasure were intertwined with gender norms, women's perceived role of providing pleasure in sexual relationships and the relationship dynamics this generated. These partner dynamics ultimately created a formidable barrier to contraceptive use or promoted contraceptive discontinuation. CONCLUSION: Family planning programs should consider the nuanced ways in which notions of sexual pleasure, partner dynamics and the broader social context are involved in decision making regarding contraceptive use.
Dynamic Relationships Between Parental Monitoring, Peer Risk Involvement and Sexual Risk Behavior Among Bahamian Mid-Adolescents.
Wang B, Stanton B, Deveaux L … +2 more , Li X, Lunn S
Int Perspect Sex Reprod Health · 2015 Jun · PMID 26308261 · Full text
CONTEXT: Considerable research has examined reciprocal relationships between parenting, peers and adolescent problem behavior; however, such studies have largely considered the influence of peers and parents separately....
CONTEXT: Considerable research has examined reciprocal relationships between parenting, peers and adolescent problem behavior; however, such studies have largely considered the influence of peers and parents separately. It is important to examine simultaneously the relationships between parental monitoring, peer risk involvement and adolescent sexual risk behavior, and whether increases in peer risk involvement and changes in parental monitoring longitudinally predict adolescent sexual risk behavior. METHODS: Four waves of sexual behavior data were collected between 2008/2009 and 2011 from high school students aged 13-17 in the Bahamas. Structural equation and latent growth curve modeling were used to examine reciprocal relationships between parental monitoring, perceived peer risk involvement and adolescent sexual risk behavior. RESULTS: For both male and female youth, greater perceived peer risk involvement predicted higher sexual risk behavior index scores, and greater parental monitoring predicted lower scores. Reciprocal relationships were found between parental monitoring and sexual risk behavior for males and between perceived peer risk involvement and sexual risk behavior for females. For males, greater sexual risk behavior predicted lower parental monitoring; for females, greater sexual risk behavior predicted higher perceived peer risk involvement. According to latent growth curve models, a higher initial level of parental monitoring predicted decreases in sexual risk behavior, whereas both a higher initial level and a higher growth rate of peer risk involvement predicted increases in sexual risk behavior. CONCLUSION: Results highlight the important influence of peer risk involvement on youths' sexual behavior and gender differences in reciprocal relationships between parental monitoring, peer influence and adolescent sexual risk behavior.
Is Unwanted Birth Associated with Child Malnutrition in Bangladesh?
Rahman MM
Int Perspect Sex Reprod Health · 2015 Jun · PMID 26308260 · Publisher ↗
CONTEXT: The association between unintended pregnancy and maternal and child health has been well documented. However, the relationship of unintended pregnancy with child malnutrition is not well understood, and may be i...
CONTEXT: The association between unintended pregnancy and maternal and child health has been well documented. However, the relationship of unintended pregnancy with child malnutrition is not well understood, and may be important in countries such as Bangladesh that have high levels of these events. METHODS: Data from the 2011 Bangladesh Demographic and Health Survey on 6,506 last-born, singleton children younger than five were used to investigate the relationship between pregnancy intendedness and the prevalence of stunting, wasting and underweight during early childhood. Multivariate logistic regression analyses were used to identify associations. RESULTS: Substantial proportions of children were stunted (40%), wasted (16%) and underweight (35%) at the time of the survey. Mothers reported that at the time of conception, 14% of their index pregnancies had been unwanted and 16% had been mistimed. Compared with children whose conception had been intended, those whose conception had been unwanted were more likely to be stunted (46% vs. 39%), wasted (19% vs. 15%) or underweight (43% vs. 33%). In regression analyses, children who had been unwanted at the time of conception had an elevated risk of being stunted (odds ratio, 1.4), wasted (1.4) or underweight (1.3). CONCLUSION: Maternal pregnancy intentions are associated with child stunting, wasting and underweight. If these associations are causal, preventing unwanted pregnancies may help reduce the prevalence of childhood malnutrition in Bangladesh.
Quality of Care and Contraceptive Use in Urban Kenya.
Tumlinson K, Pence BW, Curtis SL … +2 more , Marshall SW, Speizer IS
Int Perspect Sex Reprod Health · 2015 Jun · PMID 26308259 · Full text
CONTEXT: Family planning is highly beneficial to women's overall health, particularly in developing countries. Yet, in much of Sub-Saharan Africa, contraceptive prevalence remains low and unmet need for family planning r...
CONTEXT: Family planning is highly beneficial to women's overall health, particularly in developing countries. Yet, in much of Sub-Saharan Africa, contraceptive prevalence remains low and unmet need for family planning remains high. It is hypothesized that the poor quality of family planning service provision in many low-income settings is a barrier to contraceptive use, but this hypothesis has not been rigorously tested. METHODS: Survey data from 3,990 women were used to investigate whether family planning service quality was associated with current modern contraceptive use in five cities in Kenya in 2010. In addition, audits of selected facilities and service provider interviews were conducted in 260 facilities, and exit interviews were conducted with family planning clients at 126 high-volume clinics. Individual- and facility-level data were linked according to the source of the woman's current method or other health service. Binomial regression was used to estimate adjusted prevalence ratios, and robust standard errors were used to account for clustering of observations within facilities. RESULTS: Sixty-five percent of women reported currently using a modern contraceptive method. Provider's solicitation of clients' method preferences, assistance with method selection, provision of information on side effects and good treatment of clients were positively associated with current modern contraceptive use (prevalence ratios, 1.1 each); associations were often stronger among younger and less educated women. CONCLUSION: Efforts to assist with method selection and to improve the content of contraceptive counseling and treatment of clients by providers have the potential to increase contraceptive use in urban Kenya.
Minimum Marriage Age Laws and the Prevalence of Child Marriage and Adolescent Birth: Evidence from Sub-Saharan Africa.
Maswikwa B, Richter L, Kaufman J … +1 more , Nandi A
Int Perspect Sex Reprod Health · 2015 Jun · PMID 26308258 · Publisher ↗
CONTEXT: The relationship of national laws that prohibit child marriage with the prevalence of child marriage and adolescent birth is not well understood. METHODS: Data from Demographic and Health Surveys and from the Ch...
CONTEXT: The relationship of national laws that prohibit child marriage with the prevalence of child marriage and adolescent birth is not well understood. METHODS: Data from Demographic and Health Surveys and from the Child Marriage Database created by the MACHEquity program at McGill University were used to examine the relationship between laws that consistently set the age for marriage for girls at 18 or older and the prevalence of child marriage and teenage childbearing in 12 Sub-Saharan African countries. Countries were considered to have consistent laws against child marriage if they required females to be 18 or older to marry, to marry with parental consent and to consent to sex. Associations between consistent laws and the two outcomes were identified using multivariate regression models. RESULTS: Four of the 12 countries had laws that consistently set the minimum age for marriage at 18 or older. After adjustment for covariates, the prevalence of child marriage was 40% lower in countries with consistent laws against child marriage than in countries without consistent laws against the practice (prevalence ratio, 0.6). The prevalence of teenage childbearing was 25% lower in countries with consistent minimum marriage age laws than in countries without consistent laws (0.8). CONCLUSION: Our results support the hypothesis that consistent minimum marriage age laws protect against the exploitation of girls.
Integrating family planning promotion into the work of environmental volunteers: a population, health and environment initiative in Kenya.
Hoke TH, Mackenzie C, Vance G … +5 more , Boyer B, Canoutas E, Bratt J, Mbulo A, Waceke N
Int Perspect Sex Reprod Health · 2015 Mar · PMID 25856236 · Publisher ↗
Voluntary use of family planning is instrumental to the health and social well-being of women, families and communities.Although contraceptive use in Sub-Saharan Africa is increasing, unmet need for family planning remai...
Voluntary use of family planning is instrumental to the health and social well-being of women, families and communities.Although contraceptive use in Sub-Saharan Africa is increasing, unmet need for family planning remains high. Even within countries that have achieved increases in contraceptive prevalence, use remains low among some population subgroups. Contraceptive prevalence is generally lower in rural areas than in cities, and is consistently lower among women in the lowest wealth quintile than among those in the highest. Achieving progress in health and social indicators, such as those captured by the Millennium Development Goals, depends on expanding family planning services to poor, remote rural areas in Africa.
The case for addressing gender and power in sexuality and HIV education: a comprehensive review of evaluation studies.
Haberland NA
Int Perspect Sex Reprod Health · 2015 Mar · PMID 25856235 · Publisher ↗
CONTEXT: Curriculum-based sexuality and HIV education is a mainstay of interventions to prevent STIs, HIV and unintended pregnancy among young people. Evidence links traditional gender norms, unequal power in sexual rela...
CONTEXT: Curriculum-based sexuality and HIV education is a mainstay of interventions to prevent STIs, HIV and unintended pregnancy among young people. Evidence links traditional gender norms, unequal power in sexual relationships and intimate partner violence with negative sexual and reproductive health outcomes. However, little attention has been paid to analyzing whether addressing gender and power in sexuality education curricula is associated with better outcomes. METHODS: To explore whether the inclusion of content on gender and power matters for program efficacy, electronic and hand searches were conducted to identify rigorous sexuality and HIV education evaluations from developed and developing countries published between 1990 and 2012. Intervention and study design characteristics of the included interventions were disaggregated by whether they addressed issues of gender and power. RESULTS: Of the 22 interventions that met the inclusion criteria, 10 addressed gender or power, and 12 did not. The programs that addressed gender or power were five times as likely to be effective as those that did not; fully 80% of them were associated with a significantly lower rate of STIs or unintended pregnancy. In contrast, among the programs that did not address gender or power, only 17% had such an association. CONCLUSIONS: Addressing gender and power should be considered a key characteristic of effective sexuality and HIV education programs.
The effect of access to contraceptive services on injectable use and demand for family planning in Malawi.
Skiles MP, Cunningham M, Inglis A … +4 more , Wilkes B, Hatch B, Bock A, Barden-O'Fallon J
Int Perspect Sex Reprod Health · 2015 Mar · PMID 25856234 · Full text
CONTEXT: Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability o...
CONTEXT: Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance. METHODS: Kernel density estimation was used to geographically link Malawi women's use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services-measured by distance alone and by distance combined with supply reliability-and injectable use and family planning demand among rural and urban populations. RESULTS: Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access. CONCLUSIONS: Product availability in the local service environment plays a critical role in women's demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access.
Estimates of the incidence of induced abortion and consequences of unsafe abortion in Senegal.
Sedgh G, Sylla AH, Philbin J … +2 more , Keogh S, Ndiaye S
Int Perspect Sex Reprod Health · 2015 Mar · PMID 25856233 · Full text
CONTEXT: Abortion is highly restricted by law in Senegal. Although women seek care for abortion complications, no national estimate of abortion incidence exists. METHODS: Data on postabortion care and abortion in Senegal...
CONTEXT: Abortion is highly restricted by law in Senegal. Although women seek care for abortion complications, no national estimate of abortion incidence exists. METHODS: Data on postabortion care and abortion in Senegal were collected in 2013 using surveys of a nationally representative sample of 168 health facilities that provide postabortion care and of 110 professionals knowledgeable about abortion service provision. Indirect estimation techniques were applied to the data to estimate the incidence of induced abortion in the country. Abortion rates and ratios were calculated for the nation and separately for the Dakar region and the rest of the country. The distribution of pregnancies by planning status and by outcome was estimated. RESULTS: In 2012, an estimated 51,500 induced abortions were performed in Senegal, and 16,700 (32%) resulted in complications that were treated at health facilities. The estimated abortion rate was 17 per 1,000 women aged 15-44 and the abortion ratio was 10 per 100 live births. The rate was higher in Dakar (21 per 1,000) than in the rest of the country (16 per 1,000). Poor women were far more likely to experience abortion complications, and less likely to receive treatment for complications, than nonpoor women. About 31% of pregnancies were unintended, and 24% of unintended pregnancies (8% of all pregnancies) ended in abortion. CONCLUSIONS: Unsafe abortion exacts a heavy toll on women in Senegal. Reducing the barriers to effective contraceptive use and ensuring access to postabortion care without the risk of legal consequences may reduce the incidence of and complications from unsafe abortion.
Delayed fertility transition among indigenous women in the Ecuadorian Amazon.
Davis J, Bilsborrow R, Gray C
Int Perspect Sex Reprod Health · 2015 Mar · PMID 25856232 · Full text
CONTEXT: Communities indigenous to the Amazon are among the few remaining worldwide still practicing near-natural fertility, without the use of modern contraceptives. Given the large proportion of women desiring no more...
CONTEXT: Communities indigenous to the Amazon are among the few remaining worldwide still practicing near-natural fertility, without the use of modern contraceptives. Given the large proportion of women desiring no more births, information on the challenges women there face in limiting fertility would be useful. METHODS: Samples of women of reproductive age from five indigenous ethnic groups in the Northern Ecuadorian Amazon were surveyed in 2001 and 2012. Cross-sectional and longitudinal analyses examined married women's desire for another child at both times and modern contraceptive use in 2012, as well as determinants of a change in women's desire to have more children and of the number of children born during the study period. RESULTS: In 2001, 48% of married women desired another child, 2% used a modern contraceptive and 50% had an unmet need for limiting; in 2012, the proportions were 40%, 19% and 47%, respectively. The total fertility rate was 7.9 births per woman in 2001 and 7.0 births per woman in 2012. Characteristics associated with wanting another child in 2001 and 2012 included parity (odds ratios, 0.6 and 0.4, respectively) and experience of a child death (2.0 each); characteristics associated with contraceptive use in 2012 included desire for another child, experience of a child death and presence of a community health worker (0.3-0.5). Number of children born was positively associated, and the square of the term negatively associated, with no longer wanting more children in 2012 among women who wanted more in 2001 (2.1 and 0.9, respectively). CONCLUSIONS: Indigenous women in the Northern Ecuadorian Amazon appear to be making the transition to lower fertility. Insufficient access to credible information about the safety and efficacy of modern contraceptives, however, may slow the transition.
Achieving the goal of the London Summit on Family Planning by adhering to voluntary, rights-based family planning: what can we learn from past experiences with coercion?
Hardee K, Harris S, Rodriguez M … +4 more , Kumar J, Bakamjian L, Newman K, Brown W
Int Perspect Sex Reprod Health · 2014 Dec · PMID 25565348 · Publisher ↗
Abstract loading — click title to view on PubMed.
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