Contraception and Reproductive Medicine最新文献

Background: Provision of post abortion contraception following an abortion is an excellent opportunity to address unmet family planning needs of women. In Ethiopia, post abortion family planning is minimal and underutilized. The objective of this study is to assess determinant factors for utilization of contraception following any abortion process (induced and/or spontaneous) among reproductive age women (15-49 years) in a tertiary hospital of North West Ethiopia.

Methods: A cross-sectional study was conducted on 423 clients who presented for either spontaneous or induced abortion care from September 2016 to August 2017 in Felege Hiwot referral hospital, North West Ethiopia. Respondents were identified using a consecutive sampling method. Data was collected in clinic using an interviewer administered pre-tested questionnaire administered after services were completed. Factors associated with use of post-abortion family planning were explored using multivariable logistic regression analysis.

Results: 64.8% of clients who presented for abortion care received family planning services before discharge from the hospital. Family planning counseling during service provision [AOR: 25.47, 95% CI: (9.11, 71.58)], having previous information about family planning [AOR: 2.16, 95% CI: (1.09, 4.23)], gestational age of index pregnancy less than 3 months [AOR: 1.78, 95% CI:(1.13, 3.05)], being a housewife [AOR: 0.32, 95% CI: (0.16, 0.65)] and monthly income > 5000 ETB [AOR: 0.38, 95% CI:(0.16,0.98)] are significantly associated with post abortion family planning utilization.

Conclusions: The proportion of post abortion family planning utilization is good but could be improved. Education before and especially at the time of abortion services strongly influenced the usage of family planning services. The government and regional health bureau at large as well as health care providers at each health system level have an opportunity to provide information and counsel women on family planning methods to increase utilization of post abortion contraception.

Background: Globally, approximately half of all pregnancies occur before 24 months after child birth. In Sub Saharan Africa the unmet need for family planning is highest among postpartum women. There is a dearth of information regarding factors associated with postpartum use of long acting reversible contraception (LARC) in Tanzania particularly in the Lake zone. This study aimed to determine the prevalence and factors associated with postpartum use of LARC (< 24 months) in Bukombe District, Geita Region in the Lake zone, in 2018.

Methodology: Community based analytical cross-sectional study was conducted between May and June 2018 among women with less than 24 months since delivery. Multistage sampling technique was used to recruit participants. Face to face interviews with 768 postpartum women was conducted using standardized questionnaire. Data were analyzed using Stata Version 13.0. Multivariable logistic regression model was used to determine factors associated with postpartum use of LARC.

Results: Prevalence of postpartum use of LARC was 10.4%. Urban residence (AOR = 2.94, 95% CI: 1.07-8.06), having formal employment (AOR = 4.81, 95% CI: 1.85-12.57) and receiving family planning counseling (AOR = 4.39, 95% CI: 1.89-10.20) were significantly associated with postpartum LARC use.

Conclusion: The postpartum use of LARC was low in the studied population with implants being the most commonly used method. Urban residency, formal employment and receiving family planning counseling were associated with postpartum LARC use. Improving prenatal and quality of family planning counseling is warranted to increase postpartum LARC utilization in Bukombe.

Background: In the last decade, (2000-2019), the modern contraceptive prevalence among married women of reproductive age (14-49 years), has increased by only 2.1%. The slow progress was due to limited access to services and myths surrounding methods held by both users and providers. This case report was identified, diagnosed and managed by a midwife working in rural health center in low resource setting. However, literature is scare on the management of missing Intra-Uterine Contraceptive Device (IUCD) thread removal services of confirmed diagnosis using Vscan or limited ultrasound services in rural health centers. The aim of reporting this case report was developed to enhance easy access to intra-uterine contraceptive method removals, which may address myths associated with difficulties of undergoing the services in rural set-up. A 26 year-old married woman, Gravida 1 and Para 1, attended Mekoy Health Center for IUCD removal service after 7 years of protection and internally referred to limited obstetric ultrasound service room due to non- visualization of IUCD thread with Vaginal Speculum examination. An ultrasonography scan however, showed a centrally located copper-T 380A IUCD in the endometrial cavity. As a result, after dilatation of the cervix, a successful removal of the Copper-T 308A was conducted. The client received followed up care for 2 hours post-procedure and was then discharged.

Conclusions: This case highlights the importance of availing diagnostic and removal services in rural set ups to mitigate myths in the community. The availability of limited obstetric ultrasound scanning services can improve the diagnoses and management of conditions in clients. The reported case shows that although, the basic infrastructure was limited, ultrasound scanning and Long Acting Reversible Contraception (LARC) trained midwives can ensure the provision of safe IUCD removal services in rural areas.

Background: Women have unfair share in the burden of unintended pregnancy outcome and unhealthy interpregnancy intervals. An understanding of the triggers, ideation and motivational factors influencing utilization of modern contraceptives is relevant for efforts aimed at increasing utilization among the general public, specifically sexually active women. The objective of this study is to explore the triggers, ideation and motivational factors influencing the use of modern family planning methods including depot-medroxyprogesterone acetate subcutaneous (DMPA-SC).

Methods: Qualitative methods which include; Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) were used to elicit information from women of reproductive age and gate-keepers in selected Nigerian states; Rivers, Ogun, Kwara, Niger, Anambra, Delta, Lagos, Enugu and Oyo. The categories of respondents include; unmarried women aged 18-25 years, women in union aged 18-24 years using modern family planning (FP), women in union aged 25-49 years using modern FP, women in union aged 26-49 years non-users of modern FP, community leaders, health facility focal person, husbands of current users of modern FP, husbands of non-users of modern FP, religious leaders, state FP coordinators and women aged 18-49 years who currently use DMPA-SC. Maximum variation sampling techniques was used to enlist participants to participate in both FGDs and IDIs.

Results: Respondents reported being motivated to use FP for reasons such as benefits of the method, economic situation, suitability of the methods, fear of unwanted pregnancy and its convenience. Further analysis showed that the unmarried respondents discussed more about fear of unwanted pregnancy and accessibility and affordability as a key motivator; while women in union discussed more on economic situations, encouragement from partners and benefits of FP when compared with the unmarried. In addition, respondents reported that their partners, health workers and friends influenced their decisions to use FP. Partners' encouragement, personal experience, accessibility and availability, awareness of FP and its benefits; willingness to space children and costs were notable enablers of FP use. The triggers for FP use were; appointment cards, phone calls from health workers, reminders (text messages, phone alarms and partners' support).

Conclusion: Increasing utilization therefore requires a well-planned horizontal approach that considers all enabling factors influencing utilization including women's empowerment. Family planning programmes that are client centered, address socio-cultural and gender norms and ensure access to contraceptive mix methods are recommended to improve utilization rate. This study recommends improved care-seeking behaviour through community-based awareness creation to address myths and misconceptions of family planning use, establishment of con

Background: Knowledge of abortion law is a key determinant of the utilization of safe abortion services. Neglecting it can lead to high social and economic costs, both immediately and in the future. One of the major reasons for not utilizing the safe abortion by the youth female is inadequate knowledge about the abortion law. Therefore the aim of this study was to assess knowledge on abortion law and associated factors among female regular undergraduate students of Ambo University.

Methodology: Institutional-based cross-sectional study was conducted on 795 randomly selected undergraduate female students of Ambo University using structured and pre-tested questionnaire from March, 28-May, 18, 2018.The result of the analysis was presented by tables using descriptive frequency percentage and odd ratios. The result was presented using tables. Bivariate and multivariate logistic regression was done between dependent and independent variables at 95% confident interval and P value < 0.05.

Result: Majority (79%) of the study participants were not able to identify all the conditions under which abortion is legally available in Ethiopia. In this study receiving health education on abortion law (AOR = 7.382, 95% CI: (1.118-48.761), knowing where safe abortion can be performed (AOR = 3.116, 95% CI: (1.854-5.239)) and being member of health club in the university (AOR = 2.092, 95% CI:1.256-3.484) were the predictors of abortion law knowlwdge .

Conclusion: The study concluded that knowledge of female student's on abortion law is low in the study area. In this study, participates who received health education on abortion law and having involving in the health club at university were found to be the predictors of knowledge on abortion law .

Introduction: Women who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use.

Methods: We conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching.

Results: In total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods' discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8-8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p < 0.001). The main reason for discontinuation and switching was method-related (141 over 199), followed by partner opposition with 20 women.

Conclusion: The results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women's partners and influential people in the community to counter inhibiting beliefs.

Trial registration: Pan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784 ).

Background: Family planning services have been available at no cost in the public health settings of South Africa since 1994, and now include the long-acting reversible contraceptives (LARCs) namely, the contraceptive implant and intra-uterine device (IUD). However, the uptake of LARCs has been declining in the recent years and little is known about the cause of the decline. In many relationships, men may influence their female intimate partner's contraceptive choices. Thus, men's involvement in reproductive health decisions and family programming may improve their support for contraceptive use, including the LARC use by their female intimate partners. This study investigated factors affecting men's support for the use of contraceptive implant by their female intimate partners.

Methods: A quantitative, cross-sectional survey was conducted among adult men attending a public, primary health clinic in Cape Town, South Africa. Using a structured questionnaire, we measured men's knowledge, awareness and support of, and attitudes towards use of the contraceptive implant by their female intimate partners. Data were analyzed using SPSS version 25.

Results: The sample included 65 men with a mean age of 31.2 years. Most (76.6%) believed that both men and women should be responsible for family planning. Support for general contraception use by their female intimate partners was prevalent at 80.0%, but only 33.9% reported that they would like their partners to use the implant in the future, while 35.6% were unsure and 30.5% did not support their partner's use of the implant. Factors significantly associated with men's support of their partner's future use of the contraceptive implant included men's reports that their partner wished to have another child in future, knowledge that the implant is safe for use by women who have not had children, knowledge that the implant can effectively prevent pregnancy for 3 years, and a positive attitude towards the implant's long-lasting effectiveness.

Conclusion: Improving men's knowledge of, and attitudes toward the contraceptive implant might increase their support for their partner's use of the implant, which in turn might promote uptake of the implant among women. The findings of our study suggest the importance of actively engaging men in reproductive health and family planning programs.

Background: Age difference among spouses can be considered as an indicator of the nature of the marital bond, and influences the couple's fertility expectations. The age difference is one of the features of the traditional African marriage system. However, the likelihood that women use of contraceptives and spousal age differences is not well studied. Thus, this study was to examine the spousal age difference on contraceptive use.

Objective: This study was aimed to examine spousal age differences and its effect on contraceptive use among sexually active couples in Ethiopia.

Methods: The related variables for this study were extracted from Ethiopian Demographic and Health Survey 2016 data. IBM SPSS statistics version 20 software was used for analysis. Logistic regression was conducted to see the association between spousal age difference and contraceptive use. All analyses were adjusted for sample weights.

Results: Out of the 7268 selected women for contraceptive usage questions, one fourth (25.3%) of them were between ages 25 and 29 and in almost all 7061 (98.4%) of them there was spousal age differences, 1555 (21.4%) of them were from poor socioeconomic group. Nearly all 7184 (98.8%) of them knew contraceptive method. However, among those sexually active in the last 4 weeks only two in five (41.2%) were using a contraceptive method. Spousal age difference was found to be significant factor and women older than their spouses were (AOR: 1.771, 95%CI: 1.276, 2.459) more likely and women having spouse's age difference greater than 10 years were 1.2% (AOR: .988, 95%CI: .848, 1.150) less likely to use contraception compared to those age difference is ten or less than years respectively. Also, women who were living in urban areas (AOR: 1.482, 95%CI: 1.161 to 1.890), current working status (AOR: 1.170; 95%CI: 1.033 to 1.325), from richest economic category (AOR: 2.560; 95%CI: 2.000 to 3.278) husband's education, couples' fertility preference (AOR: 1.233; 95%CI: 1.070 to 1.420) were contraception use predictors. Similarly, being Muslim by religion (AOR: .579 95%CI: 0.496 to 0.675) and husband based decision for their health care use were (AOR: .847, CI: .729 to .985) less likely to use contraception.

Conclusion and recommendation: This study found association between spousal age differences and contraceptive use. Similarly, women's age, age difference, place of residence, religion, current working status, socioeconomic, husband's education, living children and current pregnancy, the couples' fertility preference and who decides on health care use were found to be predictors of contraceptive use. Strengthening strategies for improving women's educational status, socio-economic and demographic that will help to limit the age differences and improve contraceptive use. Further study, including qualitative is recommended to dig out the why component

Background: Unwanted pregnancy is a significant public health problem worldwide. In higher education, students are exposed to the risk of unintended pregnancy, abortion, and its related negative consequences.

Objective: The objective of this study was to assess the magnitude of emergency contraceptives and factors associated with its utilization among college female students at Debre Tabor Town, Northwest Ethiopia.

Methods: A cross-sectional, institutional-based study was conducted from June to October 2017. A multi-stage stratified sampling technique was applied to select the study participants. Data were cleaned, coded, and entered into Epi info 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression was used to identify the association between the use of emergency contraception and the predictor variables. The P-value less than 0.05 at 95% CI was taken as statistical significance.

Results: A total of 821 respondents participated with a response rate of 97.6%. The finding showed that 33.3% of them have used emergency contraceptives following unprotected sex. Female students' knowledge about emergency contraceptive [AOR: 2.3; 95% CI 1.20, 4.25], age with 20-24 years category [AOR: 2.3; 95% CI 1.21, 4.49] and married [AOR: 2.8; 95% CI 1.22, 6.21] and divorced [AOR: 4.9; 95% CI 1.12, 21.08] students were found to be significant predictors of EC utilization.

Conclusions: This study revealed that the level of emergency contraceptive utilization was low. Students' level of knowledge about an emergency contraceptive, age at present, and marital status were found to be the major predictor for emergency contraceptive utilization. Therefore, responsible bodies should develop strategies that enhance the knowledge level of students at the college level on the effective utilization of emergency contraceptive methods.

Background: Unmet need refers to fecund women who either wish to postpone the next birth (spacers) or who wish to stop childbearing (limiters) but are not using a contraceptive method. Many women who are sexually active would prefer to avoid becoming pregnant but are not using any method of contraception. These women are considered to have an unmet need for family planning. Therefore, the objective of this systematic review and meta-analysis is to estimate the pooled prevalence of unmet need for family planning and its association to occupational status of women and discussion to her partner among fecund women in Ethiopia.

Method: A systemic review and meta-analysis was conducted using published and unpublished research on the prevalence of unmet need for family planning and its association to occupational status of women and discussion to her partner among fecund women in Ethiopia. Data extraction was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, CINAHL, and Embase. All statistical analysis were done using STATA version 14 software using random effects model. The pooled prevalence was presented in forest plots.

Results: A total of 9 studies with 9785 participants were included, and the overall pooled estimated prevalence of unmet need for family planning among fecund women in Ethiopia was 34.90% (95% CI: 24.52, 45.28%). According to subgroup analysis the estimated prevalence of unmet need for family planning in studies conducted in Amhara was 32.98% (95% CI: 21.70, 44.26%), and among married women was 32.84% (95% CI: 16.62, 49.07%). Additionally, housewife women were 1.6 times more likely have unmet need for family planning compared to government employed women (OR: 1.6, 95% CI: 1.29, 1.99). Moreover, women who don't discuss to partner were 1.87 times more likely to have unmet need for family planning compared to women who had discussion to her partner (OR 1.87; 95% CI: 1.52, 2.31).

Conclusion: The analysis revealed that the overall prevalence of unmet need for family planning among fecund women in Ethiopia was high. Family planning programs should identify strategies to improve communication in family planning among couples and to ensure better cooperation between partners.