Studies in Family Planning最新文献

While there is a large literature on the prevalence of unmet need for family planning, there is no matching quantitative evidence on the prevalence of unwanted family planning; all contraceptive use is assumed to represent a "met need." This lack of evidence raises concerns that some observed contraceptive use may be undesired and coercive. We provide estimates of unwanted family planning using Demographic and Health Survey data collected from 1,546,987 women in 56 low- and middle-income countries between 2011 and 2019. We estimate the prevalence of unwanted family planning, defined as the proportion of women who report wanting a child in the next nine months but who are using contraception. We find that 12.2 percent of women have an unmet need for family planning, while 2.1 percent have unwanted family planning, with estimated prevalence rates ranging from 0.4 percent in Gambia to 7.1 percent in Jordan. About half of unwanted family planning use can be attributed to condoms, withdrawal, and abstinence. Estimating the prevalence of unwanted family planning is difficult given current data collection efforts, which are not designed for this purpose. We recommend that future surveys probe the reasons for the use of family planning.

The concept of contraceptive method choice is complex and difficult to measure, usually requiring multiple metrics that represent the service environment, access, and acceptability. One of the most used measures for the family planning service delivery environment is method availability, or specifically, the contraceptive options that are available to clients at any given family planning service delivery point. Despite the importance of the measure, indicator definitions vary widely and are not standardized. We identified six versions of the method availability indicator and calculated each version using Service Provision Assessment data from three countries with varying family planning profiles, health service structures, and from different geographic areas: Bangladesh, the Democratic Republic of Congo, and Haiti. We compared method availability estimates by urban/rural location, facility type, and across country context. Our results showed a wide variability in method availability estimates depending on the indicator used. Generally, indicators requiring a particular mix of method types had lower estimates of method availability than indicators only requiring a minimum number of methods. Results are discussed and recommendations are made to standardize indicator language and guidance. We further recommend the standardization of an indicator with a minimum mix of method types to ensure that a variety of method preferences can be met.

Family planning measures for unmarried women are based on contraceptive demand and use among sexually active women. Sexual activity status is commonly defined based on comparing reported time-since-last-sex to a cutoff time, with women defined to be sexually active if their most recent sex was within the last four weeks. While easy to understand and compute, this approach to constructing family planning measures results in a limited understanding of family planning and exposure to unintended pregnancy because it cannot comprehensively capture the frequency of sex at the population level. We propose a new statistical approach to quantify sexual activity, using reported time-since-last-sex data. Based on estimated frequencies of sex among users and nonusers in need of family planning, we propose new family planning measures, including the ratio of protected exposure over all women's exposure to risk of unintended pregnancy.

Research calls for the sexual and reproductive rights field to prioritize gender norms to ensure that women can act on their reproductive rights. However, there is a gap in accepted measures. We addressed this by including important theoretical components of gender norms: differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated the G-NORM, a gender norms scale, in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. We administered items to women of reproductive age, conducted exploratory and confirmatory factor analysis, and examined associations between the subscales and reproductive health outcomes. Like the original G-NORM, our factor analyses showed that descriptive norms and injunctive norms comprise two distinct scales which fit the data well and had Cronbach alphas of 0.92 and 0.89. More equitable descriptive gender norms were associated with higher decision-making scores, increased odds of intending to use family planning, disagreeing that it is wrong to use family planning, and older ideal age at marriage. Injunctive gender norms were only associated with disagreeing that it is wrong to use family planning. Findings offer an improved measure of gender norms in Nepal and provide evidence that gender norms are critical for agency and reproductive health outcomes.

Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.

Since childbearing desires, and trends in these desires, differ across populations, the inclusion of women who want to become pregnant in the denominator for unintended pregnancy rates complicates interpretation of intercountry differences and trends over time. To address this limitation, we propose a rate that is the ratio of the number of unintended pregnancies to the number of women wanting to avoid pregnancy; we term these conditional rates. We computed conditional unintended pregnancy rates for five-year periods from 1990 to 2019. In 2015-2019, these conditional rates per 1,000 women per year wanting to avoid pregnancy ranged from 35 in Western Europe to 258 in Middle Africa. Rates with all women of reproductive age in the denominator have concealed stark global disparities in the ability of women to avoid unintended pregnancies, and they have understated progress in regions where the fraction of women wanting to avoid pregnancy has increased.

The lack of validated, cross-cultural measures for examining quality of contraceptive counseling compromises progress toward improved services. We tested the validity and reliability of the 10-item Quality of Contraceptive Counseling scale (QCC-10) and its association with continued protection from unintended pregnancy and person-centered outcomes using longitudinal data from women aged 15-49 in Burkina Faso, Kenya, and Nigeria. Psychometric analysis showed moderate-to-strong reliability (alphas: 0.73-0.91) and high convergent validity with greatest service satisfaction. At follow-up, QCC-10 scores were not associated with continued pregnancy protection but were linked to contraceptive informational needs being met among Burkinabe and Kenyan women; the reverse was true in Kano. Higher QCC-10 scores were also associated with care-seeking among Kenyan women experiencing side effects. The QCC-10 is a validated scale for assessing quality of contraceptive counseling across diverse contexts. Future work is needed to improve understanding of how the QCC-10 relates to person-centered measures of reproductive health.

There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso. We conducted a population-based survey with 3,929 women of reproductive age, testing an array of new survey items within the three subdomains of informed choice, full choice, and free choice. In addition to providing tentative estimates of the prevalence of contraceptive autonomy and its subdomains in our sample of Burkinabè women, we critically examine which parts of the proposed methodology worked well, what challenges/limitations we encountered, and what next steps might be for refining, improving, and validating the indicator. We demonstrate that contraceptive autonomy can be measured at the population level but a number of complex measurement challenges remain. Rather than a final validated tool, we consider this a step on a long road toward a more person-centered measurement agenda for the global family planning community.

Social network-based methods are increasingly used to estimate induced abortion incidence and investigate correlates. Approaches differ in the social tie definitions used to identify which social network members' abortion experiences respondents will report. This study compares the effect of using the "best friend" (closest female friend) versus "confidante" (specifying mutual sharing of personal information) definition on abortion incidence estimation. We use data from a nationally representative survey of women aged 15-49 in Burkina Faso (conducted in 2020-2021) where respondents were randomized into two versions of an abortion module, using different friend definitions. We computed abortion rate estimates by friend definition and adjusted for assumption violations (transmission bias, surrogate sample selection bias). Unadjusted incidence rates varied from 11.7 [4.1-19.2] abortions per 1,000 women to 15.6 [9.7-21.4], depending on friend definition. The confidante definition yielded higher adjusted estimates (36.2 [25.1-47.2]) than the best friend definition (17.0 [8.7-25.3]) due to greater transmission bias adjustment. Both estimates exceeded the respondent self-reported abortion incidence (4.0 [2.2-5.9]). Our results indicate that either friend definition produces higher incidence estimates than self-report but suggest a potential advantage for the "best friend" over the "confidante" definition given lower transmission bias. Further research should assess generalizability of these findings in other contexts.