Studies in Family Planning最新文献

In Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision-making among adolescents in the informal settlements of Kisumu. We used purposive sampling to recruit 120 adolescent boys and girls aged 15-19 for focus group discussions. A semistructured interview guide was used to elicit social norms and community attitudes about sexual and reproductive health. We analyzed the data using the Framework Approach. The social stigma of adolescent sexuality and the related fear of pregnancy as an unambiguous marker of sexual activity emerged as main themes. This stigma led adolescents to fear social retribution but did not lead to more frequent contraception use due to additional stigma. The intensity of this fear was most acutely expressed by girls, leading some to seek unsafe, sometimes fatal, abortions, and to contemplate suicide. Fear of pregnancy outweighed fear of contracting HIV that was viewed as both treatable and less stigmatized. Our findings illustrate how fear of pregnancy among these adolescents is driven primarily by fears that their community will discover that they are sexually active. Interventions are urgently needed to address adolescent sexual stigma and to prevent negative outcomes.

This paper integrates contraception into the extant migrant-fertility framework using the case of internal migration within Turkey. Drawing from the 2013 Turkish Demographic and Health Survey data, we show that migration is positively associated with age of first modern contraceptive use. As women's migration is quickly followed by family formation, women also take up modern contraception after first childbirth, likely due to new encounters with medical professionals, differing contraceptive access and other social exposures. We also find that women whose childhoods were spent in urban areas have a higher risk of first modern contraception relative to women from rural areas, thus suggesting the enduring importance of socialization. These results show how selection processes, life-cycle factors, and sociocultural norms jointly shape modern contraceptive behavior in Turkey. Our results also demonstrate a need for increased reproductive care in rural areas and suggest continued fertility decline with urban migration.

The reproductive calendar is a data collection tool that collects month-by-month retrospective histories of contraceptive use. This survey instrument is implemented in large-scale demographic surveys, but its reliability is not well-understood. Our analysis helps to address this research gap, using longitudinal panel data with overlapping calendars from urban Kenya. Our findings indicate calendar data collected in 2014 underestimated 2012 reports of current use by 5 percentage points. And while the overall percentage of women reporting at least one episode of contraceptive use was similar across the two calendars (67 percent vs. 70 percent), there was notable disagreement in contraceptive behavior when comparing the histories of individual women; less than 20 percent of women with any contraceptive use reported the exact same pattern of use in both calendars. Low calendar reliability was especially apparent for younger women and those with complicated contraceptive histories. Individual-level discordance resulted in a small difference in 12-month discontinuation rates for the period of calendar overlap; when surveyed in 2014, women reported a 12-month discontinuation rate of 39 percent, compared to a rate of 34 percent reported in 2012. When using retrospective calendar data, attention must be paid to the potential for individual reporting errors.

Examining women's reproductive experiences over time reveals a more dynamic view of women's behaviors and needs than current status measures alone. This study uses sequence and cluster analyses, which are designed for identifying patterns and subgroups in longitudinal data. We apply these methods to contraceptive calendar data in Burundi to identify discrete clusters of women based on contraceptive and pregnancy behaviors over the past 5 years. We identify six unique clusters; three characterized by no use of contraception (85 percent of women) and three by use (16 percent). The Quiet Calendar cluster (42 percent) comprise women who neither experience pregnancy nor use contraception. Family Builder 1 (25 percent) and 2 (18 percent) both include women who experience two pregnancies, but differ in unmet need and lifetime experience with contraception. Modern Mother (8 percent), Consistently Covered Mother (6 percent), and Traditional Mother (2 percent) clusters differ by type of contraception used following pregnancy. Factors associated with cluster membership are need for family planning, lifetime experience with contraception, marital status, pregnancy intention, and age. This clustering approach provides a new, more holistic way to measure the diverse needs across unique subpopulations and can inform the development of multifaceted, adaptable strategies to meet women's dynamic fertility needs over the reproductive life course.

Effective family planning methods are shown to save lives, contribute to gender equality, and boost economic development. Mass media communication campaigns in low- and middle-income countries have been effective in increasing contraceptive use, although the strategies that increase the likelihood of success are unclear. The present study uses meta-analyses to uncover the average effect of media campaigns on family planning behaviors in low- and middle-income countries and to examine the effectiveness of two communication strategies: entertainment-education and advertising/public service announcements. Results indicated that mass media-delivered family planning campaigns have a positive impact on family planning behaviors: d = 0.19, 95% CI [0.15, 0.24] for women (k = 64), d = 0.16, 95% CI [0.11, 0.21] for men (k = 27), and d = 0.20, 95% CI [0.17, 0.23] for an undifferentiated target group of men and women (k = 37). The use of an entertainment-education format, often in addition to campaign advertising messages, was associated with greater campaign success rates for women. Men, however, responded negatively to education-entertainment and positively to campaigns using only advertising and public service announcement formats. Recommendations for future family planning mass media campaigns and academic research opportunities are discussed.

Norms and beliefs toward contraception, both positive and negative, motivate contraceptive use; however, they have seldom been explored longitudinally in low- and middle-income countries, limiting our understanding of their influence on contraceptive dynamics. We used PMA2020 Uganda national longitudinal data of reproductive aged women in 2018 (baseline) and 2019 (follow-up) to explore discontinuation and switching among modern contraceptive users at baseline (n = 688) and contraceptive use at follow-up among nonusers at baseline (n = 1,377). Multivariable simple and multinomial logistic regressions assessed the association of individual and community-level contraceptive beliefs with contraceptive uptake, discontinuation and switching. One-quarter of nonusers at baseline were using contraception at follow-up, while 37 percent of users at baseline had discontinued and 28 percent had switched methods at follow-up. The odds of contraceptive uptake were lower among women who strongly agreed that contraception impacted future fertility or caused conflict within a couple, relative to those who strongly disagreed (adjusted odds ratio (aOR): 0.7 and aOR: 0.6, respectively), but higher among women who strongly agreed that contraception preserved beauty (aOR: 1.6). Women who strongly agreed that it was acceptable to use contraception before having children were less likely to discontinue their method than those who strongly disagreed (adjusted relative risk ratio (aRRR): 0.5), though living in a community where more women agreed with this statement was associated with higher discontinuation (aRRR: 6.0). Family planning programs that promote positive beliefs toward family planning could improve contraceptive uptake and continuation. More research is needed to understand how contraceptive beliefs shape contraceptive decisions across the life course.

The unmet need for modern contraception remains high around the world, particularly for youth. While some of this unmet need is driven by limited health infrastructure and method mix availability, many adolescents who visit family planning providers still do not receive methods that fit their needs. This suggests that providers may be biased against youth and that interventions to change provider behavior could help close this gap. However, it is unclear if this bias is a result of age or other characteristics common among young women such as not being married and not having children. We use a discrete choice experiment in Burkina Faso, Pakistan, and Tanzania to disentangle the effects of age on providers' decisions to provide contraception from the effects of other potential confounding factors. We find that, although young women may experience the most bias, age is not the main driver. Rather, marital status and parity seem to influence provider decisions to offer services or counsel on modern methods. These findings suggest that interventions to reduce provider bias should focus on changing behavior towards unmarried and nulliparous women, regardless of their age.

Task sharing is a strategy with potential to increase access to effective modern contraceptive methods. This study examines whether community health extension workers (CHEWs) can insert contraceptive implants to the same safety and quality standards as nurse/midwives. We analyze data from 7,691 clients of CHEWs and nurse/midwives who participated in a noninferiority study conducted in Kaduna and Ondo States, Nigeria. Adverse events (AEs) following implant insertions were compared. On the day of insertion AEs were similar among CHEW and nurse/midwife clients-0.5 percent and 0.4 percent, adjusted odds ratio (aOR) 0.92 (95 percent CI 0.38-2.23)-but noninferiority could not be established. At follow-up 6.6 percent of CHEW clients and 2.1 percent of nurse/midwife clients experienced AEs. There was strong evidence of effect modification by State. In the final adjusted model, odds of AEs for CHEW clients in Kaduna was 3.34 (95 percent CI 1.53-7.33) compared to nurse/midwife clients, and 0.72 (95 percent CI 0.19-2.72]) in Ondo. Noninferiority could not be established in either State. Implant expulsions were higher among CHEW clients (142/2987) compared to nurse/midwives (40/3517). Results show the feasibility of training CHEWs to deliver implants in remote rural settings but attention must be given to provider selection, training, supervision, and follow-up to ensure safety and quality of provision.