Open access journal of contraception最新文献

Background: The sharp fertility drop-off in the Amhara region between 2000 and 2011 was due to an increase in modern contraceptive utilization of rural women. However, long-acting contraceptive method utilization was higher among urban than rural women. Therefore, this study aimed to assess rural-urban differentials of long-acting contraceptive method utilization and the contributing factors among reproductive-age women in the Amhara region: analysis of the 2016 EDHS.

Methods: The 2016 EDHS data were used. A weighted sample of 2188 (1675 rural and 513 urban) fecund reproductive-age women was used, and a mixed-effects logistic regression model was fitted. Multivariable logistic regression analysis at a P-value <0.05 and adjusted odds ratio with a 95% confidence interval were used to declare significant associations.

Results: The overall long-acting contraceptive method use was 13.3% (95% CI=11.6-15.8), and it was 14.8% (95% CI=12.4-17.2) among rural and 8.3% (95% CI=4.5-12.4) among urban women. Among urban women, the odds of long-acting contraceptive method use was higher for women living with a partner (AOR=6.83; 95% CI=1.23-37.84), married women (AOR=5.21; 95% CI=1.95-13.89), women living in a male-headed household (AOR=5.29; 95% CI=1.26-22.38), and women whose partner wanted fewer children (AOR=11; 95% CI=3.46-16.2). Among rural women, the odds of long-acting contraceptive use was higher for women in the richest wealth index (AOR=6.69; 95% CI=3.02-14.83), married women (AOR=30.26; 95% CI=8.81-42.9), women with good knowledge of LACMs (AOR=1.75; 95% CI=1.25-2.46), and women who had no correct knowledge of their ovulatory cycle (AOR=1.93; 95% CI=1.16-3.19).

Conclusion: Long-acting contraceptive method use was lower than the national target. LACM use was 8.3% (95% CI=4.5-12.4) among urban and 14.8% (95% CI=12.4-17.2) among rural women. Overall, marital status, educational level, the total number of children, knowledge of LACMs, and correct knowledge of the ovulatory cycle were significantly associated with LACM use.

Introduction: Client satisfaction influences the use of family planning and other reproductive health services. This study aimed to assess the magnitude of client satisfaction with family service and its associated factors among reproductive-age women.

Patients and methods: We conducted a facility-based cross-sectional study. A total of 411 clients, nested in four health facilities, were included in the analysis. Systematic sampling was employed to select study units for the exit interview. Data collection instruments for this study were pre-tested structured questionnaires. Client satisfaction was assessed using fifteen Likert-scaled question items. Each item of question has 5 points ranging from 1 (strongly disagree) to 5 (strongly agree) and, finally, mean was computed. The pre-coded data were entered into Epi Data version 4.2.0 and exported to SPSS version 25 for analysis. Logistic regression analysis was carried out to identify independently associated factors at a confidence interval of 95% and a significance level of p-value less than 0.05.

Results: Magnitude of client satisfaction with family planning service was 46% [95% CI: 41-50.8]. Rural residence [AOR=3.07; 95% CI: 1.10-8.62], educational level of college and above [AOR=0.22; 95% CI: 0.07-0.70] as compared to the educational level of primary education, waiting time of less than half an hour [AOR=7.80; 95% CI: 2.48-24.48], maintaining privacy [AOR=7.16; 95% CI: 2.89-17.69], describing side effects of methods [AOR=3.14; 95% CI: 1.02-9.76] were factors significantly associated with client satisfaction.

Conclusion: The overall magnitude of client satisfaction with the services was found to be low. Many of the factors that attributed to the low level of client satisfaction are modifiable. There is a need for organizing the family planning room as per standards, maintaining privacy, minimizing waiting time, and describing the side effects during the provision of service.

Background: Family planning is defined as the ability of couples or individuals to attain their desired number of children, spacing, and timing of their births with the use of contraceptive methods. Ethiopia is one of the most populated countries in Africa with a high fertility rate, a highly unmet need for family planning, and low contraceptive utilization.

Objective: This study aims to assess modern contraceptive method utilization and associated factors among women of reproductive age in Gondar City, Northwest Ethiopia.

Materials and methods: A community-based cross-sectional study design was undertaken with 708 women in the reproductive age in Gondar City, using a structured questionnaire combined with face-to-face interviews. Descriptive analysis, binary, and multivariable logistic regression analyses were applied to analyze the data.

Results: In this study, 41.2% of the respondents utilized modern contraceptive methods. Of the study participants, 52.1 % had good knowledge and 45.3% had a favorable attitude towards modern contraceptive methods. After adjusting for covariates, the odds of using modern contraceptive methods were 3.6 times, 4.7 times, 2.4 times, and 4 times higher among women of the age 20-24, 25-29, preparatory education, and degree holders, respectively. In addition, for the women having up to six desired children [AOR (Adjusted Odds Ratio) = 2.4 (95% CI: 1.1, 5.3)], a history of no-child death experience [AOR= 4.4 (95% CI: 1.03, 19.1)], good knowledge [AOR= 4.1 (95% CI: 2.7, 6.0)], and favorable attitude [AOR= 3.5 (95% CI: 2.4, 5.1)] were positively associated with modern contraceptive utilization.

Conclusion: The majority of participants had good knowledge about, but the unfavorable attitude towards the utilization of modern contraceptive methods. Therefore, the authors recommended that special awareness creation with the help of health education interventions should be employed in the community.

Background: Women's decision-making power influences the use of family planning. It is one of the denied fundamental rights of women, particularly in developing countries.

Objective: This study was aimed to assess married women's decision-making power in the use of family planning and its associated factors among married reproductive age women in Basoliben, Amhara, Ethiopia, 2018.

Methods: A community-based cross-sectional study was conducted among married reproductive age women from March 1 to 30, 2018. A multistage simple random sampling technique was employed in selecting study participants. Data were collected using structured questionnaires and analyzed through SPSS 20 software. The binary and multiple variable logistic regression models were fitted to identify factors associated with women's decision-making power on family planning use. Statistical significance was declared at p-value less than 0.05.

Results: A total of 734 married women aged 18-49 years are making a 98% response rate included in this study. The level of married women's decision-making power in family planning among married women was 80%; 95% CI (76.9, 82.8). Monthly income (AOR=2.2; 95% CI: 1.1, 4.2), husband's desired number of children of <3 (AOR=9.9; 95% CI: 3.6), husband's desired time for additional child after 3 years postbirth (AOR=4.0; 95% CI: 1.9, 8.5) and women's information on any contraceptive (AOR=9.6; 95% CI: 2.4, 39.0) were factors significantly associated with married women's decision-making power in family planning.

Conclusion: Married women's decision-making power in family planning use was optimal. Household monthly income, husband's desired ideal number of children, husband's desired time when to have another child and information about any contraceptive methods were predictors of their decision-making power on family planning use. There should be awareness creation of family planning methods to increase its utilization.

Introduction: In Ethiopia, the fertility rate declined from 5.4 in 2005 to 4.6 by 2016. Many factors have been contributing to this decline. Understanding the factors contributing to the fertility decline and their level of fertility inhibiting effect has a paramount policy implication in any country. This study aimed to assess the contribution of the four proximate determinants of fertility, ie, contraception use, postpartum infecundity, marriage and abortion rate, to fertility decline in Ethiopia since 2005.

Methods: This study used publicly available data from the Ethiopia Demographic and Health Surveys (EDHS) of 2005, 2011 and 2016. The EDHS data were the representative data collected from the reproductive-age women through a cross-sectional study. The revised and fine-tuned Bongaarts model of proximate fertility determinants was used for data analysis. The components needed for the analysis were extracted from the full EDHS data using the STAT compiler. Finally, the analysis was done using Microsoft Excel.

Results: Of the four proximate determinants of fertility, postpartum insusceptibility contributed the highest fertility inhibiting effect in all three EDHS, and its level was also more prominent among the poorest women. While post partum infecundity, marriage and abortion had a relatively constant effect on fertility over the last 15 years, the fertility inhibiting effect of contraceptive use significantly increased from 15% to 37%.

Conclusion: In conclusion, fertility variation in Ethiopia is largely due to the three intermediate determinants of fertility. Over the last one and half decades, contraceptive use was the single most important determinant responsible for fertility decline in Ethiopia. To achieve fertility at replacement level, the country needs a contraceptive prevalence rate of 69%, an increment of nearly 100% from its current contraceptive prevalence rate.

Introduction: Globally in 2019, there were 1.9 billion reproductive-age women. Around 922 million of them were using either modern or traditional methods of family planning. Women with disabilities comprise 10% of worldwide women and three-quarters of them reside in low- and middle-income countries.

Objective: The purpose of this study was designed to assess the magnitude and associated factors for family planning methods use among reproductive-age women with disabilities in Arba Minch town, southern Ethiopia.

Patients and methods: A community-based cross-sectional study was conducted among 418 reproductive-age women with disabilities. Data were collected with eight women who had completed grade 12 and two of them were proficient in sign language. The data were entered into Epi-info™ version-7 software and exported into SPSS version 20 for analysis. A statistically significant variable in the final model was declared by adjusted odds ratio (AOR), 95% confidence interval (CI) and p-value <0.05.

Results: The magnitude of family planning utilization among reproductive-age women with disabilities was 33.7%. Factors significantly associated with family planning use were being employed (AOR: 2.2, CI: 1.77-4.15), having positive attitudes (AOR: 2.3, 95% CI: 1.21-3.87) and marital status (AOR: 3.9, 95% CI: 2.31-6.63).

Conclusion: The magnitude of family planning use among reproductive women with disabilities was low. Attitude, marital status, and being employed were significantly associated factors with family planning use. Therefore, the governmental and non-governmental organizations should work to change their attitude and creating job opportunities.

Background: Women's decisions on family planning use have multiple benefits to the family and community at large. In developing countries like Ethiopia, the choice of women to use a contraceptive is challenged by social and environmental factors that mitigate their ability to decide independently and freely. This study therefore determined the level of women's decision-making power on family planning use and associated factors among married women in the study area.

Methods: A community-based cross-sectional study was conducted in Dinsho woreda from March to April 2017. A simple random sampling technique was used to select 373 married women. A structured and pre-tested questionnaire was used to collect data by trained data collectors under continuous supervision. Multivariable logistic regression was performed to identify factors associated with women's decision-making power on family planning use. Crude and adjusted odds ratios with 95% confidence interval were used and p-value of <0.05 was considered as statistical significance.

Results: A total of 344 (92.2%) women participated in the study. Of the total respondents, 179 (52%) of women had good decision-making power on modern family planning use. Multivariable analysis showed that younger age (adjusted odds ratio [AOR] =8.59 [1.61, 45.80]), good participation in household decision-making (AOR =2.65 [1.46, 4.79]), positive attitude towards family planning (AOR =2.34 [1.31, 4.19]), and better knowledge towards family planning (AOR =3.04 [1.49, 6.22]) were factors statistically significantly associated with married women's decision-making power on family planning use.

Conclusion and recommendation: Women's knowledge and attitudes toward family planning and their participation in household decision-making increased the likelihood of women's decision-making power for modern family planning use. There is a need to adopt a more comprehensive approach to reach men and women on modern family planning, to help women to decide freely without any restriction.

Background: Utilization of maternity services (UMS) exposes mothers to family planning (FP) counseling and other FP promotional activities. Uptake of postpartum modern contraceptives (PPMC) reduces both infant and maternal mortalities by reducing unwanted pregnancies and promoting good child spacing. Understanding the relationship between UMS and uptake of PPMC was therefore very important.

Purpose: To determine the association between UMS and uptake of PPMC among women of the reproductive age group in Nigeria taking into consideration the influence of the place of access to the maternity services.

Patients and methods: This study was a descriptive epidemiological study design. Secondary data obtained from the 2013 Nigerian Demographic Health Survey (NDHS) was analyzed to achieve the above aim. The uptake of PPMC was the dependent variable (DV). The independent variables (IDV) selected were the number of antenatal care (ANC) visits, place of access of ANC, place of delivery, timing of postnatal care (PNC) and place of access of PNC. Other control variables include socio-demographic factors. Descriptive statistics, chi-square testing, and logistic regression analyses were conducted to determine the association between the PPMC uptake and the IDV/other control variables. Statistical significance was claimed at p<0.05.

Results: Utilization of maternity services was associated with higher uptake of PPMC among the women (>/= 4 ANC visits OR = 2.08, 95% CI=1.65-2.62, P<0.001; public facility delivery OR= 1.80, 95% CI= 1.54-2.10, P< 0.001; private facility delivery OR =1.54, 95% CI 1.28-1.85, P< 0.001; PNC OR=1.21, 95% CI= 1.02-1.43, P=0.029). Accessing postnatal care in private health facilities was associated with increased uptake of PPMC (OR= 1.46, 95% CI =1.05-2.02, P= 0.024). The number of children alive, educational attainment, wealth index and having information about FP remained significant predictors of PPMC uptake.

Conclusion: The utilization of maternity services was positively associated with postpartum use of modern contraceptives among women of reproductive age in Nigeria. There was increased uptake of PPMC among women who utilized maternity service compared to their counterparts who did not. Regarding the place of access, accessing antenatal care as well as delivering in either private or public health facilities was not a significant predictor of PPMC use. However, accessing postnatal care in private facilities was associated with higher uptake of PPMC.

Background: Prior studies have noted that public insurance status is associated with increased uptake of postpartum contraception whereas others have pointed to public insurance as a barrier to accessing highly effective forms of contraception.

Objective: To assess differences in planned method and provision of postpartum contraception according to insurance type.

Study design: This is a secondary analysis of a retrospective cohort study examining postpartum women delivered at a single hospital in Cleveland, Ohio from 2012-2014. Contraceptive methods were analyzed according to Tier-based effectiveness as defined by the Centers for Disease Control and Prevention. The primary outcome was postpartum contraception method preference. Additional outcomes included method provision, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery.

Results: Of the 8281 patients in the study cohort, 1372 (16.6%) were privately and 6990 (83.4%) were publicly insured. After adjusting for the potentially confounding clinical and demographic factors through propensity score analysis, public insurance was not associated with preference for a Tier 1 versus Tier 2 postpartum contraceptive method (matched adjusted odds ratio [maOR] 0.89, 95% CI 0.69-1.15), but was associated with a preference for Tier 1/2 vs Tier 3/None (maOR 1.41, 95% CI 1.17-1.69). There was no difference between women with private or public insurance in terms of method provision by 90 days after delivery (maOR 0.94, 95% CI 0.75-1.17). Public insurance status was also associated with decreased postpartum visit attendance (maOR 0.54, 95% CI 0.43-0.68) and increased rates of subsequent pregnancy within 365 days of delivery (maOR 1.29, 95% CI 1.05-1.59).

Conclusion: Public insurance status does not serve as a barrier to either the preference or provision of effective postpartum contraception. Women desiring highly- or moderately effective methods of contraception should have these methods provided prior to hospital discharge to minimize barriers to method provision.

Purpose: Addressing the contraceptive needs of young married women is critical to improve their health and well-being. In patriarchal societies, young married women are under intense pressure to demonstrate their fecundity. Therefore, research that specifically address the needs for contraception of young married women have been generally given less emphasis in Ethiopia. This study assessed the extent of unmet needs for contraception and its associated factors among young married women in Eastern Ethiopia.

Methods: A community-based cross-sectional study was conducted among young married women (14-24 years of age) in Eastern Ethiopia. Data were collected using a structured questionnaire. The prevalence ratio (PR) with 95% confidence intervals (CIs) was calculated, and factors associated with unmet needs for contraception were identified using log-binomial regression statistical model.

Results: Among 2933 young women interviewed, the unmet need for contraception was 1014 (34.6%; 95% CI, 32.9%-36.4%). The prevalence of unmet needs for contraception decreased with increased young women's household decision-making autonomy score (APR= 0. 76; CI=0.62-0.94). Exposure to family planning (FP) information during the last 12 months (APR= 1.24; CI=1.1-1.42), age 18 or more years (APR=1.25; CI=1.04-1.5), multiparty (APR= 1. 9; CI=1.7-2.1) and desire to have 5 children or lesser than 5 children (APR= 1. 2; CI=1.06-1.32) were associated with higher prevalence of unmet needs for contraception.

Conclusion: One-third of married young women had unmet needs for contraception. More efforts to empower women to make decisions that affect their own life and providing appropriate family planning information are necessary to reduce the burden of unmet needs among young married women in rural settings in Ethiopia.