The Examination of Diffusion Effects on Modern Contraceptive Use in Nigeria.
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ABSTRACT:
SUBMITTER: Guilkey DK
PROVIDER: S-EPMC7329794 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
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The Examination of Diffusion Effects on Modern Contraceptive Use in Nigeria.
Guilkey David K DK Escamilla Veronica V Calhoun Lisa M LM Speizer Ilene S IS
Demography 20200601 3
This study uses data gathered for an evaluation of a Bill & Melinda Gates Foundation-funded initiative designed to increase modern contraceptive use in select urban areas of Nigeria. When the initiative was conceived, the hope was that any positive momentum in the cities would diffuse to surrounding areas. Using a variety of statistical methods, we study three aspects of diffusion and their effects on modern contraceptive use: spread through mass communications, social learning, and social influ ...[more]
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Project description:BackgroundEvidence suggests that gender equality positively influences family planning. However, the evidence from urban Africa is sparse. This study aimed to examine the association between changes in gender norms and modern contraceptive use over time among women in urban Nigeria.MethodsData were collected in 2010/2011 from 16,118 women aged 15-49 living in six cities in Nigeria (Abuja, Benin, Ibadan, Ilorin, Kaduna, and Zaria) and again in 2014 from 10,672 of the same women (34% attrition rate). The analytical sample included 9933 women living in 480 neighborhoods. A four-category outcome variable measured their change in modern contraceptive use within the study period. The exposure variables measured the changes in the level of gender-equitable attitudes towards: a) wife beating; b) household decision-making; c) couples' family planning decisions; and d) family planning self-efficacy. Multilevel multinomial logistic regression models estimated the associations between the exposure variables at the individual and neighborhood levels and modern contraceptive use controlling for the women's age, education, marital status, religion, parity, household wealth, and city of residence.ResultsThe proportion of women who reported current use of modern contraceptive methods increased from 21 to 32% during the four-year study period. At both surveys, 58% of the women did not report using modern contraceptives while 11% reported using modern contraceptives; 21% did not use in 2010/2011 but started using by 2014 while 10% used in 2010/2011 but discontinued use by 2014. A positive change in the gender-equitable attitudes towards household decision-making, couples' family planning decisions, and family planning self-efficacy at the individual and neighborhood levels were associated with increased relative probability of modern contraceptive use (adoption and continued use) and decreased relative probability of modern contraceptive discontinuation by 2014. No such associations were found between the individual and neighborhood attitudes towards wife beating and modern contraceptive use. Accounting for the individual and neighborhood gender-equitable attitudes and controlling for the women's demographic characteristics accounted for 55-61% of the variation between neighborhoods in the change in modern contraceptive use during the study period.ConclusionInterventions that promote gender equality have the potential to increase modern contraceptive use in Nigerian cities.
| S-EPMC6206649 | biostudies-literature
Project description:BACKGROUND:Postpartum family planning is the initiation and use of family planning services within the first 12 months following childbirth to impede closely spaced and unintended pregnancies. Globally, spacing pregnancies at least 2 years apart can prevent an estimated 10% of infant deaths and 21% of deaths in children 1-4 years of age. The main purpose of this study was to determine postpartum modern contraceptive use and associated factors in Hossana town, Hadiya zone, Southern nation nationalities peoples region, Ethiopia. METHODS:Facility based cross-sectional study was conducted from June 03 to July 03, 2018, in Hossana town, Hadiya zone. Data was collected by structured questionnaires using face-to-face interview on 368 women. Systematic random sampling technique was employed to approach the study participants. SPSS version 20 software was used for data analysis. Both bivariate and multiple variable logistic regression analysis were computed. Odds ratio with their 95% confidence intervals were calculated and statistical significance was decided if p < 0.05. RESULT:Two hundred seventy one (72.9%) women used postpartum modern contraception. Educational status of mothers [AOR = 0.26; 95% Cl; 0.09-0.744], resumption of sex [AOR = 4.20; 95% Cl; 1.533-11.517], menses resumption [AOR = 8.48; 95% Cl; 3.072-23.228] and duration postpartum period [AOR = 0.26; 95% Cl; 0.107-0.644] had significant association with postpartum modern contraceptive use. CONCLUSIONS:The prevalence of postpartum modern contraception use is relatively high. Educational status of mothers, resumption of sex, menses resumption and duration of postpartum period were factors significantly associated with postpartum modern contraceptive use. Improving women education & delivering messages for couples on the risk of getting pregnant prior to menses is crucial.
| S-EPMC6530850 | biostudies-literature
Project description:BACKGROUND:Afghanistan has high maternal and infant mortality which is in part driven by high fertility and low modern contraceptive use. Using modern contraceptive methods can reduce maternal and infant mortality, however there are several barriers to modern contraceptive use in Afghanistan. Married men have the potential to hinder or facilitate their wives' contraceptive use. Internally displaced persons (IDP), a growing population in Afghanistan, are rarely included in reproductive health research. We explored whether married men's, including IDPs', gender-related attitudes and other factors were associated with reported modern contraceptive use to inform programming to meet reproductive health needs of married couples. METHODS:Cross-sectional study using data from 885 married men determined to have contraceptive need in seven Afghan provinces. We explored associations between sociodemographic factors, IDP status, wives' involvement in household decision-making and men's attitudes towards intimate partner violence (IPV) with reported modern contraceptive use using logistic regression analysis. RESULTS:Most men (78%) had ?2 children, 60% reported any formal education, and 30% reported being IDPs. Only 38% of married men and 24% of IDPs with contraceptive need reported using modern contraception with their wives. Most (80% overall, 63% of IDPs) reported their wives' involvement in some/all household decisions, while 47% overall and 57% of IDPs reported IPV was justified in one or more listed circumstances. In bivariate analysis, men responding that IPV was not justified in any listed circumstance were more likely and IDPs less likely to report modern contraceptive use. In multivariable analysis, involvement by wives in household decision-making (AOR 2.57; 95% CI: 1.51, 4.37), owning a radio and/or television (AOR 1.69; 95% CI: 1.10, 2.59), having more children, age, and province of interview were independently associated with reported modern contraceptive use, while IDP status was not. CONCLUSIONS:Our findings reflect positive associations between wives' participation in household decisions and mass media exposure (television/radio ownership) with reported modern contraceptive use. Reproductive health initiatives engaging men to promote communication within couples and through mass media channels may further increase modern contraceptive use and advance Afghanistan's family planning goals. As fewer IDPs owned a radio/television, additional outreach methods should be tested for this group.
| S-EPMC7218614 | biostudies-literature
Project description:BackgroundThe slow pace of fertility decline in Africa relative to other parts of the world has important implications for the region's economic development. Modern contraceptive use is seen as important population control and family planning strategy by governments worldwide. This paper examines the socioeconomic determinants of modern contraceptive use and choice among Ghanaian men and women.MethodsWe use the most recent and nationally representative Ghana Demographic and Health Survey conducted in 2014. The analysis is observational, with no causal implications. Bivariate and multivariate methods are used to analyse the data. We first use logistic regression to explore the correlates of modern contraceptive use among Ghanaian men and women. Second, we explore the socioeconomic factors influencing the choice of modern contraceptive methods among contraceptive users using multinomial logistic regression. We classify the modern methods of contraception into three groups: long-acting reversible contraceptives (LARC), short-acting contraceptives (SAC), and permanent contraceptives.ResultsMarital status proves to be the most significant predictor for both men and women, with women in monogamous unions having a greater propensity to use modern methods of contraception (OR = 1.4, p < 0.00). We also find that different factors affect the use and choice of modern methods of contraception among men and women in Ghana. Muslim men had a higher likelihood than Catholics to choose the permanent (sterilisation) method (OR = 11.9, p < 0.05), while their female counterparts were 0.25 times less likely to choose sterilisation over SAC (p < 0.05). Moreover, women who ever tested for HIV had higher use of LAC than the SAC ((RRR = 1.6, p < 0.01). The modern contraceptive users (women) with at most basic education were more likely than those with tertiary education to choose LAC over SAC. Finally, rural women with health insurance were 0.75 times (p < 0.01) less likely to use modern methods of contraception.ConclusionsThe paper reiterates the need to intensify and sustain public health education on the health benefits of using modern methods of contraception among the adult population. The paper suggests that including family planning services on Ghana's national health insurance benefits package is commendable. It can promote modern contraceptive use and curtail unwarranted population growth.
| S-EPMC9116020 | biostudies-literature
Project description:Methods:A community-based cross-sectional study was employed among 686 mothers in Burie District from March 16 to March 25, 2017. A multistage sampling technique was used to select the study participants. Data were collected using face to face interviewer administered structured questionnaires. Then, the collected data was entered, coded, and cleaned into EPI Data version 3.1 and exported to SPSS version 20.0 for data analysis. Bivariate and multivariate logistic regression was done to assess the association of factors with postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p values <0.05 were considered to indicate statistical significance. Result:This study revealed that postpartum modern contraceptive use was found to be 20.7%. Postpartum modern contraceptive use was significantly associated with women's level of education (AOR = 0.15, 95% CI (0.03-0.71)), discussing FP methods with partner (AOR = 0.60, 95% CI (0.40-0.90)), knowing menses return after birth (AOR = 0.39, 95% CI (0.25-0.59)), ever heard about modern FP methods (AOR = 0.06, 95% CI (0.01-0.43)), and contacting health professionals (AOR = 1.85, 95% CI (1.19-2.88)). Conclusion and Recommendations. Postpartum modern contraceptive use was found to be low. Therefore, health professionals should work on improvements in women's educational status, making awareness of the women and counseling of their husbands about the use of postpartum contraception, when fertility returned and risky timing for becoming pregnant.
| S-EPMC7115150 | biostudies-literature
Project description:An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector's role in increasing contraceptive coverage and choice.In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price.Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice.There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector's role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.
| S-EPMC5812628 | biostudies-literature
Project description:Background Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Methods Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Results Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator’s reports of service provision bias. Conclusions Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population – interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2223-2) contains supplementary material, which is available to authorized users.
| S-EPMC5393003 | biostudies-literature
Project description:BackgroundHealth service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed.MethodsHealth providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status.ResultsMinimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator's reports of service provision bias.ConclusionsProvider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use.
| S-EPMC5389090 | biostudies-literature
Project description:BackgroundAccording to the 2014 World Population Data Sheet, Nigeria has one of the highest fertility and lowest contraceptive prevalence rates around the world. However, research suggests that national contraceptive prevalence rate overshadows enormous spatial variations in reproductive behavior in the country.ObjectiveI examined the variations in women's socioeconomic status and modern contraceptive use across states in Nigeria.MethodsUsing the 2013 Nigeria Demographic and Health Survey data (n = 18,910), I estimated the odds of modern contraceptive use among sexually active married and cohabiting women in a series of multilevel logistic regression models.ResultsThe share of sexually active, married and cohabiting women using modern contraceptives widely varied, from less than one percent in Kano, Yobe, and Jigawa states, to 40 percent in Osun state. Most of the states with low contraceptive prevalence rates also ranked low on women's socioeconomic attributes. Results of multilevel logistic regression analyses showed that women residing in states with greater shares of women with secondary or higher education, higher female labor force participation rates, and more women with health care decision-making power, had significantly higher odds of using modern contraceptives. Differences in women's participation in health care decisions across states remained significantly associated with modern contraceptive use, net of individual-level socioeconomic status and other covariates of modern contraceptive use.ConclusionUnderstanding of state variations in contraceptive use is crucial to the design and implementation of family planning programs. The findings reinforce the need for state-specific family planning programs in Nigeria.
| S-EPMC4530895 | biostudies-literature
Project description:ObjectivesThe study aimed to assess the determinants of modern contraceptive method use among young women in Benin.DesignA mixed-methods design.Setting and participantsWe used the Benin 2017-2018 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals in Benin. The participants were purposively selected.OutcomesContraceptive prevalence rate, unmet need for modern method and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilisation of modern methods were assessed in the qualitative part.ResultsOverall, 8.5% (95% CI 7.7% to 9.5%) among young women ages 15-24 were using modern contraceptives and 13% (12.1% to 14.0%) among women ages 25 or more. Women 15-24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared with women ages 25 or more. 60.8% (56.9% to 64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women's fertility, spousal consent and the use of non-modern contraceptives.ConclusionContraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by sociodemographic factors and social norms. Appropriate interventions might promote comprehensive sexuality education, increase community engagement, provide youth-friendly services and address gender inequalities.
| S-EPMC8728422 | biostudies-literature