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From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment.

ABSTRACT: OBJECTIVE:In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. METHODS:Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. RESULTS:Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users. CONCLUSION:By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals.

SUBMITTER: OlaOlorun FM

PROVIDER: S-EPMC7673533 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment.

OlaOlorun Funmilola M FM Anglewicz Philip P Moreau Caroline C

PloS one 20201118 11

<h4>Objective</h4>In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception.<h4>Methods</h4>Data were drawn from a national pro ...[more]

PMID: 33206705

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Project description:BackgroundDespite the availability of copious information regarding contraceptive use benefits and the factors that influence the uptake of the services, there is little evidence revealing the lived experiences of rural women. Thus, this study was conducted with the purpose of exploring the lived experiences of women regarding contraceptive use and related benefits towards women's empowerment.MethodsInterpretative phenomenological qualitative methodology was employed to explore the lived experiences of women. Data were collected through focus group discussions and in-depth individual interviews and analyzed using an interpretive phenomenological framework including phases of data immersion, transcribing, coding, theme development and phenomenological interpretation through hermeneutic circle.ResultThe reported lived experiences of rural women revealed that their livelihoods greatly improved in different ways after they began to use contraceptives. The benefits included securing more time, energy and social engagements. Contraceptive use helped women postpone unwanted pregnancies and child births and engage in various income generation activities that not only boosted family incomes but also created opportunity to mobilize the resources for different expenses without waiting for the handouts from their husbands. The women's experiences also indicated that contraceptive use improved the educational status of their daughters and they experienced improved self-image, better social standing and improved family relations. The experiences further illustrated that contraceptive use was not only emancipatory and transformative, but also created peace and stability in their lives.ConclusionThe study concludes that contraceptive use, which is part of a woman's life experience, created remarkable opportunities and achievements. One of these was that women were able to control their bodies, reproduction and fertility which resulted in a higher degree of empowerment. The control of reproduction and fertility has liberated them from worries and entrapment of unplanned and unwanted pregnancies. Moreover, contraceptive use led to wider opportunities in the community, by improving their status and building a sense of empowerment. Creating awareness around the benefits of contraceptive use has the potential to improve community and national development. Based on the result, the study recommends that systems should be established to capitalize on the lessons learned about the lives of current users and expand the remarkable achievements and experiences to non-user counterparts.

Project description:BackgroundWomen's education and empowerment are important predictors of contraceptive use across countries. However, two of the Indian states, namely, Punjab and Manipur, showed large variations in contraceptive use, despite the similar level of women's educational attainment and empowerment. Therefore, this paper attempts to understand variation in contraceptive use between these states, despite having similar level of educational attainment and empowerment among the married women.MethodsThis study primarily used cross-sectional data of the National Family Health Survey (NFHS) 2015-16 and to some extent the District Level Household Survey (DLHS) 2012-13 data. The analytical sample includes 13,730 currently married women in Punjab and 8,872 in Manipur. Modern contraceptive prevalence rate (mCPR) is the key outcome variable of this study. Bivariate, multivariate, and multilevel regression analysis are applied to understand the differences in mCPR between these states and its determinants.ResultsMean years of schooling was about 8 years among women of both the states, and about 34% of the women in Punjab and 27% of the women in Manipur have high level of autonomy. Despite this, use of modern method was 66% in Punjab and only 13% in Manipur. Coverage of family planning program indicators were significantly lower in Manipur than Punjab - frontline workers' (FLWs) outreach for family planning was only 18% in Manipur compared to 52% in Punjab. Similarly, only 11% of the public health facilities in Manipur compared to 50% of the health facilities in Punjab were ready to provide at least one clinical method of family planning.ConclusionDespite the similar level of individual level characteristics across the two states, poor coverage of family planning programs - low outreach of FLWs, low level of facility readiness, as well as sociocultural norms discouraging contraceptive use - might be responsible for lower contraceptive use in Manipur than Punjab. This implies for strengthening the health system for family planning in Manipur to meet the contraception needs of women by addressing sociocultural barriers in the state.

Project description:There is little available evidence of associations between the various dimensions of women's empowerment and contraceptive use having been examined--and of how these associations are mediated by women's socio-economic and demographic statuses. We assessed these phenomena in Pakistan using a structured-framework approach.We analyzed data on 2,133 women who were either using any form of contraceptive or living with unmet need for contraception. The survey was conducted during May - June 2012, with married women of reproductive age (15-49 years) in three districts of Punjab. The dimensions of empowerment were categorized broadly into: economic decision-making, household decision-making, and women's mobility. Two measures were created for each dimension, and for the overall empowerment: women's independent decisions, and those taken jointly by couples. Contraceptive use was categorized as either female-only or couple methods on the basis of whether a method requires the awareness of, or some support and cooperation from, the husband. Multinomial regression was used, by means of Odds Ratios (OR), to assess associations between empowerment dimensions and female-only and couple contraceptive methods.Overall, women tend to get higher decision-making power with increased age, higher literacy, a greater number of children, or being in a household that has superior socio-economic status. The measures for couples' decision-making for overall empowerment and for each dimension of it showed positive associations with couple methods as well as with female-only methods. The only exception was the measure of economic empowerment, which was associated only with the couple method.Couples' joint decision-making is a stronger determinant of the use of contraceptive methods than women-only decision-making. This is the case over and above the contribution of women's socio-demographic and economic statuses. Effort needs to be made to educate women and their husbands equally, with particular focus on highly effective contraceptive methods.

Project description:BackgroundPersistent challenges in meeting reproductive health and family planning goals underscore the value in determining what factors can be leveraged to facilitate modern contraceptive use, especially in poor access settings. In Mali, where only 15% of reproductive-aged women use modern contraception, understanding how women's realities and health system design influence contraceptive use helps to inform strategies to achieve the nation's target of 30% by 2023.MethodsUsing household survey data from the baseline round of a cluster-randomized trial, including precise geolocation data from all households and public sector primary health facilities, we used a multilevel model to assess influences at the individual, household, community, and health system levels on women's modern contraceptive use. In a three-level, mixed-effects logistic regression, we included measures of women's decision-making and mobility, as well as socio-economic sources of empowerment (education, paid labor), intrahousehold influences in the form of a co-residing user, and structural factors related to the health system, including distance to facility.ResultsLess than 5% of the 14,032 women of reproductive age in our study used a modern method of contraception at the time of the survey. Women who played any role in decision-making, who had any formal education and participated in any paid labor, were more likely to use modern contraception. Women had three times the odds of using modern contraception if they lived in a household with another woman, typically a co-wife, who also used a modern method. Compared to women closest to a primary health center, those who lived between 2 and 5 km were half as likely to use modern contraception, and those between 5 and 10 were a third as likely.ConclusionsDespite chronically poor service availability across our entire study area, some women-even pairings of women in single households-transcended barriers to use modern contraception. When planning and implementing strategies to expand access to contraception, policymakers and practitioners should consider women's empowerment, social networks, and health system design. Accessible and effective health systems should reconsider the conventional approach to community-based service delivery, including distance as a barrier only beyond 5 km.

Project description:People at risk of developing clinical depression exhibit attentional biases for emotional faces. To clarify whether such effects occur at an early, automatic, or at a late, deliberate processing stage of emotional processing, the present study used high-density electroencephalography during both covert and overt processing of sad, fearful, happy, and neutral expressions in healthy participants with high dysphoria (n = 16) and with low dysphoria (n = 19). A state-of-the-art non-parametric permutation-based statistical approach was then used to explore the effects of emotion, attentional task demands, and group. Behaviorally, participants responded faster and more accurately when overtly categorizing happy faces and they were slower and less accurate when categorizing sad and fearful faces, independent of the dysphoria group. Electrophysiologically, in an early time-window (N170: 140-180 ms), there was a significant main effect for the dysphoria group, with greater negative voltage for the high vs. low dysphoria group over the left-sided temporo-occipital scalp. Furthermore, there was a significant group by emotional interaction, with the high dysphoria group displaying greater negative amplitude N170 for happy than fearful faces. Attentional task demands did not influence such early effects. In contrast, in an intermediate time-window (EPN: 200-400 ms) and in a late time-window (LPP: 500-750 ms) there were no significant main effects nor interactions involving the dysphoria Group. The LPP results paralleled the behavioral results, with greater LPP voltages for sad and fearful relative to happy faces only in the overt task, but similarly so in the two dysphoria groups. This study provides novel evidence that alterations in face processing in dysphoric individuals can be seen at the early stages of face perception, as indexed by the N170, although not in the form of a typical pattern of mood-congruent attentional bias. In contrast, intermediate (EPN) and late (LPP) stages of emotional face processing appear unaffected by dysphoria. Importantly, the early dysphoria effect appears to be independent of the top-down allocation of attention, further supporting the idea that dysphoria may influence a stage of automatic emotional appraisal. It is proposed that it may be a consequence of a shift from holistic to feature-based processing of facial expressions, or may be due to the influence of negative schemas acting as a negative context for emotional facial processing.

Project description:BackgroundIn Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso.MethodsWe analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors.ResultsOverall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS.ConclusionsEmpowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights.Trial registrationNo clinical trial has been performed in this study.

Dataset Information

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment.

Publications

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment.

Similar Datasets

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