Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries.
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ABSTRACT:
SUBMITTER: Rios-Zertuche D
PROVIDER: S-EPMC5493184 | biostudies-other | 2017 Jun
REPOSITORIES: biostudies-other
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Project description:ObjectiveTo examine the relationship between pregnancy coercion and partner knowledge of contraceptive use.Study designCross-sectional Performance Monitoring for Action-Ethiopia data were collected in October-November 2019 from a nationally representative sample of women ages 15 to 49. The analytical sample (n = 2,469) included partnered women using contraception in the past year. We used multinomial logistic regression to examine associations between past-year pregnancy coercion (none, less severe, more severe) and partner knowledge/couple discussion of contraceptive use (overt use with couple discussion before method initiation (reference group), overt use with discussion after method initiation, and covert use of contraception).ResultsMost women reported their partner knew they were using contraception and had discussed use prior to method initiation (1,837/2,469, 75%); 16% used overtly and discussed use after method initiation, and 7% used contraception covertly. The proportion of covert users increased with pregnancy coercion severity (4%none, 14%less severe, 31%more severe), as did the proportion of overt users who delayed couple contraceptive discussions, (14%none, 23%less severe, 26% more severe); however, overt use with couple discussion before method initiation decreased with pregnancy coercion severity (79%none, 60%less severe, 40%more severe). The risk of covert use among women experiencing less severe pregnancy coercion was four times greater than women who experienced no pregnancy coercion (adjusted relative risk ratio, (aRRR) = 3.95, 95% confidence interval (CI) 2.20-7.09) and ten times greater for women who experienced the most severe pregnancy coercion (aRRR = 10.42, 95% CI 6.14-17.71). The risk of overt use with delayed couple discussion also increased two-fold among women who experienced pregnancy coercion compared to those who did not (less severe aRRR = 2.05, 95% CI 1.39-2.99; more severe aRRR = 2.89, 95% CI 1.76-4.73).ConclusionWhen experiencing pregnancy coercion, women may avoid or delay contraceptive conversations with their partners. Increased pregnancy coercion severity has the greatest association with covert use and couple contraceptive discussions.ImplicationsThe presence and timing of couple discussions about contraception are critical for ensuring safety for women experiencing pregnancy coercion. Screening for pregnancy coercion must be included within contraceptive counseling so that women can choose methods that maximize their reproductive autonomy.
| S-EPMC9525805 | biostudies-literature
Project description:BackgroundPreventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda.Study designThis was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011-2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6-18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count.ResultsAmong 455 women, 110 women reported 110 incident pregnancies with report on intent. Women had a baseline median age of 29 years, baseline CD4 count 403 cells/mm3, and were living with HIV for 3.8 years. Fifty pregnancies (45%) were reported as unintended and 60 (55%) as intended. Postpartum, 64% of women with unintended and 51% with intended pregnancy reported modern contraception (p = 0.24). In adjusted models, there was no association between pregnancy intent and post-partum contraception. However, contraceptive use prior to the referent pregnancy was positively associated with post-partum contraceptive use (aRR 1.97 (95% CI 1.12-3.48, p = 0.02), while higher baseline CD4 cell count was associated with lower post-partum contraceptive use (aRR 0.95, 95% CI 0.90-0.99, p = 0.02).ConclusionsAlmost half of incident pregnancies among WLWH in this cohort were unintended. Experiencing an unintended pregnancy was not associated with post-partum contraceptive use. Creative strategies to support contraceptive uptake for birth spacing and prevention of unintended pregnancies in the post-partum period are needed.
| S-EPMC6201927 | biostudies-literature
Project description:BACKGROUND:During the post-partum period, most women wish to delay or prevent future pregnancies. Despite this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning during this period. METHODS:Using the NICHD Global Network for Women's and Children's Health Research's multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries (India, Pakistan, Zambia, Kenya and Guatemala), we assessed fertility intention and contraceptive usage at day 42 post-partum. RESULTS:We gathered data on 36,687 women in the post-partum period. Less than 5% of these women wished to have another pregnancy within the year. Despite this, rates of modern contraceptive usage varied widely and unmet need ranged from 25% to 96%. Even amongst users of modern contraceptives, the uptake of the most effective long-acting reversible contraceptives (intrauterine devices) was low. Women of age less than 20 years, parity of two or less, limited education and those who deliver at home were at highest risk for having unmet need. CONCLUSIONS:Six weeks postpartum, almost all women wish to delay or prevent a future pregnancy. Even in sites where early contraceptive adoption is common, there is substantial unmet need for family planning. This is consistently highest amongst women below the age of 20 years. Interventions aimed at increasing the adoption of effective contraceptive methods are urgently needed in the majority of sites in order to reduce unmet need and to improve both maternal and infant outcomes, especially amongst young women. STUDY REGISTRATION:Clinicaltrials.gov (ID# NCT01073475).
| S-EPMC4464604 | biostudies-literature
Project description:ObjectiveTo evaluate the association between contraceptive knowledge and type of method used.MethodsWe analyzed data from a cross-sectional study of sexually active women in Hanoi, Vietnam, not desiring pregnancy. We used linear and logistic regression to evaluate contraceptive knowledge of users of the intrauterine device (IUD), combination oral contraception (COC) and male condoms. We measured contraceptive knowledge with seven questions on relative effectiveness of methods, reversibility, covert use, contraindications and side effects.ResultsRespondents used IUD (n = 128), COC (n = 126) or condoms (n = 167). Summary knowledge scores did not differ by current type of method used. Only one knowledge domain, contraceptive effectiveness, varied by method. Compared to condom users, IUD users had higher odds of correctly identifying the IUD as more effective than COC, condoms and withdrawal (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI], 2.7-8.3). Higher proportions of condom users (49.7%) mistakenly identified condoms as the most effective of listed methods compared to IUD (20.3%) and COC users (23.0%). On the other hand, IUD and COC users had lower odds (aOR, 0.5; 95% CI, 0.2-1.0 and aOR, 0.3; 95% CI, 0.1-0.6, respectively) of identifying consistent condom use as better for pregnancy prevention than other practices (e.g., withdrawal and postcoital douching).ConclusionsIUD users more often recognized that the IUD is highly effective while condom users appeared to overestimate condom effectiveness. Contraceptive counseling should ensure that women understand the relative effectiveness of methods. We found no evidence that other types of contraceptive knowledge differed by type of method used.ImplicationsKnowledge of contraceptive effectiveness was the sole difference detected in contraceptive knowledge between women in Hanoi, Vietnam, using the IUD, COC or male condoms.
| S-EPMC7252424 | biostudies-literature
Project description:IntroductionContraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM).MethodsA facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia.ResultsAmong sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09-1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50-0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20-1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28-1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility.ConclusionsAlthough contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.
| S-EPMC7410321 | biostudies-literature
Project description:High salt intake is a major risk factor of hypertension and cardiovascular disease. Improving knowledge, attitudes, and practices (KAP) related to salt intake in the general population is a key component of salt reduction strategies. The objective of this study was to describe and compare the KAP of adults related to salt in urban areas of five countries in sub-Saharan Africa. The survey included 588 participants aged 25 to 65 years who were selected using convenience samples in the urban areas of Benin, Guinea, Kenya, Mozambique, and Seychelles. Socio-demographic and food consumption were assessed using a structured closed-ended questionnaire administered by survey officers. Height, weight, and blood pressure were measured. Food consumption varied largely between countries. Processed foods high in salt, such as processed meat, cheese, pizzas, and savory snacks were consumed rather infrequently in all the countries, but salt-rich foods, such as soups or bread and salty condiments, were consumed frequently in all countries. The majority of the participants knew that high salt intake can cause health problems (85%) and thought that it is important to limit salt intake (91%). However, slightly over half (56%) of the respondents regularly tried to limit their salt intake while only 8% of the respondents thought that they consumed too much salt. Salt and salty condiments were added most of the time during cooking (92% and 64%, respectively) but rarely at the table (11%). These findings support the need for education campaigns to reduce salt added during cooking and for strategies to reduce salt content in selected manufactured foods in the region.
| S-EPMC6116014 | biostudies-literature
Project description:BACKGROUND: Unplanned pregnancy from casual sex, unplanned sexual activity, and sexual violence are increasing. Emergency Contraceptives (EC) are used to prevent unplanned pregnancies thereby preventing the occurrence and consequences of unplanned pregnancy. Emergency contraception is widely available in Ethiopia particularly in major cities. Yet the use of EC is very low and abortion rate in cities is high compared to the national average. OBJECTIVES: To assess knowledge, attitude and practice and determinants on the use of emergency contraception among women obtaining abortion service at selected health institutions in Dire Dawa, Eastern Ethiopia. METHODS: A facility based cross-sectional study was conducted on 390 women selected by multi-stage random sampling technique. The samples were generated from government and private for non profit health facilities. Participant's knowledge and attitude towards emergency contraception were measured using composite index based on 7 and 9 questions, respectively and analyzed using mean score to classify them as knowledgeable or not, and have positive attitude or not. Practice was assessed if the women reported ever use of emergency contraception. Determinants of use of emergency contraception were analyzed using logistic regression. RESULT: Out of 390 women interviewed, 162 women (41.5%) heard about EC, only 133 (34.1%) had good knowledge, and 200 (51.3%) of the respondents had positive attitudes towards to EC. Ever use of EC was reported by 38 (9.7%). Age, living arrangement, education, marital status, religion were found to be significantly associated with the use of emergency contraceptives. Women with poor knowledge were less likely to use EC compared to the knowledgeable ones [AOR = 0.027, 95% CI (0.007, 0.105)]. CONCLUSION: The study identified that most respondents lack adequate knowledge on the method of EC. In addition ever use of EC is very low. RECOMMENDATIONS: Health professions should give attention in increasing knowledge and uptake of Emergency Contraception.
| S-EPMC4201511 | biostudies-other
Project description:Background: Approximately 48% of unintended pregnancies occur as a result of contraceptive failure around the world, which is largely due to incorrect use, poor adherence and/or technology failure. Long-acting reversible contraceptive (LARC) methods have been developed to close this gap because it's not dependent on compliance with a pill-taking regimen; remembering to change patch or ring; or fixing an appointment with physicians. The main aim of this study is to identify the factors influencing the women associated with use of LARC and to examine the relationship between knowledge of LARC and its current use. Methods: This study assessed the PMA2020 methodology and secondary dataset using female datasets from PMA 2016 (Round 3) exercise. PMA 2016 was a survey carried out in seven states of Nigeria. The target population for this study was women of reproductive age (15-49 years) currently using contraception prior to the survey. The sample size of women meeting inclusion criteria in this study was 1927. The data were analyzed using frequency distribution, chi-square and logistic regression at 5% level of significant. Results: The results showed that 21.0% of women were using traditional methods. Concerning LARC methods, the table showed that 14.8% of the sampled women were using LARC methods. Findings further showed that at both levels of analyses there is a significant relationship (P<0.05 and P=0.00 for binary and multivariable logistic regression, respectively) between knowledge of LARCs and uses in this study. This means that knowledge of LARC & other socio-demographic variables among women of reproductive age in Nigeria can influence the use of it. Conclusions: From the result of the study we concluded that 14.8% of women using contraception were using LARC. Additionally, level of education, age of women, household wealth and number of living children were significantly associated with using LARC.
| S-EPMC7447856 | biostudies-literature
Project description:To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing.Pre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models.Between January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, [aOR 4.66 (1.76-12.35)], [corrected] have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, p<0.001). Three months after visiting the study clinic, participants from the intervention period were more knowledgeable about intrauterine and subdermal contraception and were more likely to report at 3-month follow-up a method of contraception more effective than the method they used prior to seeking pregnancy testing from the study clinic (aOR=2.02, 95% CI=1.03-3.96). The authors would like to apologize for any inconvenience caused. [corrected].Women seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in the 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling.A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of more effective contraception.
| S-EPMC4303533 | biostudies-literature
Project description:This article uses two large sets of internationally comparable national surveys to analyze urban patterns of contraceptive use, access to methods, and fertility. Urban areas show higher use of contraception and lower fertility rates than rural areas, with substantial differences in the method mix. Urban women tend more toward the long-term methods of the intrauterine device (IUD), implant, and sterilization and less toward short-term, resupply methods. The overall use increases with education and with higher wealth quintiles. By regions, contraceptive use is unbalanced between urban and rural sectors especially in sub-Saharan Africa, where the overall levels of use are lowest. Overall, the urban fertility rate is only 70% of the rural rate. Across countries, the fertility rate correlates negatively with contraceptive use. National family planning programs tend to raise contraceptive use and to improve access to the methods. About half of the unmarried, sexually active women use contraception, with great diversity in which method is preferred. This holds for all married women as well: regions and countries show quite different patterns of use. Therefore, planners and donors should focus on the circumstances in individual countries.
| S-EPMC8593950 | biostudies-literature