Low use of contraception among poor women in Africa: an equity issue

Objective To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. Methods The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method; with adjustments for: wealth index quintile; fertility intentions (to space births versus to stop childbearing); residence (urban/rural); education; number of living children; marital status and survey year. Findings The use of contraception has increased substantially between surveys in Ethiopia; Madagascar; Mozambique; Namibia and Zambia but has declined slightly in Kenya; Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique; but they have increased in Kenya; Uganda and Zambia with regard to spacing births; and in Malawi; Senegal; Uganda; the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention; women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Conclusion Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments; but inequities persist in all countries

Patterns of Knowledge and Condom Use among Population Groups: Results from the 2005 Ethiopian Behavioral Surveillance Surveys on HIV

Background:Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators of knowledge on HIV/AIDS and condom use among different groups of populations selected for behavioral surveillance in Ethiopia.Methods: We used HIV/AIDS Behavioural Surveillance Surveys (BSS) data collected from ten target groups in Ethiopia. These were female sex workers; military personnel; police force; pastoralists; long distance truck drivers; intercity bus drivers; road construction workers; teachers; factory workers and ANC catchment populations. Results: Data from 14;524 individuals were analyzed. The majority were male (63.6). Knowledge of the three preventive methods (abstinence; faithfulness and consistent condom use); misconceptions and comprehensive knowledge was 57; 75and 18.5; respectively. Female sex workers and the defence force showed positive results in using condom during last sexual encounter and did so consistently with non regular sexual partners and paying partners. Women; pastoralists and the illiterate were negatively impacted. Conclusion: Inadequate and incorrect knowledge on HIV/AIDS was observed with special deficiency among the underserved groups such as pastoralists. Women and the older age group were found to be at a disadvantage. The findings indicate the need to expand prevention activities to hard-to-reach groups and such a certain specific population segments. Population groups such as female sex workers and the defense force that were known to be severely affected by the epidemic and are focus of HIV/AIDS interventions showed positive behaviors. Although this is encouraging; considerable proportion of the study groups did not use condom during sex with non regular partners. This underscores the importance of intensifying interventions across all groups and extended to their localities