Sexual autonomy and the use of modern contraceptives in Nigeria evidence from the 2018 demographic and health survey

Objective: The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Methods: Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15-49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Results: Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25-1.46). Conclusion: There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.

Determinants of emergency contraceptive utilization among female tertiary students in the middle belt of Ghana, West Africa

Introduction: Emergency Contraceptives (ECs) are after-coital contraceptive methods used before implantation. These give females in the sexually active age group the opportunity to prevent unplanned pregnancies after refusing to patronize a contraceptive before unprotected sexual intercourse or when a regular contraceptive fails and or when raped. Higher education students fall under the sexually active age category and form a higher risk group for unplanned pregnancy because of inadequate utilization of ECs. The aim of this study was to identify the determinants of ECs utilization among female tertiary students in the Middle Belt of Ghana, West Africa. Methods: institutional-based descriptive cross-sectional study design was used with quantitative method in collecting the data from 28th March 2022 to 18th April 2022. A total of 535 female tertiary students were recruited using simple random proportionate sampling technique. Data were collected using structured questionnaires and entered into Stata version 15 and analyzed descriptively and inferentially using Chi-squared test. A conventional p<0.05 was considered statistically significant. Results: out of the 535 respondents that were interviewed, majority (426 (79.6%) were aware of ECs. However, only 44 (9.4%) had good knowledge of ECs utilization. All respondents who were affiliated to traditional religion had poor knowledge. About half of 279 (52.1%) indicated they ever utilized ECs and 200 (71.7%) of these said the efficacy of ECs was between 75-99%. Regarding barriers to ECs utilization, 333 (20.5%) indicated ECs cause infertility and 330 (20.4%) mentioned the fear of being seen by others. All Chi-square test of associations of demographic characteristics and knowledge on ECs were not statistically significant (p≥0.05). Conclusion: the study reported that ECs utilization among female tertiary students was quite low despite majority being aware of them. Most of them had poor knowledge on ECs utilization, even though majority had not experienced unplanned pregnancies. Further reproductive health and family planning education and promotion initiatives directed on the utilizations of ECs, their efficacies and typology are needed, especially among future health professionals who will later educate other young adults.

Socio-economic drivers and effects of contraceptive usage on breast cancer among women in Nigeria

Certain types of contraceptives might have adverse effects on women's health including the possibility of causing breast cancer (BC). Furthermore, the types of contraceptives used might depend on the socioeconomic status of women. The triangular linkage of socioeconomic factors, contraceptives, and some factors causing BC among women are scarce in the literature, especially in developing countries. Consequently, the objectives of the study are to investigate the socio-economic drivers of BC and assess effects of contraceptive on BC among women in Nigeria. Cross-sectional data were collected on a one-off participant at a particular point in time using questionnaires on 200 women with confirmed cases of BC in Southwest, Nigeria, on a continuous visitation to the hospitals over six months. Structural equation modeling (SEM) with strong evidence from path analysis was adopted to achieve the objectives. Exploratory factors analysis was adopted to identify the socio-economic factors. The study analysed certain socioeconomic pre-determinants of BC through the use of contraceptives among women in Southwest Nigeria. The study provided evidence that some tested socioeconomic factors influence women in the use of contraceptive implants (C2) and oral contraceptives (C3), at a 1% level of significance. While about 76.8% of variations in socio-economic factors cause women to adopt a contraceptive implant, 81.1% of socioeconomic factors cause women to adopt oral contraceptives. Again, the result further provided evidence that socioeconomic factors (CCT) are strong determinants of BC at a 1% level of significance. Given the women-specific peculiarities, implanted contraceptives and oral contraceptives should be carefully administered by medical scientists.

Evaluation of the offer of family planning services in a rural area of the Bamboutos division in the west region of Cameroon: a cross sectional study

Background and aim. The rate of utilization of contraceptive methods in Cameroon is low. The western region has a high fecundicity index and among the women in union using any contraception (30.2%), only 32.5% of them are using a modern method. This study aimed at improving the offer of family planning (FP) services by identifying factors limiting its expansion. Methods. We conducted a descriptive cross-sectional study from 1st January to 31st December 2011 in the Bamboutous health district of the West region of Cameroon. We included exhaustively public and private health institutions. The characteristics of health institutions, providers and various FP services offered were obtained from registers and interview of health care providers. Data was analyzed using Epi info software version 3.5.1. Results. Of the 68 health facilities in the Bamboutous health district, 25 (36.8%) offered FP services. Among them, 18 were public (72%), 21(84%) had been existing for over 5-years period and the service offer was integrated (88%). There was often no pipe-borne water (72%). Eighteen of 25 FP institutions had no personnel who had ever received any formal training in FP (72%). Unmet contraceptive need was estimated at 34.7%. The different contraceptive methods received by women were more often injectables (37.3%) and implants (12.6%). Male condom represents 30.8%. Conclusion. The health services in the Bamboutous division are poorly furnished with FP activities in spite of met-needs of 65.3%. Improving on the service offer for FP as well as the training of health care providers is highly recommended

Connaissances et pratiques contraceptives chez les jeunes burkinabè de 15 à 24 ans

Selon l'OMS, l'utilisation de la contraception a nettement plus d'avantages pour la santé que de risques. Néanmoins, l'accès à la contraception des jeunes reste un problème de santé publique. Cette étude visait à évaluer les connaissances et les pratiques contraceptives des jeunes de Bobo-Dioulasso, et à identifier les obstacles d'utilisation.Il s'agit d'une étude quantitative et transversale. Les données d'enquête ont été recueillies en décembre 2014 à Bobo-Dioulasso, auprès de 573 jeunes de 15 à 24 ans. Ces enquêtés ont été sélectionnés par un sondage en grappes à deux degrés. Pour tous les tests statistiques, le seuil de signification était fixé à p<0,05. La quasi-totalité (99,3%) des jeunes connaissaient au moins une méthode contraceptive moderne. Bien que près de 84,0% d'entre eux soient en situation de cohabitation, les parents étaient les sources d'information les moins citées. Seulement 28,6% des enquêtés sexuellement actifs (ou leurs partenaires) avaient utilisé la contraception lors du premier rapport sexuel. Nous avons aussi constaté que la contraception est devenue la « norme », par l'utilisation du préservatif au début de la relation, puis par la contraception orale lorsque la relation est définie comme stable. Plus les enquêtés étaient âgés, plus ils avaient utilisé un moyen contraceptif (p<0,05).Il est urgent de porter les efforts d'éducation non seulement sur les connaissances, mais aussi sur les pratiques quotidiennes dans la vie sexuelle et les éléments qui les entravent. Il va falloir aussi assurer aux jeunes, la confidentialité et la gratuité de la contraception

Factors Influencing the Uptake of Contraception Services by Vatsonga Adolescents in Rural Communities of Vhembe District in Limpopo Province; South Africa

The aim of the study was to determine the factors that influence the uptake of contraception services by adolescents in the Vhembe district of Limpopo Province; South Africa. A qualitative research method which is explorative; descriptive and contextual in nature was used to investigate the phenomenon from the adolescents' perspective. The target population comprised of adolescents residing in one of the six villages of Vhembe District. Data was collected through six focus group discussions until data saturation was achieved. Data was analysed using an open coding method. The findings revealed that adolescents are aware of the availability of contraceptive services. However; they lack a comprehensive knowledge about contraception and contraceptives; which led to negative attitudes towards using the services. Cultural health beliefs and attitudes were also identified as a barrier to the uptake and use of contraceptives. Recommendations were made on interventions to increase the uptake of contraception services amongst adolescents

Exploring contraceptive knowledge and use among women experiencing induced abortion in the Greater Accra Region, Ghana

Using a qualitative research methodology, twenty-four semi-structured interviews were conducted with women with induced abortion experiences at Korle Bu and Tema Hospitals in the Greater Accra Region, Ghana. Results suggest that these women tended not to have knowledge of contraceptive methods prior to the abortion, while others were informed but failed to use for a variety of reasons ranging from rumours of side effects to personal negative experiences with modern contraceptive methods. A few women also stated contraceptive failure as a reason for their unintended pregnancies that were later aborted. Peer and reproductive health education must be reinforced in communities in the Greater Accra Region to curb adolescents engaging in early sex and should challenge the existing rumours associated with contraception in Ghana. In addition, family planning services in terms of appropriate methods with no side effects must be made available to women in the reproductive ages (Afr J Reprod Health 2011; 15[1]: 37-46)

The Effects of Psychological Inoculation on Cognitive Barriers Against Condom Use in Women with HIV: A Controlled Pilot Study

Past studies have shown that in attempts to prevent HIV; health education yields little change in condom use. The reason may be that education fails to target barriers for changing behaviour. The present controlled pilot study tested whether psychological inoculation (PI) reduces such barriers for using male condoms. Twenty-two Nigerian women with HIV were randomly assigned to receive PI or health education (control). In the PI condition; women learned to refute sentences reflecting barriers against condom use; while controls learned how to use condoms and the consequences of their non-use. Barriers for condom use; self-efficacy to negotiate condom use with partners and actual condom use were self-reported before and one week after interventions. Results revealed that only in the PI group were there statistically significant increases in condom use negotiating self-efficacy and reductions in barriers concerning motivation; sexual satisfaction and partners. Controls reported no statistically significant changes. However; actual reported condom use was unchanged in both groups. Thus; it is feasible to conduct PI interventions in an African sample of HIV patients. Furthermore; PI can reduce cognitive barriers for condom use; while health education yields little changes in such outcomes over time. If replicated in larger samples with longer follow-ups; these findings could eventually have implications for HIV prevention in several world regions

Factors Influencing Condom Use Among Women in Ghana: an HIV/AIDS Perspective

Although in Ghana information on HIV infection and prevention; both in terms of quality and quantity; has increased considerably within the past few years; available literature indicates that behaviour change is yet to correspond with the amount of information and education provided. The objective of this study is to examine factors that influence condom use among women in Ghana in the context of HIV/AIDS prevalence. Data for this study are from the 2003 Ghana Demographic and Health Surveys (GDHS) and the study population (N=5 691) was analysed using logistic regression with the Health Belief Model (HBM) as an explanatory tool. The outcome variable for this study is condom use during last sexual intercourse. The HBM identifies perception of HIV/AIDS risks; awareness of its seriousness; knowledge about prevention; and confidence in condom use as predictors of safe sexual activity. Results show that the proportion of women reporting use of condoms remains tremendously low; in both the rural and urban areas. In the urban areas; only 15of women reported having sex with condom during their last intercourse; whereas in the rural areas the proportion is even lower (10). However; multivariate analyses based on the HBM components show that speaking with a partner about how to avoid AIDS (Odds Ratio = 1.63) and perceived benefits of using condoms (Odds Ratio = 1.54) are notable factors that predict condom use. Overall; the study points out that with the exception of perceived severity; the HBM can be applied to understand condom use among the study population. It will be important to emphasise all components of the HBM and empower women with condom negotiation skills

Young South Africans' viewson; and Perceptions of; Abstinence and Faithfulness

The goals of the Abstinence and Be Faithful Among Youth (ABY) project were to enhance local responses among the youth in South Africa to prevent HIV infection through encouraging abstinence; faithfulness and avoidance of unhealthy sexual behaviour among youths over a five-year period. A quantitative baseline evaluation of the ABY project was conducted in five cities in South Africa. Data were collected from learners and youths just before the ABY intervention started at nine randomly selected sites in Johannesburg; Cape Town; Durban; Port Elizabeth and Mthatha using a three-stage cluster sampling design. In total; nine sites were randomly selected from a possible eighteen. At each of the data-collection points; data were collected from 60 participants. In total there were 27 data-collection points and 1620 respondents. Young people have strong views on abstaining from sexual intercourse; as 83said that it was possible not to have sex for as long as you can. There was also strong support for abstinence; as 78.5said that not having sex was the best way of preventing infection with HIV. In total; 68.1of the youths said that the media had a positive influence on encouraging abstinence and 72.1said role models could help them not to have sex; while 84.3said that leadership and life skills workshops were helpful in encouraging them to abstain from sex. In total; 68.7of young people said that the media encouraged faithfulness in relationships and 84.6said that life skills workshops were helpful in encouraging them to remain faithful to one partner. Young people have strong views on and support for abstinence. They also have strong views on and perceptions of remaining faithful to one partner. These findings are a valuable guide to the views and perceptions of young people with respect to abstinence and faithfulness before interventions are implemented

Contraceptive use by women in Accra, Ghana: results from the 2003 Accra women's health survey

The study was to determine the predictors of use of modern contraception among women in Accra, Ghana. Data were collected by trained interviewers using questionnaires. Complete data for 2199 women were analysed using Stata 8.2. The study showed that educational status was the most significant predictor of contraceptive use. Women with no formal education had a 48% reduction in the odds of having ever used contraception and a 66% reduction in the odds of currently using contraception. Regular use of health facilities did not affect contraceptive use. Female education should continue to be a priority of the Ghanaian government. Education about family planning and the effects of having large families should be integrated into the school curriculum. Ghanaian health workers need to be active in promoting the use of modern contraceptive methods (Afr J Reprod Health 2009; 13[1]:123-133)

Contraceptive use: knowledge, perceptions and attitudes of refugee youths in Oru refugee camp, Nigeria

Refugee youths are vulnerable persons who have a need for contraception, yet face challenges that limit its use. Data on perceptions, knowledge, access and attitudes toward contraceptive use were collected from 208 refugee youths living in Oru refugee camp, Nigeria. Findings revealed that respondents experience difficulty gaining access to family planning services, which are not available in the camp. Most respondents had little correct information about contraceptives; 42.9% had misperceptions about its safety, believing that contraceptives are dangerous and that chemicals in contraceptives can damage their reproductive system. Such beliefs have resulted in the low use of contraceptives (31.6% use last sex) and many unintended pregnancies, which have caused some refugee girls to drop out of school. Findings may aid in the development of targeted interventions to educate refugee youths in order to dispel misperceptions about the safety of contraceptives and ensure adequate access to family planning services (Afr J Reprod Health 2010; 14[4]: 17-26)

Knowledge, perceptions and ever use of modern contraception among women in the Ga East District, Ghana

A survey of 332 women, ages 15-49 years, was carried out in the Ga East district of Ghana to identify community knowledge, perceptions, and factors associated with ever using modern family planning (FP). Knowledge of modern FP was almost universal (97 percent) although knowledge of more than three methods was 56 percent. About 60 percent of all, and 65 percent of married respondents reported ever use of a modern method. Among ever users, 82 percent thought contraceptives were effective for birth control. However, one-third did not consider modern FP safe. About 20 percent indicated their male partner as a barrier, and 65 percent of users reported at least one side effect. In a multivariate model that controlled for age, education, religion, and occupation, being married remained significantly associated (OR=2.14; p=0.01) with ever use of a modern contraceptive method. Interventions are needed to address service- and knowledge-related barriers to use (Afr J Reprod Health 2010; 14[4]: 27-32)

Influence of independent and proximate variables on condom use in selected states in Nigeria

The study examined the influence of individual and proximate factors in determining condom use. Current use of condom and condom use during last sex were used as proxies for consistent condom use. Data on 3,797 sexually active respondents of reproductive age was analyzed from the 2007 USAID-COMPASS midline evaluation on basic family planning and reproductive health outcomes in five Nigerian states. About 9% of respondents were current users, while 11% used a condom during last sex. Younger and more educated respondents were more likely to report condom use. Of the 23 variables, four were statistically significant (p<0.05) in predicting current use for females, and five for males; six were statistically significant in predicting condom use during last sex for females and seven for males. The paper concluded that understanding the determinants and predictors of condom use is critical to improving family planning and reproductive health indicators in Nigeria (Afr J Reprod Health 2010; 14[4]: 53-62)

Contraceptive Practice in a Tertiary Hospital in South-South Nigeria

Background: The high maternal and infant mortality in sub-Saharan Africa has been associated with unplanned pregnancy; high parity and short birth intervals. Use of effective contraceptive methods significantly reduce maternal and infant mortality and improved quality of life. This study determines the contraceptive practice among clients in a tertiary hospital. Method: The record cards of all clients that accepted contraceptive methods in the family planning clinic at the University of Uyo Teaching Hospital; Uyo over a 7-year period were reviewed. Results: There were 1094 new contraceptive acceptors during the study period. The modal age group of the clients was 25 - 34 years (59.3); majority of the clients were multiparous (59.8); christians (99.6) and 71.0had at least secondary school education. The most commonly accepted contraceptive methods were the intrauterine contraceptive device (45.0) and oral contraceptive pills (28.1); while clinic personnel (63.1); and friends and relatives (20.1) were the most common sources of information on contraception. Conclusion: Intrauterine contraceptive device and oral contraceptive pills were the most frequently accepted methods of contraception. We advocate increase in the contraceptive options including implants. The print and electronic media should be more involved in the awareness programs on contraception

Family planning methods among women in a vaginal microbicide feasibility study in rural KwaZulu-Natal, South Africa

This study investigated contraceptive use among women in rural KwaZulu-Natal, South Africa. Of 866 sexually active women not intending pregnancy and screened for a microbicide feasibility study, 466 (54%) reported currently using modern contraceptives: injectables (31%), condoms (12%), sterilization (6%) and pills (4%). Multivariable logistic regression analyses revealed statistically significantly higher odds of current contraceptive use among married vs. engaged/unmarried women (aOR 1.64), multiparous vs. nulliparous (aOR 4.45) and women who completed secondary education or above vs. primary or less (aOR 1.64). Significantly lower odds of use were observed among women aged 40+ vs. age 15-19 (aOR 0.38). Age, marital status, education level and parity were associated with different contraceptive method choices. Among 195 women followed longitudinally for 9 months, contraceptive use increased significantly from 56% to 70%, largely due to increased condom use (15% to 28%). Results highlight the importance of integrating family planning and HIV/STI prevention counseling and informing promotion of further contraceptive uptake among women not intending pregnancy. (Afr J Reprod Health 2008; 12[2]:45-63)

Knowledge; attitude and acceptability of spermicidal contraception among university students in Dar Es Salaam

"Objectives: The aim of this study was to assess the knowledge; acceptability and attitude towards the use of spermicides among students of University of Dar es Salaam (UDSM). Methodology: This was a descriptive cross-sectional study conducted over four-month period among UDSM students. A random sample of students was recruited from all three university campus namely University College of Land and Architectural Studies (UCLAS); Muhimbili University College of Health Sciences (MUCHS) and Mlimani Campus (MC). Questionnaires with both closed and open end-questions were used for data collection in which knowledge; attitude; and acceptability of spermicides were determined. The collected data were analyzed using SPSS/PC+ version 10.0; 1999 computer package. Results: A total of 300 students participated in this study; out of which 154 (51.3) were females and 146 (48.7) males. Majority of the students 276 (92) had poor knowledge of spermicidal products; and out of these; 146 (53) were absolutely unable to describe the use of spermicides. Ninety-three percent of the students had never used spermicides. Of those who had never used spermicides; 84 (30) said because they used other contraceptive means; 50 (17.8) said they are expensive; 29 (10.3) attributed this to unavailability of the products; 3(1.1) to fear of ""contracting"" cancer and 13(4.6) to the unreliability. Furthermore; a few who had used them didn't trust the products as ideal means of contraception. Conclusion: The respondents had poor knowledge of spermicides. Spermicides were not accepted by the students because of the presumed side-effects; being very expensive and unreliable for contraception purpose. However; the respondents accepted spermicides usage as an ideal alternative to condom and effective means for a female-controlled method to prevent/reduce unwanted pregnancy and HIV risk. The study recommends that the Government/responsible authorities should encourage spermicides usage; particularly when coupled with microbicides; in reduction of unplanned pregnancies; sexually transmitted diseases (STDs) and HIV infection inclusive.). Only 185 (56.1) of all patients reported their willingness to disclose and a freedom to talk about the disease. Risk factors for cancer staging were sex; patient's education status; awareness and knowledge of disease symptoms. Conclusions: Interventions targeted to improve health care seeking behaviour among cancer patients need to include health education and sensitization specifically of cancer disease; establish a strong referral mechanisms at primary health level and to start a population cancer registry for monitoring and evaluation purposes."

Contraceptive Challenges Experienced by Women who Requested Termination of Pregnancy Services in Mpumalanga Province

Although contraceptives are available free of charge throughout South Africa; the number of requests for termination of pregnancy (TOP) services continues to increase. This research investigated challenges preventing women from using contraceptives effectively. Structured interviews were conducted with 55 women who requested TOP services. As many as 85.5 of these women had used contraceptives. They discontinued using contraceptives when sideeffects occurred; necessitating them to request TOP services. Knowledge about; access to and the actual use of contraceptives did not enable these women to prevent unwanted pregnancies. More effective counseling about contrace- ptives' side-effects and enhanced accessibility of contraceptives over weekends and during lunch breaks could enable more women to prevent unwanted pregnancies; reducing the number of requests for TOP services

Hearing native voices: contraceptive use in Matemwe village; East Africa

Although fertility declines have been documented in various parts of Africa; fertility rates remain high in Tanzania. Widespread resistance to modern contraception is one factor associated with high fertility in Tanzania. The aim of this study was to identify cultural barriers to modern contraceptive use in Matemwe village; Zanzibar. In May 2003; more than 50 in-depth interviews were conducted with community leaders; health care workers and couples in Matemwe. Despite free and easy access to contraceptives; only 2 of Matemwe women participated in the village's family planning programme. Several factors were found to influence contraceptive use; including strong Muslim beliefs; male dominance over females (especially in polygynous relationships); and limited exposure to modern ideas via education and travel. Interviews indicated that in order to lower fertility in Matemwe; cultural barriers to family planning must be confronted. Successful implementation of a family planning programme hinges on the ability of policymakers to integrate modern ideas about contraception with Matemwe's traditional religious and political culture