Women's perceptions with use of Implanon® contraceptive device at a primary healthcare facility in KwaZulu-Natal

Background: Early 2014, subdermal contraceptive implant was introduced in South Africa, Implanon® NXT, aiming to expand the method mix, increase effectiveness and availability to long-acting contraceptives. The initial uptake was extremely high, but concerns have been raised with treatment failure and high number of removals reported. Aim: The study focuses on describing women's perceptions with use of Implanon® at a primary health care (PHC) facility in KwaZulu-Natal. Setting: This study was conducted at a selected primary health care (PHC) facility in KwaZuluNatal. Methods: A quantitative, descriptive study design was used. Through purposive sampling, a sample of 60 women from 15 to 50 years old were recruited. Data were gathered through a structured questionnaire and analysed using SPSS 24 software. Results: Study findings show that slightly above half of respondents, 32 or 58.1% expressed satisfaction towards the implant, 20 or 40.9% had stopped using the implant as a result of its major implications. It was found that an edge above half of respondents continued using the implant 28 or 50.9%, while close to half had abandoned it (27 or 49.1%). Some respondents reported that they were experiencing heavy menstrual bleeding and low sex drive as serious unwanted side effects forcing them to stop using Implanon®. Conclusion: Side-effects and poor screening, counselling and support are major reasons for early removal. It is imperative to develop an effective screening tool and to re-train healthcare workers on Implanon® NXT. Contributions: This article contributes to increase awareness of women's perceptions about Implanon® contraceptive.

Awareness and utilization of contraceptives among female students in Eldoret national polytechnic in Uasin Gishu county, Kenya, a cross sectional study

Background: Good knowledge of contraceptives is a key component for contraceptive utilization by young women. There have been increased incidences of unwanted pregnancies and induced abortions in tertiary institutions. This study sought to assess the knowledge and pattern of utilization of contraceptives among female students in Eldoret National Polytechnic, Kenya (ENP). Objective: One of the specific objectives of the study was to assess Contraceptive literacy among female students of ENP in Kenya. Methods: The study design was a cross-sectional one in form of self-administered closed ended and open-ended questionnaires. Study population was only female students of ENP, aged between 18 and 35 years. Stratified random sampling was applied to the selected sample of 360 from the study population of 5879. Results: Majority of the respondents affirmed the knowledge on contraceptive method for pills (88.0%) injections (83.4%) male condoms (82.2%), and e-pills (88.0 %) while affirming the use of alternate methods such as withdrawal (62.3%) and abstinence (77.3%). Regarding the sources of the family (FP) services, most respondents scored highly on the sources of the contraceptives with injectables, male condoms, E-pill and oral contraceptive pills at 82.8%, 80.7%, 80.4% and 73.6% respectively. Conclusion: Most participants reported good knowledge and source for short term family planning (FP) methods while long term reversible contraceptive methods are least understood. Majority of students get contraceptive information from social media and peers.

Planification familiale du postpartum à l'hôpital de district de la commune II de Bamako, Mali / Postpartum family planning at the district hospital of the commune II of Bamako, Mali

La planification familiale du postpartum est la prévention des grossesses durant les 12 mois qui suivent l'accouchement. Objectif : Etudier l'utilisation des méthodes contraceptives dans le postpartum dans le service de gynécologie obstétrique de l'hôpital de district de la commune II de Bamako. Matériels et Méthodes : Nous avons mené une étude transversale descriptive et analytique avec collecte prospective des données du 1er janvier 2019 au 31 décembre 2020. Ont été incluses, toutes les accouchées ayant choisi et bénéficié d'une méthode contraceptive. Le test statistique utilisé a été le test de Fisher avec un seuil de significativité fixé à 5%. Résultats : En 2 ans, la prévalence contraceptive dans le postpartum était de 26,1%. Plus des 2/3 des counselings (61%) ont été faits lors des consultations prénatales, 8% pendant la phase de latence, 26% dans le postpartum immédiat et 5% lors de la visite postnatale. Les méthodes les plus choisies ont été les implants (47,1%), le dispositif intra-utérin (29,6%), les pilules miro-progestatives (12,5%), les progestatifs injectables (8%) et les préservatifs (3,2%). Conclusion : La planification familiale du postpartum contribue à augmenter la prévalence contraceptive

Current practice of family planning among teachers in public secondary school in Enugu East Senatorial District, Nigeria

Background: The aim of this study is to determine the current practice level of family planning and the associated factors among public secondary school teachers in Enugu East Senatorial District. Method: A cross-sectional study was carried out among public secondary school teachers, aged 18 - 60 years, in Enugu East Senatorial District, using probability proportional to size sampling and systematic random sampling to select 1000 participants. Binary and multiple logistic regression analyses were used to determine association. An odds ratio with a 95% confidence interval (CI) was computed to determine the level of significance. Results: The current practice level of family planning is 26.5%. Respondents with bachelor's in education were 2 times more likely to be a current user of family planning (AOR=2.39; 95% CI: 1.25-4.55). However, respondents in age group 38 years and above were less likely to be a current user of family planning (AOR=0.64; 95% CI: 0.43-0.95), likewise female respondents (AOR=0.66; 95% CI: 0.44-0.98). Additionally, respondents who mentioned radio (AOR=0.64; 95%CI: 0.44-0.93), social media (AOR=0.73; 95% CI: 0.53-0.99) and healthcare (AOR=0.61; 95%CI: 0.43-0.88) as source of information were less likely to be current user of family planning. Whereas partner who encouraged the use of family planning (AOR=2.54; 95% CI: 1.71-3.78) span style="font-family: 'Times New Roman'; font-weight: bold">, partner who allow each other to decide on family planning methods (AOR=4.47; 95% CI: 2.67-7.48) and those who had good knowledge of family planning (AOR=1.96; 95% CI: 1.40- 2.67) were more likely to be current user of family planning. Conclusion: The level of current practice of family planning is low and a significant number of factors predict the current practice of family planning. A family planning educational workshop among teachers is needed to improve teacher's knowledge on family planning to address the issue of adolescent sexual reproduction as teachers are vessels of knowledge impartation to students

Assessment of knowledge, attitude and practice on family planning among women of reproductive age at hospitals and clinic centers in the rural Western Sierra Leone

Informed decisions about one's sexual and reproductive health can be made through family planning. Women of reproductive age in rural Sierra Leone's Western area were asked to participate in a survey to determine their attitudes and knowledge toward family planning and the use of contraceptives. A descriptive cross-sectional study survey was conducted in the Western Area Rural of Sierra Leone. Females in the range of 15 to 49 years old were included in the study. The research was conducted from November 2021 to December 2021. Using a pre-designed and pretested questionnaire, 180 women were assessed for their knowledge, attitudes, and practices regarding family planning. According to the study, all participants knew about family planning, but only 68.3% had used contraceptives. There were more than half who learned about it from the media. The study found that 95% of participants had a positive attitude towards contraceptives. Most commonly, contraceptives used were oral pills (31.6), injections (21.1%), implants (19.1%), lactational amenorrhea (13.8%), condoms (8.8%), and intrauterine devices (5%). In our study, the most common reasons given by participants for not using contraceptives were; not willing to disclose 52.6%, a desire for a child 19.2%, fear of side effects 15.7%, currently pregnant 8.7%, and against religious beliefs 3.5%. The study shows that even if people are aware and educated about contraceptives, they may not use them. Educating and motivating people and improving access to family planning services are still necessary to improve the effectiveness and appropriateness of contraceptive use and halt the population growth trend. (Afr J Reprod Health 2022; 26 [6]:15-21).

Factors associated with unmet need for birth spacing among Angolan women

Unmet need for family planning (UNFP) remains a public health concern in Angola. The objective of this study was to analyze the factors associated with UNFP among Angolan women aged 15-49 years in 2015-2016. This was an analytical cross-sectional study. A multiple logistic regression model using data from the Angola Demographic and Health Survey 2015-2016 was performed to determine the associated factors. In total, the study involved 8033 women, 22% of whom were between 25-29 years of age. A large number (65%) lived in urban areas and 39% had primary education. About 1/4 of the women(26%) had UNFP for birth spacing. Associated factors were multiple. Age, credible source of information on family planning were protective factors against UNFP for birth spacing while economic level, the woman's level of education were risk factors for NFP. (Afr J Reprod Health 2022;26[6]:22-26).

Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women's needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients' access to a wide range of contraceptive options.The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention's effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared prepost differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed. (Afr J Reprod Health 2022; 26[5]: 28-40)

Male attitudes towards family planning in the Limpopo province of South Africa

Women often do not receive support from their partners with regards to familyplanning (FP), which can lead to hesitancy and inconsistent use. This study sought tounderstand the male attitudes that contribute to this.Methods: A qualitative descriptive study was conducted in 2019 using focus group discussions (FGDs) with purposively selected men aged ≥ 25 years and in a relationship with a woman of childbearing age. An open-ended question guide was used to explore men's perceptions regarding FP. The discussions were recorded, translated and transcribed verbatim, whereafter transcripts were coded and analysed thematically. Results: Three major themes were identified, namely: (1) the advantages of FP, including financial benefits and the prevention of sexually transmitted infections and unwanted pregnancy; (2) the disadvantages of FP, including perceived adverse effects on men and women, as well as marital difficulties; and (3) the exclusion of men from FP by health workersand their partners. Conclusion: Men felt ambivalent towards FP. They were aware of the benefits thereof, but were hesitant to allow their female partners to use contraceptives, because of several misconceptions about the adverse effects. This underscores the need to involve men in FP programmes.

Profile of health facilities and determinants of the family planning services supply to unmarried adolescents in Burkina Faso, Ghana, and Niger

Objectives: Despite numerous interventions to facilitate adolescents' access to family planning (FP) services in West Africa, studies reveal that unmarried adolescents have difficulties accessing these services. This study analyses the supply of the FP services package to unmarried adolescents as well as the profiles of the facilities that provide this package in Burkina Faso, Ghana, and Niger. Also, it examines the determinants of the supply of this package. Design: The study adopted a spatiotemporal descriptive analysis and a binary logistic Generalized Estimating Equation (GEE) model. The data come from surveys conducted in the three countries between 2013 and 2019 as part of the Performance Monitoring and Accountability 2020 program. Participants: The target population consists of health facilities that provide health services. Results: The study indicates that more than 80% of FP services are provided by basic health facilities in Burkina Faso and Niger, while in Ghana, the profile is more diversified, including hospitals, polyclinics, and public and private primary health centres. The econometric analysis indicates that regional ownership, examination of client opinion data, ownership of a functioning computer, and knowledge of the served population are the main determinants of the supply of the FP services package to unmarried adolescents. Conclusion: By identifying facility profiles and determinants of FP services supply, this study provides a pathway for action to ensure that adolescents have access to these services regardless of their marital status in West Africa.

Urban-rural differences in health service-related factors associated with male involvement in family planning services in Abia State, Southeastern Nigeria

Objective: To identify and compare the health service-related factors associated with male involvement in family planning services among the rural and urban areas in Abia State, Nigeria. Design: A community-based cross-sectional study. Setting: Twelve communities (six urban and six rural) in Abia State, Nigeria Participants: Five hundred and eighty-eight (588) men aged 15-59 years and resident in the study area 6 months before the study were recruited. Main outcome measure: Male involvement in family planning services Results: The mean ages of the respondents were 41.8±8.0 years and 43.1±8.0 years in the urban and rural areas, respectively. Active male involvement in family planning services was significantly higher in urban areas (62.6%, 95%CI: 56.8%-68.1%) compared to the rural areas (47.6%, 95%CI: 41.5%-53.2%. p<0.001). The predictors of male involvement included gender preference of healthcare workers (aOR=1.75, 95%CI:1.01-3.03) and attitude of the healthcare workers (aOR=2.07, 95%CI:1.17-3.67) among the urban participants, compared to occupational status of the respondents (aOR=2.50, 95% CI: 1.16-5.56) and the availability of male-friendly clinics (aOR=2.27, 95%CI:1.25-4.15) among the rural participants. Conclusion: Health service-related factors associated with male involvement varied between the urban and rural settings. Stakeholders should target addressing health service-related factors by types of settlement while designing family planning programs targeting men

Behavioural intervention for adolescent uptake of family planning: a randomized controlled trial, Uganda

Objective:To evaluate the impact of a peer-referral and clinic welcome programme for reducing barriers to adolescents' uptake of family planning services in Uganda. Methods: We developed an intervention using behavioural design and carried out a stratified, randomized controlled evaluation of the intervention in girls aged 15­19 years. Sexual and reproductive health clinics were randomized into control (56 clinics) and intervention groups (60 clinics). All intervention clinics received the core intervention (materials to create an adolescent-friendly environment and referral cards to give to friends), while a subset of clinics additionally received training in youth-friendly service provision. We collected clinics' routine data on monthly numbers of visits by adults and adolescents over a 15-month baseline and 6-month intervention period, 2018­2020.Findings:In multivariate regression analysis we found significant effects of the intervention on primary outcomes in the pooled intervention group compared with control. Mean monthly visits by adolescents increased by 45% (incidence rate ratio, IRR: 1.45; 95% confidence interval, CI: 1.14­1.85), or over five additional adolescent clients per clinic per month. The mean adolescent proportion of total clients improved by 5.3 percentage points (95% CI: 0.02­0.09). Within treatment arms, clinics receiving the training in youth-friendly service provision showed the strongest effects: a 62% increase (IRR: 1.62; 95% CI: 1.21­2.17) in adolescent clients, or over seven additional adolescents per clinic per month, relative to the control group.Conclusion: A behavioural change intervention designed to target identified barriers can increase adolescents' uptake of family planning counselling and services.

Comparative analysis of psychiatric morbidity of women with infertility and those attending family planning clinic in a tertiary facility in north-east Nigeria

Background: Infertility is a major life crisis often associated with mental health consequences. It is particularly relevant in African setting including Nigeria where women are largely blamed for the cause of infertility with its attendant shame, guilt, anxiety and hopelessness. Objective: The aim of this comparative study was to assess and compare psychiatric morbidity of women with infertility and those who attend family planning clinic. Methodology: This descriptive cross-sectional study was done using consecutive sampling technique to select 400 women in each group of those attending fertility and family planning clinics. Data were collected using semi-structured socio-demographic questionnaire, self-administered General Health Questionnaire-12 and Hamilton Depression and Anxiety Scale after matching the groups by their age, marital status and years of education. Results: The study found 37.6% of those who attend fertility clinic to have met HADS cut off score for depression as against 6.8% of the family planning clinic attendees. Similarly, for anxiety subscale; a high proportion of infertile group (40.3%) met anxiety cut off compared to those who attend family planning clinic. In the same manner, attendees of the fertility clinic significantly experienced high rate of psychiatric morbidity (52.9) on the GHQ compared to those attending family planning clinic (32%). Conclusions: This study revealed that Nigerian infertile women seeking treatment are exposed to several mental health consequences such as anxiety and Depression amongst others with devastating effects on the mental health and well-being of the infertile women. Consequently, a comprehensive biopsychosocial intervention should be integrated into the overall management of infertility to improve their quality of life and chances of conception

Approche globale de besoins non satisfaits en planification familiale au Mali

Contexte : Le Mali est l'un des pays d'Afrique de l'Ouest où la fécondité est élevée et stable et la prévalence de la contraception moderne est faible. A cet effet, la présente étude s'est fixée comme objectif de chercher les facteurs associés aux Besoins Non Satisfaits (BNS) en Planification Familiale (PF) dans ce pays.Données et méthodes : Les données utilisées sont celles des EDS qui y ont été réalisées en 1995-96, 2006 et 2012-13. Leurs analyses ont été effectuées en recourant aux tableaux croisés et statistiques du chi-deux et aux modèles multivariés de régression logistique.Résultats : En 1995-96 la proportion d'enfants décédés, le nombre d'enfants survivants et les attitudes des couples vis-à-vis de la PF contribuent le plus à l'explication de la variation du risque de BNS en PF pour espacer les naissances ; en 2006 et 2012-13, on retrouve en plus les indicateurs de l'offre des services de PF. Quant aux BNS pour limiter les naissances, quelle que soit la période, le nombre d'enfants survivants explique seul presque la totalité de sa variation. Concernant le total des BNS en PF, ses facteurs explicatifs les plus importants sont similaires à ceux du risque de BNS en PF pour espacer les naissances. Les femmes les plus concernées au Mali par les BNS en PF ont un nombre élevé d'enfants survivants, ont moins expérimenté les décès d'enfants et ne sont pas informées sur la PF dans les centres de santé pendant leurs consultations médicales.Conclusion : L'amélioration de la qualité des services de PF et de la disponibilité des contraceptifs de longue durée d'action, et l'intégration santé infantile et PF devraient être renforcées au Mali pour y réduire la prévalence des BNS en PF

Internal migration and unmet need for family planning in Cotonou, Benin Republic

Context/Background: Evidence shows that addressing the unmet need for FP of vulnerable groups such as rural-to-urban migrants is another alternative to lowering fertility in developing countries. This study examines how migration affects unmet need in Cotonou. Data Source and Methods: We employed multinomial logistic regression using 2012 Benin Republic Demographic and Health Survey data concerning 827 married women aged 15-49 years and residing in Cotonou. Findings: Findings show that recent migrants were less likely to have an unmet need than non-migrants. Then, earlier migrants and non-migrants had similar odds of unmet need. After adjusting for socioeconomic variables, the risks of unmet need for spacing and limiting among recent migrants decreased and increased, respectively, by 7%. Earlier migrants became significantly less likely to have an unmet need for spacing births than non-migrants. Conclusion: The odds of unmet need are lower among migrants than non-migrants, but complementary research on migrants' fertility in Cotonou is necessary before any conclusion33

Pregnancy planning among female sex workers in Uganda: evaluation of the psychometric properties of the London measure of unplanned pregnancy

The aim of the study was to evaluate the psychometric properties of the London Measure of Unplanned Pregnancy (LMUP) among female sex workers (FSWs) in Uganda. The LMUP was translated into Luganda and adapted for use with FSWs and underwent cognitive testing and two field tests. From the final Luganda LMUP, three other language versions were created (Acholi, Lugisu and Runyakole), and preliminary field test data were collected. Final data were collected from 819 FSWs attending the Most at Risk Population Initiative' clinics. The Luganda field testing showed that there were no missing data, the scale was well targeted, Cronbach's alpha was 0.82, weighted Kappa was 0.78, measurement was unidimensional, and all construct validity hypotheses were met. Likewise, with the Acholi, Lugisu, and Runyankole translations, field testing showed that there were no missing data, the scales were well targeted, Cronbach's alpha were>0.70, and measurement was unidimensional.We concluded that the Luganda LMUP is a valid and reliable tool for assessing pregnancy planning among FSWs in Uganda and that the Acholi, Lugisu, and Runyankole versions of the LMUP also had good initial psychometric properties

Trends in contraceptive prevalence in Sub-Saharan Africa: the roles of family planning programs and education

Since the 1990s some countries in Africa have experienced very rapid increases in contraceptive prevalence (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study aims to shed light on the causes of these different trends which remain controversial. We assess the role of family planning programs vs. socioeconomic development (especially, women's educational attainment). Estimates of the effects of different explanatory factors are obtained by country level regressions in which the prevalence of modern contraception is the dependent variable and women's educational attainment,Gross National Income (GNI) per capita, percent urban and child mortality as well as the family planning program score are the independent variables. The statistical analysis finds no significant effects of GNI per capita, percent urban and child mortality. In contrast, women's educational attainment and program score have highly significant effects and are the dominant drivers of contraceptive prevalence trends. Voluntary family planning programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impact above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even where education levels have risen substantially

Community and provider perspectives on addressing unmet need for contraception: key findings from a formative phase research in Kenya, south Africa and Zambia (2015-2016)

Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the ­active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used,facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts

Child's risk attributes at birth and infant mortality disparities in Nigeria

Births in avoidable high-risk contexts defined by the interplay of sub-optimal childbearing age, short spacing, and first and high birth order incur elevated risks of childhood death. However, the extent of disparities in risks of dying in infancy vis-à-vis the continuum of non-high-risk and (un)avoidable high-risk attributes at birth as determined by mother's age at childbirth, child spacing, and birth order characteristics is yet to be adequately explored in Nigeria as elsewhere. To fill this gap, chi-square association test and Cox's proportional hazards regression were used to analyze data of 31,260 nationally representative children aged 0-59 months drawn from 2013 Nigeria Demographic and Health Survey. Disparities in infant mortality risks were mainly examined across the spectrum of birth-related risk attributes at birth broadly categorized as no extra high-risk, unavoidable firstorder risk and combined avoidable high-risk. The risks of dying in infancy differed significantly by risk attributes to the extentdictated by other confounders. Also, infant mortality risks varied significantly by all moderating factors excluding religion, water source, toilet type and place of delivery. Interventions targeted at reducing avoidable high-risk fertility rate and strengthening health system to provide life-saving care to most-at-risk children would engender rapid improvement in infant survival