Associated factors, inequalities, and spatial distribution of the use of modern contraceptive methods among women of reproductive age in Peru: a population-based cross-sectional study.

BACKGROUND: The use of contraceptive methods in Peru has remarkably increased in recent decades. Nevertheless, despite the completeness and accessibility of family planning methods, modern contraceptive methods utilization in Peru remains below the South American average. Thus, this study aimed to elucidate the factors associated with modern contraceptive use, as well as the presence of inequalities and the spatial distribution in Peruvian women aged 15-49 years in 2019. METHODS: A secondary data analysis was conducted using information from the 2019 Peruvian Demographic and Health Survey. We performed descriptive statistics, bivariate analysis, and Poisson multiple regression. Inequalities were estimated through concentration curves and Erreygers' normalized concentration index. Spatial analysis included choropleth map, Global Moran's I, Kriging interpolation and Getis-Ord-Gi* statistic. RESULTS: The prevalence of modern contraceptive use was 39.3% among Peruvian women of reproductive age. Modern contraceptive use was directly associated with youth (aPR 1.39), women having their first sexual intercourse before the age of 18 (aPR 1.41), and being married but not together (aPR 1.87). In addition, speaking Quechua or Aymara (aPR 0.87) and having no children (aPR 0.59) were inversely associated with utilization of modern contraceptives. We found the presence of inequalities in the use of contraceptive methods (pro-rich distribution), although the magnitude was low. Spatial analysis unveiled the presence of a clustered distribution pattern (Moran's Index = 0,009); however, there was inter-departmental and intra-departmental heterogeneity in the predicted prevalence of the use of modern contraceptives. In addition, significant hot and cold spots were found in Peru. CONCLUSION: Two out of five Peruvian women of reproductive age used modern contraceptives. It was associated with younger women's age, younger age at first sexual intercourse, being married or cohabitant, among others. No substantial inequality was found in modern contraceptive use. The prevalence was heterogeneous at the intra- and inter-departmental level. Those departments located in the south, south-east, and north-east had the lowest prevalence. Therefore, nonfinancial barriers must be tackled through multi- and cross-sectoral efforts and continue to universally provide modern contraceptives.

Using Household Surveys to Assess Missed Opportunities for Simultaneous Vaccination: Longitudinal Examples from Colombia and Nigeria.

One important strategy to increase vaccination coverage is to minimize missed opportunities for vaccination. Missed opportunities for simultaneous vaccination (MOSV) occur when a child receives one or more vaccines but not all those for which they are eligible at a given visit. Household surveys that record children's vaccination dates can be used to quantify occurrence of MOSVs and their impact on achievable vaccination coverage. We recently automated some MOSV analyses in the World Health Organization's freely available software: Vaccination Coverage Quality Indicators (VCQI) making it straightforward to study MOSVs for any Demographic & Health Survey (DHS), Multi-Indicator Cluster Survey (MICS), or Expanded Programme on Immunization (EPI) survey. This paper uses VCQI to analyze MOSVs for basic vaccine doses among children aged 12-23 months in four rounds of DHS in Colombia (1995, 2000, 2005, and 2010) and five rounds of DHS in Nigeria (1999, 2003, 2008, 2013, and 2018). Outcomes include percent of vaccination visits MOSVs occurred, percent of children who experienced MOSVs, percent of MOSVs that remained uncorrected (that is, the missed vaccine had still not been received at the time of the survey), and the distribution of time-to-correction for children who received the MOSV dose at a later visit.

Phenotypes and markers of cesarean delivery among Colombian women.

OBJECTIVE: To investigate the association of socioeconomic status (SES) components (education, occupation, and household wealth) with number (1 or ≥2) and timing (planned/emergency) of cesarean delivery (CD) in Colombia, rates of which are well above the levels recommended by the World Health Organization. METHODS: A cross-sectional study using the 2015 Demographic and Health Survey (DHS) of Colombia was carried out; 38 718 women answered the woman only module. Binomial and multinomial logistic regression analyses were conducted to generate estimates of the association between markers of SES and likelihood of CD, timing of CD, and number of CDs. RESULTS: The analysis included 9977 women. Although education and wealth were strongly associated with CD (P<0.001), the association between occupation and CD suggested that women in agriculture were the least likely to experience CD (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.44-1.03, P=0.061); and women in the "poorer" household wealth category were more likely to have emergency (OR 1.57, CI 1.29-1.90, P<0.001) and two or more (OR 1.64, CI 1.29-2.40, P<0.001) CDs. CONCLUSION: Markers of SES are associated with CD overuse in Colombia, as well as the number and timing of CD. More robust qualitative inquiry including additional questions to the DHS survey are needed to elucidate reasons driving the overutilization of CD in the country, particularly among vulnerable populations.

Within-country migration and obesity dynamics: analysis of 94,783 women from the Peruvian demographic and health surveys.

BACKGROUND: Rural-to-urban migration is associated with increased obesity, yet it remains unknown whether this association exist, and to what extent, with other types of internal migration. METHODS: We conducted a secondary analysis of the Peruvian Demographic and Health Surveys (2005 to 2012) on data collected from women aged 15-49 years. Participants were classified as rural stayers, urban stayers, rural-to-urban migrants, intra-rural migrants, intra-urban migrants, and urban-to-rural migrants. Marginal effects from a logit regression model were used to assess the probabilities of being and becoming obese given both the length of time in current place of residence and women's migration status. RESULTS: Analysis of cross-sectional survey data generated between 2005 and 2012. Data from 94,783 participants was analyzed. Intra-urban migrants and rural-to-urban migrants had the highest rates of obesity (21% in 2012). A steady increase in obesity is observed across all migration statuses. Relative to rural non-migrants, participants exposed to urban environments had greater odds, two- to three-fold higher, of obesity. The intra-rural migrant group also shows higher odds relative to rural stayers (42% higher obesity odds). The length of exposure to urban settings shows a steady effect over time. CONCLUSION: Both exposure to urban environments and migration are associated with higher odds of obesity. Expanding the characterization of within-country migration dynamics provides a better insight into the relationship between duration of exposure to urban settings and obesity.

Gender bias in under-five mortality in low/middle-income countries.

INTRODUCTION: Due to biological reasons, boys are more likely to die than girls. The detection of gender bias requires knowing the expected relation between male and female mortality rates at different levels of overall mortality, in the absence of discrimination. Our objective was to compare two approaches aimed at assessing excess female under-five mortality rate (U5MR) in low/middle-income countries. METHODS: We compared the two approaches using data from 60 Demographic and Health Surveys (2005-2014). The prescriptive approach compares observed mortality rates with historical patterns in Western societies where gender discrimination was assumed to be low or absent. The descriptive approach is derived from global estimates of all countries with available data, including those affected by gender bias. RESULTS: The prescriptive approach showed significant excess female U5MR in 20 countries, compared with only one country according to the descriptive approach. Nevertheless, both models showed similar country rankings. The 13 countries with the highest and the 10 countries with the lowest rankings were the same according to both approaches. Differences in excess female mortality among world regions were significant, but not among country income groups. CONCLUSION: Both methods are useful for monitoring time trends, detecting gender-based inequalities and identifying and addressing its causes. The prescriptive approach seems to be more sensitive in the identification of gender bias, but needs to be updated using data from populations with current-day structures of causes of death.

Maternal Household Decision-Making Autonomy and Adolescent Education in Honduras.

Maternal decision-making autonomy has been linked to positive outcomes for children's health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children's outcomes into adolescence and whether it impacts other domains of children's lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents' environmental contexts and individual characteristics such as gender. Our analytical sample included 6,579 adolescents ages 12-16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011-12. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents' school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers' high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents' school enrollment above and beyond other maternal, household, and regional influences.

Household food insecurity, nutritional status and morbidity in Brazilian children.

OBJECTIVE: To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old. DESIGN: Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child's mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05. SETTING: Nationally representative survey. SUBJECTS: Children (n 4064) under 5 years old. RESULTS: There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55). CONCLUSIONS: Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

Characterizing HIV epidemiology in stable couples in Cambodia, the Dominican Republic, Haiti, and India.

Using a set of statistical methods and HIV mathematical models applied on nationally representative Demographic and Health Survey data, we characterized HIV serodiscordancy patterns and HIV transmission dynamics in stable couples (SCs) in four countries: Cambodia, the Dominican Republic, Haiti, and India. The majority of SCs affected by HIV were serodiscordant, and about a third of HIV-infected persons had uninfected partners. Overall, nearly two-thirds of HIV infections occurred in individuals in SCs, but only about half of these infections were due to transmissions within serodiscordant couples. The majority of HIV incidence in the population occurred through extra-partner encounters in SCs. There is similarity in HIV epidemiology in SCs between these countries and countries in sub-Saharan Africa, despite the difference in scale of epidemics. It appears that HIV epidemiology in SCs may share similar patterns globally, possibly because it is a natural 'spillover' effect of HIV dynamics in high-risk populations.

Bolivia 1998: results from the Demographic and Health Survey.

PIP: This document presents the results of the Bolivia Demographic and Health Survey (DHS), or Encuesta Nacional de Demografia y Salud 1998, conducted by the Instituto Nacional de Estadistica, La Paz, Bolivia, within the framework of the DHS Program of Macro International. Data were collected from 12,109 households and complete interviews were conducted with 11,187 women aged 15-49. A male survey was also conducted, which collected data from 3780 men aged 15-64. The information collected include the following: 1) general characteristics of the population, 2) fertility, 3) fertility preferences, 4) current contraceptive use, 5) contraception, 6) marital and contraceptive status, 7) postpartum variables, 8) infant mortality, 9) health: disease prevention and treatment, and 10) nutritional status: anthropometric measures.^ieng

Nicaragua 1998: results from the Demographic and Health Survey.

PIP: This article presents summary statistics gathered from the 1998 Nicaragua Demographic and Health Survey (Encuesta Nicaraguense de Demografia y Salud 1998, ENDESA-98). Data from the nationally representative ENDESA-98 were collected from 11,528 households. Interviews were conducted with 13,634 women aged 15-49 years and 2912 men aged 15-59 years between December 1, 1997, and May 31, 1998. The statistics presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, differentials in median age at first birth, postpartum variables, and infant mortality. In addition, statistical data on the health and nutritional status of children were also presented.^ieng

Peru 1996: results from the Demographic and Health Survey.

PIP: This report presents findings of the 1996 Peru Demographic and Health Survey among 28,951 women 15-49 years old and 2487 men 15-59 years old. Fertility was 3.5 children/woman (5.6 in rural and 2.8 in urban areas). Fertility ranged from 2.1 among higher educated women to 6.9 among women with no formal education. 41.7% wanted the births in the 5 years preceding the survey. 23.2% wanted the birth later. 34.8% wanted no more births. A high percentage of women with 3 or more children wanted no more children. 22.9% currently used modern contraceptive methods. 41.3% used traditional methods. Contraceptive prevalence peaked at ages 35-39 years at 72.9%. Prevalence was 46.0% at 15-19 years old and 40.9% at 45-49 years old. 12% used the IUD. 18% used periodic abstinence. 42.7% of nonusers were menopausal. 12.4% were subfecund. 7.5% feared side effects. The median age at first birth was 21.5 years. Infant mortality was 43/100,000. Infant mortality was very high among rural and uneducated women. Only 1.1% were moderately to severely undernourished, but 25.8% were moderately to severely chronically undernourished.^ieng

Nicaragua data reveal high levels of domestic abuse.

PIP: Results of the 1998 Demographic and Health Survey in Nicaragua revealed high levels of domestic abuse. The study showed that 29% of ever-married women in Nicaragua have experienced at least one episode of physical or sexual violence; with higher levels reported among the less educated women, those living in urban areas and those with many children. The findings also allowed an analysis of the different acts of violence reported by abused women during the last 12 months or before. Women reported that they were pushed or shoved (78%); hit with the fist or with something that could cause harm (68%); slapped or twisted by the arm (60%); kicked or threatened with a machete, firearm, or other weapon (32%); and physically forced to have sexual intercourse (20%). Overall, 77% of abused women experienced more than one type of violence, and 80% of abused women had experienced violence more than once. One of the most striking findings is the fact that 37% of abused women suffered acts of violence while pregnant.^ieng

Children of Kenya face serious survival challenges.

PIP: Survey findings pointing to the worsening health situation for children in Kenya that were highlighted during the National Dissemination Seminar for the 1998 Kenya Demographic and Health Survey (KDHS). The survey indicates that currently, 1 in 9 Kenyan children does not live to his or her 5th birthday. Under-five mortality stands at 112 deaths per 1000 live births, a 24% increase over the last decade. The high prevalence of childhood mortality is associated with a short preceding birth interval, a low level of maternal education, and rural location (under-five mortality is 23% higher in rural than in urban areas). Moreover, the risk of children dying varies greatly across provinces. A comparison between the results of the 1993 and 1998 KDHS also indicates recent setbacks in the fight against vaccine preventable diseases. Full vaccination coverage has fallen from 79% in 1993 to 65% in 1998. One of the more positive findings is the continuing decline in total fertility rate from 8.1 children per woman in the mid-1970s to current levels of 4.7 children per woman. In addition, knowledge and use of family planning has continued to rise in Kenya. Lastly, participants in the seminar also discussed the need for further dissemination of findings and further analysis of projects.^ieng

Bolivia survey reveals disparities.

PIP: Findings from the Bolivia Demographic and Health Survey in 1998 indicate that large fertility and reproductive health disparities based on education level and geographic location still persist in the country. Despite substantial improvement in the overall education level of Bolivian women in the past 5 years, urban women are almost 5 times more likely to attend high school than rural women are. Major differences in education level also exist between provinces. Total fertility rate is at 4.2 children per woman, with women without education having more than 3 times the number of children compared to those with higher education. At such rates, rural women will have an average of 6.3 children, which are 2.5 children more than their urban counterparts. Moreover, nearly 80% of women in union know of a modern method of contraception and 45% of them are using some form of family planning. The highest levels of contraceptive use are among women with higher education and women in urban areas. There is also a notable increase in the number of women who receive assistance from a trained medical professional during delivery. Infant and child mortality rates remain among the highest in Latin America although both rates have declined since the 1994 survey findings. Infant mortality rates are still 80% higher in rural areas than urban areas.^ieng

Infant feeding practices and child health in Bolivia.

The effects of breast-feeding and supplementation practices on recent diarrhoea occurrence and stunted growth are modelled using logistic regression techniques. Data from the Demographic and Health Survey of Bolivia, 1989, show that, among children aged 3-36 months at the date of interview, the benefits of breast-feeding to child health were most pronounced among children living in rural poverty. Reduced breast-feeding among these children increased the likelihood of diarrhoea and stunted growth. In addition, the introduction of solid foods to currently lactating infants negatively influenced child health.

PIP: This study assesses, in two models, the effects of infant feeding practices on stunted growth and diarrhea incidence among breast fed children aged 3-36 months in Bolivia. Data were obtained from the 1989 Demographic and Health Survey, which included 1143 breast-fed children. About 38% of the children were stunted. Stunting increased with age and parity. In the bivariate analysis, breast feeding increased stunting, and maternal characteristics were related. Stunting increased with maternal age and indigenous ethnicity. Stunting was associated with blue collar and agricultural households and households in the rural Altiplano and Valles regions. About 33% of the children had experienced an episode of diarrhea. Bivariate analysis revealed that only maternal education and having waste removal were related to the occurrence of diarrhea. Logistic models show that the positive effects of breast feeding were more prominent in impoverished environments. Cessation of breast feeding among infants 6 months or less and living in households with extreme rural poverty increased the risk of stunting fourfold. Children with birth intervals of 2-3 years were at 1.5 times lower risk. Children in rural areas were less likely to be stunted than children in urban areas, when socioeconomic status was controlled. Children who had diarrhea were 40% more likely to be stunted. Diarrhea decreased with maternal education. Diarrhea increased with the number of household members. Food supplementation introduced at about 6-9 months, when most infants are fed solids, increased the risk of stunting by about 75%. Introduction earlier or later had no significant impact on child growth. Only 30% of infants received solids before the age of 4 months. Personal living conditions or socioeconomic status were key explanatory factors in stunting and diarrhea.

Education as policy: the impact of education on marriage, contraception, and fertility in Colombia, Peru, and Bolivia.

Using data from the World Fertility and Demographic and Health Surveys of Colombia, Peru, and Bolivia, we model the effects of education on three demographic outcomes: the timing of first sexual union, contraceptive use, and fertility. These effects are examined over time and across geographic areas using a multivariate framework. We find substantial improvements in female educational attainment over the last fifty years and a strong relationship between education and the demographic outcomes. Each successive increment in education is associated with declines in the marriage rate, increased contraceptive use, and lower fertility. Education accounts for some of the changes over time in the demographic outcomes, but the pattern varies by outcome, time period, and geographic area. In support of the social diffusion hypothesis, our results indicate that educational differences in reproductive behavior are reduced as the level of development increases and societies pass through their demographic transition.

PIP: This study examined the effects of educational attainment on the timing of first union, contraceptive use, and fertility in Bolivia, Peru, and Colombia over the past 50 years. Data were obtained from World Fertility Surveys and Demographic and Health Surveys for Colombia (1976, 1986, and 1990); Peru (1977-78, 1986, and 1991-92); and Bolivia (1989 and 1993-94). Individual level data were used to examine the effects using various multivariate techniques: Cox proportional hazards models for age at first union; logistic models with controls for socioeconomic status for contraceptive use; and log linear techniques for fertility. Findings indicate a strong relationship between each demographic outcome: marriage age, contraceptive use, and fertility. In all countries, education influenced women's individual decisions about family formation. The strongest impact occurs between primary and secondary schooling, especially for marriage age. Increased educational attainment accounted for most of the decline in marriage rates over time. Increased education contributed to an increase in contraceptive use mostly in Peru. In Bolivia and Colombia, contraceptive availability was probably more important in the expansion of contraceptive use over time. Educational attainment over time only accounted for fertility decline in Peru and Colombia, and the effects were smaller than in other studies. Changes within educational categories appear to have contributed more to fertility decline than the expansion of educational opportunities. As countries progress through their transitions, there is a corresponding increase in contraceptive use and a later decline in actual fertility.

Dominican Republic 1996: results from the demographic and health survey.

PIP: These are summary results from the 1996 Dominican Republic Demographic and Health Survey, which covered 8,831 households, 8,422 women aged 15-49, and 2,279 men aged 15-64. Tabular data are provided on population characteristics, fertility, current contraceptive use, marital and contraceptive status, postpartum variables, infant mortality, disease prevention and treatment, and nutrition.^ieng

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.

Colombia 1995: results from the Demographic and Health Survey.

PIP: This summary report consists of tables and charts from the 1995 Colombia Demographic and Health Survey. The sample included 11,140 women aged 15-49 years. In 1995, population was an estimated 29.5 million. Life expectancy was 67.7 years. 3.8% had no education, 36.5% had a primary education, and 59.7% had a secondary or higher education. Fertility during 1990-95 was 3 children/woman compared to 2.9 during 1985-90. Fertility ranged from 4.3 in rural areas to 2.5 in urban areas, and from 5.0 among uneducated women to 2.5 among women with a secondary or higher education. The mean ideal number of children ranged from 2.2 among women aged 15-19 years to 3.1 among women aged 45-49 years and from 2.1 among women with no children to 3.9 among women with 6 or more children. 40.9% desired a stop to childbearing. The proportion desiring a stop to childbearing hovered between 50.8% among women with 2 children and 46.5% among women with 6 or more children. 54.4% of births were wanted, 24.4% were wanted later, and 21.1% were unwanted. Contraceptive use stood at 59.3% for modern methods and 12.9% for traditional methods; 67.0% in rural areas and 74.4% in urban areas. The proportion of use ranged from 26.2% among women with no children to 82.5% among women with 3 children. Knowledge of modern and traditional methods was high. 13.0% of never users and 17.7% of previous users did not intend to use. 26.3% of nonusers were sterilized or infecund, 31.9% were menopausal or had hysterectomies, and 9.6% desired more children. 9.7% were nonusers due to infrequent sexual intercourse. 32.2% were single, and 54.7% were in a union. The median age at first birth was 22.1 years. Infant mortality had declined. 1.4% of children were moderately to severely acutely undernourished, and 15.0% were moderately to severely chronically undernourished. 3.5% were severely chronically undernourished.^ieng

Haiti 1994-95: results from the Demographic and Health Survey.

PIP: These are summary results from the 1994-1995 Haiti Demographic and Health Survey, which covered 4,818 households and 5,356 women aged 15-49 and a subsample of 1,610 men aged 15-59. Tabular data are provided on population characteristics, fertility, current contraceptive use, marital and contraceptive status, postpartum variables, infant mortality, disease prevention and treatment, and nutrition.^ieng