Perceptions of family planning among some Somali men living in Sweden: A phenomenographic study

ObjectiveA growing body of research in Sweden has focused on migration and reproductive health, particularly on women’s perspectives, including family planning and contraception. However, knowledge is limited on how immigrant men perceive family planning. The topic is important because women’s use of family planning has been shown to be influenced by their partners and community. Therefore, this study aims to explore perceptions of family planning among Somali men living in Sweden.MethodsA qualitative phenomenographic approach was used. Four focus group discussions were conducted with 41 men aged 28–59 years. Data were analysed using phenomenographic analysis.Findings.The following four categories were identified in the analysis: 1) a happier and more sustainable family; 2) ideal family size versus cultural commitment; 3) fears of using modern family planning methods; and 4) a need to be included in family planning. The findings illuminated the complexities of perceptions of family planning. Although Somali men understood the benefits of family planning, they seemed to prefer a large family. However, due to their new social context in Sweden, they had also changed their views on having as large a family as in their home country.ConclusionOur findings suggest that Somali men living in Sweden want to be involved in family planning counselling, which may increase women’s use of contraception. However, healthcare providers must ensure that the woman desires her partner’s involvement and be culturally sensitive about couples’ needs.     

Gender norms,contraceptive use,and intimate partner violence: A six-country analysis

BackgroundWhile considerable research has explored associations between gender norms and various sexual and reproductive health behaviors (SRH) with the aim of informing programs, no studies have examined whether couple concordance on specific gender norms is associated with both contraceptive use and reduced intimate partner violence (IPV) experience.MethodsThis study relies on analysis of Demographic and Health Survey (DHS) couples’ datasets from Mali, Nigeria, Nepal, Pakistan, Tanzania, and Zambia that were collected in/after 2015 and include the DHS Domestic Violence Module for female respondents. To examine the associations between couple concordance regarding household decision-making or justification of violence (wife beating) and women’s use of modern contraceptives or experience of violence, bivariate and multivariate logistic regression models were fit using Stata15.ResultsJoint decision-making about large household purchases was significantly positively associated with modern contraceptive use in all study countries as well as with reduced odds of IPV experience in adjusted models in Tanzania and Zambia. In Nigeria, women’s justification for violence was negatively associated with contraceptive use. Across settings, women in couples where both justified violence had significantly increased odds of reporting IPV experience.ConclusionsThe evidence suggests that family planning programs should support joint decision-making as it was positively associated with contraceptive use across the six countries and is a proxy for shared economic power within the household. IPV reduction and prevention programs should also consider encouraging joint decision-making given the correlations found in two settings. Programs should enable participants to interrogate attitudes regarding justifying violence against female partners and propose approaches to avoid IPV. Finally, husbands’ alcohol consumption, a strong predictor of IPV experience, has too long been overlooked.     

Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh

ObjectiveThis study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25 years old.MethodsThis study utilized a cross-sectional data (n = 3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ² analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women.ResultsThis study observed that 71% fecund women aged below 25 years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women.ConclusionsReproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use.     

“Using contraceptives is abandoning our culture”: A qualitative study of contraceptive use among Somali women in Finland

ObjectiveSeveral studies have reported that Somalis have negative attitudes about using modern contraceptives. However, little attention has been paid to the differences in Somali women’s attitudes toward contraceptives across generations and the attitude change happening overtime in Somali women’s attitudes toward contraception. This study explores attitudes toward contraceptives and factors influencing contraceptive use, among first- and second-generation Somali women living in Finland.MethodsThe study follows a qualitative design with data collection using in-depth interviews. Sixteen women were interviewed regarding their knowledge of, attitude toward, and use of contraceptives. Eight of the study participants were first-generation and eight were second-generation Somali women living in Finland. The data were analyzed using a thematic approach guided by a cultural anthropology framework.ResultsThree main themes emerged in the data analysis: (1) Culture influencing Somali women’s attitudes toward contraceptives; (2) information sources can work differently within the same cultural group; and (3) Somali women’s perspectives on contraceptives change over time. Cultural, religion, taboo, and knowledge resources are used to understand the whole concept of Somali women’s attitude toward and use of contraceptives. Hence, the study shows the diverse opinions of Somali women. According to the informants the main underlying factors influencing Somali women’s attitudes toward contraceptives were education, culture, misinterpreted religion, and social pressure.ConclusionsAccording to the Finish resident women interviewed for this study, Somali culture do not support the use of modern contraceptives. Even though attitudes towards contraceptives are slowly changing, there is a need for SRH education, particularly among first-generation Somalis. Second-generation women are generally more open to the use of modern contraceptives. The study also draws attention to the need to improve the training of health care professionals regarding the handling of culturally sensitive topics such as contraception use.     

Trends of contraception use among married reproductive age women: Tehran lipid and glucose cohort study 2002–2011

ObjectivesThis study aimed to examine the trends of contraception use among married reproductive age women in Tehran Lipid and Glucose study between 2002 and 2011.MethodsThis analysis investigated a proportion of women users and non-users of family planning, using data from 10 year population-based Tehran Lipid Glucose Study from surveys conducted in 2002, 2005, 2008, and 2011.Of the 6813, 6993, 7077, and 6789 women in the four phases mentioned, 34.1%, 33.9%, 33.5% and 35% of participants in each phase preferred to use contraception. Number of participants studied were 2506 women in 2002, 2529 women in 2005, 2594 women in 2008 and 2525 women in 2011.ResultsTypes of methods and patterns of change in contraception differed across time. The percentage of women using traditional methods increased significantly from 25.7% in 2002 to 34.6% in 2011 (p value for trend = 0.001). Accordingly, modern contraception use showed a reverse trend. From 2002 to 2011, 61.4%, 61%, 57.7%, and 51% of married women reported currently using various modern contraceptives, respectively (p value for trend = 0.001). The proportion of users relying on condoms showed a significant increase during this decade, being 10.9% in 2002, 15.2% in 2005, 20% in 2008 and 21.9% in 2011. The prevalence of non-users for contraception was generally low; 12.7%, 8.2%, 8% and 14.3%, respectively from 2002 to 2011, but increased significantly across time (p = 0.005)ConclusionRelying on less effective contraceptive methods has increased rapidly among women in the Tehran Lipid and Glucose cohort study, a trend that could be a warning to policy makers about the possibility of higher unsafe abortion and maternal mortality/morbidity rates in the near future.     

Motivators of contraceptive method change and implications for long-acting reversible contraception (non-)use: A qualitative free-text analysis

ObjectiveTo develop a greater understanding of the motivators of contraceptive method change over time for young Australian women, with a particular interest in long-acting reversible contraception (LARC) use.MethodFree-text comments from the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) Study were used to explore the reasons for contraceptive method change among women who reported one or more contraceptive changes across the three CUPID surveys.Results512 women reported making at least one contraceptive method change, with 740 comments explaining these changes between them. Participants reported a multitude of reasons motivating their contraceptive change. Five key themes were developed to explain these motivators: the natural, sexual and fertile body, specific contraceptive characteristics and other important people. Findings suggest that women’s decisions to switch or discontinue a contraceptive depended largely on her ability (and desire) to juggle its impact on her sexual, fertile and natural body. Importantly, the transient and fluid nature of contraceptive practices were demonstrated, as the women adjusted their method to suit their needs at the time.ConclusionRegarding LARC use, these findings suggest that rather than being appealing, the ‘temporarily permanent’ nature of these methods may be unappealing and incongruent with the needs of some women.     

Use of modern contraceptives by women with disabilities in Rajasthan,India: An analysis of the annual health survey

ObjectiveThe objective of this study is to analyze associations between disability and contraceptive use among married women in Rajasthan, India. Methods: The study uses secondary analysis of the Rajasthan dataset of the 2010–2011 Annual Heath Survey. This survey included both disability and reproductive health data. The sample includes 238,240 women aged 15–49 years. Logistic regression is used to measure associations between disability status and use of modern contraceptives and female sterilization in the sample. Stratified analyses by age and residence were also conducted. Results: The prevalence of disability among women of reproductive age was 0.9%. Modern contraceptive use was reported by 73.0% of the sample, and female sterilization by 57.7% of the sample. Women with disabilities (WWD) were less likely to report using a modern contraceptive (OR 0.87, 95% CI: 0.78, 0.95). Among modern method users, WWD were not significantly more likely to be using sterilization than another modern method; however, there were significantly higher odds of sterilization versus another modern method for urban WWD (OR 1.57, 95% CI: 1.11, 2.22). Conclusions: In this study, disability was associated with contraceptive use. Additional research is needed to determine if there is a causal relationship between disability and contraceptive use. Family planning providers should be trained to provide care to WWD and the Government of India should ensure the National Family Planning Programme is accessible to people with disabilities.     

Knowledge,challenges, and standard of care of young women with ADHD at Swedish youth clinics

ObjectivesSexual risk-taking and its consequences for young women with ADHD(attention deficit hyperactivity disorder) including sexually transmitted diseases, teenage pregnancies and underage parenthood constitute substantial challenges for individuals and midwives. The aim was to investigate current knowledge and specific challenges in reproductive health and contraceptive counselling for women with ADHD at Swedish youth clinics.MethodInductive qualitative interview study of ten midwives at six youth health clinics in Stockholm and Uppsala County. We used a semi-structured interview guide. The interviews were transcribed verbatim and analyzed with the NVivo 12 qualitative data analysis software.ResultsThree main categories were identified: (1) challenges in provision of care of young women with ADHD, (2) standard of care and active adaptations towards women with ADHD and (3) organizational readiness for change;. Several challenges and frustrations, such as difficulties with attention with or without concomitant impulsivity and overactivity, in provision of reproductive health and contraceptive counselling for young women with ADHD were identified. Midwives reported high organizational readiness for improvement of standard of care.ConclusionsInadequate contraceptive counseling or lack of knowledge on specific challenges in the sexual and reproductive health of young women with ADHD may contribute to this group failing to access, inadequately respond to, or act upon counseling at youth clinics. Support for midwives with evidence-based interventions specifically developed for these women are imperative. Development of such tools should be a priority for research.     

Knowledge,experience, and utilisation of sexual and reproductive health services amongst Nepalese youth living in the Kathmandu Valley

ObjectiveYouth have the right to utilise sexual and reproductive health (SRH) services and information to protect themselves from negative SRH outcomes. This study aimed to assess knowledge, experience and use of SRH services amongst youth living in urban areas of the Kathmandu Valley.MethodsWe conducted a two stage cluster sampling cross-sectional household survey of young men and women aged 15–24 living in the Kathmandu Valley using a structured questionnaire.ResultsAmongst the 680 young men and 720 young women participants, less than two-thirds had knowledge about the fertile period and less than a half about pregnancy risk at first sex. Over three quarters of young men and women had knowledge of condoms, and pills but less than half knew about implants or intrauterine devices. Age at first sex was similar for men and women but women were significantly less likely to have participated willingly in their first sexual encounter and were less likely to have used any contraception (for both p < 0.001). Almost all men and women (97.9%) had heard of sexually transmitted infections (STIs) but only 8% had heard about the most common STI, Chlamydia. Over 90% of youth reported feelings of shame as the major barrier to accessing SRH services.ConclusionsGaps exist between youth SRH knowledge and practices which leave them vulnerable to sexual ill health. This may indicate a lack of confidence in SRH services but also likely reflects the cultural and religious environment that hampers open expression of sexual and reproductive issues, particularly for young women.     

Factors associated with contraceptive use among postpartum women with substance use disorder

ObjectiveRates of unintended pregnancy among women with substance use disorder (SUD) are much higher than the general reproductive-age population, suggesting lower rates of contraceptive use. This study aims to determine the prevalence of contraceptive use in postpartum women with SUD and identify factors associated with its use.MethodsThis retrospective cohort study using electronic health record data from 2016 to 2019 included postpartum adult women with any SUD who received care at a high-risk pregnancy clinic (n = 353). The primary outcome was contraception utilization as identified using diagnosis and procedure codes. An adjusted multivariate logistic regression was used to evaluate the relationship between postpartum contraceptive use and sample characteristics.ResultsOf the 353 postpartum women with SUD, contraceptive use was found in 128 (36.3%) women. Among the study population, the most commonly reported substance use disorders were nicotine use disorder (70.3%), opioid use disorder (51.3%), and cannabis use disorder (15.0%). Among those with opioid use disorder, 45.3% were found to be using medication for opioid use disorder (MOUD). Women who attended a postpartum visit had 2.23 times the odds of using contraception compared to women who did not (OR: 2.23, 95% CI: 1.20–4.15). Those using MOUD had 3.69 times the odds of using contraception compared to those who were not (OR: 3.69, 95% CI: 1.89–7.19). Overall, women who utilized contraception were more likely to be younger than 25, receiving MOUD, and participating in postpartum care.ConclusionsPostpartum women with SUD are not using contraceptive methods and this is associated with a lack of appropriate healthcare interventions in the perinatal period, which can reduce the odds of receiving effective family planning services. Specialized whole-health interventions and policies to increase access to care for women with SUD should be developed.     

Hormonal contraceptive practices in young Australian women (⩽25 years) and their possible impact on menstrual frequency and iron requirements

ObjectivesTo investigate the hormonal contraceptive practices of female university students aged ?25 years, their menstrual bleeding frequency, and interest in contraceptive regimens that reduce menstrual frequency or duration.Study designA 20-item questionnaire was distributed to female students at Griffith University, Gold Coast campus. This included questions relating to: demographics, menstrual bleeding frequency, current contraceptive practices, and interest in future oral contraceptive regimens that reduce menstrual bleeding frequency and duration.Main outcome measuresDetermination of hormonal contraceptive practices and menstrual bleeding frequency undertaken by the sample population.ResultsEight hundred and fifty one participants completed the questionnaire, ～2/3rds of respondents are currently using a hormonal contraceptive (66% of all respondents), with the oral contraceptive pill (OCP) being most common. Most women (73%) reported monthly menstruation, although 16% indicated that they sometimes missed their monthly period, with bleeding every two months. Of all OCP users, approximately 2/3rds have skipped their monthly period at some time, the most common reasons being for convenience (89%). Approximately 70% of respondents were interested in OCP regimens that reduced frequency or duration of menstruation.ConclusionOCP use is popular amongst Australian university women, with many being interested in the concept of using the OCP to delay menstruation. Given this interest and the availability of hormonal contraceptives that reduce menstrual frequency and duration, assessing the impact of reduced menstrual blood loss on iron stores may be warranted.     

Integrating reproductive planning with primary health care: An exploration among low-income,minority women and men

IntroductionDespite recommendations to integrate reproductive and preconception health care services with primary health care, integration of such services is uncommon. The purpose of this study was to explore the acceptability and utility of integrating an assessment of reproductive plans into primary care encounters.MethodologyUsing a purposive sampling strategy, we purposively selected 144 African-American and Hispanic females and males from publicly-funded clinics. We assessed their desire for a child and contraceptive practices via a reproductive plans questionnaire. Patients’ written responses were attached to the medical record for provider use. After the encounter, we administered semi-structured interviews to elicit patients’ opinions about the questionnaire. We audio-recorded and transcribed verbatim responses and qualitatively analyzed them by content analysis.ResultsOverall, 58/72 (81%) of females and 30/72 (42%) of males reported the reproductive plans assessment was important to their encounter, with variation in the reason according to reported desire for a child. According to reported contraceptive practices, >45% who reported never wanting a child or not wanting a child for at least one year were ‘at-risk for unintended pregnancy.’ A substantial proportion of patients reported uncertainty about desiring a child, and a minority of these reported consistent contraception use.DiscussionQuestions to assess patients’ reproductive plans were viewed as important by the majority of female and a substantial proportion of male primary care patients, and a substantial proportion were at-risk for unintended pregnancy. Primary care practices should consider implementing a reproductive plans assessment to facilitate linkage of patients to appropriate family planning, preconception, and sexually-transmitted infection services.     

Women’s empowerment and use of contraception in India: Macro and micro perspectives emerging from NFHS-4 (2015–16)

Background and objectiveBased on the four-corner stone of population and development programmes recognized by ICPD (1994) this paper envisages the relationship between the recent waves of women's empowerment anduse of contraceptive methods in India.Data and methodsFindings are based on two rounds of NFHS (3 & 4). Liberson’s Diversity Index has been used to assess the inequality in women’s empowerment. Multiple regression analysis is used to portray the relationship and logistic regression is used to access the adjusted effects of various dimensions of women's empowerment on use of contraception.ResultsVarying degrees of equity in women’s empowerment across different states of India builds a combative relationship with uptake of contraceptive methods. Results portray a positive association between inequality in household decision making, engaged in paid work in last 12 months and having 10 years of schooling with use of any modern method. Women who participated in household decision making (OR = 1.17 p < 0.005), using mobile phone (OR = 1.23 p < 0.005) and working and were paid in cash in last 12 months (OR = 1.37 p < 0.005) are significantly more likely to use any method of contraception.ConclusionsStatus of women in India has improved in different dimensions, yet the patriarchal norms influence the decision of using contraception. The current women-centric bottom-top approach in implementation of family planning programme should focus at the women’s right to decision on their own life and health. Such efforts should hinge at strengthening inter personal counseling and capacity building sessions by outreach workers, which may empower women with enhanced knowledge about their health and bodily rights.     

Family planning practices and women’s impression of the reproductive life plan in Eswatini

ObjectiveFamily planning is limited and unplanned pregnancies are common in Eswatini. The Reproductive Life Plan (RLP) is a counselling tool to improve pregnancy planning. Mentor mothers, i.e. community health workers, were trained in using an adapted RLP and introduced it into family planning discussions with their clients. This study evaluates the clients’ impression of the RLP and investigates their family planning practices.MethodData were collected in 2018 from anonymous questionnaires filled out by the clients: mothers or pregnant women aged 15–44 years. The questionnaire comprised 20 questions on demographic background, fertility desires, pregnancy planning as well as quality and perceived need for family planning support. Chi-square tests or Fisher’s exact test were used for group comparisons.Results199 women were included. Most women (74%) chose the option that family planning discussions using the RLP had helped them ‘very much’. A majority also had a perceived need for these discussions as 70% wanted to have more support from their mentor mother and 92% wanted more information about family planning. Women with lower educational level and younger women wanted more support compared to women with higher educational level and older women (p < 0.001 and p = 0.028). The unmet need for family planning was 22%.ConclusionThe introduction of the RLP used by mentor mothers was well received among women but most of them requested more family planning support. Using the RLP may help women in this context achieve their reproductive goals.     

‘Of course,women will adopt it!’: A qualitative study on the acceptability of medical menstrual regulation in Senegal

ObjectiveMedical menstrual regulation (MMR) may offer a promising way to reach Senegalese women and girls in need of fertility management, especially in rural contexts. To assess the feasibility of introducing a MMR service in Senegal, the study aimed to (1) understand how women and girls manage their menses and fertility, and (2) document acceptability of MMR among women, youth, and health providers.MethodsSix focus group discussions and 34 in-depth interviews were conducted with women, youth, and health providers in Kaolack, Mbour, and Thiès, Senegal.ResultsAll participants characterized the pubescent period by a lack of sexual education, familial support, and access to reproductive health services. Reproductive health service utilization in Senegal was portrayed as highly stigmatized, creating barriers to contraception and reliable information on family planning. Unwanted pregnancy and clandestine abortion were depicted as common occurrences among many participants. Senegalese women and youth perceived MMR services as an acceptable method to manage a missed period with discretion, rid of moral and legal ramifications – and framed MMR as a needed mechanism to prevent abortion and avoid undesired pregnancies. The majority of health providers, with the exception of female health volunteers, were reluctant to endorse the service, comparing MMR to abortion.ConclusionsIn a context fraught with restrictive abortion laws and limited uptake of modern contraception, MMR is an acceptable among potential service users. Nonetheless, introduction and implementation of MMR will be feasible in Senegal only if policymakers approve and support the service and health provider buy-in is achieved.     

Unmarried women’s decisions on pregnancy termination: Qualitative interviews in Colombo,Sri Lanka

BackgroundIn Sri Lanka pregnancy termination is very restricted by law and social norms. Premarital sex, and pregnancies are not generally accepted and unmarried pregnant women are vulnerable in their decision-making on pregnancy termination.ObjectivesThe objective of this study was to describe the circumstances of becoming pregnant and factors considered in the decision-making for seeking pregnancy termination in a sample of unmarried women in Colombo, Sri Lanka.MethodsIndividual qualitative interviews were conducted with 19 unmarried women seeking pregnancy terminations at a reproductive health centre in Colombo, Sri Lanka. The interviews were later analysed using qualitative content analysis.ResultsBecoming pregnant in a love relationship was predominant in this sample. Awareness of contraceptives varied and initial reaction to the pregnancy involved strong contradictory emotions. Multiple interrelated factors were considered in the decision-making for termination. Family pressure was the most prominent factor followed by the partner’s qualities and attitude towards the pregnancy, economic factors and own feelings, values and future fertility. The women described that their own emotional, religious and economic reasons for continuing the pregnancy were often outweighed by their responsibility to the family, male partner and unborn child.ConclusionsThese unmarried women’s sexual and reproductive rights were limited and for many the pregnancy termination was socially unsafe. They found themselves at the interface of two value systems. Modern values allow for relationships with men prior to marriage; whereas, traditional values did not. The limited possibilities to prevent pregnancies and little hope for support if continuing the pregnancy; made women seek pregnancy termination despite own doubts.     

The role of knowledge in the contraceptive behaviour of sexually active young people in state care

AimTo analyse the role of sex-focused knowledge in the contraceptive behaviour of sexually active young people in state care.MethodsThe sample consisted of 19 care leavers (young people previously in state care) aged 18–22 years, 16 females and 3 males. In-depth interviewing was the method of data collection, and a qualitative strategy resembling modified analytical induction was used to analyse data.FindingsFindings indicated that a lack of information was not the sole or even the primary reason for engaging in unsafe sexual practices. Other factors such as ambivalence to becoming pregnant also featured in participants' accounts. Several participants conveyed a relatively weak sense of agency about consistently using contraception. A small number of participants expressed a strong determination to avoid pregnancy, and these appeared to have a level of anxiety about becoming pregnant that motivated them to engage with knowledge about contraception and its use.ConclusionLack of sex-focused information is just one aspect of a myriad of complex factors, including socioeconomic disadvantage and/or emotional deprivation, that influence contraceptive behaviour.     

Who uses long-acting reversible contraception? Profile of LARC users in the CUPID cohort

ObjectiveTo explore the characteristics of long-acting reversible contraception (LARC) users in a nationally representative cohort of young Australian women aged 18–23.MethodsData from 3155 women who responded to a question about their contraceptive use in the previous six months at the baseline Contraceptive Use, Pregnancy Intention and Decisions (CUPID) survey were included.Results726 (19.1%) women reported LARC use, with the Implanon being the most popular method (n = 478; 65.8%). A history of pregnancy was strongly associated with increased odds of LARC use in the multivariate model (OR = 2.67, 95% CI = 2.11, 3.34, p ≤ 0.001). Comparatively, using contraception for reasons other than pregnancy prevention was associated with decreased odds of LARC use in the multivariate model (period management: OR = 0.74, 95% CI = 0.60, 0.91, p = 0.004, body management: OR = 0.53, 95% CI = 0.37, 0.77, p = 0.001, medical condition: OR = 0.25, 95% CI = 0.09, 0.66, p = 0.005). Highest education and Medicare card status also contributed to the final multivariate model, and were associated with decreased odds of LARC use.ConclusionReproductive history and reasons for contraceptive use are strong indications of method choice. Promoting LARC as highly effective may not be a sufficient incentive for young women to take up the method when pregnancy prevention may be equal or secondary to their desired non-contraceptive effects.