Contraceptive practices in Armenia: Panel evaluation of an Information-Education-Communication Campaign

Induced abortion remains the major form of birth control among Armenian women, contributing to their excess mortality and preventable morbidity. Reliance on abortion is attributed to limited access to information concerning modern methods of contraception and to widely held misinformation among women regarding family planning and reproductive health. Based on the Steps to Behavior Change model, the Green Path Campaign for Family Health, an information-education-communication (IEC) campaign, was launched in June 2000. This multimedia campaign promoted greater awareness, knowledge, acceptance, and adoption of modern contraception through increased utilization of counseling and related services provided at underutilized family planning centers. A representative panel of 1088 married women aged 18-35 were surveyed on reproductive health/family planning knowledge, attitudes, and practices immediately prior to and immediately following the 6-month national campaign. Exposure to the campaign was associated with significant increases in factors associated with contraceptive behavior change: knowledge, favorable attitudes toward modern methods, favorable attitudes toward family planning services, and information seeking and utilization of family planning services. Women who were more educated, more affluent, and slightly older were more likely to use family planning services as well as modern contraceptive methods. New visits to family planning centers increased by 84%. Despite the usual 25% turnover among those using modern methods at the start of the study, use of modern contraceptive methods increased by 4.6%, significantly exceeding the projected 3% increase. The results document changes in underlying behavioral predictors consistent with the Steps to Behavior Change model and highlight the relatively untapped potential of media-based health promotion efforts in post-Soviet Republics.     

广州市海珠区江海街流动人口产后避孕服务需求调查分析

目的了解流动人口避孕节育需求并探讨其影响因素,为进一步开展有针对性的干预措施提供依据。方法用问卷调查的方法,了解流动人口孕产妇避孕服务的需求以及对避孕知识的知晓程度。结果流动人口对避孕知识的知晓程度为57.96%～91.59%,不同文化程度、经济水平对产后避孕知识的知晓程度有差异。流动人口孕产妇对避孕方法的选择和使用等知识具有迫切的需求。42.0%认为产前检查为最合适的宣教时间,发放宣传册为最喜欢的宣教方式。结论针对不同需求,利用不同的平台,开展有针对性的避孕知识宣教,有利于提高流动人口对避孕节育知识的掌握。     

Telemedicine for contraceptive counseling: An exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic

ObjectiveDuring the COVID-19 pandemic, many clinicians started offering telemedicine services. The objective of this study is to describe the experience of US family planning providers with the rapid adoption of telemedicine for contraceptive counseling during this period.Study designThis is a cross-sectional web-based survey of family planning providers practicing in the United States.ResultsA total of 172 providers completed the survey (34% response rate). Of these, 156 (91%) provided telemedicine services in the 2 months preceding the survey. Most (78%) were new to telemedicine. About half (54%) referred less than a quarter of contraception patients for in-person visits, and 53% stated that the most common referral reason was long-acting reversible contraceptive (LARC) insertion. A majority of providers strongly agree that telemedicine visits are an effective way to provide contraceptive counseling (80%), and that this service should be expanded after the pandemic (84%). If asked to provide telemedicine visits after the pandemic, 64% of providers would be very happy about it. Many providers used personal phones or smartphones to conduct telemedicine visits but stated that ideal devices would be work-issued computers, tablets, or phones. More than half (59%) of providers prefer video over phone visits.ConclusionsFamily planning clinicians in the United States reported a positive experience with telemedicine for contraceptive counseling during the early stage of the COVID-19 pandemic and believe that this service should be expanded. Clinicians seem to prefer using work-issued devices and conducting video rather than phone visits.ImplicationsTelemedicine is a promising option for providing contraceptive counseling even beyond the COVID-19 pandemic. An investment in hospital or clinic-issued devices that allow for video conferencing may optimize clinicians’ telemedicine experience.     

The impact of the family planning supply environment on contraceptive intentions and use in Morocco

Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.     

Obstacles to Contraceptive Use in Pakistan: A Study in Punjab

The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Survey data are analyzed that were collected in Punjab province in 1996 and that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and knowledge of contraception, the social and cultural acceptability of contraception, perceptions of the husband's preferences and attitudes, health concerns, and perceived access to services. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future, in which the six obstacles are treated as latent variables. The estimates indicate that the two principal obstacles to using a contraceptive are the woman's perception that such behavior would conflict with her husband's fertility preferences and his attitudes toward family planning and her perception of the social or cultural unacceptability of contraception. The results confirm the value of taking contraceptive costs seriously, and, in particular, of attempting to measure these costs in empirical research on family planning.     

Ethnic differences in contraceptive use in Sri Lanka

In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.     

人工流产少女的性行为及避孕现状调查

目的:了解人工流产少女的性行为和避孕现状,找出存在的问题并提出相关建议。方法:以成都市锦江区妇幼保健院作为研究现场,于2009年5月～2010年4月,采用自填式问卷的方法对年龄≤20岁的人工流产少女525例进行调查和统计分析。结果:本次妊娠的主要原因是未避孕(67.6%)和避孕失败(25.2%)。未避孕的最主要原因是认为偶尔无避孕性行为不会妊娠,导致避孕失败的方法依次为体外射精、避孕套、安全期和紧急避孕药。在过去6个月内,每次性行为都使用避孕措施的占4.2%,25.2%研究对象从未使用过任何避孕措施。研究对象与男伴同居的比例非本市户籍(58.1%)高于本市户籍(41.1%),农村(59.8%)高于城镇(47.9%)(P<0.05)。采用逐步回归方法分析影响重复性流产的因素,发现年龄和收入具有统计学意义(P=0.04和P<0.01)。结论:未婚同居、收入水平低、年龄小、避孕措施使用率低和方法低效是非意愿妊娠的主要原因。应加强避孕知识的宣传教育,提高避孕药具可及性及流产后服务水平和能力。     

Service provider perspectives on post-abortion contraception in Nepal

The government of Nepal has articulated a commitment to the provision of post-abortion contraception since the implementation of a legal safe abortion policy in 2004. Despite this, gaps in services remain. This study examined the perspectives of abortion service providers and administrators regarding strengths and shortcomings of post-abortion contraceptive service provision. In-depth interviews were conducted with 24 abortion providers and administrators at four major health facilities that provide legal abortion in Nepal. Facility factors perceived to impact post-abortion contraceptive services included on-site availability of contraceptive supplies, dedicated and well-trained staff and adequate infrastructure. Cultural norms emerged as influencing contraceptive demand by patients, including method use being unacceptable for women whose husbands migrate and limited decision-making power among women. Service providers described their personal views on appropriate childbearing and the use of specific contraceptive methods that influenced counselling. Findings suggest that improvements to a facility’s infrastructure and training to address provider biases and misinformation may improve post-abortion family planning uptake. Adapting services to be sensitive to cultural expectations and norms may help address some barriers to contraceptive use. More research is needed to determine how to best meet the contraceptive needs of women who have infrequent sexual activity or who may face stigma for using family planning, including adolescents, unmarried women and women whose husbands migrate.     

A socio-ecological approach for examining factors related to contraceptive use among recent Latina immigrants in an emerging Latino state

Using the Social Ecological Model, the individual, partner, social, and structural factors related to recent Latina immigrants’ contraceptive use in an emerging immigrant community were explored. During September 2013–January 2014, door-to-door sampling was used in Birmingham, Alabama to recruit Latina immigrants who had lived in the United States (U.S.) for less than 5 years. Ten women with foreign-born children and 10 with only U.S.-born children completed in-depth interviews about their contraceptive use following migration. Women’s narratives revealed interrelated barriers to using highly effective contraception after migrating to the U.S. Women had nuanced concerns about using hormonal contraception, which, when combined with other factors, led them to rely on condoms and withdrawal. Limited partner communication was a barrier to effective method use for some women, but partner attitudes that women should be responsible for contraception were less important. Weak female networks made it difficult for immigrants to learn about the U.S. health-care system, especially those with only U.S.-born children. Even once women accessed services, a full range of highly effective methods was not available or affordable. In emerging communities, integrated strategies that address immigrants’ need for information and ensure access to affordable contraception would help women achieve their reproductive life goals.     

Safer sex at holiday centres: providing contraceptive services to seasonal workers.

Many seasonal workers experience an increase in sexual activity whilst employed at a holiday centre. Evidence of sexual risk-taking while at a holiday centre has important social and health implications for purchasers and providers of sexual health services in areas which experience an annual influx of seasonal workers. This research investigates the contraceptive behaviour of seasonal workers and focuses on their access to contraception and sexual health services. In-depth interviews were conducted with seasonal workers at holiday centres along the south coast of England. Respondents were, interviewed at the beginning of the season and again, five months later at the end of the season. This longitudinal methodology enabled changes in contraceptive behaviour to be identified as well as the strategies for seeking contraception and sexual health services throughout the season. The results of this study show that there are a range of different motivations which influence seasonal worker' use of contraception and sexual risk-taking while at a holiday centre. Categories of contraceptive protection are developed to assist purchasers and providers to identify the variety of sexual health needs of workers at holiday centres and determine the most effective strategies for delivering contraceptive and sexual health services to these workers. The paper describes the motivations which influence contraceptive use and sexual risk-taking amongst seasonal workers, identifies the contraceptive and sexual health needs of these workers, and discusses the difficulties workers experienced in meeting these needs while at a holiday centre.     

Factors related to choosing oral contraception at age 15

This report aims to identify factors which are related to use of oral contraceptives at an early age. A self-administered questionnaire was completed at schools in 1988 and 1992 in southern and western Finland (N = 1339). Sexually experienced girls (mean age 15.8 years) who had answered the question concerning their oral contraceptive use were included (N = 389). Logistic regression analysis was used to compare oral contraceptive users (N = 121) with the group of non-users. Total number of coital experiences was associated with oral contraceptive use: the odds ratio for those having at least 10 coital experiences was 6.30 compared with those with only one intercourse. The proportion was 73% among oral contraceptive users and 30% among non-users. Girls using oral contraceptives perceived more often (67%) that parents accept their sexual relationship (30% among non-users). Oral contraceptive users were less afraid of getting pregnant (9% compared with 31% among non-users) and felt more often that sex was very important in their life (31 and 13%, respectively). Other factors that entered the model were age at menarche, having a steady partner and frequency of disco visits. When a young girl asks for oral contraceptives, she is probably at true risk of pregnancy, and regular contraception should be considered both in view of effective prevention of pregnancies and sexually transmitted diseases.     

Sixteen to nineteen year olds' use of, and beliefs about, contraceptive services

Unwanted pregnancies, sexually transmitted diseases and unprotected sex in young people highlight a need to improve the provision of contraceptive services for this age group. The aim of the present study was to examine young men and women's use of and beliefs about, contraceptive services. A questionnaire was completed by 967 16 to 19 year olds from South Thames concerning their use of and beliefs about, a range of services which provide contraception. The results showed variability in both service use and belie about services which related to the respondent's sexual experience and gender In terms of use, the chemist and the condom machine had been used by the largest number of respondents, with more men using the condom machine and women favouring the GP or family planning clinic. In terms of beliefs, the condom machine was regarded as the easiest and most comfortable to use but the least confidential for all respondents with men reporting higher ratings for ease of use than women and non virgins reporting more positive beliefs for all criteria. The results are discussed in terms of the implications for health education. It is suggested that contraception use in young people could be promoted by embracing rather than challenging this variability. Accordingly, health education interventions would involve providing young people with information about contraception services which was designed to be in line, rather than conflict, with their existing concerns and beliefs. Such an approach would enable them to make informed choices about the kind of contraceptive service which matched their own personal needs.     

What contraception do women use after abortion? An analysis of 319,385 cases from eight countries

Contraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2326 public-sector health facilities in eight African and Asian countries from 2011 to 2013. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas, an international non-governmental organisation. Interventions included updating national guidelines, upgrading facilities, supplying contraceptive methods, and training providers. We conducted unadjusted and adjusted associations between facility level, client age, and gestational age and receipt of contraception at the time of abortion. Overall, postabortion contraceptive uptake was 73%. Factors contributing to uptake included care at a primary-level facility, having an induced abortion, first-trimester gestation, age ≥25, and use of vacuum aspiration for uterine evacuation. Uptake of long-acting, reversible contraception was low in most countries. These findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs. Improving availability of long-acting contraception, strengthening services in hospitals, and increasing access for young women are areas for improvement.     

Consistency between most important reasons for using contraception and current method used: the influence of health care providers

OBJECTIVE: To identify factors related to consistency between women's "most important" reason for using contraception and their current contraceptive method. METHODS: A sample of 433 women completed a written questionnaire on demographics, contraceptive use history and the "most important" reason for using contraception. Women were grouped by whether their current contraceptive method "agreed" or "disagreed" with their "most important" reason for contracepting. Multivariable regression was used to identify factors associated with consistency between stated "most important" reason and current method used ("agreed"). RESULTS: Current contraceptive method was inconsistent with the "most important" reason for using a method in 25% of women. Demographic characteristics and knowledge of contraceptive effectiveness did not differ between the "agreed" and "disagreed" groups. Women using a method consistent with their reason were more likely to have discussed contraception with a health care provider (RR=1.59, 95% CI 1.13-2.25) even after adjusting for source of contraceptive method or source of contraceptive information (RR=1.57, 95% CI 1.10-2.23). CONCLUSION: Contact with a health care provider was the only factor associated with consistency between birth control method and reasons for initiating contraception. This association appears to be independent of knowledge about contraceptive effectiveness.     

Sociocultural and religious influences on the normative contraceptive practices of Latino women in the United States

Presumably, Latino women engage in little family planning because of religious or cultural objections to contraception. The purpose of this study was to examine how acculturation, religion and various demographic factors were related to the family-planning behaviors of Latino women in the United States. Data were collected on 234 pregnant women (aged 18-40 years), on their family size, how actively they planned their current pregnancy, and how consistently they used contraception in the past. Through path analysis, we found that Spanish-speaking women were more consistent contraceptive users than their English-speaking counterparts, suggesting that acculturation negatively impacts contraceptive use. However, Spanish-speaking women with longer US residency were more likely to be consistent contraceptive users than Spanish-speaking women who had lived in the United States for briefer periods, suggesting a positive effect of acculturation. Religiosity and years of education were associated with family size, but not contraceptive use. Women who were married and had fewer children were more likely to plan their current pregnancy, indicating that Latino women take family size and marital status into consideration when actively deciding to become pregnant.     

Gender and Contraception: A Proposed Conceptual Model for Research and Practice

Unintended pregnancy and birth, frequently due to contraceptive non-use or misuse, continue to be important public health problems. A large body of literature has examined women's characteristics related to contraceptive use. However, much of what is known about men and contraception has been obtained or extrapolated from interviews with women. In this paper, we first present an overview of unintended pregnancy and the link with contraception. We explore gender considerations in contraceptive decision-making and discuss the literature of men's role in contraceptive attitudes and practices both in the developing countries and in the United States. Because individuals who make contraceptive decisions are actually part of couples, we examine the recent literature on couple communication and the role of partner influence on contraceptive practice. Finally, we propose a conceptual model that can be used for studying gender differences regarding factors that influence contraceptive use. The model is comprised of a variety of factors influencing contraceptive use that include; (1) knowledge of contraceptive methods, use, and effectiveness; (2) structural/access, institutional, and financial factors that may present barriers to contraceptive acquisition and use; and (3) socio-cultural factors. These sociocultural factors include: (a) attitude (beliefs, values, perceived risk of pregnancy, cognitive assessment/acceptability of pregnancy, masculinity ideology, self-esteem, and self-efficacy); (b) the influence of significant others, including partners, peers, and family; and (c) sociodemographic factors including age, ethnicity, marital status, education, and income. This model should be useful in identifying gender differences in knowledge, attitudes, and practices about contraception and pregnancy so that efforts to reduce unintended pregnancy can effectively target both women and men.     

The experience of young people with contraceptive consultations and health care workers

In the United Kingdom, services for contraceptive consultation and family planning were first opened in the 1960s. Early and relevant information to adolescents is of importance. The aim of this paper was to examine young people's attitudes towards and experiences of consultations with health care providers about contraception, taking account of the context of their contraceptive use. Young people aged 16-21 years were recruited to the study from health services (young people's contraceptive and sexual health clinics and a termination of pregnancy clinic), secondary schools and community projects (a youth club, a young mothers' support group, a community education project and a young women offenders unit). As part of the needs' assessment, in-depth interviews and focus groups were conducted. Thirty-two young male and females were interviewed. Knowledge about contraception, sexually transmitted infections and the risk of pregnancy was often high. Many respondents noted that in a five to ten minute consultation there was not the time to discuss personal factors that may affect contraceptive decision making and effective use of methods. Many described a feeling of being rushed through the service and did not feel they had the opportunity to ask questions. What young people said they wanted from consultations with health care workers and their experiences of the consultation process often conflicted. They wanted the time and opportunity to discuss their options. Often the young men, who were accessing services, described how initially they had gone in to collect condoms, but once they knew the clinic and staff would consider making an appointment. It is concluded that young people want to be given choices and information regarding contraception that fit their lifestyles. Improving the structures of contraceptive and sexual health services for young people will help to remove some of the barriers that prevent some young people from accessing them. However, it is just as important that barriers in the service delivery are tackled to ensure young people receive effective contraceptive advice.     

Ecological factors predicting adolescent contraceptive use: implications for intervention

Questionnaires addressing areas expected to relate to contraceptive use were completed by 230 female adolescents. Contraceptive use among the 130 sexually active subjects were predicted by a model composed of 12 scales assessing social permissiveness, costs and benefits of contraception, parent communication, boyfriend support, sex education and knowledge, attitudes about pregnancy and contraception, and access to contraception services. Scales from the predictive model which raise ideas for potential intervention strategies assessed parent communication, boyfriend support, and perceived costs and benefits related to contraception. Since there has been public concern that intervention programs for enhancing adolescent contraceptive use might also stimulate sexual activity, correlations were computed between the predictive scales and the measure of sexual experience among all 230 subjects. These data indicated that positive parent communication about sexuality and a perception of high benefits and low costs associated with contraceptive use were not positively correlated with sexual experience. Implications for the prevention of adolescent pregnancy are discussed with an emphasis on designing innovative sex education, improving parent-child communication, resolving conflicts in contraceptive decisionmaking, and supporting the role of boyfriends in contraceptive use.     

How the number of living sons influences contraceptive use in Menoufia Governorate, Egypt

Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, women's responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.