Change in trend of contraceptive uptake--effect of educational leaflets and counseling

BACKGROUND: The study was conducted to determine the impact of counseling and educational leaflets on contraceptive practices of couples. STUDY DESIGN: Randomization of 600 women was done in two groups matched for age, parity and socioeconomic status at the Department of Obstetrics and Gynaecology, Shifa Foundation Community Health Centre, Shifa International Hospital, Islamabad, Pakistan. In Group A, the intervention group was exposed to contraceptive counseling and educational leaflets in the postnatal ward after delivery, whereas in Group B, the nonintervention group was not given any formal contraceptive advice. Later on, both groups were assessed regarding their contraceptive practices. RESULTS: At their follow-up visit (8-12 weeks) postpartum, 19 (6.3%) women in the nonintervention group had started contraceptive use, whereas 153 (50.8%) had decided to start contraception in the next 6 months, and 129 (42.8%) women were still undecided. The main contraceptive user was the male partner (n=117, 38.8%), and the most common method used was coitus interruptus (n=62, 36.3%). In the intervention group, 170 women (56.9%) had started using contraceptives, whereas 129 (43.1%) had decided to start contraceptive use in the next 6 months. The predominant contraceptive user was the females (n=212-70.9%), and the most popular method chosen was oral contraceptive pills (n=111, 37.1%). CONCLUSION: There is a definite increase in contraceptive uptake in women provided with educational leaflets and counseling session with a shift toward use of more reliable contraceptive methods.     

四川省农村育龄妇女避孕方法知情选择干预项目研究报告

目的:评价开展避孕节育知情选择活动对四川省农村育龄妇女的避孕节育知识和知情选择的知识、能力、态度和避孕行为等影响。方法:在四川省兴文县的2个乡开展持续1·5年的、以社区为基础、20~49岁的已婚育龄妇女为对象的干预性研究,干预活动包括组织社区宣传活动、发放宣传资料、播放录像带、组织讲座、面对面的宣传和开展同伴教育,分析干预效果。结果:干预组育龄妇女对避孕方法的使用、原理、优点、缺点得分明显高于对照组,且在干预后避孕方法使用率及使用避孕套的比例均高于干预前;避孕方法使用的最终决定者由干预前计划生育服务人员转变为干预后为本人。结论:集知识、信息、咨询与服务为一体的社区避孕节育知情选择干预项目的实施,可显著提高农村育龄妇女的避孕节育知识水平和她们选择避孕方法的能力。     

Women on top: the relative influence of wives and husbands on contraceptive use in KwaZulu-Natal

OBJECTIVES: The purpose of this paper is to examine the relative influence of husband and wife on contraceptive practice. METHODS: A cross-sectional survey was conducted among adult men and women in KwaZulu-Natal, South Africa. A matched file for 238 married or cohabiting couples was created. RESULTS: Knowledge of methods of contraception was virtually universal and attitudes to contraception were favorable both in men and women. A substantial proportion of men and women reported using a method of contraception. The wife's desire to stop childbearing was the most powerful predictor of contraceptive use among couples, after adjustment for possible confounders. The husband's approval (or not) of family planning and his preference for future childbearing were not significantly related to contraceptive use. CONCLUSION: Contraceptive use within marital and cohabiting unions is high and the wife's fertility preference was found to be a key determinant of use. This conclusion challenges conventional wisdom that men are the dominant decision-makers in fertility and family planning decisions.     

Mobilizing demand for contraception in rural Gambia

A community trial was conducted in rural Gambia in order to determine whether a community-based intervention designed to mobilize latent demand for contraception would increase use of modern contraceptives, even in the absence of improved availability of family planning services. Analysis of trial data indicates that the demand-mobilization intervention had a statistically significant positive effect on nonusers' adoption of modern contraception and that coterminous implementation of an intervention designed to improve access to services offered no additional benefit. The program component found to have the greatest impact was the "kabilo approach," in which village women provide basic health and family planning counseling to other women in their extended families. These results suggest that the principal barriers to increased contraceptive use in rural Gambia are psychosocial and that these barriers can be overcome through village-based interventions designed to provide socially appropriate counseling to potential contraceptive users.     

Reproductive health counseling at pregnancy testing: a pilot study

OBJECTIVES: To pilot brief reproductive health counseling for women obtaining pregnancy testing in a managed-care setting who did not desire pregnancy. METHODS: Women received counseling, access to contraception and a booster call at 2 weeks. Changes in contraceptive behavior were evaluated. RESULTS: Of 85 women who completed counseling, 58 (68%) completed follow-up. Participants reported that counseling was useful at baseline (94%) and follow-up (83%). The staff found the intervention important (100%) and implementation feasible (100%). Forty-one percent of participants improved their use of contraception (from no use or from less effective use to more effective use). Twenty-nine percent continued highly effective use and 9% recessed from highly effective use. Of 22 participants with risk of sexually transmitted disease, 3 (14%) began using condoms consistently, while 1 (5%) continued using condoms consistently. CONCLUSIONS: Counseling at pregnancy testing was well accepted by the staff and participants. Observed behavioral changes suggest that this intervention may be effective in increasing effective use of contraception.     

Managing unplanned pregnancies in five countries: perspectives on contraception and abortion decisions

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.     

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

In sub-Saharan Africa, high burdens of HIV and unmet need for contraception often coexist. Research emphasises the need to engage men and couples in reproductive health, yet couples’ negotiations around fertility and family planning in the context of HIV have been sparsely studied. This study examined the gendered power dynamics that frame women’s and couples’ negotiations of contraceptive use in western Kenya. We conducted 76 in-depth interviews with 38 couples, of whom 22 couples were concordant HIV-positive. Qualitative data were analysed using a grounded theory approach. Direct communication around contraception with men was often challenging due to perceived or expressed male resistance. A substantial minority of women avoided male reproductive decision-making authority through covert contraceptive use, with concern for severe consequences when contraceptive use was discovered. Many men assumed that family planning use signified female promiscuity and that infidelity motivated covert use. Men were more willing to use condoms to avoid HIV re-infection or on the recommendation of HIV care providers, which allowed some women leverage to insist on condom use. Our findings highlight the tension between male dominated reproductive decision making and women’s agency and point to the need for gender transformative approaches seeking to challenge masculinities that negatively impact health.     

Ethnic variations in sexual activity and contraceptive use: national cross-sectional survey

OBJECTIVES: Our objective was to compare data on contraceptive use in relation to reported sexual activity in women from different minority ethnic groups. DESIGN: We analyzed the National Survey of Sexual Attitudes and Lifestyles 2000. SUBJECTS: Women aged 16-44 years, numbering 6932 and residing in Britain, participated in this study. MAIN OUTCOME MEASURES: Our main outcome measures are as follows: percentage of women reporting sexual activity, use of contraception and type of contraception (hormonal, barrier or permanent methods). RESULTS: Overall, fewer women from the UK's four main ethnic minority groups reported recent sexual activity, compared with white women. Among sexually active women, contraceptive use was significantly lower in all ethnic minority groups than in white women, but this pattern differed according to marital status. In ever-married or cohabiting women, lower contraceptive use was reported by Indian (78%) and Pakistani women (74%) than by other groups. Among single women, black Caribbean (88%) and black African (82%) women reported using less contraception compared with white (95%) and Indian (100%) women. Women from all ethnic minority groups were less likely than white women to report using hormonal contraception and permanent methods and were more likely to use barrier methods. The differences between ethnic groups remained significant after adjusting for educational achievement and parity. Deprivation and acculturation did not account for the use of contraception or the type of contraceptive method used. CONCLUSION: Sexually active married Pakistani and Indian women reported the lowest overall use of contraception. Among sexually active single women, black African and black Caribbean women reported levels of contraceptive use that were lower than those reported by white women. Sexually active women from all four minority ethnic groups were less likely than white women to use reliable methods of contraception.     

A randomized study of a pregnancy and disease prevention intervention for Hispanic couples

CONTEXT: Many Hispanic women are at elevated risk for HIV infection because of the sexual behavior of their male partner. Yet, couple-based risk-reduction interventions for this population have not been developed and scientifically evaluated. METHODS: A sample of 146 Hispanic couples who received either a risk reduction intervention or the community educational standard of care were followed up at three months (men and women) and six months (women only) to measure the consistency of both condom use and effective contraceptive use, and the frequency of unprotected vaginal sex. Analyses were conducted to identify differences between the two groups at baseline and follow-up interviews, and changes over time. RESULTS: At follow-up, the two groups did not differ on any risk-related outcomes; over time, both groups increased the reported consistency of condom use and of use of effective contraceptive methods, and reduced their frequency of unprotected sex. CONCLUSIONS: If further research confirms that simply bringing couples together for a single-session, culturally appropriate risk reduction intervention helps them adopt protective behaviors, more intensive (and costly) interventions may not be necessary.     

Adolescent contraceptive use: comparisons of male and female attitudes and information.

Information and attitudes about contraception and pregnancy were assessed with a self-administered questionnaire in a sample of urban Black teenagers. Data were obtained from 607 male and female students in high school health classes and a demographically similar group of 123 never-pregnant teenage women in a family planning clinic who had not attended these classes. Males were less likely to recognize the risk of pregnancy, had less information about contraceptives, and fewer attitudes that supported contraceptive use than females who participated in the same shool health classes. More males than females indicated that school classes had been the main source of contraceptive information. Teenage women in the family planning clinic did not differ from the high school females in attitudes about contraceptives, but the school group had somewhat more contraceptive information. The female school group was more likely to have discussed contraception with parents, obtained more contraception information from their mothers, and discussed contraception more with male friends than the teenagers who requested contraceptives at the family planning clinic.     

Meeting women’s demand for contraceptives in Ghana: Does autonomy matter?

This study addressed a basic conceptual gap in research on the relationship between women’s autonomy and contraceptive behavior and included intention to use while measuring the unmet demand for family planning. The study used data from the 2014 Ghana Demographic and Health Survey. The weighted sample included 2,017 sexually active, non-pregnant, fecund women in unions, aged 15–49 years, who wanted to delay conception for at least 2 years. The relation of household decision-making autonomy to current contraceptive use and intention was assessed, adjusting for women’s socio-demographic, partner, and couple characteristics. About half of the women studied had a met demand for contraception, and over a third had no intention to use a contraceptive method in the future. In adjusted multinomial logistic regression models, household decision-making autonomy was not significantly associated with met contraceptive demand for contraceptives, but was associated with their intentions to use contraception (p = .05). Formal education, age, wealth, and region of residence were significantly associated with having a met demand. In Ghana, women’s household decision-making autonomy appears to have modest relation to contraceptive uptake. Programs to improve meeting contraceptive demand should consider contextual factors and place differences in contraceptive uptake.     

Measuring Women's Covert Use of Modern Contraception in Cross‐Sectional Surveys

A proportion of women in couples use contraception without their partners’ knowledge. There are two principal ways to measure this covert use in cross‐sectional surveys like the Demographic and Health Surveys (DHS). First is a direct question, “Does your husband/partner know that you are using a method of family planning?” Second is an indirect method: the reports of both partners to the question on contraceptive use are matched, and if the woman reports a modern contraceptive method and the male partner reports nonuse, her use is considered covert. For 21 DHS surveys for which both estimates could be made, there are large discrepancies between the two. We found that a proxy variable—responses to the question, “Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?”—has high sensitivity and specificity for classifying those in the open category for both methods and those in the covert category for both methods. Recommendations are that the direct question be reinstated in the DHS and that the indirect method not be used by itself but in conjunction with the decision‐making variable.     

城乡哺乳期妇女避孕现状比较分析

目的分析比较城乡哺乳期妇女避孕方法的使用情况、获得渠道和选择决定者，以及未避孕原因等。方法利用国家人口和计划生育委员会2001年全国计划生育／生殖健康调查的原始数据，对城乡哺乳期妇女避孕方法的使用现状进行描述性统计分析。结果我国哺乳期妇女的避孕率为78％，城乡哺乳期妇女的避孕率、未避孕原因虽然没有较大差异，但在选择避孕方法、避孕工具获得渠道和选择决定者等方面差异有统计学意义。结论我国妇女对哺乳期避孕的必要性缺乏足够认识，需从多方面加强干预。     

The impact of programs to increase contraceptive use among adult women: a review of experimental and quasi-experimental studies

CONTEXT: Because rates of unintended pregnancy, abortion and unintended birth are very high among adult women in the United States, it is important to identify interventions that can increase contraceptive use in this population. METHODS: PubMed, PsycINFO and POPLINE were searched for experimental or quasi-experimental studies published between 1990 and 2005 that evaluated policies or programs designed to increase contraceptive use or reduce pregnancy among adult women in the United States. In addition, relevant journals were searched, experts were asked to provide further citations and several subsequently published articles were included. RESULTS: Only 11 studies that assessed programs, and none that assessed policies, were found. The evaluated interventions offered pregnancy and STD prevention counseling (one study); provided contraceptives in settings other than family planning clinics (two studies); had women initiate contraceptive use during the medical visit (two studies); provided advance supplies of emergency contraception (four studies); or implemented systems to remind injectable contraceptive users about their next injection (two studies). The interventions generally had positive, albeit short-term, effects on contraceptive use; none reduced pregnancy rates. Programs that gave women a contraceptive during the visit were the most effective at increasing method use. Advance provision of emergency contraception increased the likelihood of its use and did not affect regular contraceptive use. CONCLUSIONS: Very few studies have evaluated interventions to increase contraceptive use among adult women. A research plan that rigorously assesses the impact of different approaches to increasing contraceptive use among adult women should be an integral part of any long-term effort to prevent unintended pregnancy in the United States.     

Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia

ObjectiveTo assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia.MethodsThe Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion.FindingsData on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17–1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92–1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months.ConclusionAdding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period.     

None of Them Were Satisfactory: Women's Experiences with Contraception

Seventy-two women, aged between 18 and 50 years, participated in focus groups to talk about their experiences with using contraception. There were both continuities and differences between women in each of the age groups. Younger women appeared to be more accepting of medical opinion, while many older women rejected medical interference in contraceptive decisions. Patterns of use were similar with the pill having been the contraceptive of first choice for the majority of women. The most persistent feature through the groups was a strong sense of dissatisfaction with contraception, in terms of both side effects and range of available methods.     

Concordance and discordance of couples living in a rural Pakistani village: perspectives on contraception and abortion--a qualitative study

In Pakistan, fertility rates and intended family size have fallen, but contraceptive use remains low. This has led to a high prevalence of unintended pregnancies, a large proportion of which result from disagreement between spouses about how to confront them. This study aims to understand how Pakistani couples view family planning, and how they communicate and make decisions surrounding fertility regulation. In-depth interviews were conducted with five couples and an additional five women and two men. Two focus groups--one for males and one for females--were also conducted. Family planning methods were more favoured by women than their husbands. Women reported the largest barrier to contraceptive use to be men's opposition to family planning or reproductive choices more generally, as well as fear of side effects of contraception. Abortion was viewed unfavourably except in situations of economic difficulty, having several young children or women's health problems. Couples reported rarely communicating about fertility intentions until later in childbearing after an unintended pregnancy. Discussions about family planning were largely initiated by women, although some felt unable to approach their husbands regarding this topic. Concordant intentions and communication between spouses led to desired pregnancy outcomes. In cases of discordance, women's intentions tended to determine actions and outcomes. Spousal communication, or the lack thereof, is an obstacle to effective contraceptive use, and strategies to improve couples' communication would undoubtedly enable them to achieve their reproductive intentions.     

None of them were satisfactory: women's experiences with contraception

Seventy-two women, aged between 18 and 50 years, participated in focus groups to talk about their experiences with using contraception. There were both continuities and differences between women in each of the age groups. Younger women appeared to be more accepting of medical opinion, while many older women rejected medical interference in contraceptive decisions. Patterns of use were similar with the pill having been the contraceptive of first choice for the majority of women. The most persistent feature through the groups was a strong sense of dissatisfaction with contraception, in terms of both side effects and range of available methods.     

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.