Highlights in Contraception and Family Planning 2021/22

Editorial

05 September 2023

Editorial: Highlights in contraception and family planning 2021/22

Berna Dilbaz

1,090 views

0 citations

Editors

Tamara Fetters

Ipas (United States)

Berna Dilbaz

University of Health Sciences (Turkey)

Impact

Original Research

19 May 2023

Libido–sexual disorders and abandonment of injectable contraceptives among users of the Ivorian Association for Family Well-Being in Korhogo, Côte d’Ivoire

Esme Marie-Laure Essis

, 8 more and

Joseph Aka

Introduction: The recent introduction of modern contraceptive methods in resource-limited countries is confronted with the occurrence of undesirable effects that hinder their use in the long term. This study conducted among the users of the Ivorian Association for Family Well-Being in Korhogo describes the libido–sexual problems associated with the discontinuation of injectable contraceptives in former users. The objective of the study was to identify the factors that led to the abandonment of injectable contraceptives among female users of the Ivorian Association for Family Well-Being in Korhogo between 2018 and 2019.

Materials and methods: Qualitative data were collected from 15 former users (24–38 years old) of injectable contraceptives duration of 2–3 months. Additional data were collected from five health workers aged 35–60 years. In-depth interviews were conducted to explore the experience with injectable contraceptives and reasons for discontinuation. Following data collection, audio-recorded data were transcribed, translated, and coded using thematic analysis through an inductive approach.

Results: Side effects identified as associated with injectable contraceptives include libido–sexual disorders, unusual bleeding, and weight gain. The most common reason for discontinuation were libido–sexual disorders, which impacted the households’ intimacy and provoked their abandonment or the change of contraceptive methods among injectable contraceptive users.

Conclusion: Adverse events were dominated by libido–sexual disorders, unusual bleeding, and weight gain leading to the abandonment or change of the contraceptive. These results suggest points of intervention for increasing continuation among users. This intervention should include training of health workers to investigate and manage adverse events related to the use of injectable contraceptives and the improvement of communication between health workers and users on adverse events of injectable contraceptive use.

9,275 views

0 citations

Original Research

13 September 2022

Contraceptive method use trajectories among young women in Kenya: A qualitative study

Lisa M. Calhoun

, 8 more and

Ilene S. Speizer

Background: Many young women experience important key life transitions during adolescence and early adulthood, such as initiation of sexual activity, first use of contraceptives, marriage, and childbirth. For young women to be able to plan and manage their lives, it is critical to understand how these life events intersect and shape their contraceptive decision-making. This study aims to explore young women's contraceptive method use trajectories, including the factors that influence contraceptive decision-making throughout adolescence and youth.

Methodology: In 2019, the Full Access, Full Choice project (FAFC), implemented by the University of North Carolina at Chapel Hill and the African Institute for Development Policy, conducted 30 in-depth interviews with young women aged 18–24 years in three counties in Kenya (Nairobi, Mombasa and Migori). Eligible respondents had used two or more modern contraceptive methods. Interview guides utilized a modified life history approach to capture details about respondents' contraceptive use and life experiences from the time they first used contraception until the time of interview.

Results: We identified five separate contraceptive use trajectories based on the occurrence and timing of marriage, childbirth, and contraceptive method choice as well as various influences on contraceptive decision-making. The majority of respondents began their contraceptive journey by using male condoms or emergency contraception, but subsequent contraceptive decisions were varied across trajectories and influenced by different factors. For many women, the initiation of a non-coitally dependent method occurred after the birth of a child; for some, this was the first method used. Once women transitioned to using a non-coitally dependent method such as injectables or implants, many cycled through different methods to find one that had fewer side effects or provided the desired duration of protection.

Discussion: This study highlights the nuanced needs of young women throughout their adolescent and youth years in Kenya. This suggests that programs and policies need to encompass young women's diversity of experiences and motivations to best serve them.

2,926 views

5 citations

Brief Research Report

20 May 2022

Effects of Depot Medroxyprogesterone Acetate Intramuscular Injection, Copper Intrauterine Device and Levonorgestrel Implant Contraception on Estradiol Levels: An Ancillary Study of the ECHO Randomized Trial

Rebecca Ryan

, 5 more and

G. Justus Hofmeyr

1,916 views

3 citations

Perspective

21 February 2022

Are UK Policies and Practices for Regulated Donor Insemination Forcing Women to Find Unregulated Sperm Donors Online? A Perspective on the Available Evidence

Francesca Taylor

, 2 more and

Georgina Louise Jones

5,104 views

11 citations

Sociodemographic and economic characteristics of participants from urban and rural areas of Maputo city and province and Nampula province.

Original Research

23 March 2022

“There Are Things We Can Do and There Are Things We Cannot Do.” A Qualitative Study About Women's Perceptions on Empowerment in Relation to Fertility Intentions and Family Planning Practices in Mozambique

Sofia Castro Lopes

, 3 more and

Jane Harries

2,426 views

8 citations

Brief Research Report

11 February 2022

Fertility Knowledge Among Women Struggling to Conceive Without Medical Intervention: A Brief Report

Maria Halleran

, 1 more and

Jennifer L. Gordon

Introduction: Approximately 1 in 6 women experience infertility. Though medical treatments for infertility exist, they are very costly and highly burdensome for women. It is therefore desirable to optimize women's chances of conception without medical intervention by ensuring that they have adequate knowledge of the female menstrual cycle and the timing of the fertile window. The current study therefore aimed to assess the degree to which women struggling to conceive without medical intervention are knowledgeable about these topics.

Methods: One hundred and two women of reproductive age (18–45 years old) in Canada and the United States who had been struggling to conceive without medical intervention for ≥12 months completed an online survey including a questionnaire assessing knowledge related to reproduction and fertility.

Results: Mean accuracy score on the Fertility Knowledge Questionnaire was 67%. Seventy-two women were not aware that the week before ovulation was associated with the highest chances of conception. Women using cervical mucus tracking to increase chances of conception were more knowledgeable (p = 0.02), as were women with more formal education (p = 0.01). Conversely, women who had been attempting to conceive for longer had lower fertility knowledge (p = 0.03). Age, number of children, and family income were unrelated to fertility knowledge (p > 0.05).

Discussion: Our findings suggest that women who are struggling to conceive would benefit from education related to the timing and identification of the fertile window. Reproductive and primary healthcare providers can play an important role in assessing fertility knowledge and addressing knowledge gaps to improve chances of successful conception.

1,981 views

12 citations

Perspective

13 August 2021

The Potential of Self-Managed Abortion to Expand Abortion Access in Humanitarian Contexts

Ruvani Jayaweera

, 7 more and

Tamara Fetters

6,412 views

5 citations

Review

14 December 2021

Acceptability and Satisfaction of Contraceptive Vaginal Rings in Clinical Studies: A Systematic Review and Narrative Synthesis

Thérèse Delvaux

, 2 more and

Janneke van de Wijgert

3,700 views

6 citations

Original Research

06 August 2021

Factors Associated With the Use of the Contraceptive Implant Among Women Attending a Primary Health Clinic in Cape Town, South Africa

Kim Jonas

, 5 more and

Catherine Mathews

Background: Long-acting reversible contraceptives (LARCs), which include the subdermal contraceptive implant and intrauterine contraception, offer women safe, highly effective, long-term pregnancy prevention, and have expanded contraceptive options. The implant greatly expands LARC options for South African women as it is available free of charge at public health facilities, but little is known about factors associated with its uptake. This study describes factors associated with the intention to use the implant, including knowledge and beliefs about the implant and perceived outcome expectancies of implant use among women in Cape Town, South Africa.

Methods: Between 2015 and 2016, the authors conducted a quantitative, cross-sectional survey among adult women attending a public, primary health clinic in Cape Town, South Africa. Using a structured questionnaire, they measured knowledge, awareness, and attitudes, perceived outcome expectancy, and the intention to use the contraceptive implant in future among the women.

Results: The authors surveyed 481 women (mean age 29.1 years). Most of the participants (n = 364, 75.6%) had heard about the implant, 45 (9.4%) were currently using it, and 97 (20.2%) intended to use it in the future. Knowledge about the safety of the implant, beliefs about its effectiveness, and the ease of insertion and removal, and support from intimate partners were positively associated with the current use and intentions to use the implant in the future.

Conclusions: Limited knowledge of the implant, having completed secondary schooling, support from partner for women to use implant and the perceived outcome expectancies of using the implant were factors significantly associated with the intention to use the implant. Ensuring that the contraception information is available in all South African languages, regardless of education levels in women, and that comprehensive contraception education and counseling is provided during all family planning might help improve the uptake of contraceptives, including the use of the implant in the country.

Cross-tabulation of demographic characteristics, reproductive intentions, and contraception use by intention to use the contraceptive implant in the future among women in Cape Town, South Africa.

6,037 views

9 citations

Original Research

28 May 2021

Demand for Family Planning Satisfied With Modern Methods in Urban Malawi: CHAID Analysis to Identify Predictors and Women Underserved With Family Planning Services

Nurudeen Alhassan

and

Nyovani Janet Madise

Decision tree diagram for all urban women with demand for modern methods in Malawi.

Introduction: Family planning progress under the SDGs is measured with a novel indicator, demand for family planning satisfied with modern methods (mDFPS), which provides a better indication of modern contraceptive coverage than unmet need and contraceptive prevalence rate. Yet, few studies have examined the predictors of mDFPS and the sub-groups of women with unsatisfied mDFPS in urban Saharan Africa. The objective of this study was to examine the predictors of mDFPS in urban Malawi and to identify the sub-groups of urban women underserved with modern contraceptives.

Methods: The study analysed data from the 2015–16 Malawi Demographic and Health survey. The sample was comprised of 2,917 women in urban Malawi who had a demand for family planning services. We used a Chi-square (χ²) Automatic Interaction Detector (CHAID) model to address the study objectives.

Results: The results show that the number of living children a woman had was the most significant predictor of mDFPS. Women with one or more children, who were of Chewa, Lomwe, or Tumbuka ethnic origin and who resided in the central region had the highest mDFPS (87%). On the other hand, women with no children, and who were not exposed to FP information on television, had the lowest mDFPS (41%). Among women in union, ethnicity was the best predictor of mDFPS. Ngoni, Yao, and other ethnic minority women in union who were aged 15–19 and 40 years and above and those who were Catholic, SDA/Baptist, or Muslim had the lowest mDFPS (36%).

Conclusion: This study demonstrates significant intra-urban disparities in demand for FP satisfied with modern contraceptives in Malawi. There is a need for policymakers and reproductive health practitioners to recognise these disparities and to prioritise the underserved groups identified in this study.

5,054 views

7 citations

Women's reported experiences, by ILAS sub-scale.

Brief Research Report

10 June 2021

Exploring Experiences Responding to the Individual Level Abortion Stigma Scale: Methodological Considerations From In-depth Interviews

Alexandra Wollum

, 1 more and

Sarah E. Baum

3,685 views

2 citations

Review

15 December 2020

“What if They Are Pre-conception? What Should We Do?”: Knowledge, Practices, and Preferences for Safer Conception Among Women Living With HIV and Healthcare Providers in Gaborone, Botswana

Sarah A. Gutin

, 5 more and

Chelsea Morroni

Safer conception interventions that address HIV care, treatment, and prevention for HIV-affected couples are increasingly available in sub-Saharan Africa. Botswana, an HIV endemic country, is yet to offer formal safer conception services although universal test-and-treat approaches mean that increasing numbers of young, sexually active people living with HIV will start treatment and likely desire childbearing. In order to advance the safer conception discussion in Botswana, it is necessary to understand the current safer conception knowledge, practices, and preferences of healthcare providers and women living with HIV (WLHIV). We conducted qualitative in-depth interviews with 10 HIV healthcare providers and 10 WLHIV in Gaborone. Interviews were analyzed using a phenomenological approach. Safer conception knowledge was limited and safer conception discussions were rare. Healthcare provider and WLHIV preferences were at odds, with providers preferring WLHIV to initiate safer conception discussions, and WLHIV desiring providers to initiate safer conception discussions. Quotes from women and providers highlight deeper issues about power dynamics, concerns about stigma among women, and provider fears about promoting pregnancy. Providers emphasized the need for guidelines and training in order to improve the provision of safer conception counseling. These findings point to areas where safer conception in Botswana can be improved. Both WLHIV and providers would benefit from having information about a range of safer conception methods and approaches. In addition, since WLHIV felt hesitant about initiating safer conception conversations and feared stigma, and because putting the onus for starting safer conception discussions on women is a reversal of normal roles and power structures, providers must take the lead and routinely initiate fertility desire and safer conception discussions. Assisting healthcare providers with clear safer conception guidelines and training would improve the provision of accurate safer conception counseling and facilitate reproductive choice.

4,098 views

8 citations