Browsing by Subject "Family planning"

Background: An estimated 225 million women globally have an unmet family planning need, three-quarters of whom live in low and middle-income countries. Addressing this need requires new and innovative approaches, such as digital health solutions. We examined the impact of a new phone-based screening and referral service on the take-up of family planning as part of a pilot study to prepare for a full trial of the intervention.

Methods: This pilot study tested the procedures for a randomized encouragement trial. We recruited 112 women with an unmet need for family planning from local markets in Western Kenya, conducted an eligibility screening, and randomized half of the women to receive an encouragement to try the investigational intervention. Four months after sending an encouraging to the treatment group, we attempted to conduct a follow-up survey with all enrolled participants.

Results: The encouragement sent via text message to the treatment group led to differential rates of intervention uptake between the treatment and control groups, but take-up among the group was lower than anticipated (33.9% vs 1.8% in the control group). Study attrition was also substantial. We obtained follow-up data from 44.6% of enrolled participants. Among those in the treatment group who tried the intervention, however, the instrumental variables estimate of the Local Average Treatment Effect was an increase of 41 percentage points in the probability of contraceptive take-up.

Conclusion: This randomized encouragement design and study protocol is feasible but requires modifications to the encouragement and follow-up data collection procedures. The investigational intervention appears to have a positive impact on contraceptive take-up among women with an unmet need despite a number of contextual challenges.

Background: Family planning provides women, men, and adolescents the ability to prevent or postpone childbearing. Family planning is a cost-effective strategy for reducing high-risk pregnancies, unsafe abortions, and allowing for birth spacing. This study was conducted in rural Ghana with three goals: 1) to estimate the prevalence of modern family planning use and unmet need for modern contraceptives, 2) to identify factors associated with unmet need for modern family planning, and 3) to understand women’s experiences and behaviors related to modern family planning use. Methods: This explanatory mixed-methods study collected 281 household surveys and 33 in-depth interviews of women 18-49 years old from the Amansie West District of Ghana. Measures of interest included: demographics, pregnancy history, pregnancy status, pregnancy intentions and attitudes, knowledge and perceived availability of modern contraceptives, modern contraceptive use, perception or partner’s attitude toward family planning, depression, autonomy, partner communication, freedom from coercion and partner support. Unmet need was defined as women of fertility age, that reported not having a hysterectomy, who were not currently pregnant, were sexually active in the last three months, did not wish to become pregnant in the next few months and were not using a modern family planning method. Met need was defined as women of fertility age, that reported not having a hysterectomy, were not currently pregnant, were sexually active in the last 3 months, did not wish to become pregnant in the next few months and were using a modern family planning method. Descriptive statistics were used to describe the demographic characteristics and family planning use. Cronbach’s alpha test was performed to measure the internal consistency of the measures described previously. Two-sample t-tests were used to test for significant differences between the met need and unmet need for modern contraceptives populations for continuous variables. Categorical variables were tested for statistically significant differences using a chi-squared test. The interviews explored community and individual perspectives of family planning, barriers to use, experiences with family planning use, and reasons for using or not using family planning. Results: The prevalence of met need and unmet need for modern family planning use were found to be 14.9% and 33.1%, respectively. About half (52%) of the sample were found to have no current or near future need for family planning. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. A fear of side effects was the most reported barrier to modern family planning use, 31.7% (n=89). Qualitative interviews found a fear of side effects to stem from rumors concerning consequences that occur when a woman is unable to menstruation, experienced by many women using modern contraceptives. Conclusion: This study highlights the discrepancy between the knowledge of modern family planning and perceived availability that may account for unmet need for modern family planning. Furthermore, the data illustrated the impact of rumors and misconceptions on the use of family planning and revealed that many of the predicted barriers to family planning use may no longer be as relevant.

Despite the clear benefits to women, families, and society, family planning is not universal. In 2015,12 percent of married or in-union women who want to prevent or delay pregnancy were are not currently using a method of family planning in 2015. In Africa, this rate is even higher, at 24 percent. In order to meet the unmet need for family planning, new approaches to service delivery are required. A critical question for anyone interested in ensuring universal access to sexual and reproductive health-care services like family planning is how to create new products, services and implementation models that work for users. The objective of this case study is to describe how Human Centered Design (HCD) was used to develop a digital marketplace for family planning in Kenya, called Nivi, and draw lessons for broader application to global health challenges. By using the HCD approach, we sought to better understand the challenges users face with the Nivi platform and the opportunities that exist to make improvements. By incorporating HCD, we were able to build a service with greater potential for use and usability for Nivi users. We believe that taking an HCD approach allowed us to build a product that has the potential to meet the unmet need for family planning services in Kenya. This case study highlights the strengths and challenges to inform the use of HCD for other health applications in emerging markets.

Political upheaval in Syria makes Jordan a temporary home to over one million Syrian refugees. More than half of these individuals, due to limited resources and challenging financial circumstances, do not have adequate access to reproductive health and family planning mechanisms. Among pregnant refugee women in Jordan, approximately one in five are at risk for poor obstetrical outcomes, including premature and underweight births. Due to increased rates of birth in humanitarian and lower resource settings, and the crucial need for addressing sexual and reproductive health in these settings, this study conducted a comparative analysis of the sexual and reproductive health climate among Syrian refugee and Jordanian men and women.

Using a case study research design, semi-structured qualitative interviews were conducted with 34 study participants, including 15 Syrian women, 8 Jordanian women, 6 Syrian men, and 5 Jordanian men. These interviews examined participants’ migration experiences, pregnancy outcomes, influencers for reproductive decisions, and gaps in sexual and reproductive health care.

Qualitative interviews revealed that Syrian refugees indicated greater reproductive and sexual health need than Jordanians, more specifically related to education on reproductive health and contraceptive methods. Syrian refugees were married at earlier ages than Jordanians, and, overall, had more children. Additionally, Syrian refugees confirmed that healthcare in Syria was more accessible, affordable, and comprehensive in comparison to Jordan. The greatest contributors to gaps in care for both Jordanians and Syrians were financial constraints and apathy regarding refugee welfare among providers in public facilities.

Increasing access to comprehensive sexual and reproductive healthcare among refugees in low-resourced, humanitarian settings, while also continuing to meet the needs of the nation’s own population, is a healthcare priority. The findings of this study have the potential to guide and influence policy affecting family planning mechanisms afforded to migrants in Jordan in both public and private facilities. Action is required immediately by policymakers and government officials to create budgetary resources for sexual and reproductive health education programs in Jordan in order to meet the family planning needs of refugee and migrant populations residing there.