Suchergebnisse

Unmet need for family planning is typically calculated for currently married women, but excluding husbands may result in misleading estimates of couples' unmet need. This study builds on previous work and proposes a method of calculating couples' unmet need for family planning based on spouses' independent fertility intentions. We analyze Demographic and Health Survey data from couples from three West African countries—Benin, Burkina Faso, and Mali. We find that fewer than half of couples having any unmet need had concordant unmet need (41–49 percent). A similar percentage of couples had wife‐only unmet need (33–40 percent). A smaller percentage had husband‐only unmet need (15–23 percent). Calculating unmet need based only on women's fertility intentions overestimates concordant unmet need. Additionally, that approximately 15–23 percent of couples have husband‐only unmet need suggests that men could be an entry point for contraceptive use for more couples than at present. To calculate husbands' unmet need, population‐based surveys should consider collecting the necessary data consistently.

BACKGROUND: Postpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government's efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women. METHODS: We conducted in-depth interviews (IDIs) with 13 women who had discontinued PPIUD use and 12 women who were continuing to use the method 9 months or longer following the insertion. All interviews were audio recorded, transcribed, translated into English, and analyzed using a thematic approach. RESULTS: Women discontinued PPIUD for several reasons: 1) side effects such as excessive bleeding during menstruation, nausea, back and abdominal pain; 2) poor quality of counselling and, relatedly, mismatched expectations in terms of device use; and 3) lack of family support from husbands and in-laws. In contrast, women who were continuing to use the method at the time of the study stated that they had not experienced side-effects, had received appropriate information during counselling sessions, and had the backing of their family members in terms of using PPIUD. CONCLUSION: Experiencing side-effects or complications following PPIUD insertion and poor quality of family planning counselling were the two main reasons for discontinuation. Family members appeared to play a major role in influencing a woman's decision to continue or discontinue PPIUD suggesting that counseling may need to be expanded to them as well. Improving quality of counselling by providing complete and balanced information of family planning methods as well as ensuring sufficient time for counselling and extending PPIUD service availability at lower level clinics/health posts will potentially increase the uptake and continued use of postpartum family planning, including PPIUD, in Nepal.

AbstractDespite the numerous benefits of the postpartum copper intrauterine device (PPIUD), which is inserted within 48 hours after giving birth, it is underutilized in many resource‐constrained settings, including Tanzania. We conducted in‐depth interviews with 20 pregnant women who received contraceptive counseling during routine antenatal care in 2016–2017 and 27 postpartum women who had a PPIUD inserted in 2018 to understand reasons for use versus nonuse and continuation versus discontinuation. Primary motivators for using a PPIUD included: convenience, effectiveness, perceived lack of side effects, and duration of pregnancy protection. Barriers to use included: fear of insertion, concerns related to sexual experiences post‐insertion, and limited knowledge. Women who had a PPIUD inserted continued use when their expectations matched their experience, while discontinuation resulted from unexpected expulsion and experience of unanticipated side effects. Frequent follow‐up and guidance on side‐effect management influenced women's decisions to continue use. To support uptake and continued utilization of the PPIUD, postpartum contraceptive counseling should explicitly address side effects and risk of expulsion.