Suchergebnisse

Forty eight of the African continent's 54 sovereign states are located in the Sub-Saharan Africa (SSA) region, with the government of each defining and shaping its own health services and delivery systems. This paper reviews the trends and patterns of contraceptive practice in the region. Using survey data available from the Demographic and Health Surveys and Performance Monitoring and Accountability 2020, the study finds modern contraceptive practice to be on the rise overall but with much geographic variation. The contraceptive methods most frequently used are injectables and, more recently, implants. Higher levels of use are observed among unmarried sexually active than married females. Although use is rising, contraceptive discontinuation rates are also high. Recent program initiatives discussed include expanding long-acting contraceptive options, promoting and delivering contraceptive methods in the postpartum period, and relying on community health workers for contraceptive outreach and service delivery. SSA's family planning situation remains challenged by weak health systems which must address competing priorities to manage disease prevention as well as primary health care. Increasing investments in family planning delivery in many SSA countries, however, augur for continued rapid uptake of modern contraception, possibly matching if not outpacing the record of other regions.

The linkages between marital relationship quality (MRQ) and health are well established in the West, although mutual spousal influence on each other is underexplored. In the sub-Saharan African context, despite continued health challenges and changing marital structures, this research has been neglected. This study examined the influence of spousal MRQ domains — such as trust, commitment and conflict resolution — on each other's self-reported health over time, using two waves of data from 725 couples in peri-urban Ethiopia using the Actor Partner Interdependence Model. Although MRQ and self-rated health measures of wives and husbands were associated, these relationships were complex and gendered. While the wife's health rating had a positive influence on the husband's relationship quality, the husband's health ratings were negatively associated with the wife's relationship quality. Expanding knowledge on the role of spousal influence can broaden understanding of couple mechanisms that potentially promote positive health behaviours and protect the health of spouses in different settings.

This study examines the levels and correlates of contraceptive failure and discontinuation in Romania, together with the consequences of contraceptive method failure in terms of induced abortion. Of special interest are women who rely on the traditional method of withdrawal and the proportion of withdrawal failures resulting in abortion. Our analysis is based on multiyear calendar data concerning women's contraceptive use and monthly reproductive behaviors collected in the 1999 Romanian Reproductive Health Survey. Weibull regression models are estimated to analyze the determinants of discontinuation and failure for all methods combined and for withdrawal. Overall, 19 and 28 percent of women became pregnant within the first year of using any contraceptive method and of practicing withdrawal, respectively. About 57 and 59 percent of failures from use of all methods and from withdrawal ended in abortion, accounting for 30 percent and 22 percent, respectively, of all abortions reported between 1994 and 1999. These findings suggest that high rates of contraceptive discontinuation and failure contributed significantly to the widespread reliance on induced abortion among Romanian women during this period.

This study uses couple‐level data to measure couples' concordance of self‐reported time since last coitus and of condom and other contraceptive use at last sexual intercourse among monogamous couples in Liberia (N = 1,673), Madagascar (N = 4,138), and Namibia (N = 588). The study also examines the characteristics associated with sexual behavior and contraceptive use occurring in the 28 days prior to the interviews among couples whose reports are concordant. Overall, our study finds less than 75 percent concordance in reporting of time since last coitus. Use of condoms and other contraceptives yielded fair (0.27) to substantial (0.67) agreement on the kappa index. Factors predicting a shorter time since last coitus among concordant couples in at least two of the countries included wealth, spousal age difference, education, and both partners wanting another child. The discordant reports of recent sexual behavior and contraceptive use suggest that caution should be exercised when inferring couples' behavior from the report of one spouse, that concordant reports should be examined when possible, that methodological changes to improve the validity of spousal reports should be pursued, and that family planning and HIV‐prevention programs should target those groups found to be using condoms and other contraceptives less frequently, particularly poorer couples.

Short birth intervals can have adverse consequences for maternal and infant outcomes. Optimal birth spacing is often presumed to be achieved through the practice of family planning and use of contraceptives, yet most of the available research does not address explicitly the contribution of contraceptive‐method use to birth spacing or maternal and infant survival. We conducted a systematic literature review to assess the body of evidence linking contraceptive use to birth‐interval length. Fourteen studies published in English between 1980 and 2008 met our eligibility criteria for inclusion. The findings from these studies are mixed but suggest that the use of contraceptives is protective against short birth intervals. Although results are favorable, many of the studies and methodologies employed are dated. More current research is needed to determine the impact of contraceptive‐method use on birth‐interval length in order to inform the promotion of family planning for reducing maternal and infant morbidity and mortality through birth spacing.

AbstractThe consistency of self‐reported contraceptive use over short periods of time is important for understanding measurement reliability. We assess the consistency of and change in contraceptive use using longitudinal data from 9,390 urban female clients interviewed in DR Congo, India, Kenya, Niger, Nigeria, and Burkina Faso. Clients were interviewed in‐person at a health facility and four to six months later by phone. We compared reports of contraceptive use at baseline with recall of baseline contraceptive use at follow‐up. Agreement between these measures ranged from 59.1 percent in DR Congo to 84.4 percent in India. Change in both contraceptive method type (sterilization, long‐acting, short‐acting, nonuse) and use status (user, nonuser, discontinuer, adopter, switcher) was assessed comparing baseline to follow‐up reports and retrospective versus current reports within the follow‐up survey. More change in use was observed with panel reporting than within the cross section. The percent agreement between the two scenarios of change ranged from 64.8 percent in DR Congo to 84.5 percent in India, with cross‐site variation. Consistently reported change in use status was highest for nonusers, followed by users, discontinuers, adopters, and switchers. Inconsistency in self‐reported contraceptive use, even over four to six months, was nontrivial, indicating that studying measurement reliability of contraceptive use remains important.