Contraception, unintended pregnancy and induced abortion

Multilevel modeling is commonly used to assess the influence of community-level variables on demographic and health outcomes, yet these methods have rarely been applied at the couple-level. We conduct multilevel modeling of data from 238 couples who participated in the 2005 Cebu Longitudinal Health and Nutrition Survey in the Philippines to assess the individual-, partner-, and couple-level influences on men’s and women’s family planning knowledge. Preliminary findings indicate that 17% of the total variance in family planning knowledge across participants was between couples. Individual-level (e.g., female gender and higher educational attainment) and couple-level variables (e.g., relationship duration, partnership status, and greater church participation by female partner) were significantly associated with greater knowledge of family planning methods, as compared to other couples. Subsequent analyses will assess additional individual and couple-level covariates and cross-level interactions. Preliminary results indicate that knowledge of family planning methods are influenced by individual, partner, and relationship characteristics.

Women aged 35 and older are often left out of the conversation on contraception. This study seeks to examine the influence of household decision-making power on current modern contraceptive use among Nigerian women aged 35-49 years, using secondary data from the 2008 Nigerian Demographic Health Survey. Non-pregnant women who were 35-49 years of age were eligible to be included in the analysis. The key independent variable was women’s decision-making power and assessed based on a score, calculated using principal component analysis. The mean (SE) age of women in the sample was 40.8 (0.07) years. All women (4827) were married or cohabiting with a partner, with 37.5% in polygamous unions, and 18.7% using a modern contraceptive method. Contraceptive users reported higher decision-making scores, were younger, more educated, richer and were not in polygamous unions. Following multivariate logistic regression, decision-making power remained independently associated with modern contraceptive use. Women in the highest tertile of household decision-making had a 61% higher odds of modern contraceptive use when compared with women in the lowest tertile [OR: 1.61 (1.25, 2.08)]. Programs and policies that encourage women to be involved in household decision-making will also be encouraging them to make a choice regarding modern contraception.

Background:
Unintended pregnancies pose pernicious consequences on health and well-being of families globally. Although Tanzania is one of the countries experiencing higher rates of unintended pregnancies, characteristics women who conceive unintentionally are less clear and rarely documented.

Methods:
Data were collected in a cross-sectional survey of random households in Rufiji, Kilombero and Ulanga districts of Tanzania in 2011. Women, 15-49 year-olds, who had given birth in the past two years, formed our sample. Unintended pregnancies were twofold – mistimed and unwanted-. A multinomial logistic model was used to identify characteristics of women whose pregnancies were unintended at the time of conception.

Results:
Participants were 870 women in total and averagely aged 27.9 years. While 49.3% had intended pregnancies, 34.9% and 15.8% had mistimed and unwanted pregnancies respectively. Women who were younger, multi-parous, educated, not using contraceptives, reside in urban, unmarried and ever married were more likely to conceive unintended pregnancies than their counterparts.

Conclusion:
Socio-demographic characteristics of women in the three districts in Tanzania influence pregnancy intentions. Women should be empowered with fertility control mechanisms to avoid unintended pregnancies.

This paper explores the influence of women’s education on having a particular category of unmet need (unmet need for spacing and stopping, met need for spacing and stopping, no need). Women’s education is one of the most well-established factors linked to fertility. Although we have evidence on the connections between women’s education and her fertility behavior and outcomes, we know much less about how women’s education influences unmet need. This paper attempts to fill that gap by studying education differentials in unmet need over time in India. We use data from the National Family Health Surveys to decompose total unmet need into its components of met and unmet need for spacing and stopping respectively. Preliminary analyses suggest a strong educational gradient in unmet need for spacing and stopping. The complete paper will assess this relationship using multivariate analyses, explore some of the reasons thereof, and consequences of these differentials.

After the liberalization of the abortion law, awareness of the legalization status and place of abortion has increased among Nepali women of reproductive age. As of 2006, nationally, 32.3% (95% CI: 31.4, 33.2) of the women ages 15-44 were aware of the legal status of abortion and 56.5% (95% CI: 55.5, 57.4) knew of a place where they could obtain an abortion (Thapa and Sharma, 2012). Similarly, in 2011, overall, 38.7% (CI: 37.8%, 39.6%) and 59.8% (CI: 58.9%, 60.7%) of women 15-44 were aware of the legal status of the abortion law and a place to have an abortion, respectively. Percentage of women ending their pregnancy using induced abortion has also increased from 5% in 2006 to 7% in 2011. This paper examines demographic and socioeconomic differentials in the change in knowledge and use of induced abortion and examines the extent to which the trend in knowledge and use of induced abortion vary among demographic and socioeconomic groups. Bivariate and multivariate analysis will be used to examine the relationship. Ecological and development sub-region, place of residence, wealth quintile, education, age and number of living children will be used as demographic and socioeconomic independent variables in the bivariate and multivariate analyses of the determinants of knowledge and use of induced abortion.

Contraceptive use is low, whereas pregnancy levels remain high among adolescents in Ghana. Contraceptive use is known to prevent maternal and infant deaths, but social norms among others inhibit their use by adolescents in most developing countries. Encouraging family planning (FP) uptake among adolescents is vital to reducing maternal (MDG 5) and infant mortality (MDG 4). This paper’s objective was to define the best approaches to satisfying the FP needs of adolescents in the study population. A qualitative study design was used to facilitate the understanding of societal attitudes towards FP delivery to adolescents and identify approaches to FP delivery. Focus group discussions and in-depth interviews were used to collect data from adolescents, societal representatives and FP providers. Themes that emerged from data analysis with respect to “Perspectives on FP Care Delivery to Adolescents” and “How Best to Address Adolescents’ FP needs” were presented, discussed and supported with quotes.

In 2011 the first nationally representative Women Reproductive Health Survey (RHS) was realized in Russia by the Russian Ministry of Health, the Rosstat (Russian Federation) and the CDC (USA). According to the data provided by this survey almost 37% of respondents reported their last pregnancy as unplanned; either mistimed (18.4%) or unwanted (18.3%). Pregnancies were more often reported as mistimed by respondents aged 15-24 (29%) or with no children (43.5%), whereas women aged 35-44 (33%) or those who had two or more children (23%) more often considered their pregnancies as unwanted.
Planning status had a strong correlation with pregnancy outcome: 31% of mistimed and 62% of unwanted pregnancies occurred in 2006-2001 ended in induced abortion. As few as 3% of unwanted and 13% of mistimed pregnancies resulted in a live-birth.
Almost every second pregnancy (47%) ended in induced abortion in 2006-2011 was a result of a contraceptive failure, and two thirds of these pregnancies occurred when women used any modern method of contraception.
On the base of individual data provided by the WRHS the authors will try to throw light upon the behavioral, social and economic factors of the fertility intentions and contraception choice in present-day Russia.

In developing countries like India, the issue of unintended pregnancy in the context of use of contraception has not been explored till date. This study takes advantage of calendar data, which is first time available in Indian National Family Health Survey (2005-06), to deal with type and time to initiate contraceptive after having unwanted pregnancy. Analysis revealed that, among the group of women who have experience mistimed pregnancy, more than 25 percent using modern spacing method, specially condom followed by pill. Sterilization used by women who have reported their last birth was unwanted. Surprisingly user of traditional contraceptive method like periodic abstinence and withdrawal was also used by women who have experience unintended pregnancy. More than two third women who have adopted contraceptive method just after birth to within six months, majority of them experience mistimed birth. Initiation of contraceptive within 6-18 months was mainly those women, who have experience unwanted pregnancy.

This paper describes how intimate partner violence (IVP) is associated with unintended pregnancy and abortion in a primarily Muslim community of 500,000 peoples in Mumbai. In-depth interviews were conducted with randomly selected 45 married women visiting at urban health center across various domains during 2009-2010. Out of all, 31 women reported frequent verbal and 19 physical violence in past one year. The most frequent reported forms of violence included, high tone abusive, beatings, and forced sex. Out of all, 39 women reported virginal discharge, 6 miscarriages, 3 infant deaths and 41 mental distresses. A “Women’s Health Clinic” was organized at urban health center under RISHTA program to treat women’s gynecological problems. Individual women presenting vaginal discharge at the WHC are randomized into receiving individual counseling (IC), group couples intervention (CI), both (IC and CI) and a control group. The 886 Women’s Structured Survey (WSS) was administered to assess women at baseline, six-month and one-year post intervention from 2009-2012. On the major outcome variables have shown that the intervention group shows better Reproductive Health (p <.001), greater knowledge about STIs (p <.001), less sexual problems, (p <.001) better treatment seeking in health problems (p <.001) and no miscarriages and infant death.

Use of contraceptive and its method choice is based on the decision made by a female, her husband only or both. But it is largely depends on husbands in the Indian traditional societies. Moreover, the decision taken for the use of contraceptive and its methods is primarily affected by some socio-demographic factors. Thus, there is a need to study and estimate the prevalence of contraceptive use and its methods and also to identify the factors which influence the use of contraceptive.
The objective of the present study is to explore some socio-demographic factors associated with contraceptive use and its method choice. Type of contraceptive is taken as dependent variables (modern, traditional & no use) and some socio-economic and demographic variables are taken as explanatory variables. This analysis is carried out using multinomial logistic regression technique for the currently married females those are neither infecund nor in menopause stage using data from NFHS-III (2005-06) of Uttar Pradesh, India. Results show that place of residence, education of female, wealth index, religion, age at first marriage, type of family, desire for son, husband’s education, marital duration, parity and mass media exposure significantly affect the use of contraceptive and its method choice.