Poster session on Sexuality and reproductive health (1)

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.

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.

Background
Integrating sexual and reproductive health (SRH) and HIV services improves service utilization and enables health systems respond to client’s needs. Traditional capacity building approaches such as offsite training workshops are costly, interrupts service delivery and providers rarely share new skills and knowledge acquired through such workshops. To address this, the Integra Initiative introduced mentorship as part of interventions activities in study aimed at assessing the benefits and cost of integrating HIV and RH services.
Overall objective: To describe service providers experiences and perceptions of peer mentorship approach used as a method of capacity building for integrating HIV into RH services
Study location: Fourteen health facilities in three districts in Kenya
Methodology: Stratified sampling technique was employed. Using interview guide in depth interviews were conducted with sixteen mentors and 25 mentees. Data was code and analyzed using NVIVO 9

Results: Mentoring improves knowledge and skills in HIV and HIV integration thus improving the access of a wide range of services to the clients. Adequate RH and HIV supplies/commodities; and supportive management necessary for effective mentoring.
Conclusion: Mentorship improves providers’ skills and scope of practice in integrated RH and HIV

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.

This study is based on analysis of variations in contraceptive use for women born between 1957 through 1991 considering age cohort effects; this is based on the hypothesis that people born at different time periods experience different socio - economic circumstances which influence their attitudes and behaviors towards development issues like contraception. Uganda Demographic and Health Survey 2006 data with a sample of 5,362 currently married women and those living together in unions was analyzed and conclusions drawn at the multivariate level. Binary logistic regression model was used in analysis because of the binary nature of the outcome and results indicate higher likelihood of contraceptive use for older cohorts compared to younger ones hence family planning programs should be targeted towards younger cohorts to reduce fertility rate from 6.4 children per woman and reduce maternal health problems that result from too many or too closely spaced births. Although age cohort differences are pertinent in influencing contraceptive use, other factors like women’s income levels, schooling level, place of residence have a stronger effect on the same therefore regional interventions focused particularly in the North and West Nile regions, rural communities and efforts to increase literacy levels will yield greater results.

Objectives: To assess the effects of Korean Gentle Birth (KGB) program introduced from the Leboyer Birth.
Methods: Total 182 over 16 weeks primipara pregnant women subjected; 89 with KGB (case) and 93 with general antenatal care (control). Value of maternity, cognition, attitudes to labor, mother-infant attachment and desirable maternal performance surveyed with questionnaire interview. Using MedCalc (ver 11.5, Mariakerke, Belgium), each categories' responses and the score out of 100 compared and multiple logistic regression (MLR) analysis was done.
Results: The baseline status of age, education, income showed no differences in the two groups. Almost items were significantly higher in case than control group (P<0.05), and improved at post- than pre- assessment (P<0.001). With MLR, the OR (95% CI) of the over five times use of ‘room in one' and the over one year's intention of breast feeding were significantly higher in KGB group compared to control group; 6.6 (2.8~15.5) and 13.9 (5.4~35.5), respectively.
Conclusion: Maternity identification and desirable maternal behaviors apparently improved with KGB. KGB considered that strengthening maternity and the sound culture for pregnancy and birth. When performing antenatal care, introduction and application of the KGB is highly recommended.

This paper aimed at identifying factors that contribute to unmet need for family planning among women in rural Kenya. Logistic regression analysis was carried out on 2008/09 Kenya demographic and health survey women-file data that left out currently pregnant and amenorrheic women. Among the variables found to be significantly related to unmet need for spacing, limiting childbearing and total unmet need were: marital status, current age, level of education, number of living children, employment status, region, household wealth index and exposure to mass media communications. In order to reduce unmet need for family planning in rural areas of Kenya, region-specific programmatic family planning action should be adopted; the government should prioritize female education and economic empowerment to women in rural areas; agencies involved in family planning provision and communication in rural Kenya should offer suitable services that target specific age groups, and with a greater focus on married women.

Globally, about 7 million under-five children die every year. Meanwhile, family planning is recognized as the pillar of safe motherhood and improved child health outcomes. Evidence showed that promotion of family planning has the potential of averting 32% of all maternal deaths and 10% of childhood deaths. Thus, the relevant question would seem to suggest whether unmet needs for contraception could lead to increased risk of under-five mortality. The objective of this paper is to examine whether unmet needs for contraception could result in increased risk of under-five mortality in Nigeria. The study draws on 2008 Nigeria Demographic and Health Survey. Cox regression analysis was performed on a nationally representative sample of 28,647 children to examine the effect of contraceptive use and unmet need on child survival; while adjusting for the effects of other important covariates. Findings indicate a significantly lower risk of death for children whose mothers were using contraceptives (hazard ratio: 0.54,p<0.001); and for children whose mothers had no unmet need for contraception (hazard ratio 0.89,p<0.05) compared with those in the reference category. The findings of this study suggest the importance of contraceptive use in the pursuit of the Millennium Development Goal four in Nigeria.