Poster Session on Sexuality and reproductive health (2)

Indonesia is the world’s most populous Muslim-majority nation, with its highest prevalence rate for injectables (32%). Egypt has the world’s largest Arab population, but the TFR is stalling at about half a birth higher than in Indonesia, despite both countries having comparable overall and any modern contraceptive prevalence rates. Both established clinic-oriented national family planning programs in the mid-1960s with strong bureaucratic and financial support, but each has recently hit trouble. Indonesian politicians have shifted their attention and resources away from family planning. However, injectables have become increasingly offered by local midwives with strong incentives and by more private providers. Political turmoil threatens to undermine Egypt’s program, heavily dependent on the strained public sector. However, over 7% of women now use injectables, more than in other Arab states and possibly soon usurping pills as the second most common method. In both countries, government policies have led to a loss of method choice and a narrowed range of family planning providers. We examine these developments further and ask how far can Indonesia serve as a model for how injectable contraception can help accelerate Egypt’s path towards replacement-level fertility and for influencing trends in other Arab populations.

The Nigeria Urban Reproductive Health Program (NURHI) aims to increase contraceptive use in four urban areas in Nigeria. To address supply side issues NURHI has spearheaded the formation of a Family Planning Provider Network (FPPN) in each city. A baseline study on FPPN members was conducted. Results showed FPPN members in Ibadan and Ilorin are more biased than those in Abuja and Kaduna. Gender, religion and prior modern family planning use are not associated with service provision biases. PMVs and community outreach workers have more biases than clinicians. The finding that PMV operators, a significant proportion of the FPPN and a source of contraceptive supply for around a quarter of urban Nigerians, have high biases indicates program efforts to integrate the PMV and clinician network, to reduce PMV operator biases, must be prioritized in the FPPN program.

India and Brazil face the same nature of challenges regarding the supply of family planning services and, more specifically, of tubal ligation. The size and complexity of decentralized political and administrative organizations in both countries imprint a high degree of difficulty in health provision that central governments and state-level authorities are not able to control and enforce. In this sense, local-level heterogeneity as for economic, political, social, and demographic differences reigns. The aim of this article is to analyze the factors associated with the differentials in the access of tubal ligation and clinical reversible methods in the public health sector in Brazil and India as well as to establish and discuss common treads stemming from public policies and politics that influence family planning. The focus is on poor women parity two or higher. We use the 2006 Demographic and Health Survey for Brazil and the National Family Health Survey 2005-06 for India. Although access has improved over time our findings point that contemporary obstacles to public family planning services can be traced in the early initiatives and are related to the political economy of family planning organization in the three spheres of political power – central, state-, and local-level.

Modern Contraceptives (MC) are useful for limiting fertility and protection against STIs including HIV/AIDS. MC are not easily accessible in most developing countries where high proportion of the people earns below 1$/day. This study examines the gap in MC use between women in the richest and poorest wealth quintile. It utilized Malawi Demographic and Health Survey dataset, 2010 and examined 5085 and 2290 married women aged 15-49 who met the inclusion criteria set for ever use of modern contraceptives (EUMC) and current use of modern contraceptives (CUMC), respectively. Chi-square and logistic regression were used for the analysis (α=5.0%). Mean CEB of the women in the poorest (3.94±2.7) was higher than their counterparts in the richest (2.82±2.3) wealth quintile (p<0.0001). About 76% of the women EUMC; with 66.8% and 82.4% EUMC in the poorest and richest wealth quintile respectively (p<0.0001). The prevalence of CUMC was 53.8% and was significantly higher among richest (58.5%) than the poorest (45.9%). Poorest married women were less likely 0.423(C.I=0.371-0.482) and 0.601(C.I=0.507-0.713) to EUMC and CUMC respectively than their counterparts in the richest wealth quintile. These odd ratios vaguely vary even when other potential confounding variables were used as control.

Introduction: A woman’s effective reproductive span is not only important with regard to her health status but also as a deciding factor for the number of children she would bear during her lifetime. Gradually increasing age at marriage among women in India and decreasing age at sterilisation indicate that females’ effective reproductive spans are contracting.
Objectives: This study aims to analyze the effective reproductive spans of Indian women by successive marriage cohorts.
Methods: This study utilized data from the National Family Health Survey 3, India, 2005-06.
Results: From 1992-93 to 2005-06, the median age at which women married increased from 16.1 to 16.8 and the age at which they got sterilized declined from 26.6 to 25.5 years. The effective reproductive span of women of the successive marriage cohorts decreased from 11.5 years among those who married in 1970s to 9 years among those who married in 1980s, 6.4 years among those who got married in 1990s and 2.8 years among those who got married in 2000-04.
Conclusion: These findings suggest that women are opting to end their reproductive span faster than women of the older generation did sterilization there is a gradual shrink in the effective reproductive span of women.

Ghana’s Community Health and Family Planning (CHFP) Project demonstrated dramatic success in the 1990s in reducing fertility and saving lives by posting nurses in rural villages where they worked with traditional social networks to deliver community-based health services. The CHFP approach was scaled up as a national program called “Community-based Health Planning and Services” (CHPS) and is now a major contributor to Ghana’s health care system. However, vital reproductive health components are languishing and CHPS’ impact on fertility may be falling well short of the potential to address unmet need. This qualitative study revisited the villages of the CHFP in order to clarify social and behavioral changes that have occurred and not occurred as CHPS services were scaled up. Preliminary analysis reveals that key functions of the health system that fostered community engagement have atrophied during the scale-up of CHPS. Limited human and financial resources and additions to the package of CHPS services have diluted the focus on family planning and reduced the time and energy available for community engagement for family planning uptake. Activities to change community attitudes toward family planning appear to be more fragile and difficult to sustain than other components of CHPS services in the face of resource constraints.

Background: High levels of fertility in Nigeria are a function of both low demand for and low use of contraceptive methods. Method choice is an important determinant of sustained contraceptive use and a number of barriers have been identified. However, our understanding of how clients themselves perceive their choice of method is very limited.
Methods: This study uses qualitative data to examine attitudes and norms surrounding decision-making for method choice.
Results: Choosing a contraceptive method was presented as a medical decision. Participants often mentioned the issue of whether a method is compatible with a woman’s “body system”. This compatibility is determined by tests conducted by a doctor and dictates the method chosen, with the assumption that there will be no side effects.
Discussion: This level of medical mystery placed on family planning is problematic. A belief that a test exists to predict side effects would likely result in disappointment by the user, and possibly a reluctance to switch methods, when side effects do occur. Messages need to be crafted to increase understanding among current and potential family planning users about the process of choosing a contraceptive method, the potential for side effects, and the choice of switching methods.

This study takes a retrospective look at the time course of total fertility rate (TFR) and per capita wealth among countries, relating it to family planning initiatives and other factors thought to influence either fertility or wealth. It was found that countries that implemented strong family planning programs achieved fertility reduction much faster and earlier than comparable countries that did not. Fertility decline typically preceded marked increases in wealth, but per capita wealth growth usually accelerated when fertility fell to between two and three births per woman. The negative relationship between TFR and GDP per capita tends to be deeply concave for those countries that have achieved low fertility. Higher fertility countries in the same region tend to follow a parallel course, but at a slower pace, and most with current fertility above three are yet to see sustained wealth increase. In the absence of significant income from oil or other resources, fertility reduction appears to be a necessary if not sufficient condition for sustained economic growth. Causation runs in both directions, with prosperity and development of education and health services enhancing the reduction in family size, but interventions to promote prosperity are less cost-effective in priming this cycle than interventions for fertility reduction.

The government of Nepal introduced Comprehensive Abortion Care (CAC) in March 2004 along with concerted efforts to improve access to modern contraception. An integral component of CAC is post-abortion contraceptive care. To date, there is no national level evidence on post-abortion contraceptive uptake in Nepal. More importantly, the interaction between abortion care and family planning is poorly understood in Nepal where abortion interventions are widely discussed in policy arena. There is also a concern that medical abortion program is promoted too aggressively in Nepal such that potential contraceptive users may have begun to opt for a ‘quick and easy fix’ thus essentially substituting abortion for contraception. Using the contraceptive calendar data drawn from the 2011 Nepal Demographic and Health Survey, this research investigates the level of contraceptive use before and after an abortion and examines the timing and determinants of post-abortion contraceptive use comparing women who had a live or still birth. Additional analysis focuses on the rates of discontinuation among users of post-abortion contraceptive method. The research is conceptualised based on the hypothesis that women who experience an abortion are generally found to be more motivated than their counterparts to use contraception in the post-abortion period.

Objectives: This study examined the inter-relationship between spousal communication and level of family planning use.
Methodology
This study is based on the baseline data from a longitudinal couple study in a peri-urban community, Ipetumodu, in Osun State, Nigeria collected between April and May, 2010. This study is part of a multi-country Family Health and Wealth Study in seven peri-urban communities in five sub-Saharan African countries of Ethiopia, Ghana, Malawi, Nigeria and Uganda.
Results/ Key findings:
Out of 784 women studied, 259 (33%) of the women are currently using a form of contraception. About 397 (51%) women discussed family planning with their husbands . Of these 397, 228 (57 %) are currently using a method. (P<0.0001). The odds of using family planning are 17 times higher among those who discuss family planning with their husbands. The odds of using contraception are 3.5 times higher among those desired lesser family size compared to those who desired more children. Furthermore women who have secondary or more level of education have a higher odds of using family planning
Cnclusion: Our findings also showed that the decision to use ontraceptive is majorly a joint decision between husband and wife