Recognizing and Addressing the Contraceptive Hesitancy-Acceptability Continuum: Adopting Lessons Learned From the Immunization Field.

We propose a new framework that builds from vaccine hesitancy concepts and findings for the family planning community to better conceptualize, measure, and address the major drivers of contraceptive hesitancy and acceptability.

Males' Awareness of Female and Male Contraception Methods, Information, Outreach, and Acquisition Locations in Abidjan, Côte d'Ivoire, Nairobi, Kenya, and Lagos, Nigeria.

Purpose: The aim of this study is to describe modern female and male method awareness, information sources, outreach exposures, and acquisition source awareness among young men aged 15-24 by sexual behavior status in sub-Saharan Africa.

Methods: Cross-sectional surveys were conducted with unmarried, young men aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 1,028), Nairobi, Kenya (n = 691), and Lagos, Nigeria (n = 706). Descriptive statistics characterized contraception awareness of male and female methods and information sources, outreach exposures, acquisition source awareness, and preferred contraception source.

Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings.

Background: Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence).

Is Client Reporting on Contraceptive Use Always Accurate? Measuring Consistency and Change with a Multicountry Study.

The 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.

Explaining withdrawal's persistence: correlates of withdrawal use in Albania, Armenia, Jordan, and Turkey observed in a cross-sectional study.

Withdrawal dominates the contraceptive method mix in a geographical cluster of countries in South-Eastern Europe and Western Asia that have, in part, reached low fertility. This study examines the socio-demographic determinants associated with withdrawal use in Armenia, Albania, Jordan and Turkey that could explain withdrawal's persistence and inform contraceptive programs in these unique settings. Cross-sectional data on 31,569 married women 15 to 49 years were drawn from the Demographic and Health Surveys in Albania (2017-2018), Armenia (2015-2016), Jordan (2017-2018), and Turkey (2013).

Effect of community health workers' visits on uptake of modern contraception among rural women of reproductive age in Nigeria.

This paper assessed the effect of visits by Community Health Workers (CHW) in the prior 12 months on modern contraceptive use at the time of the survey using a national sample of women residing in rural communities in Nigeria. Cross-sectional data from 5072 rural women ages 15-49 years interviewed in the PMA2020 Survey in 6 states in Nigeria in 2018 were used. Descriptive analysis and generalized linear models were conducted in Stata 15.

Missed Opportunities: Menstruation Matters for Family Planning.

Increased global attention is being paid to the importance of adolescent and adult women's experiences of menstruation in low- and middle-income countries, and the challenges these experiences present to health, education and gender equality. Although much of the focus has been on menarche as a window of opportunity for early engagement in young women's sexual and reproductive health, minimal attention has been paid to the natural linkages between menstrual health and hygiene and females' management of reproduction over their life course.

Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries: A multilevel, multinomial analysis using geographically linked data from PMA2020.

The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations.

Subnational estimation of modern contraceptive prevalence in five sub-Saharan African countries: a Bayesian hierarchical approach.

Background: Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates.

Methods: Using woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country.

Regaining Momentum in Family Planning.

Since the launch of the Family Planning 2020 initiative 5 years ago, 46 million more clients in the 69 poorest countries are using modern contraception—a tremendous accomplishment, albeit behind schedule to reach the 2020 global goal of 120 million. Family planning continues to be innovative, and as reflected in the recent 2018 International Conference on Family Planning in Rwanda, there is a newfound momentum behind the movement and a new generation of young leaders with powerful ideas, creativity, and passion who are stepping up to help propel family planning onward.

Changes in abortion service provision in Bihar and Jharkhand states, India between 2004 and 2013.

Background: The Medical Termination of Pregnancy (MTP) Act of 1971 liberalized abortion laws in India. This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013.

Methods: We used state-representative data from cross-sectional surveys of reproductive health service providers we conducted in 2004 (N = 1,323) and 2012/2013 (N = 1,020).

Mortality, fertility, and economic development: An analysis of 201 countries from 1960 to 2015.

The efficient utilization of the economic opportunities effected by rapid reductions in fertility and mortality is known as the demographic dividend. In this paper, our objectives are to (1) estimate the contribution of fertility and mortality decline during the period 1960-2015 to demographic dividend due to change in age structure, and (2) assess the economic consequences of population age structure change. Employing the cohort component method, we performed population projections with different scenarios of changes in mortality and fertility between 1960 and 2015 in 201 countries.

Contraceptive Practice in Sub-Saharan Africa.

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.

Understanding the meaning of marital relationship quality among couples in peri-urban Ethiopia.

This study explores the meaning of marital relationship quality (MRQ) among couples in peri-urban Ethiopia. We examined the factor structure of MRQ by assessing the reliability and validity of four validated Western scales capturing domains of trust, commitment, satisfaction and communication through exploratory factor analysis. Although most of the items of the original Western scales were relevant for the study population, the domains did not mirror the original Western scales and varied by gender.

Maternal Risk Exposure and Adult Daughters' Health, Schooling, and Employment: A Constructed Cohort Analysis of 50 Developing Countries.

This study analyzes the relationships between maternal risk factors present at the time of daughters' births-namely, young mother, high parity, and short preceding birth interval-and their subsequent adult developmental, reproductive, and socioeconomic outcomes. Pseudo-cohorts are constructed using female respondent data from 189 cross-sectional rounds of Demographic and Health Surveys conducted in 50 developing countries between 1986 and 2013. Generalized linear models are estimated to test the relationships and calculate cohort-level outcome proportions with the systematic elimination of the three maternal risk factors.

Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study.

Background: Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive.

Methods: This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil.

Determinants of Utilization of Health Extension Workers in the Context of Scale-Up of Integrated Community Case Management of Childhood Illnesses in Ethiopia.

Ethiopia has invested significant resources in integrated community case management (iCCM) of childhood illness. In Oromia Region, iCCM scale-up was phased in, allowing for comparisons between districts providing iCCM and routine services. We assessed the determinants of utilization of health extension workers (HEWs) delivering iCCM services at rural health posts by caregivers of sick, under-five children in a cross-sectional survey.

Access to Contraceptives in Countries With Restrictive Abortion Laws: The Case of Brazil.

We aimed to determine whether current contraceptive use is affected by a history of abortion for women from a country with abortion-restricted laws. This is an analysis of 2006 Brazil Demographic and Health Survey. Nonpregnant women whose first pregnancy occurred in the previous 5 years were selected for this study (n = 2,181).

Family and peer support matter for precoital and coital behaviors among adolescents in Lima.

We analyzed the association between sub-scales developed with adolescents and the outcomes of precoital behaviors and vaginal sex in Lima, Peru. Adolescent participants in key informant sessions operationalized concepts identified during qualitative concept mapping into several sub-scales. Face and content validity testing and pilot application with respondent debriefing were used to refine the sub-scales.

Association between condom use and use of other contraceptive methods among female sex workers in Swaziland: a relationship-level analysis of condom and contraceptive use.

Objectives: Nonbarrier modern contraceptive users often are less likely to use condoms, particularly with more intimate sex partners. We examine whether female sex workers (FSWs) in Swaziland who use nonbarrier contraception use condoms less consistently and whether this inverse association varies by relationship type.

Methods: In 2011, we conducted a survey among 325 Swazi FSWs using respondent-driven sampling.

Community, social group, and individual level correlates of rural Malawian men's and women's reproductive health intentions and practices.

Using a sample of 656 men and 930 women from rural Malawi in 2000, the authors examined the association between various individual and community level factors, as well as participation in social groups, and four reproductive health outcomes: intentions to use any contraceptives in the next six months, current use of modem contraceptives, wanting an HIV test, and having had an HIV test. Women in social groups have higher odds of reporting intentions to use contraceptives, wanting an HIV test, and of having had an HIV test than those not in groups. Among men, social group participation is only slightly associated with having had an HIV test.

Correlates of and couples' concordance in reports of recent sexual behavior and contraceptive use.

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.