Chinelo C. Okigbo

Influence of integrated services on postpartum family planning use: a cross-sectional survey from urban Senegal

BackgroundAlthough the majority of postpartum women indicate a desire to delay a next birth, family planning (FP) methods are often not offered to, or taken up by, women in the first year postpartum. This study uses data from urban Senegal to examine exposure to FP information and services at the time of delivery and at child immunization appointments and to determine if these points of integration are associated with greater use of postpartum FP.MethodsA representative, household sample of women, ages 15–49, was surveyed from six cities in Senegal in 2011. This study focuses on women who were within two years postpartum (n = 1879). We also include women who were surveyed through exit interviews after a visit to a high volume health facility in the same six cities; clients included were visiting the health facility for delivery, post-abortion care, postnatal care, and child immunization services (n = 794). Descriptive analyses are presented to examine exposure to FP services among postpartum women and women visiting the health facility. Logistic regression models are used to estimate the effect of integrated services on postpartum FP use in the household sample of women. Analyses were conducted using Stata version 12.ResultsAmong exit interview clients, knowledge of integrated services is high but only a few reported receiving FP services. A majority of the women who did not receive FP services indicated an interest in receiving such information and services.Among the household sample of women up to two-years postpartum, those who received FP information at the time of delivery are more likely to be using modern FP postpartum than their counterparts who also delivered in a facility but did not receive such information. Exposure to FP services at an immunization visit was not significantly related to postpartum FP use. Another key finding is that women with greater self-efficacy are more likely to use a modern FP method.ConclusionThis study’s findings lend strong support for the need to improve integration of FP services into maternal, newborn, and child health services with the goal of increasing postpartum women’s use of FP methods in urban Senegal.

Determinants of Sexual Activity and Pregnancy among Unmarried Young Women in Urban Kenya: A Cross-Sectional Study

Objectives With age of marriage rising in Kenya, the period between onset of puberty and first marriage has increased, resulting in higher rates of premarital sexual activity and pregnancy. We assessed the determinants of sexual activity and pregnancy among young unmarried women in urban Kenya. Methods Baseline data from five urban areas in Kenya (Nairobi, Mombasa, Kisumu, Machakos, and Kakamega) collected in 2010 by the Measurement, Learning & Evaluation project were used. Women aged 15-24 years, who had never been married, and were not living with a male partner at the time of survey (weighted n=2020) were included. Using weighted, multivariate Cox proportional hazard regression and logistic regression analyses, we assessed factors associated with three outcome measures: time to first sex, time to first pregnancy, and teenage pregnancy. Results One-half of our sample had ever had sex; the mean age at first sex among the sexually-experienced was 17.7 (± 2.6) years. About 15% had ever been pregnant; mean age at first pregnancy was 18.3 (±2.2) years. Approximately 11% had a teenage pregnancy. Three-quarters (76%) of those who had ever been pregnant (weighted n=306) reported the pregnancy was unwanted at the time. Having secondary education was associated with a later time to first sex and first pregnancy. In addition, religion, religiosity, and employment status were associated with time to first sex while city of residence, household size, characteristics of household head, family planning knowledge and misconceptions, and early sexual debut were significantly associated with time to first pregnancy. Education, city of residence, household wealth, early sexual debut, and contraceptive use at sexual debut were associated with teenage pregnancy for those 20-24 years. Conclusion Understanding risk and protective factors of youth sexual and reproductive health can inform programs to improve young people’s long-term potential by avoiding early and unintended pregnancies.

Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

BackgroundPreventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts.MethodsWe used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey.ResultsNinety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low.ConclusionYouth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth.

Trends in reproductive health indicators in Nigeria using demographic and health surveys (1990–2013)

ABSTRACT There is an urgent need to improve reproductive health (RH) in Nigeria – the most populous country in Africa. In 2015, Nigeria had the highest number of maternal deaths in the world. This study assessed the trends in select RH indicators in Nigeria over two decades. Data used were from Nigeria Demographic and Health Surveys (NDHS) conducted between 1990 and 2013. The NDHS uses a two-stage cluster sampling design to select nationally representative samples of reproductive-age women. The study sample ranged from 7620 to 38,948 women aged 15–49 across the five surveys. Trends in modern contraceptive prevalence rate, skilled antenatal care, skilled birth attendance, and adolescent birth were assessed. The results show increasing trends in modern contraceptive prevalence rate from 4% in 1990 to 11% in 2013 (p < .001); in skilled antenatal care from 57% in 1990 to 61% in 2013 (p < .001); and in skilled birth attendance from 31% in 1990 to 40% in 2013 (p < .001). The trend in adolescent birth decreased from 24% in 1990 to 17% in 2013 (p < .001). Marked disparities exist as rural, poor, and less educated women bear the greatest burden. Interventions should target the at-risk populations to improve their access and use of RH services.