Kazuyo Machiyama

Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia

Abstract Objective To assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia. Methods The Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion. Findings Data on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17–1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92–1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months. Conclusion Adding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period.

Unmet need for family planning in Ghana: the shifting contributions of lack of access and attitudinal resistance.

In Ghana, despite a 38 percent decline in the total fertility rate from 1988 to 2008, unmet need for family planning among married women exposed to pregnancy risk declined only modestly in this period: from 50 percent to 42 percent. Examining data from the five DHS surveys conducted in Ghana during these years, we find that the relative contribution to unmet need of lack of access to contraceptive methods has diminished, whereas attitudinal resistance has grown. In 2008, 45 percent of women with unmet need experienced no apparent obstacles associated with access or attitude, 32 percent had access but an unfavorable attitude, and 23 percent had no access. Concerns regarding health as a reason for nonuse have been reported in greater numbers over these years and are now the dominant reason, followed by infrequent sex. An enduring resistance to hormonal methods, much of it based on prior experience of side effects, may lead many Ghanaian women, particularly the educated in urban areas, to use periodic abstinence or reduced coital frequency as an alternative to modern contraception.

Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: Findings from health facility surveys in six sub-Saharan countries

Introduction: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi‐country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic‐level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART.

Contraceptive Adoption, Discontinuation, and Switching among Postpartum Women in Nairobi's Urban Slums.

Unmet need for contraception is highest within 12 months post‐delivery, according to research. Using longitudinal data from the Nairobi Urban Health and Demographic Surveillance System, we assess the dynamics of contraceptive use during the postpartum period among women in Nairobis slums. Results show that by 6 months postpartum, 83 percent of women had resumed sexual activity and 51 percent had resumed menses, yet only 49 percent had adopted a modern contraceptive method. Furthermore, almost half of women discontinued a modern method within 12 months of initiating use, with many likely to switch to another short‐term method with high method‐related dissatisfaction. Women who adopted a method after resumption of menses had higher discontinuation rates, though the effect was much reduced after adjusting for other variables. To reduce unmet need, effective intervention programs are essential to lower high levels of discontinuation and encourage switching to more effective methods.

An Assessment of Childbearing Preferences in Northern Malawi

Fertility preferences are an essential component of family planning program evaluation; however, doubts about their validity in sub-Saharan Africa exist and little methodological assessment has been carried out. This study investigates prospective fertility intentions in terms of their temporal stability, intensity, degree of spousal agreement, and association with future childbearing in northern Malawi. A total of 5,222 married women participated in the three-round study. The odds of having a child or becoming pregnant within 36 months were 4.2 times higher when both wife and husband wanted a child within three years and 2 times higher when both wanted to wait at least three years, compared with the odds when both wanted to cease childbearing. The influence of husbands’ and wives’ preferences on subsequent fertility was equal. Compared with the intention to stop, the intention to postpone childbearing was less stable, recorded less spousal agreement, and was much less strongly predictive of fertility.

Unmet need for family planning: past achievements and remaining challenges.

Globally, the percentage of married fecund women with unmet need-who use no contraceptive method despite wishing to avoid childbearing for two years or more-fell from 22% in 1970 to 12% in 2010. Substantial health, economic and environmental, and demographic benefits have resulted from this change. Promotion of contraception is one of the great success stories of the past 50 years. However, unmet need remains high in sub-Saharan Africa, at 25%, because of insufficient knowledge of methods, social opposition, and fear of health effects. In addition to obvious factors such as political commitment and adequate funding, success in this region will require improvement in continuation of use and the range of available methods.

FIGO postpartum intrauterine device initiative: Complication rates across six countries

To record and analyze complication rates following postpartum intrauterine device (PPIUD) insertion in 48 hospitals in six countries: Sri Lanka, India, Nepal, Bangladesh, Tanzania, and Kenya.

Consequences of maternal morbidity on health-related functioning: a systematic scoping review

Objectives To assess the scope of the published literature on the consequences of maternal morbidity on health-related functioning at the global level and identify key substantive findings as well as research and methodological gaps. Methods We searched for articles published between 2005 and 2014 using Medline, Embase, Popline, CINAHL Plus and three regional bibliographic databases in January 2015. Design Systematic scoping review Primary outcome Health-related functioning Results After screening 17 706 studies, 136 articles were identified for inclusion. While a substantial number of papers have documented mostly negative effects of morbidity on health-related functioning and well-being, the body of evidence is not spread evenly across conditions, domains or geographical regions. Over 60% of the studies focus on indirect conditions such as depression, diabetes and incontinence. Health-related functioning is often assessed by instruments designed for the general population including the 36-item Short Form or disease-specific tools. The functioning domains most frequently documented are physical and mental; studies that examined physical, mental, social, economic and specifically focused on marital, maternal and sexual functioning are rare. Only 16 studies were conducted in Africa. Conclusions Many assessments have not been comprehensive and have paid little attention to important functioning domains for pregnant and postpartum women. The development of a comprehensive instrument specific to maternal health would greatly advance our understanding of burden of ill health associated with maternal morbidity and help set priorities. The lack of attention to consequences on functioning associated with the main direct obstetric complications is of particular concern. Review registration CRD42015017774

Factors influencing the likelihood of acceptance of postpartum intrauterine devices across four countries: India Nepal Sri Lanka and Tanzania.

To examine the factors that positively influenced the likelihood of accepting provision of postpartum intrauterine devices (PPIUDs) across four countries: Sri Lanka, Nepal, Tanzania, and India.

Setting the research agenda for induced abortion in Africa and Asia

Provision of safe abortion is widely recognized as vital to addressing the health and wellbeing of populations. Research on abortion is essential to meet the UN Sustainable Development Goals. Researchers in population health from university, policy, and practitioner contexts working on two multidisciplinary projects on family planning and safe abortion in Africa and Asia were brought together for a workshop to discuss the future research agenda on induced abortion. Research on care‐seeking behavior, supply of abortion care services, and the global and national policy context will help improve access to and experiences of safe abortion services. A number of areas have potential in designing intervention strategies, including clinical innovations, quality improvement mechanisms, community involvement, and task sharing. Research on specific groups, including adolescents and young people, men, populations affected by conflict, marginalized groups, and providers could increase understanding of provision, access to and experiences of induced abortion. Methodological and conceptual advances, for example in the measurement of induced abortion incidence, complications, and client satisfaction, conceptualizations of induced abortion access and care, and methods for follow‐up of patients who have induced abortions, will improve the accuracy of measurements of induced abortion, and add to understanding of womens experiences of induced abortions and abortion care.