Practice and Intention to use long acting and permanent contraceptive methods among married women in Ethiopia: Systematic meta-analysis

  • Reproductive Health, Volume 13, No. 1, Year 2016

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Study Justification:
– The study aimed to investigate the practice and intention to use long acting and permanent contraceptive methods (LAPCMs) among married women in Ethiopia.
– This is important because Ethiopia has a high total fertility rate, as well as high maternal and child mortality rates.
– Understanding the prevalence and factors influencing the use of LAPCMs can help inform policies and programs to improve family planning services in the country.
Study Highlights:
– The study conducted a systematic review and meta-analysis of published and unpublished observational studies.
– Ten observational studies were included in the meta-analysis.
– The pooled prevalence of intention to use LAPCMs among married women was found to be 42.98%.
– However, the pooled practice of LAPCMs among the study participants was only 16.64%.
Recommendations for Lay Reader and Policy Maker:
– The study recommends making LAPCMs more readily available and accessible to women at the lower level of health service delivery.
– This can help increase the utilization of LAPCMs and improve family planning outcomes in Ethiopia.
Key Role Players Needed to Address Recommendations:
– Ministry of Health: Responsible for developing and implementing policies related to family planning services.
– Health Service Providers: Involved in delivering family planning services and counseling to women.
– Community Health Workers: Play a crucial role in raising awareness and providing information about LAPCMs to women in the community.
– Non-Governmental Organizations (NGOs): Can support the implementation of programs and initiatives to increase access to LAPCMs.
Cost Items to Include in Planning the Recommendations:
– Training and Capacity Building: Budget for training health service providers and community health workers on LAPCMs and family planning counseling.
– Service Delivery: Budget for the provision of LAPCMs at health facilities, including procurement and distribution of contraceptives.
– Awareness and Education: Budget for community outreach programs, awareness campaigns, and educational materials to promote the use of LAPCMs.
– Monitoring and Evaluation: Budget for monitoring and evaluating the implementation and impact of interventions aimed at increasing the utilization of LAPCMs.
Please note that the provided information is based on the description of the study and may not include all possible details.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it is based on a systematic review and meta-analysis of observational studies. However, the abstract does not provide information on the quality of the included studies or the specific methods used in the analysis. To improve the evidence, the abstract could include more details on the study selection criteria, the quality assessment of the included studies, and the statistical methods used in the meta-analysis.

Background: The long acting and permanent contraceptive methods (LAPCMs) has not used unlike that of short-acting methods in Ethiopia. Ethiopia is the second most populous country in Sub Saharan Africa with a high total fertility rate, and high maternal and child mortality rates. This study summarized the evidence of practice and intention to use long acting and permanent family planning methods among women in Ethiopia using systemic review and meta-analysis. Methods: A systematic review and meta-analysis of the published and unpublished observational studies were conducted. Original studies were identified using databases of Medline/Pubmed, and Google Scholar. Heterogeneity across studies was checked using Cochrane Q test statistic and I2test. The pooled proportion of intention to use and the practice of long acting and permanent contraceptive methods were computed using a/the random effect model. Results: Based on the ten observational studies included in the meta-analysis, the pooled prevalence of intention to use long acting and permanent contraceptive methods among married women according to the random effect model was 42.98 % (95 % CI 32.53, 53.27 %). On the other hand, the pooled practice of long acting and permanent methods of contraceptive among the study participants was 16.64 % (95 % CI 12.4 to 20.87 %). Conclusion: This meta-analysis revealed that women’s intention to use LAPCMs is generally good but their utilization is low. It is recommended, therefore, that LAPMCs must be made more readily available and accessible to women at the lower level of health service delivery who are in need of it.

This study was a systemic review and meta-analysis of the published and unpublished observational studies on prevalence rate of practice and intention to use LAPCMs among married women in Ethiopia. English language publications in the Medline data base, Google Scholar and HINARI (Health Inter Network Access to Research Initiative) were identified and cross-checked with reference lists containing combinations of the key words “intention to use” “demand” and “prevalence rate of LAPCMs”. In addition, a search was also made for cross-reference lists of identified original articles and reviews for other relevant articles. The data abstraction was performed from October 1 to June, 2015. A systematic review and meta-analysis were made on cross-sectional studies that were focused on the intention to use and practice of LAPCMs among married women in Ethiopia. We included articles in the meta-analysis if they reported the practice and/or intention to use LAPCMs among married women in Ethiopia without restriction of publication date. Reports of original studies, unpublished master theses and PhD dissertations which are written in English language were also included. Studies were excluded from the analysis for any of the following reasons: articles were focused on short term contraceptives, meta-analysis or systematic reviews; articles consisted of comments, editorials, or duplicate publication of the same study; response rate was less than 80 %, articles available only in abstract form and articles with sample size of less than 50. The selection of articles for review was done in three stages: titles alone, abstracts, and then full-text articles. Study quality indicators were sample size, reporting of response rate and appraisal of external validity of the study. Studies were assessed for quality and those with high quality were included for analysis. High quality studies were studies that: reported outcomes on at least 50 patients; had response rates greater than 80 %; and, reported on either practice of LAPCMs and/or intention to use LAPCMs. The data abstraction was conducted independently by two investigators (YM, KT). The selected studies were reviewed by using pretested and standardized abstraction format and the following data were extracted: title, authors, year of publication, study site/base (community-based or institution-based), sample size, response rates, and measure of rate with its confidence interval (CI). When there was a discrepancy in data abstraction between the investigators, it was resolved through discussion and consensus. STATA version 11.0 software was used for data entry and analysis. The descriptions of original studies were made using tables and forest plots. The overall effect (pooled estimated prevalence rate) of LAPCMs practice and intention to use was carried out by using a random effects model and measured by using a prevalence rate with 95 % confidence intervals [95 % CI]. Heterogeneity across studies was estimated by Cochran’s Q test [16] and I2test which shows the proportion of total variation across studies that is due to heterogeneity rather than to chance [17].

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Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health in Ethiopia:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or SMS-based systems to provide information and reminders about long acting and permanent contraceptive methods (LAPCMs), as well as access to healthcare services.

2. Community Health Workers: Train and deploy community health workers to educate women and their families about the benefits and availability of LAPCMs, and provide counseling and support for their use.

3. Task-Shifting: Expand the role of midwives and other healthcare providers to include the provision of LAPCMs, allowing for increased access to these methods at lower levels of health service delivery.

4. Integration of Services: Integrate family planning services, including LAPCMs, with other maternal health services such as antenatal care and postpartum care, to ensure that women have access to a comprehensive range of services.

5. Quality Improvement Initiatives: Implement quality improvement initiatives to address barriers to the utilization of LAPCMs, such as provider bias or lack of knowledge, by providing training and support to healthcare providers.

6. Supply Chain Management: Strengthen supply chain management systems to ensure a consistent and reliable availability of LAPCMs at all levels of the healthcare system.

7. Public-Private Partnerships: Foster partnerships between the public and private sectors to increase the availability and accessibility of LAPCMs, leveraging the resources and expertise of both sectors.

8. Health Financing: Explore innovative financing mechanisms, such as health insurance or conditional cash transfer programs, to reduce financial barriers and increase affordability of LAPCMs for women.

9. Community Engagement: Engage communities and community leaders in promoting the use of LAPCMs through awareness campaigns, community dialogues, and peer support networks.

10. Research and Data Collection: Conduct further research and data collection to better understand the barriers and facilitators to the use of LAPCMs, and to inform the development and implementation of targeted interventions.

It is important to note that these recommendations are based on the information provided and may need to be further tailored and contextualized to the specific needs and challenges of improving access to maternal health in Ethiopia.
AI Innovations Description
Based on the systematic review and meta-analysis conducted on the prevalence rate of practice and intention to use long acting and permanent contraceptive methods (LAPCMs) among married women in Ethiopia, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Increase availability and accessibility of LAPCMs: The study revealed that while the intention to use LAPCMs among married women in Ethiopia is generally good, the utilization is low. To address this, it is recommended to make LAPCMs more readily available and accessible to women at the lower level of health service delivery who are in need of it. This can be achieved by ensuring that health facilities at all levels have a sufficient supply of LAPCMs and trained healthcare providers who can provide counseling and services related to LAPCMs.

2. Strengthen health service delivery at the community level: To improve access to maternal health, it is important to strengthen health service delivery at the community level. This can be done by training and equipping community health workers to provide information, counseling, and services related to LAPCMs. Community-based health programs can be established to reach women in remote areas who may have limited access to healthcare facilities.

3. Raise awareness and address misconceptions: Many women may have misconceptions or lack awareness about LAPCMs. It is crucial to conduct awareness campaigns and educational programs to provide accurate information about the benefits, safety, and effectiveness of LAPCMs. This can help dispel myths and misconceptions and encourage women to consider using LAPCMs as a family planning option.

4. Involve men and community leaders: In many societies, decisions regarding family planning are often influenced by men and community leaders. It is important to involve men in discussions and decision-making processes related to LAPCMs. Engaging community leaders and religious leaders can also help in promoting acceptance and support for LAPCMs.

5. Improve data collection and monitoring: To track progress and identify areas for improvement, it is essential to improve data collection and monitoring systems related to LAPCMs. This can help in identifying gaps in service delivery, understanding the reasons for low utilization, and evaluating the impact of interventions aimed at improving access to maternal health.

By implementing these recommendations, it is possible to develop innovative strategies that can improve access to maternal health and increase the utilization of LAPCMs among married women in Ethiopia.
AI Innovations Methodology
In order to improve access to maternal health, it is important to consider innovations that can address the barriers and challenges faced by women in accessing maternal health services. Here are some potential recommendations for innovations:

1. Mobile health (mHealth) applications: Develop mobile applications that provide information and support for pregnant women, such as prenatal care reminders, nutrition advice, and access to healthcare providers through telemedicine.

2. Community health workers: Train and deploy community health workers to provide education, counseling, and basic healthcare services to pregnant women in remote or underserved areas.

3. Telemedicine: Establish telemedicine networks to connect pregnant women in rural areas with healthcare providers in urban centers, allowing them to receive prenatal care and consultations remotely.

4. Transportation solutions: Develop innovative transportation solutions, such as mobile clinics or ambulances, to ensure that pregnant women can easily access healthcare facilities, especially in rural areas with limited transportation options.

5. Financial incentives: Implement financial incentive programs, such as conditional cash transfers or vouchers, to encourage pregnant women to seek and utilize maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific population group that the recommendations aim to benefit, such as pregnant women in rural areas or low-income communities.

2. Collect baseline data: Gather data on the current access to maternal health services, including the number of women receiving prenatal care, the distance to healthcare facilities, and the utilization of different services.

3. Model the interventions: Use mathematical modeling or simulation techniques to estimate the potential impact of each recommendation on improving access to maternal health. This could involve estimating the number of additional women who would receive prenatal care, the reduction in travel time to healthcare facilities, or the increase in utilization of specific services.

4. Consider contextual factors: Take into account the specific context and challenges of the target population, such as cultural beliefs, infrastructure limitations, or socioeconomic factors, when simulating the impact of the recommendations.

5. Validate the model: Validate the model by comparing the simulated results with real-world data or conducting pilot studies to assess the feasibility and effectiveness of the recommendations.

6. Evaluate the impact: Assess the impact of the recommendations by measuring key indicators, such as the increase in the number of women accessing maternal health services, the improvement in health outcomes, or the reduction in maternal and child mortality rates.

By following this methodology, policymakers and healthcare providers can gain insights into the potential benefits and challenges of implementing these innovations to improve access to maternal health.

Statistics:
Citations: 7
Authors: 2
Identifiers:
DOI: 10.1186/s12978-016-0194-0
Research Areas:
Community Interventions, Genetics and Genomics, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study
Study Approach:
Mixed-methods, Quantitative, Systematic Review
Participants Gender:
Female
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