Factor associated with experience of modern contraceptive use before pregnancy among women who gave birth in Kersa HDSS, Ethiopia

BMC Public Health, Volume 16, No. 1, Year 2016

Interpretation

Background: Worldwide, every year 289,000 women die related to pregnancy and its complications. Nearly, all of these deaths occur in developing countries and more than half of this deaths occur in sub-Saharan Africa. Report suggested that using contraceptives can reduce this maternal mortality by 44 %. Even if, Ethiopia is one of the countries with highest maternal mortality, only 41 % of married women are using family planning. This analysis aimed at assessing factor associated with experience of contraceptive use before pregnancy among women who gave birth in Kersa Health and Demographic Surveillance System, Ethiopia. Methods: This study was part of data generated for Kersa Health and Demographic Surveillance System. Women who gave birth during October 2011 to September 2012 were asked whether they had used contraceptive before getting their last pregnancy. Data were collected by using Kersa Health and Demographic Surveillance System questionnaire. Both bi-variate and multivariate analysis were used to identify associated factors. Results: The proportion of modern contraceptive before pregnancy among the study participants was found to be 383 (40.9 %). The most commonly used modern contraceptives was Injectable contraceptive 270 (70.0 %) followed by oral contraceptives, 66 (17.23 %). Modern contraceptive use was negatively association with being Muslim (AOR = 0.2, 95 % CI = 0.05, 0.72) and being young mother (AOR = 0.44, 95 % CI = 0.22, 0.86). Rural town residence (AOR = 2.23, 95 % CI = 1.15, 4.35) was found to have positive association with utilization of modern contraceptives. Conclusions: Among women giving birth, only a minority had attempted to delay or prevent their recent birth by using contraception. Being young, being Muslim and living in rural area were significantly associated with low utilization of modern contraceptive. Increasing family planning education and involving religious leaders in family planning promotion would improve utilization of modern contraceptive use. The analysis used data from Kersa Health and Demographic Surveillance System (Kersa HDSS). Kersa HDSS is operated by Kersa Demographic Surveillance and Health Research Center (KDS-HRC) under Haramaya University. The field site is located between 41°40”0’ and 41°57”30’ easting and 09°15”15’ and 09°29”15’ northing. The surveillance system is located in the eastern Hararge zone, Oromiya Regional State, Eastern Ethiopia (Fig. 1). The district (Kersa District) has three climatic zones with the altitude ranging from 1600 to 3200 m above sea level. Based on figures published by the Central Statistical Agency in 2007, the district has an estimated total population of 170,816 of whom 86,134 (50.4 %) were males and 84,682 (49.4 %) were females; 11,387 or 6.67 % of its population are Rural town dwellers. The population in the district has crude birth rate of 37.2/1000, and Total fertility rate of 5.2. The district has seven health centers at different location of the district. In addition there are seven clinic/health posts and eight private pharmacies [9]. Kersa HDSS district and the 12 Sub-districts included in the surveillance process with altitude variation Kersa HDSS was established with the aim of generating community based health and demographic events in the Eastern part of Ethiopia. The Kersa HDSS covers the whole population in 12 sub-districts of 38 sub-districts that are found in kersa, Eastern Ethiopia. At the start of the surveillance process, ethical clearance was secured from FDRE, National Ethical Clearance Board having the reference number of 3.10/313/03. Consent was obtained from the study participants after they were informed about the study, the objective, out come, benefits and risk associated with the study was given to the study participants. It is an open cohort set up in 12 sub-districts of Kersa district. The site is principally rural including two small rural town (Kersa and Weter towns). The baseline census was done in 2007and since then a continuous population updated is being done twice every 6 months. During the updates, demographic and health events registered. Data is entered into the HRS-2 relational database. At the baseline 10,168 houses and 53,481 people were registered. The sex ratio and person per household was 1 and 5.1, respectively. At the end of 2013 the population becomes 63,000. Kersa HDSS is an INDEPTH member. INDEPTH is a network of Health and Demographic Surveillance Systems (www.indepth-network.org). The system uses HRS-2 database. The software is flexible and can export selected data to other software for analysis. This analysis used data collected from women who gave birth during October, 2011 to September 2012. The data was obtained from KDS-HRC through formal request. Open access is granted after the request is evaluated by kersa HDSS team. The detail data sharing policy of Kersa HDSS can be accessed at: [http://www.haramaya.edu.et/research/projects/kds-hrc/kds-hrc-project-data/]. Data were collected by using Kersa HDSS questionnaire. The questionnaire was adopted from EDHS and other relevant research report [2]. All mothers (937) residing in Kersa HDSS who gave birth their last child and identified for maternal health surveillance were asked about their modern contraceptive utilization before they conceived their last pregnancy. Modern contraceptive were defined as using any of the following contraceptives as defined by EDHS: Voluntary Surgical Contraception (VSC), the pill, Intra Uterine contraceptive Device (IUCD), injectables, implants, male and female condoms, lactational amenorrhea method, emergency contraception, and the standard days method [7]. Age of the mother, residence, religion, maternal occupation, maternal education, partner’s education, and average monthly family income, access to media, number of children alive, and knowledge of contraceptive were used as explanatory variables. The outcome variable in this analysis is experience of modern contraceptive use before pregnancy. Modern Contraceptive use in this study refers to use of any modern contraceptive before they conceived their last child i.e. whether she had previous birth or not. Data were collected by personnel recruited for the surveillance purpose. The results were presented in the form of tables, and text using frequencies and summary statistics such as mean, standard deviation and percentage to describe the study population in relation to relevant variables. Further, to identify factors associated with the outcome variable, logistic regression analysis was performed. Variables with p value ≤ 0.2 in the bi-variate analysis were considered for multivariate logistic regression model. Variables having p value ≤ 0.05 in the multivariate analysis were taken as significant predictors. Crude and adjusted odds ratios with their 95 % confidence intervals were calculated. The Hosmer and Lemeshow goodness-of-fit test was used to assess whether the necessary assumptions for the application of multiple logistic regression were fulfilled and p value > 0.05 was considered a good fit.

AI Digest

Study Justification:

– Maternal mortality is a significant issue worldwide, with a majority of deaths occurring in developing countries, particularly in sub-Saharan Africa.
– Contraceptive use has been shown to reduce maternal mortality by 44%.
– Despite high maternal mortality rates in Ethiopia, only 41% of married women are using family planning.
– This study aims to assess the factors associated with contraceptive use before pregnancy among women who gave birth in Kersa HDSS, Ethiopia.

Highlights:

– The study found that only 40.9% of women in the study had used modern contraceptives before their last pregnancy.
– Injectable contraceptives were the most commonly used method, followed by oral contraceptives.
– Being Muslim and being a young mother were negatively associated with modern contraceptive use.
– Rural town residence was positively associated with modern contraceptive use.
– The study highlights the need for increased family planning education and involvement of religious leaders in promoting modern contraceptive use.

Recommendations:

– Increase family planning education programs to improve awareness and knowledge about modern contraceptives.
– Involve religious leaders in family planning promotion to address cultural and religious barriers.
– Improve access to modern contraceptives in rural areas to increase utilization.

Key Role Players:

– Kersa Demographic Surveillance and Health Research Center (KDS-HRC) under Haramaya University
– Kersa Health and Demographic Surveillance System (Kersa HDSS) team
– Ethical Clearance Board
– Personnel recruited for surveillance purposes

Cost Items for Planning Recommendations:

– Development and implementation of family planning education programs
– Training and capacity building for religious leaders on family planning promotion
– Distribution and availability of modern contraceptives in rural areas
– Monitoring and evaluation of the impact of interventions on modern contraceptive use

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides specific data on the proportion of modern contraceptive use before pregnancy among women in Kersa HDSS, Ethiopia. It also identifies factors associated with contraceptive use. However, the abstract does not provide information on the sample size or the methodology used for data collection and analysis. To improve the evidence, the abstract should include these details to enhance the transparency and replicability of the study.

Abstract

The analysis used data from Kersa Health and Demographic Surveillance System (Kersa HDSS). Kersa HDSS is operated by Kersa Demographic Surveillance and Health Research Center (KDS-HRC) under Haramaya University. The field site is located between 41°40”0’ and 41°57”30’ easting and 09°15”15’ and 09°29”15’ northing. The surveillance system is located in the eastern Hararge zone, Oromiya Regional State, Eastern Ethiopia (Fig. 1). The district (Kersa District) has three climatic zones with the altitude ranging from 1600 to 3200 m above sea level. Based on figures published by the Central Statistical Agency in 2007, the district has an estimated total population of 170,816 of whom 86,134 (50.4 %) were males and 84,682 (49.4 %) were females; 11,387 or 6.67 % of its population are Rural town dwellers. The population in the district has crude birth rate of 37.2/1000, and Total fertility rate of 5.2. The district has seven health centers at different location of the district. In addition there are seven clinic/health posts and eight private pharmacies [9]. Kersa HDSS district and the 12 Sub-districts included in the surveillance process with altitude variation Kersa HDSS was established with the aim of generating community based health and demographic events in the Eastern part of Ethiopia. The Kersa HDSS covers the whole population in 12 sub-districts of 38 sub-districts that are found in kersa, Eastern Ethiopia. At the start of the surveillance process, ethical clearance was secured from FDRE, National Ethical Clearance Board having the reference number of 3.10/313/03. Consent was obtained from the study participants after they were informed about the study, the objective, out come, benefits and risk associated with the study was given to the study participants. It is an open cohort set up in 12 sub-districts of Kersa district. The site is principally rural including two small rural town (Kersa and Weter towns). The baseline census was done in 2007and since then a continuous population updated is being done twice every 6 months. During the updates, demographic and health events registered. Data is entered into the HRS-2 relational database. At the baseline 10,168 houses and 53,481 people were registered. The sex ratio and person per household was 1 and 5.1, respectively. At the end of 2013 the population becomes 63,000. Kersa HDSS is an INDEPTH member. INDEPTH is a network of Health and Demographic Surveillance Systems (www.indepth-network.org). The system uses HRS-2 database. The software is flexible and can export selected data to other software for analysis. This analysis used data collected from women who gave birth during October, 2011 to September 2012. The data was obtained from KDS-HRC through formal request. Open access is granted after the request is evaluated by kersa HDSS team. The detail data sharing policy of Kersa HDSS can be accessed at: [http://www.haramaya.edu.et/research/projects/kds-hrc/kds-hrc-project-data/]. Data were collected by using Kersa HDSS questionnaire. The questionnaire was adopted from EDHS and other relevant research report [2]. All mothers (937) residing in Kersa HDSS who gave birth their last child and identified for maternal health surveillance were asked about their modern contraceptive utilization before they conceived their last pregnancy. Modern contraceptive were defined as using any of the following contraceptives as defined by EDHS: Voluntary Surgical Contraception (VSC), the pill, Intra Uterine contraceptive Device (IUCD), injectables, implants, male and female condoms, lactational amenorrhea method, emergency contraception, and the standard days method [7]. Age of the mother, residence, religion, maternal occupation, maternal education, partner’s education, and average monthly family income, access to media, number of children alive, and knowledge of contraceptive were used as explanatory variables. The outcome variable in this analysis is experience of modern contraceptive use before pregnancy. Modern Contraceptive use in this study refers to use of any modern contraceptive before they conceived their last child i.e. whether she had previous birth or not. Data were collected by personnel recruited for the surveillance purpose. The results were presented in the form of tables, and text using frequencies and summary statistics such as mean, standard deviation and percentage to describe the study population in relation to relevant variables. Further, to identify factors associated with the outcome variable, logistic regression analysis was performed. Variables with p value ≤ 0.2 in the bi-variate analysis were considered for multivariate logistic regression model. Variables having p value ≤ 0.05 in the multivariate analysis were taken as significant predictors. Crude and adjusted odds ratios with their 95 % confidence intervals were calculated. The Hosmer and Lemeshow goodness-of-fit test was used to assess whether the necessary assumptions for the application of multiple logistic regression were fulfilled and p value > 0.05 was considered a good fit.

Materials

N/A

Innovations

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

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and resources on maternal health, including family planning methods and contraceptive use. These apps could also provide reminders for contraceptive use and prenatal care appointments.

2. Community Health Workers: Train and deploy community health workers to provide education and counseling on family planning and contraceptive methods. These workers can reach remote areas and provide personalized support to women and families.

3. Telemedicine: Establish telemedicine services to connect women in rural areas with healthcare providers who can offer guidance on family planning and contraceptive use. This can help overcome geographical barriers and improve access to expert advice.

4. Public-Private Partnerships: Collaborate with private sector organizations to increase the availability and affordability of contraceptives in rural areas. This could involve subsidizing or providing free contraceptives through local pharmacies or clinics.

5. Religious Leaders Engagement: Engage religious leaders in promoting family planning and contraceptive use. This can help address cultural and religious barriers and increase acceptance and utilization of modern contraceptives.

6. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the benefits of family planning and contraceptive use. These campaigns can be tailored to specific communities and address misconceptions and cultural beliefs.

7. Integration of Services: Integrate family planning services with other maternal health services, such as antenatal care and postpartum care. This can ensure that women have access to comprehensive care throughout their reproductive journey.

8. Empowerment Programs: Implement programs that empower women and girls with knowledge and skills related to family planning and reproductive health. This can include education on reproductive rights, decision-making, and negotiation skills.

9. Task Shifting: Train and empower lower-level healthcare providers, such as nurses and midwives, to provide family planning services. This can help alleviate the burden on doctors and increase access to services in underserved areas.

10. Quality Improvement Initiatives: Implement quality improvement initiatives to ensure that family planning services are accessible, affordable, and of high quality. This can involve regular monitoring and evaluation, feedback mechanisms, and continuous training for healthcare providers.

AI Innovations Description

The analysis conducted in Kersa HDSS, Ethiopia aimed to assess factors associated with the use of modern contraceptives before pregnancy among women who gave birth. The study found that only 40.9% of the study participants had used modern contraceptives before their last pregnancy. The most commonly used modern contraceptive was injectable contraceptives, followed by oral contraceptives. The analysis identified several factors associated with contraceptive use. Being Muslim and being a young mother were negatively associated with modern contraceptive use, while residing in a rural town was positively associated with utilization of modern contraceptives.

Based on these findings, a recommendation to improve access to maternal health could be to increase family planning education and involve religious leaders in family planning promotion. This could help address the low utilization of modern contraceptives among Muslim women. Additionally, efforts should be made to target young mothers and provide them with information and access to modern contraceptives. Lastly, improving access to modern contraceptives in rural areas could be achieved by increasing the availability of family planning services and resources in these areas.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive family planning education programs that target women and their partners, focusing on the benefits and importance of modern contraceptives in preventing maternal mortality. This can include community outreach programs, workshops, and campaigns to raise awareness about the available contraceptive methods and their proper use.

2. Improve access to contraceptives: Ensure that a wide range of modern contraceptives are readily available and accessible to women in both urban and rural areas. This can be achieved by strengthening the supply chain management system, increasing the number of health centers and clinics that provide contraceptives, and training healthcare providers to offer quality family planning services.

3. Involve religious leaders: Engage religious leaders and community influencers in promoting family planning and dispelling misconceptions about contraceptives. This can be done through partnerships with religious institutions to incorporate family planning messages into their teachings and sermons, as well as involving them in community education programs.

4. Address cultural and social barriers: Identify and address cultural and social factors that hinder the utilization of modern contraceptives. This can involve working with community leaders and organizations to challenge harmful traditional practices and norms that discourage contraceptive use, and promoting gender equality and women’s empowerment.

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

1. Baseline data collection: Gather data on the current utilization of modern contraceptives, demographic characteristics, and socio-economic factors of women in the target population. This can be done through surveys, interviews, or analysis of existing data sources.

2. Define indicators: Identify key indicators that will be used to measure the impact of the recommendations, such as the percentage increase in modern contraceptive use, changes in maternal mortality rates, or improvements in access to family planning services.

3. Develop a simulation model: Create a simulation model that incorporates the baseline data and the potential impact of the recommendations. This model should consider factors such as population size, demographic trends, healthcare infrastructure, and socio-cultural dynamics.

4. Run simulations: Use the simulation model to project the potential impact of the recommendations over a specific time period. This can involve running multiple scenarios with different assumptions and parameters to assess the range of possible outcomes.

5. Analyze results: Analyze the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This can include assessing the changes in key indicators and identifying any potential challenges or limitations of the recommendations.

6. Refine and validate the model: Continuously refine and validate the simulation model based on new data and feedback from stakeholders. This will ensure that the model accurately reflects the real-world context and can be used as a reliable tool for decision-making.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health and make informed decisions on which interventions to prioritize and implement.

Author

Dima Health

Statistics:

Citations: 13

Identifiers:

DOI: 10.1186/s12889-016-3292-6

Research Areas:

Community Interventions, Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Cohort Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Male & Female