Contraceptive Use

Making universal access to sexual and reproductive health care a reality, and thus building momentum for comprehensive family planning by 2030, is key for achieving sustainable development goals. However, in the last decade, India has been retreating from progress achieved in access to family planning. Family planning progress for a large country such as India is critical for achieving sustainable developmental goals. Against this backdrop, the paper investigated the question of how far family welfare expenditure affects contraceptive use, sources of contraceptive methods, and method-mix using triangulation of micro and macro data analyses. Our findings suggest that, except for female sterilizations, modern methods of contraception do not show a positive relationship with family welfare expenditure. Notwithstanding a rise in overall family welfare expenditure, spending on core family planning programs stagnates. State-wise and socio-economic heterogeneity in source-mix and method-mix continued to influence contraceptive access in India. Method-mix continued to skew towards female sterilization. Public sector access is helpful only for promoting female sterilization. Thus, the source-mix for modern contraceptives presents a clear public-private divide. Over time, access to all contraceptive methods by public sources declined while the private sector has failed to fill the gap. In conclusion, this study identified a need for revitalizing family planning programs to promote spacing methods in relatively lower-performing states and socio-economic groups to increase overall contraceptive access and use in India through the rise in core family planning expenditure.
Keywords: contraceptive use; family welfare expenditure; sources of contraception; method-mix; India

Iran has experienced a dramatic decline in fertility in recent decades, but limited access to legal abortion continues to lead many women whose pregnancies are unwanted or mistimed to undergo clandestine, unsafe abortions. No official data on the abortion rate in Iran have been collected, however. This study uses the 2000 Iran Demographic and Health Survey to estimate the abortion rate for the country as a whole and for specific regions, and to explore the role of contraceptive use and religiosity in explaining regional variations in abortion rates. We estimate the total abortion rate for the country to be 0.26 abortions per married woman, and the annual general abortion rate to be 7.5 abortions per 1,000 married women aged 15–49. We find that the negative effect of modern contraceptive use on the abortion rate is 31 percent greater than the negative effect of religiosity, and we highlight the implications of these findings for policies on reproductive health and family planning.

Just over 20% of white women in America will never bear children, the highest percentage in modern history.  Only half of this group-10% of women without children- are considered infertile.  Many women in the fertile but childless group are voluntarily so:  the self-proclaimed childfree.

Yet despite the growing acceptability in remaining a childfree adult, doctors are resistant to sterilizing women without children. Access to sterilization is usually repeatedly denied, often with tactics of humiliation, hoop jumping, or second-guessing the legitimacy of the patient’s desire for sterilization, despite the legal status of voluntary sterilization for any competent person over the age of 21- regardless of parity.     

This paper will examine the many reasons why a woman who does not have children would want to continue in her childfree lifestyle, evaluate the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization- both from the woman’s and the physicians’ perspective, and assess the legal status of voluntary sterilization for nonparous women. The paper will conclude that sterilization for childfree women is an ethical, legal option and that willing doctors should follow recommended guidelines for counseling women who desire sterilization, and urge hesitant doctors to reconsider their oppositions to voluntary sterilization for childfree women and provide the contraception of preference to women.

Having unprotected sex with multiple sexual partners (MSP) is the greatest risk factor for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among youths. Young people with MSPs are less likely to use a condom and the greater the risk for STIs. This study examines the associated risk factors of STIs and multiple sexual partnerships among youths aged 15–24 years. Data and methods; The Malawi Demographic Health Survey 2010 data was used. Out of a sample of 2,987 males and 9,559 females aged 15–24 years, 2,026 males and 6,470 females were considered in the study. Chi square test and logistic regression techniques were performed. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 22. Findings; The results indicate that 1,399 (69.0%) males and 2,290 (35.4%) females reported multiple sexual partnerships (MSP). Within the rural area, females (n = 1779) were more likely to report MSP than males (n = 1082) and within the urban areas, a higher proportion of females (n = 511) still reported MSP, with males (n = 316). About 78% rural females aged 20–24 years, and about 79% rural males aged 15–19 years reported MSP. The likelihood of MSP was higher among females in the poorest households (OR = 1.31), being married (OR = 5.71) and Catholic males (OR = 1.63), who were married (OR = 1.59). Catholic males (OR = 1.82) in the rural areas, who were married (OR = 1.80) and rural females in the northern region (OR = 1.26) were more likely to have MSP. The odds ratios were higher among urban females in the poorest (OR = 3.45) households who were married (OR = 4.22). Conclusion; Having more than one sexual partner increases the risk of STIs and sexuality education programs should be introduced that emphasize the danger that surrounds MSP.

Background: The aim was to assess the risk of venous thromboembolism (VTE) associated with use of combined
oral contraceptives (COCs) in women with a family history of VTE.
Methods: The study is a Swedish nationwide case-control study based on the Multigeneration register, the
Swedish Hospital Discharge Register, the Outpatient Care Register, and the Swedish Prescribed Drug Register.
Cases (n = 2,311) were non-pregnant Swedish women aged 15-49 with first VTE diagnoses between January
2006 and December 2010. Five controls without VTE were matched to each case on age and education level.
Conditional logistic regression examined the associations with VTE with determination of odds ratio (OR) for
first VTE diagnosis. Effect modification was assessed by interaction testing.
Results: Both among controls (14.6 % vs. 4.5 %; p < 0.0001) and cases (27.2 % vs. 8.8 %; p < 0.0001) COC use
was more common in women without a family history of VTE compared with women with a family history of
VTE. In a multivariate conditional logistic regression model the OR for VTE was 2.53 (95 % CI 2.23-2.87) for
COC users and 2.38 (2.09-2.71) for individuals with a family history of VTE. The OR for VTE for COC users with
a family history of VTE was 6.02 (5.02-7.22). There was no significant interaction between family history of VTE
and COC use (OR 0.92, 0.57-1.46).
Conclusions: Family history of VTE is a risk factor for VTE in women using COCs. The low prevalence of COC
use among women with a family history of VTE suggests that family history of VTE is considered when COCs
are prescribed in Sweden. The present study may therefore even underestimate the importance of family
history of VTE. The lack of interaction indicates that the risk of COC use in

Background: Estimates of unplanned pregnancy worldwide are of concern, especially in low and middle-income countries, including Brazil. Although the contraceptive prevalence rate is high in Brazil, almost half of all pregnancies are reported as unintended. The only source of nationally representative data about pregnancy intention is the Demographic and Health Survey, as with many other countries. In more recent years, however, it has been realized that concept of unintended pregnancy is potentially more complex and requires more sophisticated measurement strategies, such as the London Measure of Unplanned Pregnancy (LMUP). The LMUP has been translated and validated in other languages, but not Portuguese yet. In this study, we evaluate the psychometric properties of the LMUP in the Portuguese language, Brazilian version. Methods: A Brazilian Portuguese version of the LMUP was produced via translation and back-translation. After piloting, the mode of administration was changed from self-completion to interviewer-administration. The measure was field tested with pregnant, postpartum, and postabortion women recruited at maternity and primary health care services in Sao Paulo city. Reliability (internal consistency) was assessed using Cronbach's alpha and item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Scaling was assessed with Mokken analysis. Results: 759 women aged 15–44 completed the Brazilian Portuguese LMUP. There were no missing data. The measure was acceptable and well targeted. Reliability testing demonstrated good internal consistency (alpha = 0.81, all item-rest correlations >0.2). Validity testing confirmed that the measure was unidimensional and that all hypotheses were met: there were lower LMUP median scores among women in the extreme age groups (p < 0.001) , among non-married women (p < 0.001) and those with lower educational attainment (p < 0.001). The Loevinger H coefficient was 0.60, indicating a strong scale. Conclusion: The Brazilian Portuguese LMUP is a valid and reliable measure of pregnancy planning/intention that is now available for use in Brazil. It represents a useful addition to the public health research and surveillance toolkit in Brazil.

Using data from all three rounds of the National Family Health Survey, this study examines the trends and determinants of unmet need for family planning in the state of Bihar. Bivariate analysis was carried out to examine the level and trends of unmet need for family. Binary logistic regression was used to examine the factor affecting unmet need for family planning. About 25% of the currently married women, aged 15 -49 years, in Bihar at present have an unmet need for family planning services, 11% for spacing and 12% for limiting. Only 18% of total demand for spacing methods is met compared to about 72% of total demand for limiting methods. The unmet need for family planning among Muslim (32%), rural (24%) and adolescent (36%) and poor women (26%) is relatively higher than other groups. "Religious prohibition" and "husband opposed" were the main reasons for not using contraception. A considerable proportion of older women (45 -49 years) and those living in urban areas cited method-related reasons. About 86% of Muslim women cited opposition to use as the main reason for not using family planning. The same is also substantiated by logistic regression analysis where the odds of unmet need were significantly higher among Muslim women (OR = 1.88; p < 0.05). Women from Other Backward Castes (OR = 0.74; p = 0.05) and rich households (OR = 0.55; p = 0.00) had lower odds of unmet need for family planning. The results highlight the need of an effective implementation of information, education and communication activities in the communities and improvement in the quality of advice and care services related to family planning. Family planning policies and programs in Bihar should focus on reaching out to the women from disadvantaged groups such as adolescent, Muslim, poor and Scheduled Caste.

Fertility in Ghana has fallen sharply in recent years, with the rate of decline being one of the most rapid in Sub-Saharan Africa. Ghana's fertility decline has coincided with an increase in the percentage of women of reproductive age reporting exposure to family planning messages via the media, a rise in the education of women of reproductive age, and a decline in under five mortality. This paper presents a multilevel, multinomial analysis of the 1998 Ghana Demographic and Health Survey data to investigate the effects of exposure to family planning messages on the type of method of contraception a woman uses. A multilevel logistic model is used to investigate the effects on fertility. The results show exposure to family planning messages via the radio and printed sources substantially increase use of modern contraception. Secondary-level education, urban residence, a large number of surviving children, and being aged 20-34 are other factors associated with increased use of modern contraception. However, exposure to family planning messages appears not have significant effects on fertility.

Objective: To examine the association of contraceptive use in the interpregnancy interval with subsequent child health outcomes in low-and middle-income countries. Design: A cross-sectional analysis of nationally representative household samples was performed. A modified Poisson regression model was used to estimate unadjusted and adjusted relative risk ratios for high prevalence outcomes. Setting: Low-and middle-income countries. Population: Births to women aged 12-49 years for which this birth occurred 12-79 months prior to the interview were included. The sample for analysing infant mortality was comprised of 453,795 children from 35 low-and middle-income countries across 67 Demographic and Health Surveys conducted between 1990 and 2011. Main Outcome Measures: Infant mortality, stunting, underweight, wasting, diarrhoea, and anaemia. Results: Contraceptive use in the interpregnancy interval, even if contraceptive failure resulted in birth, had a positive effect on all child health outcomes compared to non-use of contraception in the interpregnancy interval. The positive effect of contraceptive use was the lengthening of the interpregnancy interval, but it also had a direct positive effect on child health, independent of birth interval. Conclusions: Extending the interval between births had a positive effect on child health outcomes, and contraceptive use had a positive effect on child health independent of the birth spacing effect. Additionally, contraceptive failure did not adversely affect child health outcomes.

The evidence concerning contraceptive use/nonuse, choice of method and adherence to regimen may help to guide clinical and public health education programs and policies to provide optimal contraceptive choice and to optimize adherence thereby reducing unintentional pregnancy.Contraceptive use among married women in Rural kerala is a less explored area by researchers. To study the pattern of use of contraceptive methods among married women of reproductive age group (15-49yrs) in Vembayam panchayath, a rural panchayath in Kerala and to understand attitudes towards different contraceptive methods and the reason for choosing a contraceptive method. This is a cross sectional study done among 135 women, by house to house survey using structured questionnaire. 71.1% of the study participants were using contraceptive methods, and of these 58.5% had sterilization, 5.9% were using condoms and rest of them using other different methods. 37.8% had selected their contraceptive preference without any expert guidance. Female sterilization remains the widely accepted method as a contraceptive method among women in rural areas of Kerala.

Sexual activity, sexuality and responses to HIV and AIDS in a rural context in South Africa were studied using a cultural-historical activity theory framework. Activity theory directs the focus onto activity and emphasises the importance of an historical perspective for understanding current preventative practices. Qualitative data were generated from interviews and focus groups with 45 male and female participants between 10 and 71 years of age. An activity system analysis illustrated critical historical
changes in a mediational artefact (the form of contraception) in sexual activity. The shift
from intercrural sex to the use of the injectable contraceptive set up particular
conditions for condom use in response to HIV and AIDS.

Background: Use of contraceptives improves individual and national health outcomes and indices as it prevents
maternal mortality and morbidity, child mortality, incidence of sexually transmitted infections and retains adolescents
and young girls in school with improvement in the economic earning power. Contraceptive Logistics is the supply of
contraceptives in the right quantity and quality at the right place at the right time for the right cost to the right people.
The Contraceptive Logistics Management System in Nigeria stipulates that to ensure uninterrupted product availability
and minimal stock out, Family Planning Service Delivery Points (SDPs) are to be re-supplied on a bi-monthly basis to
bring their stock level to a maximum of 4 months of stock at any given time.
Method: A retrospective analysis of the impacts of the three logistic models operational in six southern states in Nigeria
under the auspice of UNFPA funded family planning logistics supply chain. Three outcomes of interest used to asses the impacts were stock out rates, gaps in supply and proportion of new users of contraceptives. The three models of family planning logistics reviewed were direct government last mile distribution with external funding, direct government last mile distribution without external funding and a third party private logistic company last mile  distribution
Result: The stock out rates for the direct government logistics with external funding was 6-20%, the direct government logistics last mile distribution (LMD) without external funding had a stock out rate of 20-58% and the private logistic company last mile distribution had a stock out rate of 10-30%. In terms of the gap in supply, the supply gap with the direct government LMD with external funding model was 48%, while the direct government LMD with no external funding model had a supply gap of 73% and the private company LMD logistics model had a low supply gap of 28%. The proportion of FP users who were new users was 19% in the direct government LMD with external funding, 8% in direct government LMD without external funding, and 16% in private logistic company LMD.
Discussion: Direct government last mile distribution (LMD) with external funding reached the highest number of new FP users followed by private logistic company LMD and therefore contributed the greatest to the reduction of unmet need in family planning and increasing the contraceptive prevalence rates. The highest stock out rate of contraceptives was associated with direct government LMD without external funding and the least stock out rate was associated with
same direct government LMD but with external funding. The greatest gap in supply of contraceptives was seen with direct government LMD without external funding followed by direct government LMD with external funding. Private company LMD had the least supply gap in contraceptives.

Contraceptive use among women remains an important public health intervention. Imperatively, the equality of family planning access between rural and urban areas allows all women to have the same opportunities to receive family planning service towards better well-being of families. The study aims at comparing the family planning preferences among women aged 15 to 49 throughout Malaysia in 2018 according to the geographical locations of rural and urban areas. This is important for resource planning and allocation to the National Population and Family Development Board (NPFDB) clinic based on the locations. The data were collected from 49 NPFDB clinics throughout Malaysia. A total of 3668 married women aged 15 to 49 years used the family planning service in this NPFDB clinic in 2018. In this study, descriptive, Chi-Square, and logistic regression analyses were carried out to compare the patterns and preferences of contraceptive use. The results analysis shows that implant is the most popular method among all other contraceptive methods provided by the NPFDB clinics. Specifically, in both rural and urban areas, the three most popular contraceptive methods among married women in Malaysia in 2018 are implant, pill, and condom. Findings of the analysis based on the Chi-Square test show that age group, education levels, and different types of contraception methods were identified to have a significant association with the locations of either rural or urban areas. In conclusion, this study found that women who used implants as a method of contraceptives were often younger, better educated, and lived in an urban area. Therefore, the family planning providers especially NPFDB clinics play a key role in providing information, educating couples, and promoting the use of different family planning methods so that better family well-being could be achieved.

Background: Contraceptive failure increases the chances of pregnancy termination, including both induced abortions and spontaneous terminations. Proper separation requires accounting for competing risks of pregnancy outcomes. Objective: To measure the differential risk of spontaneous termination and induced abortion according to contraceptive use prior to pregnancy based on pooled Demographic and Health Survey calendar data. Methods: We use multinomial logistic models controlling for demographic and socioeconomic variables to estimate the differential risk of spontaneous termination and induced abortion according to contraceptive use at the time of pregnancy. We address data limitations including recall error, omission error, and possible misclassification of outcomes. Results: We find higher risk of induced abortion (RRR = 7.18, CI = 6.38–8.09) and spontaneous termination (RRR = 1.38, CI = 1.13–1.69) after contraceptive failure, with stronger effect for women under 30. Parity, union status, education, and wealth have a strong effect on induced abortion. Regarding spontaneous termination, age mainly explains the increased risk. Conclusions: Since pregnancies following contraceptive failure are less likely to end in a live birth, aggregate models of the impact of family planning should reflect that contraceptive use and induced abortion conform interdependent strategies and that spontaneous termination is a competing risk of induced abortion. Contribution: This is the first study reporting differences in the risk of spontaneous termination and induced abortion according to contraceptive use prior to pregnancy. We account for competing risks using a multinomial logit model of pregnancy outcomes conditional on pregnancy, new in the literature. Data limitations are addressed in novel ways.

This study investigated the socioeconomic determinants of contraceptive use among women of reproductive age in Tarauni local government area of Kano state, Nigeria. The research used descriptive survey design to collect and analyse cross sectional data from the study population with the aid of structured questionnaire that was validated. The population of this study comprised of Women of Reproductive Age-15-49 living in urban and rural parts of the study area. A total of one hundred and twenty (120) participants, selected through simple and systematic random sampling technique participated in the study. The study data was analysed with SPSS version 20 and presented as frequency tables and simple percentage, while chi-square statistics was used to answer the formulated research hypotheses at a 0.05 level of significance. The findings of this study indicate that religion, cultural norms and occupational status of the woman are strongly associated with the use of family planning by women of reproductive age. However, level of education was not significantly associated with the use of contraceptive in this study. The study recommends that interventions targeting Muslims should recognise the diversity among sects and be more targeted; Family planning messages should target and address cultural beliefs and norms including gender roles that hinder use of contraceptive method among women of reproductive age. Government should provide income generating opportunity for women and expand service delivery points with adequate and affordable products and services to encourage use.

This study aimed to compare complete blood cell parameters obtained using the automated XN-1000 analyzer with those
obtained by manual methods at the Kenyatta National Hospital hematology laboratory. About 110 samples were obtained from
patients requesting complete blood count (CBC) test that were used in this study. Automated CBC test was done on Sysmex
XN-100 hematology analyzer and validated against peripheral blood slide films read by a qualified lab technologist. Obtained
data were analyzed using STATA v13 and the two methods compared using t-test and correlation. The study results showed a
strong positive correlation between the automated and manual reader (p<0.001). However, basophil readings had a negative
correlation for the two methods. A statistically significant difference was noted in neutrophil (p=0.013), monocyte (p<0.001)
eosinophil (p=0.054) and MCHC (p<0.001) readings. The automated analyzer was unable to detect abnormal cell types. The
study concluded that Peripheral blood film proved superior in detection of abnormal blood cells though the automated analyzer
was able to handle a bigger workload and reduce the turnaround time. In view of the results, it is important to confirm results
flagged by the automated analyzer using manual PBF.

Background: Bangladesh had an official Family Planning (FP) programme beginning in 1960. Bangladesh has experienced a sevenfold increase in its Contraceptive Prevalence Rate (CPR) in less than forty years from 8% in 1975 to 62% in 2014. However, despite this progress, almost one-third of pregnancies are still unintended which may be attributed to unmet need for family planning and discontinuation and switching of methods after initiation of their use. To find out the acceptance of contraceptive devices among female in rural area of Bangladesh and its relation with their educational level. Methods : A cross sectional descriptive study of fifteen days' duration was conducted among female in rural area of Bangladesh. Participants not willing to respond and pregnant women were excluded. Total of 120 women were selected as study participants. Every woman was interviewed face to face with pre-tested questionnaire after taking informed consent. Results: About 46.92% were age group 26 to 35 years and 11.11% were age group more than 36 years of age, 83.96% were Muslim and 14.81% were Hindu. Maximum (83.96%) were married. About 37.04% were upto class V and 1.23% were SSC passed. About 27.16% were class VI to X. About 60.49% duration of married life 1 to 10 years and 1.23% married life 30 to 40 years. 86.42% were use contraceptive device, among them 34.43% were use condom and 3.28% were used IUD. About 43.33% respondents suffer from irregular menstruation and 25% from menorrhagia, 20.84% weight gain. About 46.66% respondents had 2 children and 4.16% had no child. Conclusion: A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies in order to ensure the adherence to and provision of the most appropriate contraceptive method for couples.

This study examined the effectiveness of contraceptive measures as means of child spacing methods among the civil servants of reproductive age in Ibadan. The research design used was a descriptive research design. A total number of 110 senior cadre civil servants and 40 junior cadre civil servants making a total of 150 civil servants were selected using accidental sampling technique. A self-structured questionnaire 'effectiveness of contraceptive measures for child spacing methods among civil servants tagged 'CMCSCS' was used. A validated questionnaire by experts with a reliability level of 0.78 was used. Simple percentages and inferential statistic of t-test was used to test the hypothesis at 0.05 level of significance. The findings revealed that the senior cadre civil servants had the knowledge of child spacing from friends, parents and colleagues while the junior cadre identified friends and parents. Very many of the senior cadre used safe periods and withdrawal system among other contraceptives. The results also showed that the major reason why junior cadre space their children was to assist in limiting the size of the family due to their income, while the senior cadre identified many reasons. Further finding showed that there was a significant difference in the type of contraceptive measures used by the senior cadre and junior cadre civil servants. It is recommended that the civil servants should be educated on the need to adopt the effective contraceptive measures.

The United States has long grappled with the question of how to maintain an appropriate combination of religion and politics in the public sphere. The current electoral cycle is no different, as Presidential candidates attempt to negotiate both the political and religious landscapes. This essay introduces a special forum on rhetoric and religion in contemporary politics and touches on some recent instances of how religious differences have played out in the current political environment. Some of the issues discussed include the separation of church and state, Mitt Romney’s membership in the Church of Jesus Christ of Latter-day Saints (Mormons), Rick Santorum’s conception of the “war on religion,” and the controversy over contraceptives at religious institutions and Rush Limbaugh’s attacks on a Georgetown law student.