family planning

We investigated factors associated with unintended index pregnancy, unmet contraceptive need, future pregnancy intention and current contraceptive use among Malawian women living with HIV in the Option B+ era. Women who tested HIV positive at 4–26 weeks postpartum were enrolled into a cross-sectional study at high-volume under-5 clinics.  We enrolled 578 HIV-positive women between May 2015-May 2016; median maternal age was 28 years (y), median parity was 3 deliveries, and median infant age was 7 weeks. Overall, 41.8% women reported unintended index pregnancy, of whom 35.0% reported unmet contraceptive need and 65.0% contraceptive failure. High prevalence of unintended index pregnancy and unmet contraceptive need among HIV-positive women highlight the need for improved access to contraceptives. To help achieve reproductive goals and elimination of MTCT of HIV, integration of family planning into HIV care should be strengthened to ensure women have timely access to a wide range of family planning methods with low failure risk.

Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the method remains underused and poorly integrated in family planning programming. Data from 15 focus group discussions conducted in 2016 among women aged 15–35 were used to examine awareness and perceptions of, and attitudes toward, emergency contraceptives. Emergency contraceptive pills have the potential to address gaps in the family planning method mix in the DRC. Assessing whether women have incomplete or erroneous information about family planning methods can provide better understanding of women's contraceptive choices in low-income countries.

The objective of this study is to explore selected pharmacies' readiness to serve women seeking emergency contraception (EC). This study used a mystery client (MC) methodology to visit 73 pharmacies in Kinshasa, Democratic Republic of Congo (DRC). Findings indicate that more than two-thirds of EC providers were knowledgeable about EC dosage, timeframe, and side effects, and 90% were deemed helpful towards novice EC users. Rare but glaring misconceptions about EC timeframe (20% of providers) and long-term side effects (4% of providers), as well as frequent stock-out (22%) and cost issues highlight priorities for programmatic improvements. As new service delivery strategies are explored to complement the uneven network of health structures in DRC, this study suggests that, given proper training and integration in FP programming, private-sector pharmacies have the potential to meet specific contraceptive needs for women living in Kinshasa.

The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics. Motives for discontinuation reflect findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

We sought to reduce the service needs of people living with HIV by increasing referral coordination for HIV and family planning, measured as network density, with an organizational network approach. We conducted organizational network analysis on two networks in sub-cities of Addis Ababa, Ethiopia. There were 25 organizations in one sub-city network and 26 in the other. This quasi experiment demonstrated that (1) an organizational network analysis can inform an intervention, (2) a modest network strengthening intervention can enhance client referrals, (3) improvement in client referrals was accompanied by a decrease in patient-reported unmet needs and (4) a series of network analyses can be a useful evaluation tool.

Our objective in this study was to identify the missed opportunities for the integration of HIV care and family planning services and to inform future network strengthening. In two sub-cities of Addis Ababa, we identified each organization providing either HIV care or family planning services. We interviewed representatives of each of them about exchanges of clients with each of the others. With network analysis, we identified network characteristics in each sub-city network, such as referral density and centrality; and gaps in the referral patterns. Representatives from the networks confirmed the results reflected their experience and expressed an interest in establishing more links between organizations. Because of organizations not working together, women in the two sub-cities were at risk of not receiving needed family planning or HIV care services. Facilitating referrals among a few organizations that are most often working in isolation could remedy the problem, but the overall referral densities suggests that improved connections throughout might benefit conditions in addition to HIV and family planning that need service integration.

To better meet women's emergency contraceptive needs and to contribute to the limited knowledge base regarding this method in Africa, this study examines data from a sample of EC users drawn from a large, representative household survey that included sexually experienced women in urban Kenya and Nigeria. Bivariate and multivariate analyses reveal greater knowledge of EC among these urban women than was reported in other nationally representative surveys. Recent users of EC were more likely to be in their 20s, unmarried, and more highly educated than never users or ever users of EC in both countries. Results contradict public perceptions of EC users as young adolescents and indicate the importance of strengthening EC provision in Africa, including targeting information and services to unmarried women and supporting private pharmacies in delivering quality services.

This systematic review of 58 observational studies identified hypothetical causal mechanisms explaining the effects of short and long intervals between pregnancies on maternal, perinatal, infant, and child health, and critically examined the scientific evidence for each causal mechanism hypothesized.