Impact of the village health center project on contraceptive behaviors in rural Jordan: a quasi-experimental difference-in-differences analysis

Abstract

BackgroundAppropriate contraceptive use remains a major health challenge in rural Jordan. The Japan International Cooperation Agency implemented a project aimed at enhancing the capacity of village health centers (VHCs) to improve the quality and quantity of family planning (FP) services in rural Jordan in 2016–2018. Facility- and community-based approaches were integrated into the interventions. We evaluated the project’s impacts on contraceptive behaviors and the effectiveness of the two approaches.MethodsWe used a difference-in-differences analysis based on the project baseline and endline surveys, and logistic regression analysis to assess associations between eight primary outcomes and three secondary outcomes (impacts). The unit of intervention was five target VHCs; the unit of analysis was currently married women of reproductive age (15–49 years) in five intervention and five control villages.ResultsOverall, 2061 married women participated; 83.8% were in need of FP. Compared with the control villages, significant effects, ranging from + 0.4% points (pp) to + 11.5 pp., were observed in the intervention villages for six primary outcomes in these categories: increasing the use of FP services at VHCs, participation in health promotion activities, and changing the sources of reproductive health information. There was a trend toward improved secondary outcomes in the intervention villages, but no significant differences were observed between the intervention and control villages regarding modern contraceptive use (mCU; + 4.3 pp), traditional contraceptive use (tCU; − 0.5 pp), and spousal agreement on contraception (+ 5.1 pp). mCU was positively associated with five primary outcomes: obtaining contraceptives at VHCs [adjusted odds ratio (AOR) 3.44, 95% confidence interval (CI) 1.26–9.40], education sessions at VHC (AOR 7.41, 95% CI 1.60–34.39), health activities in communities (AOR 7.41, 95% CI 3.28–16.78), counseling by private doctor/clinic (AOR 0.62, 95% CI 0.40–0.97), and information gained through TV (AOR 0.50, 95% CI 0.32–0.76). Spousal agreement on contraception showed similar positive trends. tCU was associated only with TV.ConclusionsThe project had impacts on increased mCU and husbands’ perception of contraception in rural Jordan. The integration of facility- and community-based approaches may be effective in shifting from tCU to mCU in other rural areas.

Demand for family planning satisfied with modern methods and its associated factors among married women of reproductive age in rural Jordan: A cross-sectional study

“…Before the project, most VHCs could not provide family planning services. The details of the project design can be found in our study published elsewhere [12]. The study team selected Irbid Governorate as the study site because no similar assistance from other donors had been implemented there before this project.…”

“…The second stage involved selecting households by systematic random sampling in each village, using the household frame of the 2015 Jordan Census which was the same as the methodology used in the JPFHS 2012 [8]. The sampling allocation is shown in S1 Table of the Supporting information, and more detailed sampling procedures can be found in our previous study [12]. When a household did not contain a woman eligible for participation, the household was replaced by the nearest one.…”

“…The sample size was calculated based on the following assumptions: 50% CPR detection based on JPFHS 2012 at 95% confidence level (CI) and 80% power. The minimal sample size was then determined to be 384 [12]. In addition, assuming that 80% of the interviewed women have a need for modern contraception, the required sample size was 480 individuals.…”

“…In addition, assuming that 80% of the interviewed women have a need for modern contraception, the required sample size was 480 individuals. The original sample size for the purpose of the project of 1000 in total, covered our required sample size [12].…”

Impact of Integrating Family planning with Maternal and child health on uptake of contraception: A Quasi-Experimental Study in Rural Pakistan

“…Although there was no specific indicator measuring the adolescent group in this study those adolescents who benefitted did in effect trickle their knowledge to their own families and to others within the community. Other studies also showed this pattern in spreading health related information and awareness through adolescent awareness and participation [25], [26].…”