Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study

Sarnak, Dana O.; Gummerson, Elizabeth; Wood, Shannon N.; OlaOlorun, Funmilola; Kibira, Simon P. S.; Zimmerman, Linnea; Anglewicz, Philip

doi:10.1016/j.conx.2022.100077

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…We found that there are a substantial number of women in this part of Nepal who use (or do not use) contraception without their partner's knowledge at some point within their marriage, as has been documented in many other settings (Sarnak et al. 2022). This may be especially true for women with lower levels of empowerment or higher levels of relationship precarity due to gender status inconsistency in the relationship.…”

Section: Discussionsupporting

confidence: 67%

More than Measurement Error: Discrepant Reporting of Contraceptive Use and the Role of Wives’ and Husbands’ Educational Attainment

Jennings¹,

Pierotti

2023

Studies in Family Planning

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This paper describes discrepancies in spouses’ reports of the use of female‐controlled, nonvisible contraceptive methods using data from rural Nepal that were collected monthly from both spouses of 822 couples between 2008 and 2016. We find that spouses in about half of couples provided discrepant reports during the period of observation, and these discrepancies occurred in 14 percent of the months of observation. We then investigate these discrepant reports as possible indicators of incomplete transparency regarding reproductive choices and examine whether they are associated with wives’ education and spouses’ relative education levels. We find, first, that wife's educational attainment was negatively associated with discrepant reports of contraceptive use, independent of spouses’ relative educational attainment. At the same time, these models suggest that educational differences between husbands and wives were associated with discrepant reports. Couples in which wives had more education than their husbands faced greater odds of discrepant reports of contraceptive use, relative to couples in which spouses had similar education. Among couples in which husbands had more education than wives odds of wife‐only reporting were lower, relative to couples with similar levels of education. These findings offer important new insights into spousal dynamics that may influence transparency regarding contraceptive use.

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Section: Discussionsupporting

confidence: 67%

More than Measurement Error: Discrepant Reporting of Contraceptive Use and the Role of Wives’ and Husbands’ Educational Attainment

Jennings¹,

Pierotti

2023

Studies in Family Planning

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“…Additionally, the contrast observed from this study’s findings in relation to the regression effects of women’s fertility preferences at the individual and community levels may show that within households, the covert use of MC may be very prevalent. This is a long-standing strategy known to be used by women to meet their NFP, especially within contexts where systemic power and gender norms put men in the dominating position in terms of reproductive decision-making, as seen within Nigeria [ 62 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique

Odjesa,

Okonofua

2024

PLoS ONE

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Background Given the health and economic benefits of family planning (FP), Nigeria’s very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria. Materials and methods A multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities. Results The mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women’s husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women’s empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of ‘1’, signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities. Conclusions Our study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.

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“…While expanding access to SRH self-care is crucial, it is important to underscore that not all people want to use SRH methods and tests themselves and some prefer to have some level of interaction with a healthcare provider. For example, people who desire covert contraceptive use, possibly due to partner opposition or fears of gender-based violence, may want to obtain their method at a facility [ 35 ]. Also, as noted by one KI in this study, specific populations, such as people who sell sex, may not prefer SRH self-care for privacy and stigma-related reasons.…”

Section: Discussionmentioning

confidence: 99%

Perspectives on sexual and reproductive health self-care among women, healthcare providers, and other key informants: a mixed-methods study in South Africa and Zambia

et al. 2023

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Background “Self-care” for sexual and reproductive health (SRH) includes contraceptive methods and other supplies that people can use with or without the support of a healthcare provider. Self-administered tests, self-injection of injectable contraception, or self-removal of intrauterine devices (IUDs) can increase people’s access to and autonomy over their own SRH. Objectives of this study were to assess women’s current interest in and use of SRH self-care and explore key informants’ (KI) opinions of self-care, especially during the COVID-19 pandemic. Methods Data for this study came from female participants in the longitudinal Contraceptive Use Beyond ECHO (CUBE) study, and KIs, including healthcare providers, in South Africa and Zambia between September 2020 and June 2021. For this analysis, we used data from a participant phone survey (n = 537), and from in-depth interviews (IDIs) completed with a sub-sample of women (n = 39) and KIs (n = 36). Survey data were analyzed with descriptive statistics, and IDI data were analyzed using applied thematic analysis. Results Female survey participants in South Africa were more interested in learning about emergency contraceptive pills, subcutaneous injectable contraception, and CycleBeads, while Zambian participants wanted more information and access to condoms. However, in IDIs in both countries, women described minimal experience with self-care beyond condom use. In the Zambian KI IDIs, COVID-19 led to increased self-care counseling on subcutaneous injectable contraception and HIV self-testing. KIs who do not counsel on self-care were concerned that women may harm themselves or blame the provider for difficulties. Two KIs thought that women could possibly self-remove IUDs, but most expressed concerns. Reported barriers to self-care included COVID movement restrictions, transport costs, lack of accessible pharmacies, women’s low awareness, and possible stigma. Conclusions Women surveyed reported interest in learning more about SRH self-care methods and resources, but in IDIs did not report extensive previous use besides condoms. KIs described some concerns about women’s ability to use self-care methods. Counseling on and provision of self-care methods and supplies may have increased during the COVID-19 pandemic, but ensuring that self-care is more than just a temporary measure in health systems has the potential to increase access to SRH care and support women’s autonomy and healthcare needs.

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Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study

Cited by 6 publications

References 21 publications

More than Measurement Error: Discrepant Reporting of Contraceptive Use and the Role of Wives’ and Husbands’ Educational Attainment

More than Measurement Error: Discrepant Reporting of Contraceptive Use and the Role of Wives’ and Husbands’ Educational Attainment

An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique

Perspectives on sexual and reproductive health self-care among women, healthcare providers, and other key informants: a mixed-methods study in South Africa and Zambia

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