During the past two decades, estimates of unmet need have become an influential measure for assessing population policies and programs. This article recounts the evolution of the concept of unmet need, describes how demographic survey data have been used to generate estimates of its prevalence, and tests the sensitivity of these estimates to various assumptions in the unmet need algorithm. The algorithm uses a complex set of assumptions to identify women: who are sexually active, who are infecund, whose most recent pregnancy was unwanted, who wish to postpone their next birth, and who are postpartum amenorrheic. The sensitivity tests suggest that defensible alternative criteria for identifying four out of five of these subgroups of women would increase the estimated prevalence of unmet need. The exception is identification of married women who are sexually active; more accurate measurement of this subgroup would reduce the estimated prevalence of unmet need in most settings.
Background While most unintended pregnancies occur because couples do not use contraception, contraceptive failure is also an important underlying cause. However, few recent studies outside of the United States have estimated contraceptive failure rates, and most such studies have been restricted to married women, to a limited number of countries and to 12-month failure rate estimates. Methods Using self-reported data from 43 countries with Demographic and Health Survey data, we estimated typical-use contraceptive failure rates for seven contraceptive methods at 12, 24 and 36 months of use. We provide a median estimate for each method across 43 countries overall, in seven subregions and in individual countries. We assess differences by various demographic and socioeconomic characteristics. Estimates are not corrected for potential errors in retrospective reporting contraceptive use or potential underreporting of abortion, which may vary by country and subgroups within countries. Results Across all included countries, reported 12-month typical-use failure rates were lowest for users of longer-acting methods such as implants (0.6 failures per 100 episodes of use), intrauterine devices (1.4) and injectables (1.7); intermediate for users of short-term resupply methods such as oral contraceptive pills (5.5) and male condoms (5.4); and highest for users of traditional methods such as withdrawal (13.4) or periodic abstinence (13.9), a group largely using calendar rhythm. Conclusions Our findings help us to highlight those methods, subregions and population groups that may be in need of particular attention for improvements in policies and programs to address higher contraceptive failure rates.
Despite renewed interest in postpartum family planning programs, the question of the time at which women should be expected to start contraception after a birth remains unanswered. Three indicators of postpartum unmet need consider women to be fully exposed to the risk of pregnancy at different times: right after delivery (prospective indicator), after six months of amenorrhea (intermediate indicator), and at the end of amenorrhea (classic indicator). DHS data from 57 countries in 2005-13 indicate that 62 percent (prospective), 43 percent (intermediate), and 32 percent (classic) of women in the first year after a birth have an unmet need for contraception (40 percent when including abstinence). While the protection afforded by postpartum abstinence and lactational amenorrhea lowers unmet need, further analysis shows that women also often rely on these methods without being actually protected. Programs should acknowledge these methods' widespread use and inform women about their limits. Also, the respective advantages of targeting the postnatal period, the end of six months of amenorrhea/exclusive breastfeeding, or the resumption of sexual intercourse to offer contraceptive services should be tested.
Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low‐income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes of contraceptive use from 15 DHSs conducted between 1992 and 2014. We estimate contraceptive method‐specific 12‐month failure rates. We also examined how failure rates vary by age, education, socioeconomic status, contraceptive intention, residence, and marital status using multilevel piecewise exponential hazard models. Our failure rate estimates are significantly lower than results from the United States and slightly higher than previous studies that included more DHS surveys, including some with lower‐quality data. We estimate age‐specific global contraceptive failure rates and find strong, consistent age patterns with the youngest users experiencing failure rates up to ten times higher than older women for certain methods. Failure also varies by socioeconomic status, with the poorest, and youngest, women at highest risk of experiencing unintended pregnancy due to failure.
Although studies have quantified the costs of cancer treatment, few have evaluated the widespread impact of cancer costs on the family unit. Specifically, little is known regarding how cancer affects patients and their families financially, and how they cope with these costs. The purpose of this descriptive study was to explore the financial impact of cancer care in neuro-oncology. Content analysis was used to examine data from interviews with 20 adults receiving treatment for a primary malignant brain tumor. Participants were recruited from across the United States through an advertisement in a national support group newsletter. Four major themes were identified -"paying for medication/healthcare", "strategies to offset costs", "impact of cancer costs", and "fear/uncertainty". Within the major themes several sub-themes were also recognized. In the theme of paying for medication/healthcare, participants emphasized sub-themes such as frustrations over "not qualifying/red tape" and being "thankful" for what was covered. Some of the strategies used to offset cancer costs included "cashing in" and relying on "family/friends" for financial support. When describing the impact of cancer costs, participants mentioned sub-themes including the "cost to their family", the "cost of their disability", and the impact of a "change in income/job". Results elucidate the financial concerns and coping strategies of persons undergoing treatment for cancer. These data help target patients' support needs during treatment, such as providing for their family and navigating their insurance policies, and suggest more efficient implementation of financial interventions are needed to alleviate the emotional burden of cancer costs.
This cross-sectional, descriptive study identified variables associated with caregivers who (1) were employed and (2) reported lost hours from work due to care demands. Family caregivers (N=80) of persons with a primary malignant brain tumor participated in a 45-60 min telephone interview, answering questions regarding the impact of providing care on their emotional health and employment status. Younger caregivers were more likely to be employed. Caregivers were more likely to report lost hours from work when care recipients required assistance with Instrumental Activities of Daily Living (IADLs) and were closer to the time of diagnosis. Data suggest that interventions to assist caregivers in maintaining employment should target caregivers of persons with limitations in physical function and should include strategies to coordinate care to assist with IADLs.
Recent reviews conclude that the benefits of attending Specialist Palliative Day Care (SPDC) are likely to be in social, psychological and spiritual domains. However, these areas are not easily identified, leaving researchers and practitioners unclear as to what aspects of these domains patients most need and desire. The objective of this review was to systematically evaluate literature on patient-perceived psychosocial experiences of attendance at SPDC. Twelve studies were included. Evidence showed that patients value a person-centred approach that reduces isolation, increases social support, encourages communication and provides activities. Future research could focus on investigating why patients value the psychosocial experiences reported and how these experiences can be defined in a way that would be meaningful to clinical service commissioners. Once this has been done, clinicians can start to measure more effectively clinical effectiveness and devise justifiable interventions to help this patient group.
Training TBAs to administer misoprostol to treat PPH has the potential to both save money and improve the health of mothers in low-resource settings.
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