The causal effect of a family planning intervention on women’s contraceptive use and birth spacing

Karra, Mahesh; Maggio, Dan; Guo, Muqi; Ngwira, Bagrey; Canning, David

doi:10.1073/pnas.2200279119

Cited by 16 publications

(15 citation statements)

References 43 publications

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“…After combining these two studies, the meta-analysis showed no significant associations with interventions (OR = 0.97, 95% CI = 0.52–1.81, I 2 = 91%, N = 2,919) based on a random effect model. Karra et al ( 40 ) found that contraceptive use after 2 years of intervention exposure increased by 5.9 percentage points compared with the control group. Of the two remaining articles that reported postpartum contraception, neither showed a statistically significant difference in interventions associated with any contraceptive uptake at 6–9 months or 12–14 months postpartum.…”

Section: Resultsmentioning

confidence: 99%

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Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Tang²,

Pei

2023

Int J Public Health

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Objectives: This study aimed to systematically review the effectiveness of service interventions for improving postpartum contraception, including contraceptive use, prevention of repeat pregnancies and induced abortions.Methods: A systematic literature search was conducted in three databases until June 2022 (PROSPERO registration CRD42022328349). Estimates of intervention effects from meta-analyses were represented as odds ratios (OR) with 95% confidence intervals (CI).Results: 16 studies with 14,289 participants were included, with four kinds of interventions recognized. Interventions effect in increasing use of contraceptives and decreasing rates of repeated pregnancy for up to 6 months postpartum (OR = 2.24, 0.06, 95% CI = 1.46–3.44, 0.02–0.22, respectively), with no significant associations with contraceptive use at 12 months postpartum, prevention of postpartum repeat pregnancies and induced abortions during 1 year after childbirth.Conclusion: We concluded that interventions impact the initiation of postpartum contraceptive use and prevention of repeat pregnancy with an overall certainty from low to moderate. These findings highlight the need for additional studies to integrate the beneficial effect of several interventions and then design more feasible strategies, which is important for the maternal and child healthcare systems.

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Section: Resultsmentioning

confidence: 99%

“…Leave-one-out influence analyses indicated that the findings of the meta-analysis did not rely on a particular study. However, one study in Malawi ( 40 ) reported the intervention group’s hazard of repeat pregnancy was significantly lower during 24 months postpartum.…”

Section: Resultsmentioning

confidence: 99%

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Tang²,

Pei

2023

Int J Public Health

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“…We use three waves of longitudinal data that were collected as part of a randomized controlled trial of a family planning intervention in urban Malawi that was conducted between 2016 and 2019; a more detailed description of the study design and data collection approach is presented elsewhere (28,29). As part of the trial, 2,143 women who were either pregnant or immediately postpartum (within 6 months of their last live birth), between the ages of 18 and 35, and living in Lilongwe, the capital, were recruited in 2016.…”

Section: Datamentioning

confidence: 99%

Hormonal Contraception and Hemoglobin Levels in Urban Malawi: A Longitudinal Analysis

Karra,

Canning

2023

Preprint

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Background Studies have highlighted potential non-contraceptive benefits from women’s use of hormonal, reversible contraceptive methods. Given the physiological pathways through which hormonal contraception may interact with menstruation, a growing body of work has documented the extent to which hormonal method use might be associated with increased hemoglobin levels and reductions in the risk of anemia in women. While these findings are promising, the scope for causal inference from these studies is restricted by their cross-sectional design, which limits the extent to which bias from individual-level confounding can be mitigated. Methods We assess the relationship between women’s use of hormonal contraception and their risk of anemia using three years of annual woman-level panel data on 2143 women from urban Malawi controlling for individual woman fixed effects. We compare our panel results with cross-sectional estimates from the same sample. Results We find that hormonal method use is associated with increased levels of hemoglobin in women, though the effects are different for different hormonal methods.. Adoption of an injectable is associated with a 3.7 g/cL increase, and adoption of an implant a 5.7 g/cL increase, in hemoglobin levels. Our estimates are consistent across cross-sectional and panel model specifications, suggesting that existing cross-sectional estimates may be reliable. Conclusions Our findings highlight potential health benefits from hormonal contraceptive use that extend beyond pregnancy prevention. These benefits, in turn, have significant implications as to how women are counseled on contraception both within family planning and nutrition programs. Trial Registration This trial was registered at the American Economics Association Registry for randomized controlled trials on May 7, 2015 (AEARCTR-0000697) and at the Registry for International Development Impact Evaluations (RIDIE) on May 28, 2015 (RIDIE-STUDY-ID-556784ed86956).

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“…However, in developing countries, over 200 million women who wish to avoid next pregnancy lack access to their preferred choice of FP method. Therefore, provision of choice for women is important to promote the use of family planning [14] [15]. In Uganda the national mCPR stands at 35% with high-unmet need for FP at 25% (UDHS, 2016).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Decision Making about Family Planning Use by Refugee and Host Population in Adjumani District, West Nile, Uganda; A Cross Sectional Study

Atuyambe

Nabiwemba

Makumbi

et al. 2022

Preprint

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Introduction Uganda currently hosts an estimated 1.5 million refugees. The majority, (60.5%, n = 964,960) come from South Sudan. This study investigated factors associated with decision making for Family Planning (FP) use among host and refugee populations in Adjumani district, Uganda. Methods This was a comparative cross sectional study conducted in three refugee settlements of Pagirinya, Nyumazi and Mirieyi, and the surrounding host communities in Adjumani district. A total of 1,307 respondents, comprising 661 refugees and 646 host household heads were randomly selected and interviewed using multi stage cluster sampling. Quantitative data were collected using structured questionnaires with Open Data Kit (ODK). Data were analyzed using STATA V.14 C. Multivariable logistic regression was carried out to establish the factors associated with decision making to use family planning. Results The study found that modern contraceptive prevalence rate (mCPR) was 28.6% and 28.4% amongst host and refugees respectively. The factors significantly associated with decision to use FP amongst host population included religion, Anglicans were 6.2 times more likely to use FP compared to Catholics, AOR = 6.21, 95% CI [1.11-34.57]. Respondents who made joint decisions were nearly three times more likely to use modern FP methods compared to those who made personal decision, AOR = 2.69, 95% CI [0.89-138.39]. Similarly, amongst refugees, Anglicans were more likely to use modern family planning methods compared to Catholic refugees; AOR= 5, 95% CI [4.75-13.23] and AOR= 7.05 95% CI [2.8-44.88] respectively; respondents who attained tertiary education. AOR = 2.17 95% CI [0.11-43.08] and those who made joint decision; AOR 6.43 95% CI [1.78-16.08] were more likely to use modern FP methods. The key barriers to decision making regarding modern FP use by the host, included harassment of women who did not consult their significant others (AOR = 0.07, 95% CI [0.01-0.79] and separation/divorce (AOR = 0.03, 95% CI [0.00-0.35]. Whereas amongst the refugees, main reasons for not using FP included not wanting to use FP” [45.8%], wanting to become pregnant [6.8%], and fear of side effects [5.8%]. Conclusions Use of modern family planning is low amongst both refugee and host populations in Adjumani district. The main factors associated with decision to use FP amongst both refugee and host populations include religion, level of education and husband’s approval. Main reasons for not using modern FP methods include fear of side effects and not wanting to use FP by both host and refugees respectively. There is need to sensitize both communities about the benefits of FP and promote male involvement including couple counseling at community level.

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The causal effect of a family planning intervention on women’s contraceptive use and birth spacing

Cited by 16 publications

References 43 publications

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Hormonal Contraception and Hemoglobin Levels in Urban Malawi: A Longitudinal Analysis

Factors Associated with Decision Making about Family Planning Use by Refugee and Host Population in Adjumani District, West Nile, Uganda; A Cross Sectional Study

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