Abstract:Contraceptive use is deemed one of the 10 greatest public health achievements of the 20th century because its benefits are universally acknowledged as a cornerstone for reducing global maternal morbidity and mortality. However, although the adoption of the Affordable Care Act in the United States (US) enhanced access to preventive health services, as well as increased contraceptive use, a considerable proportion of reproductive-aged women still have unmet reproductive health needs. Current data indicates gaps … Show more
“…This multidimensional outlook is vital to understanding and explaining the different factors that influence decision-making regarding contraceptive use. Individual level or intrapersonal factors are factors such as lack of or limited knowledge, misaligned concerns, religious beliefs, and misinformation about the safety and effectiveness of contraceptives; interpersonal factors included partner, peer, parental, and societal influences or any interactions with social networks (both formal and informal) and social support systems; institutional level factors included characteristics and health system activities that affect the use of contraceptives; and community-level factors, which included interactions between and within organisations in the health system, community, and other social networks that influence contraceptive use [36]. Policy-level factors are government policies that affect contraceptive use [36].…”
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents’ decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10–19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
“…This multidimensional outlook is vital to understanding and explaining the different factors that influence decision-making regarding contraceptive use. Individual level or intrapersonal factors are factors such as lack of or limited knowledge, misaligned concerns, religious beliefs, and misinformation about the safety and effectiveness of contraceptives; interpersonal factors included partner, peer, parental, and societal influences or any interactions with social networks (both formal and informal) and social support systems; institutional level factors included characteristics and health system activities that affect the use of contraceptives; and community-level factors, which included interactions between and within organisations in the health system, community, and other social networks that influence contraceptive use [36]. Policy-level factors are government policies that affect contraceptive use [36].…”
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents’ decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10–19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
“… Figure 2. Schéma conceptuel du recours au contraceptif par les adolescentes au Bénin en 2017–18, basé sur le modèle de Ajayi et al 15 …”
Section: Résultatsunclassified
“… 14 L’approche socio-écologique en santé a fait évoluer ces travaux de base pour définir cinq niveaux d’influence spécifiques des comportements de santé: les facteurs intra-personnels, les processus interpersonnels, les facteurs institutionnels et communautaires et les politiques publiques. 15 Cette approche a servi à la mise en place des documents de base en promotion de la santé. De plus, la charte de la conférence d’Ottawa de 1986 a mis en exergue son caractère global en identifiant les conditions de vie culturelles, sociales, économiques et environnementales comme les principaux déterminants de la santé.…”
Section: Introductionunclassified
“… 16 Compte tenu de ses avantages, l’approche socio-écologique a été adoptée dans différents domaines de la santé. 15 , 17–20 L’identification des mécanismes d’action fait appel à l’intersectionnalité. 21 Elle reconnaît que les relations complexes entre les identités multiples et les systèmes sociaux de pouvoir façonnent les expériences d'un individu.…”
Résumé
La pratique contraceptive moderne augmente lentement parmi les jeunes générations au Bénin. La présente étude analyse les tendances, les déterminants du recours aux contraceptifs et leurs mécanismes d’actions chez les adolescentes. Les approches socio-écologique et intersectionnelle ont été adoptées, avec une méthode d’étude mixte portant sur les adolescentes de 15 à 19 ans sexuellement actives et non enceintes. Le volet quantitatif recourt aux données des cinq enquêtes démographiques et de santé du Bénin entre 1996 et 2017–18, avec une analyse descriptive et une régression logistique binaire pas à pas. Les données qualitatives collectées par des observations, discussions de groupe et entretiens individuels auprès de différents acteurs nationaux, ont fait l’objet d’analyse de contenu. Les résultats révèlent une prévalence contraceptive moderne basse, passant de 4,6% en 1996 à 13,3% en 2017–18, avec le préservatif comme principale méthode utilisée (8,2%). En 2017–18, la probabilité d’utiliser les contraceptifs était plus élevée chez les adolescentes des ménages riches (OR = 2,3), les scolarisées (OR = 2,3), les célibataires (OR = 2,1), celles fréquentant les services de planification familiale (PF) (OR = 1,8), connaissant le cycle menstruel (OR = 1,6), et économiquement actives (OR = 1,5). Cependant, être Yoruba réduit les chances d’utiliser les contraceptifs (OR = 0,5). Les données qualitatives confirment ces résultats et les complètent en mettant en avant l'effet du cadre juridique favorable à la pratique contraceptive, la stigmatisation sociale des utilisatrices, et les infox véhiculées en communauté. Nous recommandons des efforts pour le maintien des filles à l’école, la généralisation des services de PF pour les adolescents, la communication communautaire, et la subvention des contraceptifs.
“…On the other hand, individual behavior shapes the social environment, which in turn shapes individual behavior. This model has been widely applied in the analysis of contraceptive use and unmet need for contraception [ 9 , 47 , 52 – 54 ] because of increasing evidence that improving access to contraceptive information and services works better when they recognize influences at the individual, community, and structural levels [ 55 ].…”
Background
Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study.
Methods
The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables.
Results
Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments.
Conclusion
The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.
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