Magister Scientiae - Msc (Statistics) / Contraception is said to be one of the vital determinants of fertility (Bongaarts, 1978). African nations, especially those in sub-Saharan Africa have a history of high fertility levels and low contraceptive use. However, contraceptive methods have been used one way or another throughout human history, although, due to improvements, these methods have evolved over the years. In Namibia, there tend to be a huge gap between women's knowledge of methods of contraception and usage thereof. For instance as per NDHS survey of 2000, 97 percent of married women knew of a contraceptive method, while 38 percent utilised them. This study aims at investigating knowledge and usage of contraceptives among women in union of reproductive age in an independent Namibia, 10 years after independence between 1992 and 2000. Socio-economic and demographic factors affecting contraceptive usage are examined in this study to determine their significance. / South Africa

Magister Philosophiae - MPhil / The present study was conceived to examine the trend and factors affecting fertility in Nigeria and Guinea. Fertility has declined by about nineteen percent in Nigeria between 1982 and 1999. In the same period it has declined by five percent in Guinea. The decline is observed in data from censuses and surveys. Studies have reported that fertility transition is in progress in most Sub-Sahara African countries (Bongaarts 2008; Guttmacher 2008), Nigeria (Feyisetan and Bankole 2002) and Guinea (measuredhs 2007). Studies and surveys done in some regions and among ethnic groups suggest that fertility is declining in Nigeria (Caldwell et al. 1992) and Guinea (measuredhs 2007). However, these studies and surveys are devoid of national representativeness as they are localized in specific regions or selected ethnic groups. Thus, they cannot be used as a national reference. The trend of the total fertility rate (TFR) from the three consecutive Demographic and Health Surveys in Nigeria did not show any meaningful decrease over time. In the same vein, no evidence of fertility decline was observed in Guinea from the Demographic and Health Surveys. The claim that fertility is declining in these two countries which assures the funding organizations that Family Planning programs are successful is beyond the scope of the present study. Based on Demographic and Health Surveys the claim that fertility is decreasing in Nigeria may be misleading, whereas in Guinea fertility has shown stability. This suggests that while the factors affecting fertility may be similar, their impacts differ from country to country. / South Africa

Master of Public Health - MPH / Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services. / South Africa

Depot medroxyprogesterone acetate (DMPA) is a long acting progesterone only contraceptive agent. Side effects such as irregular bleeding patterns and weight gain are attributed to discontinuation. The purpose of this study was to describe depot medroxyprogesterone acetate discontinuation after weight gain in 17 to 19 year-old adolescent girls.

Dual method use, or the concurrent use of one contraceptive method to prevent pregnancy and another to reduce the risk of sexually transmitted infections (STIs), is an ideal practice for young women but is underutilized. In a recent National Survey of Family Growth (NSFG) study, 7.4% of women of reproductive age reported dual method use at last intercourse. In the same NSFG study, dual method use at last intercourse among women 15-20 years old was somewhat higher at 22.8%; still, this estimate indicates low utilization when compared to recent trends in the prevalence of single-contraceptive method use by young women. Apart from the NSFG and some smaller scale studies, there have been minimal efforts to explore dual method use in high-risk populations of young women such as college students. This is surprising, given that college students typically have more opportunities to be sexually active than other groups and often engage in serial monogamy or have multiple sexual partners during their college years. This study aimed to add to previous research on women’s health and contraception by assessing college women’s contraceptive use, including dual method use, and examining factors that influence contraceptive decision-making. Female students at ETSU were surveyed through the Department of Psychology research participation system from Oct 2017-Dec 2017. Students received class credit for survey completion. Data were analyzed using descriptive statistics in SPSS (Version 24.0). To be consistent with previous studies on health behaviors of college-aged women, the final dataset included only female college students between ages 18 and 25 (n=379). About one-fifth (21.1%) of women reported current dual method use. Of particular interest, only 30.5% of women who indicated sexual activity in the past six months also reported dual method use. Nevertheless, most women reported positive feelings about dual method use and indicated they would not find it hard to achieve dual method use; 69.1% reported feeling great or good about dual method use, and 74.5% indicated that it would not be hard to use condoms plus another form of birth control together correctly. Future efforts to study dual method use in college women should include close examination of subgroups who have yet to commit to dual method use but have positive attitudes and intentions regarding dual method use. Results of this study also indicate a need to implement educational and promotional strategies in college environments to better inform college-aged women about dual method use and its benefits.

strong>Objectives: Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee. Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT. Results: Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03–36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34–18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08–0.94). Conclusions: Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.

backgroundWomen with opioid use disorder (OUD) experience unique barriers to contraception, contributing to higher than average rates of unintended pregnancy. Rates of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome resulting from antenatal drug exposure, are higher in Tennessee than the nation. Few studies have quantified experience of contraceptive barriers or their associations with contraceptive use among women with OUD. objectives This study estimated prevalence of barriers to access/acceptance of contraceptive services and their associations with current contraceptive use and unwanted pregnancy among reproductive-aged women in Northeast Tennessee receiving opioid agonist therapy (OAT). methods A cross-sectional survey was administered to female patients aged 18-55 from two OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies. results Of 91 participants, most were insured (84.4%), experienced at least one barrier (75.8%), and more than half reported unwanted pregnancies (52.8%). Most desired to avoid pregnancy (60.0%) or were ambivalent (30.0%). Common barriers were side effect aversion (53.8%), provider stigmatization (30.7%), appointment compliance (30.23%), and cost (25.0%). Experience of any barrier (AOR=11.6, 2.25-59.8) and access to a contraceptive provider (AOR=9.78, 1.34-71.7) were positively associated with use, while cost was negatively associated (AOR=0.27, 0.07-0.98). Eight barriers were significantly associated with unwanted pregnancies. conclusionWhile most participants desired to avoid pregnancy, contraceptive barriers were common. Barriers were more strongly associated with previous unwanted pregnancy than current contraception. Contraceptive provision at OAT clinics may reduce incidence of unwanted pregnancy and NAS in Northeast Tennessee.

Objective Safety-net clinics such as health department family planning (HD) and federally qualified health centers (FQHCs) provide free or low-cost contraceptive care to low-income and uninsured populations. Integration of contraceptive focused training within safety-net clinics is essential to deliver comprehensive, patient-centered contraceptive care. In SC, HDs receive Title X funding, which requires providing training to staff. However, due to different funding policies, trainings may be less available to FQHC staff which creates gap in care. This study examined perceptions of impact of trainings on overall performance and patient care among safety-net clinics in South Carolina (SC) that received externally funded contraceptive trainings for healthcare providers and clinic staff. The key focus of this study was to identify the perceptions of training among clinical staff and providers in HDs and FQHCs in SC. Our study showed that when equal funding opportunities were provided, it expanded the opportunity of positive impact. Method Key informant interviews were conducted among 58 individuals, 31 HD and 27 FQHC clinic staff and system leaders in 2019. Interview questions assessed the respondent’s perception of trainings on overall performance and patient care. Formal informed consent was obtained before the interview and participation was voluntary. Interviews were conducted privately via phone by study staff at East Tennessee State University. The interview recordings were transcribed and coded with QSR International’s NVivo 12 qualitative data analysis software. A codebook was developed, and inter-rater reliability and consensus coding methodologies were utilized to ensure consistency of coding. Results The majority of HD and FQHC respondents identified improved quality of services and infrastructure as positive impacts of provided trainings (N=14 and N=12, respectively). Additionally, four respondents from FQHC sectors mentioned that training increased capacity for contraceptive provision. Challenges with staffing capacity such as not having time for training were mentioned as a negative perception among both sectors. Perception of impact of training on patient care were positive among most respondents (N=44). Most respondents from both sectors indicated improved capacity for patient counseling as a positive impact of training (N=26). Two FQHC respondents mentioned that training led to implementing best practices. Conclusion Positive perception of contraceptive training on overall performance and patient care have been identified throughout this study. Federal funding provides support for training implementation but restrictions in funding due to policy changes and different funding mechanisms limit some clinics. Although external funding provides support; this does not ensure the sustainability of trainings after completion of the funding period which can create gaps in care and contraceptive provision. Future research should focus on training sustainability models such as Train-the-Trainer to ensure continuity of positive impact in local and state levels.

Thesis (M. A. (Communication Studies)) -- University of Limpopo, 2019 / Globally, over the years, health promotion organisations have developed communication campaigns geared towards addressing most major public health issues with the intention of preventing risky sexual behaviour. Teenage pregnancy is a major health, social, systemic and economic challenge, not only for the basic education sector but also, crucially for national development in general. The use of modern contraceptives, specifically implant contraceptives, has the potential to alleviate unintended teenage pregnancies. Modern contraceptives such as implant contraceptives have proven to be highly effective from 24 hours after insertion up to three years. Theoretically, the Health Belief Model and the Theory of Planned Behaviour have been applied to guide the study. A quantitative, descriptive survey was used in this study, with data collected using questionnaires. Purposive sampling of six secondary schools under the Mankweng Circuit in the Limpopo province where 306 participants were randomly selected was employed. Data were analysed using the SPSS version 26. The study revealed that that 34% of the participants were willing to use the implant contraceptive method based on the benefits found to be associated with the method. However, 66% were not willing to use the method regardless of the benefits found in using the implant contraceptives. In addition, it was found that only 3.9% of the participants were using implant contraceptives as a tool to prevent unintended pregnancies. This study makes a contribution to existing literature on implant contraceptives uptake among young women in South Africa. It would be informative to organisations and the National Department of Health who propose the use of implant contraceptives to stem increasing teenage pregnancies.

Introduction: Contraceptive decision-making is individual in nature and access to high-quality contraceptive care, including counseling and the full range of contraceptive methods, can help individuals achieve their personal reproductive goals and prevent unintended pregnancy. The COVID-19 pandemic disrupted provision and utilization of contraceptive counseling and contraceptive methods. Long-acting reversible contraception (LARC) methods, such as the contraceptive implant and intrauterine devices (IUDs), were particularly affected by the pandemic because they require placement by a health care provider in a clinical setting. Choose Well (CW), an ongoing statewide contraceptive access initiative in South Carolina, launched in 2017 and continues through 2022. CW aims to implement best practices of contraceptive care via training and funding for IUD and implant methods. This study examined the perceptions of access to contraceptive counseling and implant and IUD methods during the pandemic in 2020 among CW hospital partners. Methods: Data were collected in 2021 via key informant interviews with partners (n=9) at CW implementing hospitals to assess perceptions of CW activities in 2020, the first year of the COVID-19 pandemic. A semi-structured interview guide was used, and interviews were recorded, transcribed, and consensus coded. A codebook was developed based on the interview guide. Data from select questions of interest related to perceived access to contraceptive counseling, access to LARC methods, and the impact of the pandemic on contraceptive care services were analyzed for this study. Coding was conducted with NVivo software version 1.6.1. Results: Findings show that there was continued provision of contraceptive services during COVID-19 at CW partner hospitals, including an increase in access to contraceptive counseling and LARCs in 2020. The most prevalent facilitator for increased access to contraceptive counseling and LARCs at CW partner hospitals was having key personnel available such as physicians and Obstetrics (OB) navigators. Expanded access to outpatient sites was also noted as a facilitator of contraceptive counseling. Advertising and wide-spread patient education, buy-in and engagement from staff were additional facilitators for the increased access to LARCs. Considering the context of the COVID-19 pandemic, patients wanting to quickly leave the hospital and challenges with staffing contributed to an overall decline in access in some hospital locations. Challenges with staffing included not being able to receive training and nurses being overworked and overburdened. Conclusion: While COVID-19 has posed challenges to contraceptive care service provision, most individuals perceived an increase in access to contraceptive counseling and LARCs at CW partner hospitals. Hospital partners have continued to provide contraceptive services during COVID-19. The findings suggest the success of the CW initiative in increasing access to contraceptive services, particularly during COVID-19 through key facilitators. Staffing positions such as OB Navigators should be funded and maintained to increase access to contraceptive care services in hospital inpatient settings. Coordinating care between hospital inpatient and outpatient settings is similarly important for widespread patient education about contraceptive care services.