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This article follows the work of three international fieldworkers who traveled abroad for the U.S.-based Pathfinder Fund in the 1950s and 1960s to distribute contraceptives, promote the formation of family planning clinics, and support local advocates. These actors situated their work within longer traditions of maternalist humanitarian and Christian missionary internationalism, while also portraying themselves as skilled inter-cultural interlocutors, cognizant of the changing winds prompted by decolonization movements. Still, their insistence on particular methods, reliance on stereotypes, and sometimes aggressive approach fueled tension and undermined their efforts at solidarity. The article thus illustrates some of the central contradictions of post-WWII humanitarianism and the broader entangling of missionary, maternalist, and family planning projects. This article is part of the special theme section on International Organizations in the Era of Decolonization, guest-edited by José Pedro Monteiro.

تهدف الدراسة الراهنة إلي التعرف علي الفروق الريفية الحضرية في الصحة الإنجابية بمحافظة الوادي الجديد . من خلال إجراء دراسة ميدانية علي عينة من السيدات المتزوجات في الفئة العمرية من (15-49عام ) بريف وحضر مدينة الخارجة وبلغ عددهم 375 سيدة ، وتمثلت مؤشرات الصحة الإنجابية في الدراسة في استخدام وسائل تنظيم الأسرة ، تغطية الرعاية الصحية للحمل والولادة ، انتشار ظاهرة ختان الإناث .والكشف عن الفروق بين الريف والحضر في هذه المؤشرات، وأظهرت النتائج ارتفاع المستوي التعليمي لعينة الدراسة،ارتفاع مؤشر الصحة الإنجابية فيما يتعلق بنسبة استخدام وسائل تنظيم الأسرة في الريف والحضر ، وتم العثور علي فروق بين الريف والحضر فيما يتعلق بمؤشر تغطية رعاية الحمل والولادة ، وتبين وجود مشكلات تتمثل فى نقص وقصور فى الخدمات الصحية وعدم توافر الأطباء وبعد المسافة بين محل الإقامة ومرافق الرعاية الصحية، كما تبين وجود فروق ريفية حضرية فيما يتعلق بمؤشر ختان الإناث فلا تزال المناطق الريفية بمدينة الخارجة أكثر تمسكاً بهذه الممارسة ، مما يعكس العادات والتقاليد الثقافية والأعراف الاجتماعية. وخلص البحث لمجموعة من التوصيات أهمها تعزيز برامج وحملات التثقيف الصحي ، تحسين الخدمات الصحية المقدمة للسكان داخل المحافظة، التأكيد علي دور الرائدات الريفيات ورجال الدين في التوعية المباشرة بموضوع الصحة الإنجابية .AbstractThe current study aims to identify rural-urban differences in reproductive health in New Valley Governorate. By conducting a field study on a sample of married women in the age group (15-49 years) in rural and urban areas of the city of Kharga, numbering 375 women. The reproductive health indicators in the study were the use of family planning methods, health care coverage for pregnancy and childbirth, and the spread of the phenomenon of female circumcision. And revealing the differences between rural and urban areas in these indicators, the results showed a high educational level of the study sample, a high reproductive health index with regard to the percentage of use of family planning methods in rural and urban areas, and differences were found between rural and urban areas with regard to the indicator of coverage of pregnancy and childbirth care, and it was found that There are problems represented in the lack and insufficiency of health services, the lack of doctors, and the distance between the place of residence and health care facilities. It was also shown that there are rural-urban differences with regard to the female circumcision index. The rural areas of the city of Kharga are still more committed to this practice, which reflects cultural customs and traditions and social norms. The research concluded with a set of recommendations, the most important of which are strengthening health education programs and campaigns, improving health services provided to the population within the governorate, and emphasizing the role of rural women pioneers and clergy in direct awareness of the issue of reproductive health.

In 2016 in France, 4.6% of women between the ages of 15 and 49 used natural family planning (NFP). A majority of them are dissatisfied with the listening and training of general practitioners on this subject. They feel judged, ill-informed and poorly supported by them. The effectiveness of NFP depends on the motivation of the couple as well as the support of a health professional. Objective: To assess the knowledge of general practitioners concerning NFPs, as well as their perception of their effectiveness, and their desire to improve and modify practices. Method: Cross-sectional observational study of general practitioners in the former Midi-Pyrénées region by questionnaire distributed online between 18 February 2022 and 1 April 2022. Results: 189 responses were received. The best-known NFPs were the Ogino, Billings, temperature and withdrawal methods. 46.5% of participants considered none of the NFPs to be effective. The more recent and more reliable methods such as the Sympto-Thermal Method (STM) or the Lactation-Amenorrhea Method (LAM) were less known and less considered effective. One in five doctors knew a network to which they could refer patients to and more than one in two were interested in learning about such network. 44 % of the doctors questioned were interested in taking training in NFP. The perception of a lack of effectiveness of these methods was one of the main reasons given by those not wishing to take training. Conclusion: NFPs are little known to general practitioners and perceived as ineffective. There are gaps in medical training regarding NFPs, and networks or tools around NFPs are little known and uncertain. Thus, an improvement in medical training, through the performance of rigorous studies on NFP, would allow a better knowledge of general practitioners and thus better quality support and care for users. [ABSTRACT FROM AUTHOR]

Background: Family planning (FP) is a key component of primary health care (PHC). Nurses are the first source of FP information to women outside their social context. There is a paucity of research regarding clients’ lived experiences of FP, particularly understanding both the client’s and the healthcare worker’s experiences in the same clinical context and community. Aim: This study aims to explore the lived experiences of nurses and female clients regarding FP services at PHC clinics. Setting: Two PHC clinics in a rural sub-district in South Africa. Methods: A descriptive qualitative study using semi-structured interviews was conducted. Clients and nurses were selected using criterion-based purposive sampling and interviewed by female research assistants in a home language in a private setting. Transcription and translation of audio recordings were done. Data were analysed inductively using the framework method. Results: Ten clients and eight nurses were interviewed, with an equal number from each clinic. The median age of clients was 28.5 years and of nurses was 47.5 years. Four themes emerged: (1) Stigma, culture and the teenage girl; (2) Bad effects – the Big Five, clustered around weight changes, blood blockages and abnormal bleeding, pain, fertility and cancer; (3) FP social dynamics; and (4) FP and the health system. Conclusion: Family planning is highly moralised and stigmatised. Negative effects of FP were not adequately recognised by the health system. Family planning outreach into the community and dedicated FP resources at clinics were suggestions to improve the service. Contribution: This work helps to better understand patients’ experiences of family planning services.

Adolescent motherhood raises questions that are always current and transversal in socio-cultural contexts as South American countries facing birth policies. It expresses a fundamental dimension of sexuality that needs to be analyzed from a clinical and cultural point of view in the educational field. Based on a research experience carried out in Colombia, this article analyzes the psychic, intersubjective and cultural stakes of the relationship to contraception and motherhood during adolescence, in the face of the medical and educational discourse on family planning and, in the background, on the voluntary interruption of pregnancy. Through certain themes, female subjects express themselves in their relationships with others, with parents before sexual partners, defying health and academic knowledge and discourse, in the cultural contexts of socalled "southern" countries. [ABSTRACT FROM AUTHOR]

Postpartum family planning is the prevention of pregnancy during the 12 months following childbirth. Objective: To study the use of contraceptive methods in the postpartum period in the obstetrics gynecology department of the district hospital of the commune II of Bamako. Materials and Methods: We conducted a descriptive and analytical cross-sectional study with prospective data collection from January 1, 2019 to December 31, 2020. All women who had given birth who had chosen and benefited from a contraceptive method were included. The statistical test used was Fisher's test with a significance level set at 5%. Results: In 2 years, the contraceptive prevalence in the postpartum was 26.1%. More than 2/3 of counseling (61%) was done during prenatal consultations, 8% during the latency phase, 26% in the immediate postpartum and 5% during the postnatal visit. The most chosen methods were implants (47.1%), intrauterine device (29.6%), miro-progestin pills (12.5%), injectable progestogens (8%) and condoms (3.2%). Conclusion: Postpartum family planning contributes to increasing contraceptive prevalence. [ABSTRACT FROM AUTHOR]

Introduction: the purpose of this study is to provide Moroccan data, study maternal risk factors and identify perinatal complications related to closelyspaced pregnancies. Methods: we conducted a retrospective case-control study at the Provincial Hospital Center in the city of Settat from June 1, 2020 to June 1, 2021. A total of 670 patients were admitted, but only 630 were included in the study. They were divided into 2 groups: a group of patients whose interpregnancy interval was <9 months (N = 443) and a control group whose interpregnancy interval was >9 months (N = 187). Results: prematurity, hypotrophy and anemia p<0.05 were the main complications, the main risk factors for closely-spaced pregnancies were age >35 years (OR =19.079 (4.98; 73.06) p < 0.005), coming from a rural area (OR = 0.468 [0.28; 0.78] p < 0.005), having a low socioeconomic status (OR =3.465 [2.06; 5.81]; p < 0.005); the absence of contraceptive prescription in the postpartum period (OR =15.77 [7.31; 33.99]; p < 0.005); and breastfeeding breaks before getting pregnant (OR = 49.462 [15.78; 155.03]; p<0.05). Conclusion: prevention and specific family planning methods are necessary to avoid perinatal complications. [ABSTRACT FROM AUTHOR]

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Introduction: access to abortion is restrictive in Cameroon. The legislation authorizes the act in two cases: when the pregnancy results from a rape or when it puts the pregnant woman at serious risk for her health. Abortion outside this legal framework is considered illegal. This article identifies and analyses the opinions of women living in the capital Yaounde, on national legal provisions relating to abortion. Methods: thirty-five (35) semi-structured interviews were conducted in Yaounde with women aged 19 to 40. Study participants recruited from consultations (family planning or maternal and child health service) contributed to the selection of other respondents using the snowball method. The data collected were the subject of a thematic analysis of content. Results: more than half of those surveyed are against decriminalization. The transgressive dimension associated with abortion constitutes the main argument supporting the refusal of a possible relaxation of the legislation. The reason for health security is advanced in the opinions encouraging decriminalization. The difficulty of positioning oneself or the participants silence is an illustration of the sensitive nature of the subject of abortion. Conclusion: abortion in its essence carries tensions emanating from interactions between institutional logics, social group norms and individual aspirations. The polarization of debates is a brake on the examination of the issue of decriminalization from a multidimensional perspective. [ABSTRACT FROM AUTHOR]

Background: The family planning service requires a routine health information system (RHIS) that can produce quality data that will be used for making decisions. However, the quality of data generated is not always of a good standard. Its usefulness in making data-driven decisions in family planning service is questionable. Aim: The study intended to assess the quality of family planning data and determine healthcare providers’ (HCPs’) views on factors influencing data quality in Tshwane district. Setting: The study was carried out in 13 healthcare institutions in Tshwane district, Gauteng province, South Africa. Methods: This paper reports on the quantitative strand of a mixed methods study. A sample of 111 HCPs was selected through a stratified random sampling technique, and six months of monthly reports from 13 institutions were reviewed for data quality. A self-administered questionnaire and a tick sheet were utilised to collect data from the HCPs and to review monthly reports for data quality, respectively. The Statistical Package for the Social Sciences (SPSS) programme for Windows version 24.0.0 was used to analyse the data. Results: Data quality, mainly accuracy and timeliness, was a challenge. Many HCPs were not trained in the RHIS. They viewed several issues relating to organisational, behavioural and technical factors as barriers to data quality. Conclusion: The low quality of family planning data has a negative impact on policy development and decision-making. Contribution: There is a need for capacity building through training and supportive supervision, provision of adequate human and technical resources to enhance data quality and use of information for decision-making.

Introduction: Contraceptive prevalence is low in Mali. The information provided by the media men can help to increase or decrease the use of contraceptive methods. Objective: To study the knowledge, attitudes and practices of Bamako media Men on family planning. Material and Methods: We carried out a descriptive cross-sectional study with prospective data collection from June 1 to August 30, 2019. It concerned journalists and presenters of 15 radio and 6 televisions in Bamako. Results: During the 3 months, 615 media Men agreed to participate in this study. These are men and women from 36 to 45 years old in 37.2% of cases, married in 81.3% of cases. The radio with 85.5% was their main source of information on family planning. They all knew at least one contraceptive method. The best-known methods were pills (94.3%), injectables (57%) and implants (49.1%). They were in favor of the practice of family planning in 77.2% of cases, 76.9% had already used a method and 56.7% had already hosted a program on family planning. Conclusion: Media men are essential in the transmission of information. The quality of the information provided by these Media men can be influenced by their personal perceptions and attitudes. Their better involvement in the promotion of family planning can help to increase contraceptive prevalence. [ABSTRACT FROM AUTHOR]

INTRODUCTION: This study assessed the availability of Family Planning (FP) services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya. Social franchises refer to a standardized delivery model of engaging private health facilities under a common brand name/contractual arrangement. METHODS: This was a facility-based mixed-method approach. Quantitative data was collected through 581 FP client exit interviews and a facility inventory in 32 health facilities. Association between the clients´ characteristics and use of FP services was tested using univariable and multivariable logistic regression. Qualitative data were collected through five focus group discussions with FP clients and 16 key informant interviews with service providers and analysed through thematic analysis. RESULTS: The findings show that FP methods availability was the same across all facilities (p = 0.206). The findings were supported by views from the clients who indicated that contraceptives were available. Statistically significant predictors of FP use were found to be women’s age group 20-24 years (Adjusted Odds Ratio (AOR) = 2.30, 95% Confidence Interval (CI): 1.12, 4.69) or 25 to 34 years (AOR = 2.10, 95% CI: 1.86, 2.36) versus the 15-19 years and the clients with tertiary level education and above compared primary level education and below (AOR = 0.020, 95% CI: 1.13, 4.41). CONCLUSION: This study demonstrates the need to support all private health facilities with policies and supplies to expand access to all FP services, especially for adolescents.

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INTRODUCTION: Men´s involvement in family planning (FP) can be either as a user of male contraceptive methods and or support of the male partners. In some developing countries, levels of communication on this issue is low for decision-making. Unmet need for FP suggested that unwanted pregnancy and unsafe abortion are the main causes of maternal mortality in Ethiopia. Men’s involvement in family planning is very important to improve women´s health in particular and reproductive health in general. METHODS: the community based cross-sectional study design was conducted to assess men´s involvement in family planning service and associated factors among married men at Debre Tabor Town. A simple random sampling method was used to include 382 married males. Data were collected by face to face interview using a structured questionnaire. The data were entered into epi.Info 7 and were analyzed using SPSS version 21 statistical software package. RESULTS: from three hundred eighty-two participants, 373 participated yielding a 97.6% response rate. The age range of the participant was from 20 to 65 years, the mean age was 38.6 with the standard deviation of ±7.8. The majority of the participants were orthodox followers 358(96%). About 33.2% of them were greater than secondary education level. The magnitude of male involvement in family planning was 254(68.1%), 370 (99 .2%) of the participants had information on different family planning methods. Adjusting all other factors for the final model, educational status AOR = 2.39 [1.084, 5.260], source of information AOR [95%CI] =1.88 [1.016, 3.485], men’s approval AOR [95%CI] = 0.07 [0.036, 0.134], ever used contraceptive AOR [95%CI] = 0.21[0.064, 0.705] were found to be associated with men’s involvement. CONCLUSION: the level of male involvement was moderate, but their actual utilization is low.

The use of drugs is not solely determined by its therapeutic properties but refers to diversions of these properties. Objective: To assess the level of knowledge of the diversion of drugs for abortifacient purposes among hairdressers and seamstresses of the suburb of Togblékopé. Material and method: We conducted a cross-sectional study among hairdressers and seamstresses living in Togblékopé, a suburb on the outskirts of the city of Lomé. Results: Of the 114 respondents, 74.6% knew that drugs were diverted for abortion, mostly among older young people, singles and apprentices. In addition, 70.6% reported having at least once attended a drug abortion by someone. Thus, drugs such as paracetamol, chloroquine and acetylsalicylic acid have been reported for abortifacient purposes' diversion, most often purchased on the street and responsible for serious side effects. Conclusion: This study has highlighted the knowledge of drugs' use for abortifacient purposes among hairdressers and seamstresses. It is necessary to carry out actions that will aim at teaching the risks of drug intoxication and reduce the risk of pregnancy through family planning. [ABSTRACT FROM AUTHOR]

Introduction: the purpose of this study was to assess adolescents and teachers´ knowledge, attitude and practices towards family planning (FP). Methods: in 2018, a qualitative study was conducted among seven teachers and 62 teenagers aged 15-19 years based on the Theory of Reasoned Action published by Fishbein and Ajzen in 2011. Data were collected from six focus group (FG) with adolescents and seven semi-structured interviews of teachers. They were analyzed using Atlas Ti software on the basis of a deductive approach. Results: periodic abstinence, male condoms and pills were the only contraceptive methods reported. Adolescents and teachers were apprehensive about using artificial contraceptive methods other than irregularly used male condom. Girls prefer natural methods fearing side effects. The majority of adolescents wanted to be informed about FP in school; however, they felt that the content of the Life Education Course (EVIE) was insufficient and that teachers lacked of openness. Peers, brothers, sisters and internet were the main sources of information. Mothers were an important source of information especially for girls, unlike fathers who were generally less appreciated. Conclusion: knowledge about FP is weak. Misconceptions about contraception lead to the use of ineffective practices to prevent unintended pregnancies. Training programs to improve teachers´ knowledge should be developed and the content of the EVIE course should be formalized and regulated. [ABSTRACT FROM AUTHOR]

INTRODUCTION: despite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective. METHODS: we implemented a descriptive cross-sectional quantitative study was implemented, sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding. RESULTS: a total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The overall satisfaction rate was more frequent in both groups, being answered by 93.8% of youth and adults (= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p =0.05). CONCLUSION: while most users are satisfied with the services there was, however, some sharp criticism. Health professionals practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.

Background: Young mothers tend to be more prone to high maternal and perinatal risks and are thus deemed vulnerable to adverse sexual and reproductive health rights (SRHR) in terms of their right to choose contraceptives of their choice to enhance their maternal well-being and childbirth spacing should be well discussed. Achieving sufficient SRHR may be averted if the use of family planning by disadvantaged groups is not given required attention. Aim: This study aimed to identify and analyse the factors associated with the low use of contraceptives amongst vulnerable women in the South West region in Nigeria. Setting: The study area was purposively chosen to capture contraceptive use amongst vulnerable women in Osun State, Nigeria. Methods: A primary data collection was done in three senatorial districts of Osun State, Nigeria, with 140 respondents each to give a total of 420 respondents. Collected data were analysed using univariate, bivariate and multivariate measures. Results: The result showed a magnitude of association and relationship at both levels of analyses. Living arrangements and family types were 89% and 88.3%, respectively, associated with family planning use. In the same vein, living arrangement and family types were also statistically significant at p 0.05with an odds ratio of 0.23 (95% CI: 0.1184–0.4583) and an odds ratio of 0.35 (95% CI: 0.1756–0.6970) with family planning use, respectively. Conclusion: We concluded that policies and interventions to accelerate and encourage contraceptives use amongst vulnerable mothers in South West, Nigeria should be targeted at those whose husbands lived elsewhere and those whose husbands have more than one wife.

The 20th century will be remembered as a time frame in which human rights have been contemporarily promoted and violated more than ever. In particular, a new arena emerged for fights between governments and civil society: the female body. From an intimate and individual matter, motherhood became a political and public issue, where women were leaders and victims at once. Contraception became the mean by which women either claimed their empowerment or suffered male control. The Peruvian case of sterilizations shows how a contraceptive method has been paradoxically used to both promote women’s health and violate their human rights.

Background: Childbirth spacing (CBS) or Family Planning (FP) methods are considered an essential component of sexual and reproductive health. It refers to the resting period between pregnancies that provides the mother with time to recuperate from pregnancy, labour and lactation. To evaluate the impact of these methods, a storytelling evaluation approach was used. Objectives: The aim of this study was to assess the outcome of behaviour change communication intervention on demand and uptake of modern CBS methods. Method: Most significant change story technique was used to evaluate the outcome of behaviour change communication intervention in two north-western Nigerian states. Impact story template was used to collate 57 stories from the field through group discussions and in-depth interviews with women of reproductive age. Transcripts from the group discussions and interviews were analysed using qualitative analytical software. Results: One story was unanimously selected. The story was about a married 15-year-old with a history of three pregnancies and two live births, who suffered pregnancy complications and miscarriage during her last pregnancy. She had learnt about CBS methods through the community volunteers working on the social and behaviour change communication (SBCC) intervention. As a result, her husband and mother-in-law were convinced and agreed that she take up a modern FP or CBS method from the primary health facility in the community. She eventually took an implant method. Conclusion: Acceptance and uptake of modern CBS methods in north-western Nigeria has been low, and this is largely because of myths and misconceptions, and religious and cultural beliefs amongst others.

The Earth is increasingly hostile towards many living species and uninhabitable in some parts of the world. What is foretold in the coming decades is not the end of the world, but the end of the world as we know it. All over the world, many individuals (scientists, intellectuals, citizens) today believe in the inevitability of a collapse of our civilization and their existence is profoundly disrupted: can they still plan to start a family? Should they continue their studies, or should they start preparing for survival today? Does existence still have any meaning? In clinical ethics consultations, we are confronted with requests for definitive contraception for environmental reasons that put the medical profession and the very foundations of clinical ethics in difficulty. What answers are legitimate? [ABSTRACT FROM AUTHOR]

Introduction: low levels of contraceptive use in Western Africa are responsible for high fertility rates, which limits economic development. The cost of modern contraceptives is a significant constraint, then the government of Burkina Faso has implemented free family planning. Given this new policy, we provided rural women with a healthcare voucher giving free access to modern contraceptives. We conducted an analysis of the determinants of good free voucher use in order to implement adequate government policy. Methods: six months after the distribution of vouchers to women living in 30 villages in the Houet Province, we conducted a focus-group study based on individual in-depth health care provider interviews in partner healthcare centers. Results: the benefits of family planning, free contraceptive use, husband's approval and moral obligation were factors facilitating voucher use. The desire to become pregnant, husband's opposition, women's reluctance, women's lack of knowledge of contraceptives and factors associated with the intervention were the leading reasons for not using the vouchers. Conclusion: the promotion of modern contraceptive use among married women or concubines requires a holistic approach combining free access to modern contraceptives, effective policies involving men in family planning and the reduction of fertility preferences among the couples. [ABSTRACT FROM AUTHOR]

Introduction: we conducted a pilot study for transferring skills for intrauterine device (IUD) insertion and implants to primary health care workers (PHCWs) as well as to provide injectable contraceptives to community health workers (CHWs) in 20 Health Centers in the Tougan Health District. This was aimed to increase access to contraceptive methods in Burkina Faso. Moreover, the purpose of this study was to assess the quality of family planning (PF) services offered by these delegated (PHCWs and CHWs). Methods: we conducted a cross-sectional, descriptive, analytical study. Data collection was based on quantitative and qualitative methods. It included the 20 health centers in the study area and all providers (54) involved in contraceptive product supply (delegators and delegatees). Nineteen (19) recipients including 10 new contraceptive users were interviewed. The method of data collection included the observation of FP services and of the working environment, document review and individual interviews. Data were analyzed using Epi info 7 and Open Epi version 3.01. software. Chi-square test and Student's t-test were used to determine whether there was significant difference between the quality of PF services offered by the delegators and that of the delegatees. Results: PF service quality score in the study area was 73% for the delegators' vs 69% for the delegates. There was no statistically significant difference between these scores. However, there was a statistically significant difference between the quality score of community health workers (75.8%) and the quality score of counselors (delegators; 87.5%) (P <0.05). It was the same for quality score determining who was eligible for implants. The quality score of PHCWs was higher than that of delegators: 79% for delegators, 64% for delegatees. Conclusion: this purpose of this study was to improve the geographic coverage for long-acting contraceptive methods. Under certain conditions (skills-building, monitoring, coaching), it is possible to extend the transferring of skills for long-acting contraceptive methods to PHCWs as well as the provision of injectable contraceptives to CHWs, while maintaining a satisfactory level of FP service quality. [ABSTRACT FROM AUTHOR]

Copyright of Études Caribéennes is the property of Etudes Caribeennes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this article, written in the form of an interview, Malika Affes, midwife in charge of one of the family planning units of La Rabta Hospital in Tunis, and Irene Maffi, anthropologist, discuss sexual and reproductive health in Tunisia. Their conversation - which is the result of a 10-month collaboration - tackles different topics related to the institutions in charge of sexual and reproductive health, the laws regulating the access to these services, the therapeutic itineraries of women and the attitudes of health care providers. The authors particularly explore the local representations of the female body, the socioeconomic profiles of women using government sexual and reproductive health clinics, the knowledge of the law among patients and health practitioners, the application of sexual and reproductive rights in Tunisia, the impact of the revolution of 2011 and of the economic crisis on the public health services, men’s involvement in sexual and reproductive practices.

INTRODUCTION: Despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. METHODS: the study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. RESULTS: six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). CONCLUSION: this study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.

INTRODUCTION: Family planning programmes have helped in increasing the prevalence of contraceptive use and reducing total fertility rate in developing countries from six to three births per woman. However, its uptake is lower in the rural areas compared to urban areas. This study seeks to elucidate the effect of community mobilisation on awareness, approval and use of family planning among women of reproductive age in the rural areas of Ebonyi state, Nigeria. METHODS: We conducted a quasi-experimental study among women aged 15 to 49 years in two rural communities in Ebonyi state. Using simple random method, we recruited 484 women for the study. We used pre-tested interviewer-administered questionnaire to collect information from the participants. Community awareness and distribution of information, education and communication materials were carried out within one month. We estimated the effect of the intervention on the level of awareness, approval and uptake of family planning methods. RESULTS: Level of awareness increased by 19% (p=0.001) while uptake of family planning increased by 16.7% (p=0.001) in the intervention group. The approval rate was higher in the intervention group compared to the control group (p=0.008). The most commonly used method of family planning was the natural method in intervention and control arms. CONCLUSION: Although uptake of family planning increased significantly in the study population, the rate is generally low. Given the critical role of the community in family planning programmes, community mobilisation may be deployed to increase uptake of family planning in similar rural communities.

Objective: To study the epidemiological aspects of modern contraception in the family planning department of the Panzi Reference General Hospital. Material and methods: This is a descriptive, retrospective, hospital-based study of family planning program records of the socio-epidemiological and gynecological-obstetrical data of women who sought contraception over a period of time. 12 months from 01January 2017 to 31st December 2017. Results: A total of 428 women were registered for modern contraception. These women had an average age of 33 years with extremes of 17 years and 48 years. They came mainly from the Ibanda health zone for 290 women, or 67.76% of the cases. They were married in 94.63% (405 cases). About eighty-five percent had consulted for birth spacing. The implant was the most commonly used method of contraception with 63.55 cases. The average pregnancy was 2.90 and the parity was 2.72. Conclusion: Modern contraception is practiced in kivu health facilities for reasons of birth spacing. The factors that motivate the choice of a method or its refusal remain to be determined in order to make this practice more efficient and effective. [ABSTRACT FROM AUTHOR]

Introduction: family planning is a high impact strategy to reduce maternal mortality and to prevent mother-to-child transmission of HIV. This study aims to describe contraceptive practices of HIV-infected women followed upon an ambulatory basis at the Treichville University Hospital. Methods: we conducted a cross-sectional descriptive multicenter survey of people living with HIV in the ambulatory care units of the Treichville University Hospital from 1 April to 30 June 2016. During this period, all HIV positive patients of childbearing age attending the Department of Obstetrics and Gynecology, the Pneumophtisiology Department, the Department of Dermatovenereology and the Department of internal medicine were invited to complete a standardized questionnaire on the sociodemographic, medical characteristics and the contraceptive practices. Results: in total, 283 women agreed to participate in the study, their median age was 36 years with an average parity of 1.7. Patients were nulliparous in only 22.3% of cases and lived with a partner in 54.8% of cases. They had no child with the current partner in 68.2% of cases. The partner was informed about their HIV status in 51.6% of cases. They were under antiretroviral treatment in 92.9% of cases with a median mean CD4 of 382 cells/mL. The majority of patients (62.9%) declared that they were using a modern contraceptive method. They mainly used progestin injectable (45.5%) and contraceptive implant (32.6%). The practice of dual protection was reported by only 17.4% of them. Secondary and higher education (OR=2.23 [1,35-3,69], p=0.01), multiparity (OR=1.84 [1,11-3,06], p=0.002) and revelation of HIV positive status to the partner (OR=1.86 [1,14-3,03], p<0.01) were factors significantly associated with the use of contraception. Conclusion: based on our experience, contraceptive practices in women infected with HIV are generally discouraging. It is essential to develop strategies to improve the integration of family planning into the management of HIV-infected women. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Promotion of modern family planning is a major policy action for Africa to harness the demographic dividend. Family planning is an important public health intervention for maternal and child health. METHODS: analysis was based on data from Demographic and Health Surveys conducted in 2010 on samples of women from Burundi (3396) and Rwanda (4670). Descriptive and multivariate logistic regression analyses to examine the contribution and comparison of the various predictors of uptake of modern contraceptives during the postpartum period (PPFP) in the two countries were carried out using STATA statistical software. RESULTS: descriptive findings show only 20% of the samples of women in Burundi used while more than half of the women (51%) were using PPFP. Utilization of PPFP was significantly associated with primary (OR = 1.3, 95% CI = 1.1-1.6) and higher education (OR = 2.2, 95% CI = 1.6-3.1) in Burundi. Similarly in Rwanda increased use of PPFP in primary was (OR = 1.4, 95% CI = 1.2-1.6) while secondary education (OR = 1.6, 95% CI = 1.2-2.1). Protestant women were less likely to use PPFP in both Burundi (OR = 0.75, 95% CI = 0.6-0.9) and Rwanda (OR = 0.69, 95% CI = 0.6-0.8). Other significant variables in the regression models of both countries included wealth status, age of woman, number of living children and exposure to media. Professional birth delivery assistance was significant only in Rwanda. CONCLUSION: enhancing postpartum contraceptive use should target women with low education, low wealth status, and that the media has an important role to play in this transformation. Policies and programs must be put in place to ensure that the rural urban differences are eradicated.

The Ugandan UK Health alliance (UUKHA) promotes collaboration between UK- and Uganda-based organisations working in health in order to further global learning and the sharing of best practice. On 22–23 March 2018, the UUKHA held the third East African Health Improvement and Investment Summit in Kampala, Uganda. This is the report of a dynamic workshop which was aimed at encouraging thought and discussion on an innovative approach to tackling common health problems such as family planning, alcohol and malnutrition.

INTRODUCTION: The post-conflict Acholi sub-region of Uganda is undergoing a period of transition that is influencing access, acceptability and use of family planning (FP). Low FP use and high unmet need for FP in Uganda's northern region provides a unique opportunity to test a community-based group counseling approach to reduce unintended pregnancies among young couples. We share findings from a proof of concept testing model in delivering fertility awareness methods (FAM) to groups of couples by trained non-health community youth agents. METHODS: The group counseling model was developed for couples interested in two FAM-standard days method (SDM) and TwoDay Method-within rural communities in Northern Uganda. WALAN was tested in a three-month proof of concept phase, employing 24 direct observations of group counseling sessions; quantitative interviews with 9 couples using either SDM or TwoDay method; 2 focus group discussions with youth facilitators and; 9 key informant interviews with providers and leaders. RESULTS: The proof of concept results suggest model feasibility and acceptability among participating communities. Couples learned how to use FAM correctly. All 9 interviewed female users reported 100% correct knowledge of method use. Couples also reported high levels of satisfaction for both methods. SDM and TwoDay Method participants reported comfort and satisfaction in learning about FAM in small groups with other couples. CONCLUSION: The proof of concept phase confirmed intervention feasibility, albeit with some model adjustments. The results were used to inform the pilot intervention, launched in April 2016 within 15 other villages in the same region.

Background: A short inter-pregnancy interval increases the risk for maternal and neonatal deaths in addition to other pregnancy complications including: preterm delivery, low birth weight, anaemia and premature rupture of membranes. However, only one half of Kenyan women, who have no desire to conceive immediately after birth, are using contraception one year after delivery. Aim: The aim of this study was to determine the predictors of uptake of post-partum family planning (PPFP). Setting: The study was conducted among post-partum women accompanying their children for their first measles vaccination at Webuye County Hospital (WCH), in western Kenya. Methods: This was a cross-sectional study involving 259 randomly sampled post-partum women, accompanying their children for their first measles vaccination. A structured, interviewer-administered questionnaire was used to collect data. Logistic regression was used to identify correlates of PPFP uptake. Results: The uptake of PPFP among women at 9 months post-partum at WCH was found to be 78.4% ± 5.0%. The odds of PPFP uptake among women living with their sexual partners was 88.2% less than among those not living with their partners with the true population effect between 97% and 51% (OR = 0.118; 95% CI: 0.028–0.494; p = 0.003). Conclusions: Not living with her sexual partner in the same house is the key predictor of a woman’s PPFP uptake in WCH. This study recommends that any programme aimed at improving post-partum contraceptive use in WCH should target women who live with their partners in the same house.

The infant mortality rate (children under five) in Palestine is 21 deaths per 1,000 live births. Palestine has thus successfully reached the threshold set by the Millennium Development Goals for child mortality. However, this rate is higher than in neighboring countries. This indicator is extremely important as it is a highly sensitive indirect measure of population health, poverty and socio-economic development status, as well as the availability and quality of health services in a country. These are all factors that still present challenges in Palestine., (Copyright © 2023. Publié par Elsevier Masson SAS.)

Introduction: This study aimed to determine modern contraceptive prevalence and the barriers to using modern contraceptive methods among the couples in Dibindi health zone, Mbuji-Mayi, in the Democratic Republic of the Congo. Methods: We conducted a cross-sectional descriptive study from May to June 2015. Nonpregnant married women aged 15-49 years old at the time of the investigation, living in Dibindi health zone for two years and having freely consented to participate in the study were included. Data were collected by open-ended interview of these women. Modern contraceptive prevalence was referred to women who were currently using, at the time of the investigation, modern contraceptives. The comparison between proportions was performed at the significance threshold of 5%. Bonferroni's test was used to compare, two by two, the proportions of barriers to using modern contraceptive methods. Results: Modern contraceptive prevalence in Dibindi was 18.4% in 2015. It was low with regard to family planning services available in this health zone. Several women refused to use modern contraceptive methods despite available information because of their desire for motherhood, religious prohibition, opposition on the part of their husband and fear of side effects. Conclusion: Sufficient client-centered or couple-centered information and family planning information should be strengthened in order to eliminate the false beliefs and to increase the use of modern contraceptive methods. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: unmeet family planning is one of the common causes for low contraceptive prevalence rate in developing countries including Ethiopia. Thus, this study designed to assess the prevalence and associated factors of unmet need in Shire Endaslassie town, Northern west of Tigray, Ethiopia. METHODS: a community based cross sectional study design was employed. Multistage sampling technique was employed and data were collected using a semi-structured questionnaire by interviewer administered technique. Questionnaires were reviewed and checked for completeness, accuracy and consistency. Reviewed data were entered to Epi info 7 and analyzed by SPSS version 20 statistical software. Variables with P-value of less than 0.2 in bivariate analyses were entered for multivariate analysis and AOR at 95% CI with p-value of less than 0.05 were considered as significant variables. RESULTS: the overall unmet need for family planning in the study area was 109(21.4%). 74(14.5%) for spacing and 35(6.9%) for limiting. Age group of 35-39 and =40 (AOR= 2.7,95%CI:1.1,6.5), (AOR=2.65, 95%CI:1.10, 6.40) respectively, decided numbers of desired children more than five (AOR=O.48, 95%CI: 0.28, 0.80), discussions of client with heath care providers (AOR=6.32, 95%CI: 2.56, 15.58), previous use of modern family planning (AOR=2.29, 95%CI, 1.20, 4.34) were significantly associated with unmet need for family planning. CONCLUSION: unmet need for family planning in the study area was high, so continuous discussion on modern family planning with community health workers and encouraging of women to decide desired numbers of children of less than five in general are better to be strengthened.

In recent years, the sterilisation of women has increased in Guatemala, especially among indigenous populations. Some of these women are not aware of its irreversible aspect, its side effects or the existence of other contraceptive methods. Health institutions and their staff believe that indigenous patients do not fully understand the social and sanitary aspects of reproduction and therefore, deemed them to be unable to make "correct” decisions, because of their “culture”, which is considered to be irrational, male chauvinistic etc. They try to influence their patients decisions so as to be in accordance with a predefined procreative norm. This procreative norm is directly connected to the demands of International Aid Organizations and is inspired by a neo-malthusian doctrine. An intersectional analysis allows me to interpret social practices, representations and discourses relating to family planning. It thus brings better understanding concerning the relations established between institutions, providers, patients and communities, in a country where sexual violence and a will to control their bodies have been inflicted on indigenous Maya women both in the past and the present.

INTRODUCTION: globally, most postpartum pregnancies are unplanned, mainly as a result of low level of knowledge and fear of contraceptive use especially in low-income settings. The aim of this study was to evaluate the effect of prenatal contraceptive counselling on postpartum contraceptive use and pregnancy outcomes after one year.METHODS: sixteen health centres were equally and randomly allocated to control and intervention arms. Mothers were consecutively recruited during their first antenatal clinic consultations. In the intervention arm Village Health Team members made home visits and provided prenatal contraceptive advice and made telephone consultations with health workers for advice while in the control arm mothers received routine antenatal care offered in the health centres. Data were collected in 2014 in the two districts of Kiryandongo and Masindi. This data was collected 12-14 months postpartum. Mothers were asked about their family planning intentions, contraceptive use and screened pregnancy using human Chorionic Gordadotrophin (hCG) levels. hcg pregnancy tests. Socio-demographic and obstetric indices were recorded. Our primary outcomes of interests were current use of modern contraceptive, decision to use a modern contraceptive method and pregnancy. Multilevel analysis using the xtmelogit stata command was used to determine differences between intervention and control groups. Subgroup analysis of the intervention arm was conducted to determine the effect of home visits on postpartum contraceptive use. RESULTS: a total of 1,385 women, 748 (control) and 627 (intervention) were recruited. About 80% initiated breastfeeding within six hours of delivery 78.4% (control) and 80.4% (intervention). About half of the mothers in each arm had considered to delay the next pregnancy 47.1% (control) and 49% (intervention). Of these 71.4% in the control and 87% in the intervention had considered to use a modern contraceptive method, only 28.2% of the control and 31.6% in the intervention were current modern contraceptive users signifying unmet contraceptive needs among immediate postpartum mothers. Regarding pregnancy, 3.3% and 5.7% of the women were found to be pregnant in the control and intervention arms respectively. There were no statistical differences between the control and intervention arms for all primary outcomes of interests. In the subgroup analysis age (0.68; 95%CI: (0.49-0.93); p=0.0180), ethnicity 2.05(1.49-2.83); p=0.001 and education (1.56(1.09-2.22); p=0.015) were found to be significantly associated with postpartum contraceptive use.CONCLUSION: prenatal contraceptive counselling did not affect postpartum contraceptive use among postpartum mothers in Masindi and Kiryandongo districts. Being a younger mother; mother having attained eight of higher years of education; and belonging to the indigenous ethnic tribe were predictors of modern contraceptive use among postpartum mothers. Interventions aiming at improving postpartum contraceptive use should target addressing the unmet contraceptive needs and focus on older mothers, mothers of lower education level and internal migrants.

INTRODUCTION: we assessed the fertility desires, utilization of family planning (FP) methods, and incidence of pregnancies among HIV-infected women receiving care in an HIV clinic with an onsiteFP services in Kinshasa, Democratic Republic of Congo. METHODS: between November 2011 and May 2012, all HIV-infected women who attended a routine visit at the clinicwere interviewed about their fertility desires and utilization of contraceptive methods using a structured questionnaire. Routine follow-up visit data were used to identify pregnancies recorded between the interview and June 2013. RESULTS: overall, of the 699 HIV-infected women interviewed. 249 (35.7%) reported not wanting another child. Of the 499 (72.2%) participants who were sexually active at the time of interview, 177 (35.5%) were using an effective contraceptive method, including 70 (14.0%) women who reported using condoms consistently and 104 (20.8%) who were using injectable contraception. Overall, 88 (17.6%) sexually active participants who did not want another child were not using an effective FP method, and thus are considered to have had unmet need. During the median follow-up time of 22.2 (IQR: 20.2, 23.6) months, among all women interviewed, 96 (14.1%) became newly pregnant [pregnancy rate9.3 (95%CI: 7.6, 11.4) per 100 women-years) including 21 (8.7%) among women who initially reported not wanting another child [unwanted pregnancy rate 5.8 (95%CI: 3.6, 9.3) per 100 women-years). CONCLUSION: the persistence of relatively high unmet need among women receiving HIV care in a clinic with onsite FP services suggests the existence of barriers that must be identified and addressed.