Family planning methods among women in a vaginal microbicide feasibility study in rural KwaZulu-Natal, South Africa
01 Aug 2008-African Journal of Reproductive Health (Women's Health and Action Research Center)-Vol. 12, Iss: 2, pp 45-63
TL;DR: Age, marital status, education level and parity were associated with different contraceptive method choices, and contraceptive use increased significantly among women followed longitudinally for 9 months, largely due to increased condom use.
Abstract: This study investigated contraceptive use among women in rural KwaZulu-Natal, South Africa. Of 866 sexually active women not intending pregnancy and screened for a microbicide feasibility study, 466 (54%) reported currently using modern contraceptives: injectables (31%), condoms (12%), sterilization (6%) and pills (4%). Multivariable logistic regression analyses revealed statistically significantly higher odds of current contraceptive use among married vs. engaged/unmarried women (aOR 1.64), multiparous vs. nulliparous (aOR 4.45) and women who completed secondary education or above vs. primary or less (aOR 1.64). Significantly lower odds of use were observed among women aged 40+ vs. age 15-19 (aOR 0.38). Age, marital status, education level and parity were associated with different contraceptive method choices. Among 195 women followed longitudinally for 9 months, contraceptive use increased significantly from 56% to 70%, largely due to increased condom use (15% to 28%). Results highlight the importance of integrating family planning and HIV/STI prevention counseling and informing promotion of further contraceptive uptake among women not intending pregnancy. (Afr J Reprod Health 2008; 12[2]:45-63) RESUME
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TL;DR: Uptake of contraception was associated with young age, being unmarried, occupation, parity and the number and type of sexual partners, which can help to guide decisions on trial eligibility and the need for additional counselling.
Abstract: Objectives Information on pregnancy rates and factors associated with pregnancy and contraceptive use is important for clinical trials in women in sub-Saharan Africa where withdrawal of investigational products may be required in the event of pregnancy with a consequent effect on sample size and trial power. Methods A prospective cohort analysis of pregnancy and contraceptive use was conducted in Tanzanian women enrolled in a randomised placebo-controlled trial of herpes simplex virus-suppressive therapy with acyclovir to measure the effect on HIV incidence in HIVnegative women and on genital and plasma HIV viral load in HIV-positive women. The cohort was followed every 3 months for 12e30 months. Women at each visit were categorised into users or non-users of contraception. Pregnancy rates and factors associated with pregnancy incidence and contraceptive use were measured. Results Overall 254 of 1305 enrolled women became pregnant at least once during follow-up (pregnancy rate: 12.0/100 person-years). Younger age, being unmarried, higher baseline parity and changes in contraceptive method during follow-up were independently associated with pregnancy. Having paid sex and being HIV positive were associated with lower risk of pregnancy. Uptake of contraception was associated with young age, being unmarried, occupation, parity and the number and type of sexual partners. Conclusions Data on use of contraceptive methods and risk factors for pregnancy can help to guide decisions on trial eligibility and the need for additional counselling. Mandatory reliable contraceptive use in study participants may be required to reduce pregnancy rates in studies where pregnancy is contraindicated.
20 citations
Dissertation•
01 Jan 2013
TL;DR: Examining whether vaginal microbicides are compatible with socio-cultural norms regarding sexuality and sexual health in a predominantly rural area of KwaZulu-Natal, South Africa found that microbicide acceptability is evaluated from a cultural perspective, but they may be less compatible with norms relating to intravaginal cleansing and love medicines.
Abstract: There is an urgent need for additional HIV prevention options for women. Evidence supporting the benefit of microbicides in reducing the risk of vaginally acquired HIV acquisition has provided a major breakthrough. Despite the wealth of evidence supporting microbicide acceptability in Africa, there are still gaps in our understanding about how women will incorporate microbicides into their everyday lives.
In this thesis I examine whether vaginal microbicides are compatible with socio-cultural norms regarding sexuality and sexual health in a predominantly rural area of KwaZulu-Natal, South Africa. Using qualitative and quantitative data collected as part of the MDP 301 clinical trial at the Africa Centre, I adopt a mixed methods approach to evaluate microbicide acceptability from a cultural perspective. I explore the compatibility of microbicides with socio-cultural norms that relate to intravaginal cleansing, intravaginal insertion, love medicines and sexual communication.
I found that the desired effects of using intravaginal insertions to enhance sexual pleasure are compatible with the experiences of using microbicides; that contemporary socio-cultural norms relating to sexual communication in the context of the HIV epidemic are compatible with the introduction of microbicides; that women distanced microbicides from ‘love medicines’ in terms of separating microbicides from the supernatural; and, finally, that postcoital intravaginal cleansing practices could undermine a microbicides roll out programme if we fail to address these practices.
Overall I found that microbicides are compatible with socio-cultural norms relating to intravaginal insertion and sexual communication, but they may be less compatible with norms relating to intravaginal cleansing and love medicines. While incompatibility with socio-cultural norms raises challenges for intravaginal cleansing, the fact that love medicines are incompatible with microbicides could be advantageous for their introduction. Ultimately these findings have implications for future research and service delivery, as well as offering insights into microbicides, sexuality and gender equality.
19 citations
TL;DR: To evaluate the contributions of the INDEPTH Network of health and demographic surveillance system (HDSS) members to research efforts and interventions on reproductive health in low‐ and middle‐income countries (LMICs).
Abstract: Objective
To evaluate the contributions of the INDEPTH Network of health and demographic surveillance system (HDSS) members to research efforts and interventions on reproductive health in low- and middle-income countries (LMICs).
Methods
Review of peer-reviewed published papers on sexual and reproductive health (SRH) that use the HDSS framework through (i) an online search for publications using terminology related to HDSS, HIV, Maternal health, adolescent sexual and reproductive health, family planning/contraceptives and fertility, and (ii) asking INDEPTH member centres for information on their published papers on SRH publications that used the HDSS framework. A paper was included in the review only if it used HDSS data, dealt with SRH issues, and had been published in a peer-reviewed international journal.
Results
Most of the papers in the review focused on HIV, maternal health, family planning and adolescent sexual and reproductive health (ASRH). Generally, people are knowledgeable about HIV. School attendance considerably delays entry into motherhood and reduces the probability of entering into early marriage or sexual union. The general decline in maternal mortality over the last decade is partly due to better access to emergency obstetric services, improved education of women and reduction in fertility.
Conclusion
Sexual and reproductive health is a significant public health need, yet little research has been published in this area to inform policy. The HDSS framework is ideal for SRH research, as it offers the advantage to track and monitor progress of relevant health and demographic indicators, especially in family planning, marriage and fertility studies.
Objectif
Evaluer les contributions du Reseau INDEPTH des membres du Systeme de Surveillance Demographique et de Sante (SSDS) aux efforts de recherche et des interventions en matiere de sante reproductive dans les pays a revenus faibles et intermediaires (PFR-PRI).
Methodes
Revue d'articles publies sur la sante sexuelle et reproductive (SSR) qui ont utilise le cadre SSDS via (a) une recherche en ligne des publications en utilisant la terminologie relative au SSDS, VIH, sante maternelle, sante sexuelle et reproductive des adolescents, planification/contraception familiale et fertilite, et (b) en demandant aux centres des membres de INDEPTH qui ont utilise le cadre SSDS, leurs articles publies sur la SSR. Les articles n'ont ete inclus dans l'analyse que s'ils ont utilise les donnees SSDS, portaient sur des questions de SSR et ont ete publies dans une revue scientifique internationale.
Resultats
La plupart des articles dans la revue etaient axes sur le VIH, la sante maternelle, la planification familiale et la sante sexuelle et reproductive des adolescents (SSRA). En general, les gens sont bien informes au sujet du VIH. La frequentation scolaire retarde considerablement le debut de la maternite et reduit la probabilite de contracter un mariage ou une relation sexuelle precoce. La baisse generale de la mortalite maternelle au cours de la derniere decennie s'explique en partie par un meilleur acces aux services obstetriques d'urgence, l'amelioration de l’education des femmes et la reduction de la fertilite.
Conclusion
La SSR est un besoin de sante publique important, mais peu de recherches ont ete publiees dans ce domaine pour eclairer les politiques. Le cadre SSDS est ideal pour la recherche sur la SSR, car il offre l'avantage de suivre et de surveiller les progres des indicateurs pertinents sanitaires et demographiques, en particulier dans la planification familiale, le mariage et les etudes de fertilite.
Objetivo
Evaluar las contribuciones de los miembros de la red de sistemas de vigilancia sanitaria y demografica (VSyD) de INDEPTH a la investigacion en intervenciones en salud reproductiva en paises con ingresos medios y bajos (PIMBs).
Metodos
Revision de las publicaciones con revision por pares sobre salud sexual y reproductiva (SSR) que utilizaron el marco de VSyD mediante (a) una busqueda online de publicaciones utilizando terminologia relacionada a la VSyD, VIH, salud materna, salud sexual y reproductiva en adolescentes, planeacion familiar/anticonceptivos y fertilidad, y (b) preguntando a centros miembros del INDEPTH sobre sus publicaciones de SSR para las que se habia utilizado el marco de VSyD. Una publicacion se incluia en la revision solo si habia utilizado datos de VSyD, tenia que ver con SSR y se habia publicado en una revista internacional con revision por pares.
Resultados
La mayoria de las publicaciones incluidas en la revision estaban enfocadas al VIH, la salud materna, la planeacion familiar y la salud sexual y reproductiva en adolescentes (SSRA). En general, las personas tenian conocimientos sobre el VIH. El haber ido a la escuela retrasaba considerablemente la entrada en la maternidad y reducia la probabilidad de un matrimonio o union sexual temprana. La disminucion general de la mortalidad materna durante la ultima decada es en parte debida a un mejor acceso a los servicios de emergencia obstetrica, una mejora en el nivel educativo de las mujeres y una reduccion de la fertilidad.
Conclusion
La SSR es una importante necesidad de salud publica, y sin embargo se han hecho pocas publicaciones en esta area que puedan guiar las politicas sanitarias. La red de VSyD es ideal para la investigacion en SSR, puesto que ofrece la ventaja de seguir y monitorizar el progreso de indicadores sanitarios y demograficos relevantes, especialmente en estudios de planeacion familiar y fertilidad.
11 citations
Cites background from "Family planning methods among women..."
...Subramanian et al. (2008) found significantly higher odds of current contraceptive use among married vs. engaged/ unmarried women and age, marital status, education level and parity were found to be associated with different contraceptive method choices....
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01 Jan 1997
TL;DR: Widespread regardless of the race of the client was an assumption on the part of health providers that they should make decisions on behalf of their clients and a failure to encourage women to take control of their own fertility.
Abstract: The impact of apartheid on South African womens experiences of contraception and contraceptive services was assessed through focus group discussions involving 86 White and Black women from the largely urban Gauteng province. The findings contradicted the widely held assumption that White women who obtain care through the private sector receive substantially better services than Black women in the public sector. Women who attended clinics in the public sector reported hostility from providers and were subjected to sterilization procedures without their full knowledge or consent. In the private sector financial considerations were often a major motivator of services provided. Service in both sectors was characterized by long waiting periods limited information and choice of methods and inadequate provider competence. Widespread regardless of the race of the client was an assumption on the part of health providers that they should make decisions on behalf of their clients and a failure to encourage women to take control of their own fertility. Recommended on the basis of these findings are better education about sexuality and contraception in the schools and community improvements in the training of health care workers and research on the dynamics of health worker-client interactions.
10 citations
Dissertation•
28 Jul 2015
TL;DR: Holder expectations could override strong concerns for health, however, and HIV positive women were at similar risk of live birth to HIV negative women when in a regular relationship or living with a partner.
Abstract: Mixed methods investigate the association between HIV, ART and fertility following scale-up of HIV treatment and care in South Africa. Two longitudinal analyses of surveillance data from the Africa Centre for Health and Population Studies compare factors associated with live birth by HIV and ART exposure. Semi-structured interviews with women enrolled on ART and healthcare providers explore perceptions of childbearing and contraceptive use. A quantitative study reports on one open cohort analysis and a subsequent closed cohort. Crude Birth Rates declined since 2005 and an open cohort analysis (2007-2013) found consistently lower birth-rates amongst women on-ART, compared to HIV-positive ART-naive women and HIV negative women. One exception was found in the 25-29year age group: incidence was 38% higher to women on ART than ART-naive women. Crude incidence of live birth was 6.6 births/100 women-years and decreased with increasing age, higher parity, poorer self-reported health, urban area of residency, knowledge of own HIV status, being single or engaged/married, not living with a partner, awareness of the benefits of ART, use of contraception and use of injectable methods. Annual likelihood (aHR, 0.39; 95% 0.347 – 0.441) was 61% lower to HIV positive versus negative women in multivariable Poisson analysis and exposure to ART was associated with 38% reduced likelihood (aHR, 0.62; 95% 0.487 – 0.799). In a subsequent closed cohort, HIV ‘unknown’ women demonstrated similar incidence and associated factors of live birth compared to HIV negative women. HIV positive women were less likely than HIV negative and HIV ‘unknown’ women to use contraception. Women described inconsistent injectable use in semi-structured interviews due to side effects and perceptions that injectables make women ‘watery’ or are unnecessary on ART. Family planning counselling was under-prioritised within the health care service and women were unaware of safer conception topics. Recent pregnancies were considered unintended and most women desired to avoid childbearing considering current family size, economic and health risks. Partner expectations could override strong concerns for health, however, and HIV positive women were at similar risk of live birth to HIV negative women when in a regular relationship or living with a partner.
7 citations
Cites background from "Family planning methods among women..."
...However, knowledge of a modern contraceptive method does not implicitly lead to its adoption (Subramanian et al., 2009)....
[...]
...In KwaZulu-Natal, around one half of women who did not intend to have a child reported using contraception (Subramanian et al., 2009)....
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References
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846 citations
TL;DR: Analysis of links between gender ideology or gender roles and the social impact of adolescent childbearing in the lives of rural and urban adolescents in KwaZulu/Natal, South Africa indicates gender ideals are grounded in traits that reinforce poor sexual negotiation dynamics and behavioral double standards and that place adolescents at risk for early pregnancy and other sexual and reproductive health complications.
Abstract: Although the literature on Africa increasingly adopts a gendered approach to sexual and reproductive health issues, few studies have addressed adolescent pregnancy and parenthood in such a framework. This article examines links between gender ideology or gender roles and the social impact of adolescent childbearing in the lives of rural and urban adolescents in KwaZulu/Natal, South Africa. It employs a triangulated research methodology (focus-group discussions, narrative role playing and discussions, and questionnaires and in-depth interviews) to inform an analysis of adolescents' notions of male and female gender ideals. This analysis forms the basis for an exploration of the potential influence of adolescent childbearing on young peoples' lives and factors that shape their sexual and reproductive well-being. Results indicate that gender ideals are grounded in traits that reinforce poor sexual negotiation dynamics and behavioral double standards and that place adolescents at risk for early pregnancy and other sexual and reproductive health complications. Overall, adolescent parenthood is viewed negatively by participants of both sexes because it compromises personal, professional, and financial aspirations. Compared with its effect on boys, parenthood has a disproportionate (and highly negative) impact on girls that is directly linked to gender-based inequities. The article addresses the research and policy implications of these findings.
399 citations
TL;DR: Among a sample of young women, limited sexual power was associated with inconsistent condom use but not directly with HIV.
Abstract: Gender power inequities are believed to play a key role in the HIV epidemic through their effects on women's power in sexual relationships. We hypothesized that lack of sexual power, measured with a four-point relationship control scale and by a woman's experience of forced sex with her most recent partner, would decrease the likelihood of consistent condom use and increase the risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.10 times more likely to use condoms inconsistently (95% confidence interval [CI] 1.17-3.78), and women experiencing forced sex were 5.77 times more likely to use condoms inconsistently (95% CI 1.86-17.91). Inconsistent condom use was, in turn, significantly associated with HIV infection (adjusted odds ratio 1.58, 95% CI 1.10-2.27).
393 citations
TL;DR: No association was found between hormonal contraceptive use and HIV acquisition overall, which is reassuring for women needing effective contraception in settings of high HIV prevalence, however, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition.
Abstract: Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. The objective was to evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. Methods: This multicenter prospective cohort study enrolled 6109 HIV-uninfected women aged 18-35 years from family planning clinics in Uganda Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand where there were few HIV cases). HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.69-1.42] nor DMPA (HR 1.25; 95% CI 0.89-1.78) was associated with risk of HIV acquisition overall including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment among the HSV-2-seronegative participants both COC (HR 2.85; 95% CI 1.39-5.82) and DMPA (HR 3.97; 95% CI 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding. (authors)
228 citations