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Journal ArticleDOI

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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Citations
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Journal ArticleDOI
TL;DR: Pooling of data from 14,874 women in an individual participant data meta-analysis by Nicola Low and colleagues reveals that some intravaginal practices increase the risk of HIV acquisition.
Abstract: Background: Identifying modifiable factors that increase women’s vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition. Methods and Findings: We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I 2 values 0.0%– 16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18–1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00–1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01–1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04–1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p,0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p,0.001), respectively. Conclusions: This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors’ Summary. Citation: Low N, Chersich MF, Schmidlin K, Egger M, Francis SC, et al. (2011) Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual

247 citations


Cites background from "Family planning methods among women..."

  • ...9; South Africa [41] FPC, immunisation clinics Women attending clinics 12 mo 3 Monthly 07/03–07/04 261 29....

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  • ...For example, McClelland and colleagues found a strong association between intravaginal cleaning with soap and incident HIV infection in Kenya [8] but van de Wijgert and colleagues and Myer and colleagues found no associations in their studies in Uganda and Zimbabwe [44] and South Africa [20]....

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  • ...Inserting products to dry or tighten the vagina was uncommon; this was most commonly reported in four studies conducted in South Africa and Zimbabwe, where the prevalence was 13%–20% (studies 1 Zimbabwe, 7 Zimbabwe, and 8 South Africa)....

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  • ...Studies done in South Africa tended to have a low overall prevalence of any current vaginal practice (18%–27%, studies 8–10) and studies in Zimbabwe tended to have a high prevalence (69%–92%, studies 1, 6, 7)....

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  • ...Cleaning with water, with or without other practices, was reported by more than 60% of women in all but four studies in South Africa (studies 7 South Africa, 8–10)....

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Journal ArticleDOI
26 Aug 2013-PLOS ONE
TL;DR: A significant gap exists between future FP intentions and current FP practices, and integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission.
Abstract: Background: Preventing unintended pregnancies among HIV-positive women through family planning (FP) reduces pregnancy-related morbidity and mortality, decreases the number of pediatric HIV infections, and has also proven to be a cost-effective way to prevent mother-to-child HIV transmission. A key element of a comprehensive HIV prevention agenda, aimed at avoiding unintended pregnancies, is recognizing the attitudes towards FP among HIV-positive women and their spouse or partner. In this study, we analyze FP attitudes among HIV-infected pregnant women enrolled in a PMTCT clinical trial in Western Kenya. Methods and Findings: Baseline data were collected on 522 HIV-positive pregnant women using structured questionnaires. Associations between demographic variables and the future intention to use FP were examined using Fisher’s exact tests and permutation tests. Most participants (87%) indicated that they intended to use FP. However, only 8% indicated condoms as a preferred FP method, and 59% of current pregnancies were unintended. Factors associated with positive intentions to use FP were: marital status (p=0.04), having talked to their spouse or partner about FP (p,0.001), perceived spouse or partner approval of FP (p,0.001), previous use of a FP method (p=0.006), attitude toward the current pregnancy (p=0.02), disclosure of a sexually transmitted infection (STI) diagnosis (p=0.03) and ethnic group (p=0.03). Conclusion: A significant gap exists between future FP intentions and current FP practices. Support and approval by the spouse or partner are key elements of FP intentions. Counseling services should be offered to both members of a couple to increase FP use, especially given the high number of unplanned pregnancies among HIV-positive women. Condoms should be promoted as part of a dual use method for HIV and STI prevention and for contraception. Integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission.

51 citations

Journal ArticleDOI
TL;DR: It is indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.
Abstract: Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15-49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia, 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at health facilities were positively associated with current contraceptive use. By contrast, older age, a rural resident, or Muslim; belonging to the Afar or Somali ethnic groups; desiring numerous children; having husbands who desired additional children; and abortion experience were negatively associated with current contraceptive use. Our findings indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.

46 citations


Cites background from "Family planning methods among women..."

  • ...Theoretical framework of contraceptive service use. employment status of women was also positively related to contraceptive use (Subramanian et al. 2009)....

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  • ...employment status of women was also positively related to contraceptive use (Subramanian et al. 2009)....

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Journal ArticleDOI
TL;DR: In this article, the authors investigated patterns, levels and socio-demographic determinants of condom use and consistency of use among young adults aged 15-24 years in rural KwaZulu- Natal.
Abstract: Aim: To investigate patterns, levels and socio-demographic determinants of condom use and consistency of use among young adults aged 15-24 years. Background: Condoms are known to prevent HIV infection. However, HIV prevalence and incidence remain high. Methods: This study was conducted in the Africa Centre Demographic Surveillance Area (ACDSA) in rural KwaZulu- Natal. Analysis focused on resident young adults aged 15-24 years in 2005. In univariable and multivariable analyses, determinants of condom use and consistency of use among 15-24 year olds were estimated using data collected in 2005. 'Ever' condom use was defined as the proportion who reported having used a condom; consistent use among those ever using as "always" using condoms with most recent partner in the last year. Results: 3,914 participants aged 15-24 years reported ever having sex, of whom 52% reported condom use. Adjusting for age, sex, number of partners, residence of partner, partner age difference, type of partner and socio-economic status (SES), having an older partner decreased likelihood (aOR=0.69, p<0.01), while belonging to a household in a higher SES increased likelihood of ever using condoms (aOR=1.82, p<0.01). Being female (aOR=0.61 p<0.01) and having a regular partner (aOR=0.65 p<0.01) were independently associated with low consistent condom use. Conclusions: In this rural South African setting, condom use remains low, especially among females and with an older partner, situations commonly associated with increased HIV acquisition. Targeted supportive interventions to increase condom use need to be developed if HIV prevention programmes are to be successful.

43 citations

References
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Journal ArticleDOI
TL;DR: All three components of Tanzania's family planning program are shown to have had an impact on modern method choice, including logistical support, trained providers, and communications programs.
Abstract: Four pooled Demographic and Health Survey data sets are used to examine the determinants of contraceptive method choice in rural Tanzania for the period from 1991 to 1999. The individual data are linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program can be examined. The focus of the study is an examination of the effect on method choice of the three major components of Tanzania's family planning program: logistical support, trained providers, and communications programs. The statistical methods employed correct for the potential endogeneity of family planning message recall. Simulations are used to quantify the impact of the important policy variables. All three components of the program are shown to have had an impact on modern method choice.

57 citations

Journal ArticleDOI
TL;DR: In this article, the authors examined fertility patterns in a population of 21,847 women in a rural KwaZulu-Natal (KZN) demographic surveillance area and compared with patterns seen in another South African rural population under demographic surveillance, and with data from the 1998 South Africa Demographic and Health Survey.
Abstract: Little is known about the dynamics of fertility transition in South Africa, though recent studies have begun to shed light on demographic changes in the country. This study presents trends and patterns of fertility observed in a rural South African population. Various demographic and statistical techniques were used to examine fertility patterns in a population of 21,847 women in a rural KwaZulu-Natal (KZN) demographic surveillance area. These are compared with patterns seen in another South African rural population under demographic surveillance, and with data from the 1998 South Africa Demographic and Health Survey. Findings are interpreted in light of contraceptive use patterns and HIV prevalence in the population. In South Africa, the end of the fertility transition is now in sight. In rural KZN, where national fertility levels are highest, fertility has declined rapidly for about two decades and would have reached below replacement level in 2003. While fertility has declined rapidly among all women over age 18 years, fertility levels among adolescents have not changed in decades. Although most adolescents in rural KZN were sexually active (60%), few had ever used contraception (200%). High HIV seroprevalence appears to explain a small part of the fertility decline (12%); however, this effect is likely to grow in the near future as the HIV/AIDS epidemic continues in South Africa. If the current trends continue in the future, below replacement fertility, together with high mortality due to AIDS, it could soon lead to negative natural population growth in rural South Africa.

52 citations

Daulaire N, Leidl P, Mackin L, Murphy C, Stark L 
01 Jan 2002
TL;DR: A statistical analysis designed to detail the cost in women's lives and health as a result of unintended pregnancy and shed light on a hidden and intransigent epidemic of premature death and disability.
Abstract: Nearly 200 million women become pregnant around the world each year. The United Nations estimates that one-third of these pregnancies are unintended and unwanted. Of these many result in the death of the mother. How many women would be alive today if contraceptives and family planning services had been available to prevent these pregnancies? Thanks to a grant from the David and Lucile Packard Foundation the Global Health Council has compiled a statistical analysis designed to detail the cost in women’s lives and health as a result of unintended pregnancy. At the 1994 International Conference on Population and Development (ICPD) in Cairo 179 nations pledged to improve the health of the world’s women. How well has the world done in meeting this commitment? While the goal of this analysis is to provide an accurate metric for assessing the consequences of unintended pregnancy it should not be forgotten that every statistic included represents the life of a woman or girl a wife a mother a daughter or a sister. These statistics and the lives they represent shed light on a hidden and intransigent epidemic of premature death and disability that plays itself out in thousands of communities every minute of every day. The women whose lives are represented in the analysis detailed in this report and whose stories appear throughout this document were victims of a twofold tragedy: they wanted to avoid pregnancy and they wanted to live. It is a somber reflection of the world’s priorities that they were unable to do either. (excerpt)

52 citations

01 Jan 2001
TL;DR: The ASSA2000 AIDS and Demographic model developed by the AIDS Committee of the Actuarial Society of South Africa has been calibrated to produce results for each of the provinces separately, showing differences in life expectancy, child and adult mortality, numbers of orphans, numbers infected, Numbers of AIDS sick and numbers of AIDS deaths, by province, race and gender.
Abstract: This paper presents the results of the ASSA2000 AIDS and Demographic model developed by the AIDS Committee of the Actuarial Society of South Africa. This model has been calibrated to produce results for each of the provinces separately. From this and other research only, at most, five of the provinces appear to be experiencing similar epidemics, but starting at different times, while the other four (KwaZulu-Natal, Western Cape, Northern Cape and Northern Province) are clearly experiencing different epidemics. In the no-intervention, no-behaviour change scenario the ANC clinic prevalence is expected to plateau in KwaZulu-Natal at nearly 40% while it may barely reach 18% in the Western Cape. The results also show differences in life expectancy, child and adult mortality, numbers of orphans, numbers infected, numbers of AIDS sick and numbers of AIDS deaths, by province, race and gender. Understanding why different provinces are experiencing different epidemics will go a long way to helping us identifying the forces that drive the spread of this epidemic. The paper also contains a brief analysis of the likely impact by socio-economic class.

48 citations

Journal ArticleDOI
TL;DR: Contraceptive use within marital and cohabiting unions is high and the wife's fertility preference was found to be a key determinant of use, challenging conventional wisdom that men are the dominant decision-makers in fertility and family planning decisions.
Abstract: Objectives: The purpose of this paper is to examine the relative influence of husband and wife on contraceptive practice. Methods: A cross-sectional survey was conducted among adult men and women in KwaZulu-Natal, South Africa. A matched file for 238 married or cohabiting couples was created. Results: Knowledge of methods of contraception was virtually universal and attitudes to contraception were favorable both in men and women. A substantial proportion of men and women reported using a method of contraception. The wife's desire to stop childbearing was the most powerful predictor of contraceptive use among couples, after adjustment for possible confounders. The husband's approval (or not) of family planning and his preference for future childbearing were not significantly related to contraceptive use. Conclusion: Contraceptive use within marital and cohabiting unions is high and the wife's fertility preference was found to be a key determinant of use. This conclusion challenges conventional wis...

40 citations