a research proposal on family planning

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A RESEARCH PROPOSAL ON FACTORS INFLUENCING THE USE OF FAMILY PLANNING AMONG MARRIED MEN AND WOMEN IN ADO-EKITI, EKITI STATE Background to the Study

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Family planning among undergraduate university students: a CASE study of a public university in Ghana

Fred Yao Gbagbo ORCID: orcid.org/0000-0001-8441-6633 1 &
Jacqueline Nkrumah 1

BMC Women's Health volume 19 , Article number: 12 ( 2019 ) Cite this article

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Globally, the rate of unplanned pregnancies among students at institutions of higher education, continue to increase annually despite the universal awareness and availability of contraceptives to the general population. This study examined family planning among undergraduate university students focusing on their knowledge, use and attitudes towards contraception in the University of Education Winneba.

The study was a descriptive cross-sectional survey using a structured self-administered questionnaire. One hundred undergraduate students from the University of Education Winneba were selected using a multistage simple random sampling technique. A Likert scale was used to assess the attitude of the respondents towards family planning methods.

Findings show that the respondents had a positive attitude towards family planning with an average mean score of about 4.0 using a contraceptive attitude Likert scale. Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility and preference influence usage. Emergency Contraception (Lydia) was reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years who appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma.

The observation that levels of Family Planning awareness levels do not commensurate knowledge and usage levels calls for more innovative strategies for contraceptive promotion, and Education on the various university campus. The study recommends that public Universities in Ghana should consider a possible curriculum restructuring to incorporate family planning updates. In this regard, a nationwide mixed method study targeting other tertiary institutions including colleges of education in Ghana is required to explore the topic further to inform policy and programme decisions.

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The global incidence of unplanned pregnancies amongst students at higher educational institutions every year continues to increase despite the high awareness and knowledge on regular modern contraceptives and emergency contraceptives among students in higher educational institutions [ 1 , 2 ]. Despite the immense contraceptive benefits for students in higher educational institutions [ 3 ], there is no direct positive correlation between the universal awareness, knowledge and use of contraceptives which challenges global health efforts. The poor utilisation of contraceptives in tertiary institutions is associated with many interrelated factors ranging from personal to institutional setbacks [ 4 ]. This eventually contributes to high unplanned pregnancy rates which is estimated to have contributed to about 8 to 30 million annual pregnancies worldwide [ 5 ]. Global estimates have also shown that about 210 million pregnancies occur annually across the world. 75 million (or about 36%) of the 210 are unplanned or unwanted pregnancies [ 6 ]. Students between 18 and 24 years report the highest rates of unplanned pregnancies in the world’s tertiary institutions [ 7 , 8 ]. A situation associated with multiple challenges across the world for countries, academic institutions and the individuals involved [ 9 ].

Studies in Africa, have generally documented low knowledge and awareness levels of effective contraceptive use amongst higher educational students [ 10 ]. Several factors including age, culture, ethnicity, religion, poor access to contraceptive services, peer pressure and lack of partner support were identified as contributing to the non-utilisation of contraceptives in tertiary institutions [ 11 ]. In a study amongst 15 to 24 year old South African women, it was estimated that only 52.2% of sexually experienced women are using contraceptives [ 12 ]. Because 80% of undergraduate students at higher educational institutions are sexually active, it is important that they have access to safe, accessible and adequate contraceptive services [ 13 ].

Although national surveys on family planning [ 14 ] have extensively looked at contraceptive uptake in Ghana, little is known about contraceptive up take among students in Ghanaian Universities. This study therefore examines family planning acceptance among students of the University of Education, Winneba in Ghana to compliment national data on family planning.

A descriptive cross-sectional study design using a quantitative approach of data collection was adopted. This design was chosen because it fits studies in natural setting, explains phenomena from the view point of persons being studied and produces descriptive data from the respondent own written or spoken words [ 15 ].

The study was conducted in the main campus of the University of Education, Winneba. The university was established in 1992 to train middle and top-level manpower for the educational sector of Ghana. It has four main satellite campuses, (Winneba and Ajumako in the Central Region of Ghana, Kumasi, and Mampong campuses in Ashanti Region of Ghana). The Winneba campus has three smaller campuses with five faculties (Faculty of social science education, Faculty of languages, Faculty of science education, Faculty of educational studies and School of creative Arts).

The study population comprised134 ‘non-resident’ undergraduate students of the University of Education Winneba, between ages 17–36 years in 2017 who were registered with an accommodation agent in Winneba that looks for accommodation for students who are unable to obtain university accommodation on campus. This population and age group was selected because anecdotal evidence shows that being a ‘non-resident’ student has the likelihood of making one vulnerable to sexual exploitations whilst seeking accommodation off campus. This age group was considered to be the reproductive age group of the undergraduate students. Because the University only guarantees on campus residential accommodation for only selected first year students, those who do not get the university’s residential accommodation are likely to be victims of sexual exploitations in the Effutu Municipality where the university is situated. This challenge is due to the scarcity of accommodation coupled with the high rent charges for rented accommodation. As per the estimated sample size calculated, a total of one hundred respondents comprising twenty from each of the five faculties were sampled at random to include both male and female students from the various course levels. This was done to ensure a true representation of the student population for the study.

A multistage sampling technique was used to select these respondents for the study. The first stage involved half day orientation of 2 field assistants (male and female) the estimation of the undergraduate students’ population who falls in this category during the period of the study. The second stage involved sample size calculation using an online Raosoft sample size calculator at 95% confidence interval, 5% margin of error and 50% response distribution [ 16 ]. In terms of the figures, the sample size n and margin of error E are given by:

Where N is the population size (134), R is the fraction of responses that the study is interested in, and Z(c/100) is the critical value for the confidence level c. The estimated number of respondents were then randomly sampled and contacted for participating in the in the third stage of the study. The fourth stage of the study involved distributing the developed questionnaires to consented students.

A Structured Questionnaire (See Additional file 1 ), designed by the authors was used to solicit responses from respondents. The questionnaire was exploratory in nature with both opened and closed ended questions to help respondents easily share their views. The questionnaire was pre-tested among 20 potential respondents from a different university. The Contraceptive Attitude Likert scales was used to measure attitudes by asking people to respond to series of statements about the topic, in terms of the extent to which they agree or disagree with them. Thus, tapping into the cognitive and affective components of attitudes [ 17 ]. The Contraceptive Attitude Scale presented positive and negative statements to elicit for responses that portray participants’ attitudes relating to contraception.

One hundred questionnaires were administered, and all the answers to a particular question were arranged, numbered and responses were coded. The responses were again listed and grouped, putting those with the same code together. Data analysis was done after data had been collected and checked for completeness and accuracy. The Statistical Package for Social Sciences (SPSS) software version 23 was used for data analysis. Frequencies, percentages and bar charts were used to describe the data in multivariable tables.

Ethics approval and consent to participate

An approval was obtained from the University prior to data collection. Written consent for participation and publication of findings were also obtained from respondents after the purpose, objectives and potential risk and benefits inherent in the study had been explained to them. Prior to the commencement of the study, the research protocol was presented at the bi-weekly academic research seminars of the Faculty of Science Education, University of Education, Winneba. The seminar brought together lectures of the Faculty (equivalent to an ethical review meeting) who critiqued and reviewed the study protocol for ethical suitability and sound methodology. All participants in the study were given the opportunity to ask questions about the study at any stage, and to withdraw from the study at any time. All data collected were kept confidential and data was analysed anonymously to ensure that results were not traceable to individual respondent.

The overall response rate for the study was 100%. Table 1 presents the background characteristics of respondents. A large number of the respondents were within the age categories of 21 to 24 years and 25 to 28 years. Most of the respondents were single (86.0%) and have no children (86.0%).

Table 2 present results of students’ knowledge, information sources and reasons for accepting or not accepting family planning. Family planning awareness and knowledge among students was a key consideration in the study.

About 94% of respondents answered yes to whether they have ever heard about family planning. Although majority (61%) of the respondents believed FP is helpful, about (67.0%) knew that one could get pregnant by relying on the withdrawal method. It appears most students would be committed to family planning uptake if services are made available. This is evident by 69% of them responding in the affirmative when asked whether they will encourage their family or friends to use family planning services in the University.

Having knowledge of family planning does not necessarily translate into utilization since the respondents had varied reasons for and against using family planning. Respondents who were of the view that FP was not helpful (25.0%) had either not used any family planning method before (28.0%) or had ever suffered unpleasant negative side effects (20.0%) following family planning usage or believed the bible is against family planning (2.0%).

Figure 1 presents respondents’ attitudes towards family planning as estimated using the Contraceptive Attitude Scale. The overall population surveyed had a positive attitude towards family planning (average mean attitude score was about 4.0 out of 5.0).

Attitude towards Family Planning

There were however some divergent responses to the questions relating to contraceptive use. Some of these include:

‘I will not have sexual intercourse if no contraceptive method was available’

‘I will use contraceptives even if my partner does not want me to use it’

‘I will not use contraceptives because they encourage promiscuity’

When the respondents were asked if they have ever used any FP method before, the majority of the respondents (67.0%) mentioned that they had never used any FP method. Regarding availability of family planning service when needed, about 64.0% of the respondents indicated that family planning services are always available in chemical shops and from colleges on campus when needed. About 58% will use FP methods in the future. Regarding information on source of family planning services if required, most of the respondents (85%) knew where to get family planning services in their communities (Table 3 ). Young Female students aged 21-24 years were the most vulnerable in accessing and using contraceptives due to perceived social stigma relating to a female student buying a contraceptive.

Table 4 documents the various family planning choices and reasons for the choices. About 65.0% of respondents reported that they primarily use contraceptives to prevent pregnancy and usually use a contraceptive before sexual intercourse (34.0%). When asked to select the primary methods of contraception frequently used, Emergency Contraception was the most reported frequently used (51%) contraceptive followed by male condoms (34.0%). Various side effects associated with some FP methods were also reported. Some respondents were of the view that there should be education for students on the risk and benefits of FP methods for effective use. Others believed FP should not be tolerated among students because it can be abused leading to major health problems that could affect studies. Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility, preference and cost of contraceptives hinders use.

This study examined family planning among undergraduate university students focusing on their knowledge, use and attitudes towards family planning in the University of Education Winneba. The study was a descriptive cross-sectional survey using a structured self-administered questionnaire for data collection. Various findings obtained from the study had reproductive health programme and policy implications. Informal sources of family planning information such as friends, peers and relatives were common information sources for young people [ 18 ] but yet prone to misconceptions, distortions and half-truths. Other studies ranked the family (parents, brothers and sisters) as the lowest source of information on sexuality [ 19 , 20 , 21 ]. These findings are similar to those reported in the current study that high level of awareness (94.0%) of contraceptives is noted among university students.

An observation that a large number of the respondents were within the age categories of 21 to 24 years and 25 to 28 years of which most (86.0%) were single and have no children (86.0%), is an indication that current university students are relatively young and unmarried. A situation that predisposes them to sexual exploitations and requires knowledge on family planning methods to enable them make informed decision and choices regarding their reproductive intentions. Family planning awareness and knowledge among students was a key consideration in the study. The majority (94%) of respondents indicating that they have ever heard about family planning shows a near universal awareness of family planning methods. This is in line with national reports on family planning awareness in Ghana and a significant departure from many other studies which tended to focus on awareness alone or translate awareness to knowledge [ 22 , 23 ]. Understanding the methods and benefits of contraception are critical to having motivated users. It has also been noted that motivation is one of the important factors in minimizing failure rates in the utilization of contraception [ 24 ]. From previous research findings [ 25 , 26 , 27 ] it was established that the most commonly used Family Planning methods among students were short term methods predominantly, condoms, oral contraceptives and withdrawal methods. This confirms finding of other studies that students had little knowledge about effective contraceptive methods [ 28 ]. In the current study, a remarkable percentage (25%) did not know that pregnancy could occur when one relying solely on withdrawal method. Also about 21.0% of respondents did not know what oral contraceptive pills do, and some 3% also said oral contraceptive pill prevents Sexually Transmitted Infections (STIs). It was surprising to note in this era of increasing STIs that about 2% of respondents’ from a tertiary institution belief a single condom can be reused many times if washed and dried.

At the tertiary level, one would have expected that all respondents would have known the implications of unprotected sexual intercourse. However the study finding that about (61%) of the respondents believed family planning is helpful implies that there are some other students who don’t belief in family planning hence having unprotected sexual intercourse. Although accessibility to family planning methods on campus in this study was very high (66.0%), results from other similar studies were to the contrary [ 29 , 30 ]. This therefore suggests that if students know the benefits and how to use contraceptives, they will not experience unwanted pregnancies and its associated consequences of unsafe abortion complications, disruption in academic work and possible death. Contraceptive education is a component of sex education and is one of the proven approaches to prevent risky sexual behaviour and must be introduced on university campuses to guide students’ family planning choices.

Additionally, findings also shows that there are some students about (67.0%) at the university who knew that one could get pregnant by relying on the withdrawal method yet that is their preferred family planning methods. Various studies [ 31 , 32 ] have explained this observation further by indicating that some adolescents girls feel that a partner’s use of condom suggest that they (the girls) might be classified as unclean, likened to commercial sex workers or seen as engaging in extra-relationship sexual activities if they negotiate for condom use during sexual intercourse. The perception of ‘ I trust my partner so no need for condom use’ further explains the frequency of withdrawal methods being a regular family planning method on campus.

Generally, it appears most students were committed to family planning uptake if services are made available as evident by about 69% of them responding in affirmative when asked whether they will encourage their family or friends to use family planning services in the University. This observation is positive for enhanced family planning service delivery on university campuses to meet the needs of students. Contrary to this observation are those of similar studies which reported that Student frown on invasive family planning methods [ 33 , 34 ]. The distinction between invasive and non-invasive methods bothers on factors such as availability of method, ease of use and adherence to instructions of a health professional to use the method.

Respondents outlined various sources of family planning information of which television adverts constituted the most reported (31%) source of information. This observation is quite worrying since anecdotal evidence from university campuses shows that majority of student rarely have and watch televisions whist on the various campuses. It will therefore be very important and useful to devise innovative ways of educating students on family planning methods whilst on campus.

A finding that having knowledge of family planning does not necessarily translate into usage is very revealing and of public health importance. As it would have been expected, using a method is the surest way of explaining its relevance. However in this study, respondents who were of the view that family planning was not helpful had never used any family planning method before (28.0%). It is there important to use of family planning satisfied client for contraceptive education and promotion on University campuses to ensure the desired positive results. These are students who are likely to positively influence their sexually active peers on contraceptive use since they are likely to say: ‘ I will not have sexual intercourse if no contraceptive method was available’ or ‘I will use contraceptives even if my partner does not want me to use it’ as reported in the study.

Regarding information on source of family planning services if required, most of the respondents (85%) knew where to get family planning services in their communities. For availability of family planning services when needed, about 64.0% of the respondents indicated that family planning services are always available in chemical shops and from colleges on campus when needed. The obvious indicated sources of contraceptives on campus (i.e., chemical shops and peers) do not provide varying choice of services there by limiting students to short term and less effective family planning methods. It is encouraging noting that about 58% of respondents will use FP methods in future. This is an indication of them understanding the importance of family planning to studies as about 65.0% of respondents reported primarily using contraceptives to prevent pregnancy and usually use a method before sexual intercourse (34.0%) despite the various side effects associated with some FP methods reported.

Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility and preference influence usage. Emergency Contraception (Lydia) was reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years who appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma. This observation shows that Students always have a unique view on issues especially those in youthful ages. It is therefore important to incorporate their views in family planning programming. The observation that some respondents were of the view that there should be education for students on the risk and benefits of family planning methods for effective use is in the right direction and worth exploring. There are also concerns of values clarification as observed by the findings that some respondents believed family planning should not be tolerated among students because it can be abused leading students to becoming promiscuous or suffering major health problems that will affect their studies.

The following recommendations are therefore being suggested to chart a way forward:

Public Universities in Ghana should consider a possible curriculum restructuring to incorporate family planning lessons in the academic programme for students to acquire current knowledge in this area. The reproductive health education programs should include the importance of using dual contraceptive methods as a means to prevent HIV transmission and pregnancy, as well as information on how to make an informed decision relating to contraceptive choices.

The Winneba Municipal Health Directorate should incorporate family planning education on campuses into their public health programs.

The university health service should also create friendly environment for student to access family planning services and also collaborate with the student body to organise programmes to educate the students on family planning methods.

The student representative council (SRC) should also make family planning education a part of their programs and in collaboration with the university health services organise free STI testing and family planning counselling at least once yearly.

A nationwide mixed method study targeting other tertiary institutions particularly colleges of education in Ghana is required to explore the topic further for a national decision on contraceptive security in tertiary institutions in Ghana.

Conclusions

Findings of this study showed that the awareness of family planning among the students was high. However, levels of contraceptive usage were low and restricted to the short term, Emergency Contraceptives and redrawal methods. The perception by a cross-section of respondents (although by a small group) that condoms can be reused more than once confirms the gross ignorance of contraception practices and the potential risk to STIs and Pregnancy. Additionally, Emergency Contraception (Lydia) being reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years, is an indication that this student population appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma and must therefore be the prime focus of contraception education and services on the University. The University of Education being a tertiary institution mandated to train teachers, is expected to ensure that its students have accurate and current information on family planning methods relevant to educate others. This is an obvious gap that requires policy decisions at all levels and FP education interventions at the tertiary level of education in Ghana.

Abbreviations

Family planning

Statistical Package for Social Sciences

Sexually Transmitted Infections

University of Education Winneba

World Health Organization (WHO). (2013): Family planning fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs351/en / United Nations. (2011). The millennium development goals report. Retrieved from www.un.org/millenniumgoals/11_MDG%20Report_EN.pdf

Maja TMM, Ehlers VJ. Contraceptive practices in northern Tshwane, Gauteng Province. Health SA Gesondheid. 2004;9(4):42–52 https://doi.org/10.4102/hsag.v9i4.179 .

Article Google Scholar

Ersek, J.L., Brunner Huber, L.R., Thompson, M.E. & Warren-Findlow, J., (2011):‘Satisfaction and discontinuation of contraception by contraceptive method among university women’, Matern Child Health J 15, 497–506. PMID: 20428934, https://doi.org/10.1007/s10995-010-0610-y

Hubacher, D., Ifigeneia, M. & McGinn, E., (2008): ‘Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it’, Contraception 78, 73–78. PMID: 18555821, https://doi.org/10.1016/j.contraception.2008.03.002

Adhikari, R., (2009): ‘Factors affecting awareness of emergency contraception among college students in Kathmandu, Nepal’, BMC Women’s Health 9, 27. PMID: 19761598, https://doi.org/10.1186/1472-6874-9-27

Singh, S., Sedgh, G., & Hussain, R. (2010) “Unintended pregnancy: worldwide levels, trends, and outcomes”Studies in family planning 41, no. 4:241–250.

Esere MO. Effect of sex education programme on at-risk sexual behaviour of school going adolescents in Ilorin, Nigeria. Africa health science. June. 2008;8(2):120–5.

Google Scholar

Trieu, S.l., Shenoy, D.P., Bratton, S. & Marshak, H.H., (2011): ‘Provision of emergency contraception at student health centers in California community colleges’, Womens Health Issues 21(6), 431–437. PMID: 21703870, https://doi.org/10.1016/j.whi.2011.04.011

Vermaas, L., (2010). ‘Dealing with unplanned pregnancies and abortions amongst tertiary students’, paper presented at the 6th African Conference on Psychotherapy in Uganda, Kampala, Uganda, 14–16 December, viewed 13 February 2013, from http://www.tut.ac.za/News/Pages/pregnancies.aspx .

Ahmed, F.A., Moussa, K.M., Petterson, K.O. & Asamoah, B.O., (2012), ‘Assessing knowledge, attitude, and practice of emergency contraception: A cross sectional study among Ethiopian undergraduate female students’, BMC Public Health, 12, 110, viewed 06 March 2015, from http://biomedcentral.com/1471 –2458/12/110 Page 7 of Original Research http://www.curationis.org.za doi: https://doi.org/10.4102/curationis.v38i2.1535 .

Golbasi Z, Tugut N, Erenel AS. Knowledge and opinions of Turkish University students about contraceptive methods and emergency contraception. Sex Disabil. 2012;30:77–87 https://doi.org/10.1007/s11195-011-9227-3 .

MacPhail, C., Pettifor, A.E., Pascoe, S. & Rees, H.V., (2007): ‘Contraception use and pregnancy among 15–24 year old south African women: a nationally representative cross-sectional survey’, BMC Med 5, 31. PMID: 17963521, https://doi.org/10.1186/1741-17015/5/31

Bryant, K.D., (2009): ‘Contraceptive use and attitudes among female college students’, Journal of ABNF 20(1), 12–16. PMID: 19278182.

Ghana Statistical Service (2014). Ghana Demographic and Health Survey Report.

Akintade OL, Pengpid S, Peltzer K. Awareness and use of and barriers to family planning services among female university students in Lesotho’, south African journal of Gynaecology 17(3), 72–78.McNab C, (2009): what social media offers to health professionals and citizens. Bull World Health Organ. 2011;87:566.

Raosoft Sample Size Calculator Accessed on 2 nd July, 2012 from http://www.raosoft.com/samplesize.html

Tilahun D, Assefa T, Belachew T. Knowledge, attitude and practice of emergency contraceptives among Adama University female students. Ethiopia Journal of Health Sciences November. 2010;20(3):195–202.

Sigereda G., (2004): Barriers to use contraceptive among adolescents in the city of Addis Ababa. Master’s theses.

Abiodun MO, Olayinka PB. Sexual activity and contraceptive use among female students of tertiary educational institutions in Illorin. Nigeria Contraception. 2009;79(2):146–9.

Mehra, D., Agardh, A., Petterson, K.O. & Ostergren, P.O., (2012): ‘Non-use of contraception: determinants among Ugandan university students’, Glob Health Action 5, 18599. PMID: 23058273, https://doi.org/10.3402/gha.v5i0.18599

Tayo A, Akinola O, Babatunde A, Adewunmi A, (2011): Contraceptive knowledge and usage among female school students in Lagos, south-West Nigeria. Journal of public health and epidemiology January, 3 (1), pg. 34–37.

Bafana T. Factures influencing contraceptive use and unplanned pregnancy in a South African population. MA thesis: Witwatersrand University; 2010.

Egarter C, Grimm C, Ahrendt KNH-J, Bitzer J, Ehlers VJ, Zvavemwe Z. Experiences of a community based contraceptive programme. Int J Nurs Stud. 2009;46(3):302–9.

World Health Organization, WHO. Programming for adolescent health and development: report of a WHO/UNFPA/UNICEF study group on programming for adolescent health. Technical report. Geneva: WHO; 1999. p. 886.

Cadmus E, Owoaje E. Patterns of contraceptive use among female undergraduates in the University of Ibadan, Nigeria. The Internet Journal of Health. 2009;10(2).

John, H. Contraceptive Knowledge, Perceptions and use among adolescents journal of Sociol Res 2012; 3(2):170–180. 25–34.

Appiah-Agyekum, N.N. & Kayi, E.A. (2013). Students’ Perceptions of Contraceptives in University of Ghana, 7(1): 39–44. Beware of AIDS (BAWA), Offinso-Ashanti, Ghana International Conference on AIDS. International Conference of AIDS 12: 1005 (abstract number 60018).

Roberts, C., Moodley, J. & Esterhuizen, T., (2004): Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa’, Journal of Obstetrics and Gynaecology 24(4), 441–445. PMID: 15203588, https://doi.org/10.1080/0144361040001685619

Canadian Statistics, (2010): Trends in the Age Composition of College and University Students and Graduates www. Statcan.gc.ca Accessed 1/4/14.

Dreyer G. Contraception: a south African perspective. Pretoria: Van Schaik Publishers; 2012.

Adegoke AA. Adolescents in Africa: Revealing the problems of teenagers in contemporary African society. Ibadan, Hadassah Publishing; 2003.

Omo-Aghoja LO, Omo-Aghoja VW, Aghoja CO, Okonofua FE, Aghedo O, Umueri C, Otayohwo R, Feyi-Waboso P, Onowhakpor EA, Inikori KA. Factors associated with the knowledge, practice and perceptions of contraception in rural southern Nigeria. Ghana Med J. 2009;43(3):115–21.

CAS PubMed PubMed Central Google Scholar

McMahon S, Hansen L, Mann J, Sevigny C, Wong T, Roache M. Contraception. BMC Womens Health. 2004;4(Suppl1):S25.

Clements S, Madise N. Who is being served least by family planning providers? A study of modern contraceptives use in Ghana, Tanzania and Zimbabwe. Afr J Reprod Health. 2004;8:124.

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Acknowledgements

The authors are grateful to the University of Education Winneba, Faculty of Science Education for the valuable inputs in shaping the manuscript. Many thanks also to the respondents for their corporation during data collection.

The entire study was jointly funded by the authors.

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FYG conceptualized and designed the study. JN supervised the data collection, analysis and drafted the initial report. Both authors discussed the report, edited it together and approved the manuscript for final submission.

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The research protocol was first presented at the Faculty of Science Education, University of Education, Winneba periodic academic seminars for review and approval for methodology and ethical suitability. This seminar, brings together senior members and research fellows of the University to review research protocols and papers meant for publication and conferences. Approval for data collection and publication were subsequently granted following the full incorporation of comments received from the seminar presentation.

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Additional file 1:.

Appendix I-Questionaire. The appendix I contains the structured question developed by the authors and used for data collection in the study. (DOCX 23 kb)

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Gbagbo, F.Y., Nkrumah, J. Family planning among undergraduate university students: a CASE study of a public university in Ghana. BMC Women's Health 19 , 12 (2019). https://doi.org/10.1186/s12905-019-0708-3

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Offering extended use of the contraceptive implant via an implementation science framework: a qualitative study of clinicians’ perceived barriers and facilitators

Nicole Rigler 1 ,
Gennifer Kully 2 , 3 ,
Marisa C. Hildebrand 2 ,
Sarah Averbach 2 , 3 &
Sheila K. Mody 2

BMC Health Services Research volume 24 , Article number: 697 ( 2024 ) Cite this article

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Metrics details

The etonogestrel contraceptive implant is currently approved by the United States Food and Drug Administration (FDA) for the prevention of pregnancy up to 3 years. However, studies that suggest efficacy up to 5 years. There is little information on the prevalence of extended use and the factors that influence clinicians in offering extended use. We investigated clinician perspectives on the barriers and facilitators to offering extended use of the contraceptive implant.

Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively.

We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators.

Conclusions

There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years.

Peer Review reports

The etonogestrel contraceptive implant is currently approved by the U.S. Food and Drug Administration (FDA) for 3 years of continuous use for the prevention of pregnancy [ 1 ]. However, there is evidence to support its use for up to 5 years while maintaining a low risk of pregnancy [ 2 , 3 , 4 ]. The off-label use of the contraceptive implant past its FDA-approved duration and up to 5 years is known as extended use. Importantly, the FDA supports off-label use of marketed drugs and medical devices so long as there is strong relevant published evidence [ 5 ]. Off-label use such as extended use of the contraceptive implant is common with many other reproductive devices and medications, including misoprostol for labor induction, the copper intrauterine device (IUD) for emergency contraception, and, prior to its recent FDA-approval for extended use, the 52 mg levonorgestrel (LNG) IUD for pregnancy prevention. The 52 mg LNG IUD was previously FDA-approved for 5 years, however strong published evidence demonstrated longer efficacy up to 8 years, leading clinicians to counsel on extended use and eventually contributing to updated federal guidelines [ 6 , 7 ].

Though there are clinicians who counsel patients on extended use of the contraceptive implant, many patients still undergo implant replacement after only 3 years of use [ 8 , 9 ]. Continuation rates of the contraceptive implant after 1 and 2 years of use is estimated to be at 81.7% and 68.7%, with the most common reason for early discontinuation prior to 3 years being changes to bleeding pattern [ 10 , 11 , 12 , 13 ]. Ali et al. report the most common reasons that patients decided to stop implant use in years 4 and 5: unspecified personal reasons, desired fertility, bleeding problems, and other medical reasons [ 4 ]. Additionally, a recent nationwide, web-based survey amongst a diverse group of reproductive health clinicians investigated the barriers and facilitators regarding extended use of the contraceptive implant up to 5 years [ 14 ]. The most common barriers found in the study were provider concerns about pregnancy risk and the current FDA approval for only 3 years of use. The key facilitators included strong published evidence supporting extended use and patient and clinician education on extended use. Other than these studies, the patient and clinician factors that facilitate and hinder widespread implementation of extended use of the contraceptive implant have not been explored.

Increasing implementation of extended use of the contraceptive implant across practice settings may decrease unnecessary procedures, devices, healthcare visits, and could improve access to, and satisfaction with, the contraceptive implant. Long-acting reversible contraceptive (LARC) methods such as the contraceptive implant and LNG IUD have significantly higher continuation and approval rates and are more efficacious at preventing pregnancy than non-LARC methods such as oral contraceptive pills and depot medroxyprogesterone acetate injection [ 12 , 15 , [ 16 ]. Given the continued high rates of unintended pregnancies in the United States and the consequential increase in healthcare costs and poor outcomes secondary to pregnancy complications, efficacious pregnancy prevention is an important public health objective and cost-saving measure [ 17 ].

Using a qualitative approach guided by an implementation science framework, the Consolidated Framework for Implementation Research (CFIR), [ 18 ] we sought to explore clinician perspectives on extended use of the contraceptive implant up to 5 years as well as the perceived barriers and facilitators for clinicians to offer extended use.

We conducted semi-structured interviews with 20 clinicians including obstetrics and gynecology generalists, family medicine physicians, complex family planning sub-specialists, and advanced practice clinicians. We recruited interview participants from a nationwide, web-based survey that assessed the prevalence of extended use of the contraceptive implant [ 17 ]. This study recruited respondents through email listservs for the Fellowship in Complex Family Planning, the Ryan Residency Training in Family Planning Program, women’s health nurse practitioners, and family medicine physicians, as well as private social media groups for obstetrician-gynecologists. The total reach of the survey was unknown, however, the study had a survey completion rate of 66.6% ( n = 300/450). Of the 300 completed surveys, 290 respondents indicated their interest in being interviewed (96.7%).

Among the survey respondents, we invited 24 clinicians to participate in interviews, yielding an 83.3% response rate. We selectively recruited interview participants to enrich our sample, specifically focusing on clinician type, practice setting, and region of practice within the United States (U.S.). We also selected interview participants based on whether they always, sometimes, or never counsel on extended use to investigate a broad range of perspectives. For this study, offering extended use is defined as counseling on use past the current FDA-approved duration of 3 years and up to 5 years of use. Offering extended use can occur at any clinical encounter, including insertion appointments, replacement and removal appointments at or before 3 years, and general reproductive health appointments. Clinicians who always offer extended use were defined as those who counsel on extended use to patients who are considering or currently have the contraceptive implant. Clinicians who sometimes offer extended use were defined as those who counsel on extended use, but only to particular patients based on patient-specific factors such as body mass index or insurance coverage. Clinicians who never offer extended use were defined as those who never counsel on use of the contraceptive implant past 3 years of use.

The interview guide was created utilizing an implementation science framework that identifies factors for effectively enacting interventions [ 18 ]. The Consolidated Framework for Implementation Research (CFIR) is organized into 5 major domains: characteristics of the intervention, individual characteristics, inner setting, outer setting, and the process of implementation. The first domain, intervention characteristics, relates to the inherent qualities of the intervention, such as pharmacologic properties and side effects of the contraceptive implant when used up to 5 years. Individual characteristics relates to the roles and characteristics of individual patients and clinicians interacting with the intervention, such as educational background and type of insurance coverage. The inner setting domain assesses the internal setting in which an intervention will be implemented (i.e., clinic type, culture, and policies). The broader context in which an intervention will be implemented, including national policies and social norms is evaluated within the outer setting domain. Finally, the process of implementation domain explores the activities and strategies used to implement the intervention, such as educational materials or clinician and staff trainings on extended use.

We designed the interview guide around these specific domains with questions that aimed to identify targeted strategies to support successful implementation. The complete interview guide is in Appendix A . The interview guide was designed with input from clinicians who regularly prescribe contraception, including extended use of the contraceptive implant, as well as CFIR and implementation science experts. The Human Research Protection Program at our institution approved the study.

A single research team member conducted semi-structured interviews via secure video conference between July and August 2021. Interview participants provided informed consent. All participants were asked a full set of open-ended questions based on the interview guide, with focused follow-up questions to further investigate potential themes or to clarify points. All interviews were audio recorded, then transcribed. For data analysis, we used a content analysis approach to identify concepts and patterns within the dataset [ 19 ]. Themes arose deductively and inductively, with deductive themes identified from the CFIR domains and inductive themes arising from interview insights. Consensual qualitative research methods informed both our data analysis and coding process [ 20 ]. Three authors were involved in the thematic coding of the transcripts. Initially, 5 transcripts were independently coded then checked for inter-coder reliability. Any disagreements were discussed, and a consensus was achieved. The remaining transcripts were then coded by one of the three authors. Once all interviews were coded, major themes and representative quotes were identified. The research team utilized ATLAS.ti for analysis [ 21 ].

Between July and August 2021, we interviewed 20 clinicians from a variety of clinical settings, regions, and women’s health professions, achieving the intended diversity of perspectives (Table 1 ). Among participants, 7 (35.0%) always, 8 (40.0%) sometimes, 5 (25.0%) never offer extended use of the contraceptive implant (Table 2 ).

Characteristics of the intervention

We found that changes to bleeding pattern in or after the third year of use was a barrier to clinicians offering extended use of the contraceptive implant. The participants in this study noted that perceived increases in the irregularity or frequency of a patient’s bleeding makes extended use of the implant difficult for patients to accept. One clinician noticed that some patients correlate changes in their bleeding pattern with a perceived decrease in the efficacy of their implant:

"People who do start noticing changes in bleeding pattern […] [and] associating that with, ‘Oh, my implant is wearing out or becoming expired. I need to get this changed out."

-Complex Family Planning Specialist, Southwest, Academic Setting, sometimes offers extended use

The same clinician discussed that more research on bleeding patterns in the extended use period and potential treatments for implant-associated irregularities could be a facilitator of extended use:

"For bleeding, I think it would be awesome if there is a research study, looking at use of OCPs [oral contraceptive pills] to manage bleeding near the end of the use of an implant or near that three-year mark,, […] So that we could give people… Honestly, either a natural history or a, ‘Here’s how you can manage that if you do want to keep using your implant longer.’"

- Complex Family Planning Specialist, Southwest, Academic Setting, sometimes offers extended use

Information on the bleeding pattern in years 4 and 5 of use and how clinicians can address irregular bleeding during implant use may increase acceptability of extended use.

Individual characteristics

We found that insurance impacts whether a clinician offers extended use:

"I do sometimes have patients saying, ‘I might be changing jobs or I’m going to be turning 27 or whatever.’ And so insurance is a barrier and so they’re like, ‘I want the new one while I still have this insurance.’"

- Family Medicine Physician, Midwest, Community Setting, sometimes offers extended use

Many participants agreed with this concept and stated that acceptability of extended use depends on a patient’s perception of their future insurance status. Clinicians observed that if a patient believes they will have coverage for a replacement or removal in the future, they are more likely to pursue extended use of their implant. Conversely, one clinician discussed how lack of current insurance coverage could be a facilitator of extended use:

"So, I would generally offer extended use to people that didn’t have insurance and would have to self-pay. I would like go through the data with them so they wouldn’t have to pay like $1,000 to get a new implant because it could work another year, or people that were concerned about changing side effects at that time."

- Obstetrician-Gynecologist, Southwest, Academic Setting, sometimes offers extended use

Overall, clinicians perceived that patients’ concerns about current and future insurance coverage may affect acceptance of extended use.

Inner setting

This study found that having a champion of extended use at a clinician’s home or affiliate institution was a facilitator of extended use. Most clinicians in the study stated that it is or would be helpful to have someone who worked with them clinically that was knowledgeable on the data about extended use. When asked which factor would promote extended use of the implant the most, this clinician stated:

"…having a champion who is really ready to present the evidence, because the evidence can be there, but people don’t have time to read it. If it’s not brought to them, they’re not really going to know about it."

- Obstetrician-Gynecologist, West Coast, Community Setting, does not offer extended use

Potential champions identified were physicians, nurses, medical directors, or other clinicians in leadership positions, but participants generally believed that the position should be held by someone who is passionate about contraception, highly familiar with the specific setting, and knowledgeable about the clinical studies on extended use.

A barrier noted by a few participants was the effect of discordant counseling by different clinicians, sometimes within the same clinic, on acceptability of extended use:

"I mean, I guess like getting everyone on the same page, like in your practice can be a barrier. Especially in the practice I’ve been at, which like I said was in a state that was very litigious, so people weren’t always willing to like go outside guidelines that were… So getting your whole group on the same page so patients get like a more consistent message."

- Obstetrician-Gynecologist, Southwest, Academic Setting, sometimes offers extended use.

Participants discussed that it is important for clinician teams to relay a cohesive message to patients, especially in settings where patients may see multiple clinicians for their contraceptive care.

Outer setting

Lack of FDA approval for extended use was identified as barrier by many clinicians, and some clinicians counseled patients only on the FDA-approved duration of the contraceptive implant:

"So, generally in our practice we don’t really talk about extended use. We say this is FDA approved for three years."

- Advanced Practice Clinician, Southeast, Community Setting, sometimes offers extended use.

Even clinicians who do offer extended use of the implant noted that off-label use can be confusing to patients, making it difficult to counsel on extended use:

"So I have patients all the time, who’ll say, ‘Well, what do you mean I can keep X, Y or Z in for an extra year?’ And I’ll say, ‘We have big studies that tell us that this is an okay thing to do.’ But that just feels weird. People don’t necessarily understand the role of the FDA or sort of how it works. And so it’s something like extended use just might be a really such a foreign concept. Right? It’s so far outside. But I think that there are also, there are lay outlets that cover this stuff. So it’s not that it’s impossible to access. It’s just that the patient has to be interested just like the provider has to be interested."

- Complex Family Planning Specialist, East Coast, Academic Setting, sometimes offers extended use.

Clinicians also observed that certain clinics must follow official guidelines without the flexibility to offer extended use, regardless of a clinician’s perspective or willingness to counsel on extended use. Interestingly, patient confusion as well as mistrust of the healthcare system may impact patient acceptability of extended use in the context of a three-year FDA-approved duration:

"The other thing is the FDA approval because the box says three years, but then like I tell people, you can take it out in five years. And then they don’t believe… Like who is right. Is it my doctor who’s getting in front of me right or the box, right?"

- Family Medicine Physician, West Coast, Community Setting, always offers extended use.

This clinician noted that a disconnect between a clinician’s counseling and prescription information may lead patients to be confused about the recommendation for extended use.

Another barrier mentioned by a few participants was provider concern about liability in the event of an unintended pregnancy. Participants discussed fear of both legal and interpersonal repercussions of unintended pregnancy after counseling on off-label use of a contraceptive device:

"Even though there’s a slim chance that a patient would get pregnant on Nexplanon [the contraceptive implant], I feel like if we were to say, ‘Yeah, you can use it beyond the four years,’ and they come up and they get pregnant, they’re that 1% chance that gets pregnant, I feel like there could be a little bit of blame laid on us if we were to tell them that they’re able to it beyond the three years when the label doesn’t say that yet."

- Advanced Practice Clinician, Southeast, Private Practice, does not offer extended use.

Some participants felt that they would “have no ground to stand on” in the event of a lawsuit (OBGYN Physician, Midwest, Private Practice), making them concerned about the possibility of increased liability in counseling on off-label use without FDA approval.

Interestingly, multiple clinicians also discussed abortion restrictions in the United States as influencing patients in their decision to pursue extended use or not:

"In the past four years [2017–2021] have also had a lot of patients express concern about the administration. And so wanting to kind of be as current as they can be with their devices and so potentially exchanging them sooner than they need."

- Complex Family Planning Specialist, West Coast, Academic Setting, always offers extended use.

Clinicians observed that patients are noticing and reacting to abortion restrictions when making their contraceptive decisions, which may impact the widespread implementation of extended use.

Process of implementation

Many clinicians reported that a barrier to implementing extended use was patient preference for removal when they are already in clinic for a scheduled removal or replacement procedure, regardless of being counseled on extended use at that time:

“’Oh, I’m already here. I’m approved. Let’s just go ahead and get it done.’ So there’s probably not a whole lot you can do about that either, once they’re already in the clinic, and have their mind set on it.”

- Obstetrician-Gynecologist, Southeast, Academic Setting, does not offer extended use.

Many participants in this study noted that patients have made logistical arrangements prior to their appointments including paid time off, childcare, or prior authorization. It can be difficult for clinicians to offer extended use within this context, therefore counseling is better done prior to a patient coming in for a replacement appointment.

A perceived facilitator of extended use that was mentioned often was clear, concise clinician educational services or materials that illustrates existing data on efficacy and risks. Clinicians believed that this education could be in the form of continued medical education, targeted trainings, or written summaries of relevant studies, data, and recommendations. One consistency across interviews was that education on extended use must be integrated into regular practice and be easily understood by busy clinicians:

"I think that when we get a pamphlet or a brochure or a one page, something that just has everything condensed so it’s a really quick, oh, okay, this is something that we can be offering patients. And these are the reasons why it would be a benefit to them, and these are the patients that maybe would fall out of not offering this to. I think because of how busy we are, that’s the best way for us to make change."

- Advanced Practice Clinician, Southwest, Academic Setting, does not offer extended use.

Participants reported that these resources should be widely distributed beyond the complex family planning and obstetrician-gynecology community to increase accessibility to extended use.

Another potential facilitator identified was effective patient educational materials such as flyers that state the 5-year efficacy of the contraceptive implant, though producing these might require FDA approval. Participants in this study report that patients rely on clinicians to provide information on the efficacy and duration of their contraceptive implant. However, it is difficult for patients to accept extended use when there are inconsistencies across multiple sources of information:

"I mean, if online, there was information where it said you can keep it in for three to five years and they’re able to back that up. You know, people like to do their own research. I think that would be helpful, versus it says everywhere three, three, three, three, three, and then you’re the only person telling them something different, then it’s a little more tricky."

- Obstetrician-Gynecologist, West Coast, Community Setting, does not offer extended use.

Overall, participants in this study expressed that it would be helpful to have easily understood information for clinicians and patients that explained the evidence for extended use.

Our results demonstrate that there is an opportunity to increase widespread implementation of extended use through multiple interventions. Clinicians reported that patients prefer to have their implants replaced when they are already in clinic for the procedure. Therefore, intervening prior to replacement appointments at 3 years in the form of telemedicine visits or notifications from scheduling staff may make extended use of the contraceptive implant more acceptable to patients. Further, clinician and patient education on extended use that is easily understood and widely disseminated would likely increase use of the contraceptive implant up to 5 years.

The implementation of extended use of the contraceptive implant up to 5 years likely decreases healthcare costs secondary to fewer procedures and unintended pregnancies, and expands reproductive choices for patients seeking contraception. It has been found that clinicians who offer extended use state that most of their patients accept extended use when it is offered [ 14 ]. However, the reasons why a patient may or may not accept extended use are unclear, but may include changes in bleeding and concerns about use past the FDA-approved duration. Research on bleeding patterns in the extended use period may facilitate counseling and give patients a better expectation of possible changes they may see in years 4 and 5. Additionally, research on the patient perspective and acceptability of using the contraceptive implant past its FDA-approved timeframe is needed.

This study focused on clinicians and their perspectives on extended use. However, it is important to note that patients may be fully informed about extended use and choose to replace their implant at or before 3 years of duration. All discussions regarding contraception, including extended use of the implant, should always occur within a patient-centered and shared decision-making model. Widespread offering of extended use may allow for more patients to make fully informed decisions about the duration and use of their contraceptive devices, therefore expanding reproductive choice and agency in addition to potentially sparing patients from unnecessary procedures and extra healthcare costs.

Interestingly, although there are data to reflect high implant efficacy in years 4 and 5, [ 2 , 3 , 4 ] some participants in this study believe there is increased liability in counseling on off-label use without FDA approval. Importantly, off-label use is common among reproductive clinicians and is protected by the FDA if there is strong published evidence supporting off label use [ 5 ]. Additionally, the Society of Family Planning supports extended use of the contraceptive implant up to 5 years [ 22 ]. The FDA requires implant training for clinicians before they can insert or remove the implant. This training includes the FDA product labeling indicating the maximum duration of use for pregnancy prevention as three years [ 1 ]. It is possible that clinician training and product labels that advertise a 3-year duration dissuade clinicians from offering extended use of the contraceptive implant due to concerns about legal repercussions in the event of an unintended pregnancy with extended use. Therefore, organization- or systems-level guidelines, policy changes, and trainings in support of extended use may allow clinicians to feel comfortable offering off-label use of the implant. Additionally, FDA approval of the contraceptive implant to 5 years would likely greatly facilitate implementation of extended use.

Changing the FDA label to reflect extended use can be expensive, and contraceptive companies may not be incentivized to change the label. However, increasing the FDA approval of the contraceptive implant would allow for companies to have a longer-acting contraceptive device that is more directly comparable to other LARC devices such as the 52 mg LNG IUD that can be used for up to 8 years. If FDA approval for 5 years of use were to occur, it is not known if the barriers described in this study would continue to apply. However, it is likely that the facilitators of extended use from this study would support implementation of extended use irrespective of the federally approved duration.

One strength of the study is the national sample and the diversity of clinician types and settings. There is also representation of clinicians who consistently offer extended use and those who do not offer extended use. Another strength of this study is that it was designed utilizing a framework focusing on implementation, thus yielding results that can be used to create effective interventions.

Limitations of this study include the small sample size and selection bias from recruiting from a prior study that utilized listservs and social media. Additionally, we recruited from a population that was specifically interested in family planning and identified mostly as Caucasian and female. Because of this, our results may not be generalizable to the national population of clinicians who offer contraceptive implant services. However, our direct selection of participants who only sometimes or do not offer extended use allowed us to hear diverse perspectives regardless of prior knowledge or interest in extended use. Another limitation is that we did not ask advanced practice clinicians what their specific training was (i.e., nurse practitioner or physician’s assistant). As the training for advanced practice clinicians can vary greatly, our results may not be generalizable to all advanced practice clinicians.

In conclusion, this study describes the barriers and facilitators to widespread implementation of extended use of the contraceptive implant. These results offer new perspectives and potential strategies to increase widespread implementation of extended use of the contraceptive implant up to 5 years of use. Based on our findings, there is opportunity to expand access to extended use by developing educational materials for clinicians and patients, identifying a champion of extended use, and counseling on extended use prior to removal appointments at 3 years. Of note, these results should be viewed in the context of recent policy access issues regarding reproductive health and used to support patient-centered contraceptive choices, regardless of a patient’s decision to extend use of their contraceptive implant up to 5 years. It is important that clinicians and patients utilize shared decision making when discussing extended use of the contraceptive implant.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to being stored in a private, HIPAA-compliant database, but are available from the corresponding author on reasonable request.

Abbreviations

Consolidated Framework for Implementation Research

Food and Drug Administration

CoIntrauterine device

Long-acting reversible contraception

Levonorgestrel

Obstetrician-Gynecologist

United States

Nexplanon® Prescribing Information. Organon. 2021. https://www.organon.com/product/usa/pi_circulars/n/nexplanon/nexplanon_pi.pdf . Accessed 20 Feb 2023.

McNicholas C, Swor E, Wan L, Peipert JF. Prolonged use of the etonogestrel implant and levonorgestrel intrauterine device: 2 years beyond food and drug administration-approved duration. Am J Obstet Gynecol. 2017;216(6):586e.

Article Google Scholar

McNicholas C, Maddipati R, Zhao Q, Swor E, Peipert JF. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. food and drug administration-approved duration. Obstet Gynecol. 2015;125(3):599–604. https://doi.org/10.1097/AOG.0000000000000690 .

Article CAS PubMed PubMed Central Google Scholar

Ali M, Akin A, Bahamondes L, Brache V, Habib N, Landoulsi S, Hubacher D, WHO study group on subdermal contraceptive implants for women. Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: comparison to levonorgestrel-releasing subdermal implant. Hum Reprod. 2016;31(11):2491–8. https://doi.org/10.1093/humrep/dew222 .

U.S. Food and Drug Administration. (1998). Off-label and investigational use of marketed drugs, biologics, and medical devices: guidance for institutional review boards and clinical investigators . Retrieved from https://www.fda.gov/regulatory-information/search-fda-guidance-documents/label-and-investigational-use-marketed-drugs-biologics-and-medical-devices . Accessed 20 Dec 2022.

Jensen JT, Lukkari-Lax E, Schulze A, Wahdan Y, Serrani M, Kroll R. Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: findings from the mirena extension trial. Am J Obstet Gynecol. 2022;227(6):873. https://doi.org/10.1016/j.ajog.2022.09.007 .

Article CAS Google Scholar

O’Dwyer MC. Contraceptive Efficacy of the Mirena Intrauterine System Through 8 Years of Use. NEJM Journal Watch. Retrieved from https://www.jwatch.org/na55371/2022/10/04/contraceptive-efficacy-mirena-intrauterine-system-through . Accessed 7 Mar 2024.

Teunissen AM, Grimm B, Roumen FJ. Continuation rates of the subdermal contraceptive Implanon(®) and associated influencing factors. Eur J Contracept Reprod Health Care. 2014;19(1):15–21. https://doi.org/10.3109/13625187.2013.862231 .

Article CAS PubMed Google Scholar

Moray KV, Chaurasia H, Sachin O, Joshi B. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health. 2021;18(1):4. https://doi.org/10.1186/s12978-020-01054-y .

Article PubMed PubMed Central Google Scholar

Blumenthal PD, Gemzell-Danielsson K, Marintcheva-Petrova M. Tolerability and clinical safety of implanon. Eur J Contracept Reprod Health Care. 2008;13(Suppl 1):29–36. https://doi.org/10.1080/13625180801960012 .

Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care. 2008;13(Suppl 1):13–28. https://doi.org/10.1080/13625180801959931 .

Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol. 2015;213(5):e6621-6628. https://doi.org/10.1016/j.ajog.2015.08.001 .

Funk S, Miller MM, Mishell DR Jr, Archer DF, Poindexter A, Schmidt J, Zampaglione E, Implanon US Study Group. Safety and efficacy of implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception. 2005;71(5):319–26. https://doi.org/10.1016/j.contraception.2004.11.007 .

Rigler N, Averbach S, Sandoval S, Meurice M, Hildebrand M, Mody SK. Barriers and facilitators of extended use of the contraceptive arm implants: a cross-sectional survey of clinicians. Obstet Gynecol. 2022;139:4S. https://doi.org/10.1097/01.AOG.0000826380.60071.b8 .

Hubacher D, Spector H, Monteith C, Chen PL. Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction. Contraception. 2018;97(6):524–32. https://doi.org/10.1016/j.contraception.2018.02.001 .

Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, Secura GM. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366(21):1998–2007. https://doi.org/10.1056/NEJMoa1110855 .

Monea E, Thomas A. Unintended pregnancy and taxpayer spending. Perspect Sex Reprod Health. 2011;43(2):88–93. https://doi.org/10.1363/4308811 .

Article PubMed Google Scholar

CFIR Research Team-Center for Clinical Management Research. The Consolidated Framework for Implementation Research: Constructs. 2023. https://cfirguide.org/constructs/ . Accessed 24 Jan 2023.

Forman J, Damschroder LJ. Qualitative content analysis. In: Jacoby L, Siminoff L, editors. Empirical research for bioethics: A primer, vol. 11. Oxford: Elsevier Publishing; 2008. p. 39–62.

Chapter Google Scholar

Hill CE, Knox S, Thompson BJ, Williams EN, Hess SA. Consensual qualitative research: an update. J Couns Psychol. 2005;52:1–25.

Soratto J, Pires DEP, Friese S. Thematic content analysis using ATLAS.ti software: potentialities for researchs in health. Rev Bras Enferm. 2020;73(3):e20190250. https://doi.org/10.1590/0034-7167-2019-0250 .

Dethier D, Qasba N, Kaneshiro B. Society of family planning clinical recommendation: extended use of long-acting reversible contraception. Contraception. 2022;113:13–8. https://doi.org/10.1016/j.contraception.2022.06.003 .

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Acknowledgements

We thank the participants in this study.

This study was funded by Organon (Study #201908). The funder had no role in the study design, analysis, or interpretation of findings.

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SM is the principal investigator and lead data analysis, including qualitative coding, and dissemination of findings. She was also involved in study design and participant recruitment. NR was the primary interviewer and was involved in study design, recruitment, data management, data analysis, and dissemination of findings. GK and MH were involved with study design, recruitment, coordination of the study, IRB documentation, data analysis, and dissemination of findings. SA was involved with study design and dissemination of findings. All authors read and approved the final draft of the manuscript.

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S.M. is a consultant for Bayer and Merck. She has grant funding from Organon and receives authorship royalties from UpToDate. S.A. has served as a consultant for Bayer on immediate postpartum IUD use. The remaining authors report no conflict of interest.

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Rigler, N., Kully, G., Hildebrand, M.C. et al. Offering extended use of the contraceptive implant via an implementation science framework: a qualitative study of clinicians’ perceived barriers and facilitators. BMC Health Serv Res 24 , 697 (2024). https://doi.org/10.1186/s12913-024-10991-4

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How to Write a Winning Event Proposal | Step-by-Step Guide

Introduction

In the competitive world of event planning, securing new clients often hinges on the quality of your proposal. A well-crafted proposal not only showcases your expertise and creativity but also demonstrates your understanding of the client's vision and needs. It serves as your first impression and a crucial factor in winning the job.

The purpose of this article is to guide you through the process of preparing and extending a compelling event proposal that stands out from the competition. We will provide a step-by-step framework to help you effectively communicate your ideas, present your services, and highlight the value you bring to the table. By following these guidelines, you can increase your chances of impressing potential clients and securing more event planning opportunities.

Whether you're a seasoned event planner or just starting out, this comprehensive guide will equip you with the knowledge and tools needed to create a winning proposal that resonates with clients and meets their expectations. Let's dive in and explore the essential components of a successful event proposal.

Understanding the Client's Needs

The foundation of a successful event proposal lies in understanding the client's needs and vision for the event. Before you start drafting your proposal, it is essential to gather as much information as possible about the client and their expectations. Here are some steps to help you achieve this:

Initial Research

Start by conducting thorough research on the client’s business, industry, and event history. Understanding their brand, mission, and previous events will provide valuable insights into their preferences and expectations. Look for the following information:

Company Background: Learn about the client's history, values, and key products or services.
Target Audience: Identify the primary audience for the event, including demographics, interests, and needs.
Previous Events: Review past events organized by the client to understand their style, scale, and typical outcomes.

Client Communication

Effective communication with the client is crucial to grasp their specific needs and objectives. Schedule a meeting or call to discuss the event in detail. During this conversation, ask open-ended questions to gather information and clarify any ambiguities. Key areas to cover include:

Event Goals and Objectives: What are the primary goals of the event? Is it to launch a new product, celebrate a milestone, foster team building, or something else?
Event Theme and Vision: What is the client’s vision for the event? Are there any specific themes, colors, or styles they have in mind?
Budget Constraints: What is the client’s budget for the event? Understanding their financial limitations will help you propose realistic and feasible solutions.
Key Stakeholders: Who are the decision-makers and key stakeholders involved in the event planning process?
Preferred Venues and Dates: Are there any specific venues or dates the client prefers or wants to avoid?

Aligning Expectations

Once you have gathered all the necessary information, summarize your understanding of the client's needs and confirm these details with them. This step ensures that both you and the client are on the same page and helps avoid any misunderstandings later in the planning process. Provide a brief outline of your proposed approach to demonstrate your alignment with their vision.

By thoroughly understanding the client's needs and expectations, you can tailor your proposal to address their specific requirements, making it more relevant and compelling. This client-centric approach is the first step towards creating a proposal that stands out and wins the job.

Structuring Your Event Proposal

A well-structured event proposal not only looks professional but also makes it easy for the client to understand your ideas and services. Here’s how to organize your proposal to ensure clarity and impact:

Your cover page is the first thing the client will see, so make it visually appealing and informative. Include:

Event Name: The name of the proposed event.
Your Company’s Name and Logo: To reinforce your brand.
Proposal Date: The date you are submitting the proposal.
Client’s Name and Logo (if applicable): Personalize the proposal by including the client's details.

A table of contents helps the client navigate through your proposal with ease. List all the sections and sub-sections along with their page numbers for quick reference.

Executive Summary

The executive summary is a brief overview of your proposal. It should highlight the key points and benefits of your proposal, enticing the client to read further. Include:

Event Overview: A short description of the event and its objectives.
Your Approach: How you plan to meet the client's needs and ensure the event's success.
Key Benefits: The unique advantages and value you bring to the table.

Detailed Proposal Content

Introduction and background.

Your Company Overview: Provide a brief overview of your company, its history, mission, and expertise in event planning. Highlight any relevant experience or accolades that add credibility.
Understanding the Client’s Vision: Show that you have a clear understanding of the client's goals and the significance of the event. Mention any specific details the client has shared with you.

Event Concept and Objectives

Event Concept: Describe the proposed event concept and how it aligns with the client’s objectives. Use descriptive language and visuals if possible.
Goals and Objectives: Clearly outline the goals and expected outcomes of the event, such as brand awareness, product launch, employee engagement, etc.

Event Details

Event Plan: Provide a detailed plan including the date, time, and location of the event. Mention why the chosen venue and timing are ideal.
Agenda: Outline the event schedule with specific activities and timings. Include any special sessions, keynote speakers, or entertainment planned.
Theme and Design: Describe the event theme, design elements, and how they enhance the event experience. Use mood boards or sample designs if available.

Services Offered

Logistics Management: Detail your approach to managing logistics such as venue setup, equipment, and transportation.
Catering and Hospitality: Explain your catering services, menu options, and hospitality arrangements.
Entertainment and Activities: Describe the entertainment options and activities you plan to include.
Technology and AV Support: Highlight the technology and audiovisual support you will provide, such as sound systems, lighting, and presentation equipment.

Budget and Pricing

Detailed Budget: Provide a comprehensive budget breakdown, including all costs and fees. Make it clear and transparent.
Value Proposition: Explain the value and benefits of your services relative to the costs. Highlight any cost-saving measures or added value you offer.

Team and Responsibilities

Team Introduction: Introduce the key team members who will be involved in planning and executing the event. Include their roles and relevant experience.
Roles and Responsibilities: Outline the specific roles and responsibilities of each team member to show your organized approach.

Timeline and Milestones

Project Timeline: Provide a timeline of key milestones and deadlines leading up to the event. Include preparation, execution, and post-event follow-up.
Milestone Deliverables: Specify the deliverables at each milestone to ensure transparency and accountability.

Risk Management

Risk Assessment: Identify potential risks and challenges associated with the event. Mention how you plan to monitor and manage these risks.
Contingency Plans: Outline your contingency plans to mitigate these risks. Show that you are prepared for unexpected situations.

Client Testimonials and Case Studies

Testimonials: Include testimonials from past clients to build credibility and trust.
Case Studies: Provide case studies of similar events you have successfully planned. Highlight the challenges faced and how you overcame them.

By structuring your event proposal in this way, you present a professional, thorough, and persuasive document that clearly communicates your capabilities and understanding of the client's needs. This approach significantly increases your chances of winning the job.

Proposal Presentation

A polished and professional presentation of your proposal can make a significant impact. Here are some tips to ensure your proposal is visually appealing and effectively communicates your ideas:

Design and Formatting

First impressions matter, so your proposal should look as good as it reads. Pay attention to the following aspects:

Consistent Branding: Use your company’s colors, fonts, and logo throughout the proposal to maintain brand consistency.
Professional Layout: Use a clean, professional layout with clear headings, bullet points, and plenty of white space to make the document easy to read.
Visual Elements: Incorporate visuals such as images, charts, infographics, and mood boards to enhance the presentation and illustrate your ideas. High-quality images of past events can showcase your capabilities.
Typography: Choose readable fonts and ensure that the font size is large enough for easy reading. Use bold and italics to highlight important points.

Customization

Customize the proposal to the client's specific needs and preferences. This shows that you have taken the time to understand their unique requirements:

Personalization: Address the client by name and mention specific details about their business and event goals.
Tailored Content: Modify the content to reflect the client’s vision, preferences, and budget. Avoid using a one-size-fits-all approach.

Follow-Up and Communication

After submitting your proposal, follow up with the client to demonstrate your enthusiasm and commitment. Effective follow-up can make a difference in securing the job:

Proposal Submission

Submission Method: Depending on the client’s preference, submit the proposal digitally via email or through an online platform, or provide a printed copy in a professional binder.
Submission Timing: Submit the proposal within the agreed timeline to show your reliability and punctuality.

Follow-Up Strategy

Follow-Up Email: Send a follow-up email a few days after submitting the proposal to confirm receipt and express your continued interest. Offer to answer any questions they may have.
Follow-Up Call: If appropriate, follow up with a phone call to discuss the proposal further and address any concerns. This personal touch can help build rapport.
Be Persistent but Polite: If you don’t hear back immediately, follow up again after a reasonable period. Be persistent but always remain polite and professional.

In conclusion, preparing a winning event proposal requires a deep understanding of the client's needs, a well-structured document, and a professional presentation. By following the steps outlined in this guide, you can create a compelling proposal that showcases your expertise, aligns with the client’s vision, and significantly increases your chances of securing the job.

A strong event proposal not only sets you apart from the competition but also builds trust and confidence with potential clients. Remember to personalize each proposal, present it professionally, and follow up diligently. These practices will help you forge strong client relationships and grow your event planning business.

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Research Article

Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study

Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Roles Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliation Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal

Roles Data curation, Formal analysis, Writing – original draft, Writing – review & editing

Affiliation Nepal Health Sector Support Programme (NHSSP)/DFID/Ministry of Health and Population, Kathmandu, Nepal

Roles Formal analysis, Writing – original draft, Writing – review & editing

Affiliation Central Department of Public Health, Institute of Medicine, Kathmandu, Nepal

Roles Data curation, Formal analysis, Writing – review & editing

Affiliation Department of Electronics and Computer Engineering, Institute of Engineering, Tribhuvan University, Lalitpur, Nepal

Affiliation Department of Community Health Sciences, School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal

Affiliation School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing

Affiliation Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom

Navin Bhatt,
Bandana Bhatt,
Bandana Neupane,
Ashmita Karki,
Tribhuwan Bhatta,
Jeevan Thapa,
Lila Bahadur Basnet,
Shyam Sundar Budhathoki

Published: May 26, 2021
https://doi.org/10.1371/journal.pone.0252184
Reader Comments

Introduction

Family planning methods are used to promote safer sexual practices, reduce unintended pregnancies and unsafe abortion, and control population. Young people aged 15–24 years belong to a key reproductive age group. However, little is known about their engagement with the family planning services in Nepal. Our study aimed to identify the perceptions of and barriers to the use of family planning among youth in Nepal.

A qualitative explorative study was done among adolescents and young people aged 15–24 years from the Hattimuda village in eastern Nepal. Six focus group discussions and 25 in-depth interviews were conducted with both male and female participants in the community using a maximum variation sampling method. Data were analyzed using a thematic framework approach.

Many individuals were aware that family planning measures postpone pregnancy. However, some young participants were not fully aware of the available family planning services. Some married couples who preferred ’birth spacing’ received negative judgments from their family members for not starting a family. The perceived barriers to the use of family planning included lack of knowledge about family planning use, fear of side effects of modern family planning methods, lack of access/affordability due to familial and religious beliefs/myths/misconceptions. On an individual level, some couples’ timid nature also negatively influenced the uptake of family planning measures.

Women predominantly take the responsibility for using family planning measures in male-dominated decision-making societies. Moreover, young men feel that the current family planning programs have very little space for men to engage even if they were willing to participate. Communication in the community and in between the couples seem to be influenced by the presence of strong societal and cultural norms and practices. These practices seem to affect family planning related teaching at schools as well. This research shows that both young men and women are keen on getting involved with initiatives and campaigns for supporting local governments in strengthening the family planning programs in Nepal.

Citation: Bhatt N, Bhatt B, Neupane B, Karki A, Bhatta T, Thapa J, et al. (2021) Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study. PLoS ONE 16(5): e0252184. https://doi.org/10.1371/journal.pone.0252184

Editor: Mary Hamer Hodges, Helen Keller International, SIERRA LEONE

Received: June 27, 2020; Accepted: May 12, 2021; Published: May 26, 2021

Copyright: © 2021 Bhatt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: BPKIHS, B. P. Koirala Institute of Health Sciences; FP, Family Planning; FGD, Focus Group Discussion; IDI, In-Depth Interview; mCPR, Modern Contraceptive Prevalence Rate; SRH, Sexual and Reproductive Health

An unmet need for family planning results in unintended pregnancies and illegal abortions. This has major health and social implications and is often the leading cause of maternal and child mortality in low-income countries [ 1 , 2 ]. An estimated 214 million women of reproductive age lack access to contraception resulting in an estimated 67 million unintended pregnancies, 36 million induced abortions, and 76,000 maternal deaths each year [ 3 ]. Family planning (FP) is a key intervention to limit these adverse health outcomes [ 4 – 6 ]. Such interventions can prevent 90% of abortions, 32% of maternal deaths, 20% of pregnancy-related morbidity globally, and reduce 44% of maternal mortality in low-income countries [ 1 , 7 ]. FP reduces adolescent pregnancies, prevents pregnancy-related health risks, and helps to prevent HIV/AIDS [ 8 ]. Access to contraception promotes education, raises the economic status of women, and gradually empowers them resulting in improved health outcomes and better quality of life [ 3 , 5 , 9 , 10 ].

Global data show that only 32% of married women from low-income countries currently use modern contraceptives [ 9 ]. According to the Nepal Demographic Health Survey 2016, the total fertility rate was 2.3 births per woman, which is declining and approaching replacement fertility. This is an important achievement. However, the modern contraceptive prevalence rate (mCPR), which is 43%, is still below the target in Nepal [ 11 ]. Nepal has consistently failed to reach the target of mCPR for the past 20 years. The future projection of mCPR for 2030 is 60% [ 5 ], which may be a distant dream if the barriers and enablers are not identified on time to strengthen the current efforts.

Expanding the coverage and access to effective contraceptive methods are essential to meet the Sustainable Development Goals and to achieve universal access to reproductive healthcare services by 2030 [ 11 , 12 ]. For this, the government of Nepal has started a FP program with a focus on increasing the use of FP services and reducing the unmet need [ 5 , 11 ]. However, various factors negatively influence the delivery of FP services including lack of information, limited awareness of dissemination activities, lack of trained staff, and various cultural and religious factors [ 13 ].

Family planning is a choice for many youth, but they often experience barriers such as negative provider attitudes, long distances to healthcare facilities, and inadequate stock of preferred contraceptives [ 13 , 14 ]. Nepali youth are reluctant to use modern contraceptives due to misconceptions about long-term fertility risks, fear of side effects and overall lack of deeper knowledge [ 15 , 16 ]. Besides, FP decisions are mostly dependent on male household members, including husbands and other elder members [ 17 , 18 ]. Married women whose husbands are away as migrant workers face unique contraceptive challenges. When their husbands return home for a few weeks in a year, these women are not prepared with their contraceptives, which can result in unwanted pregnancies [ 18 ].

The extrapolation of the available literature on FP use among adults from Nepal and elsewhere suggests that youth is an under-researched population when it comes to FP There is also a dearth of evidence on perception and key barriers to the use of FP measures in this population. Hence, this study aims to identify the perceptions of the FP services and barriers to the use of FP among the youth in Nepal to assist policymakers in designing appropriate interventions to strengthen the family planning programs in Nepal.

Material and methods

Ethical considerations.

The study received ethical approval from the Institutional Review Committee of B.P. Koirala Institute of Health Sciences, Dharan, Nepal as per the Undergraduate Research Proposal review process (URPRB/01/015). We obtained informed written consent from all participants aged 18 and above. For minors, we obtained assent from the parents of the participants with the participants’ permission. For those who could not read, the information sheet was read aloud by a volunteer, verbal consent was given, and a thumbprint, in the presence of a witness, was used in place of a signature. To maintain the confidentiality of the information and the privacy of the participants, only selected participants and the moderators attended the sessions. Personal identifiers and locator information were not collected, and any identifying information accidentally mentioned was removed from the text before the analysis.

Study setting

The study was conducted among the participants from Hattimuda village of Morang district in Province One of Nepal. Hattimuda village is a community service area of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. BPKIHS is a public-funded health sciences university, which follows a teaching district concept adopted as a part of its community-based medical education curriculum. BPKIHS also runs a tertiary hospital service for the population of eastern Nepal [ 19 ]. There is a public health facility in Hattimuda village that provides primary health care services including FP services such as the distribution of contraceptives. The nearest secondary and tertiary levels of healthcare services are available 18 kilometers away in Biratnagar, which is the provincial capital and the headquarters of Morang district. According to the 2017/18 annual report of the Department of Health Services, the contraceptive prevalence rate of Morang district is 54.6% [ 5 ] whereas the unmet need for FP in Province One as per the Nepal Demographic Health Survey 2016 is 25% [ 11 ].

Study design

This was a qualitative study with an exploratory design to gather a deeper understanding of the perception of FP and its barriers. Focus group discussions (FGD) and in-depth interview (IDI) methods were used. The overall study lasted from November 2017 to October 2018.

Study population and sampling technique

Adolescents and young people between 15 and 24 years of age from Hattimuda were included in the study. We used the maximum variation sampling method to enroll participants. Pretesting, including one FGD and four IDIs, was conducted among residents in another village of the same district. The pretesting guided the selection of participants for FGDs and IDIs. Accordingly, FGDs were conducted among adolescents and young people, separately for male and female participants to allow for free expression of views during the discussion of potentially sensitive issues. Moreover, the respondents recommended that people at the forefront of the community such as the village leaders, schoolteachers, community health volunteers, religious leaders, youth leaders, and students be selected for the interviews to gather more information. Along with the recommendations from the pretesting, brainstorming was done with community volunteers to generate a list of people who understood the issues of adolescents and young people. More volunteers were added to the list upon the recommendation of the initial respondents. Thus, participants representing diverse backgrounds in terms of gender, profession, education, and social status, were selected. The IDIs were done among 25 prominent people in the community, which included leaders, school teachers, female community health volunteers, healthcare professionals working at the health post and FP service centers, and youth leaders from youth clubs. Health care providers were included in the interviews as their views would be invaluable due to their experience as FP service providers and as witnessing the health issues faced by youth. The teachers are regarded highly for their knowledge and opinions in Nepali communities. So, they were selected for the IDI to provide more insight into the educational barriers to FP and to help in youth mobilization for FP activities. Considering the vital role of local leaders in influencing the implementation and regulation of population-level activities in the village, they were selected for IDI. Six focus groups were conducted with a total of 48 respondents ( Fig 1 ).

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https://doi.org/10.1371/journal.pone.0252184.g001

Data collection

The Focus Group Discussions (FGD) and In-depth interviews (IDI) were conducted by the researchers within the team with prior experience in qualitative research methods. The interview team included an undergraduate medical student, two postgraduate resident doctors, a public health graduate, and a public health academic researcher. Before data collection, an orientation session was conducted for the interviewers using the interview schedule and the topic guide. The IDI guidelines and interview schedules were developed from the literature review and were modified after pretesting. Validation of the tools was ensured by using the Item Objective Congruence (IOC) index and consultation with academics with experience in FP research. Using a semi-structured open-ended questionnaire, the participants were assessed on their knowledge and perceptions regarding sexual and reproductive health (SRH) and FP, SRH problems faced by youth, challenges and barriers to use of FP services, the role of youth in combating the perceived challenges, and suggestions for enhancing the use of services. Data were considered to have reached saturation when the responses from participants became repetitive and/or no new responses were received.

Focus group discussions.

A representative group of youth from diverse backgrounds who could provide credible information about practices and factors affecting the use of FP in the community was selected. Separate FGDs were held for girls and boys to allow for free expression. A moderator was responsible for guiding the discussion and a note-taker for taking the notes, including recording non-verbal responses and ensuring the audio recording. A total of 6 FGDs, each containing 8 homogenous participants, were conducted. Each individual participated once in the FGD. Every member of the group could make their contribution to any question posed before proceeding to another question. Each FGD lasted for 60–90 minutes on average. The discussion was done in the Nepali language as preferred by participants and later translated into English during transcription.

In-depth interviews.

In-depth interviews with the key stakeholders were conducted using the Interview Schedule after obtaining the informed consent and audio-recorded with participant permission. A total of 25 IDIs were conducted for the average duration of 30–45 minutes, at a location convenient to the participant, which included their homes and offices.

Data management and analysis

A framework method of thematic analysis was used. The analysis included stages of transcription, familiarization with the interview, coding, developing a working analytical framework, applying the analytical framework, charting the data into the framework matrix, and interpretation of the data. The data collected from the focus groups and interviews were transcribed verbatim. The notes taken were used as a guide to segregate the responses by different respondents during the discussion. An independent researcher conversant in the Nepali and English languages cross-checked the transcripts for accuracy and preservation of original meaning during translation. Preliminary codes were assigned to the available data and then organized into thematic units that were continually revisited and revised as necessary. To ensure consistency of data and findings, two authors were involved in data analysis and reporting. The recordings were stored and accessed by the research team only and were destroyed after the analysis and final report preparation.

Operational definition

According to UNFPA, all persons within the age of 15–24 years are considered youth [ 20 ].

The baseline characteristics of the participants can be seen in Table 1 .

https://doi.org/10.1371/journal.pone.0252184.t001

The responses from the IDIs and FGDs revealed four broad themes. Within each broad theme were several substantive sub-themes that emerged from the data. The themes and subthemes are summarized in Table 2 below.

https://doi.org/10.1371/journal.pone.0252184.t002

Theme 1: Knowledge and perceptions of FP

A) knowledge and sources of information on fp..

Participants demonstrated awareness of some form of FP. However, some knew nothing about it. Health workers were commonly referred to as the sources of information, while some also mentioned peers, radio, television, and books. Male participants openly disclosed their sources of information on FP while some female participants were reluctant to share their sources.

b) Perceptions of FP.

Perceptions of FP varied among participants. Some male participants inferred FP measures as women’s business and did not show any interest in talking more about it. Some referred to FP as using condoms during intercourse, while others referred to oral pills and injectable hormones as FP. Some female participants looked at FP as a way of avoiding unwanted pregnancies.

“My sister used to say that she has been using injection (Depo-Provera) to control unwanted pregnancy . I think FP is about the same . ”- 19 years Female , FGD participant

Theme 2: Preference for FP methods and decision-making

Some female participants reported preference for traditional methods of contraception such as coitus interruptus and calendar method over modern methods. These people used modern methods of FP to start with, which they discontinued later due to the side effects. Participants also stated that the health facilities that provide FP services were far, and hence they had no alternative other than natural methods. Male participants hardly mentioned visiting any health facilities for FP purposes.

“Most of our clients who come for it (FP) are women. Even condoms are collected by women. Men rarely come alone or as couples for FP services.” - 35 years old Female, FP service provider, IDI participant

Yet husbands were responsible for the decision-making about FP and choices of methods for most couples. Some participants (both male and females) mentioned that women rather than men should use permanent FP measures. They believed that men being the breadwinner of the family, should not undergo sterilization, for example, as it would make them physically weak.

“Though I love my wife and I am concerned about her. But I have no options. I must work in a factory. I need to lift heavy weights there. All the major house chores are also done by me. These things (sterilization) would make me weak. How can I earn my livelihood then?”- 22 years Male, FGD participant

Some female participants expressed their concerns regarding the use of permanent FP methods. They mentioned that they had already been through various phases of pain, be it during menstruation, pregnancy, or delivery which has made them weak. Thus, they prefer their husbands to undertake any measures.

In contrast, unmarried participants stated that they would rather discuss and decide together with their partners regarding which method to choose in the future. Despite this interest, women were not sure how to engage their husbands in discussion. Some female participants said that they could not persuade their future husbands to use contraceptives as it would be disrespectful, whereas a few male participants believed it was a woman’s responsibility to use FP methods.

“It (FP) is stuff to be done by the women . So , there is no doubt about who would be doing it . Moreover , people would laugh at me if I do it -20 years Male , FGD participant “ Women have already gone through much pain in bringing up and taking care of the children and again keeping this stuff (FP) in their head is unjustifiable . As such, in comparison to the female operative procedure, I have heard that the male one is simple, less time consuming, and does not bring many complications . So, why not we men take the lead on this? ” -25 years Male, Youth leader, IDI participant

Theme 3: Barriers and challenges in the use of FP

A) supply-side barriers and challenges..

Participants indicated that contraceptive services are not always accessible nor affordable in rural areas. Health facilities are far, and many people feel reluctant to travel in a hot climate. Participants who were reluctant to travel said they were doubtful that the health facilities would have the methods in stock even if they managed to walk the distance. Others who were reluctant said they would be unable to afford the contraceptives from a private medical store regularly. A few participants raised the issue of privacy and unavailability of all services at the health centers. Similarly, young males from the community complained that the services at the health post were focused only on mothers and married couples, while the boys and the unmarried people were not given much attention. For this, they suggested changing the term to something other than FP because they believed that FP should include not only those who had families.

Participants expressed their frustration that FP and SRH services in their village had not been running well for more than a year. They felt that the government was not doing anything about it either. Some students expressed the need for an integrated curriculum at school covering every aspect of SRH and FP that would ensure adequate and proper knowledge of such crucial subjects. Despite the students’ desire to learn and understand FP, their teachers are often reluctant to talk about FP in detail. The participants also indicated that family members, in general, forbid girls and women from getting involved in FP awareness activities.

“Though we are eager to learn about those lessons (reproductive organs and health), our teacher skips them. They tell us to read it by ourselves.” -18 years Female, FGD participant

b) Demand-side barriers and challenges.

A few participants were confused about which method to choose, how to use it properly and did not even know where to seek FP services locally.

“My husband works abroad. Last year, when he came home during Dashain (festival), we had (intercourse). Later, he returned to his workplace. Meanwhile, I came to know that I was pregnant, after 3 months. I was shocked to hear that. We already had 3 children; 2 of them were unplanned. I did not have enough information about contraceptive measures in this situation. Had I known about them; I would have used them. I had serious trouble travelling to get it aborted.” - 24 years Female, FGD participant

Some female participants expressed their reluctance to use FP methods due to their own or other people’s past experiences and the fear of side effects, including vaginal bleeding, spotting, abdominal pain, nausea, vomiting, headache, acne, and infertility. These female participants expressed the need for a single-use FP method with fewer side effects for women which could be used without their husbands’ consent. The male participants were worried about the risk of unwanted pregnancy due to the breaking of condoms and a few participants also expressed concern that they experienced allergic reactions after the use of condoms. Moreover, they were concerned about not having any alternative methods of contraception other than condoms.

“I have a much bitter experience. I was using Depo injection before. But I started having over bleeding for which I was admitted to the hospital for a few days. Later, I was switched to implants but they also did not suit me. In between I also used pills, but they aggravated my acne and I was feeling nauseated every day. Uff…. I am fed up now. I swear, I won’t ever use any methods.” - 19 years Female, FGD participant “I have heard that keeping these things (Copper-T) in the uterus can cause cancer. Better to avoid it.” - 20 years Female, FGD participant “There aren’t many choices for men. I think using a condom during sex is like tying plastic around the tongue and eating food.” - 21 years Male, IDI participant

Religious and ethnic variation affected use of FP. Participants reported that people belonging to upper caste groups used FP measures more than lower caste groups. Likewise, people who had migrated from the hilly areas used FP services, whereas people from the local ethnic community did not use as they were less aware of it. FP decisions among young people seem to be influenced largely by religious beliefs, stigma, and the perceived role of men and women based on existing social norms. Some participants regarded children as a gift from God and denied using any FP methods. Some believed using FP was going against the law of nature, religion, and culture; thus, they would not avoid childbirth, but rather celebrate every birth. Some indicated that if couples did not have children within 1–2 years of marriage, then people would question the woman’s fertility. Most couples preferred sons to daughters as they believed sons would look after them and their property, while the daughters would be married and sent away, resulting in avoidance of FP measures until they have a son. Some couples even wished to have two sons because if anything unfortunate happened to one, the other son would still be with them to carry the generation forward.

“My aunt gave birth to a son after 5 successive daughters. She is pregnant again this time in the hope to have a son. She says that she cannot trust to have only one son because if anything happens to their only son, then she will have no one to pay tribute after her death.”- 22 years Female, FGD participant

Participants also said that people felt shy talking about FP openly. Female participants also felt uncomfortable asking for contraceptives with male health personnel at the health post. Similarly, teachers felt uncomfortable teaching about reproductive health and FP as their children and relatives could be present as students in the classroom. Participants indicated that some students would laugh and smile, making it difficult for the teachers to run the classroom sessions smoothly.

It was reported by a FP service provider that some men opposed their wives using any FP measures as they perceived that the use of FP measures allowed their wives to become promiscuous when they go abroad for work.

“Some husbands working abroad forbid their wives from using any FP measures because they fear the use of FP measures may provoke a sexual relationship with someone else in their absence”- 30 years Female, Health professional providing medical abortion services, IDI participant

Theme 4: Role of youth and suggestions to improve FP

The youth were interested in getting involved in a “peer to peer education” approach to increase awareness among the community about FP use. This approach would include peer training programs, role-plays/dramas, and counseling sessions to break the key barriers linked with such services. Activities ranging from redesigning the school’s curriculum to strengthening FP services in primary care centers, and from launching mobile outreach clinics to facilitating “spousal communication” were intended to change attitudes and support gender equality in sexual and reproductive health. Participants emphasized forming youth centers and collaborating with other youth clubs in the village. Furthermore, they suggested bringing religious leaders, teachers, doctors, and politicians as advisors of the youth centers would be beneficial as they are influential members of the community.

“I feel bad for my sister who is not given much importance from my parents. She got married against her choice due to her parents’ pressure. Now, they are forcing her to have kids. She is just 15 and if she gets pregnant, what will happen to her health and her child, how can she take care of a baby? I had a long debate with my father yesterday. I have now decided to start a youth club to promote awareness regarding FP and preventing early marriage and teenage pregnancies.” - 23 years Male, FGD participant

Male participants indicated that family planning programs are effective only when men prioritize women’s autonomy. Moreover, they expressed disappointment with the local government for not encouraging the involvement of men in FP programs in their village. To help address this issue, they expressed their interest in supporting the local government in bringing inclusive FP programs to their village.

“For a long time, women have been using those (Contraceptives) by hiding. We are always in fear about what others would say if they came to know about us using it. This can be addressed through male involvement and support.” -24 years Female, FGD participant

This qualitative study provides in-depth information on the understanding and perceptions of youth in Eastern Nepal regarding FP. This study generated findings regarding knowledge and perceptions of rural residents regarding FP and its methods; decision-making and preference among participants; supply-side and demand-side barriers and challenges regarding the use of FP measures; steps that can be taken to improve their use; and the role of youth in increasing FP coverage. Although most participants knew something about FP, a few female participants were completely unaware of it. And while some participants agreed that all married couples should be using FP measures, some unmarried male participants believed that those measures should be exclusively for women. These men said that they would let their wives use them after getting married. Current FP methods for men are either coitus-dependent, such as condoms or withdrawal, or permanent, such as vasectomy. Limited choices for men may have resulted in misconceptions that contraceptives are mostly for women.

Men often claimed to be the sole decision-maker of the family on important matters, including those related to family health and contraception. In most circumstances, men solely decide the FP measure to be used without having a discussion with their partner. This might be one of the reasons why women are bound to adopt a FP method that is not necessarily their choice. Besides, this problem is further reinforced by the limited options of FP methods available for men other than condoms and permanent sterilization. These findings are supported by other studies in South Asia, where family planning measures are mostly considered women’s responsibility [ 21 – 24 ]. Health workers, peers, and mass media were the most common sources of information regarding FP similar to prior studies in India [ 21 , 24 ] and Nepal [ 22 ]. Participants in this study seemed to assign FP responsibility to the other gender in terms of using FP. This could mean that there is a gap in communication within the couples when deciding about FP. There is a need for further research to identify ways to improve communication among couples.

Religious and ethnic variation influence FP use. People belonging to privileged ethnic groups used FP measures more than underprivileged groups. This is despite family planning services being free for all citizens in Nepal. In this study, people who had migrated from hilly regions knew about and used FP services more than those belonging to the ethnic community in the local region. This is an area for further research to understand differences in knowledge and perceptions regarding FP between the population groups. This can be argued as a limitation of the current FP promotion programs, which may not have considered the different needs of people from different religious and ethnic backgrounds [ 25 ]. A few participants reported that their holy scriptures forbade them from using FP methods as they viewed children as a gift from God; any artificial process interrupting pregnancy or preventing the possibility of life is a religious offense for them [ 26 ]. Previous studies from Nepal have shown that this belief has long been rooted in some communities [ 27 – 29 ].

Apart from religious beliefs, fear of side effects, having experienced adverse health consequences after using hormonal contraceptives, and fear of potential infertility in the future are reasons for reluctance using FP methods among women [ 30 ]. Besides, we can speculate that language and cultural barriers, and fear of discrimination especially by male counterparts negatively influence the use of FP measures among some women despite their strong interest in using them. The use of IEC materials in raising awareness and empowering married couples for shared decision-making could help generate demand [ 28 , 29 ]. Local cultural taboos restrict open communication about safer sex measures and sexual health in Nepal, prohibiting young girls and boys from receiving adequate information and guidance regarding sexual and reproductive health and FP [ 31 ].

Most of the married women and men stated that the decision-makers of the family are men. The husband decides whether or not to use contraception, or more specifically, whether or not to let their wives use it. However, unmarried participants expressed their willingness to decide mutually with their spouse regarding FP use in the future [ 21 , 32 ]. Most women in this study seemed comfortable letting their male partners decide on contraceptives. This attitude could be explained by the patriarchal dominance in decision-making [ 19 , 33 , 34 ].

Some men mentioned that condoms inhibit their sexual pleasure, which is why they prefer women to use other methods instead. A study conducted in Far West Nepal and another nationwide study reported similar concerns among men [ 31 , 35 ]. Adolescent girls stated that they were not comfortable talking to a male health worker about FP or to a female worker in the presence of a male health worker, which has also been reported elsewhere [ 36 ]. Some women said that their husbands forbade the use of contraceptives because they thought that contraceptives would allow their wives to become promiscuous and that using FP was a sign of infidelity. This issue, however, was not raised by any men in the study. Some women reported violence as a consequence of using contraceptives without their husband’s consent. Prior qualitative studies also reported that women may suffer domestic violence for opposing their husbands. Studies suggest that a multi-sectoral action involving stakeholders from health, women’s rights, and education sectors is imperative to further research and address this issue [ 29 , 36 , 37 ].

Supply constraints (distance to a provider for getting contraceptives, out of stock, limited choices of contraceptives, unaffordable methods, etc.) could aggravate the unmet need for contraception. These constraints are similar to all regular supplies faced by the health system in Nepal. However, supply-side interventions such as increasing the number of health facilities distributing FP services, policy focusing on consistent operating hours, and full stock of a wide variety of FP methods could largely improve uptake and increase contraceptive coverage [ 18 , 38 ].

Most female participants did not speak up when asked about their perception of the role of men in FP. On the other hand, male participants explained that the role of the youth could be disseminating FP information, conducting awareness campaigns, organizing dramas and role-plays to educate people about the religious and cultural barriers of FP use, etc. With appropriate training, the young men said they would be willing to work for FP advocacy in the community.

Reproductive health leaders and planners should identify men who are willing to share decision-making authority with their wives and devise behavioral change interventions [ 39 ]. Male participation could support the FP programs and also help empower women [ 40 ]. The participants in the study expressed the need for the current FP programs to consider the community members as key stakeholders in planning FP programs. There is a need to further explore possible ways of working with the rural, marginalized communities and hard-to-reach or specific ethnic groups to improve their update of FP services [ 41 ]. There is evidence that mass media messages increase the likelihood of FP use, which could be considered by advocacy and dissemination programs [ 42 ]. Evidence from maternal and newborn health care research shows that interventions that engage men result in more equitable couple communication and shared decision-making. This may be a relatable concept to be considered for FP programs as well [ 43 ].

We urge those in charge of the health and sexual education curriculum to find ways to encourage teachers to give equal attention to these topics, including FP education, as they would to any other. It was reported that teachers were reluctant to teach about FP as they perceived the young students felt discomfort around this topic. Further research to identify innovative youth-friendly methods to teach sexual and reproductive health topics to students may be helpful. Youth groups should be regarded as important stakeholders in the redesign of school health curricula, particularly for their insight into culturally sensitive and otherwise effective ways for delivery. Health professionals, members of local organizations, and community leaders pointed to the necessity of addressing unmet FP needs and the stigma associated with FP use through community education approaches that take into account cultural norms and beliefs [ 44 ]. Interventions focusing on reproductive health education curricula involving school teachers could be considered [ 45 ]. Strengthening health systems, bridging service gaps, improving the integration of contraceptive services and counseling with routine health care are important strategies for increasing contraceptive uptake in eastern Nepal [ 22 ].

Among the study’s limitations was the fact that it was conducted in a single village in eastern Nepal. Our findings might differ if the sample had been drawn from other parts of the country. Although participants spoke fluent Nepali, some phrases used in local dialects could not be perfectly translated into Nepali or English. These responses could have been affected by social desirability as the participants may have felt constrained from speaking freely with people from health institutions. To help reduce these obstacles we held open meetings and drop-in sessions with the support of community youth to disseminate the purpose of the study and build rapport with the young people in the village before we approached them for the study. Moreover, participants were assured anonymity and confidentiality, which may have increased their willingness to participate in the research.

Conclusions

There appear to be information and communication gaps between women and men regarding FP services and programs. The information gap could be addressed by exploring ways to increase information uptake in schools through redesigning the curriculum delivery. Mass media may be used to disseminate appropriate health education regarding FP. Health institutions could consider approaches to create FP information and service centers that are male-friendly. The communication gap may be more deeply rooted in the culture and traditions of Nepalese society. In a mostly patriarchal society, further identification of motivations for men to participate in FP related activities could be challenging. However, it is promising that men may be willing to support their partners for FP decision-making and engage in strengthening FP programs through the “peer to peer” approach via youth-led centers and community clubs. Program managers and policy makers need to take into account the fact that youth are willing to contribute to ongoing FP programs. Doing so would help bridge the information and communication gaps between school education and practice. Innovative research to further explore perceived benefits by youth on the uptake of family planning, sexual and reproductive health services is needed.

Supporting information

https://doi.org/10.1371/journal.pone.0252184.s001

https://doi.org/10.1371/journal.pone.0252184.s002

Acknowledgments

We extend our sincere thanks and regards to Dr. Agata Parfieniuk, Kirsty Lunney, and Anu Regmi for their invaluable contributions to the manuscript. We acknowledge the support received from Dr. Meika Bhattachan, Dr. Avinash Kumar Sunny, and Dr. Pawan Upadhyaya during data collection. The authors acknowledge the support received from the BPKIHS and participants for their participation in the study. Special thanks to Dr. Bibisha Baaniya, Dr. Garima Pudasaini, Dr. Soniya Gurung, Dr. Shristi Nepal, Bisha Baaniya, and Arshpreet Kaur for their generous support throughout the study.

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5. Department of Health Services. Annual Report. DoHS. 2019. Available from: https://dohs.gov.np/wp-content/uploads/2019/07/DoHS-Annual-Report-FY-2074-75-date-22-Ashad-2076-for-web-1.pdf
8. World Health Organizaton. Family planning/Contraception. WHO. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
12. United Nations Department of Economic and Social Affairs Population Division. Family Planning and the 2030 Agenda for Sustainable Development: Data Booklet. (ST/ESA/ SER.A/429). 2019.
31. Dahal G., Hennink M. & Hinde A. Risky sexual behaviour among young men in Nepal. Southampton Statistical Sciences Research Institute, University of Southampton, Southampton. 2005. Available from; http://eprints.soton.ac.uk/id/eprint/14213

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Biomed Res Int

Modern Family Planning Utilization and Its Associated Factors among Currently Married Women in Rural Eastern Ethiopia: A Community-Based Study

Teshale mulatu.

1 School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia

Yitagesu Sintayehu

2 Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, P.O. Box 1362, Dire Dawa, Ethiopia

Yadeta Dessie

3 School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia

Merga Deressa

Associated data.

The data used to support the findings of this study are available from the corresponding author after formal communication by email, if the request is for an acceptable reason.

The use of modern family planning methods among women of reproductive age (15-49 years) is of public health importance in Ethiopia. Nationally, modern family planning method use remains as low as 35%. Understanding factors associated with the use of modern family planning methods may help to improve maternal and child health. Hence, this study is aimed at assessing modern family planning method use and its determinants among women of reproductive age in the rural districts of Eastern Hararghe zone, Eastern Ethiopia. Methodology . A community-based, cross-sectional survey was conducted among 577 randomly selected, currently married, reproductive-aged women in selected rural districts of Eastern Hararghe, Eastern Ethiopia. Data were collected using a pretested, interviewer-administered questionnaire about women's sociodemographic information, knowledge about contraception, reproductive history, contraceptive use and fertility desire, couple's communication, and decision-making on family planning. Binary and multivariable logistic regression was used to analyze the association between the dependent and independent variables.

A total of 555 study participants participated, yielding a 96.2% response rate. The overall modern family planning utilization among the study participants was 18.4%. Knowledge of modern family planning methods (AOR = 16.958, CI: 4.768, 60.316), husband approval (AOR = 3.590, CI: 2.170, 5.936), couple's discussion (AOR = 2.852, CI: 1.759, 4.623), male involvement in decisions about family planning (AOR = 2.340, CI: 1.531, 3.576), desire for additional child (AOR = 2.295, CI: 1.528, 3.447), and previous use of contraception (AOR = 0.018, CI: 0.005, 0.063) were significantly associated with modern contraceptive utilization.

Even though knowledge of modern family planning methods was very high, the overall modern family planning method use in the study area was low. The government should focus on increasing modern family planning method availability. It must also ensure family planning method security and create awareness on modern family planning methods through community-based education and proper counselling to empower women to make an appropriate choice.

1. Introduction

Family planning (FP) refers to the use of contraceptive methods to prevent unintended pregnancy, limit the number of children, and space childbirth. Contraceptive methods are classified as modern or traditional methods. Modern methods include female sterilization, male sterilization, intrauterine contraceptive device (IUD), implants, injectables, pill, male condoms, female condoms, emergency contraception, and lactational amenorrhea method (LAM), whereas traditional methods include rhythm (calendar), withdrawal, and folk methods [ 1 ].

Contraceptive has many benefits; it ensures couples achieve the desired family size and reduces infant/perinatal and maternal mortality. It also reduces the risk of HIV transmission and STI acquisition and prevents unintended pregnancies. Moreover, it decreases pregnancy and birth-related complications as it provides adequate time for a mother to recover from the previous pregnancy sufferings [ 2 – 4 ].

The 1994 International Conference on Population and Development (ICPD) shifted the world from one concerned with population growth to one committed agenda of reproductive rights and justice. It created a platform to help women and men to have greater access to modern contraceptive methods and affordable, convenient FP. FP is a vital element for the achievement of sustainable development goal [ 3 ], which considers reproductive, maternal, and child health as a priority agenda [ 5 ]. However, more than one in ten married or in-union women worldwide have an unmet need for family planning [ 3 ].

Currently, greater than 200 million women in developing countries want to avoid pregnancy, but they are not using any type of modern contraceptive method. Because fertility and unmet need for contraception continue to be much greater in sub-Saharan Africa , the magnitude of maternal death is much higher in this region compared to other regions. An unmet need for contraception inevitably results in unintended pregnancies. Approximately 40 percent of all pregnancies in developing countries are unintended [ 2 , 4 , 6 ].

Worldwide, the prevalence of modern contraceptive method use was 64% in 2015. According to the UN, contraceptive prevalence must be 66%-75% in developed countries and 67% in developing countries in order to achieve the desired fertility decline by 2025 [ 7 ]. However, this trend has not been seen in developing countries where the use of modern contraception among women of reproductive age is about 43% [ 8 ].

Modern FP utilization remains low in sub-Saharan Africa (SSA). In 2012, the contraceptive coverage and unmet need for contraception in the region were 25.7% and 25.1%, respectively [ 7 , 9 ].

The 2016 Ethiopian Demographic Health Survey reported that the overall use of FP methods among currently married women was 36%: of these, 35% were using a modern method, and only 1% were using a traditional method. Data shows that 22% of currently married women have an unmet need for FP services, 13% for spacing and 9% for limiting [ 1 ].

Ethiopia has increased FP service coverage by providing various contraceptive methods at the household level. The Ethiopian government began the ongoing Health Extension Worker (HEW) program in 2003. The HEW is a community-based intervention program, which delivers disease prevention and control, family health services, hygiene and environmental sanitation, and health education and counselling [ 10 ]. FP was incorporated into the program as one of 16 essential health services provided at the community level by health extension workers. HEWs were cross-trained to work in new health outlets, a massive investment in a country as poor as Ethiopia. These auxiliary health personnel provided injectable contraception and in recent years have begun to insert implants [ 2 ].

Although Ethiopia has been mentioned as a champion for introducing HEWs who provide modern contraceptive methods at the doorstep in rural kebeles, the utilization of modern contraceptive methods remains very low [ 11 , 12 ]. Research is needed to understand factors associated with the use of modern FP methods and the factors underlying modern FP utilization. Hence, the current study was conducted with the intent to assess modern contraceptive method utilization and its determinants among married women in the rural settings of the study area.

2. Methodology

2.1. study setting.

East Hararghe is one of the zones of the Ethiopian Region of Oromia, located in the Eastern part of Ethiopia, 510 km from Addis Ababa. East Hararge is bordered on the southwest by the Shebelle River, which separates it from Bale, on the west by West Hararghe, on the north by Dire Dawa, and on the north and east by the Somali Region. The Harari Region is an enclave inside this zone. The zone has a total population of 2,723,850, of whom 1,383,198 are men and 1,340,652 are women, with an area of 17,935.40 square kilometers. East Hararge has a population density of 151.87. Only 8.27% (216,943) are urban inhabitants and 30,215 or 1.11% are pastoralists.

Approximately 580,735 households were residents of this zone at the time of the study, with an average of 4.69 persons to a household and 560,223 housing units [ 13 ]. This study was conducted on January 1-30, 2019.

2.2. Study Design

A community-based cross-sectional study was conducted.

2.3. Source and Study Population

Currently married reproductive-aged women living in rural parts of the Eastern Hararghe zone were the source population, and currently married reproductive-aged women living in selected kebeles of the study areas were the study population.

2.4. Sample Size Determination and Sampling Procedure

The single population proportion formula, n = ( Zα /2) 2 pq / d 2 , was used with the proportion (35%) which was taken from EDHS 2016, which showed that 35% are using a modern method [ 1 ]. A confidence level of 95% and a 5% degree of precision were used. By considering the 1.5 design effect and 10% nonresponse rate, the final sample size was 577. Multistage sampling techniques were used. Among woredas (districts) in the study area, three woredas were selected by lottery methods. Then, one kebele (the smallest administrative unit) from each woredas was selected by simple random sampling. Proportional allocation for each kebele was used to give equal chance. Using systematic random sampling, all eligible households in each selected kebele were selected. From the eligible households, study participants (currently married women) were selected by simple random sampling. If there was more than one eligible woman within the selected household, one woman was picked at random. Women with mental and serious health problems, pregnant women, and those who reported infertility were excluded from the study.

2.5. Data Collection

Data were collected using a pretested, interviewer-administered questionnaire asking about women's sociodemographic information, knowledge about contraception, reproductive history, contraceptive use and fertility desire, couple's communication, and decision-making about FP. Three HEWs were recruited for data collection. To control the data quality, one-day training was given for supervisors and data collectors. The tools were pretested, and modifications were made to our set-up based on the pretest results. Collected data were reviewed for quality assurance on a daily basis, and double data entry control was done.

2.6. Data Analysis

Collected data were entered into the computer by using EpiData Version 3.0.2. Data analysis was done by using Statistical Package for the Social Sciences (SPSS) software version 21. Frequencies of variables were generated; tabulation and percentages were used to illustrate study findings. Bivariate and multivariate logistic regression analyses were used to analyze the association between the dependent and independent variables. The outcome variable (current modern FP use) was coded to yes/no response, and each explanatory variable was tested for association in bivariate analyses. Covariates with a P value < 0.2 were retained and entered into the multivariable logistic regression analysis using a forward selection and backward elimination approach. Hosmer and Lemeshow's goodness-of-fit test was used to assess whether the necessary assumptions were fulfilled. An adjusted odds ratio (AOR) with 95% confidence intervals (CI) using a P value < 0.05 was considered statistically significantly associated with the outcome variable.

2.7. Measures

Modern family planning : use of modern medicines (hormonal) or artificial material (condom) and minor surgery (voluntary sterilization) to space or limit birth.

Current modern FP method utilization : a woman was considered a current user if she is using any modern FP method during the survey.

Ever use of modern FP methods : a woman was considered ever using modern FP methods if she had used any modern FP methods previously before the survey.

Knowledge of modern FP methods : a woman was considered knowledgeable if she knew at least one type of modern FP method.

2.8. Ethical Consideration

The ethical approval was obtained from the Haramaya University College of Health and Medical Sciences institutional health research ethics review committee. Formal letters were written to all concerned authorities, and permission was secured at all levels. After explaining the purpose and procedures of the study, informed, voluntary, written, and signed consent was obtained from each respondent. All the basic principles of human research ethics (respect of persons, beneficence, voluntary participation, confidentiality, and justice) were respected.

3.1. Sociodemographic Characteristics of Respondents

A total of 555 study participants participated in the study, with a 96.2% response rate. More than half 304 (54.8%) of the study participants were between the age group of 25-35 (mean age of 28.2 ± 6 SD). A majority 459 (82.7%) of the study participants were from the Oromo ethnic group.

Most of the study participants 471 (84.9%) were Muslim. With regard to educational status, 307 (55.3%) had no formal education, while 195 (35.1%) had attended primary school. More than one-third 242 (43.6%) had an average monthly income of <1000 ETB ( Table 1 ).

Sociodemographic characteristics of currently married reproductive age group women in selected rural areas of Eastern Hararghe zone, Eastern Ethiopia, January 1-30, 2019 ( n = 555).

∗ Others: Gurage, Tigre, and Somali; ∗∗ others: Catholic, Adventists, and Pagans; ETB: Ethiopian birr.

3.2. Maternal and Reproductive History of Study Participants

Regarding the reproductive and obstetric history of the study participants, almost all mothers 549 (98.9%) had both histories of pregnancy and childbirth. More than half of the study participants 319 (57.5%) had four or fewer children, followed by five children and above 236 (42.5%). When asked about the desire for more children, more than half of the study participants 293 (52.8%) had no desire for more children. The most cited reason for not desiring more children was having the desired number of children 128 (43.7%) followed by limiting birth 79 (27%) ( Figure 1 ).

An external file that holds a picture, illustration, etc.
Object name is BMRI2020-6096280.001.jpg

Reason for not desiring additional children among currently married women of reproductive age in selected rural areas of Eastern Hararghe zone, Eastern Ethiopia, January 1-30, 2019 ( n = 555).

3.3. Knowledge of Modern Contraceptive Methods towards Use of Modern Contraceptive Methods

Most of the study participants 521 (93.9%) had heard about modern FP methods. The study participants heard information from health professionals 430 (80.8%) and from friends/relatives 85 (18.2%), from the church/mosque 30 (5.6%), and at school 23 (4.1%), respectively. The most popular modern contraceptive method was injection 491 (94.2%), followed by implants 447 (85.8%), pills 367 (70.4%), intrauterine contraceptive device (IUCD) 79 (15.2%), condom 24 (4.6%), and sterilization method 4 (0.8%). Concerning the knowledge of study participants towards the use of modern family planning methods, most of the study participants 507 (91.4%) knew at least one type of modern FP method.

3.4. Modern Contraceptive Use among Study Participants

The study finding showed that 243 (43.8%) of study participants had ever used modern contraceptive methods. One hundred and two (18.4%) women currently used modern contraceptive methods. Among the modern contraceptive methods, 50 (49%) women said they were using injectable methods, 45 (44.1%) said they used implants, 5 (4.9%) used pills, and 2 (2%) used IUCD. However, none of the participants reported the use of condoms and permanent contraceptive methods. Most of the study participants were using current modern contraceptive methods for spacing 81 (79.4%), for limiting birth 14 (13.4%), and for health benefits 7 (6.9%).

When asked the reason for not using modern contraceptive methods, most of the study participants cited inconvenient for use 131 (41.9%) followed by want to become pregnant 99 (31.7%) ( Figure 2 ).

An external file that holds a picture, illustration, etc.
Object name is BMRI2020-6096280.002.jpg

Reason for not using modern contraceptive methods among the currently married reproductive age group women in selected rural areas of Eastern Hararghe zone, Eastern Ethiopia, January 1-30, 2019 ( n = 312).

3.5. Sexual and Reproductive Health Communication and Decision-Making on Modern FP Methods

Two hundred eighty-eight (51.9%) of the respondents said they believed that a couple's discussion is important in making a joint decision regarding modern contraceptive methods. Two hundred sixty-three (47.4%) of the interviewed women perceived that their husband supports the use of a modern contraceptive method. Three hundred twenty-nine (59.3%) of the women said that the male partner/husband should be involved in FP decision-making. 61.3% of interviewed women replied that they made decisions jointly with their husbands, while 30.4% of the interviewed women made decisions alone on modern contraceptive method use ( Table 2 ).

Sexual and reproductive health (SRH) communication and decision-making of modern FP methods among currently married reproductive age group women in selected rural areas of Eastern Hararghe zone, Eastern Ethiopia, January 1-30, 2019 ( n = 555).

∗ Others: relatives, friends, and health care providers.

3.6. Misconception about Modern FP Methods

Myths and misconceptions spread very easily in the community and discourage many potential or current users of family planning. Generally, 114 (20.5%) of the women perceived that using any type of modern contraceptive is a sin or against religion. The study also showed that 122 (22%) women responded that the use of contraceptive pills causes infertility. 29.2% of interviewed women feel that the injectable method causes infertility, and 25.2% feel that it causes menstrual disorders. Concerning implants, 226 (40.7%) perceived that they cause a menstrual disturbance and 78 (14.1%) of the women replied that IUCD causes infertility. Regarding condoms, 111 (20%) women responded that using condoms is a sign of promiscuity ( Table 3 ).

Misconceptions towards modern FP methods among currently married reproductive age group women in selected rural areas of Eastern Hararghe zone, Eastern Ethiopia, January 1-30, 2019 ( n = 555).

3.7. Factors Associated with Modern Contraceptive Method Utilization

The findings from the multiple logistic regression analysis revealed that couple's discussion, the desire for additional child, male involvement in the decision of family planning, husband approval, ever use of the modern contraceptive method, and knowledge of modern contraceptive methods were independently associated factors of modern contraceptive utilization ( Table 4 ).

Multivariate analysis of factors associated with modern FP method utilization among currently married reproductive age group women in selected rural districts of Eastern Hararghe zone, Eastern Ethiopia, January 1-30, 2019 ( n = 555).

∗ Significant at P < 0.05 in multivariate analysis.

4. Discussion

This study showed that modern FP utilization in the study area was very low despite universal knowledge of modern contraceptive methods by the community. The study revealed the overall modern FP utilization among the study participants was 18.4%. This finding is consistent with the study conducted in Bale zone, Southeast Ethiopia (20.8%) [ 12 ], but much higher than that of Afar Region, Eastern Ethiopia (8.5%) [ 13 ]. The variation might be due to the study population, as the first study was conducted among the pastoralist community.

The low use of modern FP in the current study is below that of the national survey (35%) [ 1 ]. The low coverage in the study area could be due to the influence of husbands, cultural taboos, and religious prohibition in an area where most (84.9%) of study participants are Muslims. Moreover, this study was conducted in a rural area with little public health and education infrastructure and high misperceptions towards modern contraception, compared to urban areas.

The study revealed that 91.4% of study participants knew at least one modern FP method. This finding is in line with a study finding from Bale zone (95.3%), Southeast Ethiopia [ 12 ], and Jimma zone (94%), Ethiopia [ 14 ]. This higher percent of information might be due to house-to-house FP information dissemination by health extension workers.

Our study finding is relatively higher than that of Dembia District (78.1%), Northwest Ethiopia [ 15 ], and Afar Region (62%), Eastern Ethiopia [ 13 ], but lower than studies from Uganda (98.1%) [ 16 ], Tanzania (98.8%) [ 17 ], and Butajira (99%) in Central Ethiopia [ 18 ] which reported almost universal knowledge of modern FP methods. The difference may be attributed to the wide variation in culture and socioeconomic characteristics of study participants.

Our study showed that women who know modern FP methods were about seventeen times (AOR = 16.958, CI: 4.768, 60.316) more likely to utilize modern FP methods than those women who do not know any type of modern contraceptive. This study finding is in line with the study finding from Awi zone, Amhara regional state, and the town of Debre Markos, Northwest Ethiopia [ 19 , 20 ]. This can be justified by the fact that better knowledge of modern FP may result in better practice of modern FP methods, i.e., the women who know modern FP methods are more likely to use the method consistently and effectively than their counterparts.

In our study, the husband's view and approval of modern contraceptives showed an independent effect on modern contraceptive's method utilization. The odds of modern FP utilization among women who perceived that their husbands support the use of modern contraception were more than three times (AOR = 3.590, CI: 2.170, 5.936) higher than those women who do not perceive that their husbands support the use of modern contraceptives. The study finding is similar to findings from Ghana, Cameroon, and Bangladesh [ 21 – 23 ].

This study showed that women who discussed with their husbands about the issue of FP or SRH were about three times (AOR = 2.852, CI: 1.759, 4.623) more likely to use modern contraceptives than those women who did not discuss with their husbands. This finding is consistent with other studies conducted in Ghana, Ethiopia, and Tanzania [ 12 , 15 , 21 , 24 ], and women whose partners were involved in FP decision-making were more than twice (AOR = 2.340, CI: 1.531, 3.576) more likely to use modern contraceptive methods than their counterparts. This finding is consistent with findings from Cameroon, Debre Markos, Northwest Ethiopia, and Zambia [ 20 , 22 , 25 ] and suggests that male involvement in decision-making improves spousal communication and decreases male opposition. This might be because women who discuss FP issues with their spouses may have their partner's approval on family planning; hence, they are more likely to use a modern method of contraception. This evidence is supported by a study conducted in the pastoralist community of Ethiopia that suggests that contraceptive use was influenced by both individual-/community-level characteristics [ 26 ]. This can be due to the fact that joint decisions for family planning are based on spousal communication implying that when couples communicate effectively, they are more likely to jointly agree on what type of contraceptive method to use, how many children to have, and the space between their offspring.

The current study reported that the odds of modern contraceptive utilization were more than two times (AOR = 2.295, CI: 1.528, 3.447) higher for women who do not desire an additional child than for those women who desire to have an additional child. This finding is similar to a study conducted in Zambia [ 27 ]. This is supported by responses from study participants, most of whom said they were using modern contraceptive methods for spacing and limiting birth.

The study also showed that women who had never used modern FP were only 0.018 times less likely to use modern FP methods, compared to those who had ever used modern FP methods (AOR = 0.018, CI: 0.005, 0.063), a similar finding to a study conducted in Uganda [ 28 ]. This can be due to the fact that ever users of modern FP methods were more familiar with the benefits of modern FP methods. Hence, they are more likely to use/continue the methods than their counterparts.

5. Limitations

Data were cross-sectional and originated from self-reported measures. In this case, it is difficult to validate claims made by respondents in the course of questionnaire administration. Moreover, there was a lack of contextual factors related to the health system, culture, religion, and societal norms of the study setting, which may affect modern FP use.

6. Conclusion

The present study contributes to our understanding of the determinants of modern FP utilization among women in rural Ethiopia. The overall prevalence of modern FP use among the study participants was low. Couple's discussion, the desire for additional child, male involvement in decision about family planning, husband approval, ever use of contraception, and knowledge of modern FP methods were found as significant factors that can increase modern FP method use.

The results of this survey suggest that the government should focus on positive action able to increase access to modern FP methods and it should create awareness of modern FP methods through mass media, community-based education, and proper counselling. The government should emphasize empowering women to make appropriate choices and address real barriers to women's use of modern FP methods.

Acknowledgments

The authors would like to thank CIRHT Ethiopia, for funding the study, and Haramaya University, College of Health and Medical Science, for unreserved technical collaboration and nonfinancial support. We also thank the data collectors and participants of the study for their contributions. Pre-Publication Support Service (PREPSS) supported the development of this manuscript by providing prepublication peer review and copyediting. This study was funded by CIRHT Ethiopia (Center for International Reproductive Health Training), the affiliate of Michigan University.

Data Availability

The funding organization has no role in designing the study, data collection, analysis and its interpretation, protocol writing, and submission.

Conflicts of Interest

The authors declare that they have no conflicts of interests.

Authors' Contributions

Teshale Mulatu is the principal investigator who generated the idea to conduct the study. He wrote the initial draft of the proposal and supervised the implementation of the study. Merga Deressa participated in proposal writing, supervising the implementation of the study, data analysis, and manuscript writing. Yitagesu Sintayehu and Yadeta Dessie participated in designing the study. All authors critically revised, read, and approved the final manuscript.

Gayle King’s son, Will Bumpus Jr., marries fiancée Elise Smith in ‘epic’ wedding at Oprah Winfrey’s house

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Gayle King’s son, William Bumpus Jr., and his fiancée, Elise Smith, tied the knot in an intimate ceremony at Oprah Winfrey’s home on Sunday.

“Oprah, of course, was there because it was at Oprah’s house,” King, 69, said on “CBS Mornings” on Tuesday of her best friend, joking that “it’s always nice” when the billionaire “lets us use” her estate in Montecito, Calif. , because the price is “feasible.”

Winfrey, 70, also was involved in planning the festivities and arranged for fireworks to go off as the bride and groom made their exit at the end of the event.

Gayle King, Oprah Winfrey and William Bumpus Jr.

King, who wore a blue one-shoulder dress for the occasion, said the “color of the day was blue,” but Smith wore a white strapless Amsale wedding gown to walk down the aisle.

The couple wrote their own vows, which the broadcast journalist said was her favorite part.

“At one point, Will said, ‘I know the man I am, but with you, I know the man I want to be.’ That gave me goosebumps,” she recalled.

William Bumpus Jr. and Elise Smith on their wedding day.

King also said she has never seen the kind of love that her 37-year-old son and his new wife share.

“You go to weddings, and everyone’s in love, but there’s something about these two that I thought was very epic and it was next-level,” she gushed.

“So, it’s always nice when you can see your own children happy and married.”

William Bumpus Jr. and Gayle King on their wedding day.

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Want celebrity news as it breaks? Hooked on Housewives?

The TV host shared that the nuptials were “strictly for family” and that seeing her ex-husband, William Bumpus, with his girlfriend was “all good.”

“I said hi and hugged and everything,” she said of her former spouse, to whom she was married from 1982 to 1993. “It was lovely. It was all great.”

King said the “beautiful day” was “filled with love” and revealed the newlyweds are planning to have a “big dance party” with their friends at a later date.

William Bumpus Jr. and Elise Smith getting engaged.

Winfrey was also present when Bumpus Jr. proposed to Smith in February.

The legendary talk show host discreetly filmed the moment that her BFF’s son got down on one knee in a garden.

King’s daughter, Kirby Bumpus, was also on hand for the engagement.

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