BACKGROUND: Self-injectable contraceptives, namely subcutaneous depot medroxyprogesterone acetate 104 mg micronised formulation delivered via uniject system, reduce the need to travel to a facility for contraceptive access, but the initial, in-person, training may be a barrier to starting this method. This article reports on a small, exploratory pilot in Kenya to test the feasibility and acceptability of digital self-injection training.
METHODS: Participants (n=11) who were currently using injectable contraceptives, intramuscular depot medroxyprogesterone acetate 150 mg injected by a healthcare worker, received digital self-injection training from a trained clinician via a WhatsApp video call. Participants administered a simulated self-injection on a model and an actual self-injection (under supervision) on themselves. The participants\' self-injection proficiency, a measure of the feasibility of remote training, was documented using a checklist, and participants were administered a questionnaire about their training experience. The training was observed, and content analysis was used to understand the functionality of training.
RESULTS: All participants were proficient when performing the self-injection on themselves after receiving the remote training and reported that the training was acceptable. A barrier to training via a video call was lack of access to quality digital devices. Eight training \'lessons learnt\' emerged from the training observations.
CONCLUSIONS: Training participants to administer self-injectable contraceptives via WhatsApp video call was feasible and acceptable. Training lessons learnt offer pragmatic adaptations for communicating about a practical skill via a digital channel. Further research is needed to ascertain the efficacy of digital training for self-injection and feasibility and acceptability for wider groups.

BACKGROUND: The Dual Prevention Pill (DPP) combines oral pre-exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self-care and technology-based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP.
METHODS: Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage.
RESULTS: Wide geographic reach, ongoing pharmacy-administered PrEP pilots in Kenya and South Africa, and over-the-counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology-based channels such as e-pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness-to-pay for all channels.
CONCLUSIONS: The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non-traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness-to-pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies.

OBJECTIVE: This study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence.
METHODS: We use data from Performance Monitoring for Action Ethiopia, a nationally representative, cross-sectional survey of 7491 women, aged 15-49, to assess agreement with the statement \'If I use family planning, I may have trouble getting pregnant next time I want to.\' We used multilevel hierarchical models to identify the association between agreement and use of a hormonal method of contraception among 3882 sexually active, fecund women who wish to prevent pregnancy. We include interaction terms for parity and residence.
RESULTS: 4 in 10 women disagreed (42.3%) and 2 in 10 strongly disagreed (20.7%) with the statement. Relative to women who strongly disagreed, women who disagreed and women who agreed had significantly lower odds of using a hormonal method of contraception (adjusted OR (aOR) 0.65, 95% CI 0.44 to 0.97 and 0.46, 95% CI 0.46, 95% CI 0.30 to 0.70). The effect of agreeing with the statement was strongest among high parity women (aOR 0.54, 95% CI 0.30 to 0.95). Greater agreement with the statement at the community-level use was associated with a reduction in the odds of using hormonal contraception but only among rural women.
CONCLUSIONS: Efforts to address concerns around contraceptive-induced fertility impairment through the provision of comprehensive counselling and through community education or mass media campaigns are necessary, particularly among high-parity women and in rural communities. Interventions should acknowledge the possibility of delayed return to fertility for specific methods and attempt to address the root causes of concerns.

BACKGROUND: The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men\'s decision-making role in the family significantly contribute to this phenomenon.
OBJECTIVE: The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.
METHODS: Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.
METHODS: Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.
METHODS: Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).
RESULTS: We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband\'s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands\' presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.
CONCLUSIONS: Despite years of programming, barriers to women\'s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.

UNASSIGNED: A survey in two districts of Odisha with reportedly high total fertility rates, i.e., Boudh and Koraput (Annual Health Survey-2014), was performed under the aegis of the Indian Council of Medical Research, aiming to improve male participation in contraceptive acceptance and services. One hundred and forty-eight women out of 217 sterilization acceptors consented to the study. A semi-structured questionnaire with responses regarding the preoperative, operative, and postoperative experiences was used as the tool, and responses were analyzed in SPSS version 25. The outcome variable was a self-reported score of satisfaction on a scale of 1-10; wherein eight was reported by 42.7% of total women. The satisfaction score using linear regression was significant for the total times the woman was pregnant (β = -0.369; P = 0.002), with a unit increase in times, the woman was pregnant, and the satisfaction declined by 0.363 units. The study provides evidence of greater advocacy of a less heard mandate of \"respectful contraception.\"

BACKGROUND: Unmet need for family planning [UNFP] remains a serious public health concern in Nigeria. Evidence suggests that UNFP remains high over the last fifteen years despite numerous policies and programmes aimed at generating demand for family planning. This study used three Demographic and Health Survey (DHS) conducted over a ten-year period (2008-2018) to assess the changes in unmet need for family planning and associated contextual determinants. Understanding changes in unmet need for family planning among women and its associated contextual factors is crucial for designing appropriate interventions.
METHODS: We analysed datasets the Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes and contextual determinants of unmet need for family planning. Data were analysed using frequency distribution, chi-square statistical test and multilevel binary logistic regression models. Due to the hierarchical structure of the data in which individuals are nested within households, multilevel mixed-effect logistic regression models were constructed. We used a multilevel binary logistic regression model after adjusting for variables not significant at the bivariate level. An adjusted odds ratio with 95% confidence interval was reported, with a p-value less than 0.05 declared to be significant predictors of unmet need for family planning.
RESULTS: Unmet need for family planning decreased from 20.21% to 16.10% between 2008 and 2013 but subsequently rose later from 16.10% to 18.89% between 2013 and 2018. The pattern of changes in unmet need for either limiting or spacing was consistently high over the 10-year period, with the highest rate of each of the indicators of unmet need for family planning occurring in 2018 while the lowest rate was in 2008, thus indicating an increase in the proportion of respondents having unmet need for family planning over the referenced period. Age of respondents, educational level, wealth status, religious affiliation, parity, sex of head of household, partner educational level, region of residence, and community socioeconomic status were significant factors associated with the unmet need for family planning across the different data waves in Nigeria (p < 0.05). An intraclass correlation (ICC) of 4.9% showed that the individual and household level factors had a greater influence on the variation in the unmet need for family planning than did community factors in Nigeria.
CONCLUSIONS: The overall prevalence of unmet need for family planning was consistently high over the ten-year period and community-level factors had lowest influence on the variation in unmet need for family planning compared to household and individual-level factors in Nigeria. Policies and interventions should focus on improving women\'s socio-economic and demographic characteristics at individual, household, and community levels to improve unmet need for family planning.

BACKGROUND: The World Health Organization defines women with an unmet need for family planning as individuals who are fecund, sexually active, and wanting to either to limit childbirth or postpone their next birth but are not utilizing any form of contraception. Previous meta-analyses and systematic reviews have focused on this topic, but no comprehensive summary of the evidence was available. Therefore, the aim of this study was to provide a summary of the findings on the unmet need for family planning among reproductive-aged women in Ethiopia.
METHODS: A search was conducted in PubMed, Google Scholar, CINAHL, Scopus, Cochrane Library, and RESEARCH 4 LIFE including Hinari, to identify relevant systematic reviews and meta-analyses of studies on the prevalence and determinants of the unmet need for family planning in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews tool, and the estimates were pooled using a random-effects meta-analysis model.
RESULTS: The umbrella review included five studies with a total of 56,169 reproductive-aged women. The pooled prevalence of unmet need for family planning was found to be 27.44% (95% CI: 22.32-32.55), with the heterogeneity index (I square = 99.45%, P = 0.000). Failure to discuss with her partner about family planning methods (OR: 2.90, 95% CI: 1.81, 4.00), being illiterate (OR: 2.17, 95% CI: 1.42, 2.92), age at first marriage (OR: 1.37, 95% CI: 1.30, 1.44), and educational status of woman\'s partner (OR: 2.61, 95% CI: 0.83, 4.40) were the factors significantly and positively associated with unmet needs for family planning.
CONCLUSIONS: The study concludes that the unmet need for family planning in Ethiopia is a significant issue that can be addressed through increasing the educational levels of women and their partners, promoting open discussions about family planning, and preventing early marriages. Collaboration between families, school administrators, and healthcare providers is essential to mitigating this problem.

Background: The COVID-19 pandemic affected global access to health services, including contraception. We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users\' desire and ability to obtain removal. Methods: Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results: Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported attempting to access FP since the start of the pandemic, the vast majority of whom were using short-acting methods. Among those who sought services, 95% obtained their preferred method. The proportion of women not using a method before and after pandemic start did not change in Zambia (31%); in South Africa, the proportion increased from 8% to 10%. Less than 7% of implant or IUD users in either country reported wanting removal. Among those who sought removal (n=22), 91% (n=10) in Zambia and 55% (n=6) in South Africa successfully obtained removal. In qualitative interviews, women with challenges accessing FP services mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions: We did not find a substantial impact of COVID-19 on contraceptive access among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people\'s ability to access their preferred contraceptive methods.

UNASSIGNED: To verify the association between reproductive autonomy and sociodemographic, sexual, and reproductive characteristics in Quilombola women (a term indicating the origin of politically organized concentrations of Afro-descendants who emancipated themselves from slavery).
UNASSIGNED: Cross-sectional and analytical study with 160 women from Quilombola communities in the southwest of Bahia, Brazil. Data were collected using the Reproductive Autonomy Scale and the questionnaire from the National Health Survey (adapted).
UNASSIGNED: Out of the 160 participating women, 91.9% declared themselves as black, one out of every three were aged ≤ 23 years, 53.8% were married or had a partner, 38.8% had studied for ≤ 4 years, over half (58.1%) were unemployed, only 32.4% had a monthly income > R$ 430 (80 US dollars), 52.5% had their first menstruation at the age of 12, 70.7% had not accessed family planning services in the last 12 months, and over half used some method to avoid pregnancy (59.0%). The women had a high level of reproductive autonomy, especially in the \"Decision-making\" and \"Freedom from coercion\" subscales with a score of 2.53 and 3.40, respectively. A significant association (p<0.05) was found between the \"Total reproductive autonomy\" score and marital status, indicating that single or unpartnered women had higher autonomy compared to married or partnered women.
UNASSIGNED: The association of social determinants of health such as marital status, education, and age impacts women\'s reproductive choices, implying risks for sexual and reproductive health. The intergenerational reproductive autonomy of Quilombola women is associated with sociodemographic and reproductive factors.

BACKGROUND: Digital technology has proliferated rapidly in low- and middle-income countries in recent decades. This trend will likely persist as costs decrease, dramatically expanding access to reproductive health and family planning (FP) information. As many digital tools aim to support informed choice among individuals with unmet contraceptive need, it is essential that high-quality information is provided. We set out to assess the accuracy and comprehensiveness of FP content in select user-facing digital self-care platforms.
METHODS: We identified 29 digital tools in circulation between 2018-2021 and selected 11 that met our eligibility criteria for analysis. Referencing global guidance documents such as the Family Planning Handbook, Medical Eligibility Criteria for Contraceptive Use, and the Digital Health for Social and Behavior Change High Impact Practice Brief, we developed an original rubric outlining 12 key content areas necessary to support informed, person-centered counseling. We applied this to each tool, enabling assignment of a numerical score that represents content accuracy and comprehensiveness across the 12 key areas.
RESULTS: FP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 identified key content areas, 5 were included in all 11 tools, while 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use.
CONCLUSIONS: Complete, accurate, and evidence-based FP content is a foundational element of quality digital self-care. Inaccuracies and omissions can impact individual user experiences and decision-making in critical ways. FP content quality should be verified before digital tools are scaled or researched at the programmatic level. From this exercise, we developed a checklist for use in conjunction with global guidance documents to improve future FP content of user-facing digital tools.
RéSUMé: CONTEXTE: La technologie numérique a proliféré rapidement dans les pays à revenu faible et intermédiaire au cours des dernières décennies, une tendance qui devrait se poursuivre à mesure que les coûts diminuent, élargissant considérablement l’accès aux informations sur la santé reproductive, y compris la planification familiale (PF). Étant donné que de nombreux outils numériques permettent de faire des choix éclairés, il est essentiel que les informations fournies soient de grande qualité. Nous avons entrepris d’évaluer l’exactitude et l’exhaustivité du contenu sur la PF dans certains outils numériques destinés aux utilisateurs. MéTHODES: Nous avons identifié 29 outils numériques utilisés entre 2018–2021 et en avons sélectionné 11 pour l’analyse en fonction de nos critères d’éligibilité. Nous avons élaboré une rubrique basée sur des documents d’orientation mondiaux, notamment le Manuel de planification familiale, les Critères d’admissibilité médicale pour l’utilisation de contraceptifs et l’aperçu du pratique a haut impact Sante Numérique pour un changement social et comportemental, reflétant 12 domaines de contenu clés du conseil éclairé et centré sur la personne. Nous avons appliqué cette méthode à chacun des outils, ce qui nous a permis d’attribuer une note quantitatif représentant l’exactitude et l’exhaustivité du contenu de chaque outil en matière de PF dans les 12 domaines de contenu. RéSULTATS: Le contenu des outils numériques en matière de planification familiale varie considérablement en termes de précision et d’exhaustivité. Sur les 12 domaines clés que nous avons identifiés, 5 ont été inclus dans les 11 outils; 6 domaines ont été traités de manière incohérente ou pas du tout. Quatre domaines ont été les plus précis et les plus complets: la liste complète des méthodes modernes, la durée de la protection, l’utilisation d’une double méthode et le retour à la fertilité. Les domaines les moins bien notés étaient la gestion des effets secondaires, les avantages non contraceptifs, l’efficacité, les effets secondaires et le mode d’emploi. CONCLUSIONS: Un contenu complet, précis et fondé sur des données probantes est un élément fondamental de la qualité des soins. Les inexactitudes et les omissions peuvent avoir un impact critique sur l’expérience et la prise de décision des utilisateurs. La qualité du contenu de la PF doit être contrôlée et vérifiée avant que les outils numériques ne soient mis à l’échelle ou que des ressources ne soient utilisées pour leur recherche. Sur la base de cet exercice, nous avons élaboré une liste de contrôle à utiliser en conjonction avec les documents d’orientation mondiaux pour améliorer le contenu PF des outils numériques destinés aux utilisateurs.
Digital tools are increasingly used to reach people in low- and middle-income countries with reproductive health information and links to services. We set out to understand the quality of the information available in digital tools relating to family planning. To do this, we searched for a set of tools and applied eligibility criteria, ultimately identifying 11 tools for assessment. To assess their content, we developed a rubric based on cornerstone documents in family planning. This rubric contains 12 FP content areas (such as method effectiveness, duration of protection, etc.) and was applied to assess accuracy and comprehensiveness of all FP content. The FP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 key content areas we identified, 5 were included in all 11 tools; 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use. Digital tool users have the right to accurate, comprehensive FP information, and gaps in quality can impact users of digital tools in various ways. Quality of FP content should be checked and verified before digital tools are scaled or resources are used to research them. Based on this exercise, we developed a checklist for use in conjunction with global guidance documents to improve the FP content of user-facing digital tools.