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Background Family planning is an integral component of maternal and child health services in Ghana. Although knowledge on contraception is universal and most women attend maternal and child health services, contraceptive use remains low among women after delivery. This study aimed to determine factors influencing current use and future contraceptive intentions of women who were attending child welfare clinics within 2 years of delivery in Sunyani Municipality, Ghana. Methods We conducted an analytical cross-sectional study among mothers in six selected health care facilities. Data was collected on their socio-demographic characteristics, reproductive and contraceptive experiences and future contraceptive intentions. Categorical variables were compared using the chi-squared (χ 2 ) test. Factors associated with current use and future contraceptive intentions were determined using Poisson regression with a robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P  < 0.1 was considered statistically significant. Results A total of 590 women were recruited into the study. Overall, 50.2% of the women were using contraception, 30.7% modern and 19.5% traditional methods. Compared to previous use, more women were using and would prefer the more effective contraceptive methods in future. Significant factors associated with current contraceptive use were, level of education ( p  = 0.02), discussing family planning during antenatal care (adjusted RR, 1.28; 95% CI, 1.07-1.53), or with one’s partner (adjusted RR, 1.22; 95% CI, 1.01-1.47) and previous contraceptive use (adjusted RR, 1.91; 95% CI, 1.56-2.33). Family planning discussions during child welfare clinic (adjusted RR, 1.12; 95% CI, 0.99-1.26) or with one’s spouse (adjusted RR, 1.20; 95% CI, 1.08-1.34), desire to space children (adjusted RR, 1.35; 95% CI, 1.17-1.55), previous (adjusted RR, 1.15; 95% CI, 1.05-1.27) and current (adjusted RR, 1.11; 95% CI, 1.01-1.22) contraceptive use were predictive of clients’ intention to adopt family planning in the future. Conclusion Effective counselling on family planning during antenatal and child welfare clinics, and encouraging spousal communication on contraception are likely to increase contraceptive use after delivery.

Introduction The high rates of unintended and early pregnancies among adolescent girls in sub-Saharan Africa are concerning and are substantially contributed to by low contraceptive uptake. Contraceptive use can avert these pregnancies, but demand remains low. We investigated the influence of psychosocial determinants on three outcomes: desire for contraception, current use and preference-aligned use among sexually-active adolescent girls from Kenya and Nigeria. Methods Our study involved data from household-based cross-sectional surveys in 282 primary sampling units in two Nigerian states and four Kenyan counties. Participants were adolescent girls aged 15–19 years. The data was collected after mapping and listing of the households where eligible participants resided. Six psychosocial determinants (contraceptive knowledge, perceived self-efficacy, contraceptive relevance and reproductive control, future aspirations and descriptive norms) were fitted into generalized linear mixed-effects models against the study outcomes. Results Data from 2,327 participants were analyzed. The majority (81.5%) were married or living as married, 16.2% were attending school and 60% were Muslim. Three-quarters had ever given birth, 71% had sex weekly while 93.5% had desire for future conception. Overall, 46.0% expressed current desire for contraception, 37.2% were using contraception while 86.5% practiced preference-aligned contraceptive use. Controlling for selected covariates, contraceptive knowledge, perceived contraceptive relevance, self-efficacy and descriptive norms were positively associated with desire for and current use. Future aspirations and perceived reproductive control were not associated with all three outcomes. In the main analysis, no psychosocial determinant was associated with preference-aligned contraceptive use. Conclusions Our study demonstrated modest desire for contraception and low contraceptive prevalence amidst high desired fertility, highlighting a critical opportunity for contextualized girl-centered programs. Such programs should focus on enhancing contraceptive knowledge, building self-efficacy, increasing perceived relevance and shifting descriptive norms to drive contraceptive demand and use. Investigated determinants could serve as intermediate outcomes tracked to monitor progress towards contraceptive use outcomes and to inform program adaptations. Despite the high preference-aligned contraceptive use demonstrated, this metric is nascent, and more research is warranted to establish its utility for evaluating programs.

Spousal family planning communication plays an important role in making better reproductive health decisions and in increasing the use of modern contraceptive methods. The objective of the current study is to examine the association of spousal family planning communication in its broader context with current modern contraceptive use among couples. A community based cross-sectional survey was conducted in twelve kebeles of Harar Urban Health and Demographic Surveillance System. A total of 2700 currently married couples of whose wives were in the reproductive age participated in the study. The selection of the study participants was made using simple random sampling and data were collected using an interviewer administered structured questionnaire and analyzed using Stata version 12. The level of current modern contraceptive use was 57.1% (95% CI: 0.53, 3.39). Effective spousal family planning communication was significantly associated with current modern contraceptive use even after controlling for socio-economic and demographic variables. Socio-economic and demographic variables such as religion of couples, number of couples' living children, household monthly income, couples' family planning approval and women's counseling about family planning by health workers were significantly associated with current modern contraceptive use. Policies and programs aimed at increasing contraceptive prevalence should properly address the importance of spousal communication about family planning and integrate men into family planning programs to facilitate and enhance couples communication skills.

Juvenile myoclonic epilepsy (JME) is both a frequent and a very characteristic epileptic syndrome with female preponderance. Treatment of JME in women of childbearing potential must consider multiple factors such as desire for pregnancy, use of contraception, seizure control and previously used antiepileptic drugs (AEDs). Approximately 85% of cases are well controlled with valproate, which remains the reference AED in JME but is nowadays considered unsafe for the expecting mother and her fetus. The prescription of valproate is now severely restricted in women of childbearing potential but may still be considered, at the lowest possible dose and when pregnancies can be reliably planned, with temporary alternatives to valproate prescribed before fertilization. Alternatives have emerged, especially lamotrigine and levetiracetam, but also topiramate, zonisamide, and recently perampanel, but none of these AEDs can be considered fully safe in the context of pregnancy. In special settings, benzodiazepines and barbiturates may be useful. In some cases, combination therapy, especially lamotrigine and levetiracetam, may be useful or even required. However, lamotrigine may have the potential to aggravate JME, with promyoclonic effects. Carbamazepine, oxcarbazepine and phenytoin must be avoided. Valproate, levetiracetam, zonisamide, topiramate if the daily dose is ≤ 200 mg and perampanel if the daily dose is ≤ 10 mg do not affect combined hormonal contraception. Lamotrigine ≥ 300 mg/day has been shown to decrease levonorgestrel levels by 20% but does not compromise combined hormonal contraception. Patients with JME taking oral contraceptive should be counselled on the fact that the estrogenic component can reduce concentrations of lamotrigine by over 50%, putting patients at risk of increased seizures. Pregnancy is a therapeutic challenge, and the risk/benefit ratio for the mother and fetus must be considered when choosing the appropriate drug. Lamotrigine (< 325 mg daily in the European Registry of Antiepileptic Drugs in Pregnancy) and levetiracetam seem to be comparatively safer in pregnancy than other AEDs, especially topiramate and valproate. Plasma concentration of lamotrigine and levetiracetam decreases significantly during pregnancy, and dosage adjustments may be necessary. With persisting generalized tonic–clonic seizures, the combination of lamotrigine and levetiracetam offer the chance of seizure control and lesser risks of major congenital malformations. The risk of malformation increases when valproate or topiramate are included in the drug combination. In one study, the relative risk of autism and autism spectrum disorders (ASD) in children born to women with epilepsy (WWE) treated with valproate were, respectively, 5.2 for autism and 2.9 for ASD versus 2.12 for autism and 1.6 for ASD in WWE not treated with valproate. More studies are needed to assess the risk of autism with AEDs other than valproate. The current knowledge is that the risk appears to be double that in the general population. In patients with JME, valproate remains an essential and life-changing agent. The consequences of a lifetime of poorly controlled epilepsy need to be balanced against the teratogenic risks of valproate during limited times in a woman’s life. The management of JME in WWE should include lifestyle interventions, with avoidance of sleep deprivation, and planned pregnancy.

Background Intimate partner violence against women is a behavior within an intimate relationship that causes physical, sexual, or psychological harm to the victim. It is well recognized as a gross violation of human rights and affects the health of women, families, and the community at large. However, the level to which Human Immuno Deficiency virus sero-positive women are experiencing recent intimate partner violence and its associated factors have not been well investigated as the majority of the study done so far were focused on the study of lifetime violence and violence among women in the general population. The study was conducted to determine the prevalence and factors associated with current intimate partner violence among sero-positive women. Methods A facility-based cross-sectional study was conducted from March 2019 to April 2019 among 396 sero-positive women visiting anti-retroviral therapy (ART) units of Adama town public health facilities. A systematic random sampling technique was used to select individual participants. Validated World Health Organization (WHO) tools were used to collect information on the outcomes and key independent variables. The collected data were entered into Epidata version 4.4.6 and analyzed using SPSS version 24. Descriptive statistics were used to compute summary statistics and proportion. Variables at a cut-off value of 0.25 on bivariate analysis and 0.05 during multivariate logistic regression were used to identify factors associated with recent intimate partner violence. Result The response rate in this study was 100% since all women approached took part in this study. The prevalence of current intimate partner violence was 32.3% while lifetime intimate partner violence (IPV) was 45.5%. Exposure to coerced first sexual intercourse [AOR = 3.0 (1.73, 5.44)], male multi-partnership [AOR = 2.2 (1.21, 4.06)], believing in the husband's right to sex [AOR = 2.3 (1.29, 4.12)], contraceptive use [AOR = 3.33 (1.67, 6.62)], and having farmer partner [AOR = 3.9 (1.43, 10.79)] were significantly associated with current intimate partner violence. Conclusion One-in-three women reported at least 2 or more forms of violence from their intimate partner. Individual-level factors (Exposure to coerced first sexual intercourse, partner’s occupation, contraceptive use, and believing in husband’s right to sex and relationship factor (Male multi-partnership) were significantly associated with recent intimate partner violence. Combined efforts are required to avert intimate partner violence among women on ART while targeting risky sexual behavior practiced among male partner factors significantly associated with violence.

This paper examines the role of exposure to mass media and interpersonal communication in predicting the current use of contraception in Bangladesh. Bivariate and multivariate analyses were carried out using the Bangladesh Demographic and Health Survey (BDHS), 2011 data to explore the association between communication and the current use of contraception. After adjusting the related socioeconomic and demographic factors, the mass media did not seem to have any role in predicting contraceptive use behavior while the findings revealed that interpersonal communication [prevalence ratio (PR): 1.0984, 95% confidence interval (CI) 1.0801-1.1170] is a strong positive predictor of the current contraceptive use. It is a well-known fact that mass media performs only the knowledge function while interpersonal communication performs an additional function of persuasion. This analysis corroborates the statement that the role of interpersonal communication is quite important in predicting contraceptive use.

Background: Despite the acknowledged benefits accruable to the mentally ill from the use of contraceptives, research and dedicated reproductive health services for this group of people in Nigeria are still underdeveloped or non-existent in many cases. This study aims at identifying the current status of knowledge and pattern of use of modern contraceptives in a clinic population. Materials and Methods: A cross-sectional descriptive study of 100 women with severe mental illness attending psychiatric outpatient clinic in Ilorin, Nigeria, using a semi-structured questionnaire. Results: A majority (88%) of the women had good knowledge of family planning, many (61%) were interested in its use but at least half of them had not used any method and current use was just 27%. Attitude to family planning was generally positive as indicated by desired family size (71%) of less than 4 children with 6 out of 10 desiring future intention to use. The male condom was the most known and ever used method (68%, 37%), respectively. Most (81%) of these women desired that family planning information be provided at the psychiatric clinic but fewer of them discussed this with their partners. Conclusion: Considering discrepancies between knowledge, interest and use, the potential health benefits of fertility regulation, and the adverse effects of unregulated family, and contraceptive use is still relatively low. There is need for improvement which might only be possible if psychiatric focused programs are initiated. The large number of women who desired clinic-based family planning education suggests that the introduction of such program is feasible.

In Lao PDR, evidence is emerging of considerable sexual activity among unmarried youth, but contraceptive services remain inadequate to meet their needs. This study explored the attitudes of formal and informal sector providers in serving the contraceptive needs of unmarried youth in Vientiane Municipality, their perceptions of quality of care, confidentiality and privacy, level of comfort in discussing sexual matters, and any differences between providers in the two sectors. In-depth interviews were carried out with 56 key informants, followed by a quantitative survey of 150 formal sector and 100 informal sector providers. We found ambivalence and discomfort among providers in communicating with unmarried youth and providing contraceptives to them, and low priority placed on their right to privacy and confidentiality. Providers tended to attribute difficulties almost entirely to young people's inhibitions and unwillingness to listen. Less than 60% of formal sector providers would supply contraceptives to unmarried youth, compared to 80% of informal providers, but the latter were more likely to charge a fee for supplies. Both formal and informal sector providers need training in communication and counselling skills for serving unmarried youth. Programmes must ensure that unmarried youth have access to good quality contraceptive services and supplies. Les recherches commencent à révéler qu'en République démocratique populaire lao, les jeunes célibataires ont une activité sexuelle considérable, mais les services de contraception demeurent insuffisants. Une étude a analysé la réponse de fournisseurs de contraceptifs du secteur formel et informel à la demande d'adolescents dans la Préfecture de Vientiane, leurs perceptions de la qualité des soins, la confidentialité, le niveau d'aisance dans la discussion de la sexualité, et toute différence entre les fournisseurs des deux secteurs. Des entretiens ont été menés avec 56 informateurs clés, suivis d'une enquête quantitative auprès de 150 fournisseurs du secteur formel et 100 du secteur informel. Les fournisseurs étaient ambivalents et mal à l'aise quand ils communiquaient avec les jeunes célibataires et leur procuraient des contraceptifs ; ils accordaient une faible priorité à leur droit à la confidentialité. Les fournisseurs attribuaient presque entièrement ces difficultés aux inhibitions des jeunes et à leur refus d'écouter. Moins de 60% des fournisseurs du secteur formel acceptaient de donner des contraceptifs à des jeunes célibataires, contre 80% dans le secteur informel, mais ces derniers risquaient davantage de faire payer les contraceptifs. Les fournisseurs des deux secteurs avaient besoin d'être formés à la communication et aux conseils. Les programmes doivent veiller à ce que les jeunes célibataires bénéficient de services de qualité et aient accés aux contraceptifs. En la República Popular Democrática de Laos se empieza a constatar una actividad sexual considerable entre jóvenes solteros, cuya necesidad de anticonceptivos permanece insatisfecha debido a la falta de servicios adecuados. Este estudio exploró las actitudes de proveedores de los sectores formales e informales al atender las necesidades anticonceptivas de adolescentes en la Prefectura de Vientiane, sus percepciones de la calidad de atención, confidencialidad y privacidad, grado de comodidad al hablar de temas sexuales, y diferencias entre los proveedores en los dos sectores. Se realizaron entrevistas con 56 informantes claves, seguidas por una encuesta cuantitativa a 150 proveedores del sector formal y 100 del sector informal. Encontramos ambivalencia e incomodidad en los proveedores al comunicarse con los jóvenes solteros y proveerlos con anticonceptivos. Dieron poca prioridad a su derecho a confidencialidad y privacidad. Los proveedores solı́an atribuir las dificultades casi enteramente a las inhibiciones y la inatención de los jóvenes. Menos de un 60% de los proveedores del sector formal proveerı́an anticonceptivos a los jóvenes solteros, comparado con un 80% de los proveedores informales, pero era más probable que estos últimos cobraran algo por los suministros. Los proveedores de ambos sectores necesitan capacitación en comunicación y consejerı́a para atender a jóvenes solteros. Los programas deben garantizar su acceso a servicios y suministros anticonceptivos de buena calidad.

The World Bank is in the initial stages of developing a new annual series of World Bank Country Briefs. Namibia - the third report in the series - will be published in the winter of 2009. These short, country-specific reports examine the economic, social, environmental, and business landscape of developing countries, focusing on issues critical to development.OverviewPeople and PovertyEnvironmentEconomyGovernance and Business EnvironmentGlobal LinksStatistical Appendix.

In Jamaica, contraceptive use is high at 66 per cent. However, only 34 per cent of pregnancies are planned. This study was carried out in 1998 to determine the factors which influenced continuation of use of family planning methods. Primary data were collected from 463 mostly post-natal women utilising eight large clinics in the public health sector in Kingston, Jamaica. They were interviewed using a closed-ended questionnaire three times over a year and a sub-sample participated in focus group discussions. The overall continuation rate was only 56 per cent Cost of methods was an issue for some women. Long clinic waiting times discouraged women from attending clinics; the scheduling of clinic appointments would reduce this problem. Women need more information about side effects of methods and to be reassured of the quality of methods given out by clinics. Health personnel need to become more aware of the significance of rumours about methods and discuss these with women so that the negative influence of misinformation is minimised. Although the findings of this study are not ‘new’ information, ‘old’ problems in the provision of services still exist. Women, at least in poorer communities, continue to lack basic information about contraceptives and there is a need for ongoing attention to improving quality of care. En Jamaïque, l'utilisation de contraceptifs atteint 66%. Néanmoins, 34% seulement des grossesses sont desirees. Cette etude de 1998 a déterminé les facteurs qui influencent la poursuite de 1'utilisation de methodes de planification familiale. Les donnees primaires ont ete recueillies aupres de 463 femmes, pour la plupart en periode post-natale et fréquentant huit grands dispensaires publics de Kingston, Jamaïque. Elles ont ete interrogees a trois reprises sur une annee avec un questionnaire a réponses libres; un sous-echantillon a participe aux discussions de groupe. Le taux global de poursuite etait seulement de 56%. Le cout des méthodes genait certaines femmes. Les longues attentes les decourageaient de se rendre au dispensaire; echelonner les rendrz-vous reduirait cet inconvenient. Les femmes avaient besoin de davantage d'informations sur les effets secondaires des methodes et devaient etre rassurees sur la qualite des methodes fournies par les dispensaires. Le personnel de sante doit être sensibilise a 1'importance des rumeurs sur les methodes et en parler avec les femmes afin de minimiser 1'influence negative d'informations inexactes. Bien que les conclusions de l'étude ne soient pas ⪢ nouvelles ⪡, des problemes ⪢ anciens ⪡ demeurent dans la prestation des services. Les femmes, du moins celles qui sont issues des communautes les plus pauvres, continuent de manquer d'informations sur les contraceptifs et il faut a ameliorer de maniere suivie la qualite des soins. En Jamaica, el nivel de use anticonceptivo es alto, un 66 por ciento. Sin embargo, solamente 34 por ciento de los embarazos son deseados. Este estudio se llevo a cabo en 1998 para determinar los factores que incidian en la continuacion de use de los metodos de planification familiar. Se recolectaron datos primarios de 463 mujeres - la mayoria de ellas post-parto - usuarias de ocho clinicas grandes del sector de salud ptiblica en Kingston, Jamaica. Las mujeres fueron entrevistadas tres veces durante un aflo por medio de un cuestionario de respuesta cerrada, y una muestra subsidiaria participo en cuatro grupos focales. La tasa global de continuacion era de solo un 56 por ciento. El costo de los metodos era un problema para algunas mujeres. Los largos tiempos de espera eran un factor en la disposicion de las mujeres de acudir a las clinicas; un sistema de citas previas aliviaria este problema. Las mujeres precisaban mas informacion acerca de los efectos secundarios de los metodos y más garantias de la calidad de los métodos entregados por las clinicas. El personal de salud deberia estar consciente del significado de los rumores acerca de los metodos y debe discutirlos con las mujeres para minimizar la influencia negativa de la informacion equivocada. Aunque los resultados de este estudio no constituye informacion “nueva”, persisten los problemas “viejos” en la provisión de los servicios. Las mujeres, por to menos. aquellas provenientes de las comunidades mas pobres, todavia carecen de informacion basica acerca de los anticonceptivos. Se requiere ademas atencion permanente al mejoramiento de la calidad de la atención.