#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey


Autoři: Sara E. Casey aff001;  Meghan C. Gallagher aff002;  Jessica Kakesa aff003;  Anushka Kalyanpur aff004;  Jean-Baptiste Muselemu aff005;  Raoza Vololona Rafanoharana aff006;  Nathaly Spilotros aff007
Působiště autorů: RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America aff001;  Save the Children US, Washington, DC, United States of America aff002;  International Rescue Committee, Kinshasa, Democratic Republic of the Congo aff003;  CARE USA, Atlanta, Georgia, United States of America aff004;  Save the Children, Goma, Democratic Republic of the Congo aff005;  CARE, Goma, Democratic Republic of the Congo aff006;  International Rescue Committee, New York, New York, United States of America aff007
Vyšlo v časopise: Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003086
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003086

Souhrn

Background

Adolescent girls in humanitarian settings are especially vulnerable as their support systems are often disrupted. More than 20 years of violence in the Democratic Republic of the Congo (DRC) has weakened the health system, resulting in poor sexual and reproductive health (SRH) outcomes for women. Little evidence on adolescent contraceptive use in humanitarian settings is available. CARE, International Rescue Committee (IRC), and Save the Children, in collaboration with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Columbia University, have supported the Ministry of Health (MOH) since 2011 to provide good quality contraceptive services in public health facilities in conflict-affected North and South Kivu. In this study, we analyzed contraceptive use among sexually active young women aged 15–24 in the health zones served by the partners’ programs.

Methods and findings

The partners conducted cross-sectional population-based surveys in program areas of North and South Kivu using two-stage cluster sampling in six health zones in July–August 2016 and 2017. Twenty-five clusters were selected in each health zone, 22 households in each cluster, and one woman of reproductive age (15–49 years) was randomly selected in each household. This manuscript presents results from a secondary data analysis for 1,022 women aged 15–24 who reported ever having sex: 326 adolescents (15–19 years) and 696 young women (20–24 years), 31.7% (95% confidence interval [CI] 29.5–34.1), of whom were displaced at least once in the previous five years. Contraceptive knowledge was high, with over 90% of both groups able to name at least one modern contraceptive method. Despite this high knowledge, unmet need for contraception was also high: 31.7% (95%CI 27.9–35.7) among 15–19-year-olds and 40.1% (95% CI 37.1–43.1, p = 0.001) among 20–24-year-olds. Current modern contraceptive use (16.5%, 95% CI 14.7–18.4) was similar in both age groups, the majority of whom received their method from a supported health facility. Among current users, more than half of 15–19-year-olds were using a long-acting reversible contraceptive (LARC; 51.7%, 95% CI 41.1–61.9) compared to 36.5% of 20–24-year-olds (95% CI 29.6–43.9, p = 0.02). Age, younger age of sexual debut, having some secondary education, being unmarried, and having begun childbearing were associated with modern contraceptive use. The main limitations of our study are related to insecurity in three health zones that prevented access to some villages, reducing the representativeness of our data, and our defining sexually active women as those who have ever had sex.

Conclusions

In this study, to our knowledge one of the first to measure contraceptive prevalence among adolescents in a humanitarian setting, we observed that adolescent and young women will use modern contraception, including long-acting methods. Meaningful engagement of adolescent and young women would likely contribute to even better outcomes. Creating an enabling environment by addressing gender and social norms, however, is key to reducing stigma and meeting the demand for contraception of young women. As we continue to build such supportive environments, we can see that they will use effective contraception when contraceptive services, including short- and long-acting methods, are available, even in protracted crisis settings.

Klíčová slova:

Adolescents – Age groups – Contraception – Contraceptives – Female contraception – Health systems strengthening – Male contraception – Pregnancy


Zdroje

1. Adolescent demographics. UNICEF; 2016 [cited 2020 Mar 9]. Available from: https://data.unicef.org/topic/adolescents/demographics/

2. Darroch JE, Audam S, Biddlecom A, Kopplin G, Riley T, Singh S, et al. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents in Developing Regions. Guttmacher Institute; 2018 Nov [cited 2020 Mar 9]. Available from: https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-of-adolescents

3. Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. The Lancet. 2016;387: 2423–2478. doi: 10.1016/S0140-6736(16)00579-1

4. UNFPA, Save the Children. Adolescent sexual and reproductive health toolkit for humanitarian settings: A companion to the Inter-agency field manual on reproductive health in humanitarian settings. UNFPA; 2009 [cited 2020 Mar 9]. Available from: https://www.unfpa.org/publications/adolescent-sexual-and-reproductive-health-toolkit-humanitarian-settings

5. Inter-agency field manual on reproductive health in humanitarian settings 2018. Inter-agency Working Group on Reproductive Health in Crises; 2018 [cited 2020 Mar 9]. Available from: https://iawgfieldmanual.com/

6. Chynoweth SK. Advancing reproductive health on the humanitarian agenda: the 2012–2014 global review. Conflict and Health. 2015;9: I1. doi: 10.1186/1752-1505-9-S1-I1

7. Casey S, Chynoweth S, Cornier N, Gallagher M, Wheeler E. Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies. Conflict and Health. 2015;9: S3. doi: 10.1186/1752-1505-9-S1-S3 25798189

8. McGinn T, Austin J, Anfinson K, Amsalu R, Casey SE, Fadulalmula SI, et al. Family planning in conflict: results of cross-sectional baseline surveys in three African countries. Conflict and Health. 2011;5: 11. doi: 10.1186/1752-1505-5-11 21752241

9. Tanabe M, Schaus K, Rastogi S, Krause S, Patel P. Tracking humanitarian funding for reproductive health: a systematic analysis of health and protection proposals from 2002–2013. Conflict and Health. 2015;9: S2. doi: 10.1186/1752-1505-9-S1-S2 25798188

10. Ministère du Plan et Suivi de la Mise en oeuvre de la Révolution de la Modernité (MPSMRM), Ministère de la Santé Publique (MSP), ICF International. Enquête démographique et de santé en République Démocratique du Congo 2013–2014. Rockville, Maryland, USA: MPSMRM, MSP, and IFC International; 2014 [cited 2020 Mar 9]. Available from: https://dhsprogram.com/pubs/pdf/FR300/FR300.pdf

11. Mulumeoderhwa M. ‘A Girl Who Gets Pregnant or Spends the Night with a Man is No Longer a Girl’: Forced Marriage in the Eastern Democratic Republic of Congo. Sexuality & Culture. 2016;20: 1042–1062. doi: 10.1007/s12119-016-9373-y

12. Casey SE, Steven VJ, Deitch J, Dumas EF, Gallagher MC, Martinez S, et al. “You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo. Sexual and Reproductive Health Matters. 2019;27: 1571309. doi: 10.1080/09688080.2019.1571309 31533559

13. Ecole de Santé Publique de l’Université de Kinshasa (ESPK), ICF. République Démocratique du Congo: Evaluation des Prestations des Services de soins de Santé (EPSS RDC) 2017–2018. Kinshasa, RDC et Rockville, Maryland, USA: ESPK et ICF; 2019 [cited 2020 Mar 9]. Available from: https://dhsprogram.com/pubs/pdf/SR258/SR258.pdf

14. Kwete D, Binanga A, Mukaba T, Nemuandjare T, Mbadu MF, Kyungu M-T, et al. Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges. Global Health: Science and Practice. 2018;6: 40–54. doi: 10.9745/GHSP-D-17-00346 29602865

15. Casey SE, Cannon A, Mushagalusa Balikubirhi B, Muyisa J-B, Amsalu R, Tsolka M. Twelve-month contraceptive continuation among women initiating short- and long-acting reversible contraceptives in North Kivu, Democratic Republic of the Congo. PLoS ONE. 2017;12: e0182744. doi: 10.1371/journal.pone.0182744 28886016

16. Casey SE, Tshipamba M. Contraceptive availability leads to increase in use in conflict-affected Democratic Republic of the Congo: evidence from cross-sectional cluster surveys, facility assessments and service statistics. Conflict and Health. 2017;11: 2. doi: 10.1186/s13031-017-0104-2 28286546

17. Casey SE, Gallagher MC, Dumas EF, Kakesa J, Katsongo JM, Muselemu J-B. Meeting the demand of women affected by ongoing crisis: Increasing contraceptive prevalence in North and South Kivu, Democratic Republic of the Congo. Anglewicz P, editor. PLoS ONE. 2019;14. doi: 10.1371/journal.pone.0219990 31323055

18. Ho LS, Wheeler E. Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo. Global Health: Science and Practice. 2018;6: 161–177. doi: 10.9745/GHSP-D-17-00365 29602870

19. Castle S, Schroffel H, Nzau Mvuezolo JJ, Mupenda B, Mumbere J, Shapiro R. Successful programmatic approaches to facilitating IUD uptake: CARE’s experience in DRC. BMC Women’s Health. 2019;19. doi: 10.1186/s12905-019-0793-3 31340794

20. Turner K, Page K. Abortion attitude transformation: A values clarification toolkit for global audiences. Chapel Hill, NC: Ipas; 2008 [cited 2020 Mar 9]. Available from: https://www.ipas.org/resources/abortion-attitude-transformation-a-values-clarification-toolkit-for-global-audiences

21. Internal program reviews conducted by Columbia University staff, including the first author, in 2015. Reports of these reviews were developed for internal use.

22. McGinn T. Reproductive Health of War-Affected Populations: What Do We Know? International Family Planning Perspectives. 2000;26: 174–180. doi: 10.2307/2648255

23. Kalamar AM, Tunçalp Ö, Hindin MJ. Developing strategies to address contraceptive needs of adolescents: exploring patterns of use among sexually active adolescents in 46 low- and middle-income countries. Contraception. 2018. doi: 10.1016/j.contraception.2018.03.016 29550455

24. Mbadu Muanda F, Gahungu NP, Wood F, Bertrand JT. Attitudes toward sexual and reproductive health among adolescents and young people in urban and rural DR Congo. Reproductive Health. 2018;15: 74. doi: 10.1186/s12978-018-0517-4 29728101

25. Radovich E, Dennis ML, Wong KLM, Ali M, Lynch CA, Cleland J, et al. Who Meets the Contraceptive Needs of Young Women in Sub-Saharan Africa? Journal of Adolescent Health. 2018;62: 273–280. doi: 10.1016/j.jadohealth.2017.09.013 29249445

26. Bertrand JT, Makani PB, Hernandez J, Akilimali P, Mukengeshayi B, Babazadeh S, et al. Acceptability of the community-level provision of Sayana® Press by medical and nursing students in Kinshasa, Democratic Republic of the Congo. Contraception. 2017. doi: 10.1016/j.contraception.2017.05.014 28647500

27. Hernandez JH, Akilimali PZ, Muanda MF, Glover AL, Bertrand JT. Evolution of a Large-Scale Community-Based Contraceptive Distribution Program in Kinshasa, DRC Based on Process Evaluation. Global Health: Science and Practice. 2018;6: 657–667. doi: 10.9745/GHSP-D-18-00205 30591574

28. Schlecht J, Lee C, Kerner B, Greeley M, Robinson C. Prioritizing programming to address the needs and risks of very young adolescents: a summary of findings across three humanitarian settings. Conflict and Health. 2017;11: 31. doi: 10.1186/s13031-017-0126-9

29. Kågesten A, Gibbs S, Blum RW, Moreau C, Chandra-Mouli V, Herbert A, et al. Understanding Factors that Shape Gender Attitudes in Early Adolescence Globally: A Mixed-Methods Systematic Review. PLoS ONE. 2016;11: e0157805. doi: 10.1371/journal.pone.0157805 27341206

30. Lundgren R, Burgess S, Chantelois H, Oregede S, Kerner B, Kågesten AE. Processing gender: lived experiences of reproducing and transforming gender norms over the life course of young people in Northern Uganda. Culture, Health & Sexuality. 2019;21: 387–403. doi: 10.1080/13691058.2018.1471160 29882476

31. Adams MK, Salazar E Fau—Lundgren R, Lundgren R. Tell them you are planning for the future: gender norms and family planning among adolescents in northern Uganda. Intl Journal of Gynecology & Obstetrics. 2013;123: e7–e10. doi: 10.1186/2191-1991-2-2

32. Muanda MF, Ndongo GP, Messina LJ, Bertrand JT. Barriers to modern contraceptive use in rural areas in DRC. Culture, Health & Sexuality. 2017;19: 1011–1023. doi: 10.1080/13691058.2017.1286690 28276915

33. Williamson LM, Parkes A, Wight D, Petticrew M, Hart GJ. Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reproductive Health. 2009;6: 3. doi: 10.1186/1742-4755-6-3 19228420

34. Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reproductive Health. 2018;15: 214. doi: 10.1186/s12978-018-0658-5 30572927

35. Prata N, Fraser A, Huchko MJ, Gipson JD, Withers M, Lewis S, et al. Women’s empowerment and family planning: A review of the literature. J Biosoc Sci. 2017;49: 713–743. doi: 10.1017/S0021932016000663 28069078

36. Ritchie HA. Gender and enterprise in fragile refugee settings: female empowerment amidst male emasculation—a challenge to local integration? Disasters. 2017;42: S40–S60. doi: 10.1111/disa.12271 29281137

37. Glass N, Perrin N, Marsh M, Clough A, Desgroppes A, Kaburu F, et al. Effectiveness of the Communities Care programme on change in social norms associated with gender-based violence (GBV) with residents in intervention compared with control districts in Mogadishu, Somalia. BMJ Open. 2019;9: e023819. doi: 10.1136/bmjopen-2018-023819 30872541

38. Akinrinola Bankole, Shawn Malarcher. Removing Barriers to Adolescents’ Access to Contraceptive Information and Services. Studies in Family Planning. 2010;41: 117–124. doi: 10.1111/j.1728-4465.2010.00232.x 21466111

39. Rivera R, Mello MC de, Johnson SL, Chandra‐Mouli V. Contraception for adolescents: social, clinical and service-delivery considerations. International Journal of Gynecology & Obstetrics. 2001;75: 149–163. doi: 10.1016/S0020-7292(01)00371-X

40. Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, et al. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reproductive Health. 2019;16: 89. doi: 10.1186/s12978-019-0749-y 31238960

41. Ajah LO, Dim CC, Ezegwui HU, Iyoke CA, Ugwu EO. Male partner involvement in female contraceptive choices in Nigeria. Journal of Obstetrics and Gynaecology. 2015;35: 628–631. doi: 10.3109/01443615.2014.991287 25535903

42. Warren N, Alvarez C, Makambo MT, Johnson-Agbakwu C, Glass N. “Before the war we had it all”: Family planning among couples in a post-conflict setting. Health Care Women Int. 2017; 1–17. doi: 10.1080/07399332.2017.1329307 28586271


Článek vyšel v časopise

PLOS Medicine


2020 Číslo 3
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Hypertenze a hypercholesterolémie – synergický efekt léčby
nový kurz
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Multidisciplinární zkušenosti u pacientů s diabetem
Autoři: Prof. MUDr. Martin Haluzík, DrSc., prof. MUDr. Vojtěch Melenovský, CSc., prof. MUDr. Vladimír Tesař, DrSc.

Úloha kombinovaných preparátů v léčbě arteriální hypertenze
Autoři: prof. MUDr. Martin Haluzík, DrSc.

Halitóza
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Terapie roztroušené sklerózy v kostce
Autoři: MUDr. Dominika Šťastná, Ph.D.

Všechny kurzy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#