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Acceptability and uptake of long‐acting reversible contraceptives in Ethiopia: A systematic review and meta‐analysis
No full textBackground and Aim: Despite their high effectiveness, the acceptability and utilization of long-acting reversible contraceptives (LARCs) in Ethiopia remain low and vary across population groups and regions. This systematic review and meta-analysis aimed to estimate the pooled levels of LARC acceptability and utilization by method type, population subgroup, and study context to inform reproductive health programming and policy. Methods: A comprehensive search was conducted across PubMed, EMBASE, Scopus, and EBSCOhost (CINAHL), along with grey literature sources including Google Scholar and Google. Studies published between 1st January 2021 and 30th June 2024 that focused on adolescents, reproductive-age women, female healthcare providers, and communities in both rural and urban settings in Ethiopia were included. Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. The review protocol was registered with PROSPERO (CRD42024594288). Findings were presented as proportions with corresponding 95% confidence intervals. Results: Out of 527 records identified, 50 studies comprising a total of 83,082 participants met the inclusion criteria. The pooled acceptability of LARCs (implants or IUCDs) was estimated at 24% (95% CI: 18%–31%), with implants alone showing higher acceptability at 26% (95% CI: 12%–49%) compared to IUCDs at 19% (95% CI: 12%–30%). The overall utilization of LARCs was 20% (95% CI: 15%–27%), with the highest uptake observed among women in the immediate postpartum or postabortion period at 30% (95% CI: 21%–39%). Utilization of implants alone was 15% (95% CI: 11%–20%), while IUCD use remained lower at 5% (95% CI: 4%–7%), with slightly higher usage in urban areas (9%). Considerable heterogeneity was detected across studies, with I² values exceeding 90%. Conclusion: LARC acceptability and utilization remain suboptimal in Ethiopia, particularly among adolescents and rural populations. Implants are more widely accepted and used than IUCDs. These findings indicate the need for targeted, context-specific interventions to address demographic, cultural, and health system-related barriers to LARC uptake
The PrEP Ring Quarterly—Edition 3, July 2025
Full text linkThis is the third edition of The PrEP Ring Quarterly newsletter, which provides information, updates, and resources dedicated to the dapivirine vaginal ring (DVR) also known as PrEP ring
Interventions addressing impacts of climate change on sexual and reproductive health and rights in sub-Saharan Africa: A scoping review
No full textSub-Saharan Africa is faced with triple challenges of high vulnerability to climate change impacts, high levels of inequality, and poor sexual and reproductive health and rights (SRHR) outcomes. Climate change impacts can worsen the SRHR situation for high-risk groups such as women, children, adolescent girls, and people living with Human Immunodeficiency Virus (HIV). This scoping review examined interventions addressing the impacts of climate change on SRHR in the region to identify barriers to and facilitators of effective integration. The review followed Arksey and O’Malley’s framework for scoping reviews. Data search was conducted in peer-reviewed journal databases and from grey literature on the official websites of selected organizations. Data charting was conducted using the Population, Intervention, Comparator, Outcome tool in Covidence. There is limited evidence on interventions at the intersection of climate change and SRHR, with seven (7) documents included in the review. Maternal and Child Health, HIV prevention, and a combination of maternal and child health and family planning were the SRHR components addressed. Other components like Gender-based violence, harmful practices, and abortion care do not have targeted interventions. A siloed approach to SRHR and climate change programming impedes intervention integration. Documented interventions are implicit about climate risks, focus on impact pathways, and do not directly target SRHR. There are no interventions targeting vulnerable and marginalized groups. Limited policy integration, financial constraints, and poor SRHR recognition deter intervention integration. Effective and equitable integration requires that population growth impacts and SRHR issues be recognized and deliberate investments (research, policies, programs, interventions, and financing) put in place to address critical SRHR gaps and climate vulnerabilities to enhance resilience
Incidence of induced abortion and severity of abortion-related complications among women in refugee settings in Ethiopia: Evidence Brief
Full text linkHumanitarian crises disrupt essential services, making it difficult for people to access basic care, including sexual and reproductive health (SRH) services. While data on SRH services in humanitarian settings is lacking, even less is known about how common abortion is or the severity of abortion-related complications in these settings. This evidence brief provides estimates of the incidence of induced abortion among refugee women in Ethiopia and the proportion of these abortions that occurred within the formal health care system. This brief also presents information on the management and severity of abortion-related complications among women living in refugee settings in Ethiopia. The data presented in this brief are based on the application of the Abortion Incidence Complications Method (AICM) in these refugee settings
The International Contraceptive Access Foundation’s model for improving access to the hormonal intrauterine device
No full textThe International Contraceptive Access Foundation is a partnership between Bayer AG and Population Council Inc. with a mission to provide levonorgestrel-releasing intrauterine contraceptive systems at no charge to providers in low- and middle-income countries. For twenty years, the Foundation has enhanced knowledge of and access to this innovative contraceptive method. The Foundation has been critical to facilitating global access to hormonal intrauterine devices (IUDs). This Foundation model should be considered for the introduction of future methods of contraception
Barriers and facilitators of acceptability and uptake of long-acting reversible contraceptives in Ethiopia: A systematic review using the COM-B model
No full textBackground: Long-acting reversible contraceptives (LARCs), including implants and intrauterine contraceptive devices (IUCDs), are essential in preventing unintended pregnancies and empowering women by providing long-term, reliable contraception that supports informed decision-making about family planning and reproductive health. However, their uptake and acceptability remain low in Ethiopia due to various individual, social, and systemic barriers. This study systematically reviews the factors influencing LARC acceptability and utilization among Ethiopian women, adolescents, and healthcare providers, using the Capability, Opportunity, Motivation, and Behaviour (COM-B) framework. Methods: A systematic search of PubMed, Embase, Scopus, African Journals OnLine, and EBSCOhost (CINAHL) was conducted, along with gray literature sources, to identify studies published between January 2021 and June 2024. Inclusion criteria encompassed studies conducted in Ethiopia that examined the acceptability and utilization of LARCs, focusing on implants and IUCDs. The types of studies considered included quantitative, qualitative, and mixed-method designs, focusing on postpartum, post-abortion, and nonpostpartum women, adolescents, and healthcare providers. Data on barriers, facilitators, and associated factors of acceptability and utilization were extracted, and the findings were mapped to the COM-B framework. Atlas.ti v.9 software was used in the analysis process. Results: A total of 58 cross-sectional, qualitative, and mixed-method studies were included, encompassing diverse Ethiopian populations and geographies. Among immediate and extended postpartum women, barriers included limited awareness and fear of insertion pain for IUCDs, low awareness, and limited access to LARCs, while postpartum counselling emerged as a facilitator. For adolescents, social stigma, male partner disapproval, and misconceptions about LARC side effects were prominent barriers; school-based education and youth-friendly services supported acceptability. Healthcare providers noted inadequate training on family planning methods as a barrier, while targeted training improved their confidence in recommending LARCs. Nonpostpartum women frequently cited partner opposition and cultural beliefs as barriers, but family planning programs with partner engagement facilitated greater acceptance. Conclusions: The findings highlight an urgent need to expand community-based education programs to dispel myths and misconceptions about LARCs, particularly in rural and pastoral regions. Prioritizing provider training to improve counselling and service delivery, alongside engaging male partners in family planning discussions, is essential for enhancing LARC utilization and meeting reproductive health needs in Ethiopia
From population goals to reproductive health autonomy: Reframing India’s fertility transition
No full textAmpliando el ecosistema de Abriendo Oportunidades®: Enfoque en la Escuela de Oportunidades
No full textDesarrollada en alianza con la Vicepresidencia en 2021, la Escuela de Oportunidades es un programa nacional de pasantías que invierte de manera intencional en jóvenes profesionales indígenas para incrementar su visibilidad en las estructuras de gobernanza. A través de una combinación de mentoría, capacitación y experiencia práctica, la Escuela de Oportunidades ha facilitado con éxito la incorporación de mujeres indígenas guatemaltecas en instituciones gubernamentales, fortaleciendo la inclusión de género y étnica en el servicio público. Este informe es parte de la Serie: El legado de Abriendo Oportunidades®, que celebra y destaca 20 años de implementación programática con impacto
A dual prevention pill for HIV and pregnancy prevention: A pilot study among adolescent girls and young women in Zimbabwe
No full textAdolescent girls and young women (AGYW) in sub-Saharan Africa are at risk for HIV/unintended pregnancy. Adherence and continuation to effective oral pre-exposure prophylaxis (PrEP) are limited in AGYW. We hypothesized that an over-encapsulated dual prevention pill (DPP) combining PrEP + oral contraceptive (OC) would be preferred, acceptable, and improve adherence compared to PrEP alone. We randomized HIV-uninfected, 16–24 year-olds 1:1 to use DPP or 2-pill regimen (2PR -PrEP and OCs separately) for three 28-day cycles each. We compared preference for DPP vs. 2PR (exact binomial test) and regimen effects on four acceptability domains: use attributes, product attributes, side effects, impact on sex (Wilcoxon signed-rank tests). Adherence was compared by regimen and sequence (mixed-effects logistic regression) using self-report, pill-count, tenofovir-diphosphate levels in dried blood spots (DBS), indicating ≥ 4 doses per week(≥ 500 fmol/punch at Month 1 and ≥ 700 fmol/punch at Months 2–6). 26/30 participants (mean age 19.4years) completed the study (Nov 2022–Sept 2023). 62% preferred DPP, 38% 2PR (p = 0.24). Most rated both regimens as acceptable, with no differences between them (all p \u3e 0.05). Adherence was high by self-report (98%) and pill-count (97%), but low based on DBS results (DPP: mean 392 fmol/punch, 2PR: mean 384 fmol/punch); with only 10% consistently adherent. There was no difference in adherence by regimen, though odds were higher in period 1 vs. 2 (AOR 3.7; 95% CI 1.10–12.8). Both regimens were safe; 2 pregnancies occurred during the DPP regimen, with no HIV seroconversions. No significant differences in preference, acceptability, and adherence between DPP and 2PR were found in this study. Adherence was low and waned over time. A larger study with a smaller co-formulated DPP may better inform its impact on HIV and pregnancy prevention
Changes in social attitudes and behavioural intentions related to female genital mutilation in the context of community-based interventions in Isiolo and Narok counties in Kenya
No full textWhile evidence on the drivers of female genital mutilation (FGM) has been expanding, programmes implementing interventions designed to end FGM have had challenges in measuring social change. Gaps exist ranging from the documentation and description of how change occurs to reducing the effect of social desirability given the illegality of FGM and the stigma associated with the practice. This study aimed to assess shifts in social attitudes/beliefs and behavioural intentions related to FGM and gender in the context of The Girl Generation support to – Africa-Led Movement (TGG-ALM) programme in Isiolo and Narok counties using public opinion poll and vignettes. Key intervention activities implemented by TGG-ALM included conducting community intergenerational dialogues, women reflect circles and couples-only dialogues