Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Progress in reducing socioeconomic inequalities in the use of modern contraceptives in 48 focus countries as part of the FP2030 initiative between 1990 and 2020: a population-based analysis
Full text linkBackground: Despite increases in modern contraception use, socioeconomic inequalities in family planning persist. In this study, we aimed to measure progress in reducing socioeconomic inequalities in modern contraceptive prevalence rate (mCPR) and demand for family planning satisfied by modern methods (mDFPS) in 48 countries as part of the Family Planning 2030 (FP2030) initiative between 1990 and 2020 for which Demographic and Health Survey data were available.
Methods: We analysed two rounds of Demographic and Health Survey data per country. Changes in concentration indices between two survey rounds were compared to measure reductions in overall socioeconomic-related inequalities in modern contraceptive use. Poisson regression models were used to measure the adjusted average annual rate of change across wealth quintiles.
Findings: In this population-based analysis study, all countries reduced socioeconomic-related inequalities in modern contraceptive use among in-union women of reproductive age (15-49 years) during the observed 30-year period. On average, mCPR increased at an annual rate of 2·1% (95% CI 2·1-2·2), and the rate of increase for the poorest women was 3·1% (3·0-3·2), which outpaced the rate of increase for the richest women of 1·3% (1·3-1·4%). The pattern of progress was similar for mDFPS, but at a slower pace. Overall, levels of mCPR and mDFPS increased, and socioeconomic-related inequalities were reduced during this period.
Interpretation: Substantial progress has been made in reducing socioeconomic-related inequalities in family planning across the 48 studied countries, which account for 86% of the population of the 82 FP2030 initiative countries. During the past three decades, poorer women have seen greater improvements in modern contraceptive use and demand satisfaction compared with richer women. As contraceptive prevalence rates are near their maximum, it is crucial to ensure marginalised and vulnerable groups are not left behind.
Funding: Bill & Melinda Gates Foundation.
Translations: For the French and Spanish translations of the abstract see Supplementary Materials section
The safety of intrauterine devices during breastfeeding: an updated systematic review
Full text linkObjectives: To update a 2016 review and answer three questions: (1) Among women using an intrauterine device (IUD), does breastfeeding increase the risk of adverse events? (2) Among breastfeeding women, does IUD use increase the risk of adverse events? (3) Among breastfeeding women, does copper (Cu)-IUD use increase risk of adverse breastfeeding or infant outcomes?
Methods: We searched multiple databases from inception to August 2023. We extracted prespecified data and assessed risk of bias (RoB) for each article and certainty of evidence for each outcome.
Results: Thirty-eight articles met the inclusion criteria; 16 were newly identified since the previous review, most with high RoB. Evidence suggested no effect of breastfeeding on IUD-related adverse events (ie, expulsion, bleeding, pain and infection) compared with not breastfeeding; however, an increased relative risk of perforation was observed with breastfeeding at the time of IUD insertion compared with not breastfeeding. For perforation, relative measures of association ranged from 1.4 to 10.1, and absolute rates varied (eg, 0.6-7% or 6.8 per 1000). Evidence suggested no effect of IUD use on risk of adverse events (ie, bleeding, pain and infection) among breastfeeding women compared with no IUD use. Evidence suggested no effect of Cu-IUD use on breastfeeding or infant outcomes among breastfeeding women compared with no Cu-IUD use.
Conclusions: We continued to find an increased relative risk of IUD perforation among breastfeeding women compared with no breastfeeding; however, the absolute risk is low. No other adverse effects with IUD use and breastfeeding were observed. The certainty of evidence for all outcomes was very low
Family planning and abortion service availability and utilisation during the COVID-19 pandemic in Ghana
Full text linkBackground: The effect of COVID-19 has manifested both in the capacity of healthcare systems to provide services as well as create a good balance between pandemic management and maintenance of essential health services. Earlier studies in Ghana during the pandemic reported low patronage of family planning (FP) services but a sudden spike in emergency contraceptive pill utilization. This paper seeks to assess health service availability and readiness, client needs for, and utilization of FP and abortion services during the COVID-19 pandemic period in Ghana.
Methods: This study was a panel study with two-time data collection points six to nine months apart. Both quantitative and qualitative approaches were used. A one-time survey was used to assess SRH service utilization by 997 clients. Qualitative data involved a total of 24 Focus Group Discussions (FGDs), 128 In-depth Interviews (IDIs) with female clients and their male partners, and 32 IDIs with healthcare practitioners in the four selected facilities. Also, the WHO Service Availability, Readiness and Assessment tool was completed for the health facilities at baseline and endline. Descriptive statistics and thematic analysis were conducted for quantitative and qualitative data respectively.
Results: Age of clients and their male partners participating in IDIs ranged between 18 and 50 years (mean = 33.2 years) while participants for community FGDs ranged between 16 and 56 years (mean = 32.0 years).
The majority (68%) of clients visiting the health facility for SRH care sought FP services while 5% sought abortion/post-abortion care of which 71% needed post-abortion care. Attendance data showed sensitivity to the occurrence of the different waves of COVID-19. Family planning and abortion services were generally available but witnessed some short-lived disruption. Healthcare managers reported financial stress which led to innovations in procurement of PPEs and hand sanitizers. Telemedicine facilities did not provide SRH care. Fear of stigma was a major barrier to access to abortion care.
Conclusion: The relatively low COVID-19 infection rates in Ghana preceded by the national COVID-19 preparedness strategy may explain the low impact on disruption of FP and abortion services. Development of SRH specific guidelines and strengthening telemedicine facilities to include SRH care may reduce future disruption
Guidance on planning, implementing and scaling up task sharing for contraceptive services
Full text linkViral shedding of SARS-CoV-2 in body fluids associated with sexual activity: a systematic review and meta-analysis
Full text linkObjective: To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion).
Eligibility: All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs.
Information sources: The WHO COVID-19 database from inception to 20 April 2022.
Risk of bias assessment: The National Institutes of Health tools.
Synthesis of results: The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models.
Included studies: A total of 182 studies with 10 023 participants.
Results: The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces.
Limitations: Scarcity of longitudinal studies with follow-up until negative results.
Interpretation: SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed.
Prospero registration number: CRD42020204741
