Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2019 Jun 20;14(6):e0218157. doi: 10.1371/journal.pone.0218157. eCollection 2019.
The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman's likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman's use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.
计划生育服务环境和社区因素对避孕措施使用的重要性早已得到研究。然而，很少有研究能够将来自具有全国代表性、同时进行和地理上相关的调查的个人和卫生机构数据联系起来。绩效监测和问责制 2020 年的数据解决了这些限制。为了评估服务提供环境和社区、家庭和个人因素对妇女在撒哈拉以南非洲五个地理和文化上不同的国家使用现代避孕药具的可能性的相对影响。从 PMA2020 获得的具有全国代表性的横断面数据在家庭和服务提供层面上进行了链接。使用特定国家和汇总多水平多项逻辑回归模型，比较了未使用者、短期和长期方法使用者。我们选择纳入多变量分析的变量是由概念框架指导的，用于描述对个人使用现代避孕药具的不同层次的影响。计算平均边际效应以提高可解释性。我们发现，背景因素的影响差异很大，但过去 12 个月内接受过计划生育宣传的卫生工作者的访问始终与短期和长期避孕措施的个人使用呈正相关。最近卫生机构的特征通常不会对妇女的避孕措施使用产生独立的影响，除非在布基纳法索，个人与最近的计划生育提供者之间的平均距离明显大于其他国家。在汇总模型中纳入国家固定效应以及在特定国家模型中不同层次的协变量的相关性表明，在社区、个人和服务提供环境因素如何影响避孕措施使用和方法选择方面，各国之间存在显著差异。在设计计划生育方案时必须考虑到背景。
