Tetui Moses, Baroudi Mazen, Ssekamatte Tonny, Birabwa Catherine, Kibira Simon Peter, Atuyambe Lynn, Delamou Alexandre, Makumbi Fredrick Edward
School of Pharmacy, Waterloo University, Waterloo, ON, Canada.
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Front Glob Womens Health. 2021 Aug 18;2:655413. doi: 10.3389/fgwh.2021.655413. eCollection 2021.
Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality. A cross-sectional study conducted among 626 women in the reproductive age (15-49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0. The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women's education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48-0.97) and high decision-making power (PR 0.64, 95% CI: 0.50-0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01-1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24-2.34). Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.
现代避孕药具的更新与使用对公共卫生有益，包括减少意外怀孕、不安全堕胎及相关孕产妇死亡率。然而，非正规住区计划生育关键指标的证据却十分匮乏。数据通常汇总于较大的城市社区，这往往掩盖了非正规住区的特殊性。本研究确定了一个城市行政区非正规住区中使用现代避孕药具的女性比例、对现代避孕药具的未满足需求以及总需求。在基拉市（坎帕拉大都市的一部分）的非正规住区对626名育龄（15 - 49岁）女性进行了一项横断面研究。采用多阶段抽样来选取受访者。进行了描述性和对数二项回归分析，以确定使用现代避孕药具的女性百分比、未满足需求以及总需求及其相关因素。所有分析均使用STATA 15.0版本进行。现代避孕药具的总需求为84.9%，现代避孕药具使用率为47.4%，接近50%的国家目标，然而未满足需求为37.3%，远高于10%的国家目标。避孕药具总需求较低与女性受教育程度较高以及想要再生育一个孩子的偏好相关，而总需求较高与至少有一个存活子女相关。现代避孕药具使用率较高与年龄较大、至少有一个存活子女以及较高的决策权相关，而现代避孕药具使用率较低与受教育程度较高以及生育偏好未确定相关。对现代避孕药具的未满足需求较低与年龄较大（PR 0.68，95% CI：0.48 - 0.97）和较高的决策权（PR 0.64，95% CI：0.50 - 0.81）相关，而在至少有一个存活子女（PR 1.40，95% CI：1.01 - 1.93）和生育偏好未确定（PR 1.70，95% CI：1.24 - 2.34）的人群中未满足需求较高。研究发现，基拉市非正规住区的总需求和避孕药具使用率较高，然而，与全国城市估计数相比，该人群中的未满足需求要高得多。这表明对避孕药具的需求要高得多，并且需要考虑城市空间的不同社会人口特征。干预措施的制定需要认真考虑不同的城市空间、相关的解释变量以及一个协作系统视角，以实现持续改善。
