Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Health Research Institute, Sheffield Hallam University, Sheffield, UK.
BMC Womens Health. 2024 Jan 3;24(1):13. doi: 10.1186/s12905-023-02859-2.
Family planning (FP) interventions have improved the use of modern contraceptives, yet a high unmet need for contraception still exists in South Asia. This systematic review of existing research was conducted to identify effective FP interventions that led to an increase in the uptake of modern methods of contraception in South Asia.
Five electronic databases were searched for relevant studies published between January 1st, 2000 and May 4, 2023. Experimental studies that reported data on the impact of FP interventions on modern contraceptive use among women of reproductive age (15-49 years) in the South Asian region were included. A random-effects Inverse Variance weighted model was employed to pool the adjusted odds ratio (OR) on modern contraceptive use and unmet need for contraception. In addition, we computed subgroup meta-estimates based on intervention type and the urban-rural divide.
Among 643 studies identified, 21 met the inclusion criteria. The overall pooled odds ratio for modern contraceptive use was significantly higher (OR 1.51; 95% CI 1.35-1.70; heterogeneity; I = 81%) for FP interventions with a significant reduction in unmet need for contraception (OR 0.86; 95% CI 0.78-0.94, I = 50%). The subgroup analysis revealed demand-generation (OR 1.61; 95% CI 1.32-1.96), health system integrated (OR 1.53; 95% CI 1.07-2.20), and franchised FP clinic interventions (OR 1.32; 95% CI 1.21-1.44) had promoted the modern contraceptive uptake. Further, FP interventions implemented in urban settings showed a higher increase in modern contraceptive use (OR 1.73; 95% CI 1.44-2.07) compared to rural settings (OR 1.46; 95% CI 1.28-1.66). Given the considerable heterogeneity observed across studies and the low degree of certainty indicated by the GRADE summary for the primary outcome, caution is advised when interpreting the results.
The review collated experimentally evaluated FP interventions that increased modern contraception use and reduced the unmet need in South Asia. The demand generation interventions were the most effective in increasing the uptake of modern contraceptive methods. Furthermore, the urban environment provides a conducive environment for interventions to improve contraceptive usage. However, further studies should assess which aspects were most effective on attitudes towards contraception, selection of more effective methods, and contraceptive behaviors.
计划生育干预措施提高了现代避孕方法的使用率，但南亚地区仍有很大一部分人对避孕方法有未满足的需求。本系统评价旨在确定有效的计划生育干预措施，以增加南亚地区现代避孕方法的使用率。
检索了 2000 年 1 月 1 日至 2023 年 5 月 4 日期间发表的五个电子数据库中关于计划生育干预措施对南亚地区育龄妇女（15-49 岁）现代避孕方法使用影响的相关研究。纳入了报告计划生育干预措施对现代避孕方法使用影响的实验研究数据。采用随机效应Inverse Variance 加权模型对现代避孕方法使用和避孕需求未满足的调整优势比（OR）进行汇总。此外，我们还根据干预类型和城乡差异计算了亚组荟萃估计值。
在 643 项研究中，有 21 项符合纳入标准。计划生育干预措施可显著提高现代避孕方法的使用率（OR 1.51；95% CI 1.35-1.70；异质性；I=81%），同时显著降低避孕需求未满足率（OR 0.86；95% CI 0.78-0.94，I=50%）。亚组分析显示，需求生成（OR 1.61；95% CI 1.32-1.96）、卫生系统综合（OR 1.53；95% CI 1.07-2.20）和特许经营计划生育诊所干预（OR 1.32；95% CI 1.21-1.44）提高了现代避孕方法的使用率。此外，与农村地区相比（OR 1.46；95% CI 1.28-1.66），城市地区实施的计划生育干预措施可显著提高现代避孕方法的使用率（OR 1.73；95% CI 1.44-2.07）。鉴于研究间存在较大的异质性，以及主要结局的 GRADE 总结表明证据确定性较低，在解释结果时应谨慎。
本综述综合了经实验评估的计划生育干预措施，这些措施提高了现代避孕方法的使用率，并降低了南亚地区的避孕需求未满足率。需求生成干预措施在提高现代避孕方法使用率方面最为有效。此外，城市环境为改善避孕措施的使用提供了有利条件。然而，还需要进一步的研究来评估哪些方面对避孕态度、更有效方法的选择和避孕行为最有效。
