Validation of the contraception-focused Preference-aligned Fertility Management Index in Uganda and Nigeria.

OBJECTIVES

This study aimed to evaluate construct validity of the contraception-focused "Preference-aligned Fertility Management" (PFM) Index, a new person-centered and rights-based outcome measure, in Nigeria and Uganda.

STUDY DESIGN

We analyzed survey data from convenience samples of new users of contraception and nonusers of contraception in Uganda and users of contraception in Nigeria. PFM Index scores were calculated by combining two indicators: indicator 1 assessing alignment between desire to use contraception and actual use; indicator 2 evaluating whether users' current methods are desired. We developed a nomological network of related constructs and conducted bivariable logistic regressions, predicting the odds of PFM associated with each variable.

RESULTS

A total of 71.3% of contraception users in Nigeria, 99.2% of new users in Uganda, and 42.9% of nonusers in Uganda were practicing contraception-focused PFM. In Nigeria, high Women's and Girls' Empowerment in Sexual and Reproductive Health Index scores and permission to visit a health center were significantly associated with higher odds of contraception-focused PFM (odds ratio [OR] = 2.72; 95% CI = 1.01-7.31; OR = 2.64; 95% CI = 1.04-6.73, respectively). In Uganda, women's and partner's secondary school education were significantly associated with higher odds of contraception-focused PFM (OR = 2.58, 95% CI = 1.58-4.24; OR = 2.01; 95% CI = 1.54-2.62, respectively); as were concordance with partner's desired number of children, recent experience of gender-based violence, and satisfaction with what (if anything) one is doing to prevent pregnancy (OR = 1.48, 95% CI = 1.30-1.69; OR = 2.33; 95% CI = 1.52-3.56; OR = 4.44, 95% CI = 2.77-7.12, respectively).

CONCLUSIONS

The contraception-focused PFM Index demonstrated construct validity in Nigeria and Uganda. PFM and other new measures of self-defined need contribute to the paradigm shift underway to align contraception indicators with human rights principles.

IMPLICATIONS

The contraception-focused PFM Index is a novel person-centered, rights-based measure that can be used to gauge whether individuals' self-defined needs related to contraception are met by programs and policies. Our study finds evidence for construct validity of the index among contraceptive users in Nigeria and Uganda and nonusers in Uganda.