Exposure to family planning messages and contraceptive use among women of reproductive age in Sub-Saharan Africa: a cross-sectional program impact evaluation study

Many women of reproductive age in sub Saharan Africa are not utilizing any contraceptive method which is contributing to the high burden of maternal mortality. This study determined the prevalence, trends, and the impact of exposure to family planning messages (FPM) on contraceptive use (CU) among women of reproductive age in sub-Saharan Africa (SSA). We utilized the most recent data from demographic and health surveys across 26 SSA countries between 2013 and 2019. We assessed the prevalence and trends and quantified the impact of exposure to FPM on contraceptive use using augmented inverse probability weighting with regression adjustment. Sensitivity analysis of the impact estimate was conducted using endogenous treatment effect models, inverse probability weighting, and propensity score with nearest-neighbor matching techniques. The study involved 328,386 women of reproductive age. The overall prevalence of CU and the percentage of women of reproductive age in SSA exposed to FPM were 31.1% [95% CI: 30.6-31.5] and 38.9% [95% CI: 38.8-39.4] respectively. Exposure to FPM increased CU by 7.1 percentage points (pp) [95% CI=6.7, 7.4; p<0.001] among women of reproductive age in SSA. The impact of FPM on CU was highest in Central Africa [6.7 pp; 95% CI: [5.7-7.7; p<0.001] and lowest in Southern Africa [2.2 pp; 95% CI: [1.3-3.0; p<0.001]. There was a marginal decline in the impact estimate among adolescents (estimate=6.0 pp [95% CI=5.0, 8.0; p<0.001]). Exposure to FPM has contributed to an increase in CU among women of reproductive age. Programs that are geared towards intensifying exposure to FPM through traditional media in addition to exploring avenues for appropriate use of electronic media remain critical

Baseline characteristics of participants and comparison among different BMI groups.

<p>Baseline characteristics of participants and comparison among different BMI groups.</p

Blood pressure patterns and body mass index status in pregnancy: An assessment among women reporting for antenatal care at the Korle-Bu Teaching hospital, Ghana

<div><p>Background</p><p>Maternal obesity in pregnancy has been linked with increased risk of pregnancy induced hypertension (PIH). In some tertiary referral hospitals in Ghana, PIH is the leading cause of institutional maternal mortality.</p><p>Objective</p><p>To evaluate blood pressure changes during pregnancy amongst different body mass index (BMI) groups and how this relates to the risk of developing PIH.</p><p>Methods</p><p>Women who had a dating ultrasound before 20 weeks gestation and registering for antenatal care at the Korle-Bu Teaching Hospital in Accra, between February and December 2013 and met the inclusion criteria were recruited into a cohort study. BMI was assessed at baseline. Blood pressure measurements were taken at (±2) 24, 28 and 36 weeks. Primary outcome measure of interest during follow-up was a diagnosis of PIH at these points. BP changes during follow up at the three points were measured. Descriptive analysis of baseline factors was carried out and compared for the BMI groups. Relative risk (RR) of PIH was estimated at 95% confidence interval.</p><p>Results</p><p>Mean (SD) age for the 361 women was 30.9 (4.8) years. Incidence of PIH amongst the cohort was 10.5% (95% CI: 7.45% - 14.45%) and 40.4% and 33.0% of them were overweight and obese respectively at baseline. Pregnant women who were obese at baseline had a three-fold increased risk of PIH compared to those with normal BMI [RR = 3.01 (1.06–8.52), p = 0.04].</p><p>Conclusion</p><p>Obese women have a significantly increased risk of PIH. Women should be screened at booking for obesity status. Antenatal protocols should have interventions for prevention or early detection of obesity and management of obesity to improve outcomes.</p></div

Mean blood pressure changes from baseline during follow up among the PIH groups.

<p>Mean blood pressure changes from baseline during follow up among the PIH groups.</p

Risk of PIH among the BMI groups.

<p>Risk of PIH among the BMI groups.</p

Association of baseline characteristics with diagnosis of PIH among cohort.

<p>Association of baseline characteristics with diagnosis of PIH among cohort.</p