Family planning methods and fertility preferences according to HIV status among women in Cameroon

We investigated whether HIV-positive women differ from HIV-negative women in their fertility, fertility intentions, and use of family planning (FP) among 16,202 women who received services through the Cameroon Baptist Convention Health Services’ Women’s Health Program from 2015 to 2017. The 13% of women who were HIV-positive had similar rates of modern FP usage and unmet need compared to HIV-negative women (26% versus 29% for modern FP usage, and 20% versus 21% for unmet need). However, HIV-positive women were more likely to be satisfied with their FP method (aOR = 1.70, p < .001). There were no significant differences in usage by HIV status for most FP methods, but HIV-positive women were more likely to use condoms (aOR = 1.85, p < .01) and less likely to use IUDs (aOR = 0.77, p < .05). HIV-positive women had fewer living children and also desired fewer children (both associations significant at p < .001 in multivariate linear regression). These findings highlight low FP usage and high unmet need among all women, and the need for integrated HIV and FP services for HIV-positive women, particularly aimed at increasing use of more reliable FP methods in addition to condoms. (Afr J Reprod Health 2021; 25[5]: 25-36)

Comment: silent burden no more: a global call to action to prioritize perinatal mental health

Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth and the postpartum period, and the prevalence among women in low- and middle-income countries is the highest at nearly 20%. Women are the cornerstone of a healthy and prosperous society and until their mental health is taken as seriously as their physical wellbeing, we will not improve maternal mortality, morbidity and the ability of women to thrive. On the heels of several international efforts to put perinatal mental health on the global agenda, we propose seven urgent actions that the international community, governments, health systems, academia, civil society, and individuals should take to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing. Addressing perinatal mental health promotion, prevention, early intervention and treatment of common perinatal mental disorders must be a global priority

Family planning and reproductive health supply stockouts: problems and remedies for faith-based health facilities in Africa

Background and aims: Faith-based organizations (FBOs) provide a substantial portion of the health care services in many African countries. FBO facilities do consider family planning and reproductive health services as essential to reducing maternal and child mortality, and to the growth of healthy families. Many health facilities, however, struggle to maintain adequate stocks of reproductive health (RH) supplies because of the various RH supply chains and funding sources, which often operate separately from other medicines and supplies. The purpose of this study is to identify the types of supply chain systems used by African faith-based health facilities to acquire reproductive health products (clotrimazole, combined oral contraceptive pills, contraceptive implants, CycleBeads®, emergency contraception, Erythromycin, female condoms, injectable contraceptives, intra-uterine contraceptive devices, magnesium sulfate, male condoms, Methyldopa, Misoprostol, Nifedpine, Oxytocin, and Progestin-only pills), to describe their problems and challenges, and to identify possible corrective actions. Methods: Through email surveys, phone interviews, and on-site visits, we studied the supply chains of 46 faith-based health facilities in 13 African countries. Sixteen RH commodities, including contraceptives, were selected as indicators. Results: Of the 46 facilities surveyed, 55 percent faced stockouts of one or more products in the three months prior to the survey. Stockouts were less common for contraceptives than for other RH products. Significant strengths of the FBO supply chain included creativity in finding other sources of commodities in the face of stockouts, staff designated to monitor quality of the commodities, high capacity for storage, low incidence of expired products, few instances of poor quality, and strong financial sustainability mechanisms, often including patient fees. Weaknesses included unreliable commodity sources and power supplies, long distances to depots, and problems maintaining the cold chain. Conclusions: By studying the supply chains of faith-based health facilities, Christian Connections for International Health (CCIH) and its members have created new awareness among FBOs and international agencies of the importance and challenges of these systems and have suggested actions toward improvement. The Alliance of Christian Faith-Based Organizations for Family Planning (ACFBOFP) formed in Cameroon to strengthen commodity security may be a good model for other FBOs to consider. Cost recovery models with stronger quantification and forecasting systems, including trained staff, can help meet the FP and RH needs of families and can help assure the long-term sustainability of FBO health systems. This study can serve as a frame of reference as we move forward, anticipating an acceleration in interest to strengthen FBO supply chains to reach as many communities as possible with available, quality supplies and services