School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys

Reports of school and work absences due to unmet menstrual needs have prompted increased attention to menstruation in policy and practice. However, there appear to be few quantitative studies reported in published literature capturing the prevalence of this hypothesised absenteeism. This study undertook secondary analysis of nationally representative Performance Monitoring and Accountability 2020 (PMA2020) data from Burkina Faso and Nigeria, and city-representative data from Niamey, Niger to determine the extent of women’s and girls’ self-reported absence from school and work due to menstruation. Among women and adolescent girls aged 15–49 years who had worked outside the household in the past month in Burkina Faso (n = 998), Niger (n = 212) and Nigeria (n = 3638), 19%, 11% and 17%, respectively, reported missing work due to menstruation. Among those aged 15–24 years who attended school in the past year in Burkina Faso (n = 461), Niger (n = 213) and Nigeria (n = 1574), 17%, 15% and 23% reported missing school in the past year due to menstruation. Findings support the assertion that menstruation is a source of absenteeism in West Africa and indicate that greater attention from research, practice, and policy is needed. In presenting this data we also reflect critically on the performance of questions regarding menstrual-related absenteeism in national monitoring surveys

The relationship between client dissatisfaction and contraceptive discontinuation among urban family planning clients in three sub-Saharan African countries

Although researchers and practitioners have suggested that the quality of family planning services impacts contraceptive discontinuation, establishing a causal relationship has been challenging, primarily due to data limitations and a lack of agreement on how to measure quality. This longitudinal study estimated the relationship of the dissatisfaction with family planning services on contraceptive discontinuation for a sample of 797 female clients who sought family planning services at urban facilities across Kenya, Nigeria, and Burkina Faso. Clients who sought family planning services were first interviewed in person at private and public health facilities and received a follow-up phone interview four to six months later

A mixed-methods study exploring women’s perceptions of terminology surrounding fertility and menstrual regulation in Côte d’Ivoire and Nigeria

Women use various terms when discussing the management of their fertility and menstrual irregularities and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology used to refer to abortion-like experiences (specifcally menstrual regulation and pregnancy removal), and the specifc scenarios that these practices encompass among women who reported doing something to bring back a late period or ending a pregnancy in Nigeria and Côte d’Ivoire.Our analysis draws upon surveys with women in Nigeria (n=1114) and Cote d’Ivoire (n=352). We also draw upon qualitative in-depth interviews with a subset of survey respondents in Anambra and Kaduna States in Nigeria, and Abidjan, Cote d’Ivoire (n=30 in both countries). We examine survey and interview questions that explored women’s knowledge of terminology pertaining to ending a pregnancy or bringing back a late period. Survey data were analyzed descriptively and weighted, and interview data were analyzed using inductive thematic analysis

Having a say matters: influence of decision-making power on contraceptive use among Nigerian women ages 35-49 years.

BACKGROUND: Research suggests that women of reproductive age who are involved in household decision-making are more likely than those who are not involved to be able to control their fertility. Little is known, however, about this relationship among women at the upper end of the reproductive spectrum. The aim of this study was to determine the association between household decision-making power and modern contraceptive use among Nigerian women ages 35-49 years. METHODS: A descriptive, cross-sectional study involving a secondary analysis of data from the Nigerian 2008 Demographic and Health Survey was conducted among women ages 35-49 years who were considered to be in need of contraception. The outcome was modern contraceptive use while the main independent variable was a woman's household decision-making power score, constructed using principal component analysis. Multivariate logistic regression was performed to determine whether the women's household decision-making power score, categorized into tertiles, was independently associated with modern contraceptive use. Data were weighted and adjusted for the complex survey design. RESULTS: Prevalence of modern contraceptive use among Nigerian women deemed to be in need of contraception in this study was 18.7%. Multivariate logistic regression showed that women's decision-making power remained statistically significantly associated with modern contraceptive use, even after adjusting for age, education, religion, polygyny, parity, wealth and domicile. Women who were in the highest decision-making power tertile had more than one and a half times the odds of using modern contraception compared with women in the lowest tertile [Adjusted Odds Ratio = 1.70; 95% Confidence Interval = 1.31-2.21, p<0.001]. SIGNIFICANCE: Older Nigerian women who are involved in making household decisions are also able to make decisions related to their fertility. Programs in Nigeria focused on increasing modern contraceptive use should include strategies to increase women's status through encouraging more visible involvement in decision-making across different spheres of their lives

Femmes en danger de violence physique causée par le partenaire intime : analyse transversale d’une communauté à faible revenu au sud ouest du Nigéria

Intimate Partner Violence (IPV) is prevalent in Nigeria but a culture of silence exists, making it difficult to identify women at risk. A descriptive cross-sectional survey was employed to determine the prevalence and predictors of physical IPV in a low income, high density community in south west Nigeria. Among 924 interviews of everpartnered women aged 15-49 years, prevalence of lifetime experience of physical IPV was 28.2%. The significant predictors for physical IPV were previous experience of psychological abuse (adjusted OR: 4.71; 95% CI: 3.236.85); sexual abuse (aOR: 5.18; 3.21-8.36); having attitudes supportive of IPV (aOR: 1.75; 1.2-2.4); partner’s daily alcohol consumption (aOR: 2.85; 1.50-5.41); and previous engagement in a physical fight (aOR: 3.49; 1.87-6.50). Community based IPV prevention programmes targeted at breaking the cycle of abuse, transforming gender norms which support IPV and reducing alcohol consumption should be developed (Afr J Reprod Health 2012; 16[1]:43-53).La violence causée par le partenaire intime (VCPI) est répandue au Nigéria, mais il existe une culture de silence, ce qui le rend difficile à identifier les femmes en danger. A travers une étude descriptive transversale, nous avons déterminé la prévalence et les indices de la VCPI physique au sein d’une communauté à faible revenu ayant une densité bien élevée au sud-ouest du Nigéria. Parmi les 924 interviews recueillies auprès de femmes âgées de 15 à 49 ans qui ont eu des partenaires dans le passé, la prévalence d’une expérience de vie de la VCPI était de 28,2%. Les indices significatifs pour les VCPI étaient l’expérience antérieure de d’un abus psychologique (OR : 5,18) et ayant des attitudes qui soutiennent la VCPI (OR : 1,75), la consommation quotidienne d’alcool par le partenaire (OR : 22,85) et l’engagement dans le passé dans un combat physique. Il faut élaborer des programmes de prévention de la VCPI basées sur la communauté et qui cherchent à rompre le cycle d’abus, à transformer les normes des sexes qui soutiennent la VCPI et à réduire la consommation d’alcool (Afr J Reprod Health 2012; 16[1]:43-53)

Women at Risk of Physical Intimate Partner Violence: A Crosssectional Analysis of a Low-income Community in Southwest Nigeria

Intimate Partner Violence (IPV) is prevalent in Nigeria but a culture of silence exists, making it difficult to identify women at risk. A descriptive cross-sectional survey was employed to determine the prevalence and predictors of physical IPV in a low income, high density community in south west Nigeria. Among 924 interviews of everpartnered women aged 15-49 years, prevalence of lifetime experience of physical IPV was 28.2%. The significant predictors for physical IPV were previous experience of psychological abuse (adjusted OR: 4.71; 95% CI: 3.23-6.85); sexual abuse (aOR: 5.18; 3.21-8.36); having attitudes supportive of IPV (aOR: 1.75; 1.2-2.4); partner&rsquo;s daily alcohol consumption (aOR: 2.85; 1.50-5.41); and previous engagement in a physical fight (aOR: 3.49; 1.87-6.50). Community based IPV prevention programmes targeted at breaking the cycle of abuse, transforming gender norms which support IPV and reducing alcohol consumption should be developed.Keywords: Intimate partner violence, women, predictors of physical violence, urban community, south west Nigeria.Afr J Reprod Health 2012; 16[1]:43-53)

Effect of community health workers’ visits on uptake of modern contraception among rural women of reproductive age in Nigeria

This paper assessed the effect of visits by Community Health Workers (CHW) in the prior 12 months on modern contraceptive use at the time of the survey using a national sample of women residing in rural communities in Nigeria. Cross-sectional data from 5072 rural women ages 15-49 years interviewed in the PMA2020 Survey in 6 states in Nigeria in 2018 were used. Descriptive analysis and generalized linear models were conducted in Stata 15.1 and average marginal effects calculated. Overall prevalence of modern contraceptive use was 14.8% (95% CI: 12.7%, 17.3%), varying from 2.1% in Kano to 22.7% in Nasarawa. Ten percent of women reported that they were visited by a community health worker in the 12-month period preceding the survey, ranging from 2.9% in Kano to 14.6% in Nasarawa. Women visited by a CHW had 50% higher odds of reporting modern contraceptive use, and these visits raised the probability of modern contraceptive use by an average of 6.4 percentage points overall. Local governments in rural Nigeria should invest in training, deploying and supervising CHWs in the provision of modern contraception through home visits to women who may otherwise have limited access to improve use. Keywords: Community Health Workers (CHWs); Family Planning; Modern contraception; Rural Nigeria &nbsp; Cet article a évalué l'effet des visites des agents de santé communautaires (ASC) au cours des 12 mois précédents sur l'utilisation de la contraception moderne au moment de l'enquête en utilisant un échantillon national de femmes résidant dans les communautés rurales du Nigéria. Des données transversales de 5072 femmes rurales âgées de 15 à 49 ans interrogées dans le cadre de l'enquête PMA2020 dans 6 États du Nigéria en 2018 ont été utilisées. Une analyse descriptive et des modèles linéaires généralisés ont été réalisés dans Stata 15.1 et les effets marginaux moyens ont été calculés. La prévalence globale de l'utilisation de la contraception moderne était de 14,8% (IC à 95%: 12,7%, 17,3%), variant de 2,1% à Kano à 22,7% à Nasarawa. Dix pour cent des femmes ont déclaré avoir reçu la visite d'un agent de santé communautaire au cours des 12 mois précédant l'enquête, allant de 2,9% à Kano à 14,6% à Nasarawa. Les femmes visitées par un ASC avaient 50% plus de chances de déclarer uneutilisation de contraceptifs modernes, et ces visites ont augmenté la probabilité d'utilisation de contraceptifs modernes de 6,4 points de pourcentage en moyenne. Les gouvernements locaux dans les zones rurales du Nigéria devraient investir dans la formation, le déploiement et la supervision des ASC dans la fourniture de contraceptifs modernes par le biais de visites à domicile aux femmes qui pourraient autrement avoir un accès limité pour améliorer l'utilisation. Mots-clés: Agents de santé communautaire (ASC); Planification familiale; Contraception moderne; Nigéria rura

Experience of intimate partner violence among rural women in Southwest, Nigeria

Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally. Women’s experiences of IPV in rural southwest Nigeria was examined in this study, conducted between July and August, 2019. A total of 677 women participated in this survey which employed a mobile phone application. Results revealed that the prevalence of experience of IPV was 39.4%. Experience of IPV was significantly higher among women who had been married longer (AOR = 2.09, 95% CI: 1.23, 2.93), completed secondary school (AOR = 1.81, 95% CI: 1.07, 3.05), were in the middle or richer wealth tertiles (AOR (95% CI= 1.59, 1.02, 2.51 and 1.84, 1.19, 2.84 respectively), and who justified IPV (AOR = 1.44, 95% CI: 1.00, 2.06). The prevalence of IPV among women in southwest Nigeria is high and determining factors are multi-faceted, hence the need for community sensitization interventions designed to address social norms that justify partner violence. (Afr J Reprod Health 2021; 25[5]: 113-124)

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women's degree of contraceptive empowerment.

ObjectiveIn Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception.MethodsData were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception.ResultsAltogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users.ConclusionBy identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals