Levels and Correlates of Non-Adherence to WHO Recommended Inter-Birth Intervals in Rufiji, Tanzania.

Poorly spaced pregnancies have been documented worldwide to result in adverse maternal and child health outcomes. The World Health Organization (WHO) recommends a minimum inter-birth interval of 33 months between two consecutive live births in order to reduce the risk of adverse maternal and child health outcomes. However, birth spacing practices in many developing countries, including Tanzania, remain scantly addressed. METHODS: Longitudinal data collected in the Rufiji Health and Demographic Surveillance System (HDSS) from January 1999 to December 2010 were analyzed to investigate birth spacing practices among women of childbearing age. The outcome variable, non-adherence to the minimum inter-birth interval, constituted all inter-birth intervals <33 months long. Inter-birth intervals >=33 months long were considered to be adherent to the recommendation. Chi-Square was used as a test of association between non-adherence and each of the explanatory variables. Factors affecting non-adherence were identified using a multilevel logistic model. Data analysis was conducted using STATA (11) statistical software. RESULTS: A total of 15,373 inter-birth intervals were recorded from 8,980 women aged 15--49 years in Rufiji district over the follow-up period of 11 years. The median inter-birth interval was 33.4 months. Of the 15,373 inter-birth intervals, 48.4% were below the WHO recommended minimum length of 33 months between two live births. Non-adherence was associated with younger maternal age, low maternal education, multiple births of the preceding pregnancy, non-health facility delivery of the preceding birth, being an in-migrant resident, multi-parity and being married. CONCLUSION: Generally, one in every two inter-birth intervals among 15--49 year-old women in Rufiji district is poorly spaced, with significant variations by socio-demographic and behavioral characteristics of mothers and newborns. Maternal, newborn and child health services should be improved with a special emphasis on community- and health facility-based optimum birth spacing education in order to enhance health outcomes of mothers and their babies, especially in rural settings

Estimated Modern Use: Employing A Service Statistics-Based Indicator to Monitor Family Planning Programs [version 1; peer review: awaiting peer review]

Estimated Modern Use (EMU) is a novel, service statistics-based indicator designed to complement Couple Years of Protection (CYP) in assessing the scale of family planning use and the first widely used metric since CYPs. Developed by the Track20 project, EMU offers a population-based proportional metric that facilitates cross-country comparisons and temporal trend analysis. By leveraging existing family planning service statistics, EMU provides a more accessible and interpretable measure of contraceptive use. The associated SS-to-EMU tool used to calculate EMU incorporates rigorous data quality review mechanisms, including data visualizations and validated review processes, to enhance the reliability and utility of family planning data for decision-making. The standardization of EMU across countries and projects promotes its integration into routine data review practices, fostering a more comprehensive approach to family planning monitoring and evaluation. Since 2014, all countries that prepare annual estimates for the FP2030 global initiative utilize the SS to EMU tool, to assess data quality and produce EMU estimates. Moreover, the EMU serves as a valuable input for the Family Planning Estimation Tool (FPET), contributing to the refinement of modeled estimates of modern contraceptive prevalence. Since its introduction, EMU has gained widespread adoption at various levels, demonstrating its effectiveness in informing global, regional, and country-level monitoring efforts. Ongoing refinements to the EMU calculation further enhance its accuracy and utility as a supplementary data source for understanding contraceptive use patterns

Analyzing the building blocks of resilience: Findings from a baseline survey of the Tuungane Population, Health, and Environment Project in western Tanzania

Although the value of population, health, environment (PHE) programs is appreciated by the development community and the conceptual linkages they incorporate are sound, little evidence exists to demonstrate their short- and long-term impacts—particularly the role that the family planning (FP) component of PHE projects plays in building resilience, improving livelihoods, and helping people adapt to climate change. To contribute to filling this gap, the Evidence Project collaborated with Tuungane, a PHE project jointly implemented by The Nature Conservancy and Pathfinder International, to conduct further analysis of their existing data and examine the evidence base around integrated PHE programming, FP, climate change adaptation, and resilience. This paper analyzes data from the Tuungane Project baseline survey to show the pre-project level of knowledge and attitudes among village residents regarding their understanding and use of FP. We hope to use this analysis to inform future efforts that will look more deeply at the relationships among and between: FP and climate change adaptation, FP and resilience, and the pathways through which the FP and other components of PHE projects like Tuungane contribute to building resilience and enhancing the ability to adapt to climate change

Extended Data for Jordan CPR TFR Paper

This document contains the extended data for our analysis of the changes in TFR and CPR in Jordan

Men’s Attitudes Towards Contraception in Sub-Saharan Africa

This paper examines male attitudes towards family planning in Sub-Saharan Africa. Studying attitudes is ideal as they can be calculated for all men, at any point in their lives, regardless of marital status, sexual activity, or fertility desires. We find that positive attitudes towards family planning have increased across Sub-Saharan Africa in the last two decades. We analyze both the association of positive attitudes with a variety of demographic characteristics (age, marital status, education, and religion) and the relationships with multiple forms of discussion about family planning (radio, television, friends, and partners). We find higher approval at older ages and higher levels of education, and lower levels of approval among Muslims compared to Christians. Interactions between characteristics and discussion of family planning demonstrate that hearing or talking about contraception has different associations for different groups. This paper offers a new way to explore fertility and reproductive health in Sub-Saharan Africa. (Afr J Reprod Health 2015; 19[3]: 41-54). Keywords: Men, Africa, Attitudes, Contraception, Communication. Cet article examine les attitudes des hommes envers la planification familiale en Afrique subsaharienne. Étudier les attitudes est idéal, car elles peuvent être calculées pour tous les hommes, à tout moment de leur vie, indépendamment de l’état civil, l'activité sexuelle, ou les désirs de fécondité. Nous constatons que des attitudes positives envers la planification familiale ont augmenté dans toute l'Afrique sub-saharienne au cours des deux dernières décennies. Nous analysons à la fois l'association des attitudes positives et une variété de caractéristiques démographiques (âge, 'état civil, éducation et religion) et les relations avec les multiples formes de discussion sur la planification familiale (radio, télévision, amis et partenaires). Nous constatons qu’il y a beaucoup plus d'approbation à un âge avancé et à des niveaux plus élevés de l'éducation, et qu’il y a des niveaux bas d'approbation parmi les musulmans par rapport aux chrétiens. Les interactions entre les caractéristiques et la discussion de la planification familiale démontrent qu’entendre parler ou de parler de la contraception a de différentes associations pour les différents groupes. Cet article propose une nouvelle façon d'explorer la fécondité et la santé de la reproduction en Afrique sub-saharienne. (Afr J Reprod Health 2015; 19 41-54). Mots-clés: hommes, Afrique, attitudes, contraception, Communicatio

Men and Contraception in Sub-Saharan Africa

This dissertation explores the caveats of men's sexual lives in sub-Saharan Africa, with an emphasis on contraception. For too long, men have been thought of only as obstacles to women's contraceptive use, but as I show in the following pages, men's desired family size has decreased over the last several decades. They have a need for contraception and attitudes about its use. The dissertation focuses on men as individuals, and examines the differences between demographic sub-groups. Men are also treated as individuals in terms of their sexual life course. The following research recognizes men, not only as husbands or partners, but as people with their own motivations and attitudes. The dissertation is broken into three chapters which look at the different ways we can study men and fertility. The first chapter takes a measure commonly applied to women, unmet need for contraception, and looks at the challenges of adapting this measure to men. The second chapter creates a measure more suitable to men and their unique sexual experiences, a measure of attitudes towards contraception. This attitude measure can be applied to all men, regardless of their relationship status or fertility desires. Finally, the period surrounding young men's sexual lives is the focus of the third chapter. As data concerning these men is limited, this chapter takes a qualitative research approach, analyzing in-depth interviews conducted in the North Region of Cameroon to understand how men learn about sex and contraception and how they conduct themselves during their sexually active lives prior to marriage. Men are individuals, with their own motivations, desires, attitudes, and actions, and it is necessary for us to include them in sexual and reproductive health and fertility research in this way. &#8195

The nature of the open birth interval distribution

Background: The open birth interval -- the time since the woman’s latest birth -- is closely correlated to the usual fertility measures, but it adds important information from the age of the woman’s youngest child, with its implications for her freedom from domestic roles.  Studies of the open interval by age and parity can elucidate the transitions in reproductive behavior that women experience over time. Methods:  249 surveys of married women in 75 countries in the DHS series provide information on the open  interval by age and parity, and by the  fertility measures of the total fertility rate (TFR), the general fertility rate (GFR), and children ever born (CEB), with time trends.  Stata 15 and the “R” software were used, and a two-parameter equation was employed to model the distribution. Results:  The distribution of women by the open interval follows a downward curve from birth to 20 years; it varies across countries and over time only by its starting level and the steepness of the curve. Declines in the shortest intervals soon after birth reflect recent fertility declines. Variations are large by both age and parity, but in quite different patterns. Past modeling analyses demonstrate the effects of female and spouse mortality, declining fecundability, contraceptive use, and reduced sexual exposure. Both period and cohort effects can impact the curve. The open interval distribution is modelled in an equation with two parameters and calculated for the latest surveys in the 75 countries. Conclusions: The time since a woman’s birth is easily captured with a single question in successive surveys. Changes in the open interval distribution serve as sensitive indicators of recent fertility changes, and the dynamics of reproductive behavior across women’s life stages are captured in new ways, as gauged by age and parity trends in the distributions.</ns4:p

The Maximum CPR Model: a demographic tool for family planning policy

The Maximum CPR Model (MCM) allows demographers, policy makers, and family planning advocates to determine a country’s highest potential contraceptive prevalence rate (CPR), based on an ideal number of children, demographic life events, and population structure. Understanding the highest potential level of CPR achievable under current circumstances in a population leads to realistic expectations and appropriate policy implementation. Countries with a large gap between current CPR and maximum CPR can focus on removing blocks to contraceptive use, while countries where the maximum potential CPR is near the actual CPR may need to shift their focus to demand generation or postpartum family planning programs. With a focus on equality of access to family planning, MCM produces CPR for all women, regardless of marital status. This paper details the mathematical construction of the MCM. A version of the model is available online for easy use by non-technical audiences in English and French.</ns4:p

The Maximum CPR Model: a demographic tool for family planning policy

The Maximum CPR Model (MCM) allows demographers, policy makers, and family planning advocates to determine a country’s highest potential contraceptive prevalence rate (CPR), based on an ideal number of children, demographic life events, and population structure. Understanding the highest potential level of CPR achievable under current circumstances in a population leads to realistic expectations and appropriate policy implementation. Countries with a large gap between current CPR and maximum CPR can focus on removing blocks to contraceptive use, while countries where the maximum potential CPR is near the actual CPR may need to shift their focus to demand generation or postpartum family planning programs. With a focus on equality of access to family planning, MCM produces CPR for all women, regardless of marital status. This paper details the mathematical construction of the MCM. A version of the model is available online for easy use by non-technical audiences in English and French.</ns4:p