Comparative perceptions of wait times for family planning services among contraceptive users and mystery clients in Kisumu, Kenya: a mixed methods analysis.

Background: Long wait times at health facilities negatively affect contraceptive access and cause dissatisfaction with care. Conventional data collection methods, such as population-based surveys and exit interviews, may not accurately capture wait times due to methodological challenges including recall and social desirability bias.

Methods: We compared mystery client observations conducted in all public facilities in Kisumu County, Kenya with data from a population-based sample of women of reproductive age (18-49, n = 744) in Kisumu County.

": A qualitative study of women's perceptions and experiences of medical reasons for non-preferred contraceptive use.

Background: People have contraceptive autonomy when they can obtain their preferred contraceptive method. Non-preferred method use may result from inappropriate medical contraindications, which occur when providers apply incorrect contraceptive eligibility criteria during consultations. Non-preferred method use and inappropriate medical contraindications are understudied in the Global South, partially due to measurement challenges.

Keeping the "R" in LARC (long-acting reversible contraception): Measuring client-centered implant removal services in sub-Saharan Africa.

As the use of subdermal contraceptive implants increases across sub-Saharan Africa, the need for person-centered removal services is more critical than ever to safeguard reproductive autonomy. In 2016, Christofield and Lacoste proposed eight conditions for client-centered implant removal, yet the extent to which these conditions have been assessed in large-scale surveys remains unexamined. Our mapping exercise collates survey information from three large data collection platforms fielded in sub-Saharan Africa, including the Demographic and Health Surveys (DHS), Performance Monitoring for Action (PMA), and the Service Availability and Readiness Assessment (SARA), utilizing questionnaire tools implemented among women, health facilities, providers, and clients to map existing data sources against these conditions.

Provider confidence and willingness to insert and remove long-acting reversible contraception methods in Kenyan public facilities.

Objective: Use of long-acting reversible contraception (LARC) in Kenya has grown over the last decade, yet emerging evidence points to challenges in LARC removal. The objective of this paper is to document provider training in LARC insertion/removal and to better understand provider experience, confidence, and willingness to both insert and remove LARC.

Study Design: In this paper we present a descriptive analysis of self-reported data from family planning providers working in all 137 public-sector healthcare facilities in Kisumu County (Western Kenya).

Association between Elevated Postnatal Blood Pressure and Postpartum Acute Care Utilization in a Southeastern U.S. Health Care System, 2021 to 2023.

Hypertensive disorders of pregnancy are a leading cause of pregnancy-related deaths in the United States and approximately 70% occur after birth. We estimated the crude and adjusted association between elevated postnatal blood pressure (BP) and acute care utilization (visits to the Emergency Department, obstetric triage, urgent care facility, or hospital readmission) in the first 12 weeks after discharge from the birth hospitalization.We constructed a retrospective cohort of birthing people aged ≥18 years who gave birth to ≥1 liveborn infant at >20 weeks of gestation from July 1, 2021, to December 31, 2022, at a quaternary maternity hospital in the Southeastern United States using electronic health records.

Provider-imposed restrictions on contraceptive use in Western Kenya.

Objective: Contraceptive providers unnecessarily restrict contraceptive use or inappropriately apply medical eligibility criteria for a variety of reasons, including knowledge gaps, personal bias, or fear of legal or social consequences. As prevalence of these restrictions is unknown, this analysis aims to document current patterns of provider-imposed restrictions on contraceptive methods at public facilities in Western Kenya and assess novel questions on medical restrictions.

Study Design: We surveyed 345 family planning providers across all 137 public healthcare facilities in Kisumu County, Kenya in 2022.

Contraceptive Use and Discontinuation Among Adolescent Women in 55 Low- and Middle-Income Countries.

Adolescent women aged 19 or younger make up a substantial and growing proportion of women of reproductive age in low- and middle-income countries. Several key features of the reproductive life course ground the need to disaggregate the contraceptive behaviors of adolescent women from those of older women, including relationship dynamics, resources and autonomy, and cultural and societal expectations regarding sexual activity and childbearing. Despite the importance and unique life course features of adolescent women, we lack the information about their contraceptive dynamics-especially their patterns of contraceptive discontinuation-needed to direct improvements to family planning programs for this oft-neglected group.

Measuring misaligned contraceptive use among reproductive-aged women in Kisumu, Kenya: a cross-sectional, population-based study.

Introduction: Global family planning scholars have critiqued traditional measures of programmatic success and called for new, person-centred measures that consider people's preferences. We propose a new measure that assesses the alignment between an individual's contraceptive desires and use.

Methods: We use data from a population-based survey implemented among adult reproductive-aged women in Kisumu, Kenya.

Postpartum Acute Care Utilization in a Health Care System in the Southeastern United States.

Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care ("outpatient"), and hospital readmissions, may indicate medical complications and signal unmet health needs. We estimated the incidence of PACU and examined patterns by sociodemographic factors, pregnancy and birth characteristics, time since discharge from the birth hospitalization, and medical indications. We constructed a retrospective cohort of people aged ≥18 years who delivered ≥1 liveborn infant >20 weeks of gestation from July 1, 2021, to December 31, 2022, using electronic health record data from a quaternary maternity hospital in the Southeastern United States PACU data throughout the health care system were collected through March 31, 2023.

Asymmetry in contraceptive information at two sites in Burkina Faso.

Background: Family planning programs are foundationally important to public health, but like any medical intervention, contraception has drawbacks in addition to its benefits. Knowledge of these drawbacks in addition to benefits is essential for informed choice. Despite a general consensus among family planning researchers and providers that contraceptive counseling should be unbiased, little quantitative research has assessed the extent of bias in contraceptive counseling, and in people's contraceptive knowledge more broadly.

Birthing parent postpartum acute care use: Multilevel opportunities for strengthening healthcare.

Background: Two-thirds of pregnancy-related deaths occur from 1 day to 1 year after birth, and medical complications frequently occur after birth. Postpartum health concerns are often urgent, requiring timely medical care, which may contribute to a reliance on acute care. One approach to improving postpartum health is to investigate birthing parents' accounts of acute care use in the months after birth, which is what we did in this study.

Preference-aligned fertility management among married adolescent girls in Northern Nigeria: assessing a new measure of contraceptive autonomy.

Introduction: Universal access to sexual and reproductive healthcare-including family planning (FP)-is a global priority, yet there is no standard outcome measure to evaluate rights-based FP programme performance at the regional, national or global levels.

Methods: We collected a modified version of preference-aligned fertility management (PFM), a newly proposed rights-based FP outcome measure which we operationalised as concordance between an individual's desired and actual current contraceptive use. We also constructed a modified version (satisfaction-adjusted PFM) that reclassified current contraceptive users who wanted to use contraception but who were dissatisfied with their method as not having PFM.

Perceptions of access to long-acting reversible contraception removal among women in Burkina Faso.

Objectives: Long-acting reversible contraception (LARC) initiation has been well-studied and intervened upon. Because LARC requires provider intervention for initiation and removal, it is critical to measure informed choice at the time of desired discontinuation as well. We examined perceptions of access to LARC discontinuation among women at two sites in Burkina Faso, where LARC is the dominant method in the contraceptive mix.

Contraceptive Behavior Dynamics and Unintended Pregnancy: A Latent Transition Analysis.

The average U.S. woman wants to have two children; to do so, she will spend about three years pregnant, postpartum, or trying to become pregnant, and three decades trying to avoid pregnancy.

Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study.

Objectives: Contraceptive implant use has grown considerably in the last decade, particularly among women in Burkina Faso and Kenya, where implant use is among the highest globally. We aim to quantify the proportion of current implant users who have unsuccessfully attempted implant removal in Burkina Faso and Kenya and document reasons for and location of unsuccessful removal.

Methods: We use nationally representative data collected between 2016 and 2020 from a cross-section of women of reproductive age in Burkina Faso and Kenya to estimate the prevalence of implant use, proportion of current implant users who unsuccessfully attempted removal and proportion of all removal attempts that have been unsuccessful.

Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity.

Introduction: Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways providers restrict access to contraception. Here, we propose a distinction between the classical "downward" provider bias that discourages contraceptive use and a new conception of "upward" provider bias that occurs when providers pressure or encourage clients to adopt contraception.

Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It.

Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values.

Measuring Contraceptive Autonomy at Two Sites in Burkina Faso: A First Attempt to Measure a Novel Family Planning Indicator.

There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso.

Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study.

Background: The prevalence of modern contraception use is higher in Kenya than in most countries in Sub-Saharan Africa. The uptake has however slowed down in recent years, which, among other factors, has been attributed to challenges in the supply chain and increasing stockouts of family planning commodities. Research on the frequency of contraceptive stockouts and its consequences for women in Kenya is still limited and mainly based on facility audits.

Provider verbal disrespect in the provision of family planning in public-sector facilities in Western Kenya.

Public-sector healthcare providers in low- and middle-income countries are a primary source of family planning but their disrespectful (i.e., demeaning or insulting) treatment of family planning clients may impede free contraceptive choice.

Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries.

Objective: This study aimed to estimate the proportion of health facilities without the capability to remove contraceptive implants and those that have the capability to insert them and to understand facility-level barriers to implant removal across 6 countries in sub-Saharan Africa.

Study Design: Using facility data from the Performance Monitoring for Action in Burkina Faso, the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, and Uganda from 2020, we examined the extent to which implant-providing facilities (1) lacked necessary supplies to remove implants, (2) did not have a provider trained to remove implants onsite, (3) could not remove deeply placed implants onsite, and (4) reported any of the above barriers to implant removal. We calculated the proportion of facilities that report each barrier, stratifying by facility type.

Do users of long-acting reversible contraceptives receive the same counseling content as other modern method users? A cross-sectional, multi-country analysis of women's experiences with the Method Information Index in six sub-Saharan African countries.

Objective: There has been a growing focus on informed choice in contraceptive research. Because removal of long-acting reversible contraception (LARC), including implants and IUDs, requires a trained provider, ensuring informed choice in the adoption of these methods is imperative. We sought to understand whether information received during contraceptive counseling differed among women using LARC and those using other modern methods of contraception.

Pandemic policies and breastfeeding: A cross-sectional study during the onset of COVID-19 in the United States.

The United States is one of the few countries, and the only high-income country, that does not federally mandate protection of postpartum employment through paid postpartum maternity and family leave policies. At the onset of the COVID-19 pandemic in the U.S.

Findings from a mixed-methods journey map study of barriers to family planning in western Kenya.

Our objective was to map and prioritize barriers to high-quality family planning care in western Kenya. We conducted key informant interviews ( = 19); focus group discussions with clients ( = 55); mystery client visits ( = 180); unannounced visitors ( = 120); and direct observation of client-provider interactions ( = 256) at public facilities offering family planning. We synthesized the data into a client and a provider journey map, which we used to facilitate client ( = 9) and provider ( = 12) discussions.