Abstract Monitoring contraceptive discontinuation is crucial to reduce unmet needs and unintended pregnancies while supporting person‐centered counseling. The objective is to summarize discontinuation rates by method type (long‐acting reversible contraceptive [LARC] or short‐acting reversible contraceptive [SARC]), type (abandonment or switching), and to describe reasons for discontinuation. This systematic review and meta‐analysis searched for studies published between 2010 and 2020, with data collected before the COVID‐19 pandemic,among women of reproductive age. Random‐effects models were used to pool 12‐month discontinuation rates and estimate the likelihood of switching versus abandoning methods. Fifty‐four studies were included. The 12‐month discontinuation rate (unit of analysis: women) was 16.2 percent for LARC users ( n = 867,658) and 57.9 percent for SARC users ( n = 18,882). SARC users had lower odds of switching than abandoning their method (odds ratio: 0.17; 95 percent confidence interval: 0.06–0.54), whereas no significant difference was observed among LARC users. By episode use, 12‐month discontinuation was 53.7 percent ( n = 13,445) for SARC and 16.0 percent for LARC ( n = 2,277), lower in postpartum women (8.5 percent) and higher among married women (22.5 percent). Pregnancy desire was the main reason for discontinuation among women not in need of contraception, whereas side effects predominated among those still in need. Monitoring contraceptive discontinuation is essential to guide public health policies and meet sexual and reproductive rights.
Female genital mutilation/cutting (FGM/C) is a significant global public health and human rights concern that has become increasingly relevant in Europe due to sustained migration from practicing countries. However, the absence of harmonized, age-specific data has limited up-to-date comparative estimates of FGM/C prevalence among migrant populations. We present updated estimates of the number of foreign-born women and girls aged 10 years and above residing in the European Union, Switzerland, Norway, and Iceland (EU+) as of January 1st, 2021, who are expected to have undergone FGM/C. Using population and census data combined with age-specific prevalence rates from national household surveys and an enhanced indirect estimation approach that accounts for cohort effects and migrant selectivity, we estimate that approximately 610,000 (40.6 percent) of the 1.5 million women and girls aged 10 years and above born in FGM/C-practicing countries and residing in the EU+ area have experienced FGM/C. Prevalence increases markedly with age, reflecting declining practice among younger cohorts, and varies substantially across destination countries depending on migrant composition. These findings provide a comprehensive benchmark for monitoring FGM/C in migration contexts and for informing evidence-based policies, prevention strategies, and service provision for affected women, while supporting efforts to prevent intergenerational transmission of the practice.
This study examines whether the number of brothers a woman grows up with is associated with her ideal number of sons among Nigerian women. Using women's data from the 2018 Nigeria Demographic and Health Survey (n = 40,628), I estimated a weighted negative binomial regression model predicting ideal number of sons. The findings show a positive and statistically significant association between the number of brothers and ideal number of sons. Women who grew up with more brothers are more likely to express desire for a higher ideal number of sons, even after controlling for sociodemographic and economic factors. Additional robustness checks showed that the association remained after controlling for total sibship size, number of sisters, and ideal number of daughters. Interaction models further showed that the association varies by age-cohort and education, but not by region of residence. The association is strongest among younger women and is slightly stronger among women with higher levels of education. These results suggest that early sibling environments may play a role in shaping women's fertility preferences and son preference in Nigeria.
The aim of this study was to develop and psychometrically assess a client-experience-of-care metric tailored for women in Lilongwe, Malawi, using self-administered or provider-administered depot medroxyprogesterone acetate subcutaneous (DMPA-SC) and to assess differences in experiences of care between the two groups. A client exit interview was administered to 400 Malawian women who had self-injected (n = 198) or received provider-administered (n = 202) DMPA-SC within the three months preceding the study. Iterative exploratory factor analysis with a polychoric matrix was performed. Cronbach's alpha was used to assess scale reliability. Bivariate and multivariate generalized linear regression models with robust standard errors were used to test for differences in client experience between self-administered and provider-administered clients. Exploratory factor analysis yielded a two-factor solution, identifying a unifying scale for client experience of care (eight items) and a subscale for empowerment (ten items). The client experience of care scale had moderate construct validity, explaining 40 percent of the variance, high criterion validity with a positive and statistically significant (p < 0.05) correlation coefficient, and low-to-moderate reliability (alpha = 0.68). In adjusted models, statistically significant differences in client experience of care were detected by injection method, with self-injecting clients reporting better experiences of care compared to provider-administered clients.
People often engage social networks when navigating abortion access constraints, but limited research links this involvement to abortion outcomes. This cross-sectional study analyzed PMA2020 data from 1,144 women in Nigeria who had abortions, identified through population-based surveys and abortion-focused follow-ups conducted in 2018 and 2019-2020, respectively. We examined how social network involvement in care-seeking-specifically, in method or provider selection-related to abortion outcomes: medically defined abortion safety, use of preferred method and provider, and success of the initial abortion attempt. Social network involvement was common (63 percent) and varied across sociodemographic groups. Outcomes differed by involvement source: when both partners and family/friends were involved, women were least likely to have the least safe abortions (23.9 percent vs. 60.9 percent, p < 0.001) or make multiple abortion attempts (13.7 percent vs. 19.1 percent, p = 0.009), though they were equally likely to use preferred care as those seeking care alone. Partner-only involvement was also significantly associated with fewer least safe abortions (36.3 percent vs. 60.9 percent, p < 0.001), while family/friend-only involvement was significantly associated with non-preferred abortion options (36.6 percent vs. 21.6 percent, p < 0.001) and more repeated attempts (27.8 percent vs. 19.1 percent, p = 0.038). These findings suggest that social networks have the potential to improve or worsen abortion outcomes, with important variation across person-centered measures of abortion experiences.
