Most recent papers:

• Aligning Funding and Need for Family Planning: A Diagnostic Methodology.
  Victoria Y. Fan, Sunja Kim, Seemoon Choi, Karen A. Grépin.
  Studies in Family Planning. October 17, 2017
  With limited international resources for family planning, donors must decide how to allocate their funds to different countries. How can a donor for family planning decide whether countries are adequately prioritized for funding? This article proposes an ordinal ranking framework to identify under‐prioritized countries by rank‐ordering countries by their need for family planning and separately rank‐ordering them by their development assistance for family planning. Countries for which the rank of the need for family planning is lower than the rank of its funding are deemed under‐prioritized. We implement this diagnostic methodology to identify under‐prioritized countries that have a higher need but lower development assistance for family planning. This approach indicates whether a country is receiving less compared to other countries with similar levels of need.

  October 17, 2017   doi: 10.1111/sifp.12034   open full text
• Providers, Unmarried Young Women, and Post‐Abortion Care in Kenya.
  Chimaraoke O. Izugbara, Carolyne P. Egesa, Caroline W. Kabiru, Estelle M. Sidze.
  Studies in Family Planning. September 22, 2017
  Young women and girls in Kenya face challenges in access to abortion care services. Using in‐depth and focus group interviews, we explored providers’ constructions of these challenges. In general, providers considered abortion to be commonplace in Kenya; reported being regularly approached to offer abortion‐related care and services; and articulated the structural, contextual, and personal challenges they faced in serving young post‐abortion care (PAC) patients. They also considered induced abortion among young unmarried girls to be especially objectionable; stressed premarital fertility and out‐of‐union sexual activity among unmarried young girls as transgressive of respectable femininity and proper adolescence; blamed young women and girls for the challenges they reported in obtaining PAC services; and linked these challenges to young women's efforts to conceal their failures related to gender and adolescence, exemplified by pre‐marital pregnancy and abortion. This study shows how providers’ distinctive emphasis that young abortion care‐seekers are to blame for their own difficulties in accessing PAC may add to the ongoing crisis of post‐abortion care for young women and adolescent girls in Kenya.

  September 22, 2017   doi: 10.1111/sifp.12035   open full text
• Announcing a New Journal Section: Data Papers.
  Rachel Friedman, Stephanie Psaki, Jeffrey B. Bingenheimer.
  Studies in Family Planning. September 08, 2017
  There is no abstract available for this paper.

  September 08, 2017   doi: 10.1111/sifp.12032   open full text
• PMA2020: Rapid Turn‐Around Survey Data to Monitor Family Planning Service and Practice in Ten Countries.
  Linnea Zimmerman, Hannah Olson, , Amy Tsui, Scott Radloff.
  Studies in Family Planning. August 28, 2017
  There is no abstract available for this paper.

  August 28, 2017   doi: 10.1111/sifp.12031   open full text
• Reproductive Health and Bodily Integrity in Tanzania.
  Judith Westeneng, Ben D'Exelle.
  Studies in Family Planning. August 10, 2017
  Several policy initiatives support the empowerment of women to improve their reproductive health. Little is known, however, about the inverse effect that reproductive health might have on women's empowerment. Women are pressured to conform to their reproductive role, and an inability to do so might affect their empowerment, including control over their own body. Using a panel dataset of 504 married women in Northern Tanzania, we find that women who experienced a pregnancy loss show more tolerant views of partner violence and that child mortality lowers their perceived control over the sexual relationship with their spouse. The number of living children did not affect bodily integrity. These results confirm that women's bodily integrity is partly dependent on the ability to fulfill their reproductive role. They strengthen the case for policies and programs that improve women's reproductive health and underline the importance of counselling after pregnancy or child loss.

  August 10, 2017   doi: 10.1111/sifp.12029   open full text
• How the Community Shapes Unmet Need for Modern Contraception: An Analysis of 44 Demographic and Health Surveys.
  Nicholas Metheny, Rob Stephenson.
  Studies in Family Planning. July 19, 2017
  Unmet need for modern contraception is a major public health concern in resource‐constrained countries. Recent research supports the application of social‐ecological theories to explain how characteristics of a woman's community shape modern contraception use. However, this research focuses largely on individual countries and uses a limited number of community‐level effects. We fitted three random‐effects logistic regression models to examine associations between 13 community‐level variables and the odds of reporting unmet need, unmet need for spacing, and unmet need for limiting for all parous, female respondents in 44 DHS surveys collected in 2010–2015 (n=528,101). Community variables explain significant variance in unmet need between communities. Associations between community variables and unmet need differ by urban and rural residence. The results highlight several commonalities in how the community shapes unmet need across resource‐constrained settings and may help in designing structural‐level interventions.

  July 19, 2017   doi: 10.1111/sifp.12028   open full text
• Evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI) Program.
  
  Studies in Family Planning. June 16, 2017
  Gaps remain in understanding whether family planning (FP) programs can change urban women's FP behaviors. Even less is known about what works among poor urban women. This article presents results of the impact evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI). Findings are based on recently collected longitudinal data from women and facilities in six cities in Nigeria. Over the four‐year follow‐up period, there was an increase of about ten percentage points in modern method use. Impact evaluation analyses using fixed‐effects regression methods indicate that both demand‐ and supply‐side program activities increased modern method use. Radio, television, community events, and living near program‐enrolled health facilities all significantly increased modern method use or were related to a desire for no more children among all women and among poor women. Results are discussed with an eye toward the design and scale‐up of future family planning programs in urban Nigeria and elsewhere in sub‐Saharan Africa.

  June 16, 2017   doi: 10.1111/sifp.12027   open full text
• Setting Ambitious yet Achievable Targets Using Probabilistic Projections: Meeting Demand for Family Planning.
  Vladimíra Kantorová, Jin Rou New, Ann Biddlecom, Leontine Alkema.
  Studies in Family Planning. May 18, 2017
  In 2015, governments adopted 17 internationally agreed goals to ensure progress and well‐being in the economic, social, and environmental dimensions of sustainable development. These new goals present a challenge for countries to set empirical targets that are ambitious yet achievable and that can account for different starting points and rates of progress. We used probabilistic projections of family planning indicators, based on a global data set and Bayesian hierarchical modeling, to generate illustrative targets at the country level. Targets were defined as the percentage of demand for family planning satisfied with modern contraceptive methods where a country has at least a 10 percent chance of reaching the target by 2030. National targets for 2030 ranged from below 50 percent of demand satisfied with modern contraceptives (for three countries in Africa) to above 90 percent (for 41 countries from all major areas of the world). The probabilistic approach also identified countries for which a global fixed target value of 75 percent demand satisfied was either unambitious or has little chance of achievement. We present the web‐based Family Planning Estimation Tool (FPET) enabling national decision makers to compute and assess targets for meeting family planning demand.

  May 18, 2017   doi: 10.1111/sifp.12025   open full text
• Links Between Education and Age at Marriage among Palestinian Women in Israel: Changes Over Time.
  Maha Sabbah‐Karkaby, Haya Stier.
  Studies in Family Planning. March 01, 2017
  This study focuses on the link between education and marriage timing among Israeli‐Palestinian women. Theoretical discussions on marriage timing center on the effect of the time women spend in educational institutions on their age at marriage, and on the change in the desirable traits of women in the marriage market. But most of these arguments overlook situations where significant changes in education take place alongside retention of traditional patriarchal values. Based on data from three population censuses – in 1983, 1995 and 2008—our results suggest that staying longer in schooling delays marriage, so women with less education are more likely to marry earlier than others. While young age is still considered an important characteristic in the Israeli‐Palestinian marriage market, and women who delay marriage face a greater risk of remaining single, education becomes more important over the years so that postponing marriage becomes especially problematic for low‐educated women. Our findings suggest that traditional norms and structural conditions together shape marriage timing.

  March 01, 2017   doi: 10.1111/sifp.12015   open full text
• The Association Between Unintended Births and Poor Child Development in India: Evidence from a Longitudinal Study.
  Abhishek Singh, Ashish Kumar Upadhyay, Ashish Singh, Kaushalendra Kumar.
  Studies in Family Planning. February 20, 2017
  Evidence on the association between unintended births and poor child development in developing countries is limited. We used data from three waves of the Young Lives study on childhood poverty conducted in Andhra Pradesh in 2002, 2006–07, and 2009 to examine the association between unintended births and poor child development in India. Multivariable linear regression models were used to examine the association between unintended births and four indicators of child development—height‐for‐age Z‐score (HAZ), Peabody Picture Vocabulary Test (PPVT) score, Mathematics Achievement Test (MAT) score, and Early Grade Reading Assessment (EGRA) test score. The Propensity Score Matching (PSM) technique was also used to analyze data. Children who were reported as unintended at birth had significantly lower HAZ, PPVT, and EGRA scores compared with those who were reported as intended. PSM results support the findings from the multivariable linear regressions. Our findings provide evidence on the association between unintended births and poor child development in India. There may be a need to reposition family planning within India's reproductive and child health care programs. Future studies must take into account the unobserved heterogeneity that our study could not address fully.

  February 20, 2017   doi: 10.1111/sifp.12017   open full text
• Integrating Community‐Based Family Planning Services with Local Marine Conservation Initiatives in Southwest Madagascar: Changes in Contraceptive Use and Fertility.
  Laura Robson, Martine Holston, Caroline Savitzky, Vik Mohan.
  Studies in Family Planning. February 16, 2017
  This study assessed changes in contraceptive use and fertility between 2009 and 2013 in the Velondriake locally managed marine area of southwest Madagascar where marine conservation organization Blue Ventures began implementing an integrated health‐environment program in 2007. The proportion of sexually active women aged 15 to 49 years using hormonal contraception and/or condoms during last intercourse increased more than twofold from 25 percent in 2009 to 59 percent in 2013. The number of births in the last 12 months per 1,000 women of reproductive age declined by 28 percent over the same period from 196 in 2009 to 141 in 2013. This program increased access to family planning for previously under‐served communities, leading to uptake of modern contraceptives with an associated decline in fertility. These results suggest that this program has enabled couples to avoid unintended pregnancies, thereby bolstering local marine conservation initiatives.

  February 16, 2017   doi: 10.1111/sifp.12016   open full text
• Unmet Need and Sex: Investigating the Role of Coital Frequency in Fertility Control.
  Suzanne O. Bell, David Bishai.
  Studies in Family Planning. February 01, 2017
  We estimate the relationship between unmet need for contraception and coital frequency using data from the most recent Standard Demographic and Health Surveys conducted from 2005 to 2015. Individual‐level analyses include 55 countries (n=245,732 women). The dependent variable is women's report of any sex in the last four weeks; the independent variable is current unmet need. Bivariate ecological results using country averages indicate that prevalence of unmet need is significantly negatively correlated with the proportion reporting recent sexual activity. Multivariate regression of individual‐level data show that the overall odds ratio of having had sex in the last four weeks is 3.23 and 2.97 for women with met contraceptive need for spacing and limiting fertility, respectively, compared with women with unmet contraceptive need. These results suggest that current estimates of unmet need exaggerate the risk of unintended pregnancy because coital frequency is not uniform with respect to unmet need. Findings also suggest that, despite being categorized as having unmet need, many women may still be taking measures to control their fertility through regulating the tempo of marital coitus, thus reducing their risk of unintended pregnancy.

  February 01, 2017   doi: 10.1111/sifp.12012   open full text
• Recent Trends in Premarital Fertility across Sub‐Saharan Africa.
  Shelley Clark, Alissa Koski, Emily Smith‐Greenaway.
  Studies in Family Planning. January 30, 2017
  The rising age of first marriage across sub‐Saharan Africa over the past 25 years has led many scholars to predict a concurrent increase in premarital childbearing. We examine whether this anticipated increase has materialized using data from 27 countries. Our results reveal considerable heterogeneity. Although levels of premarital fertility have risen by up to 13 percent in recent years in some African countries, other countries have experienced a 7 percent decline. Adolescent premarital childbearing, in particular, has shown marked decline in several countries. Furthermore, although the rising age of marriage exerts clear upward pressure on premarital fertility, decomposition analyses indicate that in half of the countries examined, other factors such as delayed sexual debut and use of contraception counteract this effect. These results temper concerns about the rising numbers of unwed mothers and demonstrate that countries can simultaneously delay marriage and achieve relatively stable, or even declining, levels of premarital childbearing.

  January 30, 2017   doi: 10.1111/sifp.12013   open full text
• Systematic Reviews of Mechanisms for Financing Family Planning: Findings, Implications, and Future Agenda.
  Craig L. Lissner, Moazzam Ali,.
  Studies in Family Planning. December 07, 2016
  The article describes an international collaboration that systematically reviewed the evidence on financing mechanisms for family planning/contraception, assessed the strength of and summarized the evidence, identified research gaps, and proposed a new research agenda to address the gaps. The review found that the evidence base is weak owing to the paucity of studies, diversity in findings, and variations in intervention, study design, and outcome measures. Of more than 17,000 papers reviewed only 38 met the eligibility criteria. A number of general recommendations on the directions and areas of future research can be drawn. There is a strong need for more robust study designs on the effectiveness of financial incentives in family planning.

  December 07, 2016   doi: 10.1111/sifp.12008   open full text
• Community‐Based Financing of Family Planning in Developing Countries: A Systematic Review.
  Mahesh Karra, David Canning, Janice Hu, Moazzam Ali, Craig Lissner.
  Studies in Family Planning. November 28, 2016
  In this systematic review, we gather evidence on community financing schemes and insurance programs for family planning in developing countries, and we assess the impact of these programs on primary outcomes related to contraceptive use. To identify and evaluate the research findings, we adopt a four‐stage review process that employs a weight‐of‐evidence and risk‐of‐bias analytic approach. Out of 19,138 references that were identified, only four studies were included in our final analysis, and only one study was determined to be of high quality. In the four studies, the evidence on the impact of community‐based financing on family planning and fertility outcomes is inconclusive. These limited and mixed findings suggest that either: 1) more high‐quality evidence on community‐based financing for family planning is needed before any conclusions can be made; or 2) community‐based financing for family planning may, in fact, have little or no effect on family planning outcomes.

  November 28, 2016   doi: 10.1111/sifp.12000   open full text
• Conditional and Unconditional Cash Transfers to Improve Use of Contraception in Low and Middle Income Countries: A Systematic Review.
  M. E. Khan, Avishek Hazra, Aastha Kant, Moazzam Ali.
  Studies in Family Planning. November 17, 2016
  This systematic review synthesizes evidence on the impact of conditional and unconditional cash transfers (CCT and UCT) on contraception in low‐ and middle‐income countries. Scientific and gray literature databases were searched from 1994 to 2016 and 11 papers from ten studies were included. Most of the studies had low risk of bias. Cash transfers were used for increasing school attendance or improving health and nutrition, but not directly for contraception. Three studies showed positive impact on contraceptive use and four showed a decrease in fertility outcomes. An increase in childbearing was observed in two studies, and three studies demonstrated no impact on fertility indicators. All studies treated contraceptive use or fertility only as unintended and indirect outcomes. The available evidence on impact of CCT and UCT on contraception is inconclusive due to the limited number of studies, varying outcome measures, and lack of intervention specifically for contraception.

  November 17, 2016   doi: 10.1111/sifp.12004   open full text
• Family Planning Vouchers in Low and Middle Income Countries: A Systematic Review.
  Ben Bellows, Carol Bulaya, Sophie Inambwae, Craig L. Lissner, Moazzam Ali, Ashish Bajracharya.
  Studies in Family Planning. November 17, 2016
  Family planning (FP) vouchers have targeted subsidies to disadvantaged populations for quality reproductive health services since the 1960s. To summarize the effect of FP voucher programs in low‐ and middle‐income countries, a systematic review was conducted, screening studies from 33 databases through three phases: keyword search, title and abstract review, and full text review. Sixteen articles were selected including randomized control trials, controlled before‐and‐after, interrupted time series analyses, cohort, and before‐and‐after studies. Twenty‐three study outcomes were clustered around contraceptive uptake, with study outcomes including fertility in the early studies and equity and discontinuation in more recent publications. Research gaps include measures of FP quality, unintended outcomes, clients’ qualitative experiences, FP voucher integration with health systems, and issues related to scale‐up of the voucher approach.

  November 17, 2016   doi: 10.1111/sifp.12006   open full text
• How User Fees Influence Contraception in Low and Middle Income Countries: A Systematic Review.
  Catherine Korachais, Elodie Macouillard, Bruno Meessen.
  Studies in Family Planning. November 17, 2016
  Accessible and quality reproductive health services are critical for low‐ and middle‐income countries (LMICs). After a decade of waning investment in family planning, interest and funding are growing once again. This article assesses whether introducing, removing, or changing user fees for contraception has an effect on contraceptive use. We conducted a search of 14 international databases. We included randomized controlled trials, interrupted‐time series analyses, controlled before‐and‐after study designs, and cohort studies that reported contraception‐related variables as an outcome and a change in the price of contraceptives as an intervention. Four studies were eligible but none was at low risk of bias overall. Most of these, as well as other studies not included in the present research, found that demand for contraception was not cost‐sensitive. We could draw no robust summary of evidence, strongly suggesting that further research in this area is needed.

  November 17, 2016   doi: 10.1111/sifp.12005   open full text
• Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review.
  Claire Blacklock, Ekelechi MacPepple, Setor Kunutsor, Sophie Witter.
  Studies in Family Planning. November 17, 2016
  Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted.

  November 17, 2016   doi: 10.1111/sifp.12001   open full text
• Counseling Women and Couples on Family Planning: A Randomized Study in Jordan.
  Marianne El‐Khoury, Rebecca Thornton, Minki Chatterji, Sarah Kamhawi, Phoebe Sloane, Mays Halassa.
  Studies in Family Planning. September 09, 2016
  This article evaluates the effects of involving men in family planning counseling in Jordan using a randomized experiment. We randomly assigned a sample of 1,247 married women to receive women‐only counseling, couples counseling, or no counseling. We measured the effects of each type of counseling on family planning use, knowledge, attitudes, and spousal communication about family planning. Compared to no counseling, couples counseling led to a 54 percent increase in uptake of modern methods. This effect is not significantly different from the 46 percent increase in modern method uptake as a result of women‐only counseling. This outcome may be due, in part, to lower rates of compliance with the intervention among those assigned to couples counseling compared to women‐only counseling. To realize the possible added benefits of involving men, more tailored approaches may be needed to increase men's participation.

  September 09, 2016   doi: 10.1111/sifp.69   open full text
• Child Wanted and When? Fertility Intentions, Wantedness, and Child Survival in Rural Northern Ghana.
  Ayaga A. Bawah, Patrick O. Asuming, Cornelius Debpuur, James F. Phillips.
  Studies in Family Planning. September 05, 2016
  Panel survey data collected in rural northern Ghana asked women about the “wantedness” status of their children. Parous women were asked whether they wanted more children, while those who had never had a child were asked whether they wanted to have children in the future; those who said that they did not want to have any more children in the future were asked whether they wanted to become pregnant when they last became pregnant and, if so, whether they wanted to become pregnant at the time, or would have preferred to be pregnant earlier or later. This article analyzes longitudinal responses to these questions over a 10‐year period. Birth and survival histories of subsequently born children linked to preference data permit investigation of the question: are “wanted” children more likely to survive than “unwanted” children? Hazard models are estimated to determine whether children born to women who indicated that they did not want to have a child at the time they did, or did not want any more children in the future, have a higher risk of mortality relative to children who were reported wanted at the time of pregnancy. Results show no significant differences in adjusted mortality risks between children who were reported to be wanted and those reported to be unwanted.

  September 05, 2016   doi: 10.1111/sifp.67   open full text
• Capturing Complexities of Relationship‐Level Family Planning Trajectories in Malawi.
  Hannah E. Furnas.
  Studies in Family Planning. August 12, 2016
  In a transitioning fertility climate, preferences and decisions surrounding family planning are constantly in flux. Malawi provides an ideal case study of family planning complexities as fertility preferences are flexible, the relationship context is unstable, and childbearing begins early. I use intensive longitudinal data from Tsogolo la Thanzi—a research project in Malawi that follows young adults in romantic partnerships through the course of their relationship. I examine two questions: (1) What are the typical patterns of family planning as young adults transition through a relationship? (2) How are family planning trajectories related to individual and relationship‐level characteristics? I use sequence analysis to order family planning across time and to contextualize it within each relationship. I generate and cluster the family planning trajectories and find six distinct groups of young adults who engage in family planning in similar ways. I find that family planning is complex, dynamic, and unique to each relationship. I argue that (a) family planning research should use the relationship as the unit of analysis and (b) family planning behaviors and preferences should be sequenced over time for a better understanding of key concepts, such as unmet need.

  August 12, 2016   doi: 10.1111/j.1728-4465.2016.00064.x   open full text
• Determinants of Quality of Family Planning Counseling among Private Health Facilities in Lagos.
  Doug Johnson, Jorge Ugaz.
  Studies in Family Planning. August 02, 2016
  We use a unique dataset that includes an objective measure of the quality of family planning counseling from 927 private health facilities in Lagos State, Nigeria, to determine which variables at the facility and provider levels are most closely correlated with the quality of family planning counseling. Our data on quality come from mystery client surveys in which the clients posed as women seeking family planning counseling. We find that quality is strongly associated with the cadre of provider, with doctors delivering substantially higher‐quality counselling than nurses. Doctors not only outperform nurses overall, but also perform better on each category of quality and spend nearly three minutes longer on average counseling the mystery client. Location, fees charged for the service, and facility type are also strongly correlated with quality. The degree to which a facility specializes in family planning and facility size are only weakly predictive of quality.

  August 02, 2016   doi: 10.1111/j.1728-4465.2016.00063.x   open full text
• Is Induced Abortion Really Declining in Armenia?
  Ann Jilozian, Victor Agadjanian.
  Studies in Family Planning. June 10, 2016
  As in other post‐Soviet settings, induced abortion has been widely used in Armenia. However, recent national survey data point to a substantial drop in abortion rates with no commensurate increase in modern contraceptive prevalence and no change in fertility levels. We use data from in‐depth interviews with women of reproductive age and health providers in rural Armenia to explore possible underreporting of both contraceptive use and abortion. While we find no evidence that women understate their use of modern contraception, the analysis suggests that induced abortion might indeed be underreported. The potential for underreporting is particularly high for sex‐selective abortions, for which there is growing public backlash, and medical abortion, a practice that is typically self‐administered outside any professional supervision. Possible underreporting of induced abortion calls for refinement of both abortion registration and relevant survey instruments. Better measurement of abortion dynamics is necessary for successful promotion of effective modern contraceptive methods and reduction of unsafe abortion practices.

  June 10, 2016   doi: 10.1111/j.1728-4465.2016.00053.x   open full text
• Measuring Access to Family Planning: Conceptual Frameworks and DHS Data.
  Yoonjoung Choi, Madeleine Short Fabic, Jacob Adetunji.
  Studies in Family Planning. June 10, 2016
  Expanding access to family planning (FP) is a driving aim of global and national FP efforts. The definition and measurement of access, however, remain nebulous, largely due to complexity. This article aims to bring clarity to the measurement of FP access. First, we synthesize key access elements for measurement by reviewing three well‐known frameworks. We then assess the extent to which the Demographic and Health Surveys (DHS)—a widely used data source for FP programs and research—has information to measure these elements. We finally examine barriers to access by element, using the latest DHS data from four countries in sub‐Saharan Africa. We discuss opportunities and limitations in the measurement of access, the importance of careful interpretation of data from population‐based surveys, and recommendations for collecting and using data to better measure access.

  June 10, 2016   doi: 10.1111/j.1728-4465.2016.00059.x   open full text
• Empowering Adolescent Girls in Socially Conservative Settings: Impacts and Lessons Learned from the Ishraq Program in Rural Upper Egypt.
  Maia Sieverding, Asmaa Elbadawy.
  Studies in Family Planning. June 10, 2016
  In rural Upper Egypt, adolescence is a critical period in girls’ transition to adulthood during which they are at risk for a number of negative outcomes, including restricted mobility and early marriage and childbearing. This study evaluates and presents lessons learned from Ishraq, an educational program that established safe spaces for out‐of‐school adolescent girls in rural Upper Egypt. Baseline and endline surveys were administered to all households containing an eligible girl in the program areas. We analyze the predictors of program enrollment and dropout and use difference‐in‐differences estimation to evaluate the impact of the program on participants as compared to non‐participating eligible girls. Although we find positive impacts on literacy, attitudes toward sports, and reproductive health knowledge, little impact was found on broader indicators of empowerment, and no impact on the attitudes of participants’ mothers or brothers. The experience of the Ishraq program highlights several key challenges facing safe spaces programs for adolescent girls, including targeting of a dispersed population with restricted mobility, reaching girls at a young age, achieving community‐level attitudinal change, and the need for long‐term follow‐up of participants to measure behavioral change.

  June 10, 2016   doi: 10.1111/j.1728-4465.2016.00061.x   open full text
• Abortion Legalization and Childbearing in Mexico.
  Edith Y. Gutiérrez Vázquez, Emilio A. Parrado.
  Studies in Family Planning. June 10, 2016
  In 2007 abortion was legalized in the Federal District of Mexico, making it the largest jurisdiction in Latin America, outside of Cuba, to allow women to have abortions on request during the first trimester of pregnancy. While the implications of the law for women's health and maternal mortality have been investigated, its potential association with fertility behavior has yet to be assessed. We examine metropolitan‐area differences in overall and parity‐specific childbearing, as well as the age pattern of childbearing between 2000 and 2010 to identify the contribution of abortion legalization to fertility in Mexico. Our statistical specification applies difference‐in‐difference regression methods that control for concomitant changes in other socioeconomic predictors of fertility to assess the differential influence of the law across age groups. In addition, we account for prior fertility levels and change to better separate the effect of the law from preceding trends. Overall, the evidence suggests a systematic association between abortion legalization and fertility. The law appears to have contributed to lower fertility in Mexico City compared to other metropolitan areas and prior trends. The influence is mostly visible among women aged 20–34 in connection with the transition to first and second child, with limited impact on teenage fertility. There is some evidence that its effect might be diffusing to the Greater Mexico City Metropolitan area.

  June 10, 2016   doi: 10.1111/j.1728-4465.2016.00060.x   open full text
• Emergency Contraception in Post‐Conflict Somalia: An Assessment of Awareness and Perceptions of Need.
  Faduma Gure, Mohammed Koshin Dahir, Marian Yusuf, Angel M. Foster.
  Studies in Family Planning. March 30, 2016
  In conflict‐affected settings such as Somalia, emergency contraception (EC) has the potential to serve as an important means of pregnancy prevention. Yet Somalia remains one of the few countries without a registered progestin‐only EC pill. In 2014, we conducted a qualitative, multi‐methods study in Mogadishu to explore awareness of and perceptions of need for EC. Our project included 10 semi‐structured key informant interviews, 20 structured in‐person interviews with pharmacists, and four focus group discussions with married and unmarried Somali women. Our findings reveal a widespread lack of knowledge of both existing family planning methods and EC. However, once we described EC, participants expressed enthusiasm for expanding access to post‐coital contraception. Our results shed light on why Somalia continues to be a global exception with respect to an EC product and suggest possible politically and culturally acceptable and effective avenues for introducing EC into the health system.

  March 30, 2016   doi: 10.1111/j.1728-4465.2016.00047.x   open full text
• Respondents’ Exposure to Community‐based Services and Reported Fertility‐Regulation Behavior: A Decade of Data from the Navrongo Community Health and Family Planning Project.
  Elizabeth F. Jackson, Ayaga A. Bawah, John E. Williams, James F. Phillips.
  Studies in Family Planning. March 30, 2016
  This article examines a decade of demographic surveillance data from rural northern Ghana linked with prospective panel survey data recording respondents’ reported fertility‐regulation behavior. We assess the impact of access to community‐based contraceptive services, reported fertility‐regulation behavior, and their interaction on the risk of a conception that results in a birth. The effects of service exposure differ by marital status. Reported use of any method to delay or avoid pregnancy appears to be more effective in reducing the risk of conception among the unmarried in areas offering community‐based contraceptive services, relative to those in areas where services are facility based. Among both married and unmarried survey respondents who state that they are not using contraception, the risk of conception is lower among women in areas with community‐based services than among women in communities without these services. The lower risk of conception among women who are receiving community‐based services and who report that they are regulating their fertility may be due to increased efficacy and duration of fertility regulation. Among women who report that they are not regulating their fertility, under‐reporting of contraceptive use in experimental areas is likely to play a role in explaining these findings.

  March 30, 2016   doi: 10.1111/j.1728-4465.2016.00049.x   open full text
• Instability in Parent–Child Coresidence and Adolescent Development in Urban South Africa.
  Letícia J. Marteleto, Shannon Cavanagh, Kate Prickett, Shelley Clark.
  Studies in Family Planning. March 30, 2016
  There is widespread recognition of the importance of family stability for child development. South Africa presents an interesting context in which to study the consequences of family instability because of the traditionally fluid nature of household composition due to labor migration, child fostering, and non‐marital fertility. More recently, the HIV pandemic has added another source of instability. Within South Africa, however, patterns of instability differ markedly across racial groups. We use the Cape Area Panel Study (CAPS) data to examine the implications of changes in parent–child coresidence for educational and sexual development of young South Africans. We show that changes in maternal and paternal coresidence have implications for the timing of sexual initiation for both black and coloured adolescents. Maternal and paternal transitions also lead to poorer educational outcomes for coloured adolescents, but parental disruptions are not significantly related to educational outcomes for blacks. These findings suggest that the implications of coresidential instability vary by race, reflecting racial differences with respect to cultural, social, and economic conditions.

  March 30, 2016   doi: 10.1111/j.1728-4465.2016.00048.x   open full text
• Myths and Misinformation: An Analysis of Text Messages Sent to a Sexual and Reproductive Health Q&A Service in Nigeria.
  Ann K. Blanc, Kimberly Glazer, Uju Ofomata‐Aderemi, Fadekemi Akinfaderin‐Agarau.
  Studies in Family Planning. March 08, 2016
  The almost 50 million young people aged 10–24 in Nigeria face many challenges to their sexual and reproductive health (SRH). MyQuestion is a platform that allows young people to ask SRH questions via text message. Trained counselors provide responses using a database of answers to frequently asked questions or customized replies. We analyze the content of more than 300,000 text messages received by the service since 2007 to address three questions: which health topics are most frequently submitted to the MyQuestion service; what kinds of questions are asked about these topics; and what language is used to convey the questions? We find a substantial unmet need for basic SRH information, with users’ questions communicated in ways that convey considerable confusion, misinformation, and urgency. The analysis can be used to improve similar Q&A services and to improve the provision of SRH services for young people more generally.

  March 08, 2016   doi: 10.1111/j.1728-4465.2016.00046.x   open full text
• Effects of the 2010 Haiti Earthquake on Women's Reproductive Health.
  Julia Andrea Behrman, Abigail Weitzman.
  Studies in Family Planning. March 08, 2016
  This article explores the effects of the 2010 Haiti earthquake on women's reproductive health, using geocoded data from the 2005 and 2012 Haiti Demographic and Health Surveys. We use geographic variation in the destructiveness of the earthquake to conduct a difference‐in‐difference analysis. Results indicate that heightened earthquake intensity reduced use of injectables—the most widely used modern contraceptive method in Haiti—and increased current pregnancy and current unwanted pregnancy. Analysis of impact pathways suggests that severe earthquake intensity significantly increased women's unmet need for family planning and reduced their access to condoms. The earthquake also affected other factors that influence reproductive health, including women's ability to negotiate condom use in their partnerships. Our findings highlight how disruptions to health care services following a natural disaster can have negative consequences for women's reproductive health.

  March 08, 2016   doi: 10.1111/j.1728-4465.2016.00045.x   open full text
• Emergency Contraceptive Knowledge and Use among Urban Women in Nigeria and Kenya.
  Gwendolyn Morgan, Jill Keesbury, Ilene Speizer.
  Studies in Family Planning. March 10, 2014
  Rates of emergency contraceptive (EC) use in sub‐Saharan Africa are highest in Kenya and Nigeria, although little is known about user characteristics and use dynamics in these countries. To better meet women's emergency contraceptive needs and to contribute to the limited knowledge base regarding this method in Africa, this study examines data from a sample of EC users drawn from a large, representative household survey that included sexually experienced women in urban Kenya and Nigeria. Bivariate and multivariate analyses reveal greater knowledge of EC among these urban women than was reported in other nationally representative surveys. Recent users of EC were more likely to be in their 20s, unmarried, and more highly educated than never users or ever users of EC in both countries. Results contradict public perceptions of EC users as young adolescents and indicate the importance of strengthening EC provision in Africa, including targeting information and services to unmarried women and supporting private pharmacies in delivering quality services.

  March 10, 2014   doi: 10.1111/j.1728-4465.2014.00376.x   open full text
• Using Biomarkers to Assess the Validity of Sexual Behavior Reporting across Interview Modes among Young Women in Kampala, Uganda.
  Christine A. Kelly, Paul C. Hewett, Barbara S. Mensch, Johanna C. Rankin, Samuel L. Nsobya, Samuel Kalibala, Pamela N. Kakande.
  Studies in Family Planning. March 10, 2014
  Understanding the transmission dynamics of HIV and other sexually transmitted infections is critically dependent on accurate behavioral data. This study investigates the effect of the mode of questionnaire delivery on the quality of sexual behavior reporting in a 2010 survey conducted in Kampala, Uganda, among 18–24‐year‐old women. We compare the reported prevalence of five sexual outcomes across three interview modes: traditional face‐to‐face interviewing (FTFI) in which question rewording was permitted, FTFI administered via computer‐assisted personal interviewing (CAPI) in which questions were read as written, and audio computer‐assisted self‐interviewing (ACASI) in which participants listened to prerecorded questions and entered responses using a computer touchscreen. We then assess the validity of the data by evaluating the reporting of sexual experience against three biological markers. Results suggest that ACASI elicits higher reporting of some key indicators than FTFI does, but self‐reports from all interview modes were subject to validity concerns when compared with biomarker data. The study highlights the important role that biomarkers can play in sexual behavior research.

  March 10, 2014   doi: 10.1111/j.1728-4465.2014.00375.x   open full text
• Development and Validation of a Reproductive Autonomy Scale.
  Ushma D. Upadhyay, Shari L. Dworkin, Tracy A. Weitz, Diana Greene Foster.
  Studies in Family Planning. March 10, 2014
  No validated measures are currently available to assess women's ability to achieve their reproductive intentions, also referred to as “reproductive autonomy.” We developed and validated a multidimensional instrument that can measure reproductive autonomy. We generated a pool of 26 items and included them in a survey that was conducted among 1,892 women at 13 family planning and 6 abortion facilities in the United States. Fourteen items were selected through factor analysis and grouped into 3 subscales to form a Reproductive Autonomy Scale: freedom from coercion; communication; and decision‐making. Construct validity was demonstrated by a mixed‐effects model in which the freedom from coercion subscale and the communication subscale were inversely associated with unprotected sex in the past three months. This new Reproductive Autonomy Scale offers researchers a reliable instrument with which to assess a woman's power to control matters regarding contraceptive use, pregnancy, and childbearing, and to evaluate interventions to increase women's autonomy domestically and globally.

  March 10, 2014   doi: 10.1111/j.1728-4465.2014.00374.x   open full text
• Voluntary, Human Rights–Based Family Planning: A Conceptual Framework.
  Karen Hardee, Jan Kumar, Karen Newman, Lynn Bakamjian, Shannon Harris, Mariela Rodríguez, Win Brown.
  Studies in Family Planning. March 10, 2014
  At the 2012 Family Planning Summit in London, world leaders committed to providing effective family planning information and services to 120 million additional women and girls by the year 2020. Amid positive response, some expressed concern that the numeric goal could signal a retreat from the human rights–centered approach that underpinned the 1994 International Conference on Population and Development. Achieving the FP2020 goal will take concerted and coordinated efforts among diverse stakeholders and a new programmatic approach supported by the public health and human rights communities. This article presents a new conceptual framework designed to serve as a path toward fulfilling the FP2020 goal. This new unifying framework, which incorporates human rights laws and principles within family‐planning‐program and quality‐of‐care frameworks, brings what have been parallel lines of thought together in one construct to make human rights issues related to family planning practical.

  March 10, 2014   doi: 10.1111/j.1728-4465.2014.00373.x   open full text
• Ethiopia 2011 DHS.
  
  Studies in Family Planning. May 29, 2013
  There is no abstract available for this paper.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00355.x   open full text
• Cameroon 2011 DHS.
  
  Studies in Family Planning. May 29, 2013
  There is no abstract available for this paper.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00354.x   open full text
• Assessing the Quality of Data Regarding Use of the Lactational Amenorrhea Method.
  Madeleine Short Fabic, Yoonjoung Choi.
  Studies in Family Planning. May 29, 2013
  This study assesses the quality of Demographic and Health Survey (DHS) data regarding self‐reported current use of the lactational amenorrhea method (LAM). LAM is an important modern contraceptive method that, when practiced correctly, has a 98 percent effectiveness rate six‐months postpartum. The objectives of this study are to examine the accuracy of self‐reported LAM use, compared with the constructed correct‐practice variable, and to explore differentials in accuracy measures by characteristics at the individual and survey level by analyzing data from 73 DHSs conducted in 45 countries between 1998 and 2011. Findings reveal that only 26 percent of reported LAM users meet the criteria for correct LAM practice. We discuss the implications for future DHS data collection and for family planning and maternal and child health programming.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00353.x   open full text
• Estimates of Female Genital Mutilation/Cutting in 27 African Countries and Yemen.
  P. Stanley Yoder, Shanxiao Wang, Elise Johansen.
  Studies in Family Planning. May 29, 2013
  The practice of female genital mutilation/cutting (FGM/C) has been documented in many countries in Africa and in several countries in Asia and the Middle East, yet producing reliable data concerning its prevalence and the numbers of girls and women affected has proved a major challenge. This study provides estimates of the total number of women aged 15 years and older who have undergone FGM/C in 27 African countries and Yemen. Drawing on national population‐based survey data regarding FGM/C prevalence and census data regarding the number of women in each country, we find that almost 87 million girls and women aged 15 and older have been cut in these 28 countries. Producing reliable figures for the number of women affected by FGM/C in these countries allows researchers and program directors to better comprehend the impact of the practice and to mobilize resources for advocacy against it.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00352.x   open full text
• Individual‐ and School‐Level Correlates of HIV Testing among Secondary School Students in Kenya.
  Eric Y. Tenkorang, Eleanor Maticka‐Tyndale.
  Studies in Family Planning. May 29, 2013
  The policy framework guiding Kenya's response to the AIDS epidemic identifies voluntary counseling and testing as crucial to risk reduction and HIV‐preventive activities. Yet in Kenya, as in most sub‐Saharan countries, voluntary testing rates are low, especially among young people. Using hierarchical linear models, we identify both individual‐ and teacher/school‐level factors that affect voluntary HIV testing among secondary school students in Kenya. Results indicate that adolescents are more likely to test for HIV serostatus when they are knowledgeable about testing, have been involved in HIV/AIDS activities in primary school, have been provided with HIV information in secondary school, perceive themselves as at high risk of contracting HIV or know of someone infected with or who has died from HIV/AIDS, and have ever engaged in sexual intercourse. Barriers include fear of going to testing centers and being perceived as HIV‐positive. Teacher/school‐level characteristics are relevant for explaining rates of HIV testing, especially among girls. To encourage testing, policymakers should attend to teacher/school‐level factors as well as individual characteristics of students.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00351.x   open full text
• The Influence of Older Classmates on Adolescent Sexual Behavior in Cape Town, South Africa.
  David Lam, Letícia J. Marteleto, Vimal Ranchhod.
  Studies in Family Planning. May 29, 2013
  This study examines the influence of exposure to older within‐grade peers on sexual behavior among students in urban South Africa. Data are drawn from the Cape Area Panel Study, a longitudinal survey of young people conducted in metropolitan Cape Town from 2002 to 2006. The combination of early sexual debut, high rates of school enrollment into the late teens, and grade repetition create an environment in which young people who progress through school ahead of many in their cohort interact with classmates who may be several years older. We construct a measure of cumulative exposure to classmates who are at least two years older and show that such exposure is statistically significantly associated with early sexual initiation among adolescent girls. This exposure also increases the age difference between these girls and their first sexual partner, and helps explain a significant proportion of the earlier sexual debut of African girls, compared with colored and white girls in Cape Town.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00350.x   open full text
• Timing of Orphanhood, Early Sexual Debut, and Early Marriage in Four Sub‐Saharan African Countries.
  Sophia Chae.
  Studies in Family Planning. May 29, 2013
  According to a growing body of literature, some orphans are at heightened risk of early sexual debut and early marriage. This study examines a rarely explored aspect of orphanhood: the timing and type of parental death and their relationship to these outcomes. The study also explores whether education mediates orphans' risk of early sexual initiation and early marriage. The data are drawn from the 2004 National Survey of Adolescents, which includes interviews with 12–19‐year‐old adolescents in Burkina Faso, Ghana, Malawi, and Uganda. Results from discrete‐time event history analysis indicate that female double orphans, regardless of timing of orphanhood, have greater odds of early sexual debut than do nonorphans. Education explains little of their increased risk. In contrast, male orphans of any type reveal no increased vulnerability to early sexual debut. Uganda is the only country where female orphans, specifically double orphans and those who are paternal orphans before age 10, have greater odds of early marriage, with education accounting for a small portion of the risk.

  May 29, 2013   doi: 10.1111/j.1728-4465.2013.00349.x   open full text