SRHR Evidence (Best practice, Systematic reviews)

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https://hdl.handle.net/20.500.14041/27

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    Protocol to assess bottlenecks inhibiting the scaling up of evidence-based family planning practices in low-income and middle-income countries using mixed methods
    (BMJ Open, 2024-11-28) Kabra, Rita; Church, Kathryn; Allagh, Komal Preet; Saad, Abdulmumin; Ali, Moazzam; Steyn, Petrus; Kiarie, James
    Introduction: Scaling up evidence-based practices (EBPs) in family planning (FP), as recommended by the WHO, has increasingly been accepted by global health actors as core to their mission, goals and activities. National policies, strategies, guidance, training materials, political commitment and donor support exist in many countries to adopt and scale up a range of EBPs, including postpregnancy FP, task sharing for FP and the promotion of social and behaviour change (SBC) for FP. While there has been some success in implementing these practices, coverage remains inadequate in many countries. To gain a better understanding of the factors that may be hindering the sustained scale-up of these interventions, WHO has developed an assessment protocol to systematically identify the health systems’ ‘bottlenecks’ to implementation and to then identify solutions and develop strategies to address them. Methods and analysis: A mixed method approach that includes document review, secondary data analysis (from surveys, service delivery data and case studies) and key informant interviews with policymakers, programme managers, health providers and community groups will be used to identify bottlenecks. This will be followed by a workshop to prioritise bottlenecks and characterise their root causes. Finally, solutions for the root causes of prioritised bottlenecks will be proposed. The protocol is structured in a modular format, with separate modules on postpregnancy FP, task sharing and SBC. Assessment themes and questions are informed by a wide body of literature on the three programmatic components, as well as studies on health policy implementation and scale-up. Ethics and dissemination: The protocol was exempt from ethical review by the WHO ethics committee. The findings of the bottleneck analysis will be presented at local, national and international conferences and disseminated through peer-reviewed publications and webinars.
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    Contraceptive equity: insights from the progress in 48 FP2030 countries
    (The Lancet Global Health, 2025-01-01) Habib, Ndema; Ali, Moazzam
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    Progress in reducing socioeconomic inequalities in the use of modern contraceptives in 48 focus countries as part of the FP2030 initiative between 1990 and 2020: a population-based analysis
    (The Lancet Global Health, 2025-01-01) Cardona, Carolina; Rusatira, Jean Christophe; Salmeron, Carolina; Martinez-Baack, Michelle; Rimon, Jose G; Anglewicz, Philip; Ahmed, Saifuddin
    Background: Despite increases in modern contraception use, socioeconomic inequalities in family planning persist. In this study, we aimed to measure progress in reducing socioeconomic inequalities in modern contraceptive prevalence rate (mCPR) and demand for family planning satisfied by modern methods (mDFPS) in 48 countries as part of the Family Planning 2030 (FP2030) initiative between 1990 and 2020 for which Demographic and Health Survey data were available. Methods: We analysed two rounds of Demographic and Health Survey data per country. Changes in concentration indices between two survey rounds were compared to measure reductions in overall socioeconomic-related inequalities in modern contraceptive use. Poisson regression models were used to measure the adjusted average annual rate of change across wealth quintiles. Findings: In this population-based analysis study, all countries reduced socioeconomic-related inequalities in modern contraceptive use among in-union women of reproductive age (15-49 years) during the observed 30-year period. On average, mCPR increased at an annual rate of 2·1% (95% CI 2·1-2·2), and the rate of increase for the poorest women was 3·1% (3·0-3·2), which outpaced the rate of increase for the richest women of 1·3% (1·3-1·4%). The pattern of progress was similar for mDFPS, but at a slower pace. Overall, levels of mCPR and mDFPS increased, and socioeconomic-related inequalities were reduced during this period. Interpretation: Substantial progress has been made in reducing socioeconomic-related inequalities in family planning across the 48 studied countries, which account for 86% of the population of the 82 FP2030 initiative countries. During the past three decades, poorer women have seen greater improvements in modern contraceptive use and demand satisfaction compared with richer women. As contraceptive prevalence rates are near their maximum, it is crucial to ensure marginalised and vulnerable groups are not left behind. Funding: Bill & Melinda Gates Foundation. Translations: For the French and Spanish translations of the abstract see Supplementary Materials section.
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    A meta-analysis into the mediatory effects of family planning utilization on complications of pregnancy in women of reproductive age
    (PLoS One, 2024-03-18) Jahanfar, Shayesteh; Maurer, Olivia; Lapidow, Amy; Oberoi, Anjali Rajkumari; Steinfeldt, Meredith; Ali, Moazzam
    Background: Despite conflicting findings in the current literature regarding the correlation between contraceptives and maternal health consequences, statistical analyses indicate that family planning may decrease the occurrence of such outcomes. Consequently, it is crucial to assess the capability of family planning to mitigate adverse maternal health outcomes. Objectives: This review investigates the effects of modern contraceptive use on maternal health. Search methods: This systematic review is registered on Prospero (CRD42022332783). We searched numerous databases with an upper date limit of February 2022 and no geographical boundaries. Selection criteria: We included observational studies, including cross-sectional, cohort, case-control studies, and non-RCT with a comparison group. We excluded systematic reviews, scoping reviews, narrative reviews, and meta-analyses from the body of this review. Main results: The review included nineteen studies, with five studies reporting a reduction in maternal mortality linked to increased access to family planning resources and contraceptive use. Another three studies examined the impact of contraception on the risk of preeclampsia and our analysis found that preeclampsia risk was lower by approximately 6% among contraceptive users (95% CI 0.82-1.13) compared to non-users. Two studies assessed the effect of hormonal contraceptives on postpartum glucose tolerance and found that low-androgen contraception was associated with a reduced risk of gestational diabetes (OR 0.84, 95% CI 0.58-1.22), while DMPA injection was possibly linked to a higher risk of falling glucose status postpartum (OR 1.42, 95% CI 0.85-2.36). Two studies evaluated high-risk pregnancies and births in contraceptive users versus non-users, with the risk ratio being 30% lower among contraceptive users of any form (95% CI 0.61, 0.80). None of these results were statistically significant except the latter. In terms of adverse maternal health outcomes, certain contraceptives were found to be associated with ectopic pregnancy and pregnancy-related venous thromboembolism through additional analysis.
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    Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis
    (BMJ Sexual & Reproductive Health, 2024-07-12) Lassi, Zohra S; Rahim, Komal Abdul; Stavropoulos, Alexandra Maria; Ryan, Lareesa Marie; Tyagi, Jyoti; Adewale, Bisi; Kurji, Jaameeta; Bhaumik, Soumyadeep; Meherali, Salima; Ali, Moazzam
    Introduction: The evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women. Methods: We ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4. Results: Forty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment. Conclusions: Empowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.