Sabu S Padmadas1, Fiifi Amoako Johnson2, Tiziana Leone3, Govinda P Dahal4. 1. Department of Social Statistics and Demography, Centre for Global Health, Population, Poverty and Policy (GHP3), Faculty of Social & Human Sciences, University of Southampton, Southampton, United Kingdom. Electronic address: S.Padmadas@soton.ac.uk. 2. Department of Social Statistics and Demography, Centre for Global Health, Population, Poverty and Policy (GHP3), Faculty of Social & Human Sciences, University of Southampton, Southampton, United Kingdom. 3. Department of Social Policy, LSE Health, London School of Economics and Political Sciences, London, United Kingdom. 4. Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy. STUDY DESIGN: A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages. RESULTS: The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21-2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters. CONCLUSION: Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning. IMPLICATIONS: Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.
BACKGROUND: Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy. STUDY DESIGN: A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages. RESULTS: The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21-2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters. CONCLUSION: Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning. IMPLICATIONS: Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.
Authors: Joris Adriaan Frank van Loenhout; Tefera Darge Delbiso; Shailvi Gupta; Kapendra Amatya; Adam L Kushner; Julita Gil Cuesta; Debarati Guha-Sapir Journal: BMC Health Serv Res Date: 2017-01-23 Impact factor: 2.655