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OBJECTIVE: To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. METHODS: The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. FINDINGS: The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. CONCLUSION: Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries.

Objective To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. Methods The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African-countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. Findings The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Conclusion Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries. Objectif Etudier l'utilisation de la contraception dans 13 pays d'Afrique subsaharienne, evaluer les changements dans la satisfaction des besoins en matiere de contraception par rapport aux inegalites liees a la richesse, et decrire la relation existant entre l'utilisation des methodes contraceptives long terme eta court terme, ainsi que les intentions d'une femme en matiere de fecondite par rapport a la prosperite de son foyer. Methodes L'analyse a ete realisee a partir des donnees de I'enquete demographique et sanitaire menee dans 13 pays d'Afrique subsaharienne. Les inegalites liees a la richesse et ayant un effet sur le recours a la contraception ont ete calculees a partir des indices de richesse des menages et des indices de concentration. Des modeles de regression logistique ont ete adaptes pour relieter la probabilite d'utilisation d'une methode contraceptive a long terme, avec les ajustements suivants: le quintile d'indice de richesse, rintention de fecondite (espacer les naissances ou arreter toute procreation), le domicile (urbain/rural), l'education, le nombre d'enfants en vie, la situation familiale et l'annee de l'enquete. Resultats Le recours a la contraception a considerablement augmente entre les enquetes menees en Ethiopie, a Madagascar, au Mozambique, en Namibie et en Zambie, mais il a legerement diminue au Kenya, au Senegal et en Ouganda. Les inegalites liees a la richesse dans la satisfaction des besoins en matiere de contraception ont decru dans la plupart des pays, notamment au Mozambique, mais elles ont augmente au Kenya, en Ouganda et en Zambie en matiere d'espacement des naissances, et au Malawi, en Ouganda, en Republique-Unie de Tanzanie, au Senegal, et en Zambie en matiere de limitation du nombre de grossesses. Apres rajustement de l'intention de fecondite, les femmes appartenant au quintile le plus riche avaient une plus grande probabilite de pratiquer une contraception a long terme que celles appartenant au quintile le plus pauvre. Conclusion Les programmes de planification familiale en Afrique subsaharienne presentent differents degres de succes pour atteindre tousles segments de la societe, toutefois des inegalites persistent et ce, dans tousles pays. Objetivo Analizar el uso de anticonceptivos en 13 paises del Africa subsahariana, evaluar los cambios en las necesidades de anticoncepcion cubiertas en relacion con una distribucion desigual de la riqueza y describir la relacion existente entre el uso de metodos anticonceptivos (comparando el uso a largo y corto plazo) y las intenciones de embarazo de una mujer en funcion del nivel economico de la unidad domestica. Metodos El analisis se realizo empleando los datos de una encuesta sobre salud y datos demograficos procedentes de 13 paises del Africa subsahariana. Se calcularon las desigualdades en el uso de metodos anticonceptivos relacionadas con el nivel economico, empleando los indices de concentracion y de economia de la unidad familiar. Respecto a la probabilidad de emplear un metodo anticonceptivo a largo plazo, se adaptaron modelos logisticos de regresion con ajustes del quintil de ingresos, la intencion de embarazo (espaciar los nacimientos frente a dejar de tener hijos), la residencia (urbana/rural), la educacion, el numero de hijos vivos, el estado civil y el ano de la encuesta. Resultados El uso de metodos anticonceptivos ha aumentado considerablemente entre las encuestas de Etiopia, Madagascar, Mozambique, Namibia y Zambia, si bien ha registrado un ligero descenso en Kenya, Senegal y Uganda. Las desigualdades de tipo economico a la hora de cubrir la necesidad de utilizar metodos anticonceptivos han disminuido en la mayoria de los paises, especialmente en Mozambique, pero han aumentado en Kenya, Uganda y Zambia en relacion al espaciamiento de los embarazos, yen Malawi, Republica flnida de Tanzania, Senegal, Uganda y Zambia respecto a la reduccion de la maternidad. Tras realizar el ajuste de la intencion de embarazo, era mas probable que las mujeres que se encontraban en el quintil mas rico emplearan un metodo anticonceptivo a largo plazo que las mujeres que se situaron en el quintil mas pobre. Conclusion Los programas de planificacion familiar en el Africa subsahariana surten efecto de manera irregular en todos los segmentos de la sociedad, si bien las desigualdades persisten en todos los paises., Introduction Global health has improved considerably over the last four decades, but everywhere the health status of the poor compares unfavourably with that of the more affluent sectors of society. [...]

Problem Governments and donors encourage the integration of family planning into voluntary testing and counselling (VGT) services. We aimed to determine if clients of VCT services have a need for and will accept quality family planning services. Approach 'Voluntary HIV counselling and testing integrated with contraceptive services' is a proof-of-concept study that interviewed 4019 VCT clients before the addition of family planning services, and 4027 different clients after family planning services were introduced. Clients attended eight public VGT facilities in the Oromia region, Ethiopia. The intervention had four components: development of family planning counselling messages for VCT clients, VCT provider training, contraceptive supply provision and monitoring. Local setting Ethiopia's population of 80 million is increasing rapidly at an annual rate of 2.5%. Contraceptive prevalence is only 15%. The estimated adult HIV prevalence rate is 2.1%, with more than 1.1 million people infected. The number of VCT facilities increased from 23 in 2001 to more than 1000 in 2007, and the number of HIV tests taken doubled from 1.7 million tests in 2007 to 3.5 million in 2008. Relevant changes Clients interviewed after the introduction of family planning services received significantly more family planning counselling and accepted significantly more contraceptives than those clients served before the intervention. However, three-quarters of the clients were not sexually active. Of those clients who were sexually active, 70% were using contraceptives. Lessons learned The study demonstrated that family planning can be integrated into VCT clinics. However, policy-makers and programme managers should carefully consider the characteristics and reproductive health needs of target populations when making decisions about service integration. Problematique Les Etats et les donateurs encouragent l'integration des services de planification familiale a ceux de conseil et de depistage volontaire (CDV). Nous nous sommes efforces de determiner si les clients des services de CDV avaient besoin de services de planification familiale de qualite et s'ils les accepteraient. Demarche Le concept d'integration des services de conseil et de depistage volontaire et des services de contraception a ete soumis a une etude de validite, dans le cadre de laquelle on a interroge 4019 clients de services de CDV avant l'adjonction des services de planification familiale et 4027 autres clients apres l'introduction de ces services. Les clients avaient consulte huit centres publics de CDV de la region d'Oromia, en Ethiopie. L'intervention comprenait quatre composantes : mise au point de messages apportant des conseils en matiere de planification familiale aux clients des services de CDV, formation des prestateurs de services de CDV, fourniture de moyens contraceptifs et surveillance. Contexte local La population ethiopienne de 80 millions d'habitants augmente rapidement, avec un taux de croissance annuel de 2,5 %. La prevalence de la contraception n'est que de 15 %. Le taux de prevalence du VIH chez les adultes est estime a 2,1%, avec plus de 1,1 million de personnes infectees. Le nombre d'unites delivrant des services de CDV est passe de 23 en 2001 a plus de 1000 en 2007 et le nombre de tests de depistage du VIH effectues a double entre 2007 et 2008, passant de 1,7 millions a 3,5 millions. Modifications pertinentes Les clients interroges apres l'introduction des services de planification familiale avaient recu notablement plus de conseils de planification familiale et avaient accepte nettement plus de contraceptifs que ceux servis avant l'intervention. Cependant, les trois-quarts de ces clients n'etaient pas sexuellement actifs Parmi les clients sexuellement actifs, 70 % utilisaient des moyens contraceptifs. Enseignements tires Cette etude a demontre que les services de planification familiale pouvaient etre integres dans les dispensaires proposant des services de CDV. Neanmoins, les decideurs politiques et les gestionnaires de programmes devraient etudier soigneusement les caracteristiques et les besoins en matiere de sante genesique des populations visees Iors de la prise de decisions concernant l'integration de ces services. Problema Los gobiernos y los donantes promueven la integracion de la planificacion familiar en los servicios de asesoramiento y pruebas voluntarias (APV) del VIH. Decidimos determinar si los usuarios de los servicios de APV tienen necesidad de servicios de planificacion familiar de calidad y si los aceptarian. Enfoque <> es un estudio demostrativo preliminar en el que se entrevisto a 4019 usuarios de APV antes de la inclusion de los servicios de planificacion familiar, y a 4027 usuarios diferentes despues de introducir dichos servicios. Se trata de usuarios que acudieron a ocho servicios publicos de APV de la region de Oromia, Etiopia. La intervencion comprendia cuatro componentes: elaboracion de consejos de planificacion familiar para los usuarios de APV, capacitacion de los proveedores de APV, suministro de anticonceptivos y seguimiento. Contexto local La poblacion de Etiopia asciende a 80 millones de habitantes y esta aumentando rapidamente a un ritmo anual del 2,5%. La prevalencia de uso de anticonceptivos es solo del 15%. La prevalencia de la infeccion por VIH en adultos es del 2,1%, con mas de 1,1 millones de personas infectadas. El numero de servicios de APV aumento de 23 en 2001 a mas de 1000 en 2007, y el numero de pruebas del VIH realizadas se duplico, pasando de 1,7 millones en 2007 a 3,5 millones en 2008. Cambios destacables Los usuarios entrevistados tras la introduccion de los servicios de planificacion familiar habian recibido significativamente mas consejos de planificacion familiar y aceptado significativamente mas anticonceptivos que los atendidos antes de la intervencion. Sin embargo, tres de cada cuatro usuarios no eran sexualmente activos. Entre los usuarios sexualmente activos, el 70% estaban utilizando anticonceptivos. Ensenanzas extraidas El estudio demostro que es posible integrar la planificacion familiar en los consultorios de APV. No obstante, los planificadores de politicas y los gestores de programas deberian analizar detenidamente las caracteristicas y las necesidades de salud reproductiva de las poblaciones destinatarias en su toma de decisiones sobre la integracion de los servicios. [TEXT NOT REPRODUCIBLE IN ASCII], Introduction Voluntary counselling and testing (VCT) is a core part of HIV/AIDS prevention and treatment programmes. Because both VCT and family planning programmes help clients avoid unwanted consequences of their [...]

PROBLEM: Governments and donors encourage the integration of family planning into voluntary testing and counselling (VCT) services. We aimed to determine if clients of VCT services have a need for and will accept quality family planning services. APPROACH: "Voluntary HIV counselling and testing integrated with contraceptive services" is a proof-of-concept study that interviewed 4019 VCT clients before the addition of family planning services and 4027 different clients after family planning services were introduced. Clients attended eight public VCT facilities in the Oromia region, Ethiopia. The intervention had four components: development of family planning counselling messages for VCT clients, VCT provider training, contraceptive supply provision and monitoring. LOCAL SETTING: Ethiopia's population of 80 million is increasing rapidly at an annual rate of 2.5%. Contraceptive prevalence is only 15%. The estimated adult HIV prevalence rate is 2.1%, with more than 1.1 million people infected. The number of VCT facilities increased from 23 in 2001 to more than 1000 in 2007, and the number of HIV tests taken doubled from 1.7 million tests in 2007 to 3.5 million in 2008. RELEVANT CHANGES: Clients interviewed after the introduction of family planning services received significantly more family planning counselling and accepted significantly more contraceptives than those clients served before the intervention. However, three-quarters of the clients were not sexually active. Of those clients who were sexually active, 70% were using contraceptives. LESSONS LEARNED: The study demonstrated that family planning can be integrated into VCT clinics. However, policy-makers and programme managers should carefully consider the characteristics and reproductive health needs of target populations when making decisions about service integration.