Analysis of the impact of sexual and reproductive health interventions, and determination of factors influencing the uptake of long-acting reversible contraceptives among young people in Zimbabwe

Chipako, Isaac and Hollingsworth, Bruce and Singhal, Saurabh (2024) Analysis of the impact of sexual and reproductive health interventions, and determination of factors influencing the uptake of long-acting reversible contraceptives among young people in Zimbabwe. PhD thesis, Lancaster University.

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Abstract

Analysis of the impact of sexual and reproductive health interventions, and determination of factors influencing the uptake of long-acting reversible contraceptives among young people in Zimbabwe. Isaac Chipako According to the United Nations, sexual and reproductive health (SRH) problems account for about 20% of the worldwide disease burden. Despite increased attention to family planning in Africa, unmet need is still high among adolescents and young people, who comprise more than 20% of the population. Over the years, many sub-Saharan African countries, including Zimbabwe, have implemented family planning programs. However, there is a paucity of information on the impact of these interventions on SRH outcomes. Targeting young people, this study was aimed at identifying the SRH interventions implemented in sub-Saharan Arica, and then Zimbabwe in particular, and their impact on SRH outcomes. Firstly, through a scoping review: community-based programs, mHealth, SRH education, counselling, community health workers, youth friendly health services, economic support and mass media interventions were found to have positive effects on SRH outcomes. Secondly, using regression and difference-in-differences analysis, when implementing the Zimbabwean Adolescent Sexual and Reproductive Health (ASRH) strategy, increased program intensity was found to have no impact on SRH outcomes. Thirdly, the study explored the socio-economic factors associated with long-acting reversible contraceptives (LARCs) uptake among young women. Multinomial logistic regression modelling showed that women with tertiary education, living with children, highest wealth class status, and/or no desire to have more children, had increased likelihood of LARCs usage. Generally, SRH interventions have a positive impact on SRH outcomes in Sub-Saharan Africa. However, in Zimbabwe, increased ASRH program intensity had no impact on SRH outcomes, implying that more resources alone do not necessarily result in improved outcomes. Additionally, the study established that LARCs usage is rising among young women, with a potential to increase their uptake by addressing the socioeconomic and demographic predictors of their use. The findings could guide the designing of future SRH strategies aimed at improving SRH services access and utilization by young women.