UCSF

Objective

To evaluate construct validity of the contraception-focused "Preference-aligned Fertility Management" (PFM) Index, a new person-centered and rights-based outcome measure, in Nigeria and Uganda.

Study design

We analyzed survey data from convenience samples of new users of contraception and non-users of contraception in Uganda and users of contraception in Nigeria. PFM Index scores were calculated by combining two indicators: Indicator 1 assessing alignment between desire to use contraception and actual use; Indicator 2 evaluating whether users' current methods are desired. We developed a nomological network of related constructs and conducted bivariable logistic regressions, predicting odds of PFM associated with each variable.

Results

71.3% of contraception users in Nigeria, 99.2% of new users in Uganda, and 42.9% of non-users in Uganda were practicing contraception-focused PFM. In Nigeria, high Women's and Girls' Empowerment in Sexual and Reproductive Health Index scores and permission to visit a health center were significantly associated with higher odds of contraception-focused PFM (OR=2.72; 95%CI=1.01-7.31, OR=2.64; 95%CI=1.04-6.73, respectively). In Uganda, women's and partner's secondary school education were significantly associated with higher odds of contraception-focused PFM (OR=2.58; 95%CI=1.58-4.24, 2.01; 95%CI=1.54-2.62, respectively); as were concordance with partner's desired number of children, recent experience of gender-based violence, and satisfaction with what (if anything) one is doing to prevent pregnancy (OR=1.48; 95%CI=1.30-1.69, OR=2.33; 95%CI=1.52-3.56, OR=4.44; 95%CI=2.77-7.12, respectively).

Conclusions

The contraception-focused PFM Index demonstrated construct validity in Nigeria and Uganda. PFM and other new measures of self-defined need contribute to the paradigm shift underway to align contraception indicators with human rights principles.