Addressing socio-cultural barriers to improve contraceptive use in Ethiopia

Addressing socio-cultural barriers to improve... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/14-442" }, "headline": "Addressing socio-cultural barriers to improve contraceptive use in Ethiopia", "datePublished": "2025-04-16T10:59:50", "dateModified": "2025-06-17T16:08:03", "author": [ { "@type": "Person", "name": "Tadesse Shiferaw Chekol" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "Ethiopia encounters significant socio-cultural barriers to contraceptive use, affecting maternal health, poverty reduction, and women's empowerment. With a fertility rate of 4.6 children per woman and only 25.9% of women of reproductive age intending to use contraceptives, significant challenges remain. This policy brief analyzes data from the 2016 Ethiopian Demographic and Health Survey (EDHS) and 2019 Mini-EDHS, revealing key barriers such as fatalistic beliefs, religious prohibitions, postpartum amenorrhea, and spousal opposition. Socioeconomic factors, including wealth, literacy, and urban residency, greatly influence contraceptive use. Multivariable and structural equation modeling underscore the complex interplay of cultural norms, economic status, and individual autonomy in shaping contraceptive behavior. The brief recommends culturally tailored education programs, male engagement strategies, targeted interventions for underserved regions, and enhanced healthcare systems to improve contraceptive uptake. Implementing these evidence-based policies is essential for improving reproductive health and empowering women in Ethiopia." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-442/v1", "name": "Addressing socio-cultural barriers to improve contraceptive use in..." } } ] } Home Browse Addressing socio-cultural barriers to improve contraceptive use in... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Chekol TS. Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.12688/f1000research.163555.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Policy Brief Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] Tadesse Shiferaw Chekol https://orcid.org/0009-0008-6950-3008 Tadesse Shiferaw Chekol https://orcid.org/0009-0008-6950-3008 PUBLISHED 16 Apr 2025 Author details Author details One Health, Armauer Hansen Research Institute, Addis Ababa, 10005, Ethiopia Tadesse Shiferaw Chekol Roles: Conceptualization, Formal Analysis, Methodology, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Sociology of Health gateway. Abstract Ethiopia encounters significant socio-cultural barriers to contraceptive use, affecting maternal health, poverty reduction, and women's empowerment. With a fertility rate of 4.6 children per woman and only 25.9% of women of reproductive age intending to use contraceptives, significant challenges remain. This policy brief analyzes data from the 2016 Ethiopian Demographic and Health Survey (EDHS) and 2019 Mini-EDHS, revealing key barriers such as fatalistic beliefs, religious prohibitions, postpartum amenorrhea, and spousal opposition. Socioeconomic factors, including wealth, literacy, and urban residency, greatly influence contraceptive use. Multivariable and structural equation modeling underscore the complex interplay of cultural norms, economic status, and individual autonomy in shaping contraceptive behavior. The brief recommends culturally tailored education programs, male engagement strategies, targeted interventions for underserved regions, and enhanced healthcare systems to improve contraceptive uptake. Implementing these evidence-based policies is essential for improving reproductive health and empowering women in Ethiopia. READ ALL READ LESS Keywords Contraceptive use, socio-cultural barriers, Ethiopia Corresponding Author(s) Tadesse Shiferaw Chekol ( [email protected] ) Close Corresponding author: Tadesse Shiferaw Chekol Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Chekol TS. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Chekol TS. Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.12688/f1000research.163555.1 ) First published: 16 Apr 2025, 14 :442 ( https://doi.org/10.12688/f1000research.163555.1 ) Latest published: 17 Jun 2025, 14 :442 ( https://doi.org/10.12688/f1000research.163555.2 )  There is a newer version of this article available. Suppress this message for one day. Background Ethiopia faces significant challenges related to contraceptive use. This has far-reaching implications for maternal health, poverty reduction, and women's empowerment. The country has a high fertility rate of 4.6 children per woman, which contributes to high maternal mortality and poverty, stemming from limited contraceptive uptake. 1 Only 25.9% of women of reproductive age use or intend to use contraceptives. 2 This indicates that there is a high predictor of unmet need for family planning services, with a large majority (74.1%) do not use contraceptives. 3 , 4 Several socio-cultural barriers and misconceptions contribute to this low contraceptive use. 5 , 6 , 7 These include fatalistic beliefs, religious prohibitions, postpartum amenorrhea, spousal opposition, and concerns about side effects. 8 Factors such as wealth status, literacy, urban residency, husband's education level, and regional disparities also play a role in influencing contraceptive use and intentions. 9 Regional disparities are evident, with significantly lower contraceptive use in regions like Somalia and Afar compared to Addis Ababa. 10 Addressing these multifaceted barriers through culturally sensitive policies is crucial for improving reproductive health outcomes and empowering women in Ethiopia. 11 Therefore, implementing socially acceptable and culturally sensitive strategies will increase contraceptive uptake, improve maternal health, and overall socio-economic development in Ethiopia. 12 Key findings Data analyzed from both the 2016 EDHS and 2019 Mini-EDHS indicate that there is a low prevalence of contraceptive use intention among women of reproductive age (WRA). Only 25.9% of WRA reported intending to use contraceptives, while the majority (74.1%) did not use them. Among those not intending to use contraceptives, key reasons included fatalistic beliefs (19%), postpartum amenorrhea (14%), and religious prohibition (10%). Multivariable analysis revealed several factors significantly associated with contraceptive use. Wealth status was a strong predictor; women in the richest wealth quintile were more likely to use contraceptives compared to the poorest (AOR = 3.61, 95% CI: 2.79-4.64). Literacy also played a significant role, with women able to read whole sentences having higher odds of contraceptive use than those with no education (AOR = 1.66, 95% CI; 1.31-2.11). Conversely, women whose husbands desired more children were less likely to use contraceptives (AOR = 0.81, 95% CI; 0.70-0.93), and rural women had lower odds of contraceptive use compared to urban women (AOR = 0.47, 95% CI; 0.37-0.60). The Structural Equation Model (SEM) analysis further elucidated the direct and indirect effects of various factors on contraceptive use and intention. The analysis demonstrated a direct negative effect of fatalism, breastfeeding, husband opposition, postpartum amenorrhea, and education on contraceptive use and intention. Specifically, the direct effect of fatalism on contraceptive use and intention was (AOR = -0.050, P = 0.019). Education also had a direct negative effect (AOR = -0.091, P < 0.0001) on contraceptive use and intention. Furthermore, the SEM revealed that religious prohibition indirectly influences contraceptive use through its effect on fatalism. Religion has a direct negative effect on fatalism (AOR = -0.243, P < 0.0001). Overall, the SEM highlights the complex interplay between socio-cultural factors like religious beliefs and individual factors like education in shaping contraceptive behavior in Ethiopia. Policy outcomes and implications This policy brief aims to address the socio-cultural and economic barriers affecting contraceptive use in Ethiopia. By analyzing data from national health surveys, the study identifies key obstacles and proposes evidence-based interventions. The findings highlight the urgent need for policy adjustments to improve reproductive health outcomes and promote gender equity. The research methods include a comprehensive review of demographic health surveys, multivariable analysis and structural equation modeling to understand the interplay between socio-cultural norms, economic status, and contraceptive use. The policy implications suggest that without targeted interventions, contraceptive uptake will remain low, exacerbating maternal health risks and gender inequality. A call for evidence-based strategies to enhance contraceptive uptake in Ethiopia Based on our analysis of the 2016 EDHS, and 2019 Mini-EDHS data, we contend that significant policy adjustments are essential to address the persistent challenges in contraceptive use and intention within Ethiopia. Our findings highlight a concerningly low prevalence of contraceptive use intention among women of reproductive age (WRA) and reveal a complex interplay of socio-cultural, economic, and individual factors that impede effective family planning. To translate these research insights into tangible improvements in reproductive health outcomes, we strongly advocate for the following evidence-based policy strategies. Our research underscores the profound influence of socio-cultural norms and beliefs on contraceptive behavior. Therefore, we emphasize the need for health education programs meticulously tailored to address specific cultural contexts. Interventions should focus on dispelling prevalent misconceptions about contraception, providing accurate information about its benefits, and addressing barriers such as fatalistic beliefs and religious prohibitions through strategic engagement with community and religious leaders. We assert that empowering women is paramount to improving contraceptive uptake. Policies should prioritize initiatives that enhance women's access to education and economic opportunities, thereby increasing their autonomy in family planning decision-making. Addressing gender inequalities must be a central focus, as our data indicates that these inequalities significantly constrain women's ability to make informed reproductive choices. Our findings also highlight the crucial role of male partners in contraceptive decision-making. We therefore recommend policies that actively promote male involvement in family planning. Interventions should target men to address their misconceptions, foster open communication within couples, and encourage shared responsibility in family planning. We stress the importance of tailored interventions for specific populations that exhibit low contraceptive use. This includes targeted strategies for regions such as Somali and Afar, which demonstrate significantly lower utilization rates. These interventions must be culturally sensitive, address region-specific barriers, and ensure that family planning services are accessible and appropriate for the unique needs of these communities. We also emphasize the need for focused efforts to reach women in rural areas and those from lower socioeconomic backgrounds, who face disproportionate challenges in accessing and utilizing contraceptives. We underscore the need for a robust and accessible health system to support contraceptive uptake. This includes ensuring a reliable need-based supply chain for contraceptives, providing comprehensive training for healthcare providers, and expanding service delivery points, particularly in underserved areas. Community health workers and mobile clinics are essential tools to extend services to remote populations and overcome geographical barriers. To ensure accountability and effectiveness of policy interventions, we advocate for the establishment of rigorous data monitoring and evaluation systems. This includes systematic data collection on contraceptive use, reasons for non-use, and associated factors, with disaggregation by key variables such as age, education, wealth, and region. Such data will enable policymakers to track progress, identify areas requiring further attention, and make evidence-based adjustments to interventions. In conclusion, we firmly believe that the implementation of these evidence-driven policy recommendations is critical to achieving meaningful improvements in contraceptive uptake, reducing unintended pregnancies, and ultimately enhancing the health and well-being of women and families across Ethiopia. Actionable recommendations To address these challenges, a comprehensive, community-based approach to family planning is essential. Culturally tailored education programs should be implemented to dispel myths and provide accurate information about contraceptive methods, ensuring that individuals have the knowledge needed to make informed reproductive choices. These educational initiatives should be delivered through schools, media, and community outreach programs to effectively reach diverse audiences. Moreover, male engagement strategies must be developed to encourage men's active participation in family planning decisions, fostering shared responsibility between partners. Programs that promote couple-based counseling, peer-led discussions, and positive role modeling can help shift traditional gender norms that often place the burden of contraception solely on women. In addition, community-based interventions should be strengthened, particularly in underserved and rural regions where access to contraceptive services remains limited. Leveraging local health workers and community leaders can facilitate discussions, offer contraceptive counseling, and improve access to family planning services. By incorporating trusted figures within communities, resistance to modern contraceptive methods can be reduced, and acceptance can be increased. At the same time, the healthcare system must be enhanced by ensuring a reliable supply chain for various contraceptive options and integrating family planning services into primary healthcare. This includes training healthcare providers to offer client-centered counseling and expanding service delivery points through mobile clinics and pharmacies. This could be done mainly through revitalizing the existing Health Extension program that has played a great role in the health system. Strengthening supply chain management will help address stockouts and ensure that contraceptives remain consistently available to those who need them. Furthermore, policy advocacy efforts should be intensified to support legislative reforms and secure increased funding for reproductive health programs. Engaging policymakers and stakeholders in prioritizing family planning within national health agendas will create a supportive environment for expanding contraceptive access. Legislative reforms that address structural barriers, along with sustained financial investments, will be crucial for long-term success. Conclusion, and Call to Action The findings derived from the 2016 EDHS, and 2019 mini-EDHS data provide a critical foundation for reshaping family planning strategies in Ethiopia. Our analysis points to the urgent need to move beyond generalized approaches and embrace a nuanced understanding of the socio-cultural dynamics that shape contraceptive behavior. To achieve meaningful progress, we must prioritize interventions that not only address access and availability but also directly confront the deep-seated beliefs and norms that hinder contraceptive uptake. Therefore, we issue a call for a paradigm shift in family planning programming. This shift entails a commitment to sustained, community-driven initiatives that foster open dialogue, challenge harmful norms, and empower individuals to make informed reproductive choices. It demands a collaborative effort involving policymakers, researchers, healthcare providers, and community stakeholders working together to translate research insights into actionable strategies. The time for incremental change has passed; a bold and transformative approach is essential to improve contraceptive prevalence, enhance reproductive health, and secure a healthier future for Ethiopia. Ethical approval and consent to participate The consent to participate was obtained from the research participants during the original data collection process. The Ethiopian Public Health Institute (EPHI) institution's research ethics review committee has provided ethical approval. The original data were collected in confirmation of international and national ethical guidelines. The purpose of the current analysis was sent to the DHS organization, and permission to download and use the data was obtained from the DHS organization. Consent for publication Consent for publication was not applicable as this study does not contain identifiable patient data. Author’s contribution The corresponding author led the conceptualization, design, and analysis of this study, and was responsible for drafting, revising, and finalizing the manuscript. Availability of data and materials The specific DHS datasets used in this analysis are available from the DHS Program website: DHS Program . Details regarding the particular survey and files used can be provided upon request. All the necessary information is required for a reader or reviewer to access the data by the same means as the authors. Acknowledgment The authors would like to acknowledge the Demographic and Health Survey (DHS) program for providing access to data. Special thanks go to policymakers, healthcare professionals, and community leaders who continuously work toward improving contraceptive services in Ethiopia. References 1. Ethiopia Mini Demographic and Health Survey report in 2019. 2. Gahungu J, et al. : The Unmet Needs for Modern Family Planning Methods Among Postpartum Women in Sub-Saharan Africa. BMC Reproductive Health. 2021; 18 : 35. PubMed Abstract | Publisher Full Text | Free Full Text 3. Mulugeta SS, et al. : Reason and Associated Factors for Nonuse of Contraceptives Among Ethiopian Rural Married Women. SAGE Open Nursing. 2023; 9 . PubMed Abstract | Publisher Full Text | Free Full Text 4. Tareke AA, et al. : Trends and Predictors of Unmet Need for Family Planning in Ethiopia. PLoS One. 2021. 5. Roy N, et al. : Prevalence and Factors Associated with Family Planning During COVID-19 Pandemic in Bangladesh. PLoS One. 2021; 16 : e0257634. PubMed Abstract | Publisher Full Text | Free Full Text 6. Tigabu S, et al. : Socioeconomic and Religious Differentials in Contraceptive Uptake in Western Ethiopia. BMC Womens Health. 2018; 18 : 85. PubMed Abstract | Publisher Full Text | Free Full Text 7. Shitu K, et al. : Individual and Community-Level Determinants of Contraceptive Use in Ethiopia. medRxiv 2022. 8. Bekele D, et al. : Contraceptive Prevalence Rate and Associated Factors Among Reproductive Age Women in Ethiopia. BMC Womens Health. 2022; 6 . Publisher Full Text 9. Ethiopian Demographic and Health Survey (EDHS) 2016. 10. Ethiopian Federal Ministry of Health, Health Sector Transformation Plan (HSTP) 2016–2020. 11. Kantorová V, et al. : Estimating Progress Towards Meeting Women’s Contraceptive Needs in 185 Countries. PLoS Med. 2020; 17 : e1003026. PubMed Abstract | Publisher Full Text | Free Full Text 12. The Reproductive health and economic growth: Investing in family planning for sustainable development. World Bank; 2019. Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 16 Apr 2025 ADD YOUR COMMENT Comment Author details Author details One Health, Armauer Hansen Research Institute, Addis Ababa, 10005, Ethiopia Tadesse Shiferaw Chekol Roles: Conceptualization, Formal Analysis, Methodology, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 17 Jun 2025, 14:442 https://doi.org/10.12688/f1000research.163555.2 version 1 Published: 16 Apr 2025, 14:442 https://doi.org/10.12688/f1000research.163555.1 Copyright © 2025 Chekol TS. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Chekol TS. Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.12688/f1000research.163555.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 16 Apr 2025 Views 0 Cite How to cite this report: Maretalinia M. Reviewer Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.179927.r383831 ) The direct URL for this report is: https://f1000research.com/articles/14-442/v1#referee-response-383831 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 May 2025 Maretalinia Maretalinia , Mahidol University, Salaya, Nakhon Pathom, Thailand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.179927.r383831 Abstract: The abstract does not adequately reflect the content of the full manuscript. It should summarize not only the study findings but also highlight the policy relevance and the broader context of socio-cultural barriers. As this manuscript ... Continue reading READ ALL Abstract: The abstract does not adequately reflect the content of the full manuscript. It should summarize not only the study findings but also highlight the policy relevance and the broader context of socio-cultural barriers. As this manuscript is submitted as a policy brief, the abstract must be reframed to present a concise synthesis of existing knowledge, stakeholder perspectives, and implications for policy and practice. Background: The background section lacks clarity on the key stakeholders involved in this issue. It is important to specify whether ethnic group leaders, religious leaders, or community figures play influential roles in shaping contraceptive use. Furthermore, there is no mention of existing literature discussing cultural or religious prohibitions against contraception in Ethiopia. Given that this is a policy brief, a broader foundation of literature—including national policy documents, religious doctrines, and cultural narratives—should be integrated to support the analysis. Key Findings: This section resembles the structure and content of a research article, focusing on original data, statistical analysis, and odds ratios. However, in a policy brief, the key findings should summarize insights drawn from a synthesis of existing literature, policies, and stakeholder inputs. For example, referencing religious or ethnic group guidelines, or summarizing community attitudes documented in prior studies, would provide a stronger foundation for policy analysis. Policy Outcomes and Implications: The policy outcomes and implications section is underdeveloped. It primarily reiterates research findings without offering clear or actionable policy directions. Recommendations should be explicitly stated and linked to relevant stakeholders, such as ethnic leaders, religious authorities, and frontline health workers. Since community beliefs and norms are deeply embedded in social structures, proposed interventions must emphasize education, information dissemination, and communication strategies that actively engage these stakeholders. This would ensure culturally sensitive and community-supported policy implementation Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Partly Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Multivariate analysis, women of reproductive age health, contraceptive use, longitudinal study I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Maretalinia M. Reviewer Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.179927.r383831 ) The direct URL for this report is: https://f1000research.com/articles/14-442/v1#referee-response-383831 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 17 Jun 2025 Tadesse Shiferaw Chekol , One Health, Armauer Hansen Research Institute, Addis Ababa, 10005, Ethiopia 17 Jun 2025 Author Response Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving ... Continue reading Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving it with reservations. Your comments have been invaluable in refining the clarity, relevance, and policy orientation of the manuscript. Below, I address each of your comments point-by-point and describe the corresponding revisions made to the manuscript. 1. Abstract: Reframing to Reflect Policy Brief Format Thank you for this important observation. I have revised the abstract to align with the expectations of a policy brief. The new abstract provides a concise synthesis of key findings, contextual socio-cultural barriers, stakeholder perspectives, and clear policy implications. It now emphasizes the broader public health and gender equity context, as well as the relevance of the findings to national development and health policy. 2. Background: Clarity on Stakeholders and Broader Literature I appreciate this insightful recommendation. The background section has been expanded to specify the influential roles played by religious leaders, ethnic elders, and community figures in shaping reproductive behaviors. I have also integrated references to relevant literature and national policy documents, as well as cultural and religious narratives that contribute to contraceptive use dynamics in Ethiopia. These additions enhance the foundation for the policy analysis that follows. 3. Key Findings: Synthesis Over Statistical Detail Thank you for this helpful clarification. I have revised the "Key Findings" section to reflect a broader synthesis of insights from national surveys, literature, and community-level narratives, rather than emphasizing statistical outputs. While relevant data from the EDHS have been retained to ground the findings, they are now discussed in a narrative, policy-relevant format. Technical terms such as odds ratios have been removed to improve readability and accessibility for general policy audiences. 4. Policy Outcomes and Implications: Specific, Action-Oriented Recommendations This comment is well taken. I have significantly revised the “Policy Outcomes and Implications” section to include specific, actionable recommendations. These now clearly identify and target relevant stakeholders, such as religious leaders, ethnic elders, health extension workers, and community influencers. The recommendations emphasize culturally grounded education campaigns, male engagement, gender empowerment strategies, and improved health system support. I have also included examples of communication strategies and stakeholder engagement mechanisms to support effective policy implementation. General Assessment Questions Thank you for Q1. I am pleased that the manuscript was found to be accessible to a broad readership. In response to Q2, I have expanded the discussion of implications by integrating current literature on socio-cultural influences on family planning in Ethiopia. Citations now include religious perspectives, local cultural norms, and policy frameworks relevant to reproductive For Q3, I have revised the recommendations to ensure they are directly aligned with the identified barriers and are presented in a clear and balanced manner. Each recommendation is now justified by the findings and supported by current evidence. Once again, I thank you for your valuable comments, which have significantly enhanced the policy relevance and practical utility of the manuscript. Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving it with reservations. Your comments have been invaluable in refining the clarity, relevance, and policy orientation of the manuscript. Below, I address each of your comments point-by-point and describe the corresponding revisions made to the manuscript. 1. Abstract: Reframing to Reflect Policy Brief Format Thank you for this important observation. I have revised the abstract to align with the expectations of a policy brief. The new abstract provides a concise synthesis of key findings, contextual socio-cultural barriers, stakeholder perspectives, and clear policy implications. It now emphasizes the broader public health and gender equity context, as well as the relevance of the findings to national development and health policy. 2. Background: Clarity on Stakeholders and Broader Literature I appreciate this insightful recommendation. The background section has been expanded to specify the influential roles played by religious leaders, ethnic elders, and community figures in shaping reproductive behaviors. I have also integrated references to relevant literature and national policy documents, as well as cultural and religious narratives that contribute to contraceptive use dynamics in Ethiopia. These additions enhance the foundation for the policy analysis that follows. 3. Key Findings: Synthesis Over Statistical Detail Thank you for this helpful clarification. I have revised the "Key Findings" section to reflect a broader synthesis of insights from national surveys, literature, and community-level narratives, rather than emphasizing statistical outputs. While relevant data from the EDHS have been retained to ground the findings, they are now discussed in a narrative, policy-relevant format. Technical terms such as odds ratios have been removed to improve readability and accessibility for general policy audiences. 4. Policy Outcomes and Implications: Specific, Action-Oriented Recommendations This comment is well taken. I have significantly revised the “Policy Outcomes and Implications” section to include specific, actionable recommendations. These now clearly identify and target relevant stakeholders, such as religious leaders, ethnic elders, health extension workers, and community influencers. The recommendations emphasize culturally grounded education campaigns, male engagement, gender empowerment strategies, and improved health system support. I have also included examples of communication strategies and stakeholder engagement mechanisms to support effective policy implementation. General Assessment Questions Thank you for Q1. I am pleased that the manuscript was found to be accessible to a broad readership. In response to Q2, I have expanded the discussion of implications by integrating current literature on socio-cultural influences on family planning in Ethiopia. Citations now include religious perspectives, local cultural norms, and policy frameworks relevant to reproductive For Q3, I have revised the recommendations to ensure they are directly aligned with the identified barriers and are presented in a clear and balanced manner. Each recommendation is now justified by the findings and supported by current evidence. Once again, I thank you for your valuable comments, which have significantly enhanced the policy relevance and practical utility of the manuscript. Competing Interests: We declare that we do not have any competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 17 Jun 2025 Tadesse Shiferaw Chekol , One Health, Armauer Hansen Research Institute, Addis Ababa, 10005, Ethiopia 17 Jun 2025 Author Response Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving ... Continue reading Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving it with reservations. Your comments have been invaluable in refining the clarity, relevance, and policy orientation of the manuscript. Below, I address each of your comments point-by-point and describe the corresponding revisions made to the manuscript. 1. Abstract: Reframing to Reflect Policy Brief Format Thank you for this important observation. I have revised the abstract to align with the expectations of a policy brief. The new abstract provides a concise synthesis of key findings, contextual socio-cultural barriers, stakeholder perspectives, and clear policy implications. It now emphasizes the broader public health and gender equity context, as well as the relevance of the findings to national development and health policy. 2. Background: Clarity on Stakeholders and Broader Literature I appreciate this insightful recommendation. The background section has been expanded to specify the influential roles played by religious leaders, ethnic elders, and community figures in shaping reproductive behaviors. I have also integrated references to relevant literature and national policy documents, as well as cultural and religious narratives that contribute to contraceptive use dynamics in Ethiopia. These additions enhance the foundation for the policy analysis that follows. 3. Key Findings: Synthesis Over Statistical Detail Thank you for this helpful clarification. I have revised the "Key Findings" section to reflect a broader synthesis of insights from national surveys, literature, and community-level narratives, rather than emphasizing statistical outputs. While relevant data from the EDHS have been retained to ground the findings, they are now discussed in a narrative, policy-relevant format. Technical terms such as odds ratios have been removed to improve readability and accessibility for general policy audiences. 4. Policy Outcomes and Implications: Specific, Action-Oriented Recommendations This comment is well taken. I have significantly revised the “Policy Outcomes and Implications” section to include specific, actionable recommendations. These now clearly identify and target relevant stakeholders, such as religious leaders, ethnic elders, health extension workers, and community influencers. The recommendations emphasize culturally grounded education campaigns, male engagement, gender empowerment strategies, and improved health system support. I have also included examples of communication strategies and stakeholder engagement mechanisms to support effective policy implementation. General Assessment Questions Thank you for Q1. I am pleased that the manuscript was found to be accessible to a broad readership. In response to Q2, I have expanded the discussion of implications by integrating current literature on socio-cultural influences on family planning in Ethiopia. Citations now include religious perspectives, local cultural norms, and policy frameworks relevant to reproductive For Q3, I have revised the recommendations to ensure they are directly aligned with the identified barriers and are presented in a clear and balanced manner. Each recommendation is now justified by the findings and supported by current evidence. Once again, I thank you for your valuable comments, which have significantly enhanced the policy relevance and practical utility of the manuscript. Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving it with reservations. Your comments have been invaluable in refining the clarity, relevance, and policy orientation of the manuscript. Below, I address each of your comments point-by-point and describe the corresponding revisions made to the manuscript. 1. Abstract: Reframing to Reflect Policy Brief Format Thank you for this important observation. I have revised the abstract to align with the expectations of a policy brief. The new abstract provides a concise synthesis of key findings, contextual socio-cultural barriers, stakeholder perspectives, and clear policy implications. It now emphasizes the broader public health and gender equity context, as well as the relevance of the findings to national development and health policy. 2. Background: Clarity on Stakeholders and Broader Literature I appreciate this insightful recommendation. The background section has been expanded to specify the influential roles played by religious leaders, ethnic elders, and community figures in shaping reproductive behaviors. I have also integrated references to relevant literature and national policy documents, as well as cultural and religious narratives that contribute to contraceptive use dynamics in Ethiopia. These additions enhance the foundation for the policy analysis that follows. 3. Key Findings: Synthesis Over Statistical Detail Thank you for this helpful clarification. I have revised the "Key Findings" section to reflect a broader synthesis of insights from national surveys, literature, and community-level narratives, rather than emphasizing statistical outputs. While relevant data from the EDHS have been retained to ground the findings, they are now discussed in a narrative, policy-relevant format. Technical terms such as odds ratios have been removed to improve readability and accessibility for general policy audiences. 4. Policy Outcomes and Implications: Specific, Action-Oriented Recommendations This comment is well taken. I have significantly revised the “Policy Outcomes and Implications” section to include specific, actionable recommendations. These now clearly identify and target relevant stakeholders, such as religious leaders, ethnic elders, health extension workers, and community influencers. The recommendations emphasize culturally grounded education campaigns, male engagement, gender empowerment strategies, and improved health system support. I have also included examples of communication strategies and stakeholder engagement mechanisms to support effective policy implementation. General Assessment Questions Thank you for Q1. I am pleased that the manuscript was found to be accessible to a broad readership. In response to Q2, I have expanded the discussion of implications by integrating current literature on socio-cultural influences on family planning in Ethiopia. Citations now include religious perspectives, local cultural norms, and policy frameworks relevant to reproductive For Q3, I have revised the recommendations to ensure they are directly aligned with the identified barriers and are presented in a clear and balanced manner. Each recommendation is now justified by the findings and supported by current evidence. Once again, I thank you for your valuable comments, which have significantly enhanced the policy relevance and practical utility of the manuscript. Competing Interests: We declare that we do not have any competing interests. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Osborne A. Reviewer Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.179927.r381793 ) The direct URL for this report is: https://f1000research.com/articles/14-442/v1#referee-response-381793 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 May 2025 Augustus Osborne , Njala University, Freetown, Sierra Leone Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.179927.r381793 General Comments The manuscript provides a timely and relevant analysis of socio-cultural barriers to contraceptive use in Ethiopia, drawing on data from the 2016 EDHS and 2019 Mini-EDHS. The study highlights critical issues such as fatalistic beliefs, religious prohibitions, ... Continue reading READ ALL General Comments The manuscript provides a timely and relevant analysis of socio-cultural barriers to contraceptive use in Ethiopia, drawing on data from the 2016 EDHS and 2019 Mini-EDHS. The study highlights critical issues such as fatalistic beliefs, religious prohibitions, and spousal opposition, which are significant obstacles to family planning. The policy recommendations are well-intentioned and align with the findings. However, the manuscript would benefit from clearer methodological details, deeper contextualization, and more nuanced discussion of limitations. Below are specific comments and suggestions for improvement. Specific Comments by Section 1. Abstract - The abstract succinctly summarizes the study’s objectives, methods, and key findings. However, it could be strengthened by briefly mentioning the structural equation modeling (SEM) results, as this is a key methodological contribution. - The policy recommendations are listed but could be more specific. For example, instead of "culturally tailored education programs," briefly note what such programs might entail (e.g., community-led workshops, religious leader engagement). 2. Background - The background effectively sets the stage for the study but could better contextualize Ethiopia’s socio-cultural landscape. For instance, it would be helpful to briefly explain why regions like Somali and Afar have lower contraceptive use compared to Addis Ababa (e.g., nomadic lifestyles, stronger religious conservatism). - The citation of the fertility rate (4.6 children per woman) and contraceptive use intention (25.9%) is clear, but the manuscript should clarify whether these figures are from the 2016 EDHS, 2019 Mini-EDHS, or another source. 3. Key Findings - The multivariable analysis and SEM results are presented clearly, but the interpretation could be deepened. For example, the direct negative effect of education on contraceptive use (AOR = -0.091) seems counterintuitive and warrants further discussion. Is this due to confounding factors, or does it reflect a specific subgroup? - The SEM analysis mentions indirect effects (e.g., religious prohibition influencing contraceptive use through fatalism), but the manuscript could better explain the practical implications of these pathways. How might policymakers leverage this insight? 4. Policy Outcomes and Implications - The policy recommendations are comprehensive but somewhat repetitive across sections. Consolidating them into a single, structured list (e.g., ranked by feasibility or impact) would improve clarity. - The call for "culturally sensitive" interventions is appropriate but vague. The manuscript should provide concrete examples, such as partnering with local religious leaders to address misconceptions or using community health workers to deliver tailored messaging. - The recommendation to "enhance healthcare systems" is critical but lacks specificity. Suggesting practical steps (e.g., training providers in client-centered counseling, expanding mobile clinics) would strengthen this section. 5. Actionable Recommendations - This section overlaps significantly with the "Policy Outcomes and Implications." Consider merging the two or distinguishing them more clearly (e.g., one for high-level policy, the other for grassroots implementation). - The suggestion to "revitalize the Health Extension Program" is excellent but needs elaboration. What specific improvements are needed (e.g., increased funding, better training)? 6. Conclusion and Call to Action - The conclusion is compelling but somewhat hyperbolic (e.g., "The time for incremental change has passed"). While the urgency is justified, the tone could be moderated to maintain academic rigor. - The call for a "paradigm shift" is inspiring but would benefit from a clearer roadmap. What specific steps should stakeholders take first? 7. Ethical Approval and Data Availability - The ethical statement is clear and appropriate. However, the data availability section could be more specific. Instead of "details can be provided upon request," include a direct link to the DHS Program website or the specific survey used. 8. References - The references are relevant but somewhat limited. Including more recent studies (e.g., post-2021) on socio-cultural barriers in Ethiopia or similar contexts would strengthen the literature review. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Partly Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Partly Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Osborne A. Reviewer Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.179927.r381793 ) The direct URL for this report is: https://f1000research.com/articles/14-442/v1#referee-response-381793 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 16 Apr 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 17 Jun 25 read read Version 1 16 Apr 25 read read Augustus Osborne , Njala University, Freetown, Sierra Leone Maretalinia Maretalinia , Mahidol University, Salaya, Thailand Sarwat Mumtaz , Ziauddin University, Karachi, Pakistan Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Mumtaz S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Sep 2025 | for Version 2 Sarwat Mumtaz , Ziauddin University, Karachi, Pakistan 0 Views copyright © 2025 Mumtaz S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Nice work; appreciated. This manuscript examines the persistent challenges surrounding contraceptive use and intention in Ethiopia, drawing on data from the 2016 Ethiopian Demographic and Health Survey (EDHS) and the 2019 Mini-EDHS. Despite decades of family planning initiatives, contraceptive uptake remains low, with only 25.9% of women of reproductive age reporting use or intention to use contraceptives, leaving a substantial unmet need. Key barriers include fatalistic beliefs, religious prohibitions, spousal opposition, misconceptions about side effects, and limited access to health services, particularly in rural and pastoralist regions such as Somali and Afar. Multivariable and Structural Equation Model (SEM) analyses highlight the complex interplay of socio-cultural, economic, and demographic factors. Wealth, literacy, and urban residency were strong positive predictors of contraceptive use, whereas fatalism, religious influence, spousal opposition, and postpartum amenorrhea negatively shaped behaviors and intentions. The findings also reveal indirect pathways, with religious teachings reinforcing fatalistic beliefs that suppress contraceptive adoption. Based on these insights, the manuscript calls for a paradigm shift in Ethiopia’s family planning strategy. Evidence-based, culturally tailored interventions are needed to address misconceptions, foster male engagement, and strengthen community-based delivery. Health system improvements — including reliable contraceptive supply chains, expanded service delivery, and revitalization of the Health Extension Program — are equally critical. Policy advocacy, legislative reform, and sustainable financing must support these initiatives to ensure scale-up and long-term impact. In conclusion, the study underscores that improving contraceptive uptake in Ethiopia requires a comprehensive, multi-level approach that addresses both socio-cultural barriers and systemic health service gaps. Implementing these strategies is essential for enhancing reproductive health, reducing maternal mortality, and advancing gender equity and socio-economic development. Overall, the manuscript is clear and very comprehensive with clear, balanced, and well-justified recommendations. However, there are some areas to polish. For example; (less repetition, more prioritization, and sharper action steps). Avoid redundancy; you repeat phrases like “comprehensive, community-based approach” and “paradigm shift”. They’re powerful but could be streamlined. All recommendations sound equally important but be more actionable. Some phrases are broad (e.g., “challenge harmful norms”). Policymakers respond better to concrete actions (e.g., “train 500 health extension workers in culturally tailored family planning counseling”). Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Yes Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Sexual and reproductive health, maternal health, quality assurance in healtcare I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Mumtaz S. Peer Review Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.183493.r414542) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-442/v2#referee-response-414542 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Maretalinia M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Jun 2025 | for Version 2 Maretalinia Maretalinia , Mahidol University, Salaya, Nakhon Pathom, Thailand 0 Views copyright © 2025 Maretalinia M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The updated version of the manuscript is well revised. There is no additional comment and feedback from my side Competing Interests No competing interests were disclosed. Reviewer Expertise Multivariate analysis, women of reproductive age health, contraceptive use, longitudinal study I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Maretalinia M. Peer Review Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.183493.r392790) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-442/v2#referee-response-392790 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Maretalinia M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 May 2025 | for Version 1 Maretalinia Maretalinia , Mahidol University, Salaya, Nakhon Pathom, Thailand 0 Views copyright © 2025 Maretalinia M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Abstract: The abstract does not adequately reflect the content of the full manuscript. It should summarize not only the study findings but also highlight the policy relevance and the broader context of socio-cultural barriers. As this manuscript is submitted as a policy brief, the abstract must be reframed to present a concise synthesis of existing knowledge, stakeholder perspectives, and implications for policy and practice. Background: The background section lacks clarity on the key stakeholders involved in this issue. It is important to specify whether ethnic group leaders, religious leaders, or community figures play influential roles in shaping contraceptive use. Furthermore, there is no mention of existing literature discussing cultural or religious prohibitions against contraception in Ethiopia. Given that this is a policy brief, a broader foundation of literature—including national policy documents, religious doctrines, and cultural narratives—should be integrated to support the analysis. Key Findings: This section resembles the structure and content of a research article, focusing on original data, statistical analysis, and odds ratios. However, in a policy brief, the key findings should summarize insights drawn from a synthesis of existing literature, policies, and stakeholder inputs. For example, referencing religious or ethnic group guidelines, or summarizing community attitudes documented in prior studies, would provide a stronger foundation for policy analysis. Policy Outcomes and Implications: The policy outcomes and implications section is underdeveloped. It primarily reiterates research findings without offering clear or actionable policy directions. Recommendations should be explicitly stated and linked to relevant stakeholders, such as ethnic leaders, religious authorities, and frontline health workers. Since community beliefs and norms are deeply embedded in social structures, proposed interventions must emphasize education, information dissemination, and communication strategies that actively engage these stakeholders. This would ensure culturally sensitive and community-supported policy implementation Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Partly Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Multivariate analysis, women of reproductive age health, contraceptive use, longitudinal study I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 17 Jun 2025 Tadesse Shiferaw Chekol, One Health, Armauer Hansen Research Institute, Addis Ababa, 10005, Ethiopia Dear Reviewer, I sincerely thank you for your thoughtful and constructive feedback on my manuscript. I appreciate the time and effort you invested in reviewing this work and for approving it with reservations. Your comments have been invaluable in refining the clarity, relevance, and policy orientation of the manuscript. Below, I address each of your comments point-by-point and describe the corresponding revisions made to the manuscript. 1. Abstract: Reframing to Reflect Policy Brief Format Thank you for this important observation. I have revised the abstract to align with the expectations of a policy brief. The new abstract provides a concise synthesis of key findings, contextual socio-cultural barriers, stakeholder perspectives, and clear policy implications. It now emphasizes the broader public health and gender equity context, as well as the relevance of the findings to national development and health policy. 2. Background: Clarity on Stakeholders and Broader Literature I appreciate this insightful recommendation. The background section has been expanded to specify the influential roles played by religious leaders, ethnic elders, and community figures in shaping reproductive behaviors. I have also integrated references to relevant literature and national policy documents, as well as cultural and religious narratives that contribute to contraceptive use dynamics in Ethiopia. These additions enhance the foundation for the policy analysis that follows. 3. Key Findings: Synthesis Over Statistical Detail Thank you for this helpful clarification. I have revised the "Key Findings" section to reflect a broader synthesis of insights from national surveys, literature, and community-level narratives, rather than emphasizing statistical outputs. While relevant data from the EDHS have been retained to ground the findings, they are now discussed in a narrative, policy-relevant format. Technical terms such as odds ratios have been removed to improve readability and accessibility for general policy audiences. 4. Policy Outcomes and Implications: Specific, Action-Oriented Recommendations This comment is well taken. I have significantly revised the “Policy Outcomes and Implications” section to include specific, actionable recommendations. These now clearly identify and target relevant stakeholders, such as religious leaders, ethnic elders, health extension workers, and community influencers. The recommendations emphasize culturally grounded education campaigns, male engagement, gender empowerment strategies, and improved health system support. I have also included examples of communication strategies and stakeholder engagement mechanisms to support effective policy implementation. General Assessment Questions Thank you for Q1. I am pleased that the manuscript was found to be accessible to a broad readership. In response to Q2, I have expanded the discussion of implications by integrating current literature on socio-cultural influences on family planning in Ethiopia. Citations now include religious perspectives, local cultural norms, and policy frameworks relevant to reproductive For Q3, I have revised the recommendations to ensure they are directly aligned with the identified barriers and are presented in a clear and balanced manner. Each recommendation is now justified by the findings and supported by current evidence. Once again, I thank you for your valuable comments, which have significantly enhanced the policy relevance and practical utility of the manuscript. View more View less Competing Interests We declare that we do not have any competing interests. reply Respond Report a concern Maretalinia M. Peer Review Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.179927.r383831) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-442/v1#referee-response-383831 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Osborne A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 May 2025 | for Version 1 Augustus Osborne , Njala University, Freetown, Sierra Leone 0 Views copyright © 2025 Osborne A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions General Comments The manuscript provides a timely and relevant analysis of socio-cultural barriers to contraceptive use in Ethiopia, drawing on data from the 2016 EDHS and 2019 Mini-EDHS. The study highlights critical issues such as fatalistic beliefs, religious prohibitions, and spousal opposition, which are significant obstacles to family planning. The policy recommendations are well-intentioned and align with the findings. However, the manuscript would benefit from clearer methodological details, deeper contextualization, and more nuanced discussion of limitations. Below are specific comments and suggestions for improvement. Specific Comments by Section 1. Abstract - The abstract succinctly summarizes the study’s objectives, methods, and key findings. However, it could be strengthened by briefly mentioning the structural equation modeling (SEM) results, as this is a key methodological contribution. - The policy recommendations are listed but could be more specific. For example, instead of "culturally tailored education programs," briefly note what such programs might entail (e.g., community-led workshops, religious leader engagement). 2. Background - The background effectively sets the stage for the study but could better contextualize Ethiopia’s socio-cultural landscape. For instance, it would be helpful to briefly explain why regions like Somali and Afar have lower contraceptive use compared to Addis Ababa (e.g., nomadic lifestyles, stronger religious conservatism). - The citation of the fertility rate (4.6 children per woman) and contraceptive use intention (25.9%) is clear, but the manuscript should clarify whether these figures are from the 2016 EDHS, 2019 Mini-EDHS, or another source. 3. Key Findings - The multivariable analysis and SEM results are presented clearly, but the interpretation could be deepened. For example, the direct negative effect of education on contraceptive use (AOR = -0.091) seems counterintuitive and warrants further discussion. Is this due to confounding factors, or does it reflect a specific subgroup? - The SEM analysis mentions indirect effects (e.g., religious prohibition influencing contraceptive use through fatalism), but the manuscript could better explain the practical implications of these pathways. How might policymakers leverage this insight? 4. Policy Outcomes and Implications - The policy recommendations are comprehensive but somewhat repetitive across sections. Consolidating them into a single, structured list (e.g., ranked by feasibility or impact) would improve clarity. - The call for "culturally sensitive" interventions is appropriate but vague. The manuscript should provide concrete examples, such as partnering with local religious leaders to address misconceptions or using community health workers to deliver tailored messaging. - The recommendation to "enhance healthcare systems" is critical but lacks specificity. Suggesting practical steps (e.g., training providers in client-centered counseling, expanding mobile clinics) would strengthen this section. 5. Actionable Recommendations - This section overlaps significantly with the "Policy Outcomes and Implications." Consider merging the two or distinguishing them more clearly (e.g., one for high-level policy, the other for grassroots implementation). - The suggestion to "revitalize the Health Extension Program" is excellent but needs elaboration. What specific improvements are needed (e.g., increased funding, better training)? 6. Conclusion and Call to Action - The conclusion is compelling but somewhat hyperbolic (e.g., "The time for incremental change has passed"). While the urgency is justified, the tone could be moderated to maintain academic rigor. - The call for a "paradigm shift" is inspiring but would benefit from a clearer roadmap. What specific steps should stakeholders take first? 7. Ethical Approval and Data Availability - The ethical statement is clear and appropriate. However, the data availability section could be more specific. Instead of "details can be provided upon request," include a direct link to the DHS Program website or the specific survey used. 8. References - The references are relevant but somewhat limited. Including more recent studies (e.g., post-2021) on socio-cultural barriers in Ethiopia or similar contexts would strengthen the literature review. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Partly Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Partly Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Osborne A. Peer Review Report For: Addressing socio-cultural barriers to improve contraceptive use in Ethiopia [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :442 ( https://doi.org/10.5256/f1000research.179927.r381793) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-442/v1#referee-response-381793 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Addressing socio-cultural barriers to improve...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/14-442/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/14-442/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/14-442/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Chekol TS'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/14-442/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/14-442", templates : { twitter : "Addressing socio-cultural barriers to improve contraceptive use.... Chekol TS, published by " + "@F1000Research" + ", https://f1000research.com/articles/14-442/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/163555/179927") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "179927"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "393133": 0, "393132": 0, "393135": 0, "393134": 0, "393131": 0, "393130": 0, "393137": 0, "393136": 0, "414535": 0, "414542": 7, "414543": 0, "414540": 0, "414541": 0, "414538": 0, "414539": 0, "414536": 0, "414537": 0, "383829": 0, "392789": 0, "383828": 0, "383831": 7, "383830": 0, "392790": 6, "414544": 0, "379101": 0, "383837": 0, "379100": 0, "383836": 0, "381791": 0, "379103": 0, "381790": 0, "379102": 0, "379097": 0, "383833": 0, "379096": 0, "383832": 0, "379099": 0, "383835": 0, "379098": 0, "383834": 0, "381797": 0, "381796": 0, "381799": 0, "381798": 0, "381793": 8, "379105": 0, "381792": 0, "379104": 0, "381795": 0, "381794": 0, "418166": 0, "418167": 0, "418165": 0, "418174": 0, "418172": 0, "418173": 0, "418170": 0, "418171": 0, "418168": 0, "418169": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "d31c2301-2809-4445-bdcc-c467a66e7773"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });