{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T12:34:52Z","timestamp":1768480492835,"version":"3.49.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004532","name":"Japan International Cooperation Agency","doi-asserted-by":"crossref","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100004532","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Appropriate contraceptive use remains a major health challenge in rural Jordan. The Japan International Cooperation Agency implemented a project aimed at enhancing the capacity of village health centers (VHCs) to improve the quality and quantity of family planning (FP) services in rural Jordan in 2016\u20132018. Facility- and community-based approaches were integrated into the interventions. We evaluated the project\u2019s impacts on contraceptive behaviors and the effectiveness of the two approaches.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We used a difference-in-differences analysis based on the project baseline and endline surveys, and logistic regression analysis to assess associations between eight primary outcomes and three secondary outcomes (impacts). The unit of intervention was five target VHCs; the unit of analysis was currently married women of reproductive age (15\u201349\u2009years) in five intervention and five control villages.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Overall, 2061 married women participated; 83.8% were in need of FP. Compared with the control villages, significant effects, ranging from +\u20090.4% points (pp) to +\u200911.5\u2009pp., were observed in the intervention villages for six primary outcomes in these categories: increasing the use of FP services at VHCs, participation in health promotion activities, and changing the sources of reproductive health information. There was a trend toward improved secondary outcomes in the intervention villages, but no significant differences were observed between the intervention and control villages regarding modern contraceptive use (mCU; +\u20094.3\u2009pp), traditional contraceptive use (tCU; \u2212\u20090.5\u2009pp), and spousal agreement on contraception (+\u20095.1\u2009pp). mCU was positively associated with five primary outcomes: obtaining contraceptives at VHCs [adjusted odds ratio (AOR) 3.44, 95% confidence interval (CI) 1.26\u20139.40], education sessions at VHC (AOR 7.41, 95% CI 1.60\u201334.39), health activities in communities (AOR 7.41, 95% CI 3.28\u201316.78), counseling by private doctor\/clinic (AOR 0.62, 95% CI 0.40\u20130.97), and information gained through TV (AOR 0.50, 95% CI 0.32\u20130.76). Spousal agreement on contraception showed similar positive trends. tCU was associated only with TV.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The project had impacts on increased mCU and husbands\u2019 perception of contraception in rural Jordan. The integration of facility- and community-based approaches may be effective in shifting from tCU to mCU in other rural areas.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-019-7637-9","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T20:44:43Z","timestamp":1572468283000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of the village health center project on contraceptive behaviors in rural Jordan: a quasi-experimental difference-in-differences analysis"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0864-0657","authenticated-orcid":false,"given":"Makiko","family":"Komasawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoyuki","family":"Yuasa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihisa","family":"Shirayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miho","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Komasawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malak","family":"Alouri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,10,29]]},"reference":[{"key":"7637_CR1","unstructured":"Higher Population Council (HPC). National Reproductive Health \/Family Planning Strategy 2013\u20132017. HPC. 2013. \n                    https:\/\/data2.unhcr.org\/en\/documents\/download\/39905\n                    \n                  . Accessed 15 Aust 2018."},{"key":"7637_CR2","volume-title":"National Resilience Plan 2014\u20132016","author":"United Nations and Host Community Support Platform","year":"2014","unstructured":"United Nations and Host Community Support Platform. National Resilience Plan 2014\u20132016. Amman: Ministry of Planning and International Cooperation; 2014."},{"key":"7637_CR3","volume-title":"Ministry of health strategic plan 2013-2017.","author":"Ministry of Health of Jordan (MOH)","year":"2013","unstructured":"Ministry of Health of Jordan (MOH). Ministry of health strategic plan 2013-2017. Amman: MOH; 2013."},{"key":"7637_CR4","volume-title":"Jordan country development cooperation strategy 2013-2019. Amended in March 2015; extended in Nov 2016","author":"United States Agency for international Development (USAID)","year":"2015","unstructured":"United States Agency for international Development (USAID). Jordan country development cooperation strategy 2013-2019. Amended in March 2015; extended in Nov 2016. Washington DC: USAID; 2015."},{"key":"7637_CR5","unstructured":"Komasawa M. Comprehensive study on family planning and women in development projects in Jordan: analysis from a capacity development perspective. Institute for International Cooperation of Japan International Cooperation Agency. 2006. \n                    https:\/\/www.jica.go.jp\/jica-ri\/IFIC_and_JBICI-Studies\/english\/publications\/reports\/study\/capacity\/200611\/pdf\/200611.pdf\n                    \n                  . Accessed 1 Aug 2018."},{"key":"7637_CR6","unstructured":"Department of Statistics of Jordan (DOS) and ICF International. Jordan population and family health survey 2012: DOS and ICF International; 2013. \n                    https:\/\/dhsprogram.com\/publications\/publication-FR282-DHS-Final-Reports.cfm\n                    \n                  . Accessed 20 Aug 2018"},{"key":"7637_CR7","doi-asserted-by":"publisher","DOI":"10.18356\/b19523c6-en","volume-title":"State of world population 2017-Worlds apart: reproductive health and rights in an age of inequality","author":"United Nations Population Fund (UNFPA)","year":"2017","unstructured":"United Nations Population Fund (UNFPA). State of world population 2017-Worlds apart: reproductive health and rights in an age of inequality. New York: UNFPA; 2017."},{"key":"7637_CR8","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1111\/tmi.12758","volume":"21","author":"L Belaid","year":"2016","unstructured":"Belaid L, Dumont A, Chaillet N, Zertal A, Brouwere V, Hounton S, et al. Effectiveness of demand generation interventions on use of modern contraceptives in low- and middle-income countries. Tropical Med Int Health. 2016;21:1240\u201354.","journal-title":"Tropical Med Int Health"},{"key":"7637_CR9","doi-asserted-by":"publisher","unstructured":"El-Khoury M, Thornton R, Chatterji M, Kyu-Choi S. Effectiveness of evidence-based medicine on knowledge, attitudes, and practices of family planning providers: a randomized experiment in Jordan. BMC Health Serv Res. 2015. \n                    https:\/\/doi.org\/10.1186\/s12913-015-1101-z\n                    \n                  .","DOI":"10.1186\/s12913-015-1101-z"},{"key":"7637_CR10","doi-asserted-by":"publisher","first-page":"567","DOI":"10.26719\/2012.18.6.567","volume":"18","author":"AI Mahadeen","year":"2012","unstructured":"Mahadeen AI, Khalil AO, Hamdan-Mansour AM, Sato T, Imoto A. Knowledge, attitudes and practices towards family planning among women in the rural southern region of Jordan. East Mediterr Health J. 2012;18:567\u201372.","journal-title":"East Mediterr Health J"},{"key":"7637_CR11","doi-asserted-by":"publisher","unstructured":"Bardaweel SK, Akour AA, Kilani MZ. Current knowledge, attitude, and patterns of oral contraceptives utilization among women in Jordan. BMC Womens Health. 2015. \n                    https:\/\/doi.org\/10.1186\/s12905-015-0275-1\n                    \n                  .","DOI":"10.1186\/s12905-015-0275-1"},{"key":"7637_CR12","unstructured":"Japan International Cooperation Agency (JICA), Earth and Human Corporation, Nagasaki University, Ministry of Health of Jordan. The Hashemite Kingdom of Jordan, Project for improvement of services at village health center in rural host communities of Syrian refugees: Project completion report: JICA, Earth and Human Corporation, Nagasaki University; 2018. \n                    https:\/\/libopac.jica.go.jp\/images\/report\/\n                    \n                   12321808.pdf. Accessed 20 Jul 2019"},{"key":"7637_CR13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/j.1728-4465.2011.00267.x","volume":"42","author":"L Mwaikambo","year":"2011","unstructured":"Mwaikambo L, Speizer I, Schurmann A, Morgan G, Fikree F. What works in family planning interventions: a systematic review of the evidence. Stud Fam Plan. 2011;42:67\u201382.","journal-title":"Stud Fam Plan"},{"key":"7637_CR14","volume-title":"Impact evaluation in practice","author":"PJ Gertler","year":"2011","unstructured":"Gertler PJ, Martinez S, Premand P, Rawlings LB, Vermeersch CMJ. Impact evaluation in practice. Washington DC: The World Bank; 2011."},{"key":"7637_CR15","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1146\/annurev-publhealth-040617-013507","volume":"39","author":"C Wing","year":"2018","unstructured":"Wing C, Simon K, Bello-Gomez RA. Designing difference in difference studies: best practices for public health policy research. Annu Rev Public Health. 2018;39:453\u201369.","journal-title":"Annu Rev Public Health"},{"key":"7637_CR16","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1111\/j.1728-4465.2014.00387.x","volume":"45","author":"J Bongaarts","year":"2014","unstructured":"Bongaarts J. The impact of family planning program on unmet need and demand for contraception. Stud Fam Plan. 2014;45:247\u201362.","journal-title":"Stud Fam Plan"},{"key":"7637_CR17","volume-title":"Advocacy and policy project (JCAP). Knowledge, attitudes, and practices toward family planning and reproductive health among married women of reproductive age in selected districts in Jordan report 2015","author":"Jordan Communication","year":"2015","unstructured":"Jordan Communication. Advocacy and policy project (JCAP). Knowledge, attitudes, and practices toward family planning and reproductive health among married women of reproductive age in selected districts in Jordan report 2015. JCAP: Amman; 2015."},{"key":"7637_CR18","volume-title":"Population and Housing 2015","author":"Department of Statistics of Jordan (DOS)","year":"2016","unstructured":"Department of Statistics of Jordan (DOS). Population and Housing 2015. Amman: DOS; 2016."},{"key":"7637_CR19","volume-title":"Unmet need for modern contraceptive methods, DHS analytical studies no. 28","author":"C Westoff","year":"2012","unstructured":"Westoff C. Unmet need for modern contraceptive methods, DHS analytical studies no. 28. Calverton: ICF International; 2012."},{"key":"7637_CR20","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1111\/j.1728-4465.2014.00377.x","volume":"45","author":"W Brown","year":"2014","unstructured":"Brown W, Druce N, Bunting J, Radloff S, Koroma D, Gupta S, et al. Developing the \u201c120 by 20\u201d goals for the global FP2020 initiative. Stud Fam Plan. 2014;45:73\u201384.","journal-title":"Stud Fam Plan"},{"key":"7637_CR21","doi-asserted-by":"publisher","unstructured":"Wulifan J, Brenner S, Jahn A, De-Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Womens Health. 2016. \n                    https:\/\/doi.org\/10.1186\/s12905-015-0281-3\n                    \n                  .","DOI":"10.1186\/s12905-015-0281-3"},{"key":"7637_CR22","doi-asserted-by":"publisher","unstructured":"Ochako R, Temmerman M, Mbondo M, Askew I. Determinants of modern contraceptive use among sexually active men in Kenya. BMC Reprod Health. 2017. \n                    https:\/\/doi.org\/10.1186\/s12978-017-0316-3\n                    \n                  .","DOI":"10.1186\/s12978-017-0316-3"},{"key":"7637_CR23","doi-asserted-by":"publisher","unstructured":"Thummalachetty N, Mathur S, Mullinax M, DeCosta K, Nakyanjo N, Lutalo T, et al. Contraceptive knowledge, perceptions, and concerns among men in Uganda. BMC Public Health. 2017. \n                    https:\/\/doi.org\/10.1186\/s12889-017-4815-5\n                    \n                  .","DOI":"10.1186\/s12889-017-4815-5"},{"key":"7637_CR24","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1016\/S0140-6736(18)30183-1","volume":"391","author":"N Akseer","year":"2018","unstructured":"Akseer N, Kamali M, Bakhache N, Mirza M, Mehta S, Al-Gashm S, Bhutta Z. Status and drivers of maternal, newborn, child and adolescent health in the Islamic world: a comparative analysis. Lancet. 2018;391:1493\u2013512.","journal-title":"Lancet."},{"key":"7637_CR25","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/j.1728-4465.2014.00380.x","volume":"45","author":"J Cleland","year":"2014","unstructured":"Cleland J, Harbison S, Shah IH. Unmet need for contraception: issues and challenges. Stud Fam Plan. 2014;45:105\u201322.","journal-title":"Stud Fam Plan"},{"key":"7637_CR26","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1728-4465.2014.00382.x","volume":"45","author":"G Sedgh","year":"2014","unstructured":"Sedgh G, Hussain R. Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Stud Fam Plan. 2014;45:151\u201369.","journal-title":"Stud Fam Plan"},{"key":"7637_CR27","unstructured":"Roudi-Fahimi F, Monem AA, Ashford L, El-Adawy M. Women\u2019s need for family planning in Arab countries. Population Reference Bureau. 2012. \n                    https:\/\/www.who.int\/evidence\/resources\/policy_briefs\/UNFPAPBunmentneed2012.pdf\n                    \n                  . Accessed 20 Jul 2019."},{"key":"7637_CR28","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/S0140-6736(12)60732-6","volume":"380","author":"J Cottingham","year":"2012","unstructured":"Cottingham J, Germain A, Hunt P. Use of human rights to meet the unmet need for family planning. Lancet. 2012;380:172\u201380.","journal-title":"Lancet."},{"key":"7637_CR29","volume-title":"Village health center operation manual for reproductive health and family planning services, 2017","author":"Ministry of Health of Jordan (MOH)","year":"2017","unstructured":"Ministry of Health of Jordan (MOH). Village health center operation manual for reproductive health and family planning services, 2017. Amman: MOH and Japan International Cooperation Agency; 2017."},{"key":"7637_CR30","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1111\/j.1728-4465.2014.00385.x","volume":"45","author":"K Machiyama","year":"2014","unstructured":"Machiyama K, Cleland J. Unmet need for family planning in Ghana: the shifting contributions of lack of access and attitudinal resistance. Stud Fam Plan. 2014;45:203\u201326.","journal-title":"Stud Fam Plan"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7637-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-019-7637-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7637-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:26:07Z","timestamp":1603844767000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-019-7637-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,29]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["7637"],"URL":"https:\/\/doi.org\/10.1186\/s12889-019-7637-9","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,29]]},"assertion":[{"value":"30 August 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approvals were obtained from the Ethics Committee of the Faculty of Medicine, Juntendo University, Japan (reference no. 2015104, dated 20 January 2016) and the Jordan Department of Statistics (reference no. 3058\/4\/2\/6, dated 7 September 2016). All women participating in the study were informed about the purpose and expected benefit of the study. Participants were also informed about their right not to participate or stop the interview at any time. All study participants gave written informed consent to participate in the study. For married adolescents aged 15\u201317\u2009years, verbal consents were also obtained from their husbands, parents-in-law, or other legal guardians during initial contact with the participants. Confidentiality of the study participants was maintained via the use of identification numbers rather than names.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1415"}}