title: Effectiveness of demand generation interventions on use of modern contraceptives in low- and middle-income countries.
abstract: OBJECTIVE
  To synthesise evidence on the implementation, costs and cost-effectiveness of demand generation interventions and their effectiveness in improving uptake of modern contraception methods.
  
  
  METHODS
  A Cochrane systematic review was conducted. Searches were performed in electronic databases (MEDLINE, EMBASE) and the grey literature. Randomised controlled trials, cluster randomised trials and quasi-experimental studies, including controlled before-after studies (CBAs) and cost and cost-effectiveness studies that aimed to assess demand interventions (including community- and facility-based interventions, financial mechanisms and mass media campaigns) in low- and middle-income countries were considered. Meta-analyses and narrative synthesis were conducted.
  
  
  RESULTS
  In total, 20 papers meeting the inclusion criteria were included in this review. Of those, 13 were used for meta-analysis. Few data were available on implementation and on the influence of context on demand interventions. Involving family members during counselling, providing education activities and increasing exposure to those activities could enhance the success of demand interventions. Demand generation interventions were positively associated with increases in current use (pooled OR 1.57; 95% CI: 1.46-1.69, P < 0.01). Financial mechanism interventions (vouchers) appeared effective to increase use of modern contraceptive methods (pooled OR 2.16; 95% CI: 1.91-2.45, P < 0.01; I2= 0%). Demand interventions improved knowledge (pooled OR 1.02; 95% CI 0.63-1.64, P = 0.93) and attitudes towards family planning and improved discussion with partners/husbands around modern contraceptive methods. However, given the limited number of studies included in each category of demand generation interventions, the dates of publication of the studies and their low quality, caution is advised in considering the results. Very limited evidence was available on costs; studies including data on costs were old and inconsistent.
  
  
  CONCLUSIONS
  Demand generation interventions contribute to increases in modern contraceptive methods use. However, more studies with robust designs are needed to identify the most effective demand generation intervention to increase uptake of modern contraceptive methods. More evidence is also needed about implementation, costs and cost-effectiveness to inform decisions on sustainability and scaling-up.
authors.affiliation: School of Public Health (ESPUM), University of Montreal, Montréal, QC, Canada. belaid.loubna@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Belaid
authors.affiliation: UMR 216 IRD - Université Paris Descartes, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Dumont
authors.affiliation: Centre de recherche du CHU Québec, Centre hospitalier de l'Université Laval, Ville de Québec, QC, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Chaillet
authors.affiliation: CHU Sainte Justine, Montréal, QC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Zertal
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: De Brouwere
authors.affiliation: Technical Division, United Nations Population Fund, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hounton
authors.affiliation: School of Public Health (ESPUM, IRSPUM), University of Montreal, Montréal, QC, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Ridde
mesh_terms: D003267:Contraception / Q000191:economics* / Q000706:statistics & numerical data*; D003906:Developing Countries; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans
keywords: Systematic review; analyse systématique; and contraception; anticonceptivos; contraception; costes; costs; coûts; demand intervention; efectividad; effectiveness; efficacité; family planning; intervention sur la demande; low- and middle-income countries; pays à faibles revenus et à revenus intermédiaires; países con ingresos medios y bajos; planeación familiar; planification familiale; revisión sistemática