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Rwebazibwa J, Migisha R, Munaru G, Byamukama O, Abesiga L, Mugyenyi GR, Kalyebara PK, Tibaijuka L, Ngonzi J, Kajabwangu R, Turanzomwe S, Mohammed F, Muhumuza J, Collins AD, Fajardo YT, Ssalongo WGM, Kayondo M, Kanyesigye H. Early contraceptive implant removal and associated factors among women attending public family planning clinics, Mbarara City, Southwestern Uganda: a cross-sectional study. Contracept Reprod Med 2024; 9:38. [PMID: 39080713 PMCID: PMC11289939 DOI: 10.1186/s40834-024-00299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Early implant removal not only results in method wastage and strains healthcare resources but also exposes women to the risk of unplanned pregnancies and associated complications if an alternative contraceptive is not promptly adopted. Studies have demonstrated that prevalence and factors associated with contraceptive use vary across different cultures and regions even within Uganda. We determined the prevalence and associated factors of early implant removal, among women attending public family planning clinics in Mbarara City, southwestern Uganda. METHODS We conducted a cross-sectional study from April to July 2023 at four public family planning clinics in Mbarara City. We consecutively enrolled women and administered a questionnaire to obtain data on demographic, and medical characteristics. We defined early removal as implant discontinuation within a period < 2 years. We excluded women who did not have a written record of the date of insertion of the contraceptive implants. We used modified Poisson regression analysis to determine factors associated with early implant removal. RESULTS We enrolled 406 women, with a mean age of 29 ± 6 years. The prevalence of early contraceptive implant removal was 53% (n = 210; 95%, CI: 48-58%). Factors associated with early implant removal were experiencing side effects (adjusted prevalence ratio [aPR] = 1.63, 95% CI: 1.20-2.21), inserting an implant to achieve career goals (aPR = 1.88, 95% CI: 1.26-2.81) and intending to use the implant for < 24 months (aPR = 1.36, 95% CI: 1.11-1.66). CONCLUSION Approximately half of the surveyed women removed their contraceptive implant early. Women who experienced side effects, chose an implant due to career obligations and those whose intended implant use was < 2 years were more likely to have an early contraceptive implant removal compared to their counterparts. We recommend strengthening of pre- and post- insertion counselling to address concerns among those who may experience side-effects. Women who intend to use implants for < 2 years and those who have career obligations should be encouraged to use short-acting methods as an option.
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Affiliation(s)
- Joseph Rwebazibwa
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Richard Migisha
- Department of Physiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gideon Munaru
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Onesmus Byamukama
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Lenard Abesiga
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Godfrey R Mugyenyi
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Kato Kalyebara
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rogers Kajabwangu
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Stuart Turanzomwe
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fadumo Mohammed
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Agaba David Collins
- Department of Physiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Tornes Fajardo
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Wasswa G M Ssalongo
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hamson Kanyesigye
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Jahanfar S, Maurer O, Lapidow A, Oberoi AR, Steinfeldt M, Ali M. A meta-analysis into the mediatory effects of family planning utilization on complications of pregnancy in women of reproductive age. PLoS One 2024; 19:e0294475. [PMID: 38498424 PMCID: PMC10947693 DOI: 10.1371/journal.pone.0294475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/01/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Despite conflicting findings in the current literature regarding the correlation between contraceptives and maternal health consequences, statistical analyses indicate that family planning may decrease the occurrence of such outcomes. Consequently, it is crucial to assess the capability of family planning to mitigate adverse maternal health outcomes. OBJECTIVES This review investigates the effects of modern contraceptive use on maternal health. SEARCH METHODS This systematic review is registered on Prospero (CRD42022332783). We searched numerous databases with an upper date limit of February 2022 and no geographical boundaries. SELECTION CRITERIA We included observational studies, including cross-sectional, cohort, case-control studies, and non-RCT with a comparison group. We excluded systematic reviews, scoping reviews, narrative reviews, and meta-analyses from the body of this review. MAIN RESULTS The review included nineteen studies, with five studies reporting a reduction in maternal mortality linked to increased access to family planning resources and contraceptive use. Another three studies examined the impact of contraception on the risk of preeclampsia and our analysis found that preeclampsia risk was lower by approximately 6% among contraceptive users (95% CI 0.82-1.13) compared to non-users. Two studies assessed the effect of hormonal contraceptives on postpartum glucose tolerance and found that low-androgen contraception was associated with a reduced risk of gestational diabetes (OR 0.84, 95% CI 0.58-1.22), while DMPA injection was possibly linked to a higher risk of falling glucose status postpartum (OR 1.42, 95% CI 0.85-2.36). Two studies evaluated high-risk pregnancies and births in contraceptive users versus non-users, with the risk ratio being 30% lower among contraceptive users of any form (95% CI 0.61, 0.80). None of these results were statistically significant except the latter. In terms of adverse maternal health outcomes, certain contraceptives were found to be associated with ectopic pregnancy and pregnancy-related venous thromboembolism through additional analysis.
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Affiliation(s)
- Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Director of Tufts University, Boston, MA, United States of America
- Affiliate of Cochrane US, Tufts University School of Medicine, Boston, MA, United States of America
| | - Olivia Maurer
- School of Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Amy Lapidow
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Anjali Rajkumari Oberoi
- Affiliate of Cochrane US, Tufts University School of Medicine, Boston, MA, United States of America
| | - Meredith Steinfeldt
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Moazzam Ali
- WHO Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Black KI, Trane W, Dorney E, Mola G. A cross-sectional study of factors associated with immediate postpartum uptake of contraceptive implants in Papua New Guinea. Contraception 2023; 117:25-29. [PMID: 36252651 DOI: 10.1016/j.contraception.2022.09.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In 2016 the Port Moresby General Hospital in Papua New Guinea introduced a midwife led postpartum contraception service to educate patients and provide contraceptive implants. This study examines the factors that were associated with immediate postpartum uptake of the implants. STUDY DESIGN We conducted a cross-sectional study of patients on the hospital postnatal ward who gave birth between March 2017 and January 2018. Patients aged 16-45 who had a vaginal birth with a singleton, live baby not requiring admission to the special care nursery were eligible for inclusion and invited to complete a survey prior to discharge. RESULTS Of 2082 patients approached, all consented to participate in the survey. Of those completing the survey, 531 (25.5%) chose to have the contraceptive implant provided immediately postpartum. Excluding patients who chose tubal ligation (n = 330), in multivariable analysis, higher odds of implant uptake was associated with no prior contraception use compared to prior use (aOR 1.38; 95% CI 1.07 -1.77), unplanned pregnancy compared to planned (aOR 1.37, 95% CI 1.07-1.79), and having received antenatal education about the implant compared to no information (AOR 1.65, 95% CI 1.23-2.10). CONCLUSIONS Antenatal education about the contraceptive implant impacted on likelihood of immediate postpartum method uptake. Patients who had no prior use of contraception and those with unplanned pregnancies were also more likely to request the implants, suggesting that the midwife-led postpartum service is successfully reaching patients with a previous unmet need for contraception. IMPLICATIONS This study demonstrates successful delivery of a postpartum implant program in a setting where community access to contraception is limited. Antenatal information and education can support implant uptake and that the program provides the opportunity for birth spacing and limiting in patients with a previous unmet need.
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Affiliation(s)
- Kirsten I Black
- Central Clinical School, Faculty of Medicine and Health, Susan Wakil Health Building D18, University of Sydney, New South Wales, 2006, Australia.
| | - Willie Trane
- Discipline of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD 111, Papua New Guinea
| | - Edwina Dorney
- Central Clinical School, Faculty of Medicine and Health, Susan Wakil Health Building D18, University of Sydney, New South Wales, 2006, Australia
| | - Glen Mola
- Discipline of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD 111, Papua New Guinea
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Baffour-Duah K, Olorunfemi G, Shimange-Matsose L. Pre- and intra -COVID-19 trends of contraceptive use among women who had termination of pregnancy at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg South Africa (2010-2020). PLoS One 2022; 17:e0277911. [PMID: 36516146 PMCID: PMC9750032 DOI: 10.1371/journal.pone.0277911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Contraception is a key prevention strategy for maternal morbidity and mortality and is an important component of postabortion care. The trend of contraceptive uptake can guide interventions among vulnerable individuals. The aim of the study was to determine the trends of immediate post-abortion contraceptive uptake among women who had induced abortion at a dedicated abortion centre in Johannesburg, South Africa. METHOD This study was a retrospective cross-sectional and trend analysis of the contraceptive uptake among women who had legal termination of unwanted pregnancy at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1 January 2010 to 31 December 2020. We reviewed the nursing records and summaries of the induced abortion cases that were performed for the past eleven years from 1 January 2010 to 31 December 2020. The trends in the annual number of abortion seeking clients, annual contraceptive uptake rate (stratified by types), age of clients and gestational age at presentation were extracted into a spreadsheet for analysis. Join point regression modelling and Pearson's chi square were utilized to assess the trends and association between categorical variables. The trends before and during the Corona Virus disease(COVID-19) era were also compared. RESULTS In all, 12,006 clients had induced abortion over the study period. Nearly half (n = 5915, 49.26%) of the clients were aged 26-40 years, one tenth (n = 1157, 9.64%) being teenagers and one third (n = 4619, 38.47%) between age 19-25 years. There was a 16.3% annual increase in the number of abortion clients performed at the facility from 2010 to 2014 and a gradual declining trend of about 9.2% per annum from 2014 to 2019. The overall postabortion contraceptive uptake rate was 74.5%. There was an initial 15.1% annual decline in contraceptive uptake per 100 clients from 2010 to 2014 and a subsequent increasing trend of about 11.1% per annum from 53.45 per 100 clients in 2014 to 98 per 100 clients in 2019. About 66.43% of the clients opted for injectable contraceptives. There was a reduction in the number of abortion seeking clients by 32.2% from 985 in 2019 to 668 in 2020 during the COVID-19 era. However, the contraceptive uptake was still high in 2020 (90.72%). There was no statistically significant relationship between the age group and the time periods. Thus, the distribution of the age group accessing the abortion services did not significantly change over the two time periods of 2010-2014 and 2015-2019. (P-value = 0.076). CONCLUSION There was increased trends in postabortion contraceptive uptake among our clients from 2010 to 2020. Although there was reduced number of performed induced abortion during the COVID -19 era, the contraception uptake rate was still high during the COVID-19 era. About 6 out of every 10 clients accepted injectable contraceptives. More education is needed to improve uptake of other long-acting contraception that may not require frequent contact with the health facility.
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Affiliation(s)
- Kennedy Baffour-Duah
- Faculty of Health Science, Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lusanda Shimange-Matsose
- Faculty of Health Science, Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Jayaratnam S, Franklin R, de Costa C. A scoping review of maternal near miss assessment in Australia, New Zealand, South-East Asia and the South Pacific region: How, what, why and where to? Aust N Z J Obstet Gynaecol 2021; 62:198-213. [PMID: 34791649 DOI: 10.1111/ajo.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/05/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. AIMS To review the scope of MNM studies undertaken in Australia, New Zealand, South-East Asia and the South Pacific region. MATERIALS AND METHODS A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. RESULTS The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre-eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective. CONCLUSIONS Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longer-term health outcomes, aspects of preventability and financial implications for health services.
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Affiliation(s)
- Skandarupan Jayaratnam
- Mater Mothers' Hospital, Brisbane, Queensland, Australia.,JCU College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Richard Franklin
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
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Yu HH, Raynes-Greenow C, Nyunt KK, Hnin Htet S, Yee NKW, Mugo NS, Black KI. Postpartum women's knowledge and planned use of contraception in Myanmar. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:179-184. [PMID: 33122257 DOI: 10.1136/bmjsrh-2020-200686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Maternal mortality in Myanmar is one of the highest in the WHO South-East Asian region. Additionally, the country has a high unmet need for contraception and low rates of uptake of long-acting reversible contraceptive methods (LARCs) including intrauterine devices (IUDs) and implants. Engagement with health professionals around the time of a birth is an ideal opportunity for women to access contraception but immediate postpartum provision is not widely offered in Myanmar. METHODS We undertook a cross-sectional survey of women immediately postpartum at two hospitals in Yangon to investigate their knowledge, and past use of, contraceptive methods and their plans for postpartum contraception including perceptions of implants and IUDs. Four trained obstetrics staff collected data using electronic tablets between January 2017 and January 2018. RESULTS Of the 1755 participants, 55.1% had used pills and 42.2% injectables. In contrast, only 0.5% had used an IUD and 0.3% an implant. Few women (4.4%) anticipated starting contraception immediately postpartum and only a minority would consider future use of an implant (36.9%) or an IUD (13.0%). Fear of side effects was the major barrier to future implant and IUD uptake, reported by 64.5% and 62.5%, respectively. CONCLUSIONS Women in maternity care in Yangon have some awareness of IUDs and implants but many hold misconceptions about their side effects leading to reluctance to use. Reducing the unmet need for contraception and improving maternal outcomes in Myanmar could be achieved by improving education, policy and practice around immediate postpartum contraception provision, with a particular focus on LARC methods.
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Affiliation(s)
- Hnin Hnin Yu
- Department of Obstetrics and Gynaecology, University of Medicine 2, Yangon, Yangon Region, Myanmar
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kyi Kyi Nyunt
- Department of Obstetrics and Gynaecology, University of Medicine 2, Yangon, Yangon Region, Myanmar
| | - Santhar Hnin Htet
- Insein General Hospital, University of Medicine 2, Yangon, Yangon Region, Myanmar
| | - Nan Kin Wutt Yee
- Insein General Hospital, University of Medicine 2, Yangon, Yangon Region, Myanmar
| | - Ngatho Samuel Mugo
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Seidu AA, Agbaglo E, Dadzie LK, Ahinkorah BO, Ameyaw EK, Tetteh JK, Yaya S. Modern contraceptive utilization and associated factors among married and cohabiting women in Papua New Guinea: a population-based cross-sectional study. Contracept Reprod Med 2020; 5:22. [PMID: 33292793 PMCID: PMC7672901 DOI: 10.1186/s40834-020-00125-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal access to family planning has been emphasized by the international development agenda, as evident in the Sustainable Development Goal 3.7. This notwithstanding, the use of modern contraceptives has been minimal in low- and middle-income countries, especially in Papua New Guinea. In view of this, we investigated the factors associated with the use of modern contraceptives and the associated factors among married and cohabiting women in Papua New Guinea. METHODS The study utilised the Demographic and Health Survey data of 2345 women in sexual unions in Papua New Guinea. We employed a descriptive and binary logistic regression analyses. We presented the results as crude Odds Ratios (COR) and adjusted Odds Ratios (AOR), with 95% confidence intervals (CI) signifying level of precision. Level of statistical significance was set at p < 0.05. RESULTS We found that 74.4% of the women were using modern contraceptives ranging from injectables (44.5%) to other modern methods (0.23%). Women aged 15-19 [AOR = 7.425, 95% CI = 2.853, 19.32], residents of the Highland region [AOR = 1.521, 95% CI =1.086, 2.131], self-employed women in the agricultural sector [AOR = 1.710, 95% CI = 1.218, 2.400], and women who listened to radio at least once a week [AOR = 1.409, 95% CI = 1.048, 1.895] had higher odds of modern contraceptive usage. However, women in the Islands region [AOR = 0.291, 95% CI = 0.224, 0.377], women whose husbands had higher education [AOR = 0.531,95%CI = 0.318,0.886], women in professional/technical/managerial work [AOR = 0.643, 95% CI = 0.420, 0.986], and those with no child [AOR = 0.213, CI = 0.0498,0.911] had lower odds of modern contraceptive use. CONCLUSION Out of the 2345 participants, we found that majority of them were using modern contraceptives and the commonly used modern contraceptive was injectables. Age, region of residence, partner's education, employment, partner's desire for children, and frequency of listening to radio are associated with modern contraceptive usage. Tailored reproductive healthcare should be developed for women who are disadvantaged when it comes to the usage of modern contraceptives in order to boost modern contraceptive use among them. Further investigation is needed to unravel the motivation for the high usage of injectables among married and cohabiting women in Papua New Guinea.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Justice Kanor Tetteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, UK
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Gupta S, Bernays S, Black KI, Ramsay P, Bolnga J, Kelly-Hanku A. Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea. Reprod Health 2020; 17:136. [PMID: 32891171 PMCID: PMC7487833 DOI: 10.1186/s12978-020-00985-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/30/2020] [Indexed: 08/29/2023] Open
Abstract
Background Despite targeted interventions to improve contraceptive implant acceptability and uptake in rural Papua New Guinea (PNG), ongoing use of this method remains limited. Previous literature has suggested community attitudes and intrinsic factors within the decision-making process may be negatively impacting on implant uptake, however these elements have not previously been studied in detail in this context. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG. Methods We conducted 10 focus-group (FGD) and 23 in-depth interviews (IDI) using semi-structured topic guides. Key sampling characteristics included age, exposure or non-exposure to implants, marital status, education and willingness to participate in discussion. Four FGDs were held with women, four with men and two with mixed gender. IDIs were carried out with five women (current implant users, former implant users, implant never users), five men, five religious leaders (Catholic and non-Catholic), four village leaders and four health workers. Two in-depth interviews (four participants) were analysed as dyads and the remaining participant responses were analysed individually. Results Men were supportive of their wives using family planning but there was a community-wide lack of familiarity about the contraceptive implant which influenced its low uptake. Men perceived family planning to be ‘women’s business’ but remained strongly influential in the decision making processes around method use. Young men were more receptive to biomedical information than older men and had a greater tendency towards wanting to use implants. Older men preferred to be guided by prominent community members for decisions concerning implants whilst young men were more likely to engage with health services directly. Conclusions In communities where a couple’s decision to use the contraceptive implant is strongly coloured by gendered roles and social perceptions, having a detailed understanding of the relational dynamics affecting the decision-making unit is useful in targeting future healthcare interventions. Engaging groups who are reluctant to connect with health information, as well as those who are most influential in the decision making process, will have the greatest impact on increasing implant acceptability and uptake.
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Affiliation(s)
- Sarika Gupta
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Sarah Bernays
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
| | - Kirsten Isla Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Department of Women's Health, Neonatology and Pediatrics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Philippa Ramsay
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Department of Women's Health, Neonatology and Pediatrics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - John Bolnga
- Department of Obstetrics and Gynaecology, Modilon General Hospital, Modilon Road, Madang, Madang Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, 2052, Australia
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