Women's contraceptive discontinuation and switching behavior in urban Senegal, 2010-2015

Factors associated with the discontinuation of modern contraceptive methods among lactating women in nine West African high-fertility countries: findings of the most recent demographic and health surveys

INTRODUCTION

Contraception discontinuation is a concern, especially if it occurs in breastfeeding women, thereby exposing them to a high risk of close and unwanted pregnancies. Our study aimed to measure the prevalence and identify the individual and community-level factors associated with the discontinuation of modern contraceptives among breastfeeding women.

METHODS

This was a secondary analysis of retrospective data of the most recent Demographic and Health Surveys (DHS) data from nine high-fertility rate countries, conducted mostly between 2018-2021. We reported weighted frequencies of modern contraceptives discontinuation (binary variable, coded 1 and 0). The independent variables included individual-level variables, including sociodemographic characteristics, female reproduction and family planning history, the women and their households exposure to media, and community-level ones such as place of residence (urban and rural) and country. Multilevel-modified Poisson regression was used to identify associated factors at the 5% threshold.

RESULTS

The overall prevalence of modern contraceptives discontinuation was 13.1% among 5,599 lactating mothers, with wide variations between countries (prevalence ranging from 8.2% in Sierra Leone to 33.6% in Guinea). Women were more likely to discontinue contraception if they were the head of the household (adjusted prevalence ratio (aPR) = 1.71; 95% CI [1.17-2.50]; p = 0.006). In addition, compared to implant users, women using pills (aPR = 3.06; 95% CI [2.24-4.16]; p < 0.001), those using injectables (aPR = 2.80; 95% CI [2.16-3.62]; p < 0.001), and women whose partners used condoms (aPR = 2.30; 95% CI [1.47-3.59]; p < 0.001) were more likely to discontinue contraception. Moreover, women who were not sexually active (aPR = 2.11; 95% CI [1.75-2.54]; p < 0.001) and those who wanted children within two subsequent years (aPR = 1.84; 95% CI [1.36-2.48]; p < 0.001) were more likely to discontinue contraception. Finally, method discontinuation varied by country, with women in Gambia, Guinea, Mauritania, and Mali more likely to discontinue a modern contraceptive method than those living in Burkina Faso.

CONCLUSION

To improve the retention of women using contraceptive, high-fertility rate countries need to focus on contraceptive education, communication about side effects, dissemination of family planning messages through the media, and regular monitoring of women taking contraceptives.

Comprendre l'adoption et la continuation de l'utilisation du diaphragme Caya au Bénin : une étude à méthodes mixtes

RésuméLe diaphragme Caya, de taille unique, est une méthode de contraception efficace dans multiples contextes. Pourtant, la recherche sur son acceptabilité, utilisation, et continuation en Afrique de l'Ouest francophone reste limitée. Ce projet pilote a introduit Caya à Cotonou et Bohicon, Bénin pour mieux comprendre comment Caya est utilisé. 225 adoptantes ont participé à une enquête, six mois après avoir choisi la méthode. 30 adoptantes, 15 hommes de la communauté et 15 prestataires ont participé à des entretiens approfondis. L'étude a révélé que les adoptantes choisissent la méthode parce qu'elle était non hormonale et ne provoque pas d'effets secondaires. Six mois après avoir adopté Caya, 76,4 % des adoptantes continuaient à l'utiliser ; celles moins instruites et avec 1 enfant ou plus, étaient plus susceptibles de continuer à utiliser Caya. Cela indique que dans ce contexte, Caya est une méthode acceptable qui ajouterait de la valeur aux autres méthodes contraceptives.

PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice

PURPOSE OF REVIEW

Despite the growing availability of oral PrEP, coverage remains suboptimal. Through the introduction of additional PrEP methods, including vaginal rings and long-acting injectable formulations, health systems globally are on the cusp of offering PrEP methods that vary by route of administration, efficacy, and frequency of use. With PrEP choice, it will be important to explore PrEP use patterns to better understand how the ability to choose and switch products affects coverage and continuation. In this review, we draw parallels with family planning (FP) by summarizing how method choice and product switching affected contraceptive coverage globally, synthesize what is known about PrEP product switching, and outline evidence gaps to help guide future research on PrEP switching in the context of choice.

RECENT FINDINGS

Decades of research in FP has demonstrated that product switching is common and can lead to more satisfaction and increases in contraceptive use. While research on PrEP product switching is nascent, findings suggest switching is common, and that providing more than one PrEP option can increase coverage. Key evidence gaps include understanding product switching in the context of full versus constrained choice, switching in the context of temporary need, and developing interventions that promote product switching for those who could benefit. Providing choice and allowing people to start, stop, and switch products according to their needs and desires is a core component of a rights-based approach to HIV prevention. More research is needed to better understand what drives use patterns, including switching, and how to leverage choice to improve coverage. Standard definitions -some of which have been proposed in this review-are needed to inform comparable measurement. Finally, there is a need to holistically frame PrEP use to acknowledge changes in need over the life course, thus making method switching a standard part of HIV prevention.

Prevalence of modern contraceptive discontinuation and associated factors among married reproductive age group women in Debre Berhan town, Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the prevalence of modern contraceptive discontinuation and associated factors among married reproductive age (15-49 years) group women.

STUDY DESIGN, SETTING AND PARTICIPANTS

A community-based cross-sectional study was conducted in Debre Berhan town among 500 reproductive age group women. Study participants were selected using two-stage sampling procedures. Data were collected using a semistructured face-to-face interview questionnaire. The data were entered in EpiData V.4.2.0 and then exported to SPSS V.25 software for data analysis. Descriptive statistics such as mean, per cent and frequency were used to summarise women's characteristics. Binary logistic regression analysis was used to identify predictors' variables with modern contraceptive discontinuation and p<0.05 was used to declare association.

RESULTS

The prevalence of modern contraceptive discontinuation among married reproductive age group women was 35.2% with a mean duration of use of 2.6±2.1 months. This study also revealed that the discontinuation rate was 12.6% within the first year of use. In the current study, those living with their husband (adjusted OR (AOR)=3.81, p<0.001), experiencing side effects while using modern contraceptives (AOR=2.45, p=0.02), getting counselling service (AOR=5.51, p<0.001) and respondent husband acceptance of her modern contraceptive use (AOR=3.85, p=0.01) were significantly associated with modern contraceptive discontinuation.

CONCLUSION

The findings of this study showed that the prevalence of modern contraceptive discontinuation rate of all methods among married reproductive age group women was 35.2%. To reduce modern contraceptive discontinuation, mutually, it is important to create community awareness about the importance of the continued use of modern contraceptives, improve the quality of family planning service in the health institution, strengthen family planning counselling service and give adequate counselling on details of effectiveness and side effects.

Long-Acting Contraceptive Switching and Its Associated Factors among Married Women in Southwest Ethiopia

Introduction

Contraceptive switching from a more effective to a less effective method is a concern, especially in developing countries with high unmet needs for family planning. Indeed, the lack of understanding regarding the reasons behind contraceptive switching behavior in the study area poses a significant challenge in effectively addressing this issue.

Objective

This study aimed to assess the magnitude and factors associated with long-acting contraceptive switching in Mizan-Aman town, southwest Ethiopia.

Methods

A community-based cross-sectional study was conducted, involving 345 women randomly selected from the population of married women in their reproductive age group. Data collection was conducted through interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were employed to ascertain factors linked with contraceptive method switching status. Statistical significance was determined at a P-value of less than .05.

Results

Out of the 345 participants interviewed, the prevalence of switching from long-acting to short-acting contraceptives was 28.4%, 95% CI (13.6%, 33.2%). Upon adjusting for confounding variables, factors significantly associated with contraceptive switching included women aged 31-35 [adjusted odds ratio (AOR) = 0.58; 95% CI (0.36, 0.74)] and aged 41-49 [AOR = 0.54; 95% CI (0.48, 0.82)], those with formal education [AOR = 0.79; 95% CI (0.52, 0.87)], those desiring future pregnancy [AOR = 2.12; 95% CI (1.98, 3.38)], experiencing complications from previous method use [AOR = 3.67; 95% CI (2.57, 7.40)], and encountering stockouts of their preferred contraceptive choice [AOR = 2.01; 95% CI (1.39, 3.24)].

Conclusion and recommendation

The study area exhibited a notable prevalence of switching from long-acting contraceptives. Complications arising from prior method use and the unavailability of preferred contraceptive options emerged as significant factors influencing this switching behavior. Thus, it underscores the importance of providing counseling and ongoing support to women, ensuring access to safer and more effective modern contraceptive methods.

Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys

Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women's risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in LMICs over the last decade. Using cross-sectional data from 49 Demographic and Health Surveys, we applied competing risks estimation to calculate monthly probabilities of contraceptive resumption and pregnancy over a 12-month period among pooled, regional, and country-specific samples of women who discontinued contraception for method-related reasons (corresponding to 174,726 episodes of discontinuation). We also examined the pregnancy intention status of births/current pregnancies among those who became pregnant in the 12 months following contraceptive discontinuation for method-related reasons. In the pooled sample, the three-month probability of pregnancy and resumption of contraceptive use was 12% and 47%, respectively; by 12 months these probabilities increased to 22% and 55%, respectively. Country-specific analyses show that the probabilities of resuming contraception by three months ranged from 15% in Liberia, Mali, and Sierra Leone to 85% in Bangladesh. On average, the majority of pregnancies/births that occured following discontinuation for method-related reasons were subsequently reported as unintended. However, reports varied depending on when women became pregnant within the 12 months following discontinuation. Our findings suggest the need for more nuanced measures of contraceptive use dynamics-including measures that distinguish between women who resume use of contraception from women who remain at risk of pregnancy in the short period after discontinuation-to better inform specific policies and interventions, particularly aimed at those who remain at risk of pregnancy.

Long-acting family planning switching and associated factors among revisit women in Toke Kutaye district of West Shoa Zone, Oromia Region public health facilities, Ethiopia: a mixed methods study

BACKGROUND

Switching from a long-acting family planning (LAFP) method to another could lead to an unintended pregnancy. However, the proportions of LAFP method switching and predictable factors are not well addressed. Therefore, the aim of this study was to determine the magnitude of LAFP method switching and associated factors among revisit women. The study also explored the reasons for the LAFP method switching among the revisited women.

METHOD

A mixed methods study was conducted among 377 reproductive age women attending public health facilities in Toke Kutaye district, West Shoa, Zone, Ethiopia, from 20 May 2021 to 28 July 2021. A systematic random sampling for quantitative and purposive sampling technique for qualitative study was used to select the study participants. A pretested structured questionnaire and in-depth interview were used to determine and explore long-acting family planning switching among revisit women. Data were analysed by Statistical Package for the Social Sciences (SPSS) version 21. Binary logistic regression was conducted to identify the dependent and independent variables at p-value < 0.05 along with 95% Confidence Interval (CI) and Adjusted Odds Ratio (AOR). The qualitative data were analysed using thematic analysis.

RESULTS

The magnitude of long-acting family planning method switching was 53.3%. Switching from an implant to other short-acting method was 39.8%, and switching from an intrauterine contraceptive device (IUCD) to other short-acting method was 13.5%. A formal education (AOR, 10.38, 95% CI: 3.48, 30.95), birth spacing (AOR, 5.52, 95% CI: 1.31, 23.33) and perceived infertility (AOR, 11.16, 95% CI: 5.55, 22.45) were factors associated with LAFP switching. The qualitative findings revealed that fear of side effects, lack of adequate information, religion, and misconceptions hinder users from maintaining the LAFP.

CONCLUSIONS

The study finds that the proportion of women switching from long-acting family planning was relatively higher than in other studies. The main reasons for LAFP switching were fear of side effects, lack of adequate information specific to LAFP and misconceptions. Therefore, the provision of quality contraceptive counselling by the service providers may mitigate the concern of IUD and implant switching. Furthermore, future prospective research at a larger sample size is needed.

Informed choice and its associated factors among women received immediate postpartum long-acting reversible contraceptives at public hospitals in Sidama Regional State, Ethiopia, 2022

INTRODUCTION

It is crucial to ensure the quality of family planning (FP) services through women's informed choice during the provision of long-acting reversible contraceptives. In Ethiopia, previous studies have focused on the quality of family planning services. However, much emphasis was not given to the informed choice of immediate postpartum long-acting reversible contraceptives (LARCs), particularly in the study area. This study determines the mangnitude of informed choice and associated factors among immediate postpartum women who received long-acting reversible contraceptives.

METHOD

An institution-based cross-sectional study was conducted from July 1 - August 31, 2022, among 373 immediate postpartum women who received long-acting reversible contraceptives at public hospitals in the Sidama regional state, Ethiopia. Women were selected and interviewed using a systematic random sampling technique and via a structured interviewer-administered questionnaire respectively. Data was collected using Kobo Toolbox software and then exported to the Statistical Package for Social science (SPSS) version 25 for analysis. A logistic regression model was used to identify the predictor variables.

RESULTS

The magnitude of informed choice of long-acting reversible contraceptives was 23.5% (95% CI (19.6%-27.7%)). The messages through posters about long-acting reversible contraceptives at the facility (AOR 3.6, 95% CI (1.92-6.79), postpartum family planning counseling during antenatal care (AOR 2.8, 95% CI (1.2-6.4), previous contraceptive use (AOR 3.23, 95% CI (1.12-9.33), and being secondary and higher educated (AOR 2.92, 95%CI (1.27-6.73) and (AOR 5.7, 95% CI (2.267-14.669) respectively were factors significantly associated with informed choice during immediate postpartum family planning service.

CONCLUSION AND RECOMMENDATION

In the current study, nearly one-fourth of women were informed about LARCs. Socio-demographic factors, prior use of contraception, exposure to posters that have messages about long-acting reversible contraceptives, and postpartum family planning counselling during antenatal care are factors that affect the woman's ability to make an informed choice. There should be immediate PPFP counselling that focuses on a full range of contraceptive method choices to facilitate postpartum women's ability to make informed choices.

Method shifting from long to short term contraceptives and its associated factors among reproductive age women, northwest Ethiopia

BACKGROUND

Even if long term contraceptives are more effective, efficient and tolerable choices, method shifting from long to short term contraceptives continued as a global challenge including Ethiopia. There is limited evidence on the proportion and factors associated with method shifting from long term to short term contraceptives in the country, specifically in the study area. Therefore, this study assessed the proportion and associated factors of method shifting from long term to short term contraceptives in Gondar city administration, northwest Ethiopia.

METHODS

Institution based cross-sectional study was conducted from February to June 2018 among reproductive age women who were long term contraceptive users. A total of 407 women of reproductive age were selected using systematic random sampling technique. Data were entered through Epi Info version 3.5.3 and analyzed using SPSS version 20. Bivariable and multivariable logistic regression analyses were employed to investigate factors associated with method shifting. Adjusted Odds Ratio with the corresponding 95% confidence intervals were used to show the presence and strength of association. Variables with P-value of < 0.05 in the multivariable model were considered to have statistically significant association with method shifting.

RESULTS

The overall proportion of method shifting from long to short term contraceptives was 48.5% [CI: 43.8, 53.3]. Having secondary level educational status [AOR = 0.18, CI = 0.07, 0.51], using long acting contraceptives for limiting purposes [AOR = 0.26, CI = 0.11, 0.60], and having enough counseling on long acting contraceptives during ANC visits [AOR = 0.20, CI = 0.08, 0.50] were factors negatively associated with method shifting, while receiving information about long acting contraceptives from colleague [AOR = 6.67, CI = 1.89, 23.52] was positively associated with method shifting.

CONCLUSION

The proportion of method shifting from long to short term contraceptives was 48.5%. Women's educational level, source of information, the aim behind using long acting contraceptives, and counseling adequacy were the main factors associated with method shifting. Therefore, health care providers better consider women's educational level, provision of accurate information and adequate counseling are crucial in the provision of long acting contraceptive methods.

Give women what they want: contraceptive discontinuation and method preference in urban Ghana

BACKGROUND

Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women.

METHODS

Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy.

RESULTS

Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001).

CONCLUSIONS

To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences.

Prevalence and associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria

BACKGROUND

Contraceptive discontinuation for reasons other than the desire for pregnancy is associated with a high rate of unintended pregnancies leading to unsafe abortions, maternal morbidity and mortality. In Nigeria, little is known about modern contraceptive discontinuation using the calendar data.

METHODS

A cross-sectional research design from the 2018 Nigeria Demographic and Health Surveys (NDHS) women's dataset was used to examine the prevalence and associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria. A weighted sample size of 3,353 currently sexually active married or in union women who have ever used a modern contraceptive 5 years before the survey and with complete reproductive histories and are not sterilised or declared infecund was analysed. Data were analysed and displayed using frequency tables and charts, chi-square test, and binary logistic regression model at 5% level of significance.

RESULTS

The prevalence of modern contraceptive discontinuation was 35.8% (1199) with 45.8% (549) of the women discontinuing using modern contraceptives while at risk of pregnancy. The most modern method discontinued was Injectables (25.2%) while the commonest reason for modern method discontinuation was because they wanted to become pregnant (36.1%). Associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria were: marital duration (aOR = 3.0; 95%CI: 1.5-6.2), visitation to a health facility in the last 12 months before the survey (aOR = 0.6; 95%CI: 0.4-0.8), education (aOR = 2.0; 95%CI: 1.2-3.4) and region of residence (aOR = 2.7; 95%CI: 1.6-4.7).

CONCLUSION

Modern contraceptive discontinuation among the study respondents was high. Region of residence, health facility visitation and marital duration were significantly associated with modern contraceptive discontinuation. The study suggests that health care providers should address the discontinuation of contraception through counselling, particularly among women who reside in the region of high prevalence of contraceptive discontinuation, short-term users as well as strengthen the use of contraception among those who are still at risk of becoming pregnant. Governments and stakeholders should also partner with private sectors to make health care accessible to women by bring health facilities closer to them to improve facility visitation.

Discontinuation of long acting reversible contraceptive use and its determinants among women in Ethiopia: Systematic review and meta-analysis

Introduction

Contraception discontinuation is a major public health issue that leads to unwanted pregnancies and unsafe abortions. Therefore, this systematic review and meta-analysis aimed to estimate discontinuation of contraceptives and its determinants in Ethiopia.

Methods

PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I² was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region, study setting, and publication. The pooled odds ratio for associated factors was also computed.

Results

Out of 654 studies assessed, 20 met our criteria and were included in the study. The total number of study participants was 8,780. The pooled prevalence of discontinuation of long acting reversible contraceptive use was 36.94% (95% CI: 28.547-45.326). According to sub-group analysis, Amhara region (45%) and institution-based studies (47.9%) had the highest prevalence. The most common reason for contraceptive discontinuation was negative side effect (42.3%).Women experienced side effects (AOR = 2.833:95% CI:2.005-4.003), didn't receive counseling on side effects (AOR = 2.417; 95% CI: 1.591-3.672), didn't appoint follow up (AOR = 2.820; 95% CI: 2.048-3.881), dissatisfied with the given service (AOR = 5.156; 95% CI: 3.644-7.296), and a desire to be pregnant (AOR = 2.366; 95% CI: 1.760-3.182) were predictors of discontinuation of contraceptives.

Conclusion

In Ethiopia, the pooled prevalence of long acting contraceptive discontinuation was high. Side effects, not being informed about side effects, dissatisfaction with the provided service, no insertion follow-up, and a desire to become pregnant were all associated factors. Healthcare professionals should focus on the client's reproductive goals, proper management of side effects, counseling, and post-insertion visits.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022347860, identifier CRD42022347860.

Factors influencing utilization of modern family planning services by persons living with Human Immunodeficiency Virus at Luwero Hospital, Uganda

Introduction

The use of modern family planning methods is key for achieving the prevention of unintended pregnancies among women living with HIV, in the prevention of Mother-to-child transmission (PMTCT) package. The purpose of this study was to examine the factors influencing the utilization of modern family planning services by persons living with HIV at Luwero Hospital, Uganda.

Methods

The study was conducted among 210 persons living with HIV attending the ART clinic and was based on cross-sectional descriptive and analytical design. Sampling was by simple random techniques. Data was collected using researcher-administered questionnaires.

Results

The uptake of Modern FP services is low (36.7%) among persons living with HIV. It was attributed to client-related factors such as being married [AOR: 2.2, 95% CI [1.123-4.140], p = 0.038]) and other factors. These are; religious views discouraging use of modern FP (p= 0.034), negative side effects (AOR: 1.8, 95% CI [0.043-1.968], p = 0.044) and services being unfriendly for persons living with HIV (p=0.000]).

Conclusions

Despite the presence of modern family planning services, uptake among persons living with HIV is low. Poor utilization is a recipe for unintended pregnancy and thus jeopardizes efforts in the elimination of mother-to-child transmission of HIV.

The relationship between client dissatisfaction and contraceptive discontinuation among urban family planning clients in three sub-Saharan African countries

Although researchers and practitioners have suggested that the quality of family planning services impacts contraceptive discontinuation, establishing a causal relationship has been challenging, primarily due to data limitations and a lack of agreement on how to measure quality. This longitudinal study estimated the relationship of the dissatisfaction with family planning services on contraceptive discontinuation for a sample of 797 female clients who sought family planning services at urban facilities across Kenya, Nigeria, and Burkina Faso. Clients who sought family planning services were first interviewed in person at private and public health facilities and received a follow-up phone interview four to six months later. In our sample, 18.2% of clients who were using a modern contraceptive at baseline stopped using it by follow-up. At baseline, nearly 14% of clients reported experiencing a problem with service convenience, nearly 12% with the availability of medicines and contraceptives, and nearly 6% with facility cleanliness and/or staff treatment. We hypothesized that client dissatisfaction with the family planning services received informed their decision to discontinue contraception and estimated univariate and bivariate probit regression models, controlling for individual and health facility characteristics. We found that client’s perceptions of staff treatment and facility cleanliness informed their expectations about service and contraceptive standards, affecting subsequent contraceptive discontinuation. The difference in the probability of discontinuing contraception was 8.2 percentage-points between dissatisfied and satisfied clients. Examining client dissatisfaction with family planning services can inform the family planning community on needed improvements to increase contraceptive adherence for women in need, which can prevent unplanned pregnancies and unwanted births in the long run.

Contraceptive discontinuation among women of reproductive age in Papua New Guinea

Background

Papua New Guinea has one of the lowest contraceptive prevalence rates among women of reproductive age in the Western Pacific Region and this makes contraceptive discontinuation in this country a critical public health issue worth studying. This study sought to assess the factors associated with contraceptive discontinuation among women of reproductive age in Papua New Guinea.

Methods

The data used for the analysis were obtained from the Papua New Guinea Demographic and Health Survey which was conducted in 2016–2018. The outcome variable for this study was contraceptive discontinuation among women of reproductive age. Crude odds ratios and adjusted odds ratios with 95% confidence intervals were estimated using binary logistic regression.

Results

About 33.26% of the women discontinued injectables, 19.15% discontinued pills and 3.77% discontinued other contraception methods. Women aged 20–24 [aOR = 2.12, CI = [= [1.04,4.31] through to those aged 30–34 [aOR = 1.98, CI = 1.03,3.79] had higher odds to discontinue contraceptive usage compared to those aged 45–49. Women with no information on choice of contraception [aOR = 2.85, CI = 2.31,3.51], those with two or more births in the last five years [aOR = 2.35, CI = 1.65,3.35] and those living in the Highland region [aOR = 1.71, CI = 1.28,2.29] were more likely to discontinue contraceptive usage compared with those with information on contraceptive choices, those with no births and those living in the Island region respectively. However, women in the rural areas [aOR = 0.78, CI = 0.61,0.99], women using LARC [aOR = 0.10, CI = 0.06,0.15], injectables [aOR = 0.43, CI = 0.30,0.63] and other modern contraception methods including condom [aOR = 0.22, CI = 0.15,0.34] were less likely to discontinue contraceptive usage.

Conclusion

A nationwide mass education on the benefits of contraception is recommended for the Papua New Guinea National Department of Health to tackle the key findings of this study which were high contraceptive discontinuation prevalence with lack of information on choice, disproportionately high contraceptive discontinuation rate in the Highland Region and the desire to give birth to more than two children as some factors associated with contraceptive discontinuation in Papua New Guinea.

Factors associated with post-abortion contraceptive discontinuation

OBJECTIVES

To assess factors associated with post-abortion contraceptive discontinuation.

METHOD

This cross-sectional study addressed 111 women aged 18-49 attending Primary Health Care Facilities in São Paulo/SP, Aracaju/SE, and Cuiabá/MT, Brazil, who reported an abortion five years before the interview held in 2015-2017. Kaplan-Meier estimates and Cox Regression were used for data analysis.

RESULTS

Oral hormonal contraceptives, male condoms, and injectable contraceptives were the methods most frequently used. The contraceptive discontinuation rate was 41.8% in the 12 months after the abortion. The pill was the method most frequently abandoned (58.3%); male condoms were the method that failed the most (72.7%), and injectable contraceptives were the method most frequently switched (50.0%). Being up to 24 years old, having ten or more years of education, having three or more children, and a desire to wait longer before becoming pregnant again were associated with post-abortion contraceptive discontinuation.

CONCLUSION

Short-acting contraceptive methods were predominant among post-abortion women. The type of discontinuation varied according to the type of method used. The factors associated with contraceptive discontinuation were age, education, parity, and reproductive intention.

Prevalence of and factors associated with contraceptive discontinuation in Kenya

BACKGROUND

 The overwhelming uptake of contraception in Kenya at 58% suggests huge potential for a continued increase, but discontinuation threatens efforts to achieve new targets. Further increases in contraceptive prevalence will depend more on continuation and re-adoption amongst past users because unintended pregnancies would increasingly result from discontinuation. Eliminating discontinuations from side effects and method failure could increase continuation rates by 10%.

AIM

 To establish the prevalence and factors associated with contraceptive discontinuation.

SETTING

 Kenya, with a successful family planning programme, but also the challenge of discontinuation rates of 31%.

METHODS

 Contraceptive calendar data from the 2014 Kenya Demographic and Health Survey were used in the survival analysis approach.

RESULTS

 Overall discontinuation rates were 37% (24 months) and 74% at (36 months), whilst discontinuation in need was 36%. Side effects accounted for 40% of discontinuations, whilst injection and pill recorded the highest rates. Current method emerged as a predictor of discontinuation at 24 months with the following hazard ratio (HR) at 95% confidence interval [CI]; intrauterine device (IUD) (HR = 0.466, CI = 0.254-0.857), injection (HR = 0.801, 95% CI = 0.690-0.930), implants (HR = 0.580, 95% CI = 0.429-0.784) and at 36 months, injection (HR = 0.808, 95% CI = 0.722-0.904) and implants (HR = 0.585, 95% CI = 0.468-0.730). Age (15-24 years) displayed influence only at 36 months (HR = 1.219, 95% CI = 1.044-1.424).

CONCLUSION

 The study showed a close link between contraceptive method used and discontinuation and thus the need to address method-related issues in an attempt to minimise discontinuation in Kenya. Expanding contraceptive options and improving the quality of service can scale up switching and thus help reduce discontinuation and unintended births.

How do fertility intentions lead to contraceptive continuation among a cohort of family planning users who received services from the private sector in Nigeria

Background: The Federal Ministry of Health of Nigeria is exploring task sharing family planning (FP) services to Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs). Yet few studies have explored contraceptive continuation of clients who received FP services from pharmacies and drug shops. This paper uses longitudinal data and looks at women's contraceptive continuation approximately nine months after they received FP services from CPs and PPMVs in Kaduna and Lagos states. Methods: Longitudinal data for this analysis come from an evaluation of the IntegratE project. 491 women were interviewed within 10 days after receiving a FP service from an IntegratE CP or PPMV and approximately nine months later. The dependent variable is contraceptive continuation at the follow-up interview and the independent variable is fertility intentions as reported at enrollment. Multivariate logistic regression models were used to assess the association between fertility intentions and contraceptive continuation. Results: 89% of women continued using contraception approximately 9 months after the enrollment interview. Women who intended to have a child in more than two years were significantly more likely to continue using contraception compared to women who intended to have a child within two-years (AOR 2.6; 95% CI 1.1-6.1). Among women who were asked about the quality of care received, 93% said the CP/PPMV asked whether they wanted to have a/another child in the future and 85% said they were asked when they would like to have that child. Conclusion: The fertility intentions of women who seek FP services from CPs and PPMVs in Nigeria can predict contraceptive continuation. As Nigeria task shares FP services to CPs and PPMVs, training on comprehensive FP counseling will be essential for scale-up. Since many women continued using FP, CPs and PPMVs have the potential to expand access to, and support women's continued use of, FP.

Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study

OBJECTIVE

To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women.

DESIGN

A prospective cohort study.

SETTING

Five counties in Western Kenya.

PARTICIPANTS

Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities.

METHODS

Patient-reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message-based surveys for 24 weeks.

MAIN OUTCOME MEASUREMENTS

Prevalence, hazards ratio (HR).

RESULTS

Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95% CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95% CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20-4.77), weight changes (aHR 2.72, 95% CI 1.47-4.68) and sexual side effects (aHR 2.42, 95% CI 1.40-4.20).

CONCLUSIONS

Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method-related discontinuation.

TWEETABLE ABSTRACT

Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects.

Survival time to Implanon discontinuation and its predictors among a cohort of Implanon users who enrolled in public hospitals of southern Ethiopia, 2021: a retrospective cohort study

Background

Pieces of evidence strongly indicate that providing high-quality family planning services is accompanied by an increase in contraceptive uptake and a decrease in contraception discontinuation. Contraceptive, especially Implanon discontinuation is a global issue that could be linked to a summary outcome indicator of poor family planning service quality. Although Implanon is becoming more popular among Ethiopian contraceptive users, little is known regarding the survival and predictors of discontinuation. The study aimed at exploring the survival and predictors of Implanon discontinuation among women enrolled in family planning units of Public hospitals in southern Ethiopia, 2021.

Methods

A hospital-based retrospective cohort study was conducted among Implanon users who enrolled in family planning units of Public Hospitals. Five years of medical records, from January 1, 2016, to December 30, 2020, were reviewed. A total of 502 women were selected by using a random sampling technique. A standardized abstraction tool was used to collect data from medical records and registration books. The data were entered into Epidata Version 3.1 and then exported to STATA 14 for analysis. The median was calculated in the case of survival time. Across covariates, the Kaplan Meier survival curve was used to estimate time to Implanon discontinuation. To identify statistically significant predictors of Implanon discontinuation, a multivariable Cox proportional hazard model was fitted.

Results

The incidence rate of Implanon discontinuation was 1.87(95% CI = 1.63, 2.15) per 100 person-months of observation. The overall estimated survival probability at the end of 24 and 36 months was 67.4% (95%CI, 62.5, 71.8) and 25.9% (95%CI, 18.4, 34.1) months respectively. Residence [AHR = 1.50; 95%CI: 1.09, 2.08], parity [AHR = 2.02; 95%CI: 1.65, 3.67], pre-insertion counselling [AHR = 2.41; 95%CI: 1.72, 3.70], experiencing heavy vaginal bleeding [AHR = 3.91; 95%CI: 2.67, 5.32], post-insertion follow up [AHR = 3.15; 95%CI:2.11, 4.75] were identified as a significant predictors of Implanon discontinuation.

Conclusion

The risk Implanon of discontinuation was high, especially at 24 and 36 months. In family planning service delivery points, health care providers should pay special attention to clients who live in rural areas and do not have children. In addition, health care providers should provide pre-insertion counseling and post-insertion follow-up that focus on potential side effects. Finally, family planning units need to engage in early side effect management and reassurance to mitigate discontinuation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00859-6.

Magnitude and associated factors of early Implanon discontinuation among rural women in public health facilities of central Ethiopia: a community-based cross-sectional study

Background

Advocating for and promoting contraception use is critical in reducing mother and child morbidity and mortality. Early Implanon discontinuation may result in unwanted pregnancies and induced abortions. Although there has been research in Ethiopia on long-acting reversible contraceptives, there has been none on early Implanon removal among rural women who have used and removed it. Hence, this study aimed to investigate the magnitude of Implanon discontinuation and related characteristics among women who had the Implanon removed in central Ethiopian public health facilities.

Methods

A community-based cross-sectional study was conducted among all women of the reproductive age group who had removed Implanon after using it. A simple random sampling technique was used to select 373 women after proportional allocation to each health facility. Data were collected using a pretested semi-structured interviewer-administered questionnaire adapted from previous studies. Data were entered using EpiInfo and exported to SPSS version 21 for analysis. A binary logistic regression model was used to determine the association between the outcome variable and independent variables. A p-value less than 0.25 was used as a cutoff point to select candidate variables for the final model. Then, a p value less than 0.05, AOR, and a 95% confidence level were used to declare statistical significance.

Result

A total of 360 participants responded to the questionnaires, making a response rate of 96.5%. In this study, the early discontinuation rate was 42% (95% CI 36.9–47.7). No formal education (AOR = 0.53 [95% CI 0.3–0.94], having medium monthly income (AOR = 3.02 [95% CI 1.38–6.6]), inadequate pre-insertion counseling (AOR = 0.55 [95% CI 0.31–0.98]), lack of appointment for follow up (AOR = 0.16 [95% CI 0.05–0.54]), didn`t satisfy with service provided (AOR = 0.067 [95% CI 0.015–0.29] and developed side effect (AOR) = 4.45 [95% CI 2.37–8.36] were significantly associated with Implanon discontinuation.

Conclusion

The discontinuation rate of Implanon among those who removed it after using it in this study was high. Lack of formal education, having a medium-income, inadequate pre-insertion counseling, lack of appointments for the follow-up, poor satisfaction, and problems with side effects were the factors associated with early discontinuation rate. Hence, quality family planning service provision is essential to reduce the discontinuation rate.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01651-y.

Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia

Background

Long Acting Reversible Contraceptives (LARCs) are contraceptives that prevent unplanned pregnancy in a more safer and effective way than other modern short acting methods. However, method discontinuation and switching are still challenges for utilization of LARCs in resource limited countries for several reasons. Thus, the aim of this study was to determine magnitude and factors for method discontinuation and switching among LARCs users in health facilities of Southern Ethiopia.

Methods

A Facility based record review was used to collect data from May to June 2019. Three hospitals were randomly selected from five hospitals found in southern Ethiopia. A total of 1050 records were included in the study from long acting family planning registers between 2018 and 2019. Data were entered to Epi-info 3.5.4 and exported to SPSS for windows version 20 for analysis. A descriptive statistics was performed to describe factors and reasons for LARCs discontinuation and switching off. Logistic regression technique with a 95% confidence level was used to determine the association between factors and magnitude of method discontinuation and switching.

Results

Of the 1050, 69.8% of women discontinued long acting reversible family planning method before the recommended duration of use and 30.2% of them switched from long acting family planning methods to any other modern contraceptive methods. Women who shifted from any LARCs to short-acting family planning methods accounted for 38.8% of those who shifted to any other modern methods. Desire to get pregnant and method specific side effect were most common reasons for both method discontinuation and switching. Women with only one child were 1.61 times more likely to discontinue than women who had greater than five number of children.

Conclusion

Discontinuation and switching of long acting reversible family planning method was high. Primiparous women were more likely to discontinue use of long acting reversible family planning methods. Re-evaluating family planning services focusing on effective counseling about side effects of LARCs methods is required. Training should also be given for family planning providers including community healthcare workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01357-2.

Ethiopia has a substantially greater percentage of unintended pregnancy than other developing and developed countries. Long-acting reversible contraception (LARC) has a potential to address a huge and growing unmet need in resource limited countries like Ethiopia, such as reducing unwanted births and abortion rates.

As part of this global approach to fertility management, Ethiopia has been implementing various strategies like an on-going task shifting and task sharing with the implanon scale up program, and IUD revitalization program starting from the community health services to higher level healthcare systems to increase access and utilization of long acting reversible family planning methods. However, discontinuing LARCs before the recommended duration use and switching to short-acting contraceptives have proven difficulty in Ethiopia. This may have led to low utilization rate of LARCs in Ethiopian contexts including the study area, when compared to the national target. Very low coverage of use of LARC among unmet need has shown by many studies in various corners of the country. Thus, determining the magnitude and factors of LARC discontinuing and switching is still a pressing need to establish additional strategies used to improve consistent use of LARC for the recommended duration and expand access to LARC for better planning of births.

In this study we assessed magnitude and factors of LARC discontinuation and switching from a relatively huge number of records extracted from systematically selected health facilities in Southern Ethiopia. Extracted data from registers of long acting reversible family planning methods were analysed using descriptive statistics and logistic regression. Accordingly, we found significant proportion women discontinued long acting reversible family planning methods before the recommended duration of use as well as switched from long acting reversible family planning methods to other modern short-acting methods due to various reasons. Only a number of children women had is associated with discontinuation and no single factor was associated with method switching in Southern Ethiopia. Family planning services should be re-evaluated with a focus on effective counseling on the side effects of LARCs approaches, and training for family planning providers, particularly community healthcare workers, should be provided.

How do changes in motivation to prevent pregnancy influence contraceptive continuation? Results from a longitudinal study with women who receive family planning services from Community Pharmacists and Patent and Proprietary Medicine Vendors in Nigeria

Background

Studies have shown that motivation to avoid pregnancy is associated with contraceptive use and continuation. These motivations can change, however, even within a short period of time. This paper uses longitudinal data to look at women’s motivation to avoid pregnancy at two time points, and how changes in motivation influence contraceptive continuation.

Methods

Data for this analysis came from an evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service from these sources and again approximately 9 months later. The dependent variable was contraceptive continuation at the follow-up interview. A categorical independent variable was used to represent changes in motivation to avoid pregnancy from enrollment to the follow-up interview. Univariate and multivariate logistic regression models were used to assess the association between changes in motivation and contraceptive continuation.

Results

89% of women continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated to avoid pregnancy were significantly more likely to continue using contraception compared to women who became more motivated (AOR 2.5; 95% CI 1.0–6.0). Women who became less motivated were 64% less likely to continue using contraception compared to who became more motivated (AOR 0.36 95% CI 0.1–0.9).

Conclusion

FP providers, including private sector pharmacists and drug shop owners, should continuously check-in with women about their motivations around pregnancy to support continuation among those who wish to avoid pregnancy.

Fatores associados à descontinuidade no uso de métodos contraceptivos após a vivência de um abortamento

RESUMO Objetivos: Analisar os fatores associados à descontinuidade no uso de método contraceptivos após a vivência de um abortamento. Método: Estudo transversal, conduzido com 111 mulheres de 18-49 anos, usuárias de Unidades Básicas de Saúde de São Paulo/SP, Aracaju/SE e Cuiabá/MT, que relataram abortamento nos cinco anos anteriores às entrevistas realizadas entre 2015-2017. Utilizou-se Kaplan-Meier e regressão de Cox para análise dos dados. Resultados: Os métodos mais utilizados foram o contraceptivo hormonal oral, preservativo masculino e injetáveis. A taxa de descontinuidade contraceptiva foi 41,8% nos 12 meses. A pílula foi o método mais abandonado (58,3%); o preservativo masculino aquele que mais falhou (72,7%); e injetáveis os mais trocados (50,0%). Ter até 24 anos de idade, mais de 10 anos de escolaridade, três ou mais filhos e querer esperar mais para engravidar associaram-se a descontinuar o uso dos métodos contraceptivos após o abortamento. Conclusão: Após o abortamento, as mulheres usaram predominantemente métodos contraceptivos de curta duração. O tipo de descontinuidade, abandono, troca ou falha, variou conforme o método usado. Os fatores associados à descontinuidade contraceptiva foram a idade, a escolaridade, a paridade e a intenção reprodutiva.

The prevalence of Implanon discontinuation and associated factors among Ethiopian women: A systematic review and meta-analysis

Background:

Implanon discontinuation before the recommended time is problematic, as it puts women at risk of unwanted pregnancies and unsafe abortions, along with negative maternal health outcomes. Although the magnitude and determinants of Implanon discontinuation have been studied in Ethiopia, the results were inconsistent, with significant variability. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of Implanon discontinuation and its determinants in Ethiopia.

Methods:

A comprehensive search of studies published before 18 February 2022 was done using electronic databases such as PubMed, Embase, Google Scholar, Scopus, Web of Science, Science Direct, and Cochrane Library. The relevant data were extracted using a Microsoft Excel 2013 and analyzed using STATA Version 16. A random-effect meta-analysis model was used to compute pooled prevalence and odds ratio. The Cochrane Q test statistics and I² tests were used to assess the heterogeneity of the included studies. A funnel plot, Begg’s, and Egger’s tests were used to check for the presence of publication bias.

Results:

A total of 11 studies with 4320 study participants were included in this meta-analysis. The overall pooled prevalence of Implanon discontinuation in Ethiopia was found to be 32.62% (95% confidence interval = 24.10, 41.13). There was significant heterogeneity among the included studies (I² = 97.4%, p < 0.001). However, there was no statistical evidence of publication bias (p = 0.533). Dissatisfied with service provision at the time of insertion (odds ratio = 3.92, 95% confidence interval = 1.54, 6.29), not having pre-insertion counseling (odds ratio = 2.98, 95% confidence interval = 1.91, 5.04), the absence of post-insertion follow-up (odds ratio = 4.03, 95% confidence interval = 2.17, 5.90), and the presence of side effects (odds ratio = 2.93, 95% confidence interval = 1.87, 3.98) were found to be determinants of Implanon discontinuation.

Conclusion:

According to this systematic review and meta-analysis, one-third of Ethiopian women discontinued Implanon before the recommended time (3 years). Program managers and service providers should consider using more evidence-based and participatory counseling approaches to enhance client satisfaction. Furthermore, family planning service delivery points should be equipped to manage and reassure women who are experiencing side effects.

Egypt Family Planning Method Mix Indicates Shifting toward Hormonal Contraceptives

BACKGROUND: The study is of practical importance for policy makers and family planning (FP) program managers as the profile of FP method-mix with a shift from a mechanical method as intrauterine devices (IUD) to hormonal methods such as oral contraceptives (OCs) and injectables predicts a critical situation for maternal and child health and reflects shortcomings in FP service delivery program. AIM: The purpose of the current study was to identify reasons for the progressive shift from IUD to OCs in Egypt. METHODS: The study is an-operations research conducted at four levels of the Ministry of Health and Population/FP (MOHP/FP) service delivery: Central (headquarter, HQ), governorate, district, and service delivery points. It included five of MOHP/United Nations Fund for Population Activities-Contraceptive Security Project governorates that represent, urban governorates, Lower Egypt, and Upper Egypt. Both qualitative data in-depth interviews with MOHP/HQ staff, Two Focus Group Discussions with FP Health Directorates staff and nurses in the five governorates, and quantitative data through a self-administered questionnaire for 607 service providers (SP). RESULTS: There was a consensus on the actual shift from IUD to OCs use. Reasons were the absence of incentives for healthcare providers for IUD insertion services (64%) and improper training of physicians (45%), and the availability of OCs all time. CONCLUSION: The three articulating issues that lead to shifting from IUD to OCs are: Unsatisfactory training and incentive systems for SPs and the clients’ choice of OCs for independent use/autonomy, and availability of OCs all the times at a reasonable cost in both the public and private sectors.

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.

Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation

BACKGROUND

In Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation.

METHODS

This was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach.

RESULTS

Family planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods.

CONCLUSIONS

The strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.

Non-communicable disease risk factors and management among internal migrant in China: systematic review and meta-analysis

Background

In 2019, there are more than 290 million people who have ever migrated from rural to urban areas in China. These rural-to-urban internal migrants account for more than one-fifth of China’s population and is the largest internal migrant group globally. We present the first systematic review that examines whether internal migrants are more likely to exhibit non-communicable diseases (NCDs) risk factors and have worse NCD management outcomes than non-migrant counterparts in China.

Methods

A systematic review was conducted via medical, public health, and economic databases including Scopus, MEDLINE, JSTOR, WHO Library Database and World Bank e-Library from 2000 to 2020. Study quality was assessed using the National Institute of Health Quality Assessment tool. We conducted a narrative review and synthesised differences for all studies included, stratified by different types of outcomes. We also conducted random-effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO: CRD42019139407.

Results

For most NCD risk factors and care cascade management, comparisons between internal migrants and other populations were either statistically insignificant or inconclusive. While most studies found migrants have a higher prevalence of tobacco use than urban residents, these differences were not statistically significant in the meta-analysis. Although three out four studies suggested that migrants may have worse access to NCD treatment and both studies suggested migrants have lower blood pressure control rates than non-migrants, these findings were not statistically significant.

Conclusion

Findings from this systematic review demonstrate that there is currently insufficient evidence on migrant and non-migrant differences in NCD risk factors and management in China. Further research is expected to investigate access to healthcare among internal and its effect on both their NCD outcomes and long-term healthcare costs in China.

Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews

Background

Available evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya.

Methods

We conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services.

Results

The Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15–24 years (aOR = 0.69, 95% CI = 0.56–0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33–0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44–0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65–0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42–2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03–1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively.

Conclusion

The quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.

Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study

Background

Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement.

Objective

Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone–based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system.

Methods

The MyIUS app is classified as a medical device and uses an artificial intelligence–based bleeding pattern prediction algorithm to estimate a woman’s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages.

Results

The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting.

Conclusions

By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting.

Return to pregnancy after contraceptive discontinuation to become pregnant: a pooled analysis of West and East African populations

BACKGROUND

The fear of infertility or delayed return to fertility is a common barrier to contraceptive use in sub-Saharan Africa, particularly among young or nulliparous women. Global evidence on return to pregnancy after method discontinuation suggests these fears may be misplaced; yet the topic has not been widely studied in sub-Saharan Africa nor by age and parity group.

METHODS

Reproductive calendar data from recent Demographic and Health Surveys of 15 sub-Saharan African countries were used to analyze time-to-pregnancy following discontinuation of a contraceptive method with the reason to become pregnant. The probability of pregnancy at 12 months was estimated using single-decrement life tables run by type of method discontinued, age and parity. Results are presented by region: francophone West Africa, anglophone West Africa and East Africa.

RESULTS

The 12-month probability of pregnancy after discontinuation of contraception to become pregnant was 73.0% in francophone West Africa, 78.8% in anglophone West Africa, and 82.0% in East Africa. Our results showed significant regional differences in return to pregnancy by 12 months, with probabilities in francophone West Africa being significantly lower than in anglophone West Africa or East Africa. A lower return to pregnancy by 12 months was seen among women ages 35-49 years and was lowest after discontinuation of a hormonal method for all age groups. Differences by parity group were only evident after discontinuation of hormonal methods in francophone West Africa.

CONCLUSIONS

Sustainable gains in increasing contraceptive uptake, especially among youth, may be difficult to achieve without information and counseling that address concerns about infertility and potential delays in return to pregnancy following use of hormonal methods.

Estimating the market size for a dual prevention pill: adding contraception to pre-exposure prophylaxis (PrEP) to increase uptake

INTRODUCTION

Uptake of oral pre-exposure prophylaxis (PrEP) remains low. The objective of this analysis was to estimate the potential market size in priority sub-Saharan African countries for a 28-day dual prevention pill (DPP) regimen containing the active pharmaceutical ingredients in oral PrEP and oral contraceptive pills (OCPs) for the prevention of HIV and unintended pregnancy.

METHODS

We selected 15 countries in sub-Saharan Africa for analysis. Population estimates were based on United Nations Population Division data from 2017. Low, medium and high rates (range 0.25% to 25%) of estimated conversion from current contraceptive method to the DPP were applied by country based on HIV prevalence (≥10% vs <10%), current contraceptive method (OCP, condom or unmet need for contraception) and age group (15-24 or 25-49 years).

RESULTS

In these 15 countries, between 250 000 and 1.25 million women could switch from their current contraceptive method to the DPP. Given that current PrEP use in the 15 countries combined is estimated to be 113 250 (women and men), the most conservative market size estimate would more than double the number of women currently using PrEP.

CONCLUSIONS

By leveraging the existing market for OCPs and assuming modest conversion from condom users and women with an unmet need for contraception, the DPP could lead to a 2- to 10-fold increase in PrEP usage in these 15 sub-Saharan African countries, expanding the broader public health benefit of this proven HIV prevention strategy.

Spatial heterogeneity in discontinuation of modern spacing method in districts of India

Background

Despite six decades of official family planning programme, the use of modern contraceptive method remained low in India. The discontinuation of modern spacing method (DMSM) has also increased from 42.3% in 2005−06 to 43.6% during 2015–16. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%).

Methods

Data from NFHS-4 (2015–16) comprising of 601,509 households, 699,686 women and a sample of 119,548 episode of modern spacing method was used for the analysis. Multiple decrement life table has used to estimate 12-month discontinuation rate of modern spacing methods (DMSM). Moran’s I statistics, Bivariate LISA cluster map has used to understand the spatial correlates and clustering the DMSM. OLS model and impact analysis has used to assess the significant associated covariates with discontinuation.

Result

The 12-month DMSM in India is 43.5%; largely due to desire for becoming pregnant and method failure. The high discontinuation rate was observed in most of the southern (62%) and central (46%) regions of India. DMSM has significantly and spatially associated with neighbouring districts of India (Moran’s I = 0.47, p-value = 0.00). The prevalence of modern spacing method is negatively associated with discontinuation in the neighbouring districts of India. The unmet need (β = 0.84, 95% CI 0.55–1.14), desire of children (β = 0.26, 95% CI − 0.05–0.57) and female sterilization (β = 0.54, 95% CI 0.14–0.95) were three main contributing factor to DMSM.

Conclusion

Districts of high DMSM need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01185-w.

Contraceptive discontinuation is major issue of family planning of India. Without getting proper knowledge of modern spacing method, women facing serious health related issues so that they tend to discontinue their family planning method. We examine the spatial heterogeneity of discontinuation of modern spacing method in 640 district of India. Using secondary data of NFHS-4 (2015–16), we calculated 12-month discontinuation rate of any method and any modern spacing method by reason of discontinuation, also we presented discontinuation pattern by regions of India. To measure the spill over effect and associated factor of discontinuation of modern spacing method, we used OLS model and estimated Impact result. The findings of our study conveys that desire to become pregnant is the leading cause of discontinuation for both any method and any modern spacing method (12.43%), followed by other fertility related reasons and methods relates reason’s (4.40%). Method failure, side effect of method and method related reason together accounts 12% of contraceptive discontinuation in India. Very low use of modern spacing method of districts should be given more attention for policy maker and planner to increase the use of modern spacing method. The districts of high discontinuation of modern spacing method need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.

Predictors of contraceptive method discontinuation among adolescent and young women in three West African countries (Burkina Faso, Mali, and Niger)

BACKGROUND

The effective use of contraception among adolescents and young women can reduce the risk of unintended pregnancies. However, the prevalence of contraceptive use remains low in this age group. The objective of this study was to estimate the rate of contraceptive method discontinuation among adolescents and young women and to identify its associated factors in Burkina Faso, Mali, and Niger.

METHOD

This was a secondary analysis of data from Demographic and Health Surveys of Burkina Faso (2010), Mali (2012-2013), and Niger (2012). The dependent variable was the time to discontinuation of contraceptive methods. Independent variables were represented by sociodemographic, socioeconomic, and cultural characteristics. Mixed-effects survival analysis with proportional hazards was used to identify the predictors.

RESULTS

A total of 2,264 adolescents and young women aged 15 to 24 years were included in this analysis, comprising 1,100 in Burkina Faso, 491 in Mali, and 673 in Niger. Over the last five years, the overall contraceptive discontinuation rate was 68.7% (50.1% in Burkina Faso, 59.6% in Mali, and 96.8% in Niger). At the individual level, in Burkina Faso, occupation (aHR = 0.33), number of living children (aHR = 2.17), marital status (aHR = 2.93), and region (aHR = 0.54) were associated with contraceptive discontinuation. Except for education and marital status, we found the same factors in Mali. In Niger, a women's education level (aHR = 1.47) and her partner (aHR = 0.52) were associated with discontinuation. At the community level, the region of origin was associated with discontinuation of contraceptive methods.

CONCLUSION

Most adolescents and young women experienced at least one episode of discontinuation. Discontinuation of contraceptive methods is associated with the level of education, occupation, number of children, marital status, and desire for children with the spouse. Promotion of contraceptive interventions should target adolescents, young women, and their partners, as well as those with a low education level or in a union.

Not All Women Who Experience Side Effects Discontinue Their Contraceptive Method: Insights from a Longitudinal Study in India

Side effects are a primary reason why women stop using contraception, even though they may still want to avoid a pregnancy. The Demographic and Health Surveys (DHS), the largest source of nationally representative data on contraceptive discontinuation, only asks women who discontinued a method their reasons for discontinuation, for which side effects is an option. Yet, side effects are also experienced by continued users. Using longitudinal data collected from a cohort of contraceptive users in Odisha and Haryana, India, this study explores the effect of side effect severity and frequency on six-month discontinuation. Among women who experienced side effects of their enrollment method, 49.7 percent continued to use it by the six-month interview. Women who experienced moderate/severe side effects infrequently were 67 percent (adjusted odds ratio [AOR]: 0.33; 95 percent confidence interval [CI]: 0.16-0.64) less likely to discontinue the enrollment method compared to women who experienced moderate/severe side effects always. Women who experienced mild side effects were even less likely to discontinue (AOR: 0.15; 95 percent CI: 0.06-0.37). Study results suggest side effect severity and frequency are more important factors than simply the experience of a side effect in understanding contraceptive discontinuation. DHS and other national surveys should expand their exploration of side effects to include questions asked of current users.

Discontinuation rate and associated factors among contraceptive implant users in Kersa district, southwestern Ethiopia

Background

Subdermal contraceptive implant is the most widely used method of long-acting reversible contraception among Ethiopian women. Many, however, discontinue use early, which results in unwanted pregnancies and induced abortions and their associated complications. The aim of this study is to determine the rate of and reasons for discontinuation of the contraceptive implant among users in the Kersa district of southwestern Ethiopia.

Methods

A mixed-method study was carried out between March and April 2019 among 475 women who had been using the contraceptive implant between January 2015 and August 2016 in the Kersa district. Systematic random sampling was used for quantitative data collection and purposive sampling was used for qualitative data collection using 8 focus group discussion and 56 In-depth interviews. A binary logistic regression was carried out for bivariate and multivariable analyses.

Results

One hundred and ten (23.2 %) contraceptive implant users requested removal before 2.5 years of use. The main reasons for the discontinuation were side effects, followed by a desire for pregnancy or to switch to another contraceptive method and misconceptions. Implant discontinuation was associated with a lack of information prior to insertion on the effectiveness of modern contraception (adjusted odds ratio [OR] 2.0; 95 % confidence interval [CI] 1.13, 3.55), being served by a midwife or nurse (adjusted OR 1.8; 95 % CI 1.04, 3.23), and not being told to return to the health facility if any side effects were experienced (adjusted OR 1.8; 95 % CI 1.01, 3.19) (all p < 0.05).

Conclusions

Almost a quarter of the study participants discontinued use of the contraceptive implant before the due date. Public health interventions should focus on providing adequate awareness for family planning users, trainings for the health care workers on effective counselling services, especially on side effect and misconceptions.

Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania

Background

Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania.

Methods

This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16–44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model.

Results

Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40–44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively.

Conclusion

Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

[Contraceptive discontinuities in the use of oral and injectable hormonal contraceptives, and male condoms]

The study aimed to estimate the total contraceptive discontinuity rates in the use of oral and injectable hormonal contraceptives, and male condoms and dropout rates due to switches to more effective and less effective methods. Data on 2,051 women, users of primary healthcare services in three Brazilian state capitals, were collected using the contraceptive calendar. The results showed that 24.5% of users of oral hormonal contraceptives, 33.5% of users of injectables, and 39% of users of male condoms had discontinued the respective method after 12 months of use, independently of the reason, and that the rates varied little between the capitals but did depend on the method. The main reason for discontinuing use of the contraceptive method was the desire to become pregnant (20.8%). Conception while using the method was reported by 20% of the women, a proportion that reached 25.7% in users of male condoms. After 12 months with the method, the dropout rate for reasons related to the contraceptive method was 11.4% in users of injectables; 15.9% of users of male condoms switched to a more effective method; and 16.3% of users of injectables switched to a less effective method. Contraceptive discontinuity rates were high and varied according to the contraceptive method.

Contraceptive discontinuation and switching in urban Istanbul region in Turkey

OBJECTIVE

To evaluate rates of contraceptive discontinuation and method switching and examine their determinants in Istanbul, Turkey, because discontinuation of modern contraception leading to unintended pregnancy is a public health concern.

METHODS

We conducted a cross-sectional household survey between March and June 2018 among 4224 married women of reproductive age (16-44 years). Information on contraceptive use and discontinuation for the 31 months preceding the survey was recorded in a monthly calendar. Using single and multiple decrement life-table methods, we calculated the overall discontinuation and the cause-specific discontinuation rates.

RESULTS

The 12-month overall discontinuation rate was 12.32%. Intrauterine devices had the lowest discontinuation rate (7.12%). The most common reasons for discontinuation were the desire to become pregnant (6.56%) and method failure (2.76%). One in three episodes of discontinuation was not followed by method switching (32.16%). Age, education, and the method type were predictive of contraceptive discontinuation.

CONCLUSION

To reduce method failure, women should be provided with information about method effectiveness, correct use of methods, and what to do if they anticipate their method failed (e.g., emergency contraception). Programs should focus on improving knowledge about discontinuation and method failure. Contraceptive counseling should also emphasize timely switching to an effective method after discontinuation.

Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the Democratic Republic of the Congo: a secondary analysis of the Yam Daabo trial

Introduction

Women who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use.

Methods

We conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching.

Results

In total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods’ discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8–8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p < 0.001). The main reason for discontinuation and switching was method-related (141 over 199), followed by partner opposition with 20 women.

Conclusion

The results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women’s partners and influential people in the community to counter inhibiting beliefs.

Trial registration

Pan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784).

Factors that affect the discontinuation of family planning methods in Myanmar: analysis of the 2015-16 Myanmar Demographic and Health Survey

Background

Access to family planning contributes up to a 44% reduction in maternal deaths. Since the majority of unplanned pregnancies and abortions occur in women who were either not using contraception or not using it consistently, greater access to contraception and more consistent use of contraception are crucial in the reduction of unplanned pregnancies and abortions. This study aims to determine which types of contraceptives are most often discontinued, the reasons for discontinuation, and the factors that influence contraceptive discontinuation for women in Myanmar.

Methods

This study is a secondary data analysis of calendar data from the 2015–16 Myanmar Demographic Health Survey. The dependent variable is discontinuation of contraception within 12 months among episodes of contraceptive use in the 5 years before the survey among women age 15–49. Multivariable logistic regression was used to identify the predictors of contraceptive discontinuation.

Results

The 12-month discontinuation rate for all contraceptive methods was 39%. The discontinuation rates for short-term methods were remarkably high (43% for pills and 42% for injectables), while the rate for long-term methods was very low (7% for intrauterine devices and 0.2% for implants). Discontinuation while still in need of contraception was high (55%) although 28% of those women switched to other modern methods. Multivariable logistic regression showed the factors associated with contraceptive discontinuation were a woman’s age, location (state/region), wealth, and number of births within the past 5 years.

Conclusions

The high rate of discontinuation while in need is very alarming given goals to reduce the unmet need for family planning in Myanmar. Family planning programs must ensure timely, informed method-switching by women who discontinue contraception, especially among women for whom discontinuation is the highest (age 45–49, middle and richest wealth quintile, regions where high discontinuation and multiparity); increase the availability of long-term contraceptive methods, and improve counseling that ensures clients’ informed and voluntary choice of family planning services.

Prevalence and associated factors of contraceptive discontinuation among reproductive-age women in Ethiopia: using 2016 Nationwide Survey Data

BACKGROUND

Contraceptive discontinuation for reasons other than the desire for pregnancy is associated with mistimed and unwanted pregnancies, unwanted births and unsafe abortions which has increased risks of maternal morbidity and mortality. However, research on the identification of factors that are associated with contraceptive discontinuation in Ethiopia is limited. Therefore, this study aimed to determine the prevalence of contraceptive discontinuation and associated factors among reproductive-age women in Ethiopia, using recent national survey data.

METHODS

A population-based cross-sectional study was conducted using secondary data analysis from of 2016, Ethiopian Demographic Health Survey. A total of 10,871 reproductive-age women were included. The analysis was performed using SPSS version 20 statistical package. Bivariate and multivariate logistic regression analysis was conducted to examine significant factors of contraceptive discontinuation, and statistical significance was declared at p-value < 0.05.

RESULTS

The prevalence of discontinuation for all contraceptives methods among reproductive-age women was 32.2% (95% C.I 31.2, 33.1). Rural residence (AOR = 1.94, 95% C.I 1.65, 2.28), women with no formal education (AOR = 1.68, 95% C.I 1.30, 2.17), women having no children (AOR = 1.95, 95% C.I 1.19, 3.58), husband desire for children (AOR = 2.57, 95% C.I 2.03, 3.26), women self-decision when using a contraceptive (AOR = 0.54, 95% C.I 0.38, 0.77), joint decision when using a contraceptive (AOR = 0.38, 95% C.I 0.29, 0.48), didn't discuss about FP with healthcare worker (AOR = 1.28, 95% C.I 1.06, 1.54) and didn't get information about side effects (AOR = 2.01, 95% C.I 1.59, 2.52) were factors significantly associated with contraceptives discontinuation.

CONCLUSION

The prevalence of contraceptive discontinuation among reproductive-age women was high and multiple factors determined it. Thus, counseling on side effects, availability of other contraceptive methods, and partner involvement in decision-making process by health care providers are strongly recommended. In addition, women empowerment should be promoted so that women are able to liberally decide on when and how many children they wish to have.

Patterns and determinants of modern contraceptive discontinuation among women of reproductive age: Analysis of Kenya Demographic Health Surveys, 2003-2014

Objectives

This study aimed to examine patterns and determinants of modern contraceptive discontinuation among women in Kenya.

Methods

Secondary analysis was conducted using national representative Kenya Demographic and Health Surveys of 2003, 2008/9, and 2014. These household cross-sectional surveys targeted women of reproductive age from 15 to 49 years who had experienced an episode of modern contraceptive use within five years preceding the surveys from 2003 (n = 2686), 2008/9 (n = 2992), and 2014 (5919). The contraceptive discontinuation rate was defined as the number of episodes discontinued divided by the total number of episodes. Weighted descriptive statistics, multivariable logistic regression analysis, and Cox proportional hazards analysis were used to examine the determinants of contraceptive discontinuation.

Results

The 12-month contraceptive discontinuation rate for all methods declined from 37.5% in 2003 and 36.7% in 2008/9 to 30.5% in 2014. Consistently across the three surveys, intrauterine devices had the lowest 12-month discontinuation rate (6.4% in 2014) followed by implants (8.0%, in 2014). In 2014, higher rates were seen for pills (44.9%) and male condoms (42.9%). The determinants of contraceptive discontinuation among women of reproductive age in the 2003 survey included users of short-term contraception methods, specifically for those who used male condoms (hazard ratio [HR] = 3.30, 95% confidence interval [CI] = 2.13–5.11) and pills (HR = 2.68; 95CI = 1.79–4.00); and younger women aged 15–19 year (HR = 2.07; 95% CI = 1.49–2.87) and 20–24 years (HR = 1.94; 95% CI = 1.61–2.35). The trends in the most common reasons for discontinuation from 2003 to 2014 revealed an increase among those reporting side effects (p = 0.0002) and those wanting a more effective method (p<0.0001). A decrease was noted among those indicating method failure (p<0.0001) and husband disapproval (p<0.0001).

Conclusions

Family planning programs should focus on improving service quality to strengthen the continuation of contraceptive use among those in need. Women should be informed about potential side effects and reassured on health concerns, including being provided options for method switching. The health system should avail a wider range of contraceptive methods and ensure a constant supply of commodities for women to choose from. Short-term contraceptive method users and younger women may need greater support for continued use.

Effect of a mobile phone-assisted postpartum family planning service on the use of long-acting reversible contraception: a randomised controlled trial

OBJECTIVE

The aim of the study was to evaluate the effect of adding mobile phone call reminders to a postpartum family planning service on the initiation of long-acting reversible contraception (LARC).

METHODS

A randomised, open-label controlled trial (ClinicalTrials.gov NCT03135288) was carried out at a university hospital between July 2017 and March 2019. The study comprised women who delivered a live birth at >28 weeks' gestation and who requested birth spacing for ≥1 year. Eligible women were recruited and randomised to two groups. The study group received contraceptive counselling and two reminders of their first postpartum appointment, one week and again 48 h before the appointment. The control group received contraceptive counselling but no mobile phone reminders of their first postpartum appointment. The primary outcome was the rate of initiation of a LARC method in the first 6 months postpartum.

RESULTS

The study comprised 500 participants in each group. The rate of initiation and continuation of a LARC method was significantly higher in the study group compared with the control group (30.2% vs 8.4% and 95.4% vs 83.3%, respectively; p < .001). In the study group, 382 (76.4%) women had started using a contraceptive method during the first 6 months, compared with 218 (43.6%) women in the control group (p < .001).

CONCLUSION

Using mobile phone reminders as part of the postpartum service increases the frequency of women who attends family planning clinics and initiates contraception, including a LARC methods, as well as the proportion who continue LARC use through the first 6 months postpartum.

Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey

Background

Ethiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia.

Methods

The unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation.

Result

Approximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25–34 (HR = 0.26; 95% CI: 0.20–0.35) and those aged 35–49 (HR = 0.17; 95%CI: 0.11–0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37–0.78), or fully (HR = 0.55; 95%CI: 0.40–0.74) and primiparous women (HR = 0.53, 95%CI: 0.33–0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02–1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28–3.46) had a higher likelihood of discontinuing these methods.

Conclusion

Majority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women’s participation in household decision-making may decrease LARC discontinuation in Ethiopia.

Biomaterials and Contraception: Promises and Pitfalls

The present state of reproductive and sexual health around the world reveals disparities in contraceptive use and effectiveness. Unintended pregnancy and sexually transmitted infection transmission rates remain high even with current prevention methods. The 20th century saw a contraceptive revolution with biomedical innovation driving the success of new contraceptive technologies with central design concepts and materials. Current modalities can be broadly categorized according to their mode of function: reversible methods such as physical/chemical barriers or hormonal delivery devices via systemic (transdermal and subcutaneous) or localized (intrauterine and intravaginal) administration, and nonreversible sterilization procedures such as tubal ligation and vasectomy. Contraceptive biomaterials are at present dominated by well-characterized elastomers such as polydimethylsiloxane and ethylene vinyl acetate due to their favorable material properties and versatility. Contraceptives alter the normal function of cellular components in the reproductive systems to impair fertility. The purpose of this review is to highlight the bioengineering design of existing methods, explore novel adaptations, and address notable shortcomings in current contraceptive technologies.

Factors Impacting Family Planning Use in Mali and Senegal

The total fertility rate in Mali (6.2) is the third highest in the world. Despite sociocultural similarities, the total fertility rate in neighboring Senegal is 4.2. The aim of this study is to identify factors which may help to explain the differences between the two countries and which may thereby inform family planning policy in Mali. A cross-sectional study was conducted with a convenience sample of 602 married women aged 16–50 from urban and rural sites in southern Mali and Senegal. A total of 298 respondents from Mali and 304 from Senegal completed a structured questionnaire between July and October 2018. In total, 11.1% of the Malian respondents and 30.9% of the Senegalese respondents were currently using family planning, and 34.6% and 40.5%, respectively, had ever used a modern family planning method. Pressure from husbands was cited as a primary influence for having more children (in 50.3% of Malians and 45.4% of Senegalese, p = 0.000). Women’s age, education level, and knowledge of different contraceptive methods were associated with ever use of contraceptives. After adjustment for confounders, discussing family planning with one’s husband was the strongest predictor of contraceptive use among both Senegalese (OR = 3.4, 95% CI (1.9–6.3), p = 0.000) and Malian respondents (OR = 7.3, (4.1–13.3), p = 0.000).

H, P. A, K. P. K, J. B. Incidence and determinants of Implanon discontinuation: Findings from a prospective cohort study in three health zones in Kinshasa, DRC

Background

Kinshasa is Africa's third largest city and one of the continent’s most rapidly growing urban areas. PMA2020 data showed that Kinshasa has a modern contraceptive prevalence of 26.5% among married women in 2018. In Kinshasa’s method mix, the contraceptive implant recently became the dominant method among contraceptive users married and in union. This study provides insight into patterns of implant use in a high-fertility setting by evaluating the 24-month continuation rate for Implanon NXT and identifying the characteristics associated with discontinuation.

Methodology

This community-based, prospective cohort study followed 531 Implanon users aged 18–49 years at 6, 12 and 24 months. The following information was collected: socio-demographic characteristics, Method Information Index (MII) and contraceptive history. The main outcome variable for this study was implant discontinuation. The incidence rate of discontinuation is presented as events per 1000 person/months (p-m), from the date of enrolment. The Cox proportional hazards modelling was used to measure predictors of discontinuation.

Results

A total of 9158.13 p-m were available for analysis, with an overall incidence rate of 9.06 (95% CI: 9.04–9.08) removals per 1000 p-m. Of nine possible co-variates tested, the likelihood of discontinuation was higher among women who lived in military camps, had less than three children, never used injectables or implants in the past, had experienced heavy/prolonged bleeding, and whose MII score was less than 3.

Conclusion

In addition to four client characteristics that predicted discontinuation, we identified one programmatic factor: quality of counseling as measured by the Method Information Index. Community providers in similar contexts should pay more attention to clients having less than three children, new adopters, and to clients living military camps as underserved population, where clients have less access to health facilities. More targeted counselling and follow-up is needed, especially on bleeding patterns.

Role of Information and Communication Technology and Women's Empowerment in Contraceptive Discontinuation in Indonesia

OBJECTIVES

This study investigated the role of information and communication technology and women's empowerment in contraceptive discontinuation in Indonesia.

METHODS

The study used data from the 2017 Indonesia Demographic and Health Survey and monthly contraceptive calendar data. A Gompertz proportional hazards model was used for analysis.

RESULTS

The 12-month contraceptive discontinuation rate was higher among women who had used the Internet in the past year, women who were mobile phone owners, and women who reported having fully participated in household decision-making than among their counterparts. These factors significantly impacted the risk of contraceptive discontinuation in Indonesia, even after controlling for contraceptive method, age, parity, contraceptive intent, education, work status, place of residence, and wealth status.

CONCLUSIONS

After adjustment for the control variables, a higher risk of contraceptive discontinuation was associated with having used the Internet in the past year, owning a mobile phone, and not participating in household decision-making. Higher contraceptive discontinuation risk was also associated with using contraceptive pills, older age, lower parity, intent of spacing births, more education, current unemployment, and rural residence, and the risk was also significantly higher for those in the lowest household wealth quintile than for those in the fourth household wealth quintile. The association of contraceptive discontinuation with the use of modern information and communication technology and relatively disempowerment in household decision-making may imply that information regarding family planning and contraception should be conveyed via social media as part of setting up an eHealth system. This must include a strong communication strategy to empower and educate women in contraceptive decision-making.