scholarly journals Anaemic women are more at risk of injectable contraceptive discontinuation due to side-effects in Ethiopia

2020 ◽  
Author(s):  
Rose Stevens ◽  
Blandine Malbos ◽  
Eshetu Gurmu ◽  
Jérémie Riou ◽  
Alexandra Alvergne
Keyword(s):  
Side Effects ◽  
Physiological Condition ◽  
Hormonal Contraception ◽  
Unmet Need ◽  
Sociocultural Factors ◽  
Reverse Causality ◽  
Injectable Contraceptive ◽  
Contraceptive Discontinuation ◽  
Calendar Data ◽  
Physiological Risk

AbstractIntroductionThis paper investigates the importance of women’s physiological condition for predicting the risk of discontinuation due to side-effects of the injectable contraceptive in Ethiopia, where side-effects account for around 20% of all discontinuations.MethodsContraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analysed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses.ResultsIn 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anaemia were at twice the risk of DSE compared with non-anaemic women, while anaemia status was not associated with DOR. The association between anaemia and experience of side-effects is likely driven by iron-deficiency anaemia, as having taken iron supplements during last pregnancy is found to decrease the risk of DSE. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE.ConclusionAccounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects. To reduce side-effects and thereby unmet need for contraception, family planning programs may benefit from providing an integrated service package addressing anaemia as well as supplying hormonal contraception.

scholarly journals Anaemic women are more at risk of injectable contraceptive discontinuation due to side-effects in Ethiopia

2020 ◽  
Author(s):  
Rose Stevens ◽  
Blandine Malbos ◽  
Eshetu Gurmu ◽  
Jérémie Riou ◽  
Alexandra Alvergne
Keyword(s):  
Side Effects ◽  
Physiological Condition ◽  
Relationship Status ◽  
Sociocultural Factors ◽  
Regression Analyses ◽  
Reverse Causality ◽  
Injectable Contraceptive ◽  
Contraceptive Discontinuation ◽  
Calendar Data ◽  
Physiological Risk

Abstract Introduction This paper investigates the importance of women’s physiological condition for predicting the risk of discontinuation due to side-effects of the injectable contraceptive in Ethiopia, where side-effects account for around 20% of all discontinuations. Methods Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analysed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Results In 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anaemia were at twice the risk of DSE compared with non-anaemic women, while anaemia status was not associated with DOR. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE. Conclusion Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects.

scholarly journals A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Susan Ontiri ◽  
Lilian Mutea ◽  
Violet Naanyu ◽  
Mark Kabue ◽  
Regien Biesma ◽  
...  
Keyword(s):  
Family Planning ◽  
Side Effects ◽  
Peer Influence ◽  
Contraceptive Use ◽  
Unmet Need ◽  
Modern Contraceptive ◽  
Modern Contraception ◽  
Modern Contraceptives ◽  
Family Planning Programs ◽  
Contraceptive Discontinuation

Abstract Background Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. Methods Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. Results Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods. Conclusion This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.

Method Related Attributes and Contraceptive Discontinuation: Results from A Prospective Study from Nairobi and Homa Bay Counties in Kenya.

2021 ◽  
Author(s):  
Yohannes Dibaba Wado ◽  
Martin K. Mutua ◽  
George Odwe ◽  
Francis Obare ◽  
Kazuyo Machiyama ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Side Effects ◽  
Contraceptive Use ◽  
Longitudinal Design ◽  
Unmet Need ◽  
Health Problems ◽  
Competing Risk ◽  
Modern Contraceptive ◽  
Fertility Preferences ◽  
Contraceptive Discontinuation

Abstract Background: Rates of contraceptive discontinuation are high in many low and middle countries contributing to unmet need for contraception and other adverse reproductive health outcomes. Few studies have investigated how method specific beliefs and strength of fertility preferences affect discontinuation rates. This study examines this question using primary data collected in Nairobi and Homa Bay counties in Kenya.Methods: We used data from two rounds of a longitudinal study of married women ages 15-39 years (2812 and 2424 women from Nairobi and Homa Bay respectively at round 1) from two communities in Kenya. Information on fertility preferences, past and current contraceptive behavior, and method-related beliefs about six modern contraceptive methods were collected, along with a monthly calendar of contraceptive use between the two interviews. The analysis focused on discontinuation of the two most commonly used methods in both sites, injectable and implants. We carry out competing risk survival analysis to identify which method related beliefs predict discontinuation among women using at the first round. Results: The percentages of episodes discontinued in the 12 months between the two rounds was 36%, with a higher rate of discontinuation in Homa Bay (43%) than in the Nairobi slums (32%) and higher for injectables than implants. Method related concerns and beliefs were the major self-reported reasons for discontinuation in both sites. The competing risk survival analysis showed that the probability of method related discontinuation of implants and injectables was significantly lower among respondents who believed that the methods do not cause serious health problems (SHR=0.78, 95% CI 0.62-0.98), do not interfere with regular menses (SHR=0.76, 95% CI 0.61 - 0.95) and do not cause unpleasant side effects (SHR=0.72, 95% CI 0.56-0.89). By contrast, there were no net effects of three method related beliefs that are commonly cited as obstacles to contraceptive use in African societies: safety for long-term use, ability to have children after stopping the method, and the approval of the husband.Conclusion: This study is unique in its examination of the effect of method specific beliefs on subsequent discontinuation for a method-related reason, using a longitudinal design. The single most important result is that concerns about serious health problems, which are largely unjustified and only moderately associated with beliefs about side effects, are a significant influence on discontinuation. The negative results for other beliefs show that the determinants of discontinuation differ from the determinants of method adoption and method choice.

Correlation of Unmet Need and Discontinuation in Ethiopia: a View

2016 ◽  
Vol 51 (6) ◽  
pp. 656-668
Author(s):  
Yishak A Lailulo ◽  
A Sathiya Susuman
Keyword(s):  
Side Effects ◽  
Research Method ◽  
Quantitative Research ◽  
Contraceptive Use ◽  
Research Question ◽  
Unmet Need ◽  
Discontinuation Rate ◽  
Key Factors ◽  
Factors Affecting ◽  
Contraceptive Discontinuation

A few key factors affecting usage of all methods and contraceptive discontinuation among women whom are currently married in Ethiopia are discussed. What are the factors affecting women’s contraceptive use? The aim is to explore the two regions on the basis of high total fertility rate (TFR) regions (Oromiya (5.6) and Southern Nations, Nationalities, and People’s Region (SNNPR) (4.9)) in the Ethiopian demographic and health survey (EDHS) 2011. A descriptive and comparative study using the quantitative research method is chosen to address the above research question. The study findings show that the contraceptive discontinuation rate for users of all types of methods is 37%. The highest women’s discontinuation rate is for the pill which is 70% due to side effects.

scholarly journals Contraceptive Use Dropout-adjusted Unmet Need for Family Planning

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 780
Author(s):  
Budi Utomo ◽  
Hariyanti Hariyanti ◽  
Sabarinah Prasetyo ◽  
Robert Magnani ◽  
Sukma Rahayu
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Unwanted Pregnancy ◽  
Unmet Need ◽  
Discontinuation Rate ◽  
Study Results ◽  
Unwanted Pregnancies ◽  
Contraceptive Discontinuation ◽  
History Of ◽  
Calendar Data

Background: In the last two decades, unmet need for family planning in Indonesia remains stagnant, and contraceptive discontinuation has increased. These two indicators describe the risk of unwanted pregnancy in a population. Therefore, this study aims to develop an accurate calculation of the unmet need for family planning in Indonesia.  Method: The study uses 2017 IDHS data to compare unmet need at survey-time and five years preceding the survey, measured by contraceptive calendar data that measured history of contraceptive use within five years preceding the survey. Unmet need at five years preceding the survey is measured by calculating the proportion of months not using contraceptive to the duration of months exposed to pregnancy in a period of 69 months. The study population is married women in Indonesia, with a sample size of 35,681.   Results: Unmet need with contraceptive calendar calculation is higher than unmet need at survey-time. A difference of 3% concerns an additional of nearly 1.6 million unwanted pregnancies. This study proves that the high number of contraceptive discontinuations is directly proportional to higher unmet need with contraceptive calendar calculation.  Conclusion: In Indonesia, with a relatively high contraceptive discontinuation rate, the calculation of unmet need using the calendar method is more precise than at survey-time method. The study results suggest the use of unmet need calendar for countries with high contraceptive discontinuation rate and provision of primary health care that is responsive to a potential unwanted pregnancy.

scholarly journals Side effects and the need for secrecy: characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods

2017 ◽  
Author(s):  
Alexandra Alvergne ◽  
Rose Stevens ◽  
Eshetu Gurmu
Keyword(s):  
Mixed Methods ◽  
Side Effects ◽  
Health Professionals ◽  
Contraceptive Use ◽  
Hormonal Contraception ◽  
Reproductive Age ◽  
Structured Interviews ◽  
Main Hypothesis ◽  
Major Barrier ◽  
Contraceptive Discontinuation

AbstractBackgroundContraceptive discontinuation is a major barrier to reducing global unmet needs for family planning, but the reasons why women discontinue contraception are poorly understood. Here we use data from Ethiopia to investigate (i) the magnitude of contraceptive discontinuation in 2005-2011, (ii) how the risk of discontinuation varies with method type and education level and (iii) the barriers to continuation. Our main hypothesis is that contraceptive discontinuation is driven by the experience of physiological side-effects associated with the use of hormonal contraception, rather than a lack of education.MethodsWe used a mixed methods explanatory sequential design to explain the quantitative results in more details through the qualitative data. First, we analysed quantitative data from the 2011 Ethiopian Demographic and Health Survey to study patterns of contraceptive discontinuation and method choice using multilevel multiprocess models. Second, we conducted semi-structured interviews and focus group discussions in the 3 most populated regions of Ethiopia with individuals of reproductive age and health professionals.ResultsThe analysis of EDHS data shows that the rate of discontinuation has not reduced in the period 2005-2011 and remains high. Discontinuation mainly takes the form of abandonment, and is a function of method type and wealth but not of educational level. Interviews with women and health professionals reveal that the experience of debilitating physiological side effects, the need for secrecy and poverty are important barriers to continuation.ConclusionsOur findings together suggest that physiological and social side-effects of contraceptive use, not education, are the root causes of contraceptive discontinuation in Ethiopia. We argue that to tackle discontinuation due to side-effects, dispelling misconceptions through educating women is not addressing the root causes of discontinuation, and that priority should be given to both engaging men and questioning the appropriateness of medical technology to the physiology of Ethiopian women, especially those living in poverty.

The recent increase in contraceptive discontinuation in Egypt

2019 ◽  
Vol 52 (1) ◽  
pp. 154-157
Author(s):  
Mona Khalifa ◽  
Wafaa Abdelaziz ◽  
Soha Metwally ◽  
Ehab Sakr
Keyword(s):  
Unmet Need ◽  
Discontinuation Rate ◽  
Unintended Pregnancies ◽  
Recent Increase ◽  
Ideal Family ◽  
The Family ◽  
Contraceptive Discontinuation ◽  
Contraceptive Prevalence ◽  
Calendar Data ◽  
Unmet Need For Contraception

AbstractThis study sought to establish whether recent changes in discontinuation of contractive use and switching in Egypt can be considered an important cause of the unexpected increase in overall fertility and slight fall in contraceptive prevalence in the country. The analysis was based on calendar data from the 2008 and 2014 Egyptian DHS. Single/multiple decrement life tables were built to calculate contraceptive discontinuation rates and examine these by reasons for discontinuation focusing on three methods: IUDs, pills and injectables. The unit of the analysis was ‘segment of use’, defined as a continuous period of use/non-use of a contraceptive method (in months). It was found that over the period 2008–2014 the rise in the ‘all method’ discontinuation rate was mainly due to the shift away from IUDs to hormonal methods, which have higher discontinuation rates. Segments of use were more likely to be discontinued for ‘method/service-related’ reasons than for ‘reduced need’ reasons. This was due to an increase in contraceptive failure and side-effect/health concerns. Also, ‘the desire to get pregnant’ increased to become the second highest reason-specific discontinuation rate. This has coincided with a recent increase in ideal family size in Egypt. About half of the women who reported discontinuing for reasons related to method/services switched to another method, while the rest became subject to the risk of an unintended pregnancy. The rate of switching, rather than stopping use, increased for IUDs, remained the same for pills and increased slightly for injectables, indicating an improvement in switching behaviour. However, a marked high percentage of switchers moved to less-effective methods. If these issues are not addressed, many women in Egypt have an unmet need for contraception, leading to an increase in unintended pregnancies. Specific interventions that would greatly benefit the family planning programme in Egypt include improvement in counselling at the time of IUD insertion and removal and the reduction in failure rates for hormonal methods.

scholarly journals Contraceptive Method Information and Method Switching in India

2021 ◽  
Vol 13 (17) ◽  
pp. 9831
Author(s):  
Md. Juel Rana ◽  
Srinivas Goli ◽  
Rakesh Mishra ◽  
Abhishek Gautam ◽  
Nitin Datta ◽  
...  
Keyword(s):  
Side Effects ◽  
Multinomial Logistic Regression ◽  
Unmet Need ◽  
Family Health ◽  
Informed Choice ◽  
Contraceptive Methods ◽  
The Sustainable Development ◽  
Comprehensive Method ◽  
Contraceptive Discontinuation ◽  
Long Acting

The stagnation in the unmet need for family planning and rise in contraceptive discontinuation rates are major concerns among researchers and policymakers in India. This study attempts to investigate the association between method information received by the users at the time of initiation and the switching of contraceptive methods in India. Using the fourth round of National Family Health Survey (NFHS) data (2015–2016), a multinomial logistic regression model has been applied to assess the net effects of method information received by the users on switching of contraceptive methods. The reuse of contraceptive methods is higher among those who were not provided any method information. The reuse is also higher among those who were informed only about the side effects. Overall, the users who received comprehensive method information are more likely to switch. Particularly, the users who were informed about how to manage side effects either alone or along with other method information have a higher likelihood of switching especially to long-acting reversible contraceptives (LARC). The findings call for program intervention to provide comprehensive method information to the users because it gives them the freedom to switch to more suitable methods. Thus, it would help in achieving the sustainable development goal (3.7) of informed choice of contraceptive methods.

scholarly journals Contraceptive discontinuation and non-use in Santarém, Brazilian Amazon

2009 ◽  
Vol 25 (9) ◽  
pp. 2021-2032 ◽  
Author(s):  
Álvaro de Oliveira D'Antona ◽  
Jessica Andrea Chelekis ◽  
Maria Fernanda Lirani de Toledo D'Antona ◽  
Andrea Dalledone Siqueira
Keyword(s):  
Side Effects ◽  
Health Services ◽  
Contraceptive Use ◽  
Hormonal Contraception ◽  
Brazilian Amazon ◽  
Hormonal Contraceptive ◽  
Health Centers ◽  
The Past ◽  
Contraceptive Discontinuation ◽  
The Relationship

In this paper we discuss the causes of non-adherence to reversible contraceptives, especially hormonal methods, among women in rural Santarém in the Brazilian Amazon. The analysis is based on questionnaires with 398 women and visits to health centers. We consider the motives reported by women who: never used contraception; used some method in the past; and who at the time of the survey were using a different method from the ones they used in the past. The results indicate a rejection of hormonal contraception and a preference for female sterilization, an option possibly influenced by the characteristics of health services in the region. The side effects of hormonal contraceptive use reported by part of the interviewees contribute to a generalized fear of the side effects even among women who have never used such methods. To improve women's health services in the Amazon, we recommend further studies of the relationship between reported side effects and available services and prescriptions, as well as an analysis of women's discourse and perceptions.

Anemic Women are More at Risk of Injectable Contraceptive Discontinuation Due to Side-Effects in Ethiopia

2020 ◽  
Author(s):  
rose stevens ◽  
Blandine Malbos ◽  
Eshetu Gurmu ◽  
Jeremie Riou ◽  
Alexandra Alvergne
Keyword(s):  
At Risk ◽  
Side Effects ◽  
Injectable Contraceptive ◽  
Contraceptive Discontinuation
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