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

Abstract 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.

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

Reproductive Health ◽

10.1186/s12978-021-01094-y ◽

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.

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Side Effect Concerns and their Impact on Women’s Uptake of Modern Family Planning Methods in Rural Ghana: A Mixed Methods Study

10.21203/rs.2.14117/v3 ◽

2020 ◽

Author(s):

Leah A. Schrumpf ◽

Maya J. Stephens ◽

Nathaniel E. Nsarko ◽

Eric Akosah ◽

Joy Noel Baumgartner ◽

...

Keyword(s):

Family Planning ◽

Side Effects ◽

Contraceptive Use ◽

Unmet Need ◽

Mixed Methods Study ◽

Modern Contraceptive ◽

Modern Family ◽

Depth Interviews ◽

Modern Family Planning

Abstract Background: Despite availability of modern contraceptive methods and documented unmet need for family planning in Ghana, many women still report forgoing modern contraceptive use due to anticipated side effects. The goal of this study was to examine the use of modern family planning, in particular hormonal methods, in one district in rural Ghana, and to understand the role that side effects play in women’s decisions to start or continue use. Methods: This exploratory mixed-methods study included 281 surveys and 33 in-depth interviews of women 18-49 years old in the Amansie West District of Ghana between May and July 2018. The survey assessed contraceptive use and potential predictors of use. In-depth interviews examined the context around uptake and continuation of contraceptive use, with a particular focus on the role of perceived and experienced side effects. Results: The prevalence of unmet need for modern family planning among sexually active women who wanted to avoid pregnancy (n=135) was 68.9%. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. Qualitative interviews revealed significant concerns about side effects stemming from previous method experiences and/or rumors regarding short-term impacts and perceived long-term consequences of family planning use. Side effects mentioned include menstrual changes (heavier bleeding, amenorrhea or oligomenorrhea), infertility and childbirth complications. Conclusion: As programs have improved women’s ability to access modern family planning, it is paramount to address patient-level barriers to uptake, in particular information about side effects and misconceptions about long-term use. Unintended pregnancies can be reduced through comprehensive counseling about contraceptive options including accurate information about side effects, and the development of new contraceptive technologies that meet women’s needs in low-income countries.

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Family Planning Providers and Contraceptive users in Rwanda Employ Strategies to Prevent Discontinuation

10.21203/rs.3.rs-145571/v1 ◽

2021 ◽

Author(s):

Hilary Schwandt ◽

Angel Boulware ◽

Julia Corey ◽

Ana Herrera ◽

Ethan Hudler ◽

...

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Family Planning Program ◽

Planning Program ◽

Group Discussions ◽

Family Planning Programs ◽

Contraceptive Discontinuation ◽

Desired Family Size ◽

Long Acting ◽

The Right

Abstract Background: Contraceptive discontinuation is a common event. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users is imperative for long-term family planning program success.Methods: This qualitative study in Rwanda in 2018 included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with contraceptive users. The data were collected in the two districts with the highest and lowest rates of contraceptive use, Musanze and Nyamasheke, respectively. The aim of this study is to better understand how providers and contraceptive users in Rwanda navigate one of the greatest challenges to family planning programs: contraceptive discontinuation.Results: Family planning providers and current users in Rwanda do not consider method discontinuation an option. Providers give support and medicine for side effects for continuers and counseling for those opting to switch. Current users are willing to try many methods until they find the right one for them – and once they find the right method, they plan to, or use the method, for long durations.Conclusions: The Rwandan family planning program is primed to meet the needs of users in their sustained use of contraceptives through empathetic and responsive counseling. Concurrently, family planning users are determined to use family planning to meet their desired family size goals. The matching goals of both providers and clients indicates that contraceptive use will likely continue to increase in Rwanda. Due to long periods of pregnancy prevention desired by users the increased use of long acting methods should be encouraged.

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“Due to the side effects she has when using the method it will be difficult for nurses to convince her to continue with that method. That’s why I said she will leave with another method.”: Family planning providers and contraceptive users in Rwanda do not consider discontinuation an option

10.21203/rs.2.9944/v1 ◽

2019 ◽

Author(s):

Hilary M. Schwandt ◽

Angel Boulware ◽

Julia Corey ◽

Ana Herrera ◽

Ethan Hudler ◽

...

Keyword(s):

Family Planning ◽

Side Effects ◽

Contraceptive Use ◽

Family Planning Program ◽

Planning Program ◽

Program Success ◽

Contraceptive Discontinuation ◽

Desired Family Size ◽

Long Acting ◽

The Right

Abstract Background Contraceptive discontinuation is a common event. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users is imperative for long-term family planning program success. Methods This qualitative study in Rwanda in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with contraceptive users. The data were collected in the two districts with the highest and lowest rates of contraceptive use, Musanze and Nyamasheke, respectively. The aim of this study is to better understand contraceptive use dynamics in Rwanda. Results Family planning providers and current users in Rwanda do not consider method discontinuation an option. Providers give support and medicine for side effects for continuers and counseling for those opting to switch. Current users are willing to try many methods until they find the right one for them – and once they find the right method, they plan to, or use the method, for long durations. Conclusions The Rwandan family planning program is primed to meet the needs of users in their sustained use of contraceptives through empathetic and responsive counseling. Concurrently, family planning users are determined to use family planning to meet their desired family size goals. The matching goals of both providers and clients indicates that contraceptive use will likely continue to increase in the future in Rwanda; however, due to long periods of pregnancy prevention desired – increased use of long acting methods should be encouraged.

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

10.21203/rs.3.rs-955245/v1 ◽

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.

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A qualitative study on determinants of choice of contraceptives in a rural

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20172154 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1943

Author(s):

Hamsa T. Swamy ◽

Bhanu M. ◽

Nanda Kumar B. S. ◽

Shivaraj N. S.

Keyword(s):

Side Effects ◽

Focus Group ◽

Irrational Beliefs ◽

Contraceptive Use ◽

Family Health ◽

Modern Contraceptive ◽

Focus Group Discussions ◽

Group Discussions ◽

Entire Family ◽

Lack Of Knowledge

Background: Family planning is a fundamental right of every human being. According to National Family Health Survey-4 Karnataka factsheet the rate of female sterilization is 48.6%, as compared to 57.4% in the NFHS-3 survey.1 Further as per NFHS-4 the rate of male sterilization is 0.1%, IUD/PPIUCD is 0.8%, pill use is 0.4%, and condom use is 1.3%. This study aims to determine factors influencing contraceptive non-use among women aged 15 - 49 years in rural area, Karnataka.Methods: Three focus group discussions were conducted in Ardesahalli Primary Health Center area to assess the knowledge and attitude of the women with regards to use and determinants for choices of contraceptives. Conceptual framework was used to develop the leading questions for the focus group discussions which included macro and micro level factors determining use or non-use of contraceptives.Results: Mother-in-law’s lack of knowledge about contraceptive use and fear of side effects regarding contraceptive had an influence on daughter and daughter-in-law’s for using/not using any method.Conclusions: Similar qualitative studies revealed that there were personal, cultural, and health system barriers to modern contraceptive use. In our study also Mother-in-law’s lack of knowledge and fear of side effects regarding contraceptive had an influence on daughter-in-law’s. It is imperative that the entire family is involved during the counseling sessions so that the misconceptions and irrational beliefs are addressed comprehensively.

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

PLoS ONE ◽

10.1371/journal.pone.0241605 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241605

Author(s):

Susan Ontiri ◽

Vincent Were ◽

Mark Kabue ◽

Regien Biesma-Blanco ◽

Jelle Stekelenburg

Keyword(s):

Side Effects ◽

Health Surveys ◽

Contraceptive Use ◽

Reproductive Age ◽

Modern Contraceptive ◽

Discontinuation Rate ◽

Women Of Reproductive Age ◽

Short Term ◽

Younger Women ◽

Contraceptive Discontinuation

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.

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Side Effect Concerns and their Impact on Women’s Uptake of Modern Family Planning Methods in Rural Ghana: A Mixed Methods Study

10.21203/rs.2.14117/v2 ◽

2019 ◽

Author(s):

Leah A. Schrumpf ◽

Maya J. Stephens ◽

Nathaniel E. Nsarko ◽

Eric Akosah ◽

Joy Noel Baumgartner ◽

...

Keyword(s):

Family Planning ◽

Side Effects ◽

Contraceptive Use ◽

Mixed Methods Study ◽

Modern Family ◽

Planning Methods ◽

Depth Interviews ◽

Modern Family Planning ◽

Family Planning Methods

Abstract Background: Despite availability of modern family planning methods and a desire for smaller families, many women decide to forgo modern methods due to anticipated side effects. The goal of this study was to examine the use of modern family planning in one district in rural Ghana, and to understand the role that side effects play in women’s decisions to start or continue use. Methods: This exploratory mixed-methods study included 281 surveys and 33 in-depth interviews of women 18-49 years old from the Amansie West District of Ghana. The survey assessed contraceptive use and potential predictors of use. In-depth interviews examined the context around uptake and continuation of contraceptive use, with a particular focus on the role of perceived and experienced side effects. Results: The prevalence of unmet need for modern family planning among sexually active women who wanted to avoid pregnancy (n=135) was 68.9%. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. Qualitative interviews revealed significant concerns about side effects stemming from previous method experiences and/or rumors regarding short-term impacts and perceived long-term consequences of family planning use. Conclusion: As programs have improved women’s ability to access modern family planning, it is paramount to address patient-level barriers to uptake, in particular information about side effects and misconceptions about long-term use. Unintended pregnancies can be reduced through comprehensive counseling about contraceptive options including accurate information about side effects, and the development of new contraceptive technologies that meet women’s needs in low-income countries.

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Peningkatan Pengetahuan Wanita Usia Subur Tentang Efek Penggunaan Kontrasepsi Progestin Terhadap Kesehatan Organ Reproduksi

JURNAL KREATIVITAS PENGABDIAN KEPADA MASYARAKAT (PKM) ◽

10.33024/jkpm.v4i5.4251 ◽

2021 ◽

Vol 4 (5) ◽

pp. 1227-1236

Author(s):

Nora Veri ◽

Alchalidi Alchalidi ◽

Dewita Dewita ◽

Nuswatul - Khaira ◽

T. Iskandar Faisal

Keyword(s):

Family Planning ◽

Side Effects ◽

Reproductive Organs ◽

Reproductive Age ◽

Hormonal Contraceptives ◽

Women Of Reproductive Age ◽

Family Planning Programs ◽

The Family ◽

The Government

ABSTRAK Pemerintah menggalakan program Keluarga Berencana (KB) untuk mengendalikan pertumbuhan penduduk. Salah satu program KB adalah dengan penggunaan kontrasepsi. Metode kontrasepsi yang saat ini yang paling banyak digunakan oleh Wanita Usia Subur (WUS) adalah suntikan Depo Medroxy Progesterone Acetate (DMPA) yang berisi hormon progesteron. DMPA memiliki efek samping yang merugikan organ reproduksi untuk penggunaan jangka panjang. Tujuan kegiatan pengabdian dilakukan untuk meningkatkan pengetahuan wanita usia subur tentang efek samping penggunaan kontrasepsi hormonal DMPA jangka panjang pada organ reproduksi. Metode pelaksanaan adalah dengan edukasi peningkatan pengetahuan tentang kontrasepsi DMPA dengan sasaran wanita usia subur akseptor KB DMPA sebanyak 60 orang. Hasil kegiatan diperoleh bahwa mayoritas pengetahuan wanita usia subur pada kategori kurang pada saat pretest sebanyak 41 orang (68,33%) dan pada saat posttest mayoritas berada pada kategori baik sebanyak 53 orang (88,33%). Adanya peningkatan pengetahuan setelah dilakukan edukasi tentang penggunaan kontrasepsi DMPA dan efek samping yang ditimbulkan akibat penggunaan jangka panjang terhadap kesehatan organ reproduksi. Kata Kunci : Depo Medroxy Progesterone Acetate (DMPA), Wanita Usia Subur, Kontrasepsi, Keluarga Berencana ABSTRACT The government is promoting the Family Planning (KB) program to control population growth. One of the family planning programs is the use of contraception. The method of contraception currently most widely used by women of reproductive age is the injection of Depo Medroxy Progesterone Acetate (DMPA) which contains the progesterone hormone. DMPA has adverse side effects on reproductive organs for long-term use. The purpose of this service is to increase the knowledge of women of reproductive age about the side effects of long-term use of DMPA hormonal contraceptives on the reproductive organs. The method of implementation is education to increase knowledge about DMPA contraception with the target of women of reproductive age DMPA to acceptors as many as 60 people. The results of the activity showed that the majority of knowledge of women of reproductive age were in the lack knowledge at the time of the pretest as many as 41 people (68.33%) and at the time of the posttest the majority were in the good knowledge category as many as 53 people (88.33%). There is an increase in knowledge after education about the use of DMPA contraceptives and the side effects caused by long-term use on the health of the reproductive organs. Keywords: Depo Medroxy Progesterone Acetate (DMPA), women of reproductive age, Contraception, Family Planning

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The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

PLoS ONE ◽

10.1371/journal.pone.0232504 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0232504

Author(s):

Anooj Pattnaik ◽

Diwakar Mohan ◽

Amy Tsui ◽

Sam Chipokosa ◽

Hans Katengeza ◽

...

Keyword(s):

Family Planning ◽

Health Facility ◽

Catchment Area ◽

Contraceptive Use ◽

Modern Contraceptive ◽

Summary Measure ◽

Modern Contraceptives ◽

Family Planning Programs ◽

Modern Contraceptive Use ◽

Combined Impact

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

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