Contraceptive Use Dropout-adjusted Unmet Need for Family Planning

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.

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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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KAP study of contraception in clients undergoing MTP and sterilization in Gujarat, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172340 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2503

Author(s):

Rakesh Patel ◽

Runoo Ghosh

Keyword(s):

Family Planning ◽

Side Effect ◽

Contraceptive Use ◽

Unwanted Pregnancy ◽

Reproductive Age ◽

Medical College ◽

Medical Termination ◽

Planning Methods ◽

History Of ◽

Reproductive Age Group

Background: Lack of awareness, knowledge and education, religious beliefs and fear of side effects are the main causes why women do not use family planning methods. To study the knowledge, attitude and practice of contraception among clients undergoing to Medical termination of pregnancy (MTP) and sterilization.Methods: This prospective study was done among 400 indoor cases at Department of Obstetrics and Gynecology in B.J. Medical college, Ahmedabad during July 2002 to October 2003. All the clients undergoing MTP and sterilization were explained and counseled about contraception with GATHER approach of family planning. After taking detail history, a thorough clinical examination of the clients was carried out with preliminary investigations.Results: Almost 58% clients were willing to accept TL method as contraceptive option, 39.5% IUCD, 1.75% OC pill method of contraception. Regarding history of side effect of contraceptive use, 17.3% condom users, 68.5% OC pill users, 63% CuT users have felt side effect. Almost 42.5% clients were operated by MTP + Lap TL, 39.5% by MTP + CuT and 14.5% by plain Lap TL.Conclusions: Efforts should be made to promote information, education and communication regarding emergency contraception targeted to all women of reproductive age group. It is important that unwanted pregnancy be prevented through effective contraceptive practice rather than abortion.

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Correlation of Unmet Need and Discontinuation in Ethiopia: a View

Journal of Asian and African Studies ◽

10.1177/0021909614553239 ◽

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.

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The recent increase in contraceptive discontinuation in Egypt

Journal of Biosocial Science ◽

10.1017/s0021932019000269 ◽

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.

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INDUCED ABORTIONS IN PAKISTAN: EXPOSITIONS, DESTINATIONS AND REPERCUSSIONS. A QUALITATIVE DESCRIPTIVE STUDY IN RAWALPINDI DISTRICT

Journal of Biosocial Science ◽

10.1017/s0021932015000255 ◽

2015 ◽

Vol 48 (5) ◽

pp. 631-646 ◽

Cited By ~ 1

Author(s):

Zaeema Naveed ◽

Babar Tasneem Shaikh ◽

Muhammad Asif Nawaz

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Service Providers ◽

Unmet Need ◽

Care Seeking ◽

Formal Schooling ◽

Care Services ◽

Induced Abortions ◽

Unwanted Pregnancies ◽

Post Abortion

SummaryOver 2 million abortions occur annually in Pakistan, mostly in a clandestine and unsafe environment. This is an area of grave concern for the reproductive health of women. A dearth of credible data and incomplete information make the problem more difficult to address. This qualitative study was conducted in semi-urban settings in Pakistan to record perceptions and practices concerning care seeking, experiences and outcomes regarding induced abortions and post-abortion care services. Women who had had induced abortions and abortion service providers were interviewed. Unwanted pregnancies and poverty were found to be the main reasons for seeking an abortion. Moreover, the unwanted pregnancies occurred due to low use of contraceptives, mainly due to a fear or past experience of their side-effects, unfamiliarity with correct usage and perceived inefficacy of the methods, especially condoms. There is an obvious need for practical and innovative interventions to address unmet need for birth spacing through improved access to contraceptives. Contraceptive providers should be provided with up-to-date and detailed training in family planning counselling, and perhaps allowed unrestricted provision of contraceptives. As a long-term measure, improvement in access to education and formal schooling could increase young girls’ and women’s knowledge of the benefits of family planning and the risks of unsafe abortion practices. Males must be involved in all the initiatives so that both partners are in agreement on correct and consistent contraceptive use.

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DESIRE FOR MORE CHILDREN, CONTRACEPTIVE USE AND UNMET NEED FOR FAMILY PLANNING IN A REMOTE AREA OF BALI, INDONESIA

Journal of Biosocial Science ◽

10.1017/s0021932010000052 ◽

2010 ◽

Vol 42 (4) ◽

pp. 549-562 ◽

Cited By ~ 14

Author(s):

MELLISSA WITHERS ◽

MEGUMI KANO ◽

GDE NGURAH INDRAGUNA PINATIH

Keyword(s):

Family Planning ◽

Health Services ◽

Contraceptive Use ◽

Unmet Need ◽

Multivariate Logistic Regression Analysis ◽

Reproductive Age ◽

Access To Health Services ◽

The Past ◽

Access To Health ◽

Living Children

SummaryExploring fertility preferences in relation to contraceptive use can increase the understanding of future reproductive behaviour and unmet family planning needs. This knowledge can help assist women in meeting their reproductive goals. The influences on the desire for more children and current contraceptive use were examined among 1528 married women of reproductive age in an isolated community in Bali, Indonesia, using multivariate logistic regression analysis. Women who were younger, had fewer living children, had given birth in the past year and had regular access to health services were more likely to desire children. Being older, having fewer living children, not having regular access to health services, having given birth in the past year and having the desire for more children were associated with a lower likelihood of using contraception. Women with regular access to health care are more likely to desire more children, probably because they are confident in their ability to have successful birth outcomes. However, specialized clinics or family planning outreach workers may be required to reduce barriers to service utilization among some groups. The findings of this study identify key target populations for family planning, including older women and postpartum women – groups that may not perceive themselves to be at risk for unintended pregnancy. Meeting unmet need for family planning among these groups could help women meet their fertility goals, as well as reduce maternal morbidity and mortality.

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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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Predictors of modern contraceptive use among women and men in Uganda: a population-level analysis

BMJ Open ◽

10.1136/bmjopen-2019-034675 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034675 ◽

Cited By ~ 2

Author(s):

Amrita Namasivayam ◽

Sarah Lovell ◽

Sarah Namutamba ◽

Philip J Schluter

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Secondary Data ◽

Population Level ◽

Modern Contraceptive ◽

Cross Sectional ◽

Factors Affecting ◽

Logistic Regression Models ◽

Modern Contraceptive Use

Objective(s)Despite substantial and rapid improvements in contraceptive uptake in Uganda, many women continue to have unmet need for contraception. As factors affecting contraceptive use are dynamic and complex, this study seeks to identify current predictors and provide effect size estimates of contraceptive use among women and men in Uganda.Study designA nationally representative cross-sectional population survey, using secondary data from Uganda’s 2016 Demographic and Health Survey. Stratified by sex, weighted bivariable and multivariable logistic regression models were derived from a suite of potential predictor variables. Predictive abilities were assessed via 10-fold cross-validated area under the receiver operating characteristic curves (AUCs).SettingUganda.ParticipantsAll women aged 15–49 years who were permanent residents of the selected households or stayed in the household the night before the survey were eligible to participate. In one-third of the sampled households, all men aged 15–54 years who met the same residence criteria were also eligible.Primary outcome measuresModern contraceptive use.ResultsOverall, 4914 (26.6%) women and 1897 (35.6%) men reported using a modern contraceptive method. For women and men, both demographic and proximate variables were significantly associated with contraceptive use, although notable differences in effect sizes existed between sexes—especially for age, level of education and parity. Predictively, the multivariable model was acceptable for women with AUC=0.714 (95% CI 0.704 to 0.720) but less so for men with AUC=0.654 (95% CI 0.636 to 0.666).Conclusion(s)Contemporary significant predictors of contraceptive use among women and men were reported, thereby enabling key Ugandan subpopulations who would benefit from more targeted family planning initiatives to be identified. However, the acceptable AUC for women and modest AUC for men suggest that other important unmeasured predictors may exist. Nonetheless, these evidence-based findings remain important for informing future programmatic and policy directions for family planning in Uganda.

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Post-abortion fertility desires, contraceptive uptake and unmet need for family planning: voices of post-abortion care clients in Tanzania

Journal of Biosocial Science ◽

10.1017/s0021932020000607 ◽

2020 ◽

pp. 1-16

Author(s):

Colin Baynes ◽

Erick Yegon ◽

Grace Lusiola ◽

Japhet Achola ◽

Rehema Kahando

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Unmet Need ◽

Pregnancy Intentions ◽

Middle Income ◽

Fertility Desires ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion ◽

Contraceptive Uptake

Abstract Post-abortion care (PAC) integrates elements of care that are vital for women’s survival after abortion complications with intervention components that aid women in controlling their fertility, and provides an optimal window of opportunity to help women meet their family planning goals. Yet, incorporating quality family planning services remains a shortcoming of PAC services, particularly in low- and middle-income countries. This paper presents evidence from a mixed method study conducted in Tanzania that aimed at explaining factors that contribute to this challenge. Analysis of data obtained through client exit interviews quantified the level of unmet need for contraception among PAC clients and isolated the factors associated with post-abortion contraceptive uptake. Qualitative data analysis of interviews with a subset of these women explored the multi-level context in which post-abortion pregnancy intentions and contraceptive behaviours are formed. Approximately 30% of women interviewed (N=412) could recall receiving counselling on post-abortion family planning. Nearly two-thirds reported a desire to either space or limit childbearing. Of those who desired to space or limited childbearing, approximately 20% received a contraceptive method before discharge from PAC. The factors significantly associated with post-abortion contraceptive acceptance were completion of primary school, prior use of contraception, receipt of PAC at lower level facilities and recall of post-abortion family planning counselling. Qualitative analysis revealed different layers of contextual influences that shaped women’s fertility desires and contraceptive decision-making during PAC: individual (PAC client), spousal/partner-related, health service-related and societal. While results lend support to the concept that there are opportunities for services to address unmet need for post-abortion family planning, they also attest to the synergistic influences of individual, spousal, organizational and societal factors that influence whether they can be realized during PAC. Several strategies to do so emerged saliently from this analysis. These emphasize customized counselling to enable client–provider communication about fertility preferences, structural intervention aimed at empowering women to assert those objectives in family and health care settings, availability of information and services on post-abortion fertility and contraceptive eligibility in PAC settings and interventions to facilitate constructive spousal communication on family planning and contraceptive use, after abortion and in general.

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Reproductive and contraceptive healthcare for vulnerable people in the Netherlands: Pregnant not now!

European Journal of Public Health ◽

10.1093/eurpub/ckz185.572 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

C W Rijlaarsdam ◽

D W M van Sambeek ◽

L Rust

Keyword(s):

Public Health ◽

Family Planning ◽

The Netherlands ◽

Emergency Preparedness ◽

Contraceptive Use ◽

Gain Control ◽

Medical Emergency ◽

Contraception Use ◽

Vulnerable People ◽

Unwanted Pregnancies

Abstract Issue/problem Unplanned and unwanted pregnancies are an important issue in public health. Especially when parents already are in complex or vulnerable situations, for example being homeless, having an addiction, serious psychiatric- or financial problems or intellectual disabilities. Although most of these parents are in contact with several professionals, family planning and contraceptives are rarely discussed. Description of the problem In 2014 a pilot programme was developed to support vulnerable adults on family planning and adequate use of contraception. In a qualitative explorative case study the pilot was evaluated. Results The pilot showed a significant increase in postponed pregnancies by using appropriate contraceptives. Over eighty percent of this population started contraception on a voluntary basis. The study showed 5 determinants influencing contraception use: responsibility, knowledge, finance, emotion and social environment. If needed, the programme played a role on all different determinants. The method of working was the key element in the success: addressing family planning and contraceptive use through an outreach practise orientated presence approach and empowerment. Another important factor for success was the collaboration between public health and medical doctors. Lessons The successful pilot became regular care for vulnerable (potential) parents in Tilburg. The pilot was replicated in two other cities, Rotterdam and Nijmegen, with similar results. In 2018-2021 the programme will be implemented nationwide with financial support of the Ministry of Health, Welfare and Sports, coordinated by GGD GHOR Nederland (the Association of GGDs (Regional Public Health Services) and GHOR-(Regional Medical Emergency Preparedness and Planning) offices in the Netherlands). Key messages ‘Pregnant not now!’ successfully supports vulnerable people with family planning and contraceptives, helping them to gain control over their future and preventing unplanned and unwanted pregnancies. The programme is unique and preventive, its innovative character is applicable in other communities in the Netherlands and possibly across Europe.

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