Determinants of reversible contraceptive method discontinuation among women of reproductive age in Kano metropolis, Nigeria

Contraceptive discontinuation contributes substantially to the total fertility rate, unwanted pregnancies and induced abortions thereby increasing the already high maternal morbidity and mortality. This study aimed to access contraceptive discontinuation among women of reproductive age in Kano metropolis. Using a cross-sectional study design with concurrent mixed method of data collection, 350 women were studied. Data was collected using a structured interviewer administered questionnaire, focus group discussion and key informant interview guides. Of the 350 participants, 168 of them had discontinued a method of contraception giving a total discontinuation rate was 48%, with method specific discontinuation rate of 35.1% for implants, 33.9% for injectables, 21.4% for pills, and IUD having the lowest rate (15.5%). The study also found side effects to be the most common reason why women discontinued contraception (67.1%), intention to get pregnant (59.5%), method failure (16.7%), method switch (12.0%), and husband’s disapproval (9.5%). Factors significantly associated with discontinuation at bivariate level were ethnicity, influence on method choice, type of facility where method was obtained, and the type of contraceptive method. These factors were found not to be significant at multivariate level. Contraceptive discontinuation is prevalent in Kano metropolis, meaning that women are at high risk of unintended, mistimed pregnancies, and unsafe abortions, increasing maternal morbidity and mortality. Efforts should be made to tackle the problem of discontinuation through effective educational strategies and counselling techniques.

SIDE EFFECTS OF INJECTABLE AND ORAL CONTRACEPTIVE AND UNINTENDED PREGNANCY AMONG REPRODUCTIVE WOMEN IN INDONESIA

Using contraception is essential for protecting women from the risk of unintended pregnancy. However, contraceptive discontinuation, caused by side effects of contraceptives or health problems, is still high. This study aimed to assess the impact of injectable and pill contraception discontinuation due to side effects or health problems on unintended pregnancy among women aged 15-49 years in Indonesia. This study is based on the 2017 Indonesia Demographic and Health Survey. As many as 1,613 women who discontinued their oral contraceptives and 5,022 women who discontinued their injectables were followed retrospectively. Pregnancy rates were tested for differences between categories using survival analysis. It was found that one year after stopping contraceptives due to side effects, almost 16-17% of oral/injectable contraceptive users were already pregnant. The pregnancy rate was higher among women aged less than 25 years. Unplanned pregnancy occurred more frequently among women who were not working than women who were working. Counseling services need to be strengthened by improving provider knowledge and skills to give comprehensive information including contraceptives’ side effects.

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

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.

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.

Contraceptive Method Information and Method Switching in India

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.

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.