Association between contraceptive implant knowledge and intent with implant uptake among postpartum Malawian women: a prospective cohort study.

Jennifer H Tang,Christopher C Stanley,Phylos Bonongwe,Michele O’Shea,Mwawi Mwale,Stephen Kaliti,Dawn M Kopp,Mina C Hosseinipour,Gretchen S Stuart,Nora E Rosenberg,William C Miller

doi:10.1186/s40834-016-0026-1

Abstract

BackgroundLong-acting reversible contraception (LARC) can assist women with birth spacing and reduce unintended pregnancies. Sub-Saharan Africa has low uptake of the two available methods of LARC, the subdermal implant and intrauterine contraception (IUC). Our primary objectives were to: 1) calculate the incidence of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake.MethodsThis study was a prospective cohort study of 634 postpartum women who were recruited from the postpartum ward of Bwaila Hospital in Lilongwe, Malawi. Study participants completed a baseline survey in the postpartum ward. Follow-up telephone surveys about contraceptive use were conducted at 3, 6, and 12 months postpartum. Cox proportional hazards regression analysis was performed to evaluate if implant knowledge and intent to use implant were associated with implant uptake.ResultsOne hundred thirty-seven implant and 10 IUC placements were reported over 12 months of follow-up; given the low rate of IUC uptake, further analysis was only done for implant uptake. The incidence rate for implant uptake was 35.6 per 100 person-years (95 % CI 30.0, 42.2). Correct implant knowledge (adjusted HR = 1.69; 95 % CI 1.06, 2.68) and intent to use implant (adjusted HR 1.95; 95 % CI 1.28, 2.98) were both associated with implant uptake.ConclusionsMore women reported implant use than IUC use in our study. Correct implant knowledge and intent to use implant were both associated with implant uptake, with a stronger association for intent. Interventions to increase LARC uptake should focus on improving LARC knowledge and removing barriers to LARC.Trial registrationClinical Trial Registration #: NCT01893021

Highlights

Long-acting reversible contraception (LARC) can assist women with birth spacing and reduce unintended pregnancies
Our primary objectives were to: 1) calculate the incidence rate of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake
In this prospective cohort study of postpartum Malawian women, we found a substantial proportion of women initiating LARC with an implant uptake incidence rate of 35.6 per 100 person-years

Summary

Introduction

Long-acting reversible contraception (LARC) can assist women with birth spacing and reduce unintended pregnancies. Our primary objectives were to: 1) calculate the incidence of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake. Subdermal implants and intrauterine contraception (IUC) are the most effective reversible contraceptives and are known as “long-acting reversible contraception” (LARC) [4, 5] They are used by less than 3 % of reproductive-aged women (which includes postpartum women) in sub-Saharan Africa, including in Malawi [6, 7]. Our primary objectives were to: 1) calculate the incidence rate of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake. Our secondary objectives were to describe barriers to LARC uptake and reasons for discontinuation among LARC users

Methods

Results

Discussion

Conclusion