Abstract
BackgroundPostpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania.MethodsThis was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16–44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model.ResultsOverall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40–44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively.ConclusionLactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.
Highlights
Contraceptive discontinuation is defined as starting contraceptive use and stopping for any reason while still at risk of an unintended pregnancy [1]
It has been reported to be higher for short-acting methods such as condoms, injectables, pills and traditional methods as they can be discontinued by the user herself compared to longacting reversible methods such as implants and the Intrauterine device (IUD) which require a visit to facility to discontinue [1,2,3]
Previous investigators have demonstrated that women who discontinue contraception use during the postpartum period may opt not to use any method or switch to different modern method which is less effective than the previous method at preventing pregnancy, and thereby exposes women to risk of unintended pregnancy, abortions and mistimed pregnancies/births [7, 8]
Summary
Contraceptive discontinuation is defined as starting contraceptive use and stopping for any reason while still at risk of an unintended pregnancy [1]. Postpartum period in the first 12 months following childbirth has been associated with high unmet need for contraceptives coupled with unintended pregnancies [5]. Previous investigators have demonstrated that women who discontinue contraception use during the postpartum period may opt not to use any method (contraceptive discontinuation) or switch to different modern method (method switching) which is less effective than the previous method at preventing pregnancy, and thereby exposes women to risk of unintended pregnancy, abortions and mistimed pregnancies/births [7, 8]. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania
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