Unfulfilled need for contraception among women with unmet need but with the intention to use contraception in Rakai, Uganda: a longitudinal study

Tom Lutalo,Fredrick Makumbi,Ron Gray,David Guwatudde,Heena Brahmbhatt,John Santelli,Sanyukta Mathur,Fred Nalugoda,David Serwadda

doi:10.1186/s12905-018-0551-y

Abstract

BackgroundLongitudinal data from a rural Ugandan cohort was used to estimate rates of unfulfilled need for contraception, defined as having unmet need and intent to use contraception at baseline but having an unintended pregnancy or with persistent unmet need for contraception at follow up.MethodsBetween 2002 and 2009 (5 survey rounds), a total of 2610 sexually active non-pregnant women with unmet need for contraception at the start of an inter-survey period were asked whether they intended to use any method of contraception until they desired a child. Modified Poisson multivariate regression was used to estimate unadjusted and adjusted prevalence ratios (PR) and 95% CI of unfulfilled need for contraception.ResultsThe proportion of women with unmet need at the start of an interval who intended to use contraception significantly increased from 61 to 69.1% (p < 0.05). However the majority of women who said they intended to use contraception had unfulfilled need for contraception at the subsequent survey (64.8 to 56.8%). In the adjusted analysis, significant predictors of unfulfilled need for contraception included age 40–49 years (PR = 1.34; 95% CI 1.04–1.74) and those with unknown HIV status (PR = 1.16; 95% CI 1.06–1.26).ConclusionsThere is a significant discrepancy between women’s intent to use contraception (> 60%) and subsequent initiation of use (< 30%) with many having unintended pregnancies which might explain the persistent high fertility in Uganda. Future research needs to address unfulfilled need for contraception among women at risk of unintended pregnancies.

Highlights

Longitudinal data from a rural Ugandan cohort was used to estimate rates of unfulfilled need for contraception, defined as having unmet need and intent to use contraception at baseline but having an unintended pregnancy or with persistent unmet need for contraception at follow up
The data came from the Rakai Community Cohort Study (RCCS), a prospective, open-cohort of consenting adolescents and adults aged 15–49 years interviewed at approximately 12–16 month intervals, in 50 communities in Rakai District, South Central Uganda
During survey round 13 (2008/2009) we identified women with unmet need for Family Planning (FP)

Summary

Introduction

Longitudinal data from a rural Ugandan cohort was used to estimate rates of unfulfilled need for contraception, defined as having unmet need and intent to use contraception at baseline but having an unintended pregnancy or with persistent unmet need for contraception at follow up. Addressing unmet need is consistent with human rights and a feminist approach to fertility control, and it has been estimated that the fertility reduction goals of most programs could be achieved by meeting the contraceptive needs of women who desire to avoid or postpone future births [2]. Reductions in unmet need would reduce the occurrence of unwanted pregnancies, Lutalo et al BMC Women's Health (2018) 18:60 intend to use contraception in the future, but may fail to initiate contraception due to limited choices if services are unavailable. Unwanted or unplanned pregnancies among women with unmet need who intend to use contraception, leads to the notion of unfulfilled need for FP. A study among women within one year of their last birth found that two thirds had unmet need for contraception and nearly 40% said they planned to use a method in the 12 months, but were currently not doing so [5]. An earlier study in 25 developing countries found that about half the women with unmet need had no intention of using contraceptives even if they were made freely available [6]

Methods

Results

Conclusion